Workbook for session 4. Improving Your Sleep. Putting it all together. Controlling your future

Workbook for session 4 Improving Your Sleep Putting it all together Controlling your future Stress affects sleep and the quality of our sleep can affe...
Author: Marjory Glenn
1 downloads 0 Views 491KB Size
Workbook for session 4 Improving Your Sleep Putting it all together Controlling your future Stress affects sleep and the quality of our sleep can affect how we cope with stress. Session 4 teaches you how boost your self-confidence by retraining your sleep Session 4 will also review your learning and encourage you to continue to work hard at putting it into action

Sponsored by Charlie Waller Institute from a donation made by the James Wentworth Stanley Memorial Foundation © Dr Jim White 2007 www.talkinttherapies.berkshire.nhs.uk

“I can go to bed at night feeling dog tired but as soon as that light goes out, my mind comes to life. I can’t shut it down and get to sleep. I toss and turn and feel rotten. Joe is fast asleep in seconds and I’m wide awake” “I wake up at two in the morning with a load of stupid thoughts going round and round in my head. I just get up and I spend half the night in the living room. I can't tell you how lonely I feel then. And of course, during the day, I am walking about half-asleep all the time" “I’m quite down just now and I find that I’m awake at 4 in the morning. And that’s me for the rest of the night. I’ll not get back to sleep again even though I want to sleep more” “I have to take a few drinks to get me off to sleep. But I wake up within a few hours and that might be me for hours” “I wake up and feel that I’ve hardly slept. I still feel tired and don’t feel I’ve got the energy to face the day”

These are all quotes from people who have a sleep problem.

-1-

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Reasons for poor sleep Sleep problems can come about for a range of reasons. Tick the ones that apply to you:

Stress You may find that you are better as long as you can keep busy and distracted. When you go to bed, a host of thoughts or worries can invade your mind. This stops you from sleeping.

Shift work This can badly affect sleep as your body can’t get into a good sleep habit.

Age As we get older, we need less sleep yet often try to sleep for the same number of hours as we needed when we were younger.

Need to go to the toilet This is often tied to age. Most people over 60 get up at least once a night

Pain Any illness that results in pain can cause poor sleep

Surroundings Sleep can be poor if you live in a noisy street or if the neighbours are playing music till all hours. Your room and bed may also play a part.

We will look at ways to overcome some of these later.

-2-

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Sleep problems and stress often go hand in hand. There are four main types. You may find you have more than one. Tick the ones that fit your sleep:

Getting off to sleep

You may feel dog tired when you get ready for bed. But as soon as you get into bed, you can’t get off to sleep. You are restless. You toss and turn. Your body may be tired but you mind is not. Your mind bursts into life and you can’t switch off. You get more and more annoyed and stressed.

Staying asleep

You may wake up at different times of the night. You may find it hard to get back to sleep.

Waking too early in the morning

You find yourself waking at 4am or 5am and know that you are not going to get any more sleep even though you want to.

Sleep quality You feel that you don’t get a good night’s sleep. You may feel you don’t get into a deep sleep. You may feel restless during the night. You do not feel refreshed by your sleep.

-3-

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

What happens when we sleep? Sleep is made up of 5 stages. When we first fall asleep, we go into Stage 1 sleep. This is very light sleep.

As you go into Stage 2 and Stage 3, your sleep gets deeper.

By Stage 4, you are in a very deep sleep.

You then go into a stage called Rapid Eye Movement (REM) sleep. This is when most of our dreams occur. (You will only remember your dreams if you wake up during this stage).

Once REM sleep is over, you go back to Stage 1 sleep. You go through this cycle about 4 or 5 times each night.

As you get older, you seem to need less deep sleep. This may be one of the reasons why older people tend to wake more often during the night.

A lack of REM and Deep sleep can badly affect you during the day.

-4-

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Daytime effects of poor sleep You need to sleep to recharge your batteries - both body and mind. If you don’t do this then you will drag yourself through the day. You may feel like a half-shut knife. You may feel tired, lethargic, irritable, less vigilant, take longer to react, make more mistakes, have poor concentration and poor memory. You just don’t feel ‘with it’. If your sleep is poor for some time, you will find it much harder to learn new tasks.

