Cognitive behavioral therapy may help you relieve insomnia


Sleep expert Dr. Rachel Manber has seen pain everywhere insomnia. Patients who were depressed and tired told her that they lay in bed all night tossing, looking for elusive comfort points.Others give up evening outings or vacations so as not to mess up their lives go to bed schedule. Others feel anxious before going to bed, thinking about whether to take sleeping pills or get a good night’s sleep.

Manber, a professor of psychiatry and behavioral sciences at Stanford University Medical Center and an expert in behavioral sleep medicine, said that trying to fall asleep can backfire.

“When you talk to people who are sleeping well, you will ask them:’How do you fall asleep? How do you do it?’ They are likely to look at you with their eyes wide open. They do nothing. Sleep is an automatic process. ,”she says.

“When you talk to someone who has trouble falling asleep, they will list a long list of things they tried to fall asleep. And this very hard sleep will eventually cause arousal and interfere with sleep.”

carry on

Manber said that instead of trying to sleep, it’s better to let sleep happen.

In the past two decades, she helped patients get rid of ineffective habits, stopped the treatment of sleeping pills, and fell asleep alone.Her method: cognitive behavior treatment Insomnia (CBTI) is a non-drug treatment that can improve sleep by helping patients change their beliefs and behaviors.

Since the guidelines issued by the American College of Physicians in 2016, more and more doctors are aware of CBTI, which the guidelines refer to as the first-line treatment for chronic diseases insomnia In adults, priority over sleep drug.

This is not to say that sleep medication is ineffective. They often work, but they may have side effects and drug interactions and are not suitable for long-term use. In addition, once the patient stops taking the medication, the insomnia may relapse, requiring another course of medication.

In contrast, CBTI can solve insomnia without medication and equip patients with “skills that no one can get rid of so that they can use them when insomnia occurs,” Manber said. “As you know, life happens, and when we feel stressed, we often lose sleep because of it.” By using CBTI skills, people can prevent new episodes of chronic insomnia or recover from it.

Manber said that when patients undergo CBTI surgery accompanied by a sleep specialist, insomnia usually improves after four to six treatment sessions. However, many people can get relief through these family measures.

Wake up at the same time every day

You can’t control when you fall asleep or if you don’t have insomnia. But you can control what time to get up every day. “If you always wake up at the same time,” Manber said, “you are adjusting your internal biological clock to control sleep and wakefulness.”

She recommends choosing a regular wake-up time that suits your circadian rhythm. She said that a steady wake-up time will be a reminder to your body. “It creates a very strong biological clock. If you change the wake-up time, the signal amplitude will flatten and the signal will become weaker. It does not support your sleep.”

“When the clock is stable, you will naturally feel more or less sleepy every night. That’s why I say you must start in the morning.”

Manber said that many sleep problems are caused by irregular schedules, so avoid the temptation to fall asleep even during your rest days.

Go to bed when you are sleepy, not when you are tired

People usually confuse their bodies tired Or mental fatigue due to sleepiness, “but this is a completely different experience,” Manber said. “We define’sleepy’ as the possibility that putting your head on the pillow will quickly fall asleep.”

Another way to understand the difference is: “Tiredness is a function of energy; sleepiness is a function of sleep.”

When we are awake, the need for sleep will increase, but if people are still in a state of high arousal or stimulation, they will not feel it. “In other words, people may get tired, but they will be helpless. The feeling of being “wired” prevents them from feeling sleepy, so they cannot fall asleep.”

As Manber suggests: “If you fall asleep when you are no longer wired and start to feel sleepy, you will fall asleep faster.”

When insomniacs are lying in bed and unable to sleep, they usually worry about another bad night and the pain of the next day. Doing so can adjust their thinking to see the bed as a awake place, pressure, with anxiety.

carry on

On the contrary, if people spend most of their time playing sn, then the mind will learn to associate it with peaceful sleep.

However, there is a warning: People should rest in bed for at least 5½ hours every night, even if they sleep less than that.

Don’t spend too much time in bed

Patients with insomnia often spend much longer time in bed than sleep time, emphasizing quantity over quality. They will lie in bed for 8 hours, but can only sleep for 6 hours in total.

Manber said that they tend to have poor sleep quality and short sleep duration. “When people spend too much time in bed, many people actually end up playing here and there. Sleep. So brain Take a nap. This is not very refreshing sleep, not very good sleep. However, if you add all the breadcrumbs, it does increase. “

To avoid lack of sleep, try to limit the time you spend in bed to consolidate your sleep as a whole. If you only have an average of 6 hours of sleep per night, you should spend 6 hours in bed every night in order to get a deeper quality sleep. Manber said: “If you have 6 hours of sleep, it would be better to combine them together.”

carry on

You may feel tired at first, but once you have established a stable sleep time, you can extend the time in bed. But please be careful to shorten your sleep time to avoid unsafe levels of drowsiness.Manber said: “If you have obvious drowsiness, please shrink back and consult a CBTI therapist.” These experts can also check for other causes of drowsiness, such as sleep apnea.

Manber says there is another good reason to avoid spending too much time in bed: enough time to build a sleep drive during waking hours.

“Sleep drive is something accumulated in our system. The longer we wake up, the stronger our sleep motivation.” she said.

If you don’t build enough sleep pressure, “when you fall asleep, you actually lower your sleep drive, which will not support long-term sleep,” Manber said. “This is one of the main reasons why we don’t want people to spend too much time in bed: to make sure that you sleep well.”

Lying in bed only while asleep

People with chronic insomnia not only have difficulty falling asleep, but they also have to stay asleep. For example, if they wake up at 3 in the morning, they may not be able to fall asleep after a few hours.

According to CBTI’s standard recommendations, if people cannot fall asleep within the first 20 minutes of the night, they should get up and do some quiet things, such as reading a book, and then return to bed when they are sleepy.

Manber agreed. “You should stop trying.”

However, it is important to avoid any activities that cause physical or mental stimulation, such as cleaning the house or reading political books that irritate your emotions.

She said that despite this, not everyone is unable to get up in the middle of the night, for example, those who are bedridden or staying in hotel rooms with others. “In that case, you have entered the most important core here, and the core is that you stop trying to sleep.”

carry on

Some studies have shown that for people who wake up at midnight, “if you just lie in bed and stop trying and do some calming things, that can also help,” Manber said.

Some patients prefer to lie in bed and listen to audiobooks. “People choose to listen to books they’ve heard before,” Manber said. If you use any electronic devices, make sure to block blue light, which will interfere with your biological clock. Again, the trick is to find materials that are not too exciting. Instead, she said, people should listen to “something pleasant but compelling but not boring.”

In doing so, “their attention was removed from sleep. They stopped trying to fall asleep, and sleep surfaced and took them away.”



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