Getting enough sleep is crucial to both our physical and mental health. We can implement every other mental and physical health strategy to perfection, but if we’re not getting enough sleep we will never be at our best.
Research indicates that sufficient sleep has a large positive effect on a whole host of physical and mental aspects of our health, including: emotion regulation, cognitive thinking, decision making, attention, memory, and it also plays a large role in protecting the immune system. Until recently we have known very little about what happens in the brain when we sleep, and although we still have much to learn, we are starting to understand more about what happens when we go to bed at night.
THE SLEEP CYCLE
We now know we cycle through different periods of sleep several times a night, and in the final stage of each of these cycles we enter Rapid Eye Movement sleep (REM), the period when dreaming occurs. It’s thought REM sleep is particularly important for our wellbeing, as it’s involved in replenishing our neurotransmitters, cleaning out toxins, and consolidating our memories. Research has also indicated those who have more REM sleep tend to have lower amygdala reactivity (the part of the brain that activates the anxiety response), and as a result, less anxiety. So getting a good night’s sleep plays a key role in calming the amygdala and decreasing anxiety. Conversely, lack of sleep increases reactivity in the amygdala, raising our general levels of anxiety and making us more sensitive to other emotional states such as anger and irritability.
So how much sleep is sufficient? Eight hours of sleep is normally the magic number suggested to ensure the brain is performing at its best, but recent research suggests it varies from individual to individual, and the optimal time is somewhere between seven to nine hours. However, these recommendations miss out on an important understanding of the sleep cycle.
The full sleep cycle lasts around ninety minutes and goes through five stages, with the REM part of the sleep cycle being the last stage:
Stage 1 — Light sleep in which we drift in and out of sleep and can be awakened easily.
Stage 2 — Still in light sleep. Heart rate slows and body temperature drops. The body is getting ready for deep sleep.
Stages 3 & 4 — These are the deep sleep stages. Difficult to wake up. No eye movement or muscle activity. Waking in these stages feels disorientating.
REM Stage — Breathing becomes more rapid, irregular, and shallow, our eyes jerk rapidly in various directions, limb muscles become temporarily paralysed. Heart rate also increases and blood pressure rises. We dream in this stage and waking during REM sleep often comes with bizarre and illogical thoughts as dreams are recalled.
After completing a full cycle we return to the first stage again and repeat this pattern throughout the night. The first few sleep cycles of the night contain relatively short periods of REM sleep, but long periods of deep sleep. However, as the night progresses, the periods of REM sleep increase in length, while deep sleep decreases. By morning, we spend nearly all of our sleep time in stages 1, 2, and REM.
If we wake up during one of the ninety minute cycles, we start again at the first stage when we go back to sleep, regardless of what stage we woke up in. Then we cycle through the stages until we get to the REM stage again. So two hours of sleep, followed by a period of being awake, and then another five hours sleep isn’t necessarily the same as seven hours of continuous sleep. You don’t carry on where you left off in the cycle, you have to start again at the beginning. Keep this in mind when you’re assessing your quality of sleep.
GETTING TO SLEEP WHEN ANXIOUS
Getting a good night’s sleep is often a struggle for people with anxiety because the amygdala is regularly in an aroused state and the sympathetic nervous system is chronically activated. This makes going through the sleep cycles more difficult and is often compounded by worrying thoughts that make it more difficult to drop off. So the key to sleeping well is to try to (1) ensure you’re in as calm a state as possible before going to bed, and also (2) finding a strategy that enables you to fall asleep without too much trouble. You may not always have the time to create a calm environment but it’s important to take some time do so if sleeping is a problem for you. Once you’re able to sleep consistently well, you will be able to be more flexible with your routine.
1. Creating a Calm State
Activities that will help to enter a calmer state before going to bed include:
A consistent and relaxing routine before bedtime — stick to a consistent bedtime on most nights, at least until you start to begin to sleep well. By repeating a regular pattern, you will condition your body and mind to realise it’s time to go to sleep. Begin your routine about 30 to 60 minutes before bedtime and build activities into this time that will reduce stimulation and help you relax; such as reading, having a bath, or listening to music.
Eliminate as much light as possible — avoid television, computers, tablets and smartphones. Numerous studies suggest blue light in the evening disrupts the brain’s natural sleep-wake cycles. If you do go online, use an app or software that eliminates blue light on electronic devices. Many can be found by searching for ‘blue light’ in both iPhone and Android app stores.
