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Do you remember Pavlov’s dogs?? If you have ever taken a psychology course you have likely heard of Pavlov’s dogs. Let me give you a basic refresher… Pavlov was a behaviorist who did studies on many different types of animals. He was interested in shaping behavior. One of his experiments involved dogs, a bell, and dog food. He would present food to the dog and at the very same time he would ring a bell. The dog would salivate in response to the food that was being presented to him. After several trials of this pairing of the food with the bell, when Pavlov then just rang the bell and did not present the food, the dog still salivated! So what he discovered was that by pairing the bell with the food eventually the bell became associated with food and the dog salivated to the bell even in the absence of food. Ok, so what in the world does this have to do with sleep? Well when we spend a lot of time in our beds awake, say watching tv, reading, knitting, doing work, we start to associate our beds with being awake. Just like the dog’s associated the bell with food. Over time as we spend a lot of wake time in bed, it starts to become difficult to sleep there because we respond to it as a place for wakefulness. This is referred to as conditioned insomnia. One sure fire sign that you have developed conditioned insomnia is if you find yourself falling asleep or feeling very sleepy on the couch in the living room but as soon as you get into bed you feel wide awake. That is a sign that your bed is a wakefulness cue for you. Another sign is if you tend to sleep better in a hotel versus your bedroom. Something to be mindful of is that people who are tense or anxious may be more susceptible to conditioned insomnia than others. Spending time in bed awake refers to not only spending time in our beds during the day awake, but also during sleepless nights. If someone with insomnia is up in the middle of the night and spending 2-3 hours awake laying in bed, that is an anxious experience. The person may then start to dread going to bed because they anticipate the sleepless night. The bed becomes a cue for the sleeplessness. When I ask my clients with insomnia what they do when they are up in the middle of the night, resoundingly all of them say with pride, “I stay in bed and try to go back to sleep.” There are two things perpetuating the insomnia in that statement. One thing that Dr. Meg Danforth, Ph.D. CBSM, of Duke University Medical Center, stressed in her training was that you cannot “try” to fall asleep. She said sleep is the one thing that does not reward hard work. The more you try to sleep, the more there is no payoff. Sleeping is the one thing that you cannot try to do. The more you try to fall asleep, the more you fail because sleep requires complete relaxation and trying is essentially the opposite of relaxing! She did say that relaxation exercises are beneficial, however, as long as their goal is just to relax, not to fall asleep. Again, as soon as you start to focus on sleep as the goal, the more difficulty you will have reaching that goal. The other thing perpetuating the insomnia in that statement is that the person is staying in bed awake! Again, the more time you spend in bed awake the stronger the association between being awake and your bed. So, what do you do? You create a quiet comfortable place to go to in the middle of the night if you cannot sleep. I often suggest finding a place near a lamp where you can read, watch unexciting television, or do something else, quiet and non-stimulating. You go to this place when you cannot sleep and you stay there doing something non-stimulating until you feel SLEEPY. This is important - it is not until you feel tired, it is until you feel SLEEPY. SLEEPY meaning your eyes are starting to close or your head is nodding. When you feel sleepy you go back to bed and lay down. If you get into bed and you find yourself suddenly feeling awake again, get back out of bed and go to your place until you feel, you guessed it, sleepy again. By getting out of bed when we are awake, the research shows that we can re-associate our bed with sleep in about two weeks. If you find yourself awake in the middle of the night and unable to fall back asleep in about 20 minutes, get out of bed to break the association of wakefulness and your bed! Until next time :) Dr. B. References Perl, J. (1993). Sleep Right in Five Nights: A clear and effective guide for conquering insomnia. New York, NY: William Morrow and Company, Inc. Danforth, M. (2018). Treating Insomnia: Evidence-based strategies to help your clients sleep. Presentation, New Jersey.
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The next aspect of sleep and insomnia I want to share with you is about circadian rhythms. What exactly is a circadian rhythm, you may ask? A circadian rhythm is approximately a 24-hour cycle that governs the physiological processes of living things.
