A Time to Sleep
Donald A. Cadogan, Ph.D.
That we are not much sicker and much
Madder than we are is due exclusively
To that most blessed and blessing of all
Natural graces sleep.
- ALDOUS HUXLEY
Surveys by the National Sleep Foundation indicate that over forty million adults in the United States suffer from some kind of sleep disorder. Sleep difficulties, especially in the form of insomnia, are also among the most common problems encountered in psychotherapy. Medical and psychological issues are often at the root of these difficulties. But chronic lack of sleep can produce its own problems, which, in turn, may further aggravate the original underlying issues.
Over the centuries we have tried a variety of remedies for sleeplessness. These include such diverse procedures as counting sheep, consuming alcohol, smoking marijuana, drinking warm milk, taking relaxing herbs, and using other over-the-counter sleep inducing drugs. Although useful to some extent, many of these remedies are ineffective for the long haul, especially when the insomnia is more than mild or the root cause is not addressed. In our search for relief from sleeplessness many of us have turned to medical treatment for help. But because many hypnotic, or sleep-inducing prescription drugs are readily abused this has often resulted in an excessive and problematic use of sleep medications.
Each year, according to the National Sleep Foundation, over fourteen billion dollars is spent directly on medical treatment for sleep problems. And much of this is spent on drugs prescribed to induce sleep. Unfortunately, the medical research and testing phase for most of these drugs is usually only four weeks, which means they are not really approved for use beyond this period. Although there are some exceptions, it can be unwise for many people to use hypnotic drugs for longer periods. Clinical findings indicate that excessive use of sleep-producing compounds can actually cause sleep disorders. Hypnotic dependency or drug-induced insomnia has become a prominent diagnostic entity.
An important exception is worth noting here. Older people often sleep less with sleep patterns of poorer quality. These sleep changes frequently result from cerebral changes associated with age. The resulting down shift in sleep has been linked to a number of medical and psychological problems including memory loss and depression. Treatment often requires medication.
With the exception of this and other severe medical conditions, treatment of chronic insomnia today tends to minimize the use of drugs and relies more heavily on modern psychological and psychotherapeutic techniques. I will be discussing four effective techniques that are in current use. However, you will probably find that these techniques are more effective when you have some knowledge about the sleep process. In fact, I have found that an understanding of this process by some people was all that was necessary to eliminate their sleep complaints.
WHAT IS SLEEP?
Science defines sleep on the basis of brain wave patterns. Several times each night we pass through four sleep stages. These stages are characterized by distinct differences in rhythmic, electro-chemical wave patterns. We enter sleep at stage one, descend to stage four, which is deep sleep, them ascend back to stage one. Stage four is important for growth hormone secretion, which encourages growth in children, and aids muscle repair in adults. Stage one ascending is usually where we dream. This cycle takes about ninety minutes and is repeated four or five times each might. There is some variation in these stages throughout the night.
We are still not exactly sure why we sleep, but evidence indicates that it is vital to our mental and physical functioning. Without it we would die. Some believe sleep enables us to restore body chemicals depleted during wakefulness. This argument has clinical support. However, the biochemical process involved is yet to be fully specified.
Although biochemical restorations do clearly take place during sleep, the time required for this process varies widely. Infants tend to sleep fourteen to eighteen hours per day. Five-year olds usually sleep ten to eleven hours. Young adults average around eight hours. Older people often need less sleep than younger people. It is not uncommon for people who needed eight hours per day as young adults to require only five hours when they are in their sixties.
Within each age category there is much individual variation. Some people need a great deal more sleep per day than is average for their age group while others seem to get by with very much less sleep. Thus, the effect of lost sleep would differ in accordance with individual differences in sleep need.
But misunderstandings about these personal variations have led some people to believe they had insomnia when in fact they were merely short sleepers. It is more important that you feel restored after your sleep than that you sleep a specific amount of time. The best way to avoid worry or confusion here is to adjust your sleep time to your individual needs. And this adjustment should be based on how rested you feel when you awaken and not made by comparing yourself to a possibly inapplicable eight hour per night sleep standard. People who are normally wide awake when they go to bed and, thus, unable to sleep might well be victims of this eight-hour myth.
