Get to Bed and Get Some Sleep!

Jenny Cadman and Josie Bannon (Psychological Wellbeing Practitioners)

Helping

Yourself

to...

Improve your Sleep

2

3

It can be hard to ask for help with sleep problems,

particularly at University when everyone else may

look like they have no trouble sleeping. Well done

in taking the first step towards tackling the

problem.

This booklet is aimed at anyone who struggles with sleep problems. It includes a

number of student examples to illustrate different ideas and techniques. All the

techniques in the booklet are based on the Cognitive Behavioural Therapy

approach. CBT has a lot of research to show that it can be very helpful for a range

of problems. You may be working through the booklet on your own or with the

support of a practitioner from the Wellbeing Centre. It can also be helpful to talk

to someone you trust such as a family member or a friend so you have their

support as well.

If you are working with a practitioner it is likely you will have regular sessions

where you can talk through how you have got on using the different techniques

and any problems that may have arisen. You can talk together about how to solve

these problems and progress with the techniques.

Tackling sleep problems can be a difficult and challenging process and there may

be times where you feel as though you aren't getting anywhere. Just remember

that we all have good days and bad days so try not to let the bad days feel as

though you have taken ‘two steps back’.

The idea of this booklet is to give you the

information you need to help yourself to improve

your sleep. This means that you need to have a go

at all the techniques to find out which ones are the

most helpful for you.

4

People differ in the amount of sleep they need, but generally we know 7-8 hours is the optimum amount. The type of sleep we get also changes throughout our lives. As we get older our sleep often becomes more fragmented and we spend less time in the deeper stages of sleep. People often say they get less sleep when in actual fact they are not happy with the quality rather than the quantity of their sleep.

The Stages Of Sleep

How much sleep do we need?

Sleep contributes to a healthy immune system, and can also play a role in our feelings of hunger and fullness. When we’re sleep deprived, we may feel the need to eat more, which can lead to weight gain. The one-third of our lives that we spend sleeping, far from being “unproductive,” plays a direct role in how full, energetic and successful the other two-thirds of our lives can be.

5

What happens when we sleep?

We all go through different stages of sleep during the night (these are explored in more

detail on the next page). On a typical night 75% of our sleep will be stages 1-4 and about

25% will be Rapid Eye Movement (REM) sleep.

Stage one

Stage two

Stage one is where we are between being

awake and falling asleep. During this stage

it can feel as though we are daydreaming.

We may experience a feeling that we are

falling or have sudden muscle contractions.

During stage one we are only lightly asleep

and can be woken up easily.

Stage two marks the onset of sleep. At this

point we become disengaged from our

environment, our body temperature begins

to drop and our heart rate slows down.

Stage three and four

Stage three is a transitional stage from light to

heavy sleep. Stage four is the deepest and most

restorative stage of sleep. During stage 4 we are

least likely to be woken up. At this point our blood

pressure drops, our breathing becomes slower, and

our muscles relax. This is the stage where all the

bodies healing takes place, blood flow to the

muscles is increased and tissues growth and repair

occurs. Stage four is also important for restoring

energy and feeling rested.

Stage five or rapid eye

movement

REM takes up around 25% of the night. It first

occurs about 90 minutes after falling asleep

and recurs about every 90 minutes, getting

longer later in the night. REM provides energy

to brain and body and supports daytime

performance. During this stage the brain is

active and dreams occur, our eyes dart back

and forth, hence the name REM. Our body

becomes immobile and relaxed, as muscles

are turned off. In addition, levels of the

hormone cortisol dip at bed time and increase

over the night to promote alertness in

morning.

6

What makes us sleep?

Sleep is regulated by two body systems: sleep/wake homeostasis and

the circadian biological clock.

When we have been awake for a long period of time, sleep/wake homeostasis tells us that a need

for sleep is building up and that it is time to sleep. It also helps us maintain enough sleep

throughout the night to make up for the hours of being awake. If this restorative process existed

alone, it would mean that we would be most alert as our day was starting out, and that the long-

er we were awake, the more we would feel like sleeping. In this way, sleep/wake homeostasis

creates a drive that balances sleep and wakefulness.

