The most useful and efficient way of starting one’s sleep program is by understanding their current sleep–wake patterns. The standard measurement tool for insomnia is the “sleep diary”. Sleep diaries are not really diaries, but simple logs, based on one’s recollection of their last night’s sleep. Because they are the expert on their insomnia, they are the best person to report on each night’s sleep in order to measure their sleep problem. In fact, people with insomnia who go to sleep labs usually have trouble sleeping in the lab, which simply confirms their insomnia. Although the sleep information obtained from consumer wearable devices is appealing, at the time of writing this, these trackers are not yet ready for use in Sleep Therapy. This chapter provides a note about personal electronic sleep trackers and discusses logging your sleep with a sleep diary.
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After Week 4 of Sleep Therapy, it is recommended that one should check to see if they are now free from insomnia. One can do this by looking at the same things in their current sleep diary, before they started Sleep Therapy. This chapter provides suggestions to find out the experiences of initial insomnia, multiple awakenings, middle insomnia, and terminal insomnia. If a person takes longer than 30 minutes to fall asleep, he/she is experiencing “initial insomnia”. If a person has more than 3 awakenings per night, he/she can describe it as having “multiple awakenings”. If a person awakes each night, (3 nights or more) for greater than 30 minutes, he/she is experiencing “middle insomnia”. If a person wakes up for more than 30 minutes too early on at least 3 mornings, then he/she has “terminal” or “end-of-night” insomnia.
Sleep Therapy is the term used for the specific program, which combines the most powerful and effective components of cognitive behavioral therapy for insomnia. The first part of the program, called FIRST THINGS FIRST, involves recording one’s sleep using sleep diaries to assess the nature of their insomnia. This chapter focuses on how to uncover, or rediscover, the biological processes that allow one to sleep. It shows how to tailor one’s bedtime and rise time in order to get solid sleep, and how to associate one’s bed with great sleep. The procedures will be summarized in Six Steps to Solid Sleep, the main techniques of Sleep Therapy. With some practice of these relaxation and “cognitive therapy” techniques, one knows how to move their mind into a state that is more conducive to having sleep arrive, to having the velvet hammer descend.
Hygiene means “principles of maintaining health; the practice of these”. In the strict sense “sleep hygiene rules” are tips for maintaining good sleep health. They include things that our grandmother may have told us, such as don’t eat a big meal before we go to bed. The research concurs: Sleep hygiene alone is not effective for reversing chronic insomnia. This chapter offers the recommendations or the top tips for better sleep. They can be helpful for people who usually sleep well but who have occasional or situational sleep problems in order to prevent further problems. By following them, one can certainly eliminate some of the factors that can interfere with sleep.
The completed sleep diaries will provide very interesting and useful information. This chapter helps the reader to go through their baseline sleep diary and see what it tells us. One will be looking at certain rows of their sleep diary now. The chapter guides us through the sleep diary, pointing out what to look for. It follows the same sequence that the author uses when he examines people’s sleep diaries in the clinic, which is not necessarily the same order in which we filled out the sleep diary. The first mission is to identify what type of insomnia we have. One has just looked at their baseline sleep diary for initial insomnia, multiple awakenings, middle insomnia, and terminal insomnia. It is quite common for people to have more than one type of insomnia problem. Our impression of how we are sleeping is, of course, one of the most important measurements.
One’s sleep diary provides good information about their sleep timing, quality, and quantity, and is the best way to measure sleep if a person has insomnia. For more in-depth examination of sleep by scientists, or sleep medicine clinicians, special equipment is used to track sleep stages and cycles through the night. To determine sleep stages, three main measurements are used: brain waves, eye movements, and muscle tone. These are measured using electrodes that are attached to the scalp, the face near the eyes, and under the chin, respectively. Polysomnography is measurement of sleep overnight in the sleep lab, with electrodes that are attached to the scalp, face, and chin, to determine sleep stages. Actigraphy is another way that sleep can be measured, but only roughly.
Sadness and anxiety are normal human emotions and stress is a normal occurrence in our lives. When we’re feeling somewhat down, anxious or stressed, we can benefit from exercise, relaxation, recreation, eating nutritious foods, allowing time for sleep, and talking to a friend. Clinical depression and anxiety are very common conditions. This chapter looks at what they are, what happens to sleep, and what helps recovery of mood and sleep. It outlines what is known about treating insomnia in three forms of clinical depression: major depression, Seasonal Affective Disorder, and Bipolar Disorder. Research on how people respond to natural disasters has told us that within the first months of disaster, many people develop signs of anxiety, depression and posttraumatic stress. With respect to sleep, people with posttraumatic stress disorder tend to get somewhat less deep sleep, longer periods of being awake during the night, and an overall shorter sleep duration.
There are several helpful strategies for calming active thoughts. To begin with, it is helpful to take an observer’s stance, and notice where exactly one’s mind is going. The chapter discusses the thoughts or worries about the effects of not sleeping, and the worries about things going on in one’s life. It is very common to have worries about work, school, relationships, family, or health issues. If this is true for one, write these issues down. Then consider which are productive worries and which are nonproductive. Nonproductive thoughts and worries are things that can be released and let go of at night. This is more easily said than done. Another approach to get out of problem-solving mode, or overactive-thinking mode, is by training one’s mind with meditation. There are many types of meditation and one can choose the type that suits them best.
Although women tend to report insomnia in greater numbers, men have their share of sleep problems. Testosterone, a hormone that occurs in much higher levels in men than in women, influences the development and maintenance of male sexual characteristics, including reproductive organs, body structure, beard growth, strength, sex drive, aggression, and mood. There are important connections between testosterone and sleep. Research shows that the more the father is involved in caring for the infant—both during the day and at night—the better the mother’s sleep and the fewer times the infant wakes at night. There are two sleep disorders that occur more frequently in men than in women. These are “sleep related breathing disorders” and “
REMsleep behavior disorder”. This chapter outlines both. With age, men’s sleep, like women’s, becomes shorter and more broken up by awakenings. As with women, men experiencing stress at work are at high risk of insomnia.
This chapter guides one forward after the third week of sleep therapy. It presents a chart called Calculating Your Week 3 Sleep Efficiency. By entering the sleep diary answers for Questions 1 to 7 in the top section of the chart one can calculate the sleep efficiency. The chapter also presents Six Steps to Solid Sleep for week 4: go to bed only when sleepy and not before your threshold bedtime; maintain a regular threshold rise time in the morning; use the bed only for sleeping; leave the bed if one can’t fall asleep or go back to sleep within 10–15 minutes, return when sleepy, and repeat this step as often as necessary during the night; if sleepiness is overwhelming, one may take a short nap (set aside no longer than 45 minutes) in the afternoon, between 1:00 and 4:00 p.m; and maintain a sleep diary.