The Wellbeing Plus Course

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Alberta McCarthy
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1 The Wellbeing Plus Course Resource: Good Sleep Guide The Wellbeing Plus Course was written by Professor Nick Titov and Dr Blake Dear The development of the Wellbeing Plus Course was funded by a research grant from beyondblue.

About Sleep Many people with anxiety or low mood experience difficulties with their sleep, such as difficulties getting to sleep, staying asleep, sleeping too much or sleeping too little.

This resource aims to provide you with some general information about sleep, some common problems that people experience, as well as some proven tips for maximising the quality of your sleep.

2 About Sleep Many people with anxiety or low mood experience difficulties with their sleep, such as difficulties getting to sleep, staying asleep, sleeping too much or sleeping too little. Many people also find themselves struggling with worries about things like financial problems, work issues and family matters, etc. These issues and worries can also contribute to sleep disruption. This resource aims to provide you with some general information about sleep, some common problems that people experience, as well as some proven tips for maximising the quality of your sleep. People vary considerably in how much sleep they need. Some basic facts about sleep are: Most people require somewhere between 6 to 9 hours per night to feel refreshed. While some people can function with very little sleep, some others need more. The more active you are, the more sleep you generally need. The amount of time people take to fall asleep varies a lot between individuals. The Circadian Rhythm Human beings have an internal body clock that follows a roughly 24-hour cycle. This body clock is formally known as the Circadian Rhythm and involves physical, mental and behavioural changes that correspond to light and darkness in a person s environment. There is also a strong relationship between body temperature and sleep, with people typically feeling alert when their body temperature is highest and sleepy when their temperature falls. The circadian rhythm enables human beings to regulate the sleep-wake cycle by controlling our body temperature. Research suggests that establishing a regular routine is one of the most important issues when it comes to sleep. Because their sleep is often interrupted by their symptoms, many people with anxiety and low mood often try to catch up at other times by sleeping during the day, etc. While this is understandable and makes sense, it can make your sleep far worse in the long term. Having a routine helps to get your body into a rhythm, which helps 2

3 your body clock to prepare for when to sleep (i.e., to start gearing down ) and when to prepare to wake (i.e., to start gearing up ). Establishing a routine means: Having a regular time when you go to bed Having a regular time when you wake up Trying to stick to your times for sleeping and waking Tips for improving sleep Below we discuss a number of simple but important things you can do to improve your sleep. These are key things that we all need to work on! However, if you are already doing all of these things and are still experiencing difficulties, it is worthwhile speaking to your GP. Manage Your Symptoms. Many people with worry, anxiety, sadness and low mood, find that these symptoms seem worse at night and when going to bed. This is often partly because there are fewer things to distract us and so the symptoms can become more obvious. Learning some basic skills for managing these symptoms, which we teach during this Course, can not only improve wellbeing, but also be helpful for improving sleep. For example, many people find it helpful to make sure that they: Are not working themselves up with worry and unhelpful thoughts before bed we cover this in Lesson 2. Remain relaxed and comfortable while in bed we cover skills for this in Lesson 3. Are engaged in pleasant activities during the day, which can make them more ready for sleep at night we cover skills for this in Lesson 4. Give Yourself Time. Most sleep difficulties develop over a long period of time and it takes time to reverse the changes that have occurred. Most people find it takes a couple of weeks of hard work to start to develop good sleep habits and to start to improve their sleep quality. Most people also find that, early on, they have some very restless and sleepless nights so it can be helpful to identify and plan a good time to work on your sleep, e.g., at the start of the weekend rather than during the week. 3

Try not to catastrophise. One of the most common problems we experience, if we are having sleep difficulties, is worry about not having enough sleep!

Although not getting enough sleep is unpleasant, research suggests that it does not have major longterm consequences for our health or quality of life.

It s important to limit the number of activities we engage in while in bed and the bedroom, including eating, watching television, reading and working.

4 Try not to catastrophise. One of the most common problems we experience, if we are having sleep difficulties, is worry about not having enough sleep! Almost everyone experiences periods with sleep difficulties. Sometimes the reason for these difficulties is unclear and sometimes it is obvious, e.g. when we are stressed or unwell. Although not getting enough sleep is unpleasant, research suggests that it does not have major longterm consequences for our health or quality of life. Therefore, anxiety about the consequences of not having a good sleep is not helpful, because all it does is leave us frustrated and less likely to get the sleep we want. The Bed is for Sleeping. It s important to limit the number of activities we engage in while in bed and the bedroom, including eating, watching television, reading and working. Limiting the amount of activity you do in bed allows your brain to associate bed with sleep. So, when you get into your bed or bedroom, your body automatically starts to physically and mentally prepare for sleep. Develop a Wind-Down Ritual. Develop a short 10 minute routine before going to bed, including washing your face and brushing your teeth. This routine can act as a cue to your body and brain to start preparing for sleep. Engaging in relaxing activities (e.g. reading) before bed can also be helpful. These activities can help you to wind down and also provide your brain and body with time so that it can start to get ready for sleep. Limit Caffeine, Nicotine and Alcohol. There are a number of things you can eat or drink which can affect your sleep. For example, caffeine and nicotine stimulate our bodies and brains by releasing various hormones and chemicals. Both can stay in the body for a long time, so it is important to try and limit caffeine after about 3pm and abstain from smoking for at least 1 hour before bed. Alcohol causes you to have a much poorer sleep. Try to limit alcohol consumption to a maximum of 2 standard drinks per day, and avoid using alcohol to help you sleep. Don t Stay in Bed. If you are lying in bed and unable to sleep, get up and do something which is relaxing or boring, such as reading a book or listening to some light music. Avoid stimulating activities such as playing video games or action movies, as you want your brain and body to be as relaxed as possible. 4

Avoid Napping. Daytime napping is very unhelpful when it comes to obtaining good sleep. Daytime sleepiness, especially after a bad night s sleep, can make it feel like sleep is the best thing to do.

tired. Daytime napping can lead to a vicious cycle, where a daytime nap reduces the quality of your sleep at night, which leads to more daytime sleepiness and then more daytime napping.

