Hurrying Sleep: What Zen Tells Us
October 16, 2022
I've had the book, "Zen and the Art of Motorcycle Maintenance: An Inquiry into Values" by Robert M. Pirsig (1974) on my bookshelf for a long time. I finally have gotten started and am enjoying it. It's a book that you can read a little at a time, and it's definitely not a read to hurry through. He has a great quote:
“When you want to hurry something, that means you no longer care about it and want to get on to other things.”
I think this applies to the sleep process in a lot of ways.
CBT-I (cognitive-behavioral therapy for insomnia) is a stand-out therapy in terms of how quickly change can be made, as it typically runs for 6-8 sessions. This is quite atypical for just about any other psychotherapy treatment for any problem; the only other treatment that is shorter that I can think of off of the top of my head is for simple phobias, like a snake phobia (did you know snake phobia was part of my research as a grad student?).
The quick nature of turning around sleep patterns does not mean that we are hurrying sleep. What is your relationship to sleep?
I've been talking a lot about sleepiness in these emails, and I'm going to squeeze it in again today because it's important and relevant to the idea of not hurrying: you cannot hurry the process of becoming sleepy; while sleep medications have their place, they also give us the impression that we should be able to "turn on" sleepiness at will. Our bodies just don't naturally work that way.
If you struggle to fall asleep or return to sleep, it's important to allow your body to experience non-medication-induced sleepiness.
Listen for the sleepiness and pay attention to when that process actually happens. Then, consider if the time that you are shutting off your lights and trying to fall sleep is timed to that naturally-occurring sleepiness.
If your natural sleepiness and bedtime aren't timed together, then you have a big, easy opportunity to make change -- turn out your lights at the time your body is naturally sleepy and NOT before then, even if that time is much later than you wish to sleep. The second, separate step, is to move your bedtime earlier gradually...but ONLY AFTER you have established your body's sleepy time and fallen asleep at that time regularly. The second step is less of an insomnia issue and more of a circadian rhythm timing issue (often related to social jet lag).
If you are saying to yourself, "But if I wait for sleepiness, it will never come!" Well, then it is likely that what you are dealing with is a clinical level of insomnia. Insomnia comes in many forms, and difficulty with feeling sleepiness when in bed is one of the common signs. It's one of the main symptoms that CBT-I and associated techniques target, so that you can fall asleep, stay asleep and return to sleep using your body's natural processes.
If you are considering taking the online program in January 2023, please respond to this quick poll about preferred times. I'm considering options for our next cohort.
Happy Sleeping,
Alissa Yamasaki, Ph.D.
Dozing Before Bed
September 19, 2022
The topic of dozing has come up a few times this week in conversations with people working on sleep improvement, so I thought that this might be a topic worth covering here. I am wondering if this sounds familiar to any of you who struggle with sleep:
"I could barely keep my eyes open last night. I was sitting on the couch and watching t.v., and I think that I even fell asleep for a moment...I'm not sure how long it was. But, by the time that I got into bed, I was suddenly awake and it took me a while to finally go to sleep. It's so frustrating."
I can attest to this happening. I do it myself more often than I would like, and it's not a good habit because it sets up problems with sleep for the night. I'll write more next week on what I do in this situation if I happen to doze before bed.
At any rate, even if you just very briefly close your eyes in that scenario of sitting on the couch at night, the chances are, if we had an electroencephalogram (EEG) on your head to measure the actual brain waves, then in those brief moments prior to and while your eyes are actually closed, the EEG would show that you are getting actual sleep.
Sometimes, especially for people who have trouble sleeping, those brief dozes are enough to give you a "second wind" of energy for the evening and/or inhibit your ability to fall asleep quickly when you get in bed.
Interestingly, there is a sleep condition in which people have difficulty differentiating between being awake and asleep (paradoxical insomnia); many people who struggle with sleep probably are familiar with a little bit of this phenomenon, being unsure of when they are awake or sleep, finding sleep to be restless or fitful.
If you have trouble sleeping, I recommend minimizing allowing oneself to be in the state in which you are unsure if you are awake or asleep. In my last entry, I previously recommended always differentiating between being sleepy and being fatigued, and the importance of being intentionally awake (either relaxed or not) vs. intentionally asleep is equally important.
Being relaxed, with eyes closed, is not a replacement for good sleep. Many people who struggle with sleep do a lot of being relaxed, with eyes closed; this is not an appropriate strategy for dealing with lack of sleep; it serves to exacerbate the problem because little dozes can interfere with the ability to fall asleep and with the ability to have high quality of sleep at night.
