Goodnight Mind (11 page)

The consequences of having this expectation are similar to those of holding on to other beliefs and expectations we discussed in this section. As minutes pass and you are not asleep yet, you worry that this will be “an insomnia night,” and the worry digs you deeper into the hole of having insomnia. Moreover, failure to realize that you have experienced many “normal” nights (i.e., nights in which it takes you thirty minutes or less to fall asleep) convinces you that you are a poor sleeper. Believing that you are and always will be a poor sleeper can become a self-fulfilling prophecy.

Avoid Self-Fulfilling Prophecies

“I feel tense, so I
know
I am never going to be able to sleep.” Sound familiar? Hopefully not, because negative predictions are likely to come true. While good sleepers do not think much at all about their sleep, poor sleepers predict that they won’t sleep well and then monitor for evidence that their belief was true; that is, they look for proof that they are not sleeping well. They predict that they won’t function well during the day and then monitor for evidence of fatigue or difficulty concentrating; often they find such evidence, but simply because they are looking for it. Sleep researchers have never consistently found that a night of poor sleep necessarily means a day of poor functioning, so assuming that it does is neither accurate nor helpful.

Avoid Mental Calculations in the Middle of the Night

If I fall asleep
right now
, I will be able to get five hours of sleep…if I fall asleep
now
, I can still get four and a half hours of sleep….
If you become an expert mathematician during the night, constantly calculating how much sleep opportunity you have left, you will be too anxious to ease back into sleep. A team of sleep researchers at the University of California at Berkeley showed that watching the clock makes people think that their sleep is worse than it actually is (Tang, Schmidt, and Harvey 2007). Avoid the temptation to engage in mental arithmetic at night. Turn your clock around so that you cannot see it.

Avoid Thoughts That Create Performance Anxiety

Performance anxiety occurs in situations in which there is something that you have to do and you worry that you may not be able to do it, or at least do it well. People with insomnia often believe that they must exert effort to sleep. When you are not able to sleep readily, you may become anxious.

Do you believe that when faced with poor sleep you should try harder? Can you sleep only when you don’t want to, or when you should not sleep? For example, do you lie awake for most of the night but fall soundly asleep an hour before your alarm is set to go off? (Perhaps you can then sleep after the alarm goes off, knowing that you should really get up to get ready for work.) Or, perhaps you lay your head down after work to rest and find that you sleep for much longer than you intended. Or you doze in the evenings while watching television.

Although some people with sleep problems, no matter how tired, cannot sleep readily under any circumstances, you may find it difficult to resist sleeping under circumstances in which you should not sleep. Then, when you should sleep—that is, at night—you are unable to sleep. Why is it that you can fall asleep when you do not “want” to fall asleep but cannot sleep during conventional hours, when you “want” to sleep?

The answer is this: when there is a demand for sleep, sleep is more difficult to produce. When the pressure to sleep is alleviated, sleep is easier to produce. Nurses often use the following strategy when someone comes to the emergency room in the middle of the night because of an inability to fall asleep. They tell the patient, “The doctor is going to be a while, but please wait up so that you are awake when the doctor comes.” This is often successful in facilitating sleep for the patient, as there is now a pressure to stay awake. Similarly, one effective treatment for insomnia, called paradoxical intention, is to ask the person to stay awake all night. In response to this request, the person will often say, “But I do that every night”; however, the attempt to stay awake on purpose is often unsuccessful. The message behind this treatment is that it is easier to sleep when you are not
supposed
to sleep. An effective strategy for this problem is to determine a sleep window as described in chapter 2, and then develop a plan, such as enlisting someone to help make sure that you are awake at all times except during that window. In addition, you can change your thinking about sleep; that is, you can stop
trying
to sleep. If you find yourself awake during the night and it is obvious that you are not going to be able to return to sleep readily, give up the idea that you will try to sleep; instead, get out of bed and don’t return until you become sleepy again.

Stop and Question Whether the Thought Is Actually True

You may have noticed a general theme here: that having a thought or belief does not necessarily make it true. Challenging and changing the way you think about your sleep can be as important as challenging or changing your sleep habits. We ask you to stop and question the veracity of your thoughts, because thoughts about sleep can arise automatically. When thoughts are seemingly automatic, you may question whether you can change them at all. You may also believe that because they occur automatically they must somehow be true. Neither of these beliefs is necessarily true. However, if your thoughts about sleep and fatigue are automatic, it will take practice to catch yourself having such thoughts and to actively challenge them. This may be difficult to do, because you may not be aware of your thoughts.

The best way to catch yourself and examine your thoughts may be to notice when your mood worsens—when you become tense or frustrated—and then recall what you were thinking just before your mood changed. Once you identify the thought that is most connected to how you are feeling, ask yourself the following questions:

1. Is the thought 100 percent true?
   (Often thoughts are somewhere between completely true and completely untrue.)
   
2. Am I discounting evidence that does not support the thought?
   
3. Am I jumping to conclusions? Am I creating a self-fulfilling prophecy?
   
4. What would I tell someone I loved if he or she was having the same thought?
   
5. Does the thought lead to feeling worse?
   
6. Does the thought lead me to do something that actually interferes with sleep or makes me more apt to feel fatigued?
   

Answering these questions and changing your thinking to something more realistic and something that makes you less upset can change your sleep problem. For example, maybe you are used to telling yourself and others, “I don’t sleep.” Such a thought is inaccurate and anxiety-provoking. If you catch yourself having this thought and you stop to remind yourself that you
do
sleep, albeit less than you would like to, and there are things you can do to sleep even better, this modified thought is more hopeful and adaptive.