Our internal circadian biological clocks regulate the timing of periods of sleepiness and wake-

fulness throughout the day. The circadian rhythm dips and rises at different times of the day,

so adults' strongest sleep drive generally occurs between 2:00-4:00 am and in the afternoon

between 1:00-3:00 pm, although there is some variation. The sleepiness we experience during

these circadian dips will be less intense if we have had sufficient sleep, and more intense when

we are sleep deprived. The circadian rhythm also causes us to feel more alert at certain points

of the day, even if we have been awake for hours and our sleep/wake restorative process

would otherwise make us feel more sleepy.

In the mornings, with exposure to light, the part of the brain that controls the

circadian rhythm sends signals to raise body temperature and produce hormones

like cortisol. It also responds to light by delaying the release of other hormones like

melatonin, which is associat4ed with sleep onset and is procured when the eyes

signal to this part of the brain that it is dark. Melatonin levels rise in the evening

and stay elevated throughout the night, promoting sleep.

Circadian disruptions (e.g. jet lag) put us in conflict with our natural sleep patterns. The shift in time

and light cues on the brain forces the body to alter its normal pattern to adjust. This can leave you

feeling poorly and having more difficulty thinking and performing well. These symptoms can occur

in everyday life, when the circadian rhythm is disrupted by keeping long and irregular hours. Be-

cause of this, it is important to keep a regular sleep schedule and allow plenty of time for quality

sleep, allowing these two vital biological components -- the sleep/wake restorative process and the

circadian rhythm -- to help us perform at our best.

7

Myths (and facts)

about sleep

You can "cheat" on the amount

of sleep you get. Most adults need between 7 and 9 hours of sleep each night for opti-mum performance, health and safety. When we don't get adequate sleep, we accumulate a sleep debt that can be difficult to "pay back" if it becomes too big.

Insomnia is characterized by difficulty falling asleep.

Difficulty falling asleep is but one of four symptoms generally associated with insomnia. The others include waking up too early and not being able to fall back asleep, frequent awakenings, and waking up feeling unrefreshed.

During sleep, your brain rests.

The body rests during sleep, however, the brain remains active, gets "recharged," and still controls many body functions including breathing. When we sleep, we typically drift between two sleep states, REM (rapid eye movement) and non-REM, in 90-minute cycles. Even in the deepest non-REM sleep, our minds can still process information. REM sleep is an active sleep where dreams occur, breathing and heart rate increase and become irregular, muscles relax and eyes move back and forth under the eyelids.

Daytime sleepiness always

means a person isn't getting

enough sleep.

Excessive daytime sleepiness is a condition in which an individual feels very drowsy during the day and has an urge to fall asleep when he/she should be fully alert and awake. The condition, which can occur even after getting enough night-time sleep, can be a sign of an underlying medical condition or sleep disorder such as narcolepsy or sleep apnoea. These problems can often be treated, and symptoms should be discussed with a physician.

Waking up in the middle of the night and not being able to go back to sleep is a symptom of insomnia. Relaxing imagery or thoughts may help to induce sleep more than counting sheep, which some research suggests may be more distracting than relaxing. Whichever technique is used, most experts agree that if you do not fall back asleep within 15-20 minutes, you should get out of bed, go to another room and engage in a relaxing activity such as listening to music or reading. Return to bed when you feel sleepy. Avoid watching the clock.

If you wake up in the middle of

the night, it is best to lie in bed,

count sheep, or toss and turn un-

til you eventually fall back asleep.

8

There are 4 main types of sleep problem:

Falling asleep

Staying asleep

Non restorative/light sleep

Waking up to early

About sleep problems Sleep problems are very common, around three in ten people will experience

problems at point in their lives. Unfortunately this is an even higher rate among

students, coming to University may mean changes to environment, routines and

noise levels all of which can affect sleep, not to mention any extra stress. Generally

people have most problems getting to sleep. There can be many reasons for

problems with sleep.

What Causes Sleep Problems?

