I Can't Sleep....

By, Dr. Meghan Dow DNP-PMHNP, CARN-AP

              Insomnia can impact us for many reasons, and in the realm of psychiatric conditions it is all too prevalent. Cognitive Behavioral Therapy for Insomnia (CBT-I) is first line treatment for insomnia. But is there anything I can do first?

Start with tracking your sleep

              Do it yourself with a sleep journal/diary (attached version below). I recommend hanging on your mirror in the bathroom- completing each night before bed and morning when you wake. Or of course there is an app for that! You can use a variety of sleep tracking devices- Apple Watch, Oura Ring, and Fitbit watch. The Oura Ring is my recommendation because of its strong comparison rates to the polysomnography (formal sleep study). But what if you don’t know what the results mean? Most of the apps give you a rating score- you can review for yourself too. You want to have 4-6 sleep cycles a night, with REM sleep stages (20-25% of total sleep time) and deep sleep comprising (20-25% of total sleep time). If you are not using a device you will not be able to monitor this, total sleep hours can be used for baseline monitoring- school aged children should get 9-11 hours; teens 8-10 hours; adults 7-9 hours and older adults 7-8 hours.

Break the bed-insomnia connection

              Avoid doing anything in bed besides sleeping. Meaning in the wind down phase at night do it out of bed and go to bed when you are tired. If you cannot sleep in what is perceived to be 20 minutes (DON’T clock watch), get up and do a non-stimulating activity and return to bed when you are tired. Have a set wake point/time in the morning. Avoid snoozing!

Build a sleep load

              We build this through the day in a variety of ways, increasing exercise can help significantly. You want to expend energy. Avoid daytime napping when not a threat to safety.

Discover your wind down activity

              You can do this by trying different activities before bed, the longer you engage in any activity the more activating it is for you. Try to find non-stimulating activities to use 1-2 hours prior to sleep, or just find the activating activities that activate you and avoid these 1 hour before bed.

https://www.nhlbi.nih.gov/resources/sleep-diary

For established clients we offer 6 week CBT-I groups, ask your provider about availability.