The vast majority of individuals who come to our service have significant difficulties with their sleep.
It is becoming increasingly clear that once sleep problems have developed they will not just disappear of their own accord, these problems need to be the focus of a clear and specific intervention plan.
The Lancashire an South Cumbria Traumatic Stress Service makes dealing with sleep problems an early treatment priority. Our experience has convinced us that helping to regain good sleep habits not only starts to give individuals back a sense of control over their lives but also puts people in a much better position to tackle other modules in our treatment programme.
We base our approach on the work of Professor Espie and use the very helpful book “Overcoming Insomnia and Sleep Problems”. With the kind permission of Professor Espie we reprint below an overview of a cognitive behavioural therapy (CBT) programme for overcoming insomnia.
Overview of the CBT programme for overcoming insomnia
- Think of insomnia as a bad habit that can be corrected and stick to the program until you establish a good habit.
- Consider gradually reducing any sleeping tablets that you take, but consult your physician further to agree a plan.
- Get a comfortable bed and mattress suitable to your needs and preferences.
- Work out your sleep schedule, your average sleep length, your planned rising time and threshold time for considering going to bed. Threshold time can be calculated by subtracting the average duration of your sleep at present from your planned rising time.
- Always follow your planned sleep schedule 7 nights a week.
- Make adjustments to your schedule at a maximum rate of 15 minutes per week and only after your sleep efficiency, the proportion of time spent asleep when in bed, reaches 90 percent.
Before you go to bed:
- Take light exercise in the later afternoon or early evening.
- Put the day to rest long before bedtime. Think it through, tie up ‘loose ends’ in your mind and plan ahead. A notebook and diary will help to record your plan.
- Wind down during the evening. Do not do anything mentally challenging within 90 minutes of bedtime, and stick to a routine.
- Do not sleep or nap in the armchair. Keep sleep for bedtime.
- Do not drink too much coffee or tea; eat a light snack for dinner and avoid eating chocolate and other products containing caffeine. Try to get used to de-caffeinated drinks.
- Cut down your smoking in the evening and try not to smoke if you wake during the night.
- Do not drink alcohol to aid your sleep – it usually upsets sleeps.
- Make sure your bed and bedroom are comfortable – not too cold, warm, noisy or bright. The room should be well aired and the alarm clock turned towards the wall.
- Make preparations for waking during the night, such as leaving the heating on low in the living room and making a flask of a warm milky drink.
- Stay out of bed until your threshold time and until you feel ‘sleepy-tired’ – a tiredness that will make you fall asleep quickly and take you through the night.
- Once in bed switch the light off immediately.
- Do not read, watch TV, speak on the telephone, and eat drink, etc. in bed. The bedroom is for sleeping only, with the exception of sexual activity.
- Practice relaxation exercises, followed by your imagery story. These procedures should be practiced in the daytime before you try to apply them at night.
- Give up trying to sleep. Keep your eyes open and gently resist sleep, or adopt a carefree or accepting attitude to wakefulness.
- Remind yourself that sleep will come naturally. Repeat steps 13 and 14 as required.
- Have your alarm set for the same rising time every day, 7 days a week, and make sure you rise at this time.
If you can’t sleep or if you wake:
- If you can’t sleep within quarter of an hour of putting the light out, get up and go into the living room.
- Use the same rule above if you wake during the night and can’t get back to sleep quickly.
- Do something relaxing (planned beforehand) for a while when out of bed and do not worry about tomorrow.
- Remind yourself that sleep problems are common and not as damaging as you think. Try to avoid getting upset or frustrated.
- Challenge all other intrusive and inaccurate ideas and mental images. Evaluate them and try to prevent them from dominating your thoughts.
- Go back to bed when you feel ‘sleepy-tired’ again. Put the light out and relax.
- Try to block out unwanted thoughts by repeating the word ‘the’ to yourself every 2 seconds. Try to keep this up for 5 minutes at a time.
- Write down any intrusive thoughts or concerns in a notebook kept at your bedside and deal with them in the morning.
- If you still can’t sleep then get up again after quarter of an hour and repeat steps 19 to 24.
All intervention programmes within the LTSS are developed in a collaborative fashion and are based on the information collected from a two week sleep diary record.
Overcoming Insomnia and Sleep Problems – a self-help guide to using cognitive behavioural techniques, (2010) is widely available and is one of the titles in the “Overcoming” series of books which are designed to enable people to take control of their own recovery programme using the latest techniques of cognitive behavioural.