Treating Insomnia with Cognitive Behavioral Therapy

By Annabelle Parr and CSAM Insomnia Expert Dr. Melissa Jenkins

We all know what it feels like to get a bad night’s sleep. You know you have a big day tomorrow, but you watch as the minutes and hours tick by as sleep feels elusive. Or you fall asleep but you toss and turn, dreaming about that presentation you have to give at work. You finally fall into a deep sleep and it feels like that is the moment the alarm goes off. A bad night’s sleep on occasion is pretty typical – when we are super stressed it can be harder to sleep soundly.

When sleep – or lack thereof – becomes a problem…

But for some of us, bad sleep becomes a pattern. It can become a vicious cycle with loads of stress and a lack of sleep where it’s hard to tell what’s causing what. How can you tell if your poor sleep quality is typical or whether it might be time to get some help?

Is it a few bad nights or is it insomnia?

The DSM-V defines insomnia disorder as difficulty falling asleep, difficulty staying asleep, and/or waking up too early and being unable to return to sleep for at least 3 nights per week, lasting at least 3 months. The sleep difficulties must also cause significant impairment in important areas of functioning (such as work, relationships, school, etc.), and occur despite enough opportunity for sleep. It’s also important to rule out whether sleep difficulties are due to another disorder – sleep disorder or otherwise – and are not the result of substance use.

When to seek help…

Though full clinically diagnosable insomnia has fairly specific criteria, if you are unable to sleep well often enough that it is having a negative effect on your day to day life, it’s worth talking with a professional to see how you might get better sleep. It’s a common misconception that sleep difficulties require medication – such as sleep aids – to be alleviated. However, medication is often a short-term solution, like a band aid; in order to achieve long-term results, it’s important to address the underlying problem.

People don’t often think that therapy can help them with sleep – especially if it feels like sleep is the main problem rather than a byproduct of anxiety. However, there is a particular form of therapy entirely dedicated to the treatment of insomnia: Cognitive Behavioral Therapy for Insomnia (CBT-I).

What is CBT-I?

CBT-I involves a number of elements, and is based on helping the client learn strategies that will help facilitate better sleep. According to Dr. Melissa Jenkins, CSAM’s resident insomnia expert, CBT-I focuses on improving the quality and quantity of one’s sleep. Dr. Jenkins explains some of the core therapy components include… 

Sleep efficiency therapy: People frequently say there is no pattern to their insomnia, a very common yet frustrating experience. A skilled CBT-I therapist can help make sense of otherwise confusing sleep patterns. By first examining what your current sleep (or lack thereof) looks like, a CBT-I therapist then guides you to change your sleep schedule. This strategy can greatly improve your quality of sleep. It often involves making significant changes to when you go to bed and when you wake up. These changes are often counterintuitive! People with insomnia often find this one of the most difficult but most effective parts of CBT-I. With the help of a skilled therapist, you learn how to regain control over your sleep.

Stimulus control: After extended periods of not being able to sleep in one’s bed, bed often becomes a place of stress (not rest!). The body becomes primed to be alert in bed, the exact opposite of what we need to be able to fall asleep. So, we often say the brain needs to be re-trained!  A CBT-I therapist helps re-train your brain so that you can once again sleep when and where you want to. This involves looking at what you currently do when you cannot sleep as well as things you do in your bed and bedroom that are possibly maintaining insomnia (e.g., watching tv, reading).

Sleep hygiene and psychoeducation: Another important element of CBT-I is helping you to understand the host of habits that contribute to sleep quality. Sleep hygiene involves everything from the food we eat, to the substances (such as caffeine and alcohol) we consume, the environment in which we sleep, the times of day in which we engage in particular activities such as exercise, our exposure to light (natural and artificial), and our routine leading up to bedtime. It’s not all intuitive, but when we know what can help or hinder our shut eye time, we are empowered to improve our own sleep and our health overall. CBT-I can also help teach natural ways to “trick” the body to either increase sleepiness for bedtime or alertness for optimal daytime functioning.

Relapse prevention: The goal of therapy is to give you the tools you need to create change and empower you going forward. The relapse prevention stage of CBT-I involves consolidating gains made in treatment to maintain good sleep going forward. Helping you to recognize potential triggers for an onset of acute (short term) insomnia and providing you with the tools for preventing relapse back into chronic insomnia is critical. Also, if you need to come back to therapy for a tune up, good news! Clients who return to therapy for a tune up during a relapse tend to recover quickly.

