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1 CRUfADclinic Patient Resource CRUfADclinic.org - Resource Additional Resource Good Sleep Guide

2 2 Improving your Sleep Many people with anxiety and depression suffer from difficulties with their sleep. Problems with sleep can also exacerbate difficulties with depression and anxiety. This resource is designed to explain a little bit about improving sleep and hopefully give you some tips on how to overcome some common sleeping difficulties. A bit about sleep All humans have a biological clock within them which enables them to regulate things such as body temperature and activity. This is referred to as circadian rhythm. Body temperature reaches its highest and lowest points once every 24 hours. Feelings of sleepiness and alertness tend to parallel rises and falls in body temperature, so that people typically feel the most alert in the early afternoon when their body temperature is highest, and begin to feel sleepy when their body temperature falls. The circadian rhythm influences our readiness to fall asleep at any time by controlling these variations in body temperature. Everyone differs in the amount of sleep they need. Sleep research indicates that people differ a lot in the amount of sleep they need and require less sleep as they get older. Is my lack of sleep harmful? There is no evidence from studies about sleep deprivation (keeping people awake between 70 and 205 hours and monitoring their physical and mental performance) that it causes short or long term damage to the body or the mind. The main finding is that people who have been sleep deprived experience extreme sleepiness, difficulty maintaining concentration and lack motivation. This contradicts the commonly held belief that lack of sleep causes madness and/or physical illness. We know that preventing people from sleeping becomes increasingly difficult as the duration of time without sleep increases. Sleep deprived people require constant stimulation if wakefulness is to be maintained. Thus, nature has provided us with an inbuilt mechanism which ensures that if we really need to sleep we will. Sleepiness may cause you to feel listless and irritable, but you cannot die from lack of sleep and it will not cause long term mental or physical damage. If your body really needs sleep you can be sure that almost nothing will be able to stop it. Good Sleep Guide Depression and Anxiety Program Resource CRUfADclinic.org page 2 of 5

3 3 When is Sleeplessness a Problem? For many people sleeplessness is an unpleasant and stressful experience. This is largely due to the fact that a lot of the time awake during the night is spent worrying and consequently these people are tired during the day, not only because they slept relatively little, but also because the worrying has exhausted them. You are the best person to judge whether you need to do something about your sleep. When you cannot sleep, lying in bed worrying only makes things worse. A more effective way of dealing with insomnia is to get up and do something which is distracting yet relaxing. This way even if you are not asleep you are resting and are less likely to feel tired the next day than if you spent the night tossing and turning in bed. Improving your sleep Insomnia is defined as a chronic inability to sleep, however, most people complaining of insomnia do sleep, but feel that the sleep they get is not enough, or it is subject to too many disruptions so they do not feel refreshed in the morning. Frequently it is not so much the lack of sleep which drives a person to seek help with insomnia, but more how the person feels about and copes with their sleeplessness. Common Causes of Sleep Disturbance Anxiety Many people find it difficult to wind down as they climb into bed at night after a hectic day. They can then find themselves lying in bed worrying over uncertainties and dwelling on problems when they would rather be sleeping. Feelings of tension and arousal often accompany these thoughts and in turn make it even more difficult to fall asleep so they worry about their sleeplessness and toss and turn well into the night. If you think that your sleeplessness is caused by anxiety about things which are happening in your life there are several things you can do to improve your sleep: a) Set aside a time for problem solving during the day: Set aside some time when you are alone where you can think of ways to resolve your problems. This may require you to make decisions. This may be difficult, but postponing stressful decisions or avoiding facing anxious thoughts only prolongs the experience of anxiety. In most cases the uncertainty which accompanies indecision is much more stressful and unpleasant than living with the consequences of a decision once it is made. When you get into bed, if you experience the same thoughts, remind yourself that you have already thought about them for today and postpone worrying until tomorrow. b) Get out of Bed: If you are lying in bed unable to stop thinking about things, get up and do something which is distracting, yet relaxing (reading a book, listening to classical music). Do not return to bed until you feel sleeping again. If you return to bed and feel the same way, get out of bed again and do something distracting, yet relaxing, again. You may need to do this a number of times initially before you can get into bed and fall asleep. The whole idea is that you learn to associate bed with sleep and not with distressing wakefulness. Good Sleep Guide Depression and Anxiety Program Resource CRUfADclinic.org page 3 of 5