Life events; e.g. Relationship break up or bereavement

Medical Problems; e.g. if you are in pain

Depression or low mood

Anxiety or stress

Worrying

Environment

Some medications

You may have a predisposition to sleep problems

Disturbed routine (student life style)

9

What sleep problems do you experience?

Student examples...

Throughout the booklet we are going to be covering a number of ideas

and techniques. Here are some examples of sleep problems that are often

reported by students. We will use some of these examples to show how

the techniques in the booklet can be applied.

10

Lifestyle habits

Getting up at the

same time each day

is one of the most

important things you

can do to improve

your sleep. Even if

you haven't slept

much the night

before!

Alcohol interrupts the quality of sleep a

person has and can cause more waking in

the night. It can also lead to tiredness in

the day.

Going to bed full up

or hungry can

interfere with sleep,

best to have an

early dinner and a

light snack before

bed .

Nicotine and caffeine are

both stimulants and can

interfere with getting to

sleep. Try to avoid 4-6

hours before going to bed.

Physical activity is great

for improving sleep; but

avoid 4 hours before bed

time.

How to improve your sleep:

Another way to improve sleep is to look at the things you

could improve in your lifestyle. Below are some examples

of different things might influence your sleep.

11

The effect of caffeine

There is no nutritional need for caffeine in the diet. Moderate caffeine intake, however, is not associated with any recognized health risk. Three 8 oz. cups of coffee (250 milligrams of caffeine) per day is considered a moderate amount of caffeine. Six or more 8 oz. cups of coffee per day is considered excessive intake of caffeine.

One mug of instant coffee: 100mg.

One mug of filter coffee: 140mg.

One mug of tea: 75mg.

One can of cola: 40mg.

One can of energy drink: 80mg.

One 50g bar of plain (dark) chocolate: around 50mg.

One 50g bar of milk chocolate: around 25mg.

http://www.barnsleyhospital.nhs.uk/

How much Caffeine is in what?

Here is a guideline of how much caffeine is in some different food and drinks. Try to work out how

much caffeine you are currently consuming.

How Caffeine works

Caffeine is a stimulant. It can seriously interfere with sleep, it can temporarily make us feel more alert by blocking sleep-inducing chemicals in the brain and increasing adrenaline production. However, the more caffeine we have the more sleep chemicals are produced to combat the caffeine. This means we feel exhausted if we don’t have caffeine.

Caffeine enters the bloodstream through the stomach and small intestine and can have a stimulating effect as soon as 15 minutes after it is consumed. Once in the body, caffeine will persist for several hours: it takes about 6 hours for one half of the caffeine to be eliminated. This means if you are having problems with sleep, you should avoid caffeine all together.

During the day the chemical Adenosine, accumulates in the brain. This binds to receptors and

slows down brain activity. The higher the level of adenosine, the more tired you will feel.

Caffeine competes with the adenosine and combines with the adenosine receptors. This stops

the adenosine binding and stops you feeling tired.

To compensate for this the body will create more receptors which means that you will need

more caffeine to get the same effect.

Caffeine also increases adrenaline and dopamine.

12

Things in the environment

Electronic screens

are overly

stimulating for the

brain due to the

visual stimulation.

They can make it

harder to fall asleep.

Ear plugs can be good for

blocking out the noise.

Its important to have the

right duvet, the ‘tog’

indicates how thick it is.

If your too hot or too

cold this interfere with

falling asleep.

Central heating can

cause ‘stuffiness’

and poor air quality

which can make it

harder to fall

asleep.

You can buy ‘black out’ curtains that block a lot of light,

or eye mask. If its light then your brain is getting the

message that its day time and that you should be awake.

‘Topper’ mattresses are

good for improving the

comfort of your bed,

they are usually quite

cheap too.

How to improve your sleep:

Another way to improve sleep is to look at what you might be able to

change in your environment. Below are some examples of environmental

factors that might influence your sleep.

13

Before going to bed...