5 Avoid Napping. Daytime napping is very unhelpful when it comes to obtaining good sleep. Daytime sleepiness, especially after a bad night s sleep, can make it feel like sleep is the best thing to do. However, if you struggle with sleep difficulties, taking a daytime nap can confuse your body s sleep-wake-cycle and make it harder for you to get to sleep later that night, because you re not as tired. Daytime napping can lead to a vicious cycle, where a daytime nap reduces the quality of your sleep at night, which leads to more daytime sleepiness and then more daytime napping. This can really confuse your body so you should avoid daytime napping - no matter how tired you are. Limit Noise, Light and Discomfort. Noise and light are common sources of sleep disturbance. If you sleep near a noisy environment, try to block out the sound by closing windows and doors or by using earplugs. Similarly, a light room will make it more difficult for you to fall asleep, so try to darken the room before going to bed, or use an eye mask. It is also important to ensure that you are relatively comfortable when going to bed. If you are hungry, have a light snack before going to bed. Make sure that the room is at a comfortable temperature. Many people find their worries appear at night when activities slow down. While we all experience this, it s not helpful to sit in bed worrying we cover good skills for managing worry in Lesson 2. 5

6 Frequently Asked Questions Is my lack of sleep harmful? No. Even though sleep deprivation can lead to difficulty maintaining concentration, irritability or restlessness, there is no evidence that sleep deprivation causes short- or long-term damage to the body or mind. In fact, studies have shown that it is difficult to prevent people who are extremely sleep deprived from falling asleep. The body has an inbuilt system that ensures that, if we need to sleep, we will. People find it helpful to remind themselves of this if they are spending time in bed worrying about not getting enough sleep. How much sleep do I need? Some people can get by with less sleep, while others need more. You are the best person to judge whether you need to do something about your sleep. However, for most people, worry about the lack of sleep often causes a lot more distress than the sleep difficulties themselves. Research suggests that people who report difficulties with their sleep have a tendency to overestimate the amount of time they take to get to sleep, and underestimate their total sleep time! In fact, some studies have shown that, just by reminding themselves of this, people with sleep difficulties often became less anxious about sleep, and sleep better as a result. Do I have insomnia? Insomnia is the chronic inability to fall asleep. Most people with sleep difficulties do get to sleep, but believe that the amount of sleep they get is not enough. Often it is not the lack of sleep that causes people to seek treatment. But, rather, how they feel about and cope with their sleeplessness. How does sleep change as we age? Sleep changes markedly across the life span. Older people tend to take longer to fall asleep and require less sleep than younger people do. Research also suggests that older people tend to spend less time in deep sleep and experience more fragmented sleep. Although insomnia is a common complaint among older people, it is not a normal part of aging. Do sleeping pills work? In the short term, sleeping pills are helpful because they can help you fall asleep. However, the benefits of sleeping pills wear off if you continue to use them regularly and you may find yourself needing to take a high dosage in order to achieve the same effect. In addition, sleeping pills can be addictive or make people believe that they will not be able to get to sleep without sleeping tablets. Lastly, sleeping pills can have rebound effects when people stop taking them. A rebound effect is when people s sleep difficulties return for a short period (sometimes the difficulties are worse!) when they stop taking the medication. Many people are prescribed medications to help with their sleep. If you are currently taking sleeping pills to help you sleep, it is important that you monitor how frequently you use them and to keep your GP informed of your usage. 6

We have discussed some of the common reasons that people experience sleep difficulties.

7 Summary The Good Sleep Guide provides key information about sleep and some practical tips on helping you to improve your overall sleep. Many people find that there are a few basic things that they can do which are very helpful for improving their sleep. We have discussed some of the common reasons that people experience sleep difficulties. Remember, we all experience sleep difficulties from time to time, and worrying about not getting enough sleep can make things worse. Improving the quality of sleep is an important part of improving our emotional wellbeing. Good luck! The MindSpot Clinic Team Copyright 2015 The MindSpot Clinic All rights reserved. You may use and/or copy this information for personal reference only. The MindSpot Clinic endeavours to ensure all information contained in this material is correct at the time of inclusion. However, the accuracy of the material cannot be guaranteed and people using the information do so entirely at their own risk. The information may not be reproduced or published in any other way or by any means without the prior written consent of The MindSpot Clinic. 7

Sleep. Information booklet. RDaSH. Adult Mental Health Services

Sleep. Information booklet. RDaSH. Adult Mental Health Services Sleep Information booklet RDaSH Adult Mental Health Services Sleep problems are often referred to as insomnia. They are very common, particularly in women, children and people over 65, so it is quite normal