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Lynne S. Gots, Ph.D.
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Got Insomnia? Tips for Getting a Better Night’s Sleep

By Lynne Gots, posted on April 13th, 2013.

I love spring, especially the longer days. As the inhabitant of a windowless office, I welcome the arrival of Daylight Savings Time. Seeing the sun come up during my morning commute and going out for an evening walk with the dogs while it’s still light lifts my spirits.

Or it would have this spring, if only I’d been sleeping better.

I’d already been developing a mild case of insomnia due to a stressful period in my life when we lost an hour to DST. I never fully recovered. When I found myself going to the Starbucks down the block nearly every day for a grande iced coffee with an extra shot, I realized I needed to do something about my broken sleep before the problem became intractible.

Fortunately, I know all about cognitive-behavioral interventions for insomnia, having attended an intensive training workshop on CBT-I. So I put myself on the treatment protocol.

First, I collected detailed data by monitoring my sleep patterns for two weeks. I recorded the time I got into bed, when I turned off the lights, how long (approximately, without looking at the clock) it took me to fall asleep, how many times (again, a rough estimate) I woke during the night, how long I stayed awake, when I woke up in the morning, and the time I got out of bed. I also noted how rested I felt. Then I tallied the time I spent in bed and the time I actually spent sleeping and came up with an average for each. Finally, with a formula I’d spent way too much time learning about during the CBT-I training (Average Sleep Time/Average Time in Bed x 100%), I calculated my “sleep efficiency.” Mine was 92%. Not bad, to my surprise. Anything over 85% is considered clinically sufficient.

One of the two main targets of a CBT-I intervention is “sleep consolidation.” This usually requires shortening the time in bed, an approach many insomniacs often view skeptically and with considerable resistance. It’s counterintuitive. After all, shouldn’t you go to bed earlier with the hope of becoming drowsy and taking advantage of the increased opportunity for sleep?

The answer is no. If you’re spending a lot of time in bed not sleeping (i.e., your sleep efficiency is poor), you’re actually training yourself to be more wakeful when you hit the sack. So the solution is to restrict, not extend, your time in bed. This is usually accomplished by going to bed later, since most people’s waking time during the week is less flexible than their bedtime. It also requires sticking to the same bedtime and waking time every day, even on weekends, until the sleep problem has resolved. And no “catching up” on lost sleep by napping.

My not-bad sleep efficiency number resulted from a few factors. My “sleep latency” (the length of time it took me to fall asleep after turning out the lights) was usually less than ten minutes—not very long from a clinical perspective, though it sometimes felt interminable to me. And even though I was waking up three to four times during the night, making me feel less rested than I would have liked, I fell back asleep quickly. I never had the luxury of hitting “snooze” more than once, at least during the workweek, so I wasn’t staying in bed long after the alarm went off. I also stopped reading in bed before turning out the lights, further limiting my non-sleeping time in bed.

The second focus of CBT-I is modifying the environmental and cognitive triggers for wakefulness. Some of the well-known impediments to sleep include consuming caffeine too late in the day, going to bed hungry or overly stuffed, watching the clock, drinking alcohol (which causes sleepiness but poor sleep quality), and exercising right before bed. Another, less obvious culprit is the habit of lying awake in bed. Worrying also makes it hard to fall asleep, particulary when the worrier focuses, as insomniacs so often do, on not being to sleep.

For me, seeing the numbers helped alleviate my concerns about my sleep patterns and relieve the mounting anxiety—as stimulating as a double cappucino—I’d started to feel every night when my head hit the pillow. I realized I wasn’t sleeping as poorly as I’d thought and, even more important, discovered I could get by quite well on far less sleep than I’d believed I need.

Not everyone requires eight hours of sleep a night to function optimally. In fact, the cure for insomnia can sometimes be as simple as improving sleep efficiency by cutting back on the hours spent staring at the ceiling, waiting for sleep to come. If you feel adequately rested after six and a half hours of sleep, as I seem to, there’s no added health benefit in pushing for more.

My insomnia wasn’t longstanding and didn’t present a hazard. I wasn’t falling asleep at the wheel or waking short of breath. If my sleep difficulties had been more serious, I would have needed to undergo a sleep study to pinpoint the nature and cause of the problem. CBT-I isn’t appropriate or effective for some sleep disorders, such as sleep apnea or narcolepsy, or for sleep disruptions caused by a psychiatric disorder, such as depression.

But for “primary insomnia”—sleeplessness not due to an underlying neurological, physical, or environmental cause—modifying your sleep schedule and improving your nighttime routines by following a few basic guidelines can help.

  1. Figure out how much time you’re spending in bed and how much time you’re actually asleep. Add 30 minutes to your average sleep time (calculated over a two-week period) to determine when to turn out the lights and when to get up in the morning.
  2. Keep the same schedule every day.
  3. Don’t nap.
  4. Use your bed for only two activities: sleep and sex. No reading, watching TV, or surfing the Internet (all should be done in another room prior to getting into bed for the night).
  5. Don’t lie awake for more than 15 minutes. If you can’t sleep, get up and go into another room to read or watch TV until you feel sleepy.
  6. Avoid caffeine after midday.
  7. Keep the temperature in the bedroom cool.
  8. Exercise regularly, but not less than two hours before bedtime.
  9. Avoid alcohol and heavy meals late in the evening.
  10. Turn the clock so you can’t see it.
  11. Try to leave your worries at the bedroom door. No good solutions come in the middle of the night.
  12. Let go of any preconceived notions you have about how much sleep you need. Everyone is different, and striving for eight or nine hours if your sleep requirements are less will only make it harder for you to sleep.

