The Nuts and Bolts of Sleep
Sleep is important to many aspects of our daily life, yet many women with insomnia continue to push on day after day.
Two major processes regulate our sleep: the circadian rhythm and the sleep drive.
The circadian rhythm helps keep our clock body in tune overall (sleeping at night and awake during the day). The sleep drive is like an appetite for sleep, building up throughout the day and relieved at night.
The longer we are awake during the day, the greater the sleep drive at night, and it is even stronger when it is timed properly with our circadian rhythm for sleep.
As Your Hormones Change, So Will Your Sleep
While there are things that women can do to sleep better during the various stages of the life cycle as our hormones fluctuate, we need to understand what is normal for sleep during these different times and what is abnormal.
Sleep changes during different life stages, and there’s variation from night to night. Pharmacologic options may be useful to help with hormonal changes, but they are not always indicated.
Other Sleep or Mood Disorders That Might Look Like Insomnia
Many sleep disorders can also look like insomnia
evaluate whether you want to consider a consultation to rule out any other sleep disorders that might look like insomnia.
With the growing rates of sleep apnea and RLS especially in women, make sure to rule out any symptoms that might require a separate medical treatment and possible sleep study.
If you think that you have depression or anxiety that is not likely to improve with just improving your sleep, talk with your doctor about adding in treatment for that issue.
Treating the sleep problem alone may reduce the severity of co-occurring mood disorders, but keep a close eye on any worsening (or remaining) depression and/or anxiety during and after implementing treatment strategies.
Cognitive Behavioral Therapy for Insomnia
CBT-I is a combination of a core set of strategies to combat insomnia.
Some people find it is best to do all the strategies at the start, to get the most robust effect at the beginning, whereas others feel it is easier to gradually introduce one after another—go with your comfort level and what works in your life.
CBT-I is highly effective for people of all ages, for both women and men
Track Your Sleep
The sleep diary is a very useful tool to track your sleep patterns, synthesize your average sleep quantities, and determine how efficient you are at sleeping while in bed.
Use your diary to note any obvious patterns. This will give you a great deal of insight into what you should try to change to improve your sleep
Stomp Out the Sleep Stealers
Sleep hygiene alone is not usually a cure for insomnia, but it helps act as a foundation for the other treatment modules in this book.
Remember to limit liquids, heavy meals, alcohol, and nicotine within 3 hours of bedtime and to wind down without blue light 1 hour before bedtime.
Avoid naps and caffeine after 2 p.m., and get up at the same time every single morning.
Practicing good sleep hygiene will put you well on your way to effectively adding in the other treatment modules
Learn to Love Your Bed Again
The bed is only for sleep and sex.
If you can’t sleep at any point between your bedtime and wake time, get up after a short while (don’t look at the clock, just estimate around 20 minutes).
Go to a different room, or at least a different area, and do something quiet, calm, and relaxing in dim light that passes the time.
Find activities that work best for you that aren’t too stimulating (such as reading, knitting, scrapbooking, or relaxation or mindfulness exercises).
Return to bed only if you’re sleepy.
If you get back into bed and sleep doesn’t come, repeat the exercise: get out of bed again, and return to bed again only if you’re sleepy.
Stick with it on a nightly basis—consistency is what works here!
Spend Less Time in Bed to Sleep More
Sleep restriction can be challenging to implement consistently, but when used properly, it is one of the most beneficial strategies for insomnia currently available.
Sleep restriction can easily be combined with many other behavioral and cognitive strategies for insomnia, but caution must be taken if you already use nighttime sedating medications (speak with your doctor for the best overall timing for taking these medications).
Before starting sleep restriction, track your baseline sleep in a sleep diary for 1–2 weeks to see how much sleep you’re getting, averaged across that time period. Determine your initial “sleep window” based on your sleep diary data; then week after week if your sleep diary shows you’re improving, move your bedtime earlier by 15 minutes.
Don’t focus on a particular number of hours of sleep each night as your “goal” for sleep restriction—that can worsen your insomnia. Instead, stop sleep restriction once you’ve reached a sleep window where you feel happy with your sleep most nights each week (allowing for one or two nights weekly when it may not be ideal).
Change Your Thoughts for Better Sleep
Our thoughts can be our biggest sleep stealers.
Worries about (not) getting enough sleep or daytime consequences of poor sleep and trying to force sleep to happen only make us more frustrated, tense, and anxious, thereby making sleep even harder to obtain.
Tips for Productive and Unproductive Worries
Two ways to dial down the volume of our worries are practicing worry time and productive worrying.
Confront unproductive worries using worry time.
Tackle productive worries in a systematic fashion with a to-do list.
While women may multitask more than, and somewhat better than, men do, we also have busier and more anxious brains overall.
Despite popular belief, multitasking is not as efficient or effective as performing one task at a time.
Our brains typically have a lot of mental chatter, and women with insomnia tend to have lots of mental noise related to sleep, worries about sleep, and what will happen as a result of poor sleep.
Cultivating a practice of mindfulness on a regular basis has been shown to help us quiet our brain and observe noisy thoughts without getting stuck on them.
Allowing ourselves to not get stuck on nighttime thoughts, and instead to let them pass by, quiets the brain at night and sets a much better stage for sleep.
What to Do When Life Gets in the Way of Sleep
Protect your sleep/wake schedule at night and allowing time to wind down and get in bed on time should be at the top of your basic needs list.
Making sleep a priority will benefit you and your family in the long run.