If you're looking for a small behavior change to improve your odds for good sleep, then you want to catch those little dozes and get rid of them. Save up the pressure to sleep, also known as "sleep drive," for when you put your head on your pillow at bedtime. That will set you up for a better quality of sleep at night.
Happy Sleeping,
Alissa S. Yamasaki
Licensed Psychologist
Sleepiness vs. Fatigue
September 7, 2022
A few weeks ago, I had the pleasure of working with Centre Volunteers in Medicine to discuss sleep with their behavioral health team. We discussed various interventions to help people who struggle with sleep, and one topic that came up is differentiating sleepiness vs. fatigue.
Have you ever wondered why you can feel EXHAUSTED but not fall asleep?
It's typical for people who have chronic sleep problems to experience a paradox of having extreme fatigue, but when given an opportunity to nap or sleep, they find that they cannot.
With chronic sleep problems, the body is on a type of overdrive which interferes with natural sleepiness.
How does one find sleepiness, and why is it so important?
Sleepiness is found when we have been awake for a sufficient amount of time. This amount of time varies by individual and circumstances. The higher a person's anxiety, the bigger the variations in when one wakes up in the morning, the longer you stayed awake in the morning lying in bed...all of those are factors (among others) dictate when sleepiness will arrive.
If you attempt to sleep before the "sufficient" amount of time has passed for your body's sleepiness kicks in and don't understand when to attempt to sleep (e.g., attempting too early in the night or staying in bed in the morning), then you will not find enough sleepiness to sleep well on a predictable basis.
Bottom line on this topic today? Start to differentiate between sleepiness and fatigue. Good sleep becomes predictable when there is sleepiness and not when there is only fatigue.
You can educate yourself and refine your sleep approach.
If you missed it in my last email, you can take a look at stats and how we use them to discern appropriate decisions to improve sleep when taking a formal, structured approach. You can also download a copy of a checklist of common reasons for fatigue if you are concerned that there might be reasons besides sleep that are driving your fatigue.
Happy Sleeping,
Alissa S. Yamasaki, Ph.D.
Licensed Psychologist
More CBT-I Stats
August 25, 2022
You may have heard me say that there is no "one size fits all" answer to a person's sleep problems and that finding good sleep is like finding a good shoe.
You want to try on the shoe and test things out, rather just wear the shoe size that your friend wears.
With that said, we use data to inform our sleep decisions and to examine if the "fit" is a good one. I thought you might want to see an example of one of the nuances we sometimes face when we making decisions about sleep change.
The goal of sleep work is to 1) reset the body's sleep pattern, and then 2) progressively modify the sleep schedule to ultimately land on a personalized sleep formula that creates a feeling of confidence in the body's ability to sleep and a feeling of restedness.
In the process of narrowing down the formula for ourselves, we need to make the smart decisions.
Here's a typical example of how similar scenarios actually require different decisions. It's a topic we were discussing at the last Sleep Q&A with the current cohort, and this type of decision-making also comes up frequently in one-on-one CBT-I sessions.
Person #1: Doing sleep improvement because they don't feel rested
Sleep efficiency: 85% (amount of time spent in bed compared to amount of time spent sleeping; the higher the efficiency, the better, with above 85% being associated with decent sleep and "good" sleepers often at 90%)
Total time spent asleep: 7.0 hrs on average
Average number of nighttime awakenings: A lot. Sometimes too many to count.
Restedness: Low
A smart decision entails: Decrease the time spent in bed by 15 minutes. This will help reduce the number of awakenings, ultimately leading to feeling more rested even if the total number of hours of sleep is not yet long enough to be fully satisfying. Practice accepting that restedness will be low temporarily at this stage, but the priority is to minimize awakenings so that the body is better trained to sleep solidly and restfully before introducing longer times in bed. Do NOT increase time spent in bed for sleep yet.