Try to go to bed at the same time each night

Have the same routine an hour before going to bed

The brain will start to know when its time to go to sleep

Do the same thing each night an hour before bed

Avoid anything stimulating (physically or mentally)

This should be ‘wind down time’

Clare’s 60 minute pre-bed routine: 23:00: Read a fiction book for half an hour 23:30: sort my bag out for the next day 23: 40: Have a wash; Brush my teeth and get changed for bed 23:50: Relaxation exercise for 5-10 mins before going to bed

It can be really difficult to get into a good routine when you’re a student, there may

often be nights where you go out or staying up late with friends. Although going to

bed at the same time each night can help, if you are unable to do this then a pre-

bedtime routine can still help to improve your sleep. It can help to cue your brain/

body to know that it is time to sleep, having wind-down time before bed can also

help you to relax .

The importance of routine

What could your routine be for the hour before you go to bed?

Here’s an example of Clare’s pre-bed routine:

Clare’s example...

14

Relaxation is very important in order to help mood, memory, stress levels and sleep,

although this is something that students sometimes find hard to justify. You may feel that

you should be spending all of your time studying and feel too busy to relax. However,

humans are not designed to be on the go throughout the waking day. It is important to

have activities in your day to day routine that you find relaxing.

Daniel: “When I play football I have no worries, I am totally absorbed in the game. I feel that it is my ‘time out’ from my Uni work and other stresses. “I also find listening to music relaxing”

Active

Passive

Physical

Playing football A leisurely walk

Mental

Playing Sudoku Listening to music

Types of Relaxation...

Relaxation

15

Active

Passive

Physical

Mental

What relaxing activities could you do?

Scheduling it in…

When (what day and time):

Where:

With whom:

16

It is really important to allow yourself time to ‘wind-down’ after each day. Otherwise

your body and mind will still be active when you try and sleep. Without wind-down

time you may end up lying in bed with loads of thoughts going through your head. On

the next few pages are a number of techniques that you can use to help you to relax.

Relaxation exercises

Focusing on the breath: The Calming Technique When we feel stressed our breathing often changes. We tend to take quicker shallower

breaths and take in more oxygen. This is all part of the fight or flight response. Over

breathing (whilst not dangerous) can leave you feeling exhausted or “on edge”, and can

make it difficult to fall asleep. Slowing down your breathing can help you to feel calmer

and more relaxed

1 Ensure that you are sitting on a comfortable chair or laying on a bed

2 Take a breath in for 4 seconds (through the nose if possible

3 Hold the breath for 2 seconds

4 Release the breath taking 6 seconds (through the nose if possible)

then pause slightly before breathing in again.

5 Practise, practise, practise!

Breathing tips - When you are doing your breathing exercises, make sure that you are

using a stomach breathing style rather than a chest breathing style. You can check this by

placing one hand on your stomach and one hand on your chest. The hand on your stom-

ach should rise when you breathe in.

17

Progressive Muscle Relaxation

PMR sequence:

1. Right hand and forearm. Make a fist with your right hand.

2. Right upper arm. Bring your right forearm up to your shoulder to “make a muscle”.

3. Left hand and forearm.

4. Left upper arm.

5. Forehead. Raise your eyebrows as high as they will go, as though you were surprised by something.

6. Eyes and cheeks. Squeeze your eyes tight shut.

7. Mouth and jaw. Open your mouth as wide as you can, as you might when you‘re yawning.

8. Neck. !!! Be careful as you tense these muscles. Face forward and then pull your head back slowly, as

though you are looking up to the ceiling.

9. Shoulders. Tense the muscles in your shoulders as you bring your shoulders up towards your ears.

10. Shoulder blades/back. Push your shoulder blades back, trying to almost touch them together, so that

your chest is pushed forward.

11. Chest and stomach. Breathe in deeply, filling up your lungs and chest with air.

12. Hips and buttocks. Squeeze your buttock muscles

13. Right upper leg. Tighten your right thigh.

14. Right lower leg. Do this slowly and carefully to avoid cramps. Pull your toes towards you to stretch

the calf muscle.

15. Right foot. Curl your toes downwards.

16. Left upper leg. Repeat as for right upper leg.

17. Left lower leg. Repeat as for right lower leg.

18. Left foot. Repeat as for right foot.

Practice means progress. Only through practice can you become more aware of your muscles, how they

respond with tension, and how you can relax them. Training your body to respond differently to stress is

like any training – practising consistently is the key. Centre for Clinical Interventions

PMR can be a really helpful technique for reducing tension in the

muscles. Often we don’t even realise when we are feeling tense.