Additional therapy components: Other important aspects of treatment can include stress management and cognitive therapy (how the way you think may be triggering or perpetuating sleep problems).

At the end of CBT-I, the goal is to become your own sleep doctor: To put you back in control of your sleep and to know what to do if problems return in the future. Over the course of CBT-I, you can also learn how to determine your optimal amount of sleep (which is often different than the common myth that everyone needs 8 hours!). CBT-I is short term and typically includes 7 or 8 sessions, but can vary depending on individual needs. Treatment, while structured, is tailored the specific person and their behaviors. CBT-I is offered in individual therapy or group therapy.

Announcing: CBT-I group therapy is available at CSAM!

Interested in learning more about or receiving CBT-I? Dr. Melissa Jenkins is CSAM’s resident insomnia expert! She offers individual and group CBT-I, and is currently accepting clients for a CBT-I group waitlist in our Carlsbad office. For more information, please contact us at 858-354-4077 or at info@csamsandiego.com

Mental Health Awareness Month: Fitness #4Mind4Body

by Annabelle Parr

May is Mental Health Awareness Month. Every year, Mental Health America designates a particular theme for the month to highlight an important aspect of mental health. This year’s theme is Fitness #4Mind4Body, and it focuses on acknowledging the connection between mental and physical wellbeing. #4Mind4Body explores the role of nutrition, exercise, the gut-brain connection, sleep, and stress in our overall wellbeing and examines the ways each of these areas impact our functioning. Below is a summary of the topics covered in the Mental Health Toolkit from Mental Health America.

Diet and Nutrition

Eating a well-balanced, nutritious diet is an integral part of health. Diets high in processed, fried, and sugary foods can increase the risk not only for developing physical health problems like diabetes, heart disease, obesity, and cancer, but are also linked to mental health problems, including increased risk for depression symptoms. A healthy diet consists of a variety of fruits, vegetables, legumes, whole grains, fish, nuts, and olive oil. Maintaining a balanced, nutritious diet is linked with a lower risk for depression and even an improvement in depression symptoms.

Exercise

Regular exercise not only helps control weight, increase strength, and reduce the risk of health problems like high blood pressure, cardiovascular disease, and some cancers, but it also helps boost endorphins and serotonin, among other important proteins and neurotransmitters that impact mental health. Endorphins serve to mitigate pain in the face of stress and increase pleasure in the body. Serotonin affects appetite, sleep, and mood, and is the target of SSRIs, a class of antidepressant commonly used to treat anxiety and depression. Just thirty minutes of exercise per day can help improve mood and mental health.

The Gut-Brain Connection

The gut, also known as the “second brain,” communicates directly with the brain via the vagus nerve and via hormones and neurotransmitters. The communication goes both ways, so anxiety, stress, and depression can impact the gut and result in gastrointestinal symptoms, but changes in the gut microbiome can impact the brain and mood, exacerbating or even resulting in symptoms of anxiety and depression. Eating a nutritious diet that includes prebiotics and probiotics is an important part of maintaining a healthy gut and a healthy mind. 

Sleep

Quality of sleep impacts the immune system, metabolism, appetite, the ability to learn and make new memories, and mood. Good sleep for adults means getting between 7-9 hours of mostly uninterrupted sleep per night. Problems with getting good quality sleep can increase the risk of developing mental health symptoms, and symptoms of anxiety and depression can negatively impact sleep, creating a negative cycle. Cognitive Behavioral Therapy for Insomnia (CBT-I) can help clients reestablish healthy sleep patterns through addressing negative thoughts and worries as well as behavioral patterns that are impacting sleep habits.

Stress

Stress is a normal part of life, and the body is equipped with a fight or flight response designed to help mobilize internal resources to manage stressors. After the stress has passed, the body can return to its regular equilibrium state. However, when stress becomes chronic, it can cause inflammation, impaired immune system functioning, muscle aches, gastrointestinal problems, sexual dysfunction, changes in appetite, and increased risk for heart disease. Too much stress can also impact mental health.

Mental health involves a complex interplay between numerous factors, including but certainly not limited to the areas listed above. Furthermore, though maintaining a healthy diet, regular exercise routine, good sleep habits, and utilizing stress management techniques can help prevent or improve existing mental health symptoms, if you are struggling with mental health issues, it can be difficult to attend to these areas.

If you are struggling with anxiety, stress management, depression, chronic illness, or insomnia, seeking professional assistance can be helpful. Evidence based therapies like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help to address problematic thoughts and behaviors that are contributing to emotional distress. Therapy offers a warm, supportive, safe environment to explore painful issues. A therapist can also provide support in helping the client to develop good self-care habits, like those mentioned above.