It is helpful to know, however, regardless of individual differences that our physiological rhythms, or internal clocks, are usually consistent and follow a sleep-wake cycle that recurs naturally every twenty-five hours. This is called the circadian rhythm. If we let our sleep-wake cycle run on its own and not be influenced by clocks or changes in light we would tend to sleep later and go to bed later each day. However, since we live in a twenty-four hours-a-day world it is necessary to reset this cycle daily, which we do when we keep consistent bedtime schedules. In other words, the sleep-wake routines we create for ourselves help set our internal clocks and have an important influence on both our readiness and capacity for sleep
But when we need sleep and try to obtain it, but can’t, what do we do?
First of all, it is important to know that when your body must have sleep is will be impossible to stave it off. In other words, you are not really going to die from lack of slumber. Worrying about your nocturnal experience only compounds the worries that may already be interfering with your sleep and tends to prolong the time of sleep onset. However, there are some things we can do to facilitate sleep induction.
Proper sleep hygiene is important. Briefly, this means keeping regular sleep hours. Go to bed and get up at the same time each day. Keep this pattern even on weekends if possible. If you are having sleep problems, especially insomnia due to sleep phase issues this can be vital. The wake up time is actually the most important. The reason for this is simple. We can make ourselves wake up and get up in the morning, but we can’t make ourselves sleep when we go to bed. The ideal is to go to bed when you feel ready for sleep but arise at the same time each morning. By engaging in some relaxing activity before bed and until “ready” for sleep you will find it easier to fall asleep when you go to bed.
It is important to know that, short of using drugs, we cannot make ourselves sleep we can only let ourselves sleep. Therefore, in order to sleep we will need to create the conditions necessary for somulence, and then simply let it happen. Remember, the more you press for sleep the more tense and awake you become.
The general rule for dealing with insomnia is: 1. If you are lying awake in bed and are unable to sleep, get out of bed. Go to a different room and read a book, watch television, or do something else restful. Return to bed when you feel sleepy. Tossing and turning all night while trying to sleep can turn your bedroom into a torture chamber. 2. If you are lying awake in bed, but you feel sleepy and comfortable – stay in bed. This may be the time to use the relaxation techniques described next. To ease your worry here, know that just lying in bed can be very restful and restorative even when you don’t (or don’t think) you slept, provided you are not being physiologically activated through worrisome thoughts. Many people feel sure they have been awake all night when actually they have drifted in and out of different sleep stages, but have no awareness of it.
In order to enter sleep we must first pass through a pre-sleep stage. This stage has been termed the alpha stage, which is named after the brain wave pattern produced during this period. Throughout alpha, we are awake, but very relaxed. This is the stage we are in when we are hypnotized or in deep meditation. Hypnogogic reverie or a free-floating, waking dream type of experience often accompanies alpha.
Most of our sleep problems are characterized by difficulty in letting go of the day’s concerns and, thus, difficulty obtaining the relaxation experience associated with a the pre-sleep alpha stage. The sleep induction techniques that seem most effective are procedures that help bring us to the alpha state. Once this is achieved, sleep generally follows. I will describe three techniques that can help us achieve alpha. These procedures have been descriptively called Thought Stopping, Fantasy Switch, and Passive Meditation. A forth mode of sleep induction also available to us is through the use of hypnotic/sleep tapes.
This procedure is based primarily on the premise that thoughts produce feelings and physiological states that can be incompatible with sleep. In other words, our thoughts can prevent us from sleeping. Thought Stopping allows us to replace troublesome or anxiety producing thoughts with the word “stop.” We simply get into the habit of shouting “stop” silently to ourselves whenever wake intrusive or disturbing thoughts invade our consciousness. It is important to note, however, these disturbing thoughts readily return and it is necessary to be persistent. But eventually the thought stopping method becomes almost automatic when we are trying to sleep. To make Thought Stopping more effective some people also visualize a stop sign when they become aware of sleep disturbing thoughts. This combination of imagined auditory and visual stimuli can, for many people, effectively terminate unwanted thought and lead to restful sleep.
There is one caution, however. Thought Stopping essentially forbids unwanted thinking and can induce an element of fear. When people who are very anxious or obsessive use this method it can actually increase the staying power of the thoughts and make them more difficult to banish.