This tension can make it very difficult to sleep. PMR involves working through all the

major muscles groups tensing and relaxing the muscles. It can also help us to tune

into the feeling of tension so we can notice it happening at the time we become

tense and then focus on relaxing the muscles. Try doing this in a quiet space to start

with.

18

Start by getting comfortable in a quiet place where you won't be disturbed, and take a

couple of minutes to focus on your breathing, close your eyes, become aware of any

tension in your body, and let that tension go with each out-breath.

Imagine a place where you can feel calm, peaceful and safe. It may be a place you've

been to before, somewhere you've dreamed about going to, somewhere you've seen

a picture of, or just a peaceful place you can create in your mind’s eye.

Look around you in that place, notice the colours and shapes. What else do you

notice?

Now notice the sounds that are around you, or perhaps the silence. Sounds far away

and those nearer to you. Those that are more noticeable, and those that are more

subtle.

Think about any smells you notice there.

Then focus on any skin sensations - the earth beneath you or whatever is supporting

you in that place, the temperature, any movement of air, anything else you can touch.

Notice the pleasant physical sensations in your body whilst you enjoy this safe place.

Now whilst you're in your peaceful and safe place, you might choose to give it a name,

whether one word or a phrase that you can use to bring that image back, anytime you

need to.

You can choose to linger there a while, just enjoying the peacefulness and serenity.

You can leave whenever you want to, just by opening your eyes and being aware of

where you are now, and bringing yourself back to alertness in the 'here and now'.

www.getselfhelp.co.uk/imagery.htm www.get.gg © Carol Vivyan 2009, permission to use for therapy purposes

Relaxing 'Safe Place' Imagery

The effect that mental images can have on our physiology

is amazing. Just take a minute to imaging your favourite meal,

imaging how it would look, the aroma, the texture as you took the first

mouthful and the delicious flavours. Now, what do you notice happening? Do you

have increased saliva in your mouth, or a rumbling in you stomach? Often the

images we have in our minds have a direct impact on how we feel and our

physiology. With this in mind, practicing relaxing imagery exercises can be really

helpful at calming the body and mind.

19

In bed awake

worried about not

sleeping

Associate the bed with

being awake rather

than sleep

Unconscious association is a powerful thing. The more two things occur together the

stronger the association - this is the same with bed and sleep.

Those who sleep well associate their bed with sleep.

Those with sleep problems associate bed with being awake or feeling worried or

anxious.

The association between bed and sleep

In the next few pages we will look at ways to help you to improve this association and to

break this cycle.

When you struggle to sleep you can get into a vicious cycle where you start to worry about not being

able to sleep and to watch the clock (‘if I get to sleep now I’ll have 5, 4, 3,etc hours sleep)—this then

means you associate bed with being awake, which then makes it harder to sleep which reinforces the

worry about sleeping

20

The bed is for

sleep rule

The 20 minute rule

The sleepy rule

The night time rule

Everything else (except sex) is banned! So no

reading; working; talking on the phone; looking at

the internet; nothing in bed but sleep. Sometimes

this might be difficult being a student; but its

worth doing if sleep is a problem. Some people do

find reading in bed helpful, however this is also

about association. Good sleepers read to stay

awake; poor sleepers read to get to sleep

Healthy sleepers generally fall asleep within

twenty minutes. If you are lying in bed unable to

get to sleep for longer than this then the

association between bed and wakefulness/

anxiety is strengthened. If your not asleep within

20 minutes; get up, go into a different room if

possible and do something relaxing until you feel

sleepy again, then go back to bed.

4 Rules for better sleep

The association we have between our bed and sleep can make a big difference to

how easily we fall asleep. If we often lie in bed worrying and struggle to get to

sleep we might start to associate the bed with stress rather than calmness and

sleep. The longer we spend in bed awake, the weaker the association will be with

sleep. Below are 4 different rules to strengthen the association between bed and

sleep which will help to improve sleep.

