Goodnight Mind (10 page)

Challenge Worries about Sleeplessness

Is your worry specifically about sleep or sleeplessness? If so, you may have already realized that thinking about being sleepless makes you anxious. You may have found that your anxiety and frustration make it even more likely that you will think about how worried you are about sleeplessness, making you more anxious and sleep even more elusive. One way to interrupt this cycle of worrying is to challenge the idea that being sleepless is a complete disaster.

When you find yourself awake in the middle of the night, do any of the following thoughts occur?

• This is horrible!
  
• I can’t take it!
  
• I
  need
  to get to sleep
  now
  , or I’m going to have a horrible day.
  

Consider a seemingly silly question for a moment: what is so inherently bad about being awake? Try the following exercise: write down “Being awake at night is a complete disaster because… .” Then list all the reasons you can come up with, even those that may seem silly as you write them; no one has to see this list. Now consider how having these thoughts affects your sleep. Are there any consequences to having these thoughts? Answer this question for each of the items on your list.

Imagine two people, Anne and Janet, each with a different reaction to being awake at 2:00 a.m. Anne thinks:
Oh my god—it’s 2:00 a.m. If I don’t fall asleep within the next twenty minutes, I am going to lose it.
Janet thinks:
Ugh, it’s 2:00 a.m.—I might as well go watch television rather than lie here awake.
For whom are the next twenty minutes more likely to be pleasant—Anne or Janet? Who is under
less
pressure to sleep? What is the impact on the likelihood of returning to sleep of feeling a stronger pressure to sleep? Remember that, as we discussed previously, your reaction to sleeplessness can be more harmful than the sleeplessness itself. Catastrophizing about sleeplessness is not helpful. It makes you more upset in the moment and it keeps you awake longer; in other words, it interferes with sleep.

If worrying about the consequences of poor sleep makes sleep worse, then what is the alternative? One answer is to change what being awake at night means to you. Try this experiment the next time you are awake: Think back to a time when you were awake at the exact same moment you find yourself awake now, when it was actually pleasant. This may be a time when you were out with friends. It may be when your child was born. It may be when you were with someone you love. How would you finish the following sentence? “My best memory of a time when I was awake in the middle of the night is….” If you do not have such a memory, imagine a circumstance in which it would be pleasant to be awake in the night. In either case, spend some time with this pleasant memory or imagined possibility. Close your eyes. Take a deep breath. Allow the memory or image of a pleasant experience of being awake in the middle of the night to unfold, watching it as if it were a movie projected on the insides of your eyelids. Recall or imagine it as vividly as possible. Take in all the scenery. Where were you? Were you with someone? When did this happen? What were you doing? Remember the feeling you had at the time. How do you feel now? Take a deep breath and scan your body. If you notice anxious thoughts about sleeplessness during this exercise, let them be, and return to your pleasant memory. Be open to the pleasant feelings that may arise from focusing on this memory.

Being awake in the middle of the night does not have to be unpleasant. A poor night’s sleep does not guarantee feeling horrible the next day. There are times you will have a good night’s sleep and feel groggy the next day, and there are times you will sleep horribly yet feel surprisingly well. Remind yourself that although being awake can feel unpleasant, you want to avoid adding to the unpleasantness by becoming highly anxious about it. For more strategies on challenging thoughts that interfere with sleep and accepting wakefulness, read chapters 8 and 9.

Don’t Relive the Worst Part of Your Day

Worrying and rumination are often partners in crime in keeping you awake at night. Rumination is like worrying, in that it involves turning information over and over again in your mind. Worrying tends to involve future events; for example, you may worry that you will get fired because of your sleep problems. Rumination tends to focus on past events; for example, you may be thinking about something you said at work and wishing you had said something different. On the surface, figuring out what went wrong and why may seem helpful in preventing similar disasters in the future, but ultimately both worry and rumination lead to feeling worse. Even worse, frequent rumination and worry can become difficult to control.

All the strategies we have discussed so far for dealing with worrying can also be used for dealing with rumination. We now briefly introduce a new strategy that will be elaborated upon in a later chapter—staying focused in the present moment.

If you find yourself reliving the worst part of your day over and over again and you have already left the bedroom but the problem continues, remind yourself that this type of thinking is unhelpful and you need to switch gears and focus on the present moment. Rumination requires attention. To resist rumination, draw your attention away from thoughts of the past by focusing on the here and now. Take a deliberate vacation from your rumination, engage with the here and now, and see how it makes you feel.

How do you do this? First, focus your attention on your breathing. Focus on the sounds and feeling of air moving into your nose, warming your nasal passages, and traveling down into your chest. Now focus on the sounds and feeling of air being moved upward and out of your body. If your attention wanders, do not judge yourself; it is normal for the mind to wander. Instead, gently bring your attention back to your breath. You can build upon this exercise by using the strategies in chapter 10.

Summary

In this chapter, you learned to deal with your worries by setting aside time in the evening to address concerns. If your worries persist at bedtime, take some time to write about your concerns right before bed. Get out of bed if you find yourself worrying or engaging in problem solving in bed and do not return until you have stopped worrying; you will find that, over time, you engage in the worry habit less and less. Remember:

• If your worries persist, generate thoughts and images to distract you from them that are engaging but not too alerting.
  
• Challenge the idea that being awake at night is a complete catastrophe.
  
• Counteract rumination and worry by focusing on the present moment.
  

Chapter 8

Think Like a Good Sleeper

I
f you have suffered from sleep difficulties for a long time, you may spend more time thinking about sleep than good sleepers do. Preoccupation with sleep makes it difficult for you to quiet your mind, and this contributes to your sleep problems. This chapter will help you identify whether the way you think about sleep could be causing your mental overactivity and sleep problems and will give you the tools you need to manage these unhelpful thoughts.

