Better in their words…

WSJ 8/9/2021  by Elizabeth Bernstein

How are you sleeping?

After one year of a pandemic—and a lot of disturbed slumber—it’s clear that our usual sleep strategies aren’t working. Scientists say many of the things we do to chase sleep are actually hurting us, and recommend a counterintuitive approach instead: Stay in bed for less time, not more.

“Our brains have to feel like the world is safe and secure to be able to fall asleep,” says Wendy Troxel, a clinical psychologist, certified behavioral sleep medicine specialist and senior behavioral and social scientist at Rand Corp. “Sleep is a vulnerable state.”

We all know we’re supposed to have good sleep hygiene—keep a consistent schedule; use the bed for sleep and sex only; avoid alcohol, caffeine and bright lights before bed and practice other healthy sleep habits. This is important. But the American Academy of Sleep Medicine recently declared it’s not enough to solve chronic insomnia. In an article published online in February in the Journal of Clinical Sleep Medicine, it recommended a series of treatments collectively known as cognitive behavioral therapy for insomnia, or CBT-I.

Unlike run-of-the-mill sleeping problems, insomnia is a clinical disorder. We have insomnia when we have difficulty falling or staying in sleep three or more times a week, and this lasts a month or longer, leading to daytime consequences, such as fatigue, mood changes or difficulty concentrating. Sleep experts believe insomnia is triggered in part by the fear and anxiety we have about not sleeping.

The brains of people with insomnia act differently than the brains of people who are sleeping well, according to Daniel J. Buysse, a professor of psychiatry and sleep medicine specialist at the University of Pittsburgh School of Medicine. Dr. Buysse has conducted PET scans of people who sleep normally and people with insomnia. In people with insomnia, parts of the brain involved with self-reflection and monitoring the environment show higher levels of activity during sleep compared with normal sleepers.

Ironically, insomnia is also driven by the things we do to try to solve it, experts say. We start to chase sleep—waking up later, taking naps, going to bed too early. This diminishes our sleep drive, which is our body’s need for sleep. It makes it harder to sleep when we’re supposed to. And it creates a vicious cycle: More time in bed means more opportunity for frustration and failure. Before long, we’ve taught our brain to associate our bed with the negative emotions we feel lying there.

“It’s Pavlovian,” says Philip Cheng, a clinical psychologist and sleep researcher at the Henry Ford Sleep Disorders and Research Center. “If you spend a lot of time in bed worried and frustrated and miserable, in time your brain learns that your bed is a place to do all of these things but sleep.”

CBT-I focuses on breaking this loop by helping us change the thoughts and behaviors that are counterproductive. Research shows it may have lasting effects—not just fixing our sleep problems in the present but helping us form a sort of sleep resilience. A study conducted by Dr. Cheng and colleagues and published online in November in the journal Sleep found that people who received CBT-I years ago have been sleeping better and have better mental health during the pandemic than those who did not.

The treatment is typically six to eight sessions with a therapist, but there is an abbreviated version, as well as online programs to try at home. The primary component is “sleep restriction,” also called sleep retraining, which is limiting the amount of time we spend in bed awake. To track this, we calculate our “sleep efficiency number,” which is the percentage of time we’re in bed that we’re asleep. The goal is at least 85%.

To help boost our sleep efficiency, we should avoid going to bed unless we’re sleepy. (I’ve learned the hard way that being bone-weary exhausted is not the same thing as sleepy.) And we shouldn’t stay in bed unless we’re asleep. If we’re having trouble falling asleep, we should go to another room, keep the lights low and do something pleasant but not too absorbing. Read a book. (No screens!) Do a crossword. Listen to some soothing music.

We need to wake up at the same time every day. (Yes, weekends too.) This helps regulate our circadian rhythm and keeps us from sleeping late, which would harm our ability to sleep the following night. To figure out when to go to bed, calculate the amount of time you are actually asleep during the night. Then subtract that from the time you need to wake up. That’s your bedtime, for now. (Don’t give yourself less than 6 hours in bed.) As your sleep gets back on track, start lengthening your time in bed slowly, by 15 minute intervals, to try to increase your sleep duration.

Finally, we need to challenge our thinking about our sleep. When we tell ourselves we “can’t sleep” or “won’t be able to function” the next day, we’re causing ourselves a lot of anxiety, which further interferes with our sleep.

https://www.wsj.com/articles/cant-sleep-here-are-some-surprising-strategies-that-actually-work-11616515200?st=bgt54tadokjsa59&mod=ff_0421