You may have a vicious circle - stress may cause you to sleep poorly, poor sleep causes more stress and so on....

Stress

Poor sleep

Controlling stress should help improve your sleep. You can also improve your stress by controlling your sleeping problems. This is a positive circle. The next section will show you how to do this.

Controlling your stress

Getting a better sleep -5-

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Getting a good night’s sleep

This handout will teach you how to assess and then treat your sleep problem. You will learn to do this in 4 steps:

STEP 1: know your enemy

STEP 2: relaxation

STEP 3: retraining your sleeping

STEP 4: sleeping tips

-6-

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Know your enemy

You will find diary forms at the back of this handout. Each form lasts for 4 nights and asks you 7 questions:

1. When did you try to go to sleep? 2. How long did it take you to fall asleep? 3. How often did you wake up last night? 4. How long did it take you to get back to sleep each time? 5. When did you wake? 6. When did you get up? 7. How was your sleep last night?

Fill them out each morning for at least three weeks. This will help you know your enemy better. In turn, you will find it easier to know exactly what the problem is and how best to fight it.

The Diary will also let you track your progress while using the techniques.

-7-

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Relaxation

Use either your relaxation CD or Breathing Retraining. The Breathing should be used as described in that handout. Follow these four stages if using the CD:

First stage

Learn to relax during the day (see ‘Controlling your Body’ workbook).

Second stage

Once you feel tired, go into bed and play the relaxation CD in bed. Use ‘Deep Relaxation’

Third stage

Move onto ‘Rapid Relaxation’ when you feel ready

Fourth stage

Try to get to sleep by relaxing yourself without using the CD -8-

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Retraining your sleeping This is a very good way to get rid of the bad habits that can keep poor sleep going. It is hard to do but well worth it in the end.

You must follow this approach to the letter. There are six stages:

STAGE 1: Don't go to bed until you feel sleepy Only go to bed once you start to feel sleepy. Don't go to bed because the others are going to bed, or you feel bored or because it is 'bed-time'. You must stay up until you feel tired no matter how long this takes.

STAGE 2: Your bedroom is only for sleeping This step gets rid of the things that keep you from sleep. While reading a book seems like a good idea, it is not. If you are reading, you are not sleeping, so it must go. So you should not read, watch TV, listen to the radio, write letters, phone friends, etc. This does not include sex. Sex can help relax you and may help you get off to sleep.

As soon as you get into bed, put the light out and try to sleep. Though you may know good sleepers who read in bed or watch TV, you must do these things outside the bedroom at least until you get on top of the problems.

-9-

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

STAGE 3: If you don’t fall asleep in 25 minutes, get up If you are not asleep in 25 minutes, you may not be asleep in 50. So after 25 minutes, go back to the living room. Don’t watch TV. Don't eat or drink. Try reading a magazine or listening to relaxing music. You must stay in the living room until you feel tired again no matter how long this takes. When you feel sleepy, go back to bed.

At the start, you will be up many times each night. It is hard to get out of a warm bed but you must do this.

STAGE 4: Repeat (and repeat and repeat) Repeat step 3 again and again if you have to. So you have 25 minutes each time to get to sleep. If you don't - it's back to the living room.

- 10 -

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

STAGE 5: Get up early each morning Get up no later than 8.30am. Set the alarm and as soon as it goes off, get up and out the bedroom.

Even if you feel that you have hardly slept a wink, you must follow this to the letter. You should also try to do this seven days a week, i.e. no lie-ins at the weekend until you get this problem sorted out.

STAGE 6: Don’t try to catch up on sleep You may want to nap during the day to catch up on lost sleep, e.g. after a meal. Don’t do it. Save the sleep for bedtime.

Work out when you most want to sleep during the day. Then work out a way of dealing with this - go out for a walk, phone a friend, etc.

KEEP AT IT This is a very good approach but it is also a hard one to follow. It makes great demands on you. It is very tempting to stay in bed after 25 minutes, to have along lie or to have an afternoon nap because you can hardly keep your eyes open. Fight these urges the whole way.

Don't expect rapid change. Your poor sleep may have built up over a long time. So it will take time to get better.

