A Good Sleep – You Can Sleep Well Again

Woman With Insomnia 1 in 5 Canadians struggle with insomnia.

If you find you have trouble…

Falling asleep
Staying asleep or
Getting a restful sleep

…despite having enough time to sleep, chances are good you’re living with insomnia.

There is a particular style of thinking that a person with insomnia may experience.

Sleep researchers have termed this type of thinking as the insomnia brain. The insomnia brain tends to be very noisy – it can feel as if negative thoughts are spreading like wildfire.

You may notice feeling tired and ready for sleep as you get into bed but as soon as you turn out the light, it’s as if a mental switch flips and the thoughts flood in.

When your brain is alert you will not sleep. The more this happens the more it’s likely to continue to happen.

This thinking style can become an unintentional and unwanted mental habit and over time the bed can become a signal for worry and upset.

Worse yet, for people who tend to worry at night, sleep is often one of the topics that gets worried about. When you worry about sleep, stress levels increase. This in turn makes it harder to fall asleep.

Sleep – and concerns about not sleeping – can begin to feel all-consuming and out of your control.

So what can you do?

Sleeping medication can be an effective short-term solution, providing immediate relief during a period of high stress or grief.

But if you’ve been taking sleeping medication for 3 months or more, you may have found that over time it stops working, or that higher doses are needed.

Unfortunately higher doses bring stronger side effects, such as daytime sleepiness, headaches, stomach upset, and difficulty with memory and attention.

To make matters worse, long-term use of sleeping pills can actually interfere with the quality of sleep you do get.

So what about the abundance of sleep related gadgets — the fancy pillows, expensive masks and herbal remedies?

You may have tried some of these and found that they just don’t work. That’s because these remedies do not address the root cause of your insomnia.

Cognitive behavioural therapy for insomnia (CBT-I) together with acceptance and commitment therapy (ACT) will target the cause of your sleep problem.

Unlike store bought sleep products and prescribed sleeping pills, a blend of CBT-I together with ACT focuses on breaking the cycle of chronic insomnia to bring you long term results.

My Unique Answer To Your Sleep Problems

Woman With Sleep Issues The physical and emotional health benefits of getting enough good quality sleep are well documented:

Our ability to manage stress, pay attention, remember information and be more productive is significantly improved.
We make better food choices.
Sleep has a positive impact on our mood and our ability to cope with pain.
We have more energy to put into our relationships and love lives.

CBT-I is a structured program that will help you overcome insomnia and take advantage of all the benefits that good quality sleep provides.

ACT helps to address the distress caused by unwanted thoughts, emotions and physical sensations associated with not sleeping.

I’ll help you gain control over the underlying causes of your sleep problem by exploring and identifying the thoughts and behaviours that interfere with your sleep. Together we’ll work towards replacing these interfering factors with those that promote quality sleep.

Many of the people I work with have struggled with sleep issues for years, or even decades.

I understand the feelings of hopelessness that can result from this struggle.

The good news is it doesn’t have to continue that way. A blend of CBT-I together with ACT can help.

My clients often see – and more importantly feel – a big difference after only 3-4 sessions.

I use these two approaches together because this works.

How does CBT-I work?

Woman And Man Sleeping Cognitive behavioural therapy for insomnia (CBT-I) aims to improve sleep habits and behaviours.

The cognitive part of CBT-I teaches you to recognize and change beliefs that affect your ability to sleep. For instance, learning how to control or eliminate negative thoughts and worries that keep you awake.

The behavioural part of CBT-I helps you develop good sleep habits and avoid behaviours that keep you from sleeping well.

Depending on your needs, the following CBT-I techniques may be recommended:

Stimulus control therapy. This method helps remove factors that condition the mind to resist sleep.
Sleep consolidation. Lying in bed when you’re awake can become a habit that leads to poor sleep. Through the use of a daily sleep log we’ll determine your personal sleep window and work towards optimizing the quality of your sleep.
Sleep hygiene. This strategy involves changing basic lifestyle habits that influence sleep.
Sleep environment improvement. This offers ways you can create a comfortable sleep environment.
Relaxation training. This method helps you calm your mind and body. Approaches include mindfulness meditation, imagery, progressive muscle relaxation and others.
Remaining passively awake. Also called paradoxical intention, this involves avoiding any effort to fall asleep. Worrying that you can’t sleep can actually keep you awake, so letting go of this worry can help you relax and make it easier to fall asleep.

How does ACT work?

ACT targets the development of coping strategies to help manage feelings of anxiety and frustration that can occur when unable to sleep. To acknowledge and work with discomfort versus struggling to actively avoid these moments. Struggle and avoidance often lead to further distress and wakefulness at night.