Signs of Thinking Like a Poor Sleeper

Good sleepers simply do not think very much about sleep. Whereas people who sleep poorly think about their sleep and other life problems when they lie down to sleep, good sleepers report that when they lie down to sleep they think about “nothing in particular.” They just go to sleep. In addition to differing from good sleepers in how much they think about sleep, poor sleepers also differ in the way they think about sleep. Are the following thoughts familiar to you?

• I will have a poor night’s sleep.
  
• I cannot manage sleep loss.
  
• If I cannot sleep, I should try harder.
  
• Nothing (short of a miracle drug) could ever help my insomnia.
  
• Monitoring the clock will help me fall asleep more quickly.
  
• My sleep problem is the source of most other problems in my life.
  
• Others should tiptoe around me when I sleep, because I will not be able to fall back asleep if they wake me up.
  
• My tossing in bed at night disturbs my partner (even if my partner has never told me so).
  
• If I do not sleep well on a given night, I will be useless during the day.
  

These types of thoughts and beliefs can actually interfere with your ability to sleep. Changing how you think about sleep will help you have fewer sleep-interfering thoughts in bed and pave the way to better sleep.

Take Sleep Loss in Stride

If you woke up in the middle of the night and thought:
Oh no, I can’t sleep. I won’t be able to fall back asleep; tomorrow will be a tough day,
you would likely feel upset, anxious, or worried. These feelings would make it even harder to fall back asleep. You would probably toss and turn for quite a while.

In contrast, what if you took waking up in stride? For instance, what if you had a matter-of-fact approach and thought:
It seems as if my mind is too active to sleep right now. Trying to force sleep is counterproductive; I am going to go to the couch and watch a sitcom
? Most likely you would be less upset than if you reacted with
Oh no…
. Most likely, if you really did take it in stride you would start feeling sleepy while watching one or two sitcom episodes and go back to bed and fall asleep without much tossing and turning.

The way you think about your sleep affects the way you feel, and the way you feel affects your ability to sleep soundly. You may believe that your sleep determines the quality of your life. You may believe that your sleep problems prevent you from enjoying life. Whereas it is true that after a night of poor or insufficient sleep you may not be at your best during the day, the extent to which poor sleep impacts your performance and sense of well-being the next day depends on your reaction to the experience.

If you were to take sleep loss in stride, what would that look like? At night you would remain calm. You might not sleep as much, but you would be resting by calmly engaging in a restful, pleasant experience. You would feel more rested than after an extended struggle with sleep, tossing and turning in bed. During the day you would put thoughts about sleep out of your mind and focus on the day’s activities. You might need to alter some behaviors, such as not driving while sleepy, but for the most part you would not change your plans. Moreover, taking sleep in stride means being less distressed, which is always conducive to feeling good during the day and sleeping well at night. The next time you have a night of poor sleep, take it in stride; carry on with your planned activities and see what happens.

Have Realistic Expectations and Beliefs about Sleep

Some poor sleepers think about sleep in an unrealistic or rigid way. There are many common misconceptions about sleep that may lead you to have unrealistic expectations about your sleep. You may not recognize that your expectations are not realistic. Below we discuss how to change a few examples of unrealistic expectations to more realistic ones that could pave the road to better sleep.

I need eight hours or more of sleep.
This is an unrealistic belief about sleep because sleep need varies across people, and even for the same person sleep need may not be a constant. For example, when people start a new romantic relationship they tend to sleep considerably less than usual yet still do well during the day—in fact, their life is so exciting that sleep feels like a waste of time. In contrast, when people feel down and depressed they tend to want to sleep for eight hours or more. However, wanting more sleep and needing more sleep are not the same thing. The problem with holding rigidly to the belief that you need eight hours of sleep is that if you sleep for less than eight hours, you may experience anxiety over not having slept “enough.”

Within reason, sleep quality is far more important than sleep quantity. You have probably already experienced this truth: think back to a time in which you produced eight hours or more of sleep but did not have optimal mood, energy, or concentration. Or, think back to an occasion on which you had little sleep and were surprised at how well you felt during the day. Read chapter 3 to determine how much time in bed will help you produce the best quality of sleep, and retire the “eight hours of sleep” myth.

I used to have no sleep problems.
I should be able to sleep like that again. As we discussed in the previous paragraph, sleep need is not a constant. Moreover, your ability to sleep changes as you age, and it is important that you adjust your expectations accordingly. If you have a middle-aged body, you will be perpetually disappointed if you hold on to the belief that you should have the sleep and energy of a young adult. As you age, the amount of deep sleep you produce decreases and how easily you tire during the day increases. These are normal processes. The consequence of holding on to the unrealistic expectation that you should be able to sleep just the same as when you were younger is that you may become worried that you are not getting enough sleep. You may become anxious at bedtime, which, as we discussed many times in this book, interferes with your ability to sleep. Driven by your worries about sleep, you may try to “fix” your sleep problems in counterproductive ways. In chapters 2 and 3 we discussed a constructive approach to increasing the quality of your sleep, and in chapter 9 we discuss how to increase your energy during the day.

I should fall asleep as soon as my head hits the pillow, and I should stay asleep until morning.
Spending up to thirty minutes trying to fall asleep or thirty minutes awake in the middle of the night is considered normal. It is also normal for the brain to briefly wake up many times throughout the night. Most people are unaware of these awakenings or fall quickly back asleep. If your friend tells you that she never wakes up in the middle of the night, she would be more accurate if she said that she is not aware of waking up. People who can sleep at any time, are asleep within minutes, or spend no time awake in bed likely either are very sleep deprived or have an undiagnosed sleep problem such as sleep apnea.