Person #2: Doing sleep improvement because they don't feel rested
Sleep efficiency: 85% (amount of time spent in bed compared to amount of time spent sleeping)
Total time spent asleep 7.0 hrs on average
Average number of nighttime awakenings: 1 brief awakening to go to the bathroom and able to fall back asleep quickly
Restedness: Low
A smart decision entails: Increase time spent in bed by 15 minutes to increase the level of restedness. The body seems to be trained well enough to sleep solidly without interruption. If sleep efficiency continues to stay high after a couple of weeks, then again increase the time spent in bed by 15 minutes. The main task now is to slowly increase the opportunity given to the body to sleep in bed, while identifying the length of time spent in bed at which sleep efficiency starts to decrease (it will inevitably decrease at a point that is fit to your body's needs, and for some people it's closer to 6 hours or even lower, and for some people it's closer to 9 hours, and for many of us, it is in-between those two points).
~
Notice how the sleep complaint (not rested) and sleep stats were very similar, but the awakenings were different. This led to different sleep decisions.
We resisted the desire to just stay in bed in hopes of sleep getting better on its own (for Person #1), and we certainly did NOT use a one-size-fits-all approach or recommend trying to sleep for random lengths of time!
While it's too much information to go into detailed explanations here for why Person #1 must prioritize addressing awakenings,
I think this gives you an idea of why you want to have proper knowledge and some details when making sleep decisions.
Happy Sleeping,
Alissa S. Yamasaki
Thoughts On Sleep Restriction
August 10, 2022
We all know that making changes can be difficult at times whether it is a small mindless habit or a decades-long habit.
You may have heard that CBT-I (the basis of many of our approaches) can be rough. I also warn people in the self-help courses that sleep change requires "grit," implying that you have to be ready to persevere through difficult times.
One of the mindset barriers that people face is believing that they must get a certain number of hours to sleep in order to function. While it is true that our bodies function best at a certain amount of sleep...this amount can vary greatly between individuals (despite that you may have heard otherwise).
Therefore, setting your sights on a particular amount of sleep without really knowing how much your body needs is a mistake. I cannot tell you how many people, including myself before I knew better, believe that their body needs more sleep than it does. You cannot know how much your body needs if you are making estimates on poor quality sleep or irregular sleep patterns.
One way to start is to hone in on the true amount of sleep you need is through the use of a technique, which carries an unfortunate name that I believe unnecessarily incites anxiousness, called "sleep restriction."
"Sleep restriction" is the technical term for purposefully setting your sleep schedule to be shorter than usual (we choose a time that is fit to your body's ability to sleep, so it's not a standardized number).
Anxious minds will hyperfocus upon the word "restriction" but that is misguided. Sleep restriction leads to beautiful things AND is not necessarily as awful as people tend to anticipate. Mindset plays a huge role. This topic also came up in a last month at a Sleep Q&A session, so it's fresh in my mind.
What I hear people say is something along the lines of:
"I thought that I would really be suffering while getting less sleep on my new sleep schedule. Actually, I'm getting less sleep, but it's not that much less. AND, I am surprised that I don't feel worse. I mean, I'm dragging right now, but my sleep quality is better. I can feel that something is different [in a good way]."
All I can say is "YAY!"
That is a sign that everything is on the right track. It suggests the presence of a GREAT prognosis. There is other work to be done, but that will fall into place with some diligence and effort.
So, the takeaway today is to consider that sometimes challenging changes can lead to good things and are not always as hard as we anticipate.
Happy Sleeping,
Alissa S. Yamasaki
Can't Stay Asleep?
August 3, 2022
On the surface, difficulty staying asleep or returning to sleep seems like it would be an easy fix. Without knowing sleep information, I am fairly certain that I would look to things that would "knock me out" and/or remove all disturbances.
I understand the desire to just get the problem fixed with whatever seems to work, but I actually recommend to people that they not move into ANY "fix" until they have assessed the problem.
Let's first talk about what is normal for awakenings.
It's typical to have awakenings the second half of the night for a few minutes while we stumble to the bathroom in a half-awakened state. It's not typical to have awakenings which are associated with a pounding heart, panic attack feeling or with regular morning headaches.
If you have regular awakenings during the night or a lot of sleepiness during the daytime despite sleeping through the night, then you will want to make sure that you don't have sleep apnea. It's more common than you think. Stats cited by Cleveland Clinic suggest that perhaps 25% of men and 10% of women have it.
Risk factors and signs include:
Obesity, but people without obesity also can have it.
Snoring, especially if someone has witnessed you stop breathing, is a sign.
So are morning headaches.
So is high blood pressure.
And so are awakenings during the night.
What should a person do? I don't love the word "should" because I don't enjoy putting obligations on myself or others, but this is one of those important "should's." The best way to test for apnea is through a sleep test. You don't have to go to a sleep lab. Your family doctor can usually just order a home test for you. If your home test results are negative, but you still suspect that you have it, then you should request a sleep lab test.