Feeling tired and feeling sleepy are different. You

actually feel tired without feeling sleepy but you

should only try and go to sleep when you feel

sleepy. When you feel sleepy you might yawn a lot,

have hot, heavy eyes that feel like they want to

close and have heavy muscles.

Only sleep at night. Make sure not to nap in the

day, no matter how much sleep you missed the

night before. Napping in the day decreases the

need to sleep at night and gets rid of the ‘sleepy’

feeling you need to fall asleep at night

21

Sophie lives with 4 other people, she has her desk in her room and a kettle for tea. She often prefers to read Uni books and papers on her bed as its comfier than her desk. She also talks to friends and family on the phone whilst lying in bed. When she wakes up in the morning she can lie there for hours getting frustrated, before she finally gets up.

Sophie’s example of the association between bed and sleep...

Sophie made a comfy space on her floor to read her Uni books and papers and decided to talk to her friends and family down stairs in the living room; if her house mates were around she would go in the garden. She also started getting up in the morning when she woke up (using the 20 min rule), even though it was five o’clock. When she got up she found she did start to feel ‘sleepy’ again so went back to bed, she found that she was more likely to fall back asleep after getting up then if she was lying there getting frustrated.

The Problem...

What Sophie Did...

Sophie used rules one two and three:

The bed is for sleep rule

The twenty minute rule

The sleepy rule

22

When the amount of time you are spending in bed asleep is up to 90% you can increase your sleep window by 15 minutes.

Use the equation on page 25 to work out what percentage of the time in bed you are asleep for.

How to improve your sleeping pattern

Often when people are having sleep problems their sleeping pattern becomes very

irregular. People often spend a lot of time awake in bed, whether this is due to not being

able to get to sleep, waking in the night or waking up early. Having a regular sleeping

pattern is really important and this technique will help you to improve this. The technique

works by finding out how much you time you currently spend asleep and initially only

going to bed for this period of time. As you start to sleep through this period, you gradually

increase the time that you’re in bed until you are able to sleep through the night.

First you need to work out the average amount of sleep you get a night (You may

need to keep a sleep diary for a week to determine this). Then give yourself a set

time for getting up, and for going to bed. Finally, subtract your average amount of

sleep from your ‘getting up time’

This is your sleep window

Whilst it might sound counter–intuitive, the next step is to only go to bed during

this sleep window. So if your sleep window is 5 hours and you want to get up at

8:00am then you would go to bed at 3am.

23

Although the sound of ‘the sleep window’ probably sounds pretty horrible, there are a number of benefits to having a tight sleep window. Having a tight sleep window means that:

The benefits of a tight ‘sleep window’...

•Less time is spent frustrated in bed

•There is an improved association between bed and sleep

•There is increased ‘sleepiness’ when in bed

•Quality of sleep is improved

•More refreshing and uninterrupted sleep

•Ultimately it increases the amount of sleep you get

Clare’s example of using the sleep window to increase her sleep...

Clare worked out that she was getting about four hours sleep a night. She would go to

sleep at different times but aimed to be in bed by 12:30. She was often still awake at 3 or

4 and she would have to get up around 7:00. Using the sleep window described she

decided that she was still going to get up at 7:00 which meant going to bed at 3:00am.

To start with she found that it still took her a while to get to sleep (70% sleep efficiency)

and she felt worse for the first week. But after the next week she started to notice an

improvement in her % of sleep efficiency. Due to the improvement she added 15 mins to

her ‘sleep window’ so started going to bed at 2:45. After a few months she was going to

bed at 1:00 and getting to sleep within twenty minutes. She was now getting around six

hours sleep a night rather than four. Clare continued to adjust the time that she went to

bed as the % of her sleep efficiency improved.

24

When your sleep efficiency is at 90% then you can add an extra 15

minutes to your going to bed time. (e.g. 3:00am becomes 2:45).

Review your sleep efficiency each week and add 15 minutes each

time it reaches 90%.

Your sleep efficiency

We have been talking about sleep efficiency for the last few pages. If you want

to work out your % of sleep efficiency then use the equation below. Try to do

this on an average night rather than a night where have slept either better or

worse than usual.