This year’s mental health awareness theme reminds us of the importance of recognizing the multiple avenues through which we can approach mental health, and the variety of tools we have at our disposal to improve overall wellbeing.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References

Mental Health America. (2018). 2018 Mental Health Month Toolkit. Retrieved from http://www.mentalhealthamerica.net/sites/default/files/Full_2018_MHM_Toolkit_FINAL.pdf

How Do I Know What Kind of Therapist to Choose?

by Annabelle Parr

Choosing a therapist can be overwhelming. If you search Google or Psychology Today, you will likely find a long list of different therapists including licensed marriage and family therapists, licensed professional clinical counselors, licensed clinical social workers, psychologists, and psychiatrists. How do you know what kind of therapist will be the best for you? And what is the difference between all those different licenses?

Licensed Marriage and Family Therapists (LMFT):

An LMFT holds a Master’s degree in counseling, which typically involves between two and three years of school. LMFTs are trained to view individuals from a family systems perspective, meaning that they learn to see individuals in the context of their relationships. Relationships include family, friends, significant others, and even your relationship to yourself. Despite what their license seems to imply, LMFTs also work with individual clients; they do not exclusively offer marriage and family therapy. Their license speaks to the lens through which they view clients and the various presenting problems they may bring into therapy. LMFT’s must complete at least 3,000 hours of supervised experience before becoming licensed, and this experience must include working with children, families, and/or couples.

An Associate Marriage and Family Therapist has completed their Master’s but is still working on their 3,000 hours of supervised experience.

Licensed Professional Clinical Counselors (LPCC):

An LPCC also holds a Master’s degree in counseling. Many Master’s programs qualify students to sit for both the LMFT and LPCC licensing exams. However, LPCCs tend to work more generally, with a focus on mental health issues as opposed to relational issues, and tend to focus on the individual rather than the individual in the context of their relationships. LPCCs also must complete 3,000 hours of supervised experience prior to licensure, and a portion of their experience must be in either a hospital or community based mental health setting.

An Associate Professional Clinical Counselor has completed the Master’s degree requirements but is still working toward the 3,000 hours of supervised experience.

Licensed Clinical Social Workers (LCSW):

An LCSW holds a Master’s degree in social work. Their training teaches them to help connect clients with resources, both externally (like community resources, support groups, etc.) and internally (like coping skills). An LCSW must complete 3,200 hours of supervised experience in order to get licensed, and they must be supervised specifically by another LCSW for a portion of their hours. They may also provide individual, family, or couples therapy, but the lens through which they have been trained focuses on ensuring clients have access to all the resources they need to thrive.

An Associate Clinical Social Worker has completed the Master’s degree requirements but is still working toward the 3,200 hours of supervised experience.

Psychologists:

A licensed psychologist holds a doctorate degree, either a Ph.D. (doctor of philosophy in psychology, focused on both research and clinical work) or a Psy.D. (doctor of psychology, more clinically focused than research focused), which can take between four and seven years to complete. Licensed psychologists also require 3,000 hours of supervised clinical experience for licensure. Psychologists typically have more training in psychometric assessment and test administration than an LMFT, LPCC, or LCSW. A psychologist with a Ph.D. is prepared to practice clinical work, conduct research, and/or teach, whereas a Psy.D. is typically primarily focused on clinical work.

Registered Psychological Assistant or Postdoctoral Fellow: A registered psych assistant is still working toward the doctoral degree and receiving supervised clinical experience. A postdoc has already completed the doctorate, but is completing the supervised clinical experience hours toward licensure.

Psychiatrists:

A psychiatrist holds a medical degree, and has completed a period of residency, and fellowship. Psychiatrists are medical doctors and are able to prescribe medications. A psychologist, LMFT, LPCC, and LCSW are not able to prescribe medication. Psychiatrists are also able to provide psychotherapy services, but their training is more medically focused.

What’s the takeaway?

Ultimately, there can be a lot of overlap in the services provided by the above practitioners. They are all qualified to assess, diagnose, and treat the full range of mental and emotional disorders found in the Diagnostic and Statistical Manual (DSM). The specific license under which a therapist operates speaks to the lens through which they have been educated, and the duration of education.

