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Sleep Hygiene Workbook
Page
Index
3
Develop good habits that prepare you for sleep
4
Your Sleeping Environment, Getting ready for bed,
A word about television
5
Waking: Getting Up in the Middle of the Night
6
Other factors, Medications
7
Control intrusive thoughts, Delayed Sleep Phase Syndrome
8
Chronic Pain and Sleep Disturbance
11
Sleep Diary
Do you . . .
Pay Attention to Insomnia
Sleep apnea sleep disorders
Use meditation to help fall asleep. Take a mindfulness class, listen to a guided meditation on tape, or learn progressive relaxation.
Use a "white noise" machine or keep a radio on static or keep a fan running nearby for the white noise sound.
Your Sleeping Environment
Getting Ready For Bed
Waking: Getting Up in the Middle of the Night
As soon as you notice you are awake, try to get back to sleep immediately. This is not a time to ponder, plan, ruminate or rehearse. Observe the urge and return to getting back to sleep.
Stay physically drowsy. If you move at all, move only once, gently so as not to wake yourself up. Do not turn on the light. Use relaxation techniques.
Relaxation Techniques: (1) Scan your body in a calm and leisurely way, noticing and letting go of any tension you find. Particularly attend to your face, forehead, scalp and shoulders. Try hearing words in your mind such as, “Shoulders… warm and heavy, arms… warm and heavy, legs… warm and heavy.” (2) Develop some calming and quieting images which promote safety, warmth and heaviness—like lounging on a quiet beach in the sun. (3) Attend to your breaking. Count your breaths.
If you are making no progress toward getting to sleep after about 10 or 15 minutes, slowly and calmly get out of bed. Do not switch on the light or do anything active. Merely stand still, relaxing in the dark, with your mind as still as possible. Do not fight feelings of heaviness and drowsiness. Soon you will probably feel tired and will want to lie down. Return to bed, savoring your tiredness.
Most people wake up one or two times a night for various reasons. If you find that you get up in the middle of night and cannot get back to sleep within 15-20 minutes, then do not remain in the bed "trying hard" to sleep. Get out of bed. Leave the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You will generally find that you can get back to sleep 20 minutes or so later. Do not perform challenging or engaging activity such as office work, housework, etc. Do not watch television.
Is something waking you up? Try keeping track of certain sounds or changes in your surroundings (creaking doors, cold room, sounds or ambient light).
Keep room as dark as possible. We need 8 hours of darkness (no ambient light) a night.
Are you waking up to go the bathroom? Limit water before bed (and caffeine)
Hypoglycemia. You may be experiencing low blood sugar at night. If your brain is low on glucose, the body releases adrenaline to provide glucose. The adrenaline wakes you, and often starts the “should committee” talking in your head.
Try: ¼ cup fruit juice diluted in a glass of water, followed by a spoon of nut butter.
Other Factors
Several physical factors are known to upset sleep. These include arthritis, acid reflux with heartburn, menstruation, headaches and hot flashes.
Psychological and mental health problems like depression, anxiety and stress are often associated with sleeping difficulty. In many cases, difficulty staying asleep may be the only presenting sign of depression. A physician should be consulted about these issues to help determine the problem and the best treatment.
Many medications can cause sleeplessness as a side effect. Ask your doctor or pharmacist if medications you are taking can lead to sleeplessness.
Melatonin. This naturally occurring peptide released by the brain in response to the setting of the sun has some function in setting the circadian clock. It is available without prescription at most pharmacies and health food stores. Typically the dosage sizes sold are too large. Almost all of the published research on Melatonin is on doses of 1 mg or less, but the doses available on the shelves are either 3 or 6 mg. Nothing is gained by using doses greater than one milligram.
Periactin. The prescription antihistamine, cyproheptadine (Periactin), works like Benedryl but has the added advantages of suppressing dreams and reversing stimulant-induced appetite suppression. For those with no appetite loss, weight gain may limit Periactin's usefulness.
Clonidine. Some practitioners recommend in a 0.05 to 0.1 mg dose one hour before bedtime. This medication is used for high blood pressure (and it is the drug of choice for the hyperactivity component of ADHD). It exerts significant sedative effects for about four hours. Suppression of adrenalin.
Antidepressant medications, such as trazadone (Desyrel), 50 to 100 mg, or mirtazapine (Remeron), 15 mg, used by some clinicians for their sedative side effects. Due to a complex mechanism of action, lower doses of mirtazapine are more sedative than higher ones. More is not better. Like Benedryl, these medications tend to produce sedation into the next day, and may make getting up the next morning harder than it was.
Control Intrusive Thoughts
Often what gets in the way of sleep are intrusive thoughts – worrying or planning or anticipating or rehearsing. It is important to commit yourself to letting go of all such thoughts. You must convince yourself that even if the cure for cancer suddenly comes to you, you must let it go while you are in bed. Cheerlead yourself: “Everything is as it should be now. There is no need for me to lie awake thinking. I can simply go to sleep.”
Set aside a quiet time just before bed, outside your bedroom, to do your worrying, planning, etc. Jot down any notes on thoughts or ideas you want to follow-up on. Do not dwell on any one thought or idea—merely jot something down and put the idea aside.
Block intrusive thoughts while you are in bed by doing the following: immediately start saying the word “the” over and over, under your breath, with only the slightest movement of your tongue. Repeat “the” at a comfortable rate, 2 or 3 times per second. If you also have intrusive images, try moving your eyes as if you were following an irregular circle. Keep your eyes closed, and follow the circle in a slow and lazy way. Try picturing a map of the United States and slowly move your eyes around the borders. If a thought intrudes, notice it nonjudgmentally and simply return to repeating “the” and following the circle. The unwanted thoughts will be blocked and you will soon drift off to sleep again.
