Overcoming Insomnia:
Sleep Improvement Guidelines

Did you sleep last night?  I did, but only because I took NyQuil.  It is estimated that one in ten people suffer from Insomnia- and Jack D. Edinger and Colleen E. Carney have written a guide that can keep you from suffering alone.  Overcoming Insomnia, in our Treatments That Work series, has two editions, one designed for therapists and one designed for patients.  Below is an excerpt from the patient workbook, which provides essential information about healthy sleep and the reasons for improving sleep habits, and then introduces a behavioral program designed to address that patient’s specific sleep problems.

–Select a standard rising time
It is important that you choose a standard rising time and stick to it every day regardless of how much sleep you actually get on any given night. This practice will help you develop a more stable sleep pattern. As discussed in the previous chapter, changes in your sleep-wake schedule can disturb your sleep. In fact, you can create the type of sleep problem that occurs in jet lag by varying your wake-up time from day to day. If you set your alarm for a standard wake-up time, you will soon notice that you usually will become sleepy at about the right time each evening to allow you to get the sleep you need.

– Use the bed only for sleeping
While in bed, you should avoid doing things that you do when you are awake. Do not read, watch TV, eat, study, use the phone, or do other things that require you to be awake while you are in bed. If you frequently use your bed for activities other than sleep, you are unintentionally training yourself to stay awake in bed. If you avoid these activities while in bed, your bed will eventually become a place where it is easy to go to sleep and stay asleep. Sexual activity is the only exception to this rule.

– Get out of bed when you can’t sleep
Never stay in bed, either at the beginning of the night or during the middle of the night, for extended periods without being asleep. Long periods of being awake in bed usually lead to tossing and turning, becoming frustrated, or worrying about not sleeping. These reactions, in turn, make it more difficult to fall asleep. Also, if you lie in bed awake for long periods, you are training yourself to be awake in bed. When sleep does not come on or return quickly, it is best to get up, go to another room, and only return to bed when you feel sleepy enough to fall asleep quickly. Generally speaking, you should get up if you find yourself awake for 20 minutes or so and you do not feel as though you are about to go to sleep.

– Don’t worry, plan, or problem solve in bed
Do not worry, mull over your problems, plan future events, or do other thinking while in bed. These activities are bad mental habits. If your mind seems to be racing or you can’t seem to shut off your thoughts, get up and go to another room until you can return to bed without this thinking interrupting your sleep. If this disruptive thinking occurs frequently, you may find it helpful to routinely set aside a time early each evening to do the thinking, problem solving, and planning you need to do. If you start this practice you probably will have fewer intrusive thoughts while you are in bed.

– Avoid daytime napping
You should avoid all daytime napping. Sleeping during the day partially satisfies your sleep needs and, thus, will weaken your sleep drive at night.

– Avoid excessive time in bed
In general, you should go to bed when you feel sleepy. However, you should not go to bed so early that you find yourself spending far more time in bed each night than you need for sleep. Spending too much time in bed results in a very broken night’s sleep. If you spend too much time in bed, you may actually make your sleep problem worse. The following discussion will help you to decide the amount of time to spend in bed and what times you should go to bed at night and get out of bed in the morning.