Why is a sleep test important? Basically, when you have apnea, you stop breathing. This can be briefly or it can be for longer than that. It can be for a couple of times a night, or many times in an hour. I've seen all varieties. During those times that breathing stops, your body isn't getting oxygen, so your risk of stroke and heart attack are greatly increased.
Before doing any insomnia work, I always ask people to consider if they need a sleep apnea test. I actually go as far as refuse to work with people who have strong signs of it and haven't yet been tested; while I want to help people find good sleep, I don't want to increase your ability to sleep without awakenings if you have apnea; it's important to have those awakenings if you aren't breathing at times during the night, and I don't want to interfere with that.
If you think some of the symptoms sound familiar (like snoring), then it's time to ask your physician about it. Your physician can help you decide if your symptoms warrant further exploration.
If you have frequent awakenings during the night but have no signs or symptoms of apnea, then we can address that type of restless, disrupted sleep with behavioral interventions used in CBT-I and in our online programming.
As always, we continue to offer free access to a short sleep self-assessment and tutorial, which does include a section on apnea. In the next week or two, I am planning to be able to open application/registration for our online self-help program for chronic sleep problems. Our one-on-one slots are currently full, but I will update you as new ones become available.
Sleep education does not equal CBT-I
July 27, 2022
Today's info is for people who want to know what the research says.
A friend thoughtfully passed along an article from Harvard Health (from Harvard Medical School). The content pleased me, despite that the stats are staggeringly concerning.
The article cited the finding that non-depressed people with insomnia have a twofold risk to eventually develop depression compared to people with no sleep difficulties, as shown in an epidemiological longitudinal study of the relationship between insomnia and depression.
The article encouraged the consideration of CBT-I treatment of insomnia as a preventative measure for depression, including for older adults. It also cited an article published in JAMA which showed that CBT-I was more effective than a sleep education program.
As you can imagine, this last part DELIGHTED me to read.
Takeaway messages:
1) There isn't going to be a single answer as to whether we should work on depression or insomnia first. Based upon the research, it sounds like if the depression developed after you developed insomnia, it make sense to treat the insomnia and see if that helps mood.
2) If you suffer from sleep disruption, you really don't want to let it go unchecked for an extended period of time, as you risk the development of depression.
3) You don't just want to learn some general information about sleep, as that is not sufficient; you want to consider if you are a candidate for CBT-I. While our online self-help programming is not a full substitute for CBT-I, our approaches are highly informed by the same behavioral and physiological principles and are appropriate for chronic mild to moderate sleep disruption (not strictly only for diagnosed insomnia).
If you need to talk someone immediately because you are having thoughts about suicide, then reach out to the National Suicide Prevention Lifeline for immediate help: 1-800-273-TALK or use the newly-implemented suicide hotline number: Just dial 988.
I have made a portion of Good Sleep 101 available for preview (find it in the Course Curriculum section); I recommend the "Sleep Drive" lecture, and don't worry about the written material, but scroll down to the video.
I love research, data and understanding the body:)
Happy Sleeping,
Alissa S. Yamasaki
How 20 minutes awake in bed turns into 1 hr (or more)
July 9, 2022
I get this question fairly frequently, and it was asked at one of our recent Sleep Q&A sessions:
"I am trying not to clock-watch at night because it makes me anxious. I've been trying to follow the course's recommendation to get out of bed when I cannot sleep. I was surprised when I thought it had been about 20 minutes, but it had actually been about an hour when I looked at the clock!"
The 20 minutes that is referenced by the group member is the standard rough estimate of time that I recommend that people get out of bed when they cannot sleep (there are a lot of details that go into that recommendation, but that's the short version).
Do you know why there is such a difference in the perception of time that had passed? Has this ever happened to you?
Although I'm obviously not there while you try to sleep, my best educated guess is that when a long time goes by in bed, you are probably actually going in and out of very light, early stage sleep. You may not realize that you are dozing. This is the same reason why people get into motor vehicle accidents by falling asleep at the wheel of a car. We aren't particularly good at knowing when we are entering light sleep.
The consequences are actually pretty significant regarding bedtime sleep when you start to get that light sleep without knowing it. Getting that light sleep, followed by being alert, sets up the body to have difficulty falling asleep in a solid manner for the night and sets you up to have the kind of night that includes a lot of "tossing and turning" and that leaves you feeling like you didn't sleep well.
