Bad sleep is a waking nightmare for millions. But while struggling to drift off often feels hopeless, around 90% could improve their sleep quality - and therefore their quality of life - in just one week, according to sleep expert Professor Jason Ellis.
A Professor of Sleep Science at Northumbria University, Ellis has devised a cognitive behavioural therapy (CBT) course which takes people through a series of seven steps, one per day, to tackle their sleep problems, all outlined in his new book, The One-Week Insomnia Cure.
“About a third of the population suffer from insomnia every year, and for about 10-15%, it persists,” says Ellis, who notes that what causes insomnia, and what makes it persist, are now the same thing. For example, if someone has a negative life event, a medical problem etc, they may have a stress response which lasts about two weeks.
“During that time, it’s quite normal to lose sleep, but it’s how we cope with it that largely keeps insomnia alive after that. People develop rituals and habits they think are helpful to get them back to sleep, or they develop worries, not only about not sleeping, but about its impact on the daytime. Those two things are what fuel insomnia, and turn it from what’s a normal stress response into what we see in clinics and hospitals,” Ellis explains.
THE WAITING GAME
People with insomnia tend to lie in bed just waiting for sleep to come, but that’s clearly not what good sleepers do. “If you ask any normal sleeper how they do it, they’ll say they just do - they get into bed and sleep happens. But people with insomnia are trying to sleep, and if you lie in bed and you’re actually trying to sleep, you’re going to get angry, frustrated and tense, and that’s really not conducive to falling asleep, “ says Ellis.
“People with insomnia will say they’ve tried everything, including over-the-counter remedies, their GP, and prescription sleep medication, and by that point they’re frustrated and knackered and they want someone to take this on. But what we need people to do is take this on themselves.”
THREE-STEPS TO SLUMBER
So how does Ellis think people should go about this? Sleep diaries are an integral part of his seven-day cure; they should be completed every morning, answering questions such as what time you went to bed, how long it took to fall asleep, how many times you woke, etc, both before starting the course and after, in order to give a rough estimate of timings.
Armed with your sleep diary, the basic course steps are...
: : Day 1: Sleep rescheduling
A personal sleep schedule is created by using the pre-course sleep diary to calculate your total sleep time (TST) average over a week, by estimating time in bed minus time awake in bed. Divided by seven days, this average becomes your prescribed time in bed (PTIB), which should never be less than five hours, as studies show that four hours sleep or less can have a significant impact on the ability to function properly.
From your PTIB, you calculate your bedtime and wake time, anchored to what time you need to get up and working back from that to determine your bedtime. If this new bedtime is much later than normal, Ellis suggests you can do anything you like during the pre-bedtime period, except work, exercise, eat, look at pornography, use a device which emits blue light, exercise or nap, as these aren’t conducive to immediate sleep.
: : Day 2: Stimulus control
This seeks to break the association between the bedtime routine, the bed, and not being able to sleep, by using the on-course sleep diary.
The rules are that the bedroom should only be used for sleep and sex, there should be no napping elsewhere, and if you’re in bed and can’t sleep, get up and leave the bedroom; Ellis suggests going to a warm place away from the bedroom for about 30-45 minutes, but don’t lie on the sofa, as you might fall asleep and sleeping outside the bedroom isn’t the aim.
“If you get out of bed, you start to break the association with the bedroom being somewhere you can’t sleep,” Ellis notes.
: : Day 3: Cognitive control
Designed to slow down your racing mind and reduce worry, this step involves determining a cut-off time when you stop all your daytime activities, like work. Then, at least two hours before bedtime, you write a series of lists about what you’ve achieved during the day, what you hope to achieve tomorrow and how you feel about it, followed by 20 minutes writing down your worries, and what you can do about them. Close the notebook and leave it with a pen by the side of the bed, in case you think of anything else during the night.
: : Day 4: Cognitive distraction techniques
These are the practical steps to slow down your racing mind, involving filling the mind with other, all-consuming, thoughts - alphabetical, numerical or visual - so negative, sleep-related thoughts don’t disrupt sleep. Examples of such techniques are counting backwards from 1,000 in sevens, or thinking of, say, a city beginning with A, and then thinking of a city beginning with whatever letter your first city ended with, etc.
: : Day 5: Decatastrophising sleep
The idea behind this step is to help poor sleepers identify and manage unrealistic and dysfunctional sleep-related thoughts. Ellis points out that during the night, whether we’re asleep or not, the part of the brain that controls rationality, reason and logic is ‘down-regulated’, or goes to sleep. As a result, even the simplest issue can seem more catastrophic at night.
He suggests writing down those night-time catastrophic thoughts during the day, assessing how likely your night-time self would believe the resulting worst-case scenario would be, and then comparing that assessment with your daytime view of the situation. Your night-time thoughts are likely to have been way off a realistic kilter, and Ellis advises: “Keep telling yourself something like, ‘My reason sleeps elsewhere’.”
: : Day 6: Sleep titration and progressive muscle relaxation
This stage is about assessing how well the previous techniques are working, and looking at additional relaxation techniques, including progressive muscle relaxation, which involves systematically tensing and relaxing muscles individually from head to toe, noticing the difference in how they feel, and deep breathing.
: : Day 7: Maintaining success and relapse prevention
To help round off the process, as well as identifying issues which may cause sleep disturbance in the future, this section contains suggestions for stimulus control methods, such as particular books which have helped prompt sleep in the past.
:: The One-Week Insomnia Cure: Learn To Solve Your Sleep Problems by Professor Jason Ellis is published by Vermilion, priced £10.99. Available now