If You Do Wake Up At Night
When you wake up in the middle of the night and can’t get back to sleep, it’s tempting to reach for a sleeping pill or start worrying about your aches and pains. A better idea is to do some of the breathing exercises designed to quiet the mind: listening to the sound of your breath and feeling your belly move up and down as your diaphragm expands and contracts. Inhale slowly and deeply; then exhale slowly. You can also try holding your inhalation for a count of four or five.
Like everyone else, I’m sometimes too wound up to get a full night’s sleep. When I find myself staring at the ceiling in the middle of the night, a special gratitude exercise seems to help me nod off in no time. I think about all the things I’m grateful for, like my family, friends, patients, or something special that happened to me that day. Then a sense of calm rapidly washes over me, and I can usually ease back to sleep in a matter of moments.
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If you’re not able to get back to sleep within 30 minutes or so, it’s best to get out of bed.
Otherwise you’ll get frustrated and start to associate your bed and the middle of the night with trouble. So get up and go to another room, where you can read, fold laundry, or engage in some other relaxing or mindless activity. You might also meditate or do some relaxing yoga poses—but nothing strenuous. What you do isn’t as important as what you think, so keep reminding yourself that it’s perfectly natural to have trouble sleeping, especially when you’re in pain. One bad night isn’t the end of the world. You can redouble your efforts to get sunlight and exercise tomorrow. And if you continue to practice good sleep hygiene, you’ll have an easier time of it tomorrow night.
If the sleep hygiene habits I described above don’t help you enjoy the restful sleep you need, your next step should be to explore CBT, which stands for cognitive-behavioral therapy. An action-oriented form of therapy (as opposed to “talking therapy”), CBT zeroes in on the thoughts and behaviors that cause a problem. Once these thoughts/behaviors are identified, the patient and therapist work together to reduce or eliminate them
The use of CBT to treat insomnia has been studied extensively, and there is now more scientific support for CBT as a tool for better sleep than any other modality. In one study,7 published in the Journal of the American Medical Association, CBT, whether used alone or with medicines, reduced the amount of time it takes to fall asleep, as well as the amount of “awake time” during the night. It also improved sleep efficiency, the ratio of time spent asleep to total time spent in bed. The study found that long-term results are best when sleep medications are discontinued. In a separate paper on sleep,8 which reviewed the results of five different studies, CBT was found to be more effective than sleeping pills and was recommended as a first-line treatment for insomnia.
When you enter into CBT therapy, you work with your therapist to develop good habits and handle other problems that may be interfering with your sleep. Sleep inhibitors that you may explore with your therapist can include family, job- or school-related stress, counterproductive habits like texting in bed, as well as food and medication use. You’ll work on relaxation techniques that will quiet mind and body as you prepare for sleep, and even learn how to remain passively awake. This may sound a bit strange, but deliberately not trying to fall asleep can encourage sleep, for you’re no longer trying to force something to happen and then worrying when it doesn’t.
Unlike sleeping pills, CBT is designed to discover the reasons for your insomnia, then remove the obstacles to a good night’s sleep.
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