In order to get rid of difficulty falling asleep and replace the sense of "tossing and turning" with deeper, more satisfying sleep, then you must understand how and when to get out of bed. A good place to start is when you sense that it has been a while and you are still somewhat awake. My prediction is that it will be longer than 20 minutes. Test it and see for yourself. After 20 minutes, you are basically training your body to be awake in bed, and you want to minimize reinforcing the body to be awake in bed if you truly want to sleep well.
Wish to start to learn more about the mechanisms of sleep? I recommend starting with our free tutorial, "First Things First," to decide if behavioral changes are likely to be helpful for your sleep problems.
I'll have some opportunities to use coupon codes for our paid courses in upcoming weeks, so I recommend that you don't register for any paid courses just yet.
I wouldn't call a 4-hour night of sleep "bad"
June 30, 2022
I am so curious to know if you agree or disagree when I say, "I wouldn't call a 4-hour night of sleep bad.” I realize that it is a provocative statement, and I don't necessarily enjoy a short night of sleep, but there is an important function of a 4-hour night of sleep for which I have deep gratitude.
This topic is on my mind because we have our "newbies" starting out in our self-help group for chronic sleep problems. When making sleep changes, especially in the beginning stages, it's important to grasp the idea that we don't have to catastrophize a short night of sleep.
When you understand the mechanisms of how good sleep works, then you also understand that technically, a 4-hour night of sleep is “short” and not “bad.” Short nights of sleep actually set up the body to be followed with a night of high quality sleep.
The reason for this is that a short night of sleep maximizes something called “sleep drive." Sleep drive is why people often yo-yo between "good" and "bad" nights of sleep. We can learn to collect our sleep drive in a way that allows us to have consistent ease in falling asleep and staying asleep.
In contrast, we can also sabotage sleep drive inadvertently, creating sleep that is broken, restless, low quality and yo-yo's between high quality and low quality.
I have lots to say on this topic...but if I have to choose one area that may be relevant to a lot of people, it would be to practice mindfulness about your assumption or language around calling a short night of sleep "bad." Some alternatives include "inconvenient" or "challenging" or just plain, "short." AND, remember that a short night of sleep sets up the body for restful sleep.
Want to know more? Sleep drive is a topic and cornerstone of sleep knowledge needed when it comes to addressing sleep disruption. Check out our courses.
Melatonin? Medication? Sleep Meditation? New Mattress?...What is a person to do?
June 8, 2022
I enjoy waking up in the morning and having the energy needed to do my day without grumpiness and fatigue.
If you are trying to improve sleep, the complicated aspect is that we are bombarded by sleep "fix" suggestions, making it hard to know what to do. Should a person find a good sleep meditation? Try an over-the-counter supplement? Get a prescription? Get a sleep study? Follow the directions from a smartwatch?
What I find that people don't necessarily realize is that sleep improvement is a not a one-size-fits all, straightforward solution.
The process of sleep improvement is more like finding the right shoe. You want to measure first, and you can't judge its fit based on one time of use. Sometimes, it takes a few times wearing the shoe in order to figure out if it's a good fit.
Keep in mind that the true test of a real improvement in sleep is if it works for 2 weeks or more, night after night (it's the measure used when working with sleep changes for cognitive-behavioral therapy for insomnia, CBT-I). Be careful not to make assumptions about a "fix" based upon a few nights of sleep.
I also like to ask the question of whether or not you worry about getting enough sleep; if you are worrying about sleep, then there is definitely room for improvement in the techniques you are using.
The same applies if you have tried multiple "fixes," found that nothing lasts, and you still don't feel satisfied with sleep. It sounds like you still don't have the shoe that fits.
Before you try a new approach to sleep, it's a good idea to get an assessment of your sleep first (like you would measure your foot before you buy a shoe). This ultimately saves you time and energy.
A good place to start is to just have your family doctor help with assessing the situation, including discussing symptoms, diagnoses and options. I'm biased, but my hope is that CBT-I (behavioral interventions) might be discussed if you are someone who hasn't found the shoe that fits. While I do not believe that CBT-I and behavioral interventions are a fix for every sleep situation, CBT-I tends to be a viable option for more situations than people tend to assume.
Happy Sleeping,
Alissa S. Yamasaki, Ph.D.
Interested in learning more about sleep? Our Good Sleep 101 course is now available.