4 4 c) Don t Nap: If you have had a bad night s sleep you are more likely to feel sleepy the next day, which can make it tempting to want to take a nap in the middle of the day or early afternoon. Unfortunately, this makes it much more likely you will have another night of poor sleep, this is because you will not be as tired that evening when it comes time for bed. You will probably take longer to fall asleep and awaken more frequently during the night. Consequently you will feel sleepy the next day and be tempted to have another nap. Thus this can become a vicious cycle. So, no matter how tired you are during the day, avoid daytime naps. d) Keep a routine: Keep regular sleep times by going to bed at the same time every night and waking at the same time very morning. This can help to get your body into a rhythm which makes it much easier for your body to get used to the times when it is meant to be asleep. Caffeine Caffeine is contained in coffee, tea, cocoa, cola drinks, energy drinks (such as red bull) and some over the counter prescriptions. Consumption of any of these products before bed time will increase feelings of energy and wakefulness and make it more difficult to fall asleep. Nicotine Nicotine stimulates the nervous system by initiating the release of a hormone called adrenaline. Adrenaline arouses the body and mind and makes you alert and ready for action. This is important as smoking prior to bed causes an increase in energy and liveliness at the time when someone might want to go to sleep. If you smoke you should abstain for at least an hour before going to bed so the stimulating effects of nicotine can wear off. Alcohol Alcohol may cause you to fall asleep quickly, but it causes you to get much poorer sleep overall and to spend less time in the deeper stages of sleep. If you drink regularly you may find that you come to depend on the alcohol to reduce your anxiety and help you get to sleep. This will make you feel unrefreshed upon awakening in the morning but you are likely to have rebound anxiety which will last throughout the day and make it even more difficult to get to sleep at night. Limit alcohol consumption to within the guidelines which are a maximum of 2 standard drinks daily for women and 4 for men, and have at least 2 alcohol free days a week. Do not use alcohol to help you sleep. Being uncomfortable Aches and pains or being cold can inhibit relaxation. It is important to ensure that all your immediate needs have been met before you try to sleep. If you are hungry have a light snack or warm milk drink before you go to bed. If you are in pain take a mild pain reliever. Getting to sleep is easier when you are comfortable. Noise Periodic loud noises such as traffic noises disturb sleep. Even if you do not awaken, they can interfere with the normal pattern by which you experience the different sleep stages during the night. If you sleep in an environment which tends to be noisy, try to attenuate sound by closing windows and doors, Good Sleep Guide Depression and Anxiety Program Resource CRUfADclinic.org page 4 of 5

5 5 wearing earplugs or sound-proofing. Some people also find it useful to turn off appliances which make white noise during the night (the noise that TV s and other appliances can emit even when they are on). Sleeping Pills Using sleeping pills can facilitate sleep onset and decrease anxiety in the short term. In the long term these benefits disappear if you continue to use them regularly. You will begin to feel anxious and sleepless even though you are taking the pills. This can make you tempted to take more, but these benefits will not be permanent either; you will again start to experience the symptoms of anxiety and sleeplessness. Sleeping tablets can be useful in the short term, but the development of tolerance means that they do not provide a long term solution to chronic sleeping problems. Sleeping tablets can be very difficult to give up because of the rebound effects. If you are currently taking sleeping pills every night to help you sleep it is advisable that you speak to your doctor about gradually reducing your use. Summary: Tips for Improving sleep Here is a list of tips and things to try in order to improve your sleep. It includes a summary of those outlined above as well as a few additional tips. Make sure all your immediate needs are met before you get into bed and try to sleep (make sure you are not hungry or cold). Go to bed at the same time every night and get up at the same time every morning. Do not sleep late in the mornings trying to make up for lost sleep. Do not take naps during the day. Set aside time for problem solving during the day. Do not lie in bed awake or worrying for long periods of time. If you cannot sleep get out of bed and do something distracting but not too stimulating such as listening to classical music or reading a book. Return to bed only when you are sleepy again. Do not use alcohol to help you sleep. Avoid caffeine in the evenings, and preferably in the afternoons. Do not smoke for at least an hour before going to bed. Sleeping pills do not provide a long-term solution to chronic sleeping problems. Speak to your GP about coming off these. Try to reduce noise levels by closing windows and doors. Regular exercise during the day or early in the evening can improve sleeping patterns. If you do exercise regularly do not exercise late in the evening as this may make it more difficult for you to get to sleep. Develop a short and relaxing routine that you do every night before going to bed (including things such as washing your face and cleaning your teeth); such routines help to wind you down and get you in the mood for sleep. Sleep well! The CRUfADClinic Team Good Sleep Guide Depression and Anxiety Program Resource CRUfADclinic.org page 5 of 5

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