Free Sleep Soundly Every Night, Feel Fantastic Every Day by Robert S. Rosenberg Page A

surrounding the rituals of going to bed and the bedroom environment. A good night’s sleep becomes impossible. In fact, some find it easier to sleep in a foreign environment, such as a hotel or at a friend’s house that does not contain stimuli that trigger their anxiety about sleep. I find that some actually sleep better in our sleep lab than at home. Sleep specialists call this Reverse First Night Effects.
    This treatment focuses on reducing exposure to things that cause wakefulness at night, and the goal is to establish immediate sleep and an optimal sleep–wake cycle. This therapy helps an insomniac to reprogram negative associations about going to bed, the bedroom rituals, and the environment, into a pleasurable or desirable activity for the specific goal of sleep. Instructions for this therapy include:
    1.   Go to bed only when sleepy.
    2.   Get out of bed when unable to sleep.
    3.   Go to another room and return to bed only when sleep is imminent.
    4.   Curtail all sleep-incompatible activities.
    5.   Rise at a regular time every day, regardless of the amount of sleep the night before.
    6.   Avoid napping.
SLEEP RESTRICTION
    This method ensures the time spent in bed corresponds to the actual time you are sleeping, and not the total time spent in bed trying to sleep. You are in bed only to sleep, and you limit the time in your bed not sleeping. You go to bed later but maintain the same wake time, and then increase the time in bed over a specific period, according to your sleep expert’s guidance, until you sleep all night.
    For instance, you sleep only six hours but spend eight or more in bed. In sleep restriction therapy, the sleep specialist will start you at six and one-half available hours for going to sleep and waking up. The specialist checks your sleep diary weekly to see if you are sleeping more than 85% of the time spent in bed. If yes, then he will extend your total sleep time available in bed by 15 minutes. This sleep time will be extended or shortened weekly, depending on whether you are sleeping more or less than the 85% of time available to sleep.
COGNITIVE BEHAVIORAL THERAPY (CBT)
    CBT is a form of psychotherapy or counseling, with varied techniques to help you regulate your thoughts as well as behaviors around sleep. The focus on thinking about how you feel and act helps you become more aware of negative thought patterns that prevent you from changing behaviors. In time, you’ll learn how to regulate behaviors using CBT techniques. CBT is used for persistent insomnia, as the primary disorder, along with coexisting disorders.
Cognitive Restructuring
    Some insomniacs develop