ACT may include topics such as:

Acceptance. To learn a more accepting attitude toward periods of difficulty with sleep. When we are willing to experience poor sleep this results in fewer struggles, less arousal and paradoxically greater levels of sleepiness.
Mindfulness. The ability to objectively and non judgmentally take note of your internal and external experiences as they unfold. To be able to stand back and observe wakefulness or unwanted thoughts and emotions without becoming entangled, a quality that is inherent in the normal act of falling to sleep.
Defusion. The ability to see thoughts and emotions for what they are, naturally occurring responses and create space for them to exist, rather than seeing them as something that needs to be removed, before sleep can be restored.

The most effective treatment approach may combine several of these methods.

What To Do Next

Man Sleep Well Many of my clients have been struggling with sleep issues for a long time and often feel helpless.

It doesn’t have to be that way.

The combined approach of CBT-I together with ACT is effective, and I know you can end your struggle with sleep.

If you’re ready to see how this approach can help you, or even if you’re still unsure, let’s talk.

I offer free 20 minute phone consultations so we can discuss your sleep concerns and discuss if this is indeed the best treatment choice for you.

After that, my fees are as follows:

90 minute initial assessment $275
50 minute treatment sessions $185

My role is to assess the thoughts and behaviours you may be engaging in that interfere with your sleep. This is a very collaborative style of treatment. Once we’ve determined the sleep-interfering factors, we’ll work together to develop a plan to address them and put into place strategies that promote good quality sleep.

Can I still take my sleeping medication?

In some cases, a combination of sleep medication and CBT-I/ACT may be the best approach.

If you chose to continue to use prescribed sleeping medication while completing CBT-I/ACT treatment, taking the same dose of medication every day, at the same time of day is recommended.

If you wish to stop taking medications for sleep doing so before treatment begins or after treatment has concluded is most effective. Medication tapering should be done together with the prescribing physician.

Rebound insomnia is a common side effect when coming off sleeping medication and booster sessions can be helpful.

What is an occupational therapist?

Occupational therapists complete a two-year post-graduate degree and are licensed healthcare professionals.

The focus of occupational therapy is to assist individuals with solving the problems that interfere with their ability to do the things that are important to them (the occupations of life). This includes areas such as sleep.

An occupational therapist is trained to understand how injury, illness and disability can impact a person’s ability to take care of themselves, participate in paid or unpaid work, or enjoy leisure time. Occupational therapists believe that the activities we participate in describe who we are and how we feel about ourselves.

People experiencing persistent insomnia often report that concerns about sleep interfere with doing the things they want and need to do, and that it affects their overall sense of well-being. Occupational therapists are ideally suited to address these concerns.

What is “Normal” sleep?

Typically, people sleep between 6-9 hours with 7.5 hours being the average.

When asleep, we pass through five stages: 1, 2, 3, 4 and REM (rapid eye movement) sleep. These stages progress cyclically from 1 through REM then back again to stage 1.

A complete sleep cycle takes an average of 90 to 110 minutes. We pass through several cycles each night.

Slow wave or “deep sleep” occurs during the first 3-4 hours of sleep while REM sleep occurs in the following 3-4 hours.

Waking may occur after the REM period. If the waking period is long enough, the person may remember it the next morning.

Stages of Sleep

Stage 1. Eyes are closed, person may feel like they are drifting in and out of sleep and can be awakened easily.

Stage 2. A person enters light sleep, heart rate slows, body temperature drops, body is getting ready for deep sleep.

Stages 3 and 4. Referred to as deep sleep or delta sleep. It is very difficult to wake someone. In deep sleep, there is no eye movement or muscle activity. During deep sleep the body repairs and re-grows tissues, builds bones and muscle and strengthens the immune system.

REM Stage. Breathing becomes more rapid, irregular and shallow, eyes move rapidly under the eyelids. Brain waves during this stage increase to levels experienced when a person is awake. Heart rate increases, blood pressure rises, this is the time when most dreams occur. If awoken during REM sleep, a person can usually remember their dream. Most people experience three to five intervals of REM sleep each night. REM sleep is an important time for memory consolidation.

Could I have another sleep disorder?

There’s a difference between sleepiness and fatigue.

Most people with insomnia are fatigued but not sleepy.

People with insomnia have trouble falling or staying asleep.

People who have sleepiness have trouble staying awake.

Sleepiness often indicates the presence of another disorder and should be evaluated by your doctor.

If you are unsure about your degree of sleepiness versus fatigue please take a few minutes to complete the Epworth Sleepiness Scale (ESS) found on this website and contact me to set up a time to discuss your score, what it means and what to do next.

Epworth Sleepiness Scale

Articles

Medical Research

Final Note

Sleep is a cornerstone of physical and mental wellness. Allowing insomnia to continue can have a profound negative effect on your mood, relationships, food decisions and the ability to cope with daily life problems. There is help.

A combination of CBT-I together with ACT is a highly effective form of treatment. Most of the people I see feel a big difference after only 4 sessions and the improvements are long lasting.

If you would like to learn more, contact me today and we can discuss your sleep difficulties and if this treatment is right for you.