Fear of breaking a good sleep pattern
May 4, 2022
“I'm sleeping better right now...so I don’t need to work on sleep."
Is it really better? Or, are you scared to look at it or make changes for fear of losing the good sleep you got for a few nights? If you’ve been through this cycle of good/bad/good sleep and are fearful, then you probably lack some important pieces of knowledge needed to fully understand the process of sleep and fully protect you from cycles of poor sleep.
Believe it or not, the underlying physiological and behavioral mechanisms of sleep work together in very predictable ways that everyone can learn. If you wrack up enough of a sleep deficit, then you will also inevitably have some good nights of sleep that follow it. If you don’t understand how to regulate your body’s sleep pattern, those precious good nights will also be followed by bad nights of sleep, too. That is just the way that the body works.
The typical cycle is that people will have some poor nights of sleep, fuel the difficulties in the following nights with worry about the lack of sleep and lying in bed awake, crash at some point during the week into some good nights of sleep, and then oversleep in order to “make up” for lost sleep. That “make up” night(s) results in not having enough of something called “sleep drive,” for the following night, which is part of the essential pieces need to have a good night of sleep after that “make up" sleep. Thus, the cycle is doomed to repeat.
Sound familiar? One solid step to reducing sleep problems is to reduce your “sleeping in” after a bad night of sleep. This sounds simple, but it’s pretty hard to do when you are cozy in bed and sleepy. This is why I work with people on sleep; we use data, specific formulas, and eliminate the guesswork in sleep decisions. If you understand sleep, you know how to break the good sleep and bring it back again.
Happy Sleeping,
Alissa Yamasaki, Ph.D.
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Tidbits from this week's Q&A session
April 26, 2022
I have come to appreciate that sometimes people want a peek inside of what is happening while they are contemplating the idea of seeking to change sleep. The group members who are piloting our online program had some great questions/comments this week! See the highlights below:
-Navigating the time change. One member was surprised to discover that there was some remaining anxiety about ability to fall asleep, despite having sleep well for a while now and through a variety of circumstances. The first night with the time change set off the anxiety and uncertainty. However, this member worked from her existing knowledge to keep herself on track with her wake-up time. The second night, she had mild difficulty but again remembered to stick with what is recommended according to sleep physiology facts. By the third night, her circadian rhythm shifted (because of her knowledge of sleep physiology and associated choices), and sleep returned to easily falling asleep and getting restorative sleep during the night. She now feels even more confident in her ability to navigate sleep challenges.
-The importance of "grit." In the process of changing sleep, members have heard me emphasize the necessity of having grit. Members noted that they really learned to use their grit and that this left them with a feeling of having "earned" the good sleep that they are getting now. A feeling of empowerment was also identified, as they found that grit + knowledge to solve sleep problems = strength and efficacy in navigating sleep challenges as they arise.
-How to deal with thoughts about loss, grief, and tough news without it interfering with sleep. One member mentioned that losses and changes in relationships were at the forefront of her thoughts, even when she wants to sleep. We took time to acknowledge that there are so many areas where our thoughts can go and that they can interfere with sleep. We reviewed some strategies that related to what they have already been practicing for worry control, as well as just appreciated that it is a task in itself to accept life's changes as they happen.
Happy Sleeping,
Alissa Yamasaki, Ph.D.
Wish to receive blog posts to your email? Let us know at [email protected]
How I came to teach about sleep
May 30, 2021
So, my start wasn't a glamourous start, but isn't that how lots of good endings start?
As a psychologist in PA, we must complete a certain number of hours of education in order to renew our licenses. Having waited a little to the last minute, I was in need of a good number of hours of credits and the course that fit into my schedule was the one on sleep! I chuckle when I think of this. I had no idea what I was getting into. But, what I learned was that sleep problems are rampant and that there is a very well-documented body of research repeatedly showing high rates of effectiveness for treating insomnia without medication.
How did I not know this? I had already been working with people to get control of worries and using some of the techniques similar to those I have previously mentioned for sleep. That got me thinking about how many of my clients could be helped and how much quality of life could improve. At that point, I was hooked. What could be better than knowing how to better help others in such a foundational way?
When I reflect about how sleep played a role in my own life, I wish that I had known more as a teenager. I was chronically sleep-deprived, and somehow, I functioned enough to be a competitive gymnast. It makes me wonder what practices would have been like with a little more energy behind them. I remember dragging every single day to practice and getting naps whenever I could. I really thought that I needed 10 hours of sleep to feel good. In hindsight, that was likely partly a result of the yo-yo-ing of the amount of sleep I was getting, some nights getting less than 6 and some nights getting 10 hours). I felt like when I got to college, everything was easier. I wonder now if that was because I started getting enough sleep.