However, the provider’s area of expertise and scope of practice tends to depend upon the clinical experience that they have gained. So when looking for a therapist, it can help to understand what their license means, but it is perhaps more important to understand the specific supervised and licensed experience that the therapist has. Do they have experience working with anxiety, panic, trauma/PTSD, depression, identity issues, couple’s therapy, child therapy, family therapy? What modalities are they trained in? Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Psychodynamic Therapy, EMDR, Emotion Focused Therapy, Somatic Therapy? Do their areas of expertise and treatment modalities align with your needs and goals?

Research consistently shows that the therapeutic relationship is the most important factor in whether therapy is successful. So it’s key that the therapist you choose feels like the right fit for you personally. But it can be hard to try to figure out who might be a good match based on credentials and website information alone. A good place to start in narrowing your search is looking at the therapist’s areas of expertise and preferred treatment modalities. Once you have found someone whose specialties line up with your goals, you can reach out to the provider and ask any questions that may not have been addressed on the practice website. (If they won’t take the time to respond to your questions, they might not be the best fit!) If you feel comfortable with the therapist during the initial contact, you can schedule your first session. You will want to meet with the therapist 2-3 times to evaluate how safe and comfortable you feel working with this person. Choosing a therapist is a process, and it can feel overwhelming at first. But once you know how to narrow your search and find a provider that feels like a good fit, it can be incredibly rewarding.

HOW TO SLEEP BETTER WITHOUT SPENDING ANY $$$ ON SLEEP MEDICATION

a guest blog repost by Alisa Palioni

Do you often find yourself lying awake at night, staring at your alarm clock as it ticks away the time? Or, do you wake regularly during the night, leaving you feeling as if you haven’t slept at all?

According to the National Sleep Foundation, nearly half the population reports suffering from at least one symptom of insomnia (difficulty falling asleep, frequent nighttime awakenings, waking up too early, and waking up feeling unrested).

Many of your daily habits likely play a bigger role in your nightly struggles than you think. Both our ability to fall asleep, and the quality of sleep we have are highly dependent on a variety of external and internal stimuli.

Learning about how each activity impacts your sleep patterns can help you make changes and finally get a good night’s rest.

1. Exercise

Why An Exercise Routine Helps Regulate Sleep

Body heat: Part of the natural changes our circadian rhythm brings about over the day are changes in body temperature.

The rise and fall of our body temperature associated with exercise mimics the natural fluctuations which lead up to sleep.

This can be enough to gently nudge your circadian rhythms back into ideal synchronization if exercise is performed at the right time of day. 1

Beneficial stressor: Exercise is a “beneficial stressor” in that it activates sympathetic nervous system (our flight-or-fight response). Your body compensates by increasing the time spent in deep sleep - leaving you feeling more rested. 

Decrease stress, anxiety and depression: Many of us experience difficulty falling asleep due to ruminating thoughts related to real or perceived stress.

Exercise has been scientifically proven to reduce reactivity to stressors, so that we are better able to manage stressful situations when they come our way.

It has likewise proven itself to be effective in reducing the symptoms of anxiety and depression. 2

What Kind Of Exercise Should I Do?

When it comes to improving your quality of sleep, aerobic exercise wins. Numerous studies have documented the efficacy of regular aerobic exercise programs for treating chronic insomnia. 

Aerobic exercises (“with oxygen”) include any that involve sustained activity which requires the body to consume large amounts of oxygen, such as walking, swimming and biking.

Whereas, weight training and sprinting are anaerobic exercises. While an important component of a healthy lifestyle, these activities are not effective for promoting sleep. 3

What Time Of Day Should I Exercise?

While fitting in exercise whenever feasible for your lifestyle can go a long way towards improving your sleep, studies have shown that exercising in the late afternoon or early evening has the greatest impact.

The reason for this relates back to how exercise promotes better sleep: In order to take advantage of the drop in body temperature you’ll want to complete your workout approximately 3-5 hours before bedtime.

How Long Should I Exercise?

While exercising for 15-45 minutes daily is the optimal duration; however studies have shown that 150 mins/week is sufficient to see improvements in quality of sleep up to 60%.

2. Diet

Your diet impacts your sleep through more means than just providing calories: What we eat and when we eat it can enhance or inhibit our sleep.

Foods That Inhibit Sleep

While some foods are well known for their ability to interfere with sleep, other dietary staples are equally responsible for keeping you up at night.

1. Coffee: Caffeine has a half-life of 5 hours: which means that 10 hours after drinking your coffee, 25% left in your system; and 20 hours later 12.5% of the caffeine still remains.10

So, while an early afternoon coffee as a post-lunch pick-me-up may seem like a good idea, it might be what is keeping you up at night.

