The CBT formula for good sleep

by BRENDAN STREET
Clinical Lead, Cognitive Behavioural Therapy      

MORE BY THIS AUTHOR
EMOTIONAL WELLBEING, EMOTIONAL WELLBEING AT WORK, LIFESTYLE MANAGEMENT, SLEEP, WELLBEING AT WORK​
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These cognitive behavioural therapy techniques retrain your body and mind to sleep well at night. Brendan Street explains the basic formula.Most of us will experience a lack of quality sleep at some time, and for some this endures over the long term. Whether you’re a new parent, a shift worker, or feeling the effects of stress and anxiety, sleep is often one of the first things to suffer and it can have severe effects on your overall health. 

Getting to the root of the problem is important, and small adaptions to your lifestyle can make a big difference to your sleep too. But there’s also a formula that is used by cognitive behavioural therapists to tackle the majority of sleep-disturbing factors. 

There are two main interventions that cognitive behaviour therapy (CBT) utilises in order to help an individual to tackle sleep difficulties. These interventions are sleep hygiene and stimulus control. Sleep hygiene is about forming good sleep habits and stimulus control works to strengthen the connection between the bed and sleep behaviour.

Implementing the key aspects of these two interventions will help individuals to unwind more quickly when they go to bed and so be ‘sound asleep’. The aspects of the two interventions fit conveniently into this acronym: 

Stimulus control
S – Sleep – The bed should be reserved for sleep and sex only. In order to strengthen the connection with the bed and sleeping you need to associate it with sleeping. The more additional things that you do in bed (read, eat, use smartphone, watch TV) the weaker, more diluted, the connection between sleep and the bed.
O – Observe - Whilst in bed observe the feel of the mattress beneath you, the comfort of the pillows, the sense of being ‘absorbed’ into the mattress. Try to make all the sensations associated with the bed and sleep as vivid as possible.
U – Unable to get to sleep - If you can't sleep after 15 to 20 minutes, apply the quarter of an hour rule. Get up, get out of bed and go to a different room and do something not stimulating for 20 to 30 minutes, then return to bed. If you are still unable to get to sleep after 20 to 30 minutes get up again. Repeat until you sleep. This is hard but necessary. If you lie in bed unable to sleep for long periods you start to associate your bed with wakefulness and maybe agitation. The only way to break the cycle is by re aligning the bed-sleep association.
N – No napping - In order to strengthen the connection between night-time sleep behaviour and the bed, you need to ban any daytime napping. It's essential to associate both the night (and the bed) with sleep and the day with wakefulness. 
D – Decide your routine and stick to it -  If you go to bed at 11:00 pm – always have a fixed rising time no matter how well you sleep. The amount of sleep we need differs from person to person but if you don’t have fixed bed time and rising time the risk is that sleep starts to ‘seep’ into the day and you lose that valuable association between sleep behaviour and night-time/the bed. 

Sleep Hygiene
A – Alcohol and nicotine - Both will interfere with sleep so limit these before bed
S – Sleep environment – Make sure the bedroom is dark enough, comfy enough (pillows, mattress), quiet enough with good air quality and appropriate temperature for sleep
L – Leave it out - Leave laptops, smart phones, TV’s, paperwork out of the bedroom
E – Exercise regularly - Around an hour's exercise a day will help, but leave a ‘buffer’ period of at least 2 hours before bed
E - Eat a balanced diet - Wakefulness can be caused by hunger, but going to bed too full can also cause wakefulness. As such, make sure you consume a balanced diet throughout the day and aim to have a ‘buffer’ period of at least 2 hours before going to bed after eating a large meal. If you’re up late and haven’t eaten for four to five hours a small snack before bed might prevent wakefulness due to hunger.
P – Plan for sleep – have a pre-bedtime wind down. Think of it as your very own – bath, story, bed. Children sleep well when they have a specific routine associated with bed time, and…so do we. As such, try to develop a ‘wind-down’ routine at least 60 minutes before you go to bed. This period should involve ceasing doing stimulating activities (e.g. paperwork) and instead engaging in more relaxing activities – e.g. having a bath, listening to relaxing music etc.
WEDNESDAY 5 OCTOBER 2016

The Science Behind Yoga and Stress
By Dr M Storoni MD PhD on Tuesday July 14th, 2015 - Uplift  

What does bending your body into yoga poses do to your brain chemistry and nerve connections?There are two functional parts of the brain that play a key role in stress. These serve the functions of emotion and cognitive function. So I am calling them the ’emotional’ brain (amygdala and its connections and medial forebrain structures including the medial prefrontal cortex) and the ‘logical’ brain (the dorsolateral prefrontal cortex, other parts of the prefrontal cortex, parts of the cingulate cortex and parts of the hippocampus).

The emotional brain is able to initiate a ‘stress response’ via the sympathetic nervous system which culminates in adrenaline and cortisol racing through our circulation.The logical brain is always trying to ‘turn-off’ this stress response and it is also trying to restrain the emotional brain. The stronger our logical brain, the better it becomes at doing these two things. When the stress response is ‘turned off’, our parasympathetic nervous system signal is ‘turned on’. This signal ‘relaxes’ the body. So a strong logical brain goes hand in hand with relaxation.

The stress response and ‘relaxing’ signals travel through the body along a particular route and parts of this route have little ‘switches’ which we can physically manipulate to turn the signals on or off. The neck is an example of where such switches are located (by the carotid arteries).
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“Everytime we are holding a posture our logical brain is being activated”

Training the stress circuit
Yoga is training this entire stress circuit at two levels. First, every time we are ‘holding’ a posture, staying very still to concentrate or trying to balance, our logical brain is being activated. When we are bending forwards, our ‘relaxation’ signal is being turned on through the ‘switches’ in the neck. So bending forwards and concentrating at the same time is triggering both the logical brain and the relaxation signal at the same time.

Bending backwards triggers the stress response signal through the switches in our neck. Contracting a muscle also triggers the stress response signal. So, when we bend backwards and contract our muscles while still having to stay still and concentrate on balancing, our logical brain is given an extra challenge. It has to overcome the stress response signal being triggered in these two ways before we can be still and concentrate during a posture. This ‘extra’ resistance the logical brain is having to work against, ‘trains’ it like a muscle.

“New circuitry that enables you to find it easier to control your thoughts is formed” 

Rewiring the nerve connections
At the end of a series of yoga postures, the logical brain has had a ‘workout’. It is buzzing with activity. You feel mentally calm as it is keeping your emotional brain quiet. Training the logical brain in this way for a long time can result in a rewiring of the nerve connections within the logical brain. New circuitry that enables you to find it easier to control your thoughts is formed. You may find it easier to channel your thoughts in the direction you want and not ‘dwell’ on negative thoughts or experiences. This is partly why yoga seems to have a positive effect on depression and anxiety, where sufferers have a tendency to dwell on negative life events. Stronger connections within the logical brain keeps the lid down on the emotional brain and the stress response. This is why yoga can be so effective at battling stress.
The key thing to do is to attempt yoga postures which are structured in a well-formulated sequence where each posture involves a long hold. Then your yoga and stress will begin to be balanced.
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