According to the World Health Organization (WHO) 40% of the world’s population suffers from some type of sleep disorder. Specialists point out that people who suffer from insomnia are easy to identify due to their changeable mood and low level of concentration, two symptoms that stand out as the most common.
Doctors claim that there are more than 80 diseases linked to sleep disorders. They can be grouped into three main types: insomnia, sleep during the day and abnormal behaviors at night. For more in-depth detail about combating against insomnia, talk to Shawn or Mark Paschke (insomnia treatment expert in Minneapolis, MN) at Crested River.
Insomnia and sleep apnea are the most common of the conditions. Those who suffer from sleep apnea cannot get a good rest, because it is interrupted throughout the night by moments in which the breath is cut off for a few seconds. With regard to insomnia there are several types: the one that is produced by external causes (annoying noise, an uncomfortable bed), the one related to physical illnesses (pain, discomfort) and the one of psychological origin.
But the most common insomnia is that suffered by people who cannot relax and who have a high level of stress. Experts agree that difficulty concentrating at work, excessive irritability and constant drowsiness, prolonged for a certain time, are warning signs. If they persist, these problems can worsen and affect blood pressure, immune and metabolic systems.
Recommendations to combat insomnia:
- Try to avoid heavy and large dinners.
- Do not consume caffeine, alcoholic beverages, or cigarettes for at least 4 hours before going to sleep.
- Do not exercise before bed.
- Don’t sleep during the day.
- If you take medications, ask your doctor if they can affect your sleep.
- Try to get used to going to bed and getting up at set times.
- Condition the bedroom so that it is comfortable, quiet, without light and noise leaks, and has a comfortable temperature.
- If you can, take a bath before going to bed with natural products or soothing salts.
- Have a cup of warm milk or linden or valerian tea.
- At bedtime try to relax your body, and free your mind from thoughts.
- Avoid arguments or problems before going to sleep. Don’t go to bed angry or grumpy, try to solve what bothers you first.
- If you can’t fall asleep, don’t be nervous, read a book or listen to soft music until you feel sleepy.
If these recommendations do not help you, consult a specialist to investigate in depth what are the causes of your sleep disorder. If possible, do not use sleeping pills, unless your insomnia is chronic and your doctor thinks there is no other solution.
Cognitive behavioral treatment of insomnia
The treatment has to be given to restore the mechanisms that have been broken, which implies taking two steps,
- Restore the conditions that trigger sleep automatically and then
- Get the automaticity to be established.
To take the first step you have to:
- Get adequate physiological conditions.
- Maintain an environment conducive to sleep.
- Get a physical and cognitive deactivation.
Finally, to recover the automatism, one has to resort to classical conditioning so that the previous mechanisms are done automatically and without any effort. It is about controlling stimuli in such a way that, for example, getting into bed triggers sleep by itself.
Here are tips that can help you achieve those two goals.
1. Get the right conditions.
Sleep hygiene: achieving the appropriate physiological conditions.
To achieve the physiological conditions necessary for sleep, it is necessary to adapt our behavior so that we change the personal habits that take us away from that goal. It is prescribed to:
- Continuously exercise moderately, but do not exercise vigorously just before going to bed.
- Control physiological variables before going to bed, not going to bed hungry, thirsty, wanting to urinate, etc.
- Eat a proper diet and do not eat too much before going to bed.
- Avoid ingesting coffee, tea, cola, nicotine or any CNS stimulant throughout the day, but especially in hours close to sleep.
- Alcohol initially increases drowsiness and can lead to 4 to 5 hours of sleep, but increases the likelihood of waking up in the second half of the night. Alcohol metabolism consumes a lot of water, so it is necessary to avoid excess alcohol so as not to wake up thirsty in the middle of sleep.
2. Maintain an environment conducive to sleep.
Achieve a suitable environment: Control of physical stimuli.
- Control the environment of the room, ensuring that the room temperature is cool and pleasant, that there is no strong light and that the humidity is adequate.
- Check that the bed is adequate, that the mattress and box spring are hard enough and comfortable and that the clothing is not scarce, excessive or annoying.
- Noises are an important factor that distorts sleep, so it is necessary to ensure that while sleeping there is a quiet and noise-free environment.
- Get a physical and cognitive deactivation.
Physical deactivation: relaxation
The Jacobson’s relaxation method has been classically used to promote sleep as it teaches us to reduce muscle tension and therefore promotes physiological deactivation. Now, it cannot be applied as a sleeping pill, that is, doing the exercises when not sleeping, because the essential condition to relax is not met, which is to do it without an end, because in reality we are turning it into an effort to Sleep and exertion do not lead to relaxation or sleep. That is why it is recommended to do relaxation exercises at another time of day and with the exclusive aim of learning to distinguish when you are tense and how to relax. Jacobson’s relaxation exercises included in the “Acceptance Therapeutic Course”,
Breathing is also a good relaxation method. Sleep is associated with deep, regular and abdominal breathing that can lead to physiological deactivation.
Thoughts and concerns are for some authors (Espie, 2002) the fundamental component of insomnia. The type of thoughts that prevent sleep have been studied and are those to which the person who is in bed and does not sleep is engaged and the following classes have been identified: solving daily problems, worry about not falling asleep, noise home and other room conditions, and general concerns (Harvey, 2000).
