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.
There are things over which one have direct control. So, if they are contributing to poor sleep, they can be addressed right away. One will now be perusing their sleep diary for three things: naps, alcohol, and sleep medication. Not that any of these things is bad, one just wants to make sure that they are not interfering with their nighttime sleep. If they are interfering, it is much easier to deal with them now, before one goes further. If one did nap, were the naps inadvertent or intentional? If they were inadvertent, this can be a sign of “excessive daytime sleepiness”. If the naps were intentional, then look at the timing of each nap. If one is taking sleep medication, it is dangerous to also drink alcohol. So, if one takes sleep medication, be sure to read and follow the instructions on the medication label.
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.
This book provides us with what we need to sleep well. It provides the tools and techniques to reverse insomnia and improve sleep long-term. Insomnia, persistent trouble getting to sleep or staying asleep, affects our daytime functioning and wellbeing. The book breaks down the principles of cognitive behavioral therapy for insomnia (
CBT-I), the sleep program considered first-line treatment in the clinic, into a step-by-step and reader friendly program that can be easily followed at home. Written by a clinical psychologist and researcher who has worked in the sleep field for 40 years, the book uses data from a real patient to illustrate each step of the process. The book is complete with detailed sleep diaries, worksheets, and more, all of which are also available online to download and use on your own journey to sleeping better now and into the future. Guiding readers through this self-directed sleep therapy program, the book features updated information and new scientific findings on key topics for patients and health care providers including: tried-and-true CBT-Imethods of sleep management; successful cognitive therapy methods to deal with racing thoughts at bedtime; different sleep needs for women and men through life and health conditions; influence of nutrition, exercise, and sex on sleep in a brand-new chapter; depression, anxiety, and traumatic stress and how they intersect with sleep; and prescribed and non-prescribed medications, herbal remedies, and cannabis for sleep.
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.
This chapter guides one forward after the second week of sleep therapy. It presents a chart called Calculating Your Week 2 Sleep Efficiency. By copying one’s sleep diary answers to Questions 1 to 7 for the typical night into the top section of this chart one can calculate the sleep efficiency for week 2. The chapter also presents a chart that helps to adjust one’s threshold bedtime, and Six Steps to Solid Sleep for week 3. The six steps are: 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 you can’t fall asleep or go back to sleep within 10–15 minutes; if sleepiness is overwhelming, one may take a short nap (set aside no longer than 45 minutes) in the afternoon; and maintain a sleep diary.
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.
This chapter guides one forward after the first week of sleep therapy. It presents a chart called Calculating Your Week 1 Sleep Efficiency. By entering the Sleep Diary answers to Questions 1 to 7 for one’s typical night into this chart one can calculate the sleep efficiency for Week 1 of Sleep Therapy. If at any point one realizes that the night chosen is not really representative of the week, then one can try another night and see how close the sleep efficiencies are. If the nights are not consistent, then one may want to calculate all 7 sleep efficiencies and take the average for the week. The chapter also presents a chart that helps to adjust one’s threshold bedtime, and Six Steps to Solid Sleep.
This chapter summarizes the strategies of sleep therapy in 6 specific steps. The steps of sleep therapy appear to be simple, but they require some time and effort. The most important factor that determines whether their sleep will improve is the consistency with which one follows the steps. The chapter discusses fifth and sixth steps. Fifth step is 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. Many programs recommend that one avoid daytime naps entirely because naps may make it harder to sleep at night. While this is partially true, one also knows that humans are biologically predisposed to have a nap in the afternoon if circumstances permit. Sixth step is maintaining a sleep diary. Keeping a sleep diary will show how one’s sleep improves as a result of their actions.