Forever Yawning: Behavioral Techniques for Sleep Problems

Julie Sherman, Ph.D.

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Recent reports indicate that insomnia is very common and occurs in approximately 30-60 percent of the general population. The DSM-IV-R defines insomnia as having problems with initiating and/or maintaining sleep, despite adequate opportunity and time to sleep, leading to impaired daytime functioning. Many individuals today have one or more sleep complaints, which include problems falling asleep, problems staying asleep or falling back to sleep after waking, waking early, and excessive daytime sleepiness.

When people come to see me about sleep problems, my first thought is towards sleep hygiene. Sleep hygiene involves several things, including a structured bedtime routine. Listed below are ten recommendations for improving the quality of your sleep:

  • When you feel rested get out of bed. Oversleeping will disrupt the circadian rhythm and actually make you feel more tired than refreshed.
  • Maintain a regular sleep schedule, and avoid napping during the day. This involves doing the same things to get ready for bed, and going to sleep at the same time every night.
  • Refrain from drinking caffeine or smoking in the evening as these activities stimulate the areas in your brain that are associated with arousal and wakefulness.
  • Refrain from drinking alcohol in the evening. Although alcohol initially makes you tired and relaxed, it also causes withdrawal symptoms when it leaves the body, resulting in frequent awakenings and poor, fragmented sleep.
  • Exercise regularly, but not 4-5 hours before bed. Exercise initially raises body temperature, but after 3-6 hours, there is a compensatory drop in temperature that maximizes drowsiness. Keeping your room at a cooler temperature will also help to make you tired.
  • Use the bed only for sleep, and not for working, reading, watching TV, eating, or other mentally stimulating activities. Even if the TV is on while you sleep, your brain is still working to decode what is happening.
  • Go to bed only when you feel ready to sleep. Sleepiness is signaled by behaviors such as drooping eyelids, involuntary nodding, and yawning.
  • Turn off the lights and all the noise in and around the bedroom. A quiet atmosphere will help you to relax more quickly and improve the quality of your sleep. Another helpful hint is to turn the clock away from you so that you cannot see it.
  • Get up at the same time very morning, even on the weekends. This helps to keep your body on a regular schedule. Don’t worry if you don’t sleep well one night, because the drive to sleep will be higher the following night.
  • If you do not fall asleep within 20 minutes after lying down, get up and try some relaxation techniques until you are ready to sleep again. Staying in bed only during sleep strengthens the association between your bed and sleeping. Instead of associating your bed with being awake, you associate your bed with being sleepy, and eventually, lying in bed will cause you to be tired, even if you weren't tired beforehand.
    • Relaxation techniques are a great way to relieve stress, and involve sitting or lying comfortably and relaxing muscles of the body in one area at time. This may be combined with biofeedback and deep breathing to promote further body relaxation.

Another evidenced-based, non-medical, behavior therapy for insomnia is called sleep restriction. Sleep restriction is based on the principle that reducing the time you spend in bed helps to solidify sleep. It creates a mild state of sleep deprivation that makes it easier to fall asleep and stay asleep. At first, clients are asked to record both the total time they spend in bed and the proportion of the time they spend sleeping. The next step is to limit the time you spend in bed to only the time that you spend sleeping. For example, a person who spends 8 hours in bed and only sleeps for 5 hours would be told to decrease the amount of time they spend in bed to 5 hours. Gradually, sleep time is increased by 15-20 minute increments until the client reaches his or her optimum sleep time.

Good sleep hygiene and other behavioral sleep interventions are an essential part in treating insomnia and other sleep problems, and better sleep leads to better daytime functioning. Contact me or the Tarnow Center for more information on self-management skills for initiating and maintaining quality sleep. The Tarnow Center has clinicians who specialize in Adult Psychiatry, Adolescent Psychiatry, Child Psychiatry, Adult Psychology, Adolescent Psychology, and Child Psychology in Houston and Sugar Land.

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