2. Alcohol: Alcohol is a little more tricky in how it affects sleep; because it causes drowsiness many mistakenly believe that a drink can serve as a sleep-aid.

However, research has shown that while alcohol increases slow-wave sleep during the first half of the night, it actually leads to an increase in sleep disruptions during the second half. 4

3. Chocolate: Chocolate, particularly dark chocolate, can contain high levels of caffeine and thus needs to be treated similarly to coffee and other caffeinated beverages. 

In general try to avoid any kind of sweets in the evening though since it will not only improve your sleep but your overall health as well.

4. Spicy Foods: Capsaicin - the molecule which gives your spicy foods that kick - can causes changes in body temperature that can cause a disturbance in your circadian rhythms if consumed late at night.

5. High-Fat Foods: We all know that certain unhealthy fats negatively impact our health; but there’s also evidence that they may be keeping you up at night.

Animal studies have shown that high-fat diets are associated with more fragmented sleep, along with excessive daytime sleepiness.

Researchers speculate that this may be linked to the neuro-chemical orexin -- which plays an integral role in our sleep-wake cycles. Rats who were fed high-fat diets showed a decrease in orexin-sensitivity. 5

Foods That Promote Sleep

There are many foods that are lauded for their ability to promote a better, more restful sleep. These are the key components you want to be on the lookout for when planning your bedtime snack:

1. Magnesium and potassium: One of the symptoms of magnesium deficiency is insomnia, so you’ll want to load up on healthy sources of this mineral such as leafy greens, beans and lentils, and bananas. 6

Magnesium and potassium promote muscle relaxation, and thus not only help you feel more comfortable but can help deal with nighttime leg cramps.

2. Tryptophan: Tryptophan is an amino-acid found in both animal and plant proteins. Our bodies use tryptophan to create serotonin -- a neurotransmitter involved in both mood regulation and sleep cycles.15

Many foods are great natural sources of tryptophan, such as milk, bananas, peanut butter and walnuts.

3. B Vitamins: B vitamins are essential for both the synthesis and release of certain neurotransmitters and hormones that are part of the sleep-wake cycle: such as serotonin and melatonin.

Supplements are often prescribed to treat restless-leg-syndrome - a nighttime movement disorder which significantly disrupts sleep.

However, there’s no need to take a supplement. You can get your fill from legumes (chick peas), dark green vegetables, whole grains and fish. 7

4. Theanine: Theanine is yet another useful amino acid when it comes to treating sleep disorders. Research has shown that administering a theanine supplement improves sleep quality and increases sleep efficiency, while decreasing nighttime awakenings.

There is one superfood packed with theanine: Green tea. However, while green tea has significantly less caffeine than a cup of joe, it is recommended to opt for the decaffeinated kind if your goal is a good night’s sleep. 8

5. Melatonin: Melatonin is naturally produced by your pineal gland under direction of your circadian rhythms and is what makes us feel sleepy as we near bedtime.

It usually begins to release around 9 p.m. and remains at a high level for the next 12 hours, throughout the night into the next morning.

While there are certain foods that contain melatonin, you can also purchase this essential sleep-inducing hormone in capsules at your local pharmacy or health food store.

Taken at the right time of day, and in the right dosage, melatonin supplements can help reset your biological clock to optimal levels and is often used as a natural treatment for sleep disorders.19

However, you don’t need to take supplements: simply add tart fruits, like cherries and pineapples, to your diet. Oats, walnuts and bananas are likewise great natural sources of melatonin.

Here are some more foods that will help you to sleep better.

via Well+Good

Timing Your Meals

It’s not just what you eat, when you eat also counts.

Research at Yale’s School of Medicine has revealed just how vital the timing of our meals is to maintaining optimal circadian rhythms.

For instance, when we wake in the morning and our central clock is being stimulated by the light of day, but we decide to skip breakfast we have just given our body conflicting information that can in turn disrupt our circadian rhythms. 9

The main takeaway from this study and similar research is that you should not be eating close to your intended bedtime; but the recommendations for how long before bed you should refrain from eating vary: some saying not to eat after 7 pm, while others suggest 5 hours before lights-out and still others indicate a minimum of 12 hours before you eat breakfast. 

It’s also recommended to reserve large meals for the first half of your day, and consuming lighter snacks in the evening.

3. Environment

Mattress & Pillows

When it comes to choosing a mattress and pillows, there’s no universal rule for everyone to follow. Whether you should opt for firm or soft, memory foam or pocket coil all depends on your personal preferences, particularly the position you sleep in.