Create an environment conducive to sleep — make your bedroom as dark as possible and remove all distractions to sleep out of the bedroom (electronic devices, televisions, work items etc.).
Avoid caffeine, alcohol and spicy foods from early evening onwards — these will stimulate your brain and body.
Exercise earlier in the day — physical activity will help tire your body and make it more ready for sleep, but try to exercise no later than early evening to avoid over stimulating your body before bedtime. This doesn’t have to involve going to the gym or running for miles. A short brisk walk can have an excellent impact.
Avoid napping during the day — this is especially important if you’re not getting a full night of sleep.
Just before you get into bed do some relaxed breathing or a short meditation.
If none of these strategies appeal to you, do anything you want to do before bedtime, but ensure that in the last two hours before you attempt to go to sleep you avoid work, food, exercise, blue light, and pornography (this is not a moral judgement but a strategy to reduce stimulus before bedtime).
2. Strategies to Fall Asleep
While changing your bedtime routine to maximise the chances of going to bed in a calmer state of mind will definitely help with getting to sleep, people who struggle with anxiety often find as soon as they get into bed and can no longer distract themselves, they start worrying or ruminating. This worrying stimulates the cortex, activates the amygdala, and can make dropping off to sleep very difficult. So what can we do to help us drop off to sleep quickly?
Some of the traditional methods used for getting to sleep, such as counting sheep, are often ineffective. Just knowing we are consciously trying to get to sleep often makes it very difficult, and boredom inducing strategies tend to make our anxious thoughts even more attractive and often keep us awake for longer. However, there are some exercises known to be effective:
Cognitive shuffling — This involves mentally picturing a random object for a few seconds before moving onto another: a carton of milk, a car, a castle, a paperclip, and so on. It’s important to ensure the sequence is truly meaningless, otherwise you’ll drift back into rumination. This method was developed by Canadian scientist Luc Beaudoin, and described by journalist Oliver Burkeman in his health and wellbeing column in The Guardian newspaper. The exercise is based on the theory the brain tests if it’s safe to fall asleep by checking what our cortex is doing. If the cortex is engaged in rational thinking activity, it determines it may be considering dangers and it would therefore be best for us to stay awake. However, if the thoughts are random nonsense, the brain considers we are relaxed and tired, and sleep should be induced.
Cognitive shuffling also reduces rumination by the simple fact that it’s difficult to focus your attention on more than one thing at a time. It’s hard to ruminate about a problem at work if you’re busy generating images of balloons, cheese, and train carriages. Beaudoin has an app that provides random words and speaks them into your ear. However, I’d suggest avoiding using an app or headphones in bed, as sleep aids like this, while useful for a time, can act as a crutch, and make sleeping without them difficult in the future. Instead, it would be more effective create these random words yourself by going through the alphabet and naming as many items as you can think of for each letter before going on to the next.
Scanning through your day in detail — This exercise involves mentally going through your day in detail, starting from the moment you woke up. So when you get into bed, close your eyes and recall the very first moment of the day you can remember, and then scan through the day as if you’re fast forwarding a video. Don’t do this too quickly, just do your best to remember all the different parts of the day. It has a certain rhythm to it. So it might be something like this: I woke up — walked to the bathroom — went to the toilet — brushed my teeth — had a shower — woke my child — went into the kitchen — made the breakfast — brushed my teeth — walked to the car — drove to work, and so on. Just work your way through the day remembering all of the different things you did. It should take a few minutes. You may get to parts of the day you’d like to pause and spend a little bit of time thinking about, but don’t pause, just keep going, leave that behind. Let go of the conversation or situation you’d like to focus on and continue to work your way up right up to the present time when you’re in bed. Notice when your mind wanders off from scanning the day, and when you realise it’s wandered, just gently bring it back to the scanning, starting up again from you left off.
When you’ve finished scanning through your day, very slowly start to become aware of your breath. Don’t change it, but just be aware of it. Count your breaths until you get to ten. If you lose count or your mind wanders, don’t worry, just bring your attention back to your breath and start again from one. If you’re still awake at this stage, start counting backwards from 100 right the way down to zero, not with the intention of falling asleep but with the intention of getting to zero. If you’re still awake after reaching zero, start again at 100 and count down again, and keep repeating this.
Sleep meditation — there is an extended audio guide version of the above exercise, with a few extra stages in, including a meditation tailored for sleep. If you find you are still unable to sleep. You can access and download the exercise here: Dr Matt Lewis — Sleep Meditation
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