Many will be familiar with the problem of “overthinking and undersleeping”, which Cheryl Cole has revealed led her to try sleeping tablets. Nighttime waking is a normal occurrence. Contrary to what people think, sleep is not a single entity; we all have multiple awakenings each night – known as micro-arousals – and they are part of the normal circadian sleep pattern, where we go into lighter and deeper periods of sleep.
The problem tends to arise when one of these naturally brief arousals opens out into more of a chasm and instead of simply turning over and being awake momentarily, there’s a cognitive realisation you’re awake, which can lead to this “racing mind” phenomenon.
Just like a child wakes up at night and can either turn back to sleep or wonder where their mum or dad is and wake up properly, we can get into the habit of waking when things are on our mind. Our mind then goes into overdrive, and inevitably, the harder we try to go back to sleep the more elusive it becomes. Before you know it, the habit of waking at 3am every morning is established, and reinforced by concern about sleep itself.
Studies show that this common sleep problem is more prevalent in women and can be made worse by hormonal changes such as menopause, pregnancy or during certain times of the menstrual cycle. It is particularly common around the age of 50, just a year before the average age of the menopause when melatonin – the hormone that governs the sleep/wake cycle which releases before sleep and expresses itself during the night – significantly reduces.
Whether or not hormonal factors contribute, weeks or months of insomnia will leave you struggling, like Cole, throughout the day. We need our sleep to function physically, but one of its primary purposes is to help us manage our emotions. People with chronic insomnia are twice as likely to have a depressive illness than good sleepers.
The good news is that cognitive behavioural therapy (CBT) can fix all these issues, at whatever age or stage of life. NICE guidelines recommend that CBT is the first line of treatment, instead of sleeping pills. CBT can be hard work but it does result in habit change. Here are some ideas used during a course of CBT that can help:
Reframe sleep positively
If a good sleeper wakes at 3am, they might look at the clock and think: “It’s only 3am, great. I’ve got another four hours sleep to go.” A person suffering with insomnia, however, will look at the clock in horror at 3am and think: “Oh no, here we go again.”
The challenge is to change your mindset into that of the good sleeper; to think about sleep and wakefulness in an entirely different and positive way.
Try to stay awake to fall asleep
During CBT for insomnia, we teach people that trying to remain awake is the key to falling sleep. If you wake up at night and don’t immediately fall back to sleep, just lie quietly with your eyes open and keep them open for as long as you can. You might feel sleepy and want to close them but resist. In your gentle attempt to stay awake, you could easily fall asleep.
The quarter of an hour rule
If this doesn’t work and you’re not asleep within a quarter of an hour, then get up and do something you enjoy – read a book, watch TV, even go on your phone – and go back to bed when you feel sleepy. You might do this scenario three or four times a night, but eventually you’ll break the habit and be able to turn over and just go back to sleep.
Manage your racing mind
Set aside time to do what you need to and put the day to rest before going to bed. While it’s fine to get up and watch TV or read a book at night when you’re struggling to sleep, I wouldn’t encourage looking at your work as this should be something you have addressed in the day. Also don’t worry too much about stress because as humans we’re designed to manage stress. Know that your sleeping brain is actually better at managing this stress than being awake; sleep allows your brain to reset overnight so you can start again the next day.
Personalise your sleep
When should you go to bed? How long should you be sleeping for? Finding a sleep size that fits is trial and error. If you’re suffering from insomnia, it’s clear what you’re doing now isn’t working. Tracking your sleep over a week or a fortnight should help you figure out the optimum sleep requirements for you. Jotting down some notes is just as good as using a device.
Protect your sleep
Exposing yourself to bright outdoor light tells your body clock the day has begun. Even going out on a dull winter’s day is better than staying indoors as the exposure will help to trigger your circadian alerting system that keeps you awake during the day. In the same way, dim the lights as it gets closer to bedtime to alert your body clock that it’s time for sleep.
Regular timing of meals and a balanced, healthy diet also work together with a balanced sleep/wake schedule. Don’t eat meals that are heavy and difficult to digest just before bed or drink alcohol as this destroys the normal sleep architecture.
If you’ve had a bad night and are feeling sleepy in the day, take a safety nap of 10 minutes or less. Make sure you know the difference between sleepiness (nodding off, yawning, eyes closing) which may require a safety nap and fatigue (exhaustion, weariness, low energy) when you need to activate yourself to re-energise and overcome it.
And finally... Trust in your sleep
Sleep is an involuntary behaviour and therefore any attempt to control it won’t work. You have to think of sleep like breathing – you’ve been doing it since you were born. Implicitly, what good sleepers are doing are not thinking about or dwelling on sleep – they’re just doing it. If they have a bad night, they shrug it off, expecting to sleep well the next night. The key is to allow sleep to become dominant again, not your thoughts.
As told to Lauren Libbert
Colin Espie is professor of sleep medicine in the Nuffield Department of Clinical Neurosciences, co-founder of Big Health, which offers digital therapeutic solutions, and author of Overcoming Insomnia