I'm not immune to sleep problems. Nobody is. In fact, it's normal to have a night here or there which gets disrupted. A colleague once asked me if I have perfect sleep -- I laughed, as I do not have perfect sleep or sleep habits. I am human like everyone else. My particular mode of sleep disruption tends to be that I will doze at the tv before bed, which sets things up to not get satisfying sleep at night. I kind of drag the next day. When I'm staying fully awake until bedtime, I feel much better.
I now fully recognize that sleep is essential in having a good life. It seems simple, but I missed that fact for a long time. After that initial training on sleep, I was excited to learn more. I went on to receive training through a program at University of Pennsylvania, as well as to shadow the clinical work of Dr. Julio Mendoza in Hershey, PA. I am especially grateful for his influence, as his work opened my eyes to all of the nuances and pieces to understand in helping people sleep well. He modeled being passionate about his work and expertise to take on the most difficult sleep situations. I couldn't believe the variety of sleep situations he worked with.
I guess my bottom line is this: there is hope regardless of your sleep situation.
Happy Sleeping,
Alissa Yamasaki, Ph.D.
5 things to do during the day to help you sleep at night
April 5, 2021
When I work with people on their sleep, there are principles which need to be followed in order to recalibrate their sleep, especially when sleep problems have started to interfere with daily life. We crunch numbers and work on finding a good sleep formula. But, you don't have to wait until sleep problems escalate to that level before implementing some of the tools we use. I always tell people that what you are doing in bed is affected by what you do during the day. If you have a mind which tends to run a bit too much when you get into bed, then you may find some helpful hints below.
1. Be sure to take some time to work through problems productively during your waking hours. We often have such busy schedules that we don't take time to reflect upon the day and tidy up things, which sets us up to reflect at the first time when we have a quiet moment. For many, that ends up happening when we get into bed. Whether it is figuring out what is for dinner tomorrow or a major work decision...you don't want to do that in bed, as you set yourself up to have less-than-restful sleep.
What I typically recommend: Schedule just a bit of time (15 minutes) to reflect, write down some things on your mind if that helps, and then mentally put it aside to return to on the next day.
2. Related to the above, but worth highlighting is that it is important to practice setting aside worries and problem-solving during the day. That ability to shift and pause the problem-solving is a healthy, essential skill for helping your nights.
What I typically recommend for a good starting place: Start with awareness. Encourage yourself to notice when you are worrying. From there, you can start to practice reminding yourself to set it aside if there is something more pressing to do or focus upon. That practice is harder at night, so you want to be good at it during daylight hours as a foundation.
3. Make sure you are doing a good wind down time prior to bed. Your body is easily conditioned to things with cues, just like your dog comes running when he hears the treat box rattle.
What I typically recommend: Your routine doesn't have to be elaborate, but it does have to be practiced on most days of the week regardless of the type of day you have had -- good or bad. It's easy to ditch it when you are very tired, but this is the best time to condition your body in the direction you want, so don't skip the opportunity.
4. Avoid blue light prior to bedtime. I’m sure you’ve heard this one before. I encourage not overlooking the details of timing.
What I typically recommend: Consistent with the body's physiology, is to start this from 2-3 hours prior to bedtime, and not less than that. Natural melatonin release in your body begins around that time and you don't want to interfere with the process.
This last one always receives a lot of skepticism, but at the risk of alienating all of you, I'm still going to say it…
5. Most people have a sense of when the mind is just too active to fall asleep, and you should get out of bed at those times. During the day, you can help yourself make that process easier by identifying something that is an incentive to get out of bed when you cannot sleep.
What I typically recommend: Find something mildly pleasant, but not overly interesting, like a magazine or book, and put on the couch in your living room. If you don't choose something during the day, when your impulse control is higher than at night, you risk just picking up your phone and scrolling. And given #4 above, that is not a good option. A smartphone is generally too stimulating and the light can lead to delaying your sleep even later into the night. At night, you should get out of bed if you can't fall asleep within about 20 minutes. This rule helps to keep your body well-trained to be asleep in bed. More on this rule to come in future posts!
Happy Sleeping,
Alissa Yamasaki, Ph.D.