Average number of hours of sleep a night =

What's the best time for you to get up =

Set time for going to bed (getting up time, subtract average

hours of sleep a night) =

You will need to calculate your % of sleep efficiency each night so you know when

you can start adding to your bed time.

25

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26

It can be very difficult to stop or control worries. Worries often happen in bed as you are not occupied at this point and they can stop you from getting to sleep. This in turn can weaken the association between bed and sleep and strengthen the association between bed and stress.

Whenever you notice a worry write it down (make a list)

Give yourself a set amount of undisturbed time each day to go through your list of worries

Separate practical worries (e.g. problems that you can do something about) from hypothetical worries (e.g. ‘What ifs’)

Write an action for all practical worries (what; when; where and who?)

Give yourself time to think about the hypo-thetical worries (Not right before going to bed)

Once the time is up you need to stop worrying and focus on something else

You might want to screw the paper up

Try and do something engaging and get a change of scenery

Any worries that you have outside of your worry time; write them down and think e.g. “I will think about that tomorrow at 5:00. There is no need to worry about it now”

When in bed, try to focus your attention on your breathing, in-out, in-out

Notice when your mind wanders and bring your attention back to your breathing

Worrying and sleep

Centre for Clinical Interventions

We are now going to look at a technique that you can use to help you to control your worries. This can feel difficult to do at first, but should become easier the more you practice it.

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Stress around not sleeping Often when we are having sleep problems we start to worry about not sleeping. As you

can see below this can then feed into the vicious cycle making it harder for you to sleep.

Again, these unhelpful thoughts also weaken the association between bed and sleep.

Thought Emotion/

Feeling

More helpful thought Emotion/

Feeling

I’m going to

be awake all

night

Stressed,

upset

It is rare that I never sleep

in the night; I will sleep

sooner or later, generally

I get around 4 hours a

night at least

Less

stressed;

more relaxed

Challenging these thoughts can help to break this cycle and improve your sleep.

When we are worrying our thinking often becomes more negative, it is important to

identify our negative thoughts, then to take a step back and to look at the facts of the

situation. This can help you to come up with a more helpful thought which can reduce

your worry and help you to sleep better.

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Habit reasons Sleeping too much: it sounds odd, but this can make you tired.

Activity: a 'roller-coaster' of too much activity followed by too much rest; if you do too much on a good day, you may overdo things and feel even more tired the next day.

Staying up through the night: people who stay up in the night often find that they get tired easily. This is more likely if the times that they are awake are constantly being changed.

Tiredness is a problem that a lot of people report, particularly whilst

studying at University. There are lots of reasons why we get tired:

Problems with tiredness that are

unrelated to sleep

Physical Reasons Being overweight

Being underweight

Physical illness

Not doing enough (getting unfit)

Doing too much (physical or mental, if you push yourself when you’re tired you may find it harder to recover).

Psychological reasons Worries and Stress

Depression

Everyday difficulties, e.g. Moving house.

Emotional shock, e.g. a bereavement or break up.

Expecting too much of yourself. Standards can be helpful, they give you direction, however if you expect too much of yourself you may find yourself repeatedly failing which is frustrating and exhausting.

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Start with a little bit each day then gradually build up to half an hour a day

If you feel more tired after this then reduce the amount you’re exercising to start with

You should build it up to a point where you start to feel a bit out of breath

Walking is a good form of exercise

Being outside and with other people also helps

Try to make sure that you don't have any really hectic, tiring days

Organise it so that you do a little every day

If you cram everything into one day, you may be too exhausted to do anything for the rest of the week

Try to do important activities when you think you will have the most energy

Improving tiredness

Feeling tired can have a big impact on your life, it can effect our energy levels,

concentration, ability to have fun and perform at our best. Sometimes simple things can

help to improve this. We will now look at a few techniques to help you to reduce this.

Exercise/Physical activity

Exercise can feel like the last thing you want to do when you’re feeling tired, but it

can really help to increase our energy. It gets the blood pumping through our bodies,

oxygen is delivered to our muscles and endorphins are released which improves how

we feel.

