Can’t Sleep? Here’s the First Thing You Should Try

By Dr. Susan Biali Haas August 28, 2018 psychologytoday.com

Do you have problems sleeping? So do I. At least I used to, until I implemented the tool I’ll be telling you about.

Insomnia isn’t just having trouble falling asleep. It refers to sleeplessness and poor sleep quality in general. Trouble falling asleep, trouble staying asleep, waking up too early, waking up exhausted – each counts as a sleep quality issue.

Diagnosing Insomnia

If you’ve been dissatisfied with the quality of your sleep for three or more nights a week, for more than three months, you officially suffer from insomnia.

This definition may be a wake-up call for you. It was for me.

I was forced to re-examine my sleep after attending a Lifestyle Medicine course at Harvard Medical School. When Eric Zhou, PhD, from the Division of Sleep Medicine shared this definition of insomnia, it caught me off guard.

You see, most of the time I sleep pretty well.

Most of the time. Say, four nights a week. The other nights I may have trouble falling asleep or wake up way too early. It’s been a stressful year, so I hadn’t been sleeping as well or as much as usual.

Alarm bells went off: poor sleep quality, three times a week, for months. Insomnia.

Zhou emphasized something I already knew, that Cognitive Behavioral Therapy for Insomnia (CBT-I) is the “first-line” treatment (I stay on top of my health, so there wasn’t a medical issue causing poor sleep).

The first step in CBT-I?

Keeping a Sleep Log

I went home from Boston and did this. For the next couple of weeks, every morning I noted the following points in my journal (not every sleep journal is this detailed):

• The time I started getting ready for bed (if it was unusually late, I noted why)
• The time I turned the lights out
• The time (roughly) I fell asleep
• The time (roughly) it took to fall asleep
• The time I woke up
• The number of hours I was actually asleep
• The number of total hours in bed (this is used to calculate “sleep efficiency”)
• Whether I had had wine, or exercised the day prior
• General quality of sleep
• How I felt the next day

It was so eye-opening.

The Power is in the Details

For 7 of 14 nights, I had slept less than 7 hours.  Some nights 6 hours or less. How was this possible? I had usually been that person who got 7 to 8 hours, but something had clearly gone awry. My sleep had gradually gotten this bad without my realizing how frequent it was.

When I looked at the log, the “bad” nights were the ones where I started getting ready for bed after 11 pm. When my husband and I reviewed this, it was usually because we’d stayed out late. On several occasions we arrived home from short or longer road trips much later than planned. My wake-up time was also erratic.

We made a plan. I’d start getting ready for bed shortly after 10 pm every night, as those were the nights that I had gotten my best rest. Lights out before 11 pm.

If we were out, or driving in from somewhere, we had to plan to leave on time, to be home by 10 pm at the latest.

Optimize Your Circadian Schedule

Because of the importance of a consistent wake-up time, I aimed to get up at 7 am. As soon as I woke up, I’d go into the living room and open the blinds to expose myself to daylight.

The more consistent your circadian rhythms and habits, the better your sleep quality will be. Keeping a regular sleep-wake circadian schedule helps other key body functions, such as maintaining a healthy weight and a positive mood. I did my best to get to bed and get up at the same time, every day.

After just one week, the impact was remarkable. I’d expected to have to implement the “sleep restriction” process which is the next step in CBT-I, but didn’t have to. I continued to keep a log, and within a couple of weeks was sleeping 7 to 8 hours a night, every single night. And I was sleeping much more soundly. It was like a miracle.

Try keeping a sleep log, and optimize your sleep habits based on what you observe. There is more to CBT-I that is beyond the scope of this article, and not all sleep problems are this simple (though many are!).

If you struggle severely with sleep, it’s critical to let your doctor know so that the issue, and appropriate treatment, can be more specifically determined.

For more information about CBT-I, Dr. Zhou recommended two online programs: Sleepio and SHUTi.

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