To help you along the way, the next few pages offer tips to help your sleep: - 11 -

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Sleeping tips

Your bedroom Make sure the bed and room are warm. If your bed is past its best and if you can afford it, think about getting a new one. The same goes for your pillows. Are the curtains heavy enough to keep the room dark?

Noise It might be hard to stop noise from outside the house. Make sure you control as much noise inside the house as you can.

Your partner If your partner snores or is restless, ask if he or she could move to another room if you have one until you start to sleep better. He or she must move - not you - as you must learn to sleep well in your own bed.

Exercise Exercise can help you sleep better. Do this in the morning, afternoon or early evening. A brisk walk for 20-30 minutes is as good as anything. But don’t do your exercise in the three hours before bed. - 12 -

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Relax before bed Try to slow down in the hour before going to bed. Have a hot bath; listen to music, read a book. If you work on the back-shift or are studying for exams, don't go straight to bed from your work. Give yourself time to switch off. Try to build up a relaxed routine

Caffeine Caffeine is a stimulant. You get it in tea, coffee, fizzy drinks, energy drinks and tablets, some headache tablets and pain killers. Try to cut down your caffeine intake across the day. Try to cut out as much as you can in the later afternoon and evening.

Smoking Nicotine, like caffeine, is a stimulant. Don't smoke in the three hours before bedtime. Never smoke during the night if you wake up. If you are a heavy smoker, you would be best to give it up. Ask your GP for help.

Alcohol If you rely on a night-cap to get off to sleep, you must stop this now. It may well get you over to sleep. But as the alcohol level in your blood drops, it will wake you again in 2-4 hours. It will then be hard to get back to sleep. It also disrupts sleep rhythms and cuts down your REM and deep sleep. Alcohol may keep stress alive and this, in turn, helps keep your sleep poor. - 13 -

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Warm milky drinks The old wives were right! Ovaltine, Horlicks or warm milk may help you get more deep sleep. Drink these instead of tea and coffee at night.

Food Try not to eat for about two hours before going to bed. Your body starts to work to digest the food. You want it to be slowing down. If you are hungry, take a very light snack. Try not to eat during the night if you wake up.

Drink Try to drink as little as you can in the evening. This may stop you from waking to go to the toilet during the night.

Your sleeping needs Most of us sleep around 7-8 hours each night. On the whole, we need less sleep as we grow older. Yet older people still try to sleep 7-8 hours. This may explain why many older people wake up in the latter parts of sleep. The amount of sleep also depends on your life-style. If you have young children who keep you on the go all day, you may need more sleep. If you are not active during the day, you may need less. Some people seem to thrive on only 4 hours a night.

So you have to find your own level. This may mean changing habits such as going to bed at the same time each night. Start to get a grip on your sleep by filling out the sleep diary first thing each morning. Keep filling them in as you use these ideas. You will then be able to see your progress. - 14 -

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Stress Control: Sleep diary When did you How long did How often did try to go to it take you to you wake sleep? fall asleep? during the night?

How long did When did When it take to get you wake? you back to sleep up? each time?

EXAMPLE 10.45

1) 25 min 2) 60 min

85 minutes

twice

7.15

8am

did How was your sleep last night? get

Usual - was restless and getting angry with myself. Didn’t feel rested at all when I woke. Couldn’t stop thinking about work.

Night 1

Night 2

Night 3

Night 4

Night 5

15

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Stress Control: Sleep diary When did you try to go to sleep?

EXAMPLE 10.45

How long did it take you to fall asleep?

85 minutes

How often did you wake during the night?

twice

How long did it take to get back to sleep each time?

When did you wake?

When did you get up?

How was your sleep last night?

1) 25 min 2) 60 min

7.15

8am

Usual - was restless and getting angry with myself. Didn’t feel rested at all when I woke. Couldn’t stop thinking about work.

Night 1

Night 2

Night 3

Night 4

Night 5

16

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Stress Control: Sleep diary When did you try to go to sleep?

EXAMPLE 10.45

How long did it take you to fall asleep?

85 minutes

How often did you wake during the night?

twice

How long did it take to get back to sleep each time?

When did you wake?

When did you get up?

How was your sleep last night?