Back SleepersSleeping on your back is often the sleep position recommended by doctors, since it allows the body to lay relatively straight.

However, that does not mean there is no pressure being put on your spine as you sleep.

You should have a mattress which is both able to support the spine -- and not allow the exaggeration of any curves -- but is also plush enough to not cause painful compression.

• Opt for a medium to firm mattress
• Memory foam is more ideal since conforms to natural curves while maintaining support
• May substitute for a pocket coil with pillow top.

Side Sleepers: Sleeping on your side has its own benefits: It can help reduce acid reflux, reduces the pressure on the lungs, and promotes better blood circulation.

The main complaints of side-sleepers are achiness in the shoulder and hip area. The way to circumvent this is to ensure your mattress adequately cradles these parts.

• Medium to soft mattress
• Memory foam is ideal for reducing number of pressure points

Front Sleepers: Sleeping on your front is by far the worst for your health: Not only does it put pressure on your stomach, but the spine is the least supported in this position.

While it is recommended you switch sleeping positions, there are certain considerations when choosing a mattress that can help alleviate some of the negative side-effects.

Opt for a firmer mattressPocket-coil mattresses are a big no-no, as the entire front side of your body is exposed to the pressure points and they will not support your spine.

Bed Sharing

There’s no doubt that sharing beds can add to your difficulty getting a good night’s sleep.

It’s unlikely that both people with have identical wants and needs when it comes to their sleep position and mattress preferences; and when one partner is uncomfortable their tossing and turning can quickly cause problems for the other.

Upsize to a Queen: A Full-sized bed will leave you and your partner with only 27 inches of space -- which amounts to the size of a baby’s crib.

Opt for memory foam, or ditch your box spring: While memory foam is the optimal choice for reducing the transfer for movements, replacing your box spring with slats can serve as a quick fix.

Invest in a mattress designed for couples: The Sleep Number mattress let’s you and your partner select your ideal level of firmness, comfort and support so you don’t have to compromise.23

Colors

Research has shown that people who sleep in blue rooms tend to sleep longer than when compared to other colors. Blue toned walls can serve as yet another signal telling your brain it’s time to sleep.24

It’s important that your bedroom makes you feel comfortable and relaxed. It’s less important to follow a strict guide than to follow your own intuition.

Light

Light is one of the most powerful cues for your body’s internal clock, it’s thus important to ensure that you are exposing yourself to light and dark during the optimal times.

Try to keep your bedroom as dark as possible while you sleep by using black-out curtains.

However, lighting is not just important when you are sleeping. It’s recommended to dim the lights one hour before heading to bed to cue your brain it’s time for sleep.

For this reason it’s also best not to stare at bright screens (TVs, computers, and smartphones) during this time period, although many phones do offer a “night-mode” setting that can help.

In fact, the blue light -- in the 460-nanometer range -- emitted by electronics and energy-efficient lightbulbs has been shown to delay the release of melatonin.25

Temperature

Generally speaking, the optimal temperature for sleep is between 60-70 degrees Fahrenheit (15.5-19 degrees Celsius).

This, yet again, links back to the natural changes that occur as part of your circadian rhythms: your body temperature drops during the night, and thus maintaining a cooler room will help maintain this.

Setting your thermostat far below or above this ideal point can make it more difficult to fall asleep, lead restlessness and even affect the time you spend in REM sleep.26

The material of your mattress, pillows, bed linens and pajamas can significantly impact your temperature while sleeping. Look for fabrics that are breathable and won’t trap heat such as cotton; likewise choose pillows made of natural materials over synthetic.

As for mattresses, memory foam is the best option when it comes to temperature control.

Noise

Your brain continues to register noises while you sleep, which although unknown to you may be causing you to toss-and-turn or wake briefly.

It’s more likely for a noise to wake you up while in stages 1 and 2 of sleep, than while in 3 and 4. Additionally noise tends to cause more sleep disruptions in the second half of the night.

There’s also evidence that you’re more likely to respond to a sound while sleeping if it is emotionally significant to you: Such as when a mother hears her baby crying.27

If noises outside of your control are keeping you up at night, white noise can be used to “drown” them out. White noise works by reducing the difference between the ambient noise and a sudden, “peak” sound -- like a toilet being flushed -- lowering the chances your sleep will be disturbed.

There are many white noise generators you can purchase, and now there are even phone apps that can do the trick. However, a simple fan or air purifier may be sufficient to help you sleep through the night.

