As you will now know from Part I, getting enough sleep of the right kind is vital for both our health and overcoming anxiety. We need enough slow-wave sleep to restore our bodies and renew our energy, and we need dream sleep to discharge unexpressed emotional arousals from the day, so that we can start tomorrow charged up and ready to go.
But how much sleep is enough? Worrying about not getting enough sleep can actually be a cause of insomnia. Some people, mainly men, can manage quite comfortably on four hours' sleep a night. Others say they have to have 10 hours to feel right. The view from some sleep experts is that most adults don't actually need more than seven. But if you wake up refreshed and energised and ready to start the day, you are getting enough sleep, however many hours you have had.
It really is important to believe that last sentence, as we will see. In a fascinating study, researchers at Oxford University gave 22 insomniac students a gadget that displayed electronically how much sleep they had had the previous night. But, unbeknownst to the students, the researchers had manipulated the reading. They found that the day after students thought they had slept badly (when they had in fact slept quite well) they were more likely to think that they couldn't cope with their daily tasks and to suffer physical discomfort, such as feeling sleepy and having tired eyes. It is well known that insomniacs sleep more than they think. So, it is possible that, for you too, anxiety that you might not have slept well could be a large cause of any daytime problems you experience.
However, if, instead of waking up feeling refreshed, you feel as though you are a bit drunk or in a daze, can't concentrate properly and forget things, then you are not getting enough sleep. So you need to do something about that. Although there are many possible reasons for finding it hard to sleep or for waking early and finding it hard to get back off again (see the list at the end of this article), by far the most common is stress. But as well as identifying what is causing the stress and finding ways to reduce it (see next section), it is important to establish good sleeping habits too. This becomes even more crucial as we get older. When we are young, we can sleep any-where. But, as we age, sleep is a far more fragile state and good sleep patterns must be gently nurtured.
Tips for a better night's sleep
- It may sound obvious, but go to bed earlier if you go to bed very late and always wake up tired!
- Avoid drinking tea or coffee late in the evening.
- Avoid drinking too much alcohol. Having several drinks may indeed get you off to sleep but, in the middle of the night, once the alcohol has been metabolised, your body is in withdrawal and that wakes you up.
- Don't take exercise within two hours of bedtime. But do exercise earlier in the day or evening.
- Have a milky drink or camomile tea before bedtime.
- Have a relaxing warm bath or shower before going to bed.
- Ensure you have a comfortable mattress, not one that is old and saggy.
- Put up blackout curtains or blinds, if necessary, to keep the light from waking you.
- Use the bedroom primarily for sleep. Don't watch television in it or listen to loud music with a fast beat, or do anything else that wires you up. Having sex is good, however - although sex stimulates, it discharges energy and so doesn't adversely affect sleep.
- Wear earplugs if your partner snores, or noise disturbs you from outside.
- Make sure you're not too hot or too cold in bed.
- Try spraying some lavender around the bed or use a lavender pillow. Many people find the scent helps to induce sleep.
- Do not nap at lunchtime or in mid-afternoon.
- Don't worry about whether you are sleeping or not!
And if that doesn't work ...
Two powerful strategies to promote good sleep
- Try some visualisation: Lie comfortably in your bed and close your eyes. Use one of the methods we described earlier for inducing relaxation and then take yourself off in your imagination to a peaceful, beautiful, quiet place. Perhaps imagine yourself walking by a stream in the cool evening breeze, or strolling along a deserted beach at sunset. While doing that remember times when you've been away somewhere and had the feeling that you've left all your cares behind you. Give yourself the suggestion every so often that, "sooner rather than later, I can drift off into a sound refreshing sleep". This can be a swift, enjoyable way to promote falling into a deep, refreshing sleep.
- Unlearn bad habits: Sleeping through the night is a conditioned behaviour. It isn't actually natural - indeed, parents have to teach young children to do it! It may be the norm to sleep only at night in cold countries, but in hot countries it is common to take a two-hour sleep during the heat of the day and sleep fewer hours at night. So, our sleep habits are learned. And we can learn bad ones as easily as good ones. For instance, suppose you watch television till 11 or 12 at night, during which time you fall into a snooze. When you finally get up to go to bed, you are probably wide awake again. You lie there tossing and turning. And the result is that you start to associate bed with being awake instead of asleep. This is called 'reverse conditioning' and we need to undo it. The important thing is not to reward the brain for staying awake. Some people decide, after lying awake for half an hour, to get up and watch an exciting film or to have something to eat. We even know of people who got into the habit of cooking a mixed grill for themselves every morning at 3 a.m., because they couldn't sleep. But it is imperative that we don't reward the brainstem (the primitive part of the brain that wakes us up) by giving it food or something interesting to do. Instead, it needs to be punished! And this is how:
- Pick a time to get up each morning and (during this relearning phase) stick to it even on days when you don't have to get up for work or to take the children to school, etc.
- Don't go to bed until you are physically tired.
- If you are not asleep 30 minutes later, get up and do an extremely boring task. This must be something (preferably quiet) that you really loathe doing; something you hate doing at any time of day, let alone the night; something you put off and off, or else groan and moan and huff and puff about, whenever you are doing it. It might be working your way through a pile or ironing; doing your accounts; waxing the floor; sewing on buttons or filling before you can decorate. As soon as you are really tired, however, abandon the task and go back to bed.
- If you are still awake 30 minutes later, get up and do another extremely boring task. It might be the same one, if you didn't finish before, or it might have to be a different one. If you don't hate any household or work task enough, invent one. Perhaps you must read out loud all the labels on all the jars in a kitchen cupboard. Or get sheets of blank paper and rule 50 lines on each. Be creative about being boring! The brainstem may be primitive and stupid but it's not that stupid. If it realises that it is going to get punished instead of getting fed or stimulated, it will very quickly learn to let you sleep through the night.
Celia couldn't sleep
A psychologist was once contacted by a strong-minded woman in her 50s, called Celia, who said she was desperate to overcome her insomnia. However, she also announced: "But I fear you'll never be able to help me, really. My mother suffers from it, and my grandmother did, and my great-grandmother before that. I'm convinced it's something that runs in the family."
Despite her despondency, Joe relaxed her and began some guided imagery, to try to help her create a pleasant, relaxing place in her mind that she could 'visit' to ready her for sleep. But Celia quickly brought that to a stop, saying "that sort of thing" wasn't 'her' at all.
So the psychologist moved on to the method just described above. Celia was willing to establish a time to get up each morning and to stay up until physically tired. But, although she was happy to get up again after 30 minutes, if still awake, she balked at carrying out some boring or useless task. "I don't find any chores boring," she said. "And I get involved in everything I do. I'm certainly not going to waste precious time drawing lines on sheets of paper when I could be using it for reading!"
It turned out that Celia loved reading, although she didn't have as much time to engage in it as she would have liked. The psychologist decided to make use of that. He suggested that she should choose a book which she would find quite challenging, because of its dense plot or dense writing style. Then, if she was still awake after 30 minutes of trying to sleep, she should get up and read it - standing up.
She called him a week later to say she was sleeping like a baby.
Possible causes of poor sleep
- a pain condition that is not controlled well enough at night
- restless leg syndrome
- sleep apnoea (momentarily ceasing to breathe, every so often)
- eating an evening meal too late
- drinking too much alcohol
- being overstimulated from watching television late at night
- drinking too much caffeine
- exercising too late in the evening
- withdrawing from tranquillisers or alcohol
- jetlag depression
- generalised anxiety
- suffering from too much stress
- shift work
Continued in this article: Find an enjoyable way to unwind