The circadian rhythm, while it influences and is responsible for many things throughout day, is mainly known for it’s influence on the sleep/wake cycle. It regulates our feelings of sleepiness and wakefulness throughout the day. Circadian rhythms are internally driven, however, we rely on environmental cues to keep us on track. I say this because the circadian rhythm actually runs a little longer than 24 hours so things like sunlight, temperature, regular bedtimes/wake times, and meal times help us manage the drift of our circadian rhythm and stick to our schedule. But what if we don’t stick to a regular schedule, meaning regular bedtimes/wake times and meal times? Well, then we can cause ourselves some problems. Some people with insomnia have a habit of varying their sleep and wake times. I hear this all the time in my clinical practice… “Well I couldn’t sleep last night so I let myself sleep-in.” “I was up in the middle of the night so I slept 2 hours later.” “I didn’t sleep well so I took a nap and then I couldn’t fall asleep at night.” Several nights of these types of wacky sleep schedules can throw off your circadian rhythm and make an insomnia problem even worse. So what do we do? Well it isn’t the most popular answer, but we establish a sleep/wake schedule, and we stick to it 7-days a week. Wait. What?? 7-days a week, even on the weekends? Yes even on the weekends. We are all familiar with sleeping in on the weekends, but when we do this we expose ourselves to social jet lag. The feeling is not dissimilar from regular jet lag, however we do not have the fun memories of a great trip to California or Costa Rica. Social jet lag is what occurs when we change our sleep schedules over the weekend. In order to avoid that dragging tired feeling, it is best to stick to your sleep/wake schedule everyday. If you must sleep-in on the weekend make sure it is no more than one hour later than your usual wake time. But how can I establish a regular sleep/wake schedule when I cannot control when I fall asleep?? Good question! We start by establishing a wake time and sticking to it. But what if I can not fall asleep, or I am up for hours in the middle of the night? Well you still get up at the same time in the morning. We cannot control the exact time that you fall asleep, but we can control our wake times by using an alarm clock. You set your alarm clock and get up at the same time every morning regardless of how you slept the night before. Oh and did I mention, NO NAPS!! Again this is to get our circadian rhythm into a good, pun intended, rhythm. Plus if you take a nap you are deflating your balloon!! If you do not know what I mean by “your balloon” visit my previous blog on adenosine. So no naps and wake up at the same time everyday. Eventually you will start to establish a regular sleep time and circadian rhythm. So, what about night owls and morning larks? People are unique in their circadian rhythms and different people reach their peak level of alertness and performance at different times of the day. Night owls function best at night, while morning larks are at their best in the morning. Most of us, however, fall in the “normal” range. Yes, I am talking about the bell curve, true night owls and morning larks are outliers, and most of us fall somewhere in the middle, meaning there is not a whole lot of variability in our peak times of alertness as a people. Again, if we want good/quality sleep, and who doesn’t right? Stick to a regular sleep/wake schedule as nearly to every day as you possibly can. Until next time :) Dr. B References Perl, J. (1993). Sleep Right in Five Nights: A clear and effective guide for conquering insomnia. New York, NY: William Morrow and Company, Inc. Danforth, M. (2018). Treating Insomnia: Evidence-based strategies to help your clients sleep. Presentation, New Jersey. What do sleep and mental health disorders have in common?? Well it turns out more than you might think. First of all, most, if not all, mental health diagnoses impact or demonstrate disruptions in sleep. At one point researchers thought that psychiatric disorders caused the sleep disorders, however more recent studies have indicated that it might be the opposite, that sleep problems may influence mental health problems. This is important information because if we can focus on sleep and getting enough good-quality sleep, than maybe we can also influence how psychiatric disorders present themselves.
If we take a step back and think about this, it makes total sense. How many times have you had a late night, lost some sleep, and the next day find yourself more emotional than usual? Maybe you cry more easily, or lose your temper more readily. Or look at our kids, if our son or daughter is misbehaving or having temper tantrums we often consider - oh he or she is tired, they missed their nap, they went to bed late, etc. Why do we not consider the same for ourselves as adults?? I want to talk a little bit about sleep because it is so important, not just for overall well-being and health, but also for our mental health. I have to confess that sleep is of particular interest to me because for years I lovingly referred to it as my “elusive friend.” My personal interest, along with my professional interest, brought me to a training on CBT-I or Cognitive Behavioral Therapy for Insomnia. I have to give a huge shout out to Meg Danforth, Ph.D. CBSM, Director of the Behavioral Sleep Medicine Program at Duke University Medical Center. She was a fabulous instructor and she made the most seemingly non-lively thing that we do extremely interesting and engaging. Information on sleep that I am sharing in this blog series come mostly from the training I attended with Dr. Danforth, as well as from the book Sleep Right In Five Nights, by James Perl PhD. For me the use of this blog is to help me process and digest information from trainings or books that I have read so that I can better explain and implement the concepts in my clinical practice. If I can learn it, read it, digest it, and write about it, I can teach it. Here we go… The first aspect of sleep that is interesting to know, is that during the day, when we are awake, we build up this chemical in our bodies called adenosine. When we wake up in the morning, we do not have a lot of adenosine in our cells. As the day goes on we build up more adenosine. Dr. Danforth compared it to a balloon. She explained that in the morning our balloon is empty, if we are active and do a lot during the day, we fill our balloon, aka build up adenosine in our cells. Adenosine is responsible for deep sleep drive. So the more adenosine we have the more deep sleep drive we have, meaning more ability to fall into a deep sleep, which is what we want! When it comes to sleep it is very important to be mindful of how you are spending your day. It was stated that most adults need about 16-18 hours of alert time to build enough deep sleep drive for quality sleep, 14-15 hours of alert time may not produce enough. If you are having trouble sleeping and realize that you spent most of your day in bed, on the couch, or sitting down, then scheduling some active activities into your day might be beneficial. The more you can do during the day the better chances of filling your balloon, building up that adenosine, and achieving a good level of deep sleep drive! So that is tip #1 that I want you to know about sleep. It seems so simple right?? Like common sense, yes doing more during the day will help you sleep better, but for some reason I think we forget this. Knowing some science behind it helps make it more meaningful. Get out there, and do some things during the day so you can sleep better at night! Until next time…Dr. B. References Perl, J. (1993). Sleep Right in Five Nights: A clear and effective guide for conquering insomnia. New York, NY: William Morrow and Company, Inc. Danforth, M. (2018). Treating Insomnia: Evidence-based strategies to help your clients sleep. Presentation, New Jersey. |
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