1) 25 min 2) 60 min

7.15

8am

Usual - was restless and getting angry with myself. Didn’t feel rested at all when I woke. Couldn’t stop thinking about work.

Night 1

Night 2

Night 3

Night 4 Night 5

17

© Dr Jim White 2007 www.talkingtherapies.berskhire.nhs.uk

Controlling your future You have now learned a lot about stress and a lot about how to fight it. Now you are at a crossroads. One road leads to control over your stress. The other leads back to square one. This step will help you find the right road. If you do this, you will head down the first road. If you don’t, you might end up back where you started.

These ideas will help you go down the right road:

Dealing with set-backs 

Don’t expect progress to be easy or smooth. Set-backs are common. You should aim to slowly increase the number of good days and decrease the number of bad days.



Try to predict when a set-back is more likely - if there are problems in the house, stress at work, after drinking too much, etc. Work out ways to prevent it.



Don’t panic if you have a set-back. Accept what is going-on. Stand back and work out why you are having the set-back. Then work out what you can do about it.



Don’t see a set-back as putting you back at square one. If you have taken five steps forward and a set-back puts you back one step, you are still four steps up on the deal.

18

© Dr Jim White 2007 www.talkingtherapies.berkshire.nhs.uk

Let others help you 

Express your feelings to them and get things off your chest. Choose people you can trust to help you. Be comforted by their concern. Listen to their advice. If the advice is sound, act on it.

Learn to pat yourself on the back 

If you have reached any of the goals you have set. If you faced and then solved a problem. If you fought back worry then you deserve praise - give yourself some straight away.

Build up supports 

Stress can build up when you lack a range of supports in your life. If you have problems in one area of your life, you can lean on other supports until you sort out the problem. The moral is: don’t put all your eggs in one basket.

Make sure you keep relationships strong. Build up new interests, new hobbies. Work on your social life. Make sure you have a structure to your day or week.

Watch for problems creeping up 

Watch that old bad habits don’t creep in to your life. These could be to do with avoiding, cutting yourself off from others, drinking to control stress. Jump in and stop these dead.

19

© Dr Jim White 2007 www.talkingtherapies.berkshire.nhs.uk

Look into the future 

Face problems that lie in the future. Don’t just worry about the problems - work out how you are going to deal with them. Never just wait to see what happens. You must take control.



Don’t leave things to chance - think and plan ahead. Use the ‘Controlling your future' form on the next page. Most of all:

Believe in yourself

20

© Dr Jim White 2007 www.talkingtherapies.berkshire.nhs.uk

Controlling your future Now that you have learned a lot about stress, the hard work must begin. It is like passing your driving test - you know what to do but you have to practise hard before you will become a good driver. Over the next few weeks and months, you should keep an eye on your progress using this form. End of the first week:

End of the first month:

End of the second month:

End of the third month:

21

© Dr Jim White 2007 www.talkingtherapies.berkshire.nhs.uk

20 ways to cope Read through all these ideas and pick up the one's that best meet your need.

1) Deal with problems on the spot Don't bottle up your feelings. They will grow and grow inside you until they erupt. This will weaken your sense of control. So if there are problems at, e.g. work, make sure that you deal with them on the spot. Use Problem Solving to deal with them.

2) Strong, confiding relationships Stress often makes us harder to live with. This can weaken relationships. But we know that strong relationships can help fight stress. So if you have a weak relationship, work hard at fixing it.

3) Slow down Don't do things at 100 miles an hour. Eat, walk and drive more slowly. If you don't get as much done as you would like then it is no big deal. There is always another day.

4) Divide problems up If you face a huge problem and can see no way to cope with it, see if you can divide it up into ‘bite sized’ bits. Then tackle the bits one at a time. Problem Solving is very good for this.

5) Must’s and Should’s "I must see my mother today"; "I should offer to run the football team this year". Work out what is reasonable for you to achieve and be happy with this - "If I get through all the things I want to at home, I'll take a run down to my mothers. If not, I'll see her later in the week"; "I 22

© Dr Jim White 2007 www.talkingtherapies.berkshire.nhs.uk

don't get a chance to relax as it is so it's daft to take on more pressure - someone else can take a turn"

6) Coping with ruts If you feel your life is in a rut just now - same old routine day in and day out then think about change. Plan your week-ends - do something different - go for a drive, visit friends, go for a long walk. Take up new hobbies. Look for challenges. If you can afford it, plan the odd week-end away as a change of scenery can help.