The problem with the control of thoughts is that it is ironic or paradoxical (Wegner, 1994) because there is a process of looking for alternative thoughts and another in the background that checks if it is being achieved or there is a failure and makes the thought increase. its frequency. When we want not to think about something, we think about something else and we achieve it, but suddenly we realize that we have achieved it and that we have not thought about it, so that thought becomes present again. Wanting to stop thinking about something has been shown to increase the frequency of that thought.
Consequently, to achieve cognitive deactivation, the following techniques have been used:
- The paradoxical intention giving the instruction to follow all the thoughts that are being had without establishing any struggle to avoid them, they are even written to materialize them and make them concrete, of course it has to be done out of bed. Acceptance exercises help in a very significant way to accept the anxiety caused by not sleeping.
- Thought observation has also been proposed, that is, realizing what is being thought and letting it go. Symbolically, you can imagine your thought being put into a jar or a door being opened in your head for it to go away.
- The meditation. The techniques mentioned in the previous point, in reality, are forms of meditation that have as a result, not objective, to leave the mind blank. In this sense, the use of a mantra or a cognitive task that requires us a lot of attention and does not have affective relevance, such as saying the alphabet backwards, can help control thoughts.
- Directed imagination. Harvey AG (2001) proposes that imagination directed at a particular thought or image that is not exciting be used as a means of combating activating thoughts at the time of sleep.
- The interruption of the stay in bed when not sleeping also serves this purpose, although its main mission is to associate the bed with sleep.
As specific elements within a cognitive behavioral treatment, it should be noted:
- Getting used to making plans for the day in the morning, avoiding that the bed is an element to plan which necessarily leaves things pending and undone.
- Fichten et al. (2001) propose to change thoughts that are exciting or distressing, watch TV or read because in this way attention is distracted.
- These same authors also suggest that, since there is influence of the daily worries that occur in the waking moments, it is necessary to solve the daily problems to promote a restful sleep.
- Meditation, relaxation and acceptance exercises, performed out of bed are an ideal training to achieve physiological and cognitive deactivation. The “Acceptance Therapy” includes the basic exercises that allow to carry out the plan included in these pages.
Achievement of automatism: conditioning yourself to stimuli that trigger sleep by themselves. Adapt sleep to a specific time of day.
- Do not sleep or nap during the day.
- Maintain regular hours, both to get up and to go to bed. Get up and go to bed at the same time every day regardless of whether you are sleepy or not. Trying to get a lot of sleep one night or spending too much time in bed can interfere with the automaticity needed to trigger sleep.
- Establish a series of pre-sleep routines that activate the conditioning that automatically leads to the calm that is necessary for sleep. For example, close the door, turn off the gas, brush your teeth, connect the alarm and perform all those tasks that are necessary for that time of night, always do them in the same order.
The bed as a trigger for sleep.
- Do not use the bed or bedroom for any activity other than sleep or sex. It is not advisable to read, watch TV, talk on the phone, argue with your partner, or eat in bed.
- When you are in bed, the lights should be turned off with the intention of falling asleep immediately. If you can’t fall asleep in a while (about 10 minutes), get up and go to another room. Engage in some quiet activity until you begin to feel sleepy, and then return to the bedroom to sleep.
- If you do not fall asleep in a short period of time, the above sequence should be repeated. Do it as many times as necessary during the night. Use this same procedure for waking up in the middle of the night if you cannot fall asleep again in about 10 minutes. The moment you realize that you are awake or upset, get up and repeat step 3.
- Finally and very important is to adjust the time you are in bed to the time you are asleep. The previous point is already an important step, but it is necessary to go further with the sleep restriction: it consists of adjusting the amount of time you are in the bed with which you are really asleep, ending the fallacy that the more The longer you are in bed the more you sleep. When the patient sleeps more than 90% of the time they are in bed for a week, they are allowed to increase the time they stay in bed by a quarter of an hour, on the contrary, if it is less than 80%, it is reduced in bed. quantity, up to a minimum of four hours (for example, if you sleep an average of 5 hours per night in the week from 8 or 9 in bed, you will start with a total of 5 hours in bed, from lying down to getting up). If during a week the efficiency of sleep is greater than 90%, (in the example if one slept an average of 4h30min) the time in bed would be extended by 15-20 minutes, advancing for example the time to go to bed; on the contrary, if the efficiency is less than 80% (in the example, if you slept less than 4 hours) the time spent in bed will be shortened by 15 or 20 min. Periodic adjustments should be made to an optimal duration of sleep. on the contrary, if the efficiency is less than 80% (in the example, if you slept less than 4 hours) the time spent in bed will be shortened by 15 or 20 min. Periodic adjustments should be made to an optimal duration of sleep. on the contrary, if the efficiency is less than 80% (in the example, if you slept less than 4 hours) the time spent in bed will be shortened by 15 or 20 min. Periodic adjustments should be made to an optimal duration of sleep.
Cognitive restructuring, altering thoughts and beliefs about sleep.
There are thoughts and beliefs that must be questioned because they do not favor falling asleep, for example:
- Consider that sleep is wasted time and that its only objective is in terms of achieving the physical repair necessary to continue performing the next day.
- Overvaluing the consequences of being sleepy on daily performance. You have to realize that with sleep you can meet all the daily obligations and if they are not done it is most likely due to the difficulties inherent to the task or the anxiety it generates and the lack of sleep is just one more factor and it is certainly not the determining factor.