Posted on 08 November, 2016 By Dr. Manvir Bhatia
Poor sleep is a common condition affecting around one-third of the entire population at some point in their lives. It can become so troublesome that you can wake up very tired or heavy headed for the entire day. Tiredness can add to the toll in the day. Some people have irritability and are unable to concentrate because of insomnia. Some might switch to long term drugs or alcohol use which further aggravate such symptoms over time. Insomnia , on a long run, increases your chances of developing chronic health problems like diabetes, obesity , heart attacks and stroke. In addition, memory loss, depression,rapid decline in intellectual abilities can pose significant problems , when insomnia has set in for a long time. Overall, quality of physical, mental and social well-being can become crippled with insomnia.
In the initial stages, #insomnia is very easy to control. It requires a doctor to evaluate your symptoms and ascribe a cause to your insomnia and treat the cause. Besides addressing the cause, #poor sleep also needs separate attention . This is because once a person is in habit of getting poor sleep, even if you remove the cause, its effect i.e. poor sleep may persist. In fact, the current view of most expert doctors managing poor sleep is that non-drug measures or sleep self-help tips should come as first prescriptions. Here, I present to you an overview of some important ideas and skills that can help you make your sleep better. Many of them will require the help of a psychologist .
- #Sleep Hygiene: It includes keeping a regular schedule of waking up and sleep time, even on holidays, having a healthy diet and regular daytime exercise, having a quiet sleep environment, and avoiding napping, caffeine, other stimulants, nicotine, alcohol, excessive fluids, or stimulating activities before bedtime. A usually neglected part of sleep hygiene these days is the tendency of watching movies, using internet , chatting ,etc before bedtime. This causes your brain to be active due to massive dose of visual stimulus to increase your wakefulness. People with poor sleep should carefully allot at least an hour before bedtime to relax under not-so-bright light with either a soft music or a simple book with not-very exciting but pleasant reading material like an auto-biography, etc.
- #Stimulus control therapy: It is an extension of the sleep hygiene principle where thoughts and external cues (sounds/sights, etc) that disturb sleep are kept at bay by limiting the type of activities allowed in the bedroom. An example of stimulus control is going to bed only when you are sleepy, and getting out of bed if you’ve been awake for 20 minutes or more. A person can then engage in relaxing activity (reading, soft music) outside bed until drowsy then return to bed—But one should not make conscious attempts to go to sleep nor do exciting activities then. A lot of people worry of their plans for the day after or analyse their day at bedtime, leading to poor sleep. These people can benefit from setting aside half an hour in evening to write down things/plans for tomorrow, set alarm also or do all the necessary analysis of the previous day then, and then bury the topics long before bedtime. This is a method to have a relaxed mind in the bed. One should tell himself/ herself that things have been taken care of and need not be worried at bed. With this measure, one can condition the bed to sleep . When regularly followed , this habit can later help one fall asleep soon at the sight of bed .
- Relaxation training: These are tools to relax an overactive restless mind at bed. Progressive muscle #relaxation, #guided imagery, and abdominal breathing are three most commonly prescribed relaxation tools.
Progressive muscle relaxation training involves methodical tensing and relaxing different muscle groups throughout the body. Ideally they should be done with the help of a clinical psychologist. You may google or see some youtube videos that involve relaxation techniques for further idea into this useful technique.
Guided imagery therapy is another such relaxation tool which is only done under supervision of a trained personnel (usually a psychologist). Here, a person is lead to focus on some specific imaginary objects and processes which helps overcome fears and maladaptive pattern of thinking associated with one’s insomnia.
- Cognitive therapy: It is a very effective insomnia management modality. It involves a face-to-face session with a trained psychologist who seeks to change the patient’s overvalued beliefs and unrealistic expectations about sleep. Common #cognitive distortions that are identified and addressed in the course of treatment include: “I can’t sleep without medication,” “I have a chemical imbalance,” “If I can’t sleep I should stay in bed and rest,” “My life will be ruined if I can’t sleep.” With this therapy supervised by the psychologist, he /she can tide over arousal provoking thoughts at night by own effort.
- Sleep restriction : Decreasing the time spent in bed automatically ensures you are asleep most of the time you spend in bed unlike previously when you might spend more than half your time awake in bed. In initial phases of treatment of insomnia, a person is asked to stay in bed for a duration shorter than his/her daily sleep requirement. For example, if seven hours of sleep is adjudicated as essential for you to feel refreshed, the doctor will ask you to remain in bed for only 6 hours. By this method, in a few days your body automatically sets itself to sleep when you go to bed. Counter-intuitive it may seem, but this method works because the mild sleep deprivation will push you to sleep the following night. Overtime when sleep continuity substantially improves, time in bed is gradually increased, to provide sufficient sleep time for you to feel rested during the day, while preserving what has been achieved in terms of rapidity of sleep onset. It is always best to be supervised for sleep #restriction by your doctor.
- #Paradoxical intention: It is a specific cognitive therapy in which the patient is trained to overcome the fear of staying awake and its likely effects. He/she is asked to try and feel relaxed and not to try to go to sleep actively in bed. The fear of remaining short of sleep should be removed . The objective is to decrease a patient’s anxiety about poor performance in sleep. It works especially in people who are insomniacs due to anxiety.
- #Biofeedback therapy : Other less commonly used therapy includes #biofeedback therapy where the trainer trains the patient to control some symptoms by self-monitoring of certain bodily things that can be seen or heard or felt by the patient himself. These symptoms should act as cautions to stop doing what they are when found to be present and engage in other activities as instructed. The objective is to reduce excitement and wakefulness. A common method to overcome emotionally charged thoughts that keep one awake at night is to replace it with neural emotions or activity like uttering the word ‘the’ silently in the mind for as long as one is comfortable.
To sum up, #insomnia is a problem that requires constant and patient efforts from both sleep specialist, psychologist and foremost – the patient himself to overcome. With a co-ordinated effort, satisfactory results are obtainable in over 80% of the patients.
Best wishes !