7) One thing at a time Think of someone at work cradling a phone between his shoulder blade and ear. With one hand, he is writing a letter and, with the other, searching through some papers. At the same time, he is trying to grab a quick snack. He is overloading the system. If you are making a phone call, make only the call and nothing else. The message is don't keep too many balls in the air at the one time.

8) Look and sound relaxed Other people will pick up how you are feeling by seeing your ‘body language’. So try to look relaxed, e.g. don't sit on the edge of your seat, slow down your speech, relax your shoulders, don't fidget. Ask those close to you how you act when you are tense so that you know what changes to make. You will feel better if you know that, on the outside at least, you are looking calm. Use relaxation to help.

9) Past experience If you are in a jam, ask yourself if you have been in a similar jam before. How did you deal with it? If what you did worked, try it again. If it didn't, learn from your mistakes. 23

© Dr Jim White 2007 www.talkingtherapies.berkshire.nhs.uk

10) Don’t accept other people’s targets Do people expect too much of you? If you feel they do, confront this. Have a quiet word and try to sort this out. If you can’t agree, say 'NO'.

11) Eating Some people suggest that supplements of vitamins A, C and E help stress but this will not help unless your diet is very poor. Bear in mind that taking too many vitamins can be as bad as taking too little.

It may be that you can reduce stress levels in the short term by taking a lot of carbohydrates (potatoes, rice, pasta, bread, etc.) and cutting down on protein (meat, fish). So if you face a very stressful day, you might plan to have this meal the night before. But as you need balance in food, do not stick to a diet like this for more than a few days.

Over the long term, try to eat more healthy foods - get away from fried and fatty food. Cut down on sugar and salt. Eat fewer sweets and cakes. Eat more fruit, veg and whole-wheat bread. Don't eat too much.

12) Smoking Some people find that smoking helps them to relax. But smoking kills. It also floods the body with nicotine. This stimulates the body and may increase feelings of stress. Try to stop. Ask your GP for help.

13) Situations out of your control There are things in life that you can't change - maybe you are out of work, maybe a loved one is ill. If you accept that you can't do anything to change things for the better, this may help deal with the stress that remains.

24

© Dr Jim White 2007 www.talkingtherapies.berkshire.nhs.uk

14) Build relaxation into your life No matter how busy you are, put aside some time each day just for you. Go out for a walk, phone a friend, do the garden, read a book, watch TV, listen to music. Once you stop using the tape to relax, try to keep this time for yourself.

15) Prioritise If you do have a busy life, you must set up your priorities. Decide what has to be done and decide what can wait. Put these priorities in some order. Number 1 has to be done first thing, number 2 by 12 o’clock..........number 10 has to be done by the end of the week. Keep revising your list.

16) Do the worst thing first If you have a list of things to do, do the one you least want to do first. You can get it out of the way and the rest of the tasks will be easier to cope with. If you keep putting it off, it will prey on your mind and may seem a lot worse than it really is. Tie this in with your priority list.

17) Don’t try to be Superman or Wonder woman Do you try to do it all? succeed at everything?, be the best?. Why? Bear in mind that the house or your job will still be there long after you are gone. Stick to your good points and learn to live with your faults. Accept you are not perfect. None of us is.

18) Confide in others If there are people around whom you can trust, let them know how you feel. They may be able to see ways out of problems that you have not thought about. In any case, getting things off your chest can help. It may also help reduce the feelings of being alone that are so common in stress.

25

© Dr Jim White 2007 www.talkingtherapies.berkshire.nhs.uk

19) Other people’s shoes Imagine you have a problem. Imagine how you would react if a friend came to you with that same problem. What advice would you give them? Would that advice work for you?

20) Keep up a routine If you are off work, make sure you get up early. Make sure you get dressed first thing. Make sure you eat cooked meals at the right times. As far as you can, make sure you do the same things that you normally do. Keeping a structure in your day will help hold back the problems.

Good luck

26

© Dr Jim White 2007 www.talkingtherapies.berkshire.nhs.uk