4. Meditation

Fifty percent of people who experience difficulty sleeping blame stress and worry for their troubles.

Meditation, in relieving feelings of stress and anxiety, and - over time - improving our overall response to stressful situations, has been proven to improve both the duration and quality of sleep, with the effect increasing with prolonged practice.

Researchers at the Stanford Medical Center conducted a pilot study to investigate the effectiveness of meditation in treating insomnia. 10

Following a six-week mindfulness meditation training program, 60% of the participants no longer fit the qualifications for the diagnosis - falling asleep twice as quickly as they had previously.

A 12-month follow-up revealed that the majority of the benefits were long lasting.28 Similarly, experienced meditators show enhancement in both REM and non-REM sleep; as well as experiencing fewer awakenings when transitioning between cycles. 11

Meditating at any time of day helps to reduce stress and improve sleep; however, incorporating meditation into your bedtime routine can be especially effective in preparing your body and mind for sleep.

5. Structuring Your Bedtime Routine

Sleep is a behavior: You can teach yourself to sleep well, but you can equally teach yourself to sleep poorly. Our habits surrounding our bedroom routines have a much more significant impact on the quality of our sleep than many of us believe.

Children often have bedtime routines to encourage the onset of sleep, but this is just as important for adults.

Our body needs time to adjust and cool down after a busy day: Just as sleep inertia affects our ability to feel alert after being abruptly roused from a nap we need to allow our body and mind time to transition into a state of relaxation and finally sleep.

When structuring your bedtime routine the main goal is to reinforce your natural circadian rhythms. By developing a scheduled routine of activities at bedtime we can form habits that promote sleep, while avoiding those that impede it.

General Guidelines:

• Follow a scheduled pre-sleep routine
• Avoid stimulating activities and all screens for 30-60 minutes before bedtime
• Reserve your bed for sleep and intimacy
• Get rid of your alarm cloc

Rituals

Maintain a regular sleep/wake schedule (even on weekends): While it may seem like a treat to sleep in way past your usual waking time on the weekends, altering your sleep-wake schedule for just one night is sufficient to cause disruptions in your circadian rhythms that will affect you for days following.

Choose a favorite relaxing activity to wind down: Close off your day with a period of relaxation by incorporating one of your favorite calming activities into your bedtime routine.

Choose what works for you -- while one person may find reading relaxing, if you aren’t a bookworm yourself this will be counterproductive.

Some suggestions include:

• Reading
• Listening to music
• Stretching (yoga)
• Meditating

Prepare your room for sleep:

• Dim the lights
• Lower the temperature

Make your bed: A recent poll conducted by the National Sleep Foundation revealed that making your bed may be more than just a morning nuisance.

Those who reported they made their bed every morning had a 19% higher chance of getting a good night’s sleep than those who skipped this chore.

While the reason behind this is still unknown, researchers speculate that it’s related to feeling good about where you sleep.

Decluttering and maintaining a tidy bedroom can go a long way towards promoting better, more restful sleep.31

6. Tools And Resources

Nowadays there are many helpful tools to help you sleep better available at the click of a mouse -- or the swipe of a finger.

Sleep Cycle

Sleep Cycle Alarm Clock will revolutionize the way you wake up. This innovative app actually tracks your sleep patterns, and uses this information to gently rouse you when you’re in a light stage of sleep -- preventing sleep inertia.

The app achieves this by monitoring your movements throughout the night, as these vary depending on what stage of sleep you’re in.

There are two modes: Either using your phone’s microphone which “hears” your movements, or the accelerometer, which is placed on your mattress to detect your movements throughout the night.

At only $0.99 on iTunes it’s a small price to pay for waking up feeling refreshed.

F.lux

F.lux began as a software which adapts the colors of your computer’s display for different times of the day: Not only optimizing your viewing experience, but reducing your exposure to blue light - which inhibits the release of melatonin, a hormone essential for sleep.

While the app is still under construction, there are plenty of similar ones to choose from on iTunes and Google Play Store, so you can enjoy your devices in the evening without disrupting your sleep.

For iOS you can also use the built-in Nightshift mode to adjust white balance of your screen based on time of day.

White Noise

White Noise by TM Soft allows you to choose from a library of sound loops including beach waves, air conditioner and running water.

The app comes in three versions: Free, Full and Pro; with even the freebie coming with 40 sound loops as well as additional alarm sounds.