Summary

Sometimes the way you think about sleep can make your sleep worse, or at least make it seem worse. This chapter taught you to change the way you think about sleep in several important ways. When you are not overly concerned about sleep loss, refrain from thinking in absolutes such as “I don’t sleep,” set realistic expectations for your sleep, and avoid thoughts that create anxiety and make it difficult to sleep, you are on your way to thinking like a good sleeper. Try it and enjoy the results! Remember the following tips:

• Take sleep loss in stride.
  
• One night of poor sleep does not mean the whole week is, or will be, bad.
  
• Saying “I don’t sleep” is inaccurate and increases sleep-related anxiety.
  
• Sleep is not something that can be produced on demand; believing that you must try to sleep will only make it more difficult to sleep.
  
• Stop and challenge thoughts that are unhelpful or untrue.
  

Chapter 9

Focus on the Daytime to Help during the Night

Y
our sleep problems are not just about your nights; they affect and are affected by your days. Most insomnia sufferers complain less about how they feel at night and more about how they feel during the day. Yet preoccupation with sleep during the day, though understandable, does not solve insomnia; it makes it worse and prolongs the suffering. This chapter gives you tools for modifying your daytime thoughts and actions in order to improve your nights; these include methods to reduce worries, promote acceptance, and challenge unhelpful beliefs about sleep. This chapter also teaches you cognitive skills you can use to help reduce your fatigue and suggests some things you can do during the day to minimize the effects of poor sleep.

Challenge the Myth That Worrying Is Necessary or Helpful

As we discussed in chapter 7, worrying at night can interfere with sleep. Daytime worries can carry over into the night. When facing a worry, ask yourself three questions:

1. Is this worry about something that has a low probability of actually happening?
   
2. Is this worry about something that is out of my control?
   
3. Is this worry unrealistic or out of proportion?
   

If the answer to any of these is yes, then your worrying is not constructive and it is time to challenge this unhelpful habit (this is addressed in the next paragraph and in greater detail in chapter 7). If the answers to all of the above are no, then it may be helpful to turn your attention from worrying to a more action-oriented stance—problem solving. Schedule a private “worry time” (see chapter 7 for a detailed suggestion) to address problems on your mind (but not within an hour or so of your bedtime). You can address the problem by breaking the solution down into manageable steps and identifying the next (immediate) step to take. A common mistake is to ignore the possible intermediate steps; people who make this mistake tend to become overwhelmed and therefore lose confidence in their ability to solve the problem; thinking of the
next
step that you could do today, tomorrow, or sometime this week helps you move toward a solution.

If the answer to any of the above questions is yes, then you are experiencing unproductive worrying. You may engage in this type of worrying because on some level you believe there is some benefit to worrying. Rate the extent to which you believe each of the following statements:

Each of these beliefs is suspect. Worrying about something that is out of your control will not prevent it from happening. If worrying prevents bad things from happening, then worrying now to minimize your distress later is pointless. Although concern about things that matter to people you care about is one form of expressing your caring, worrying about things that you can do little about ties up energy that you could be investing into other, more productive, ways to express your caring. When you are worried and anxious, you are less available to the people around you. Finally, although worrying can help generate solutions to problems that are solvable, things that are outside of your control or that have a low probability of happening are not solvable problems. Moreover, excessive anxiety can get in the way of putting good solutions into place.

The first step in addressing excessive unproductive worrying, whether about sleep or a myriad of other issues, is to recognize that it is a habit worth changing. Changing this habit requires a commitment to challenging the beliefs that your worrying serves any beneficial purpose and that it is impossible to stop worrying.

Don’t Accept Insomnia Myths as Facts

The most common worry of people with insomnia is that they will be unable to cope with the consequences of sleep loss. If you have insomnia, you may be worried that it will lead to some long-term negative health or occupational consequence. After all, sleeping is a basic human function, and it is natural to become anxious when you feel helpless to produce sleep. However, for most people with insomnia these worries are blown out of proportion—that is, they overestimate the likelihood of some future bad consequence. Ask yourself,
What is the evidence that my insomnia will lead to disability or some other negative outcome? What horrible diseases have I contracted so far as a result of my insomnia?
The vast majority of people with clinical insomnia have had untreated or inadequately treated insomnia for years without any major health consequence. If you have heard in the media that sleeping for an average of four hours or less per night is linked to shorter life expectancy, it is important to note that such studies do not assess insomnia; it is therefore not clear whether it is insomnia or other reasons for short sleep duration that underlie this link (Gallicchio and Kalesan 2009). Moreover, the same type of studies also report that sleeping for an average of ten hours or more is also linked to shorter life expectancy. Many people with insomnia do not consistently sleep for only less than four hours. They may experience some very poor nights with little sleep, but they usually also experience some nights with more sleep, and their average sleep time is usually more than four hours.