Plan your day and week

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How to improve tiredness: Diet

Other important things to aim for...

The best way to eat if you want to banish tiredness is to have a healthy, balanced diet that contains foods from the four main food groups in the right proportions. The four food groups are:

potatoes, bread, rice, pasta and other starchy foods

fruit and vegetables

milk and dairy foods

meat, fish, eggs, beans and other non-dairy sources of protein

Eat at regular intervals - If you eat at regular times, your body knows when your next meal is coming and learns to manage feelings of hunger and sustain your energy levels. Try to eat three meals a day and limit snacks – especially high-fat ones – between meals.

Breakfast boosts your energy - Breakfast gives you the energy you need to face the day. Despite this, up to one third of us regularly skip breakfast, according to the British Dietetic Association.

Go for healthier options, such as porridge with fruit; vegetable omelette or wholemeal toast.

If you can’t face eating as soon as you get up, take a high-fibre snack to eat on the run, rather than snacking on high-sugar or high-fat foods.

Aim for 5 a day for more vitality - Most people in the UK eat too much fat, sugar and salt, and not enough fruit and vegetables.

Fruit and vegetables are good sources of vitamins, minerals and fibre, essential nutrients that your body needs in order to work properly. Try to incorporate at least five portions of a variety of fruit and veg into your daily diet. They can be fresh, frozen, tinned, dried or juiced to count.

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Slow-burning starches give sustained energy - Starchy foods (also called carbohydrates) such as potatoes, bread, cereals and pasta are an important part of a healthy diet. They’re a good source of energy and the main source of a range of nutrients in our diet.

Starchy foods should make up about a third of everything you eat. But there are different types of starch. Where possible, go for slow-burning whole grain or wholemeal varieties, as they provide energy gradually.

Sugar steals your stamina - Adults and children in the UK eat too much sugar. Sugar is not only bad for your teeth, it can also be bad for your waistline. And it gives you a rush of energy, but one that wears off quickly.

Cutting out all sugar is virtually impossible. There are natural sugars in lots of foods, including fruit and veg, and you don’t need to avoid these. But it’s a good idea to cut down on foods with lots of added sugar, such as sweets, cakes, biscuits, non-diet fizzy drinks and chocolates.

Iron-rich foods prevent fatigue - Two out of five (42%) teenagers and one in three (33%) of 19-24 year olds have low iron stores, according to the National Diet and Nutrition Survey. Being low on iron can make you feel tired and look pale.

While red meats, green vegetables and fortified foods such as breakfast cereals are good sources of iron, the important thing is to eat a range of foods to get enough iron.

Soft drinks boost zest levels - Watch your intake of alcohol. It can dehydrate you, which will make you feel tired. Make sure you stay hydrated in general by drinking six to eight glasses of water a day.

Eat enough to pack a punch - Make sure you eat the right amount for your activity level. The average man needs around 2,500 calories a day, and the average woman needs 2,000 calories. But remember, we all overestimate how active we are.

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Action plan for improving sleep

What techniques are you going to use?

What changes are you going to make?

What have you learned?

Which techniques are most relevant for you?

Well done on getting to the end of the Improving Sleep Workbook! It can be helpful to look back over

the techniques you have learnt and to think about what has been the most helpful. This can help you to

make a plan for how you will improve your sleep

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A final note...

Well done for taking the first steps to improve your sleep! It can be helpful to

schedule in a Wellbeing day a month where you can focus on YOU! Where you can

have a look back through this booklet to refresh your self on the different

techniques that were helpful. If you schedule it in you’ll be more likely to do it,

these things can easily get lost or forgotten about otherwise.

You might feel as though you’re still not where you want to be in terms

of your sleep. This is completely normal, remember that it can take

time for these techniques to work. Cognitive Behavioural Therapy is

more effective the more you use it—like a muscle. If you found that

they have made any difference at all even if its small this is

encouraging, just keep up to good work and as time goes on you will

notice more improvements.

Coping Tips

Jenny Cadman and Josie

Bannon (Psychological

Wellbeing Practitioner)

Wellbeing Centre

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