Whether you are looking for a way to drown out nighttime noise disturbances, or need a substitute for your favorite fan while traveling, White Noise’s variety will suit any preference.

Headspace

For those interested in experiencing how meditation can transform your sleep, Headspace is a great place to start.

With short guided meditations readily available on both desktop and mobile devices Headspace makes it easy to incorporate meditation into your bedtime routine.

You can try their Take 10 program for free, or choose from a variety of subscription options to get started today.

GoodnighT

While lying awake at night staring at your alarm clock waiting for sleep to come may make you feel powerless, there are a lot of concrete actions you can take to conquer your sleeping problems once and for all.

It’s not necessary to undergo a total life overhaul in order to enhance the quality of your sleep. Start by experimenting with the tips that are most appealing to you and see how they impact your sleep.

Keeping a journal can help you track what works and what doesn’t. Once you’ve felt the effects of a good night’s sleep you’ll wonder how you ever got by without it.

Originally posted on NestMaven.com.

10 Tips to Stop Sleep Anxiety: More Rest, Less Stress (Part 2 of 3)

by Lucas Myers

With people juggling work, school, friends, families, and the 1,001 other things we've got to do everyday, Americans are not getting enough sleep. This week we continue our 3 part series 10 Tips to Stop Sleep Anxiety: More Rest, Less Stress.

4. Practice good habits

Having the same bedtime ritual night after night teaches your body when to expect sleep and eases the transition into a drowsy, bed-ready state. Bright lights, especially those from TV's computers and other electronics promote alertness, so try to avoid them before bedtime. Instead, try reading a book, taking a soothing bath or shower, listening to relaxing music and dimming the lights as you get ready for bed.

5. Eliminate distractions

The bedroom should be your sanctuary for sleep, so avoid watching TV in bed, bringing the laptop to bed, or engaging in any other activities. You want your mind to associate this setting with relaxation and rest rather than stimulating daytime activities. Consider setting limits on children or pets sleeping in your bed with you.

6. Get comfortable

Find bedding that feels comfortable to you. If you share your bed, make sure it is large enough for both of you to sleep comfortably. Most mattresses last 9-10 years; make sure to replace them when they exceed their life expectancy because a good mattress should be comfortable and supportive. Your pillow should support your head without straining your neck. Make sure your bedding is allergen free.

7. Set the mood

Dark curtains can help prevent light from inadvertently resetting your internal clock. Even the tiny light from an alarm clock can be disruptive so seek ways of limiting light pollution. Even small noises can interrupt sleep. Earplugs are helpful for some. A fan, or a free white noise app on your phone can help cover the sounds of noisy neighbors, car alarms, traffic and other disruptive nighttime noises. To keep your bedroom from becoming too hot or dry for comfort consider a fan, air conditioner, or humidifier.

REMEMBER: Having an occasional sleepless night is normal, but if you are experiencing a pattern of restless or sleepless nights, don't hesitate to seek an expert, especially if lack of sleep is beginning to interfere with your normal daytime functioning. Contact your doctor to determine whether physical causes may be contributing to sleep problems. If your physical health is sound, contact a psychologist with experience treating sleep problems. Cognitive behavioral therapy and other evidence-based treatments are highly effective for improving sleep. If you are in the San Diego area and you would like to speak with one of our other qualified therapists, you may contact the Center for Stress and Anxiety Management at 858-354-4077 or csamsandiego@gmail.com.

Want more tips? Subscribe to the CSAM RSS feed, and follow us on Facebook or Twitter (@CSAMSanDiego) so you don't miss Parts 2 and 3 of our 10 Tips to Improve Your Sleep and articles on other hot topics such as stress, anxiety, depression, OCD, PTSD, and more. 

References

Dement, William C; Vaughan, Christopher (1999). The promise of sleep: a pioneer in sleep medicine explores the vital connection between health, happiness, and a good night's sleep. New York: Delacorte Press. ISBN 0-385-32008-6.

Dement, WC (2005). "Sleep extension: getting as much extra sleep as possible". Clinics in Sports Medicine 24 (2): 251–268, viii. doi:10.1016/j.csm.2004.12.014. PMID 15892922.

Kryger, Meir H; Roth, Thomas; Dement, William C (2011). Principles and practice of sleep medicine (5th ed.). Philadelphia, PA: Saunders/Elsevier. ISBN 978-1-4160-6645-3.

Sleep Tips: Seven steps for better sleep. Mayo Clinic Staff. Retreived on November 25th, 2013 from: http://www.mayoclinic.com/health/sleep/HQ01387

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