This technique is similar to Thought Stopping and can be used in conjunction with it. When using Fantasy Switch, instead of just stopping the unwanted thought, you switch it to a more relaxing fantasy. The relaxing fantasy produces the physiological state concomitant with relaxation and can lead rapidly to pre-sleep alpha. To use this technique try to remember or fantasize about the most relaxing experience you ever had or ever would like to have. It is important to visualize the experience as though in your mind you were watching a movie of yourself. For example, I am sometimes able to relax by visualizing a picnic I went to with my wife. After the meal I reclined under the silent and peaceful shade of a beautiful tree. I felt very relaxed then and tend to relax whenever I think of the experience. At bedtime I substitute the worrisome, disturbing thoughts of the day with this relaxing fantasy. Thus, I am able to reproduce a state of relaxation and am usually able to move towards pre-sleep alpha. Gently relinquishing the fantasy at that point allows me to pass through alpha and on into sleep.
The two methods just described can be considered active processes in that they are actively forced into use. They also work well together. Thought Stopping can be used first to drive out unwanted thought. Fantasy Switch can then be used to keep the unwanted thought from returning.
The next technique to be described requires less active participation or manipulation of thought. As a result, a sense of failure potentially associated with any active endeavor is less likely to be experienced during the critical learning phase. And, of course, for anxious or obsessive individuals, the danger associated with having unwanted thoughts when using Thought Stopping is diminished.
This method is very similar to some of the procedures used in Transcendental Meditation and is adapted from a process developed by Herbert Benson, M.D. called the Relaxation Response. Unlike Transcendental Meditation, however, no secret mantra need be used and, unlike the Relaxation Response, the individual assumes a reclining position as when sleeping. There is also nothing mystical or religious about this procedure. Passive Meditation is actually my personal favorite.
To use this technique, select a non–stimulating or psychologically neutral syllable such as “L” or “M” or any letter, number or sound that feels pleasant or comfortable. Benson uses the word “one”. I am partial to the sound “Ohm” which is the more classic mantra sound. Some people use the word “calm”, but this tends to place a demand on the sleeper. Whichever you use, the sound is repeated rhythmically and silently as you breathe out, usually at the end of the breath. No effort is made to concentrate on the sound; it is just repeated mentally. Any thoughts that come to consciousness are very gently disregarded as the steady rhythmic and relaxing sound continues mentally. This process once mastered leads quickly to alpha state relaxation. For many people, obtaining and sustaining alpha is their only goal. This is accomplished by meditating in a seated position. Sustained alpha stage relaxation has amazing rejuvenating powers. However, for sleep induction Passive Meditation is best performed in a sleeping position. This more relaxed posture allows the individual to effectively and comfortably pass from the alpha state into initial sleep and beyond to deeper stages.
The principle difference between Passive Meditation and the two previously mentioned methods is that with this procedure unwanted thought are passively disregarded instead of actively avoided or substituted.
Self-Hypnotic Sleep Induction
This procedure, as I describe it here, is a combination of both passive and active forms of sleep induction and can be used on nights when your sleep difficulties are particularly stubborn. Self-Hypnosis is an active state due to its fantasy component, but I recommend using it in conjunction with Passive Meditation as a hypnotic induction procedure. Passive Meditation actually induces a light form of hypnosis in which a very restful alpha state is induced. You can deepen this hypnotic state by using a more focused form of Fantasy Switch. After you are more relaxed, simply see yourself going to a very restful place like a beautiful beach or a serene forest. You can give it hypnotic power by incorporating as many of your senses as possible. For example, if you fantasize about going to a beach you can not only see yourself at the beach, but you can also let yourself hear the waves and the sound of the sea gulls, you can feel the warmth of the sun or cooling breezes on your body, and you can smell the special fragrance of the ocean. These aspects help to narrow your focus and further draw your attention away from your troublesome thoughts and sleep disturbing issues.
One other procedure more in the passive catagory of sleep induction is the use of hypnotic/sleep tapes. Here, the individual is lulled into a relaxed state through the use of recorded hypnotic statements and/or vividly describe relaxing scenes. Nature’s naturally relaxing sounds are also used, such as ocean waves, rainfall, gentle water flowing, etc. Tape-recorded messages to induce sleep can be effective even when other methods have failed.
I have put together a sleep tape based on a hypnotic fairy tale that many people suffering from insomnia have found helpful.
All these methods are designed primarily to deal with and effectively ameliorate insomnia, but without the potential side effects of drugs. However, in some cases drugs are necessary. In these cases it is wise to follow the advice of a prudent physician who has a thorough understanding of sleep disorders. Beyond this, the problems causing your sleeping difficulties may require attention and resolution.