Above all, be patient. Don’t expect to sleep soundly right away. It takes time to resolve insomnia, and hoping for a quick fix will only make you more worried about not sleeping. But if you get on a tighter schedule and stop trying so hard to catch the elusive ZZZs, you may find yourself getting a better night’s sleep before you know it.




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Don’t Believe Everything You Think

By Lynne Gots, posted on March 13th, 2013.

Have you ever acted cooly towards a coworker because she seemed aloof and condescending, then gotten to know her better and realized she’s just shy and insecure? Or felt hurt when a friend forgot your birthday, then learned he’d been laid low by the flu?

These examples illustrate a central premise of cognitive-behavior therapy: thoughts are not facts. Our interpretations are hypotheses, and often—especially when strong emotional reactions are involved—they don’t hold up under objective scrutiny.

Take the assumptions we form during virtual interactions. Emails and texts notoriously lend themselves to drawing conclusions based on inferences— the meaning of an exclamation point or emoticom, say, or the absence thereof. It’s easy to read into the speed or length of a response, too.

Having been married for many years, long before the advent of Match.com, I never tried online dating. (Though a classmate and I did create a matchmaking inventory for a course requirement in graduate school. Too bad we were too shortsighted to realize its potential!) But I have no trouble envisioning the stories my mind would spin about possible suitors. My imagination has run away with me in situations where I have far less at stake emotionally.

I’ve talked before about my preoccupation with—OK, addiction to—Words With Friends. Mostly, I maintain ongoing games with people I know. But occasionally I get tired of waiting for them to make a move and seek out a random opponent.

I’ve developed a virtual friendship with one, whose screen name is “Amadbama.” Unlike many of the strangers I’ve played against, Amadbama kept initiating new games despite losing frequently, and by many points, to me. I was impressed by the sportsmanship and persistence. So one day, when Amadbama scored 109 points on a triple word play, I offered my congratulations.

Thus began our exchanges—just a few, impersonal comments at first, then some more details about where we’re from, our families, and the like.

This is where my assumptions started to get turned upside down.

At first I envisioned Amadbama as a young (because that’s probably the likely demographic for people playing games online), Muslim (because Amad has a Middle Eastern ring to it) man living in Alabama (‘bama). Then I learned he lives in Michigan.

OK, so the new geographic information required me to revise my hypothesis slightly. But it also bolstered my theory about his being Muslim because Michigan is home to the largest Muslim population in the US.

Then in a conversation about our respective Thanksgivings, Amadbama said he’d gone to bed at 8:00 pm because entertaining the six grandkids had been exhausting. I updated my mental image of him from a twenty-something to a bearded patriarch.

Recently I learned the truth (or, at least, what I assume to be true) about Amadbama’s identity: she is a 55-year-old woman named Susan. I was sorely disappointed to lose my multicultural friendship, even though it was only a figment of my overactive imagination.

And another thing. Susan’s game has improved dramatically, and she now beats me quite often. She seems like a completely different player.

I assume she must be cheating.




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Digging Out of a Negative Thinking Hole

By Lynne Gots, posted on August 31st, 2012.

I’m writing this at 7:00 am, in my office. I left for work this morning in an autopilot haze, thinking I had a 7:00 am appointment as I usually do on Fridays, and not bothering to check my schedule.

Oops.

My first reaction was annoyance at myself. OK, maybe a little more than annoyance. I felt myself sinking into a full-blown funk. Being an experienced cognitive-behavioral therapist, I had no trouble capturing the negative thoughts fueling the feelings:

“That was really stupid!”

“You could have slept for another half hour.”

“Or you could have gotten up and walked the dogs. It’ll be too hot for a long walk when you get home, and you won’t get any exercise.”

“You don’t get enough exercise. You’re really out of shape.”

“Now you’ll be really tired all day when you could have felt rested.”

“You should always look at your calendar.”

If you’re familiar with the CBT model and its concept of thinking errors—characteristic patterns of distorted thinking associated with negative moods—you’ll recognize a few in my litany of self-flagellating thoughts: labeling, fortune-telling, all-or-nothing thinking, should statements.

Fortunately, I saw immediately that I had a choice. I could either allow myself to wallow, which would undoubtedly make the rest of my day difficult, or I could do something about it.

I chose action.

Now it’s only 7:30 am, and I’m just about done writing a long-overdue blog post. And my mood has taken a 180. I’m no longer upset. Instead, I feel pleased with myself for seizing an opportunity to be productive.

One of the complaints I often hear about CBT thought-challenging techniques (uncovering distorted thoughts and replacing them with more rational ones) is that “just thinking” differently isn’t enough to produce a change in mood. And that certainly is true. Rewriting your thoughts won’t have much impact unless you also change your behavior

It’s 7:50 am, and I’m still tired. But a little more coffee should take care of the brain fog. And now I can look forward to a relaxing holiday weekend with no pressure to write!

 




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This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.

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