Sleep difficulties are highly common, especially in today’s fast-paced, high productivity, high stimuli world. The sleep and sleep disorder statistics can be quite surprising and somewhat validating to know you’re not alone. Sleep concerns are highly treatable.
Sleep often comes up in therapy, as sleep affects every area of our lives. There are often a variety of factors affecting poor sleep. In therapy, we can work on a variety of strategies to understand how mental and behavioral health are contributing to sleep difficulties. While there are multiple types of approaches to improving sleep, there’s no one-size-fits all approach. Within the mental health realm, reducing anxiety, depression, and stress, as well as improving sleep-promoting behaviors are often key.
When I work with clients on their mental and behavioral health related to sleep, I also recommend that they meet with their physician to discuss their sleep concerns to help ensure there are no underlying physical causes contributing to poor sleep. In many cases, physicians will review your medical history and may order a sleep study to check for sleep apneas (there's more than one type!), restless legs, and other physical conditions which may contribute to poor sleep. Sleep aids may or may not be recommended by your physician based on your needs and medical history.
To help you get better sleep faster, below are some practical tips you can apply relatively easily.
1. Keep your bed, and ideally your bedroom, a place for sleep and sex only.
Using your bed/bedroom for other activities, such as watching TV, working, etc. can create an association that your brain should be alert/active rather than an association with your bed as one where your brain relaxes. In cases where your bedroom serves multiple purposes, such as your workspace, do your best to have a separate workspace (such as a dedicated corner in your room for your desk) and/or an area that can be partitioned off from your sleep/rest area.
2. Create a sleep-promoting environment.
Most people sleep best in cool, comfortable, dark rooms, with minimal distractions.
a. Find what air temperature works best for your sleep.
b. Ensure your bedding and pillows are as comfortable as possible. Cooling mattress toppers, weighted blankets (consult weight guides for appropriate use), soothing textures, etc. may help your sleep.
c. Make your space darker with blackout curtains. If necessary, use night lights minimally.
d. Minimize activating stimuli (like TVs, music, etc.) as much as possible. If you need noise to fall asleep, try sleep stories, sleep meditations, sleep music, or white noise machines.
3. Maintain regular sleep and wake times.
As much as possible, try to go to sleep and wake up at the same times each day as much as possible… yes, even on the weekends. Keeping a regular schedule helps your brain and body create and stick to a regular circadian rhythm.
4. Avoid napping or, if you must, nap appropriately.
Avoid napping to support your regular sleep and wake times. Napping for an hour or more will often throw off your sleep/wake schedule. If you find you must nap, short “cat naps” around 20 minutes can often provide enough rest to help get you through the rest of your day while helping to prevent major disruption to your regular sleep routine. Also, try to make sure you nap in your bed so your brain keeps the association with sleeping in your bed (not sleeping on the couch, in the chair, etc.).
Note: In the USA, we largely live in a monophasic (one sleep period) society. That doesn’t work for everyone though. In some cases, some people work best with a biphasic (two sleep periods) or polyphasic (multiple sleep periods) sleep schedules, especially people who work early in the morning, overnights, etc. If you need naps or multiple sleep periods, you can certainly integrate them into your sleep routine, just try to keep them as regularly scheduled as possible.
5. Have a bedtime routine.
Get into a regular bedtime routine that you consistently follow, such as locking up the house, putting on pajamas, brushing your teeth, and washing your face. Following a bedtime routine creates behavioral cues that your brain recognizes as a sign it needs to begin “shutting down” for sleep. I parallel this with your computer’s shutdown sequence. When you shut down your computer, it goes through a specific sequence. If something goes wrong, you get a spinning circle cursor as it figures out what went wrong and how to get back on track to shut down. Your brain can react similarly if you don’t have a routine or stray from your routine.
6. Engage in relaxing activities before bedtime.
Do your best to wind down before bed. Avoid things that are mentally or physically activating, ideally for at least one hour before bedtime. These activities could be anything from screen time, to news and social media, to eating and exercise. Instead, do these things earlier and work on incorporating relaxing activities before bed, such as gentle stretching, reading (in a book, not on a screen), journaling, meditating, etc.
7. Help settle your brain’s thoughts.
If you’re having trouble turning off your thoughts, keep a notebook near your bed. Write down the things that are floating around in your head – often it’s the things we’re reflecting on from our day or “can’t forget to do this tomorrow…” types of thoughts. Write them on paper and mentally tell yourself that they’re written down, so you won’t forget, and you’ll get to those things tomorrow or in the coming days. This can be soothing to your brain and allow some of those thoughts to stop cycling.
8. If you’re not sleepy, don’t force it.
If you’re lying in bed for a while and finding your having a hard time falling asleep after a period of time, don’t try to force yourself to go to sleep. Forcing yourself will lead to frustration and create a negative sleep association. Instead, create a soothing space (using the same principles above) that you can move to and relax. This could be corner of the couch with a comfy blanket; a floor pillow you sit on and listen to a sleep meditation; a cozy space you can curl up and see the night sky. You’ll want a space that allows you to relax for a little bit until you get sleepier. Try not to fall asleep there though! Stay there until you get sleepy, then transition back to bed so you can sleep in bed.
9. Avoid activating activities if you wake during the night.
When waking in the middle of the night and having difficulty going back to sleep, it’s common for people to want to get up and do something… grab the phone and scroll social media, watch TV, do menial housework, etc. While it can be seen as filling time and avoiding frustration, it will be counterproductive to getting back to sleep. Instead, handle any physical needs – get a sip or water or go to the bathroom – and go to your cozy place (see #8) until you get sleepy enough to go back to bed.
10. Soothe and assure yourself when bad or vivid dreams occur.
If you have nightmares, bad dreams, or vivid dreams, take steps to soothe and assure yourself. You may benefit from one or a combination of the following:
a. Take some deep breaths,
b. Briefly write them down (if you feel that’s helpful) and make mental note that the info is on paper and it’s not necessary for your brain to keep repeating the details,
c. Mentally remind yourself that you’re safe and it was just a dream, and
d. Engage in the rest of the above-noted tips to get back to sleep.
For individualized support, please work with a physician or a therapist to ensure you’re getting personalized recommendations and treatment for your specific needs.