Sleep problems are an equal opportunity torture.
That’s how educator and clinical psychologist Amelia J. Wilcox describes insomnia or other types of issues that deprive us of a good night’s sleep.
You lay there, tossing and turning. Thoughts race through your mind, with the most anxiety-producing thought likely to be, “Why am I awake?”
It’s a problem many men and women — both older and younger — know all too well. Even after busy or even exhausting days, sleep can still be elusive. Either we can’t fall asleep, or we awake in the night and can’t go back to sleep. And with the current pandemic on our minds, it’s no wonder we’re having trouble feeling rested.
If counting sheep hasn’t been working for you, consider one of the newest treatments for insomnia called cognitive behavioral therapy, or CBT-1. It is the first line of treatment and endorsed by the American College of Physicians.
What makes this treatment so innovative is that is requires no medications, sleep studies or machines.
Instead, Wilcox says it teaches you to recognize and change beliefs that affect your ability to sleep. It helps you develop good sleep habits and avoid behaviors that keep you from sleeping well.
It usually takes four to six sessions to rewrite habits; good outcomes require self-discipline and motivation.
“You’re going to hate me if you can’t tolerate some discomfort for a month or so while you develop new habits,” Wilcox says. “But the payoff is an improved quality of life.”
CBT-1 is not recommended for sleep apnea, restless legs and some psychiatric disorders. This process of “sleep hygiene” is not the current signature treatment for these issues.
For those suffering from run-of-the-mill insomnia, Wilcox starts at the pineal gland in the brain, which produces and secretes melatonin, a hormone that helps regulate biological rhythms such as sleep and awake cycles.
Melatonin is inhibited by light and triggered by darkness. Stress also upsets the rhythm and can cause sleep troubles.
“It is important to keep in mind that even good events can set off an episode of insomnia,” she says. “It could include an injury, moving to a new house, a job change, winning the lottery — the list goes on and on.”
When we encounter stressful times in our lives, our brains invent different ways of coping.
“It might include loading up on coffee all day, drinking to excess at night, taking naps, avoiding the gym, lolling around in bed in the morning,” she says. “These types of behavior may make sense in the moment, but they perpetuate the insomnia episode.”
CBT-1 is designed to help you develop better coping strategies, Wilcox says, so you can return to a healthier sleep cycle.
For example, we head to bed, but then get anxious, worrying about our sleep, what someone said to us at work that day, strange noises in the house, etc.
“This cognitive arousal is also part of what CBT-1 is designed to treat,” she says.
If you normally get up at 6 a.m. five days a week, continue that habit into the weekends. Get up and out, and get some exercise.
“Don’t give in to it — that desire to go back to sleep,” Wilcox says. Conversely, if at night you can’t get back to sleep after 20 minutes, it is best to get out of bed and read or do something quiet until you again feel sleepy.”
Cognitive therapy helps identify your best sleep time and environment.
Wilcox recommends sleeping in cooler temperatures and using “optimized” bedding, such as the use of weighted blankets, which are often clinically recommended to ease issues related to anxiety, autism and insomnia.
Using a weighted blanket is better than “stacking” blankets, she says. They can be found online or at stores that sell bedding. Cost usually ranges between $80 and $150.
Other ways to help relax the mind and body include meditation, yoga and tai chi.
“They are wonderful helps,” Wilcox says.
She definitely opposes bringing your smart phone to bed with you because the blue light emanating from the devices is received as daylight by your eyes and upsets your hormonal balance.
“Never bring screens close to your head,” she says. “And no naps.”
And the benefits of practicing better sleep habits?
A good night’s sleep allows the mind to consolidate and clear debris from its memory banks, giving us a “clean slate for the next day,” Wilcox says. “It is protective of mood. Otherwise, you are cognitively fuzzy.”
“I am always impressed by how people feel when they get a good handle on sleep,” she says.
Amelia Wilcox is an assistant professor of psychology at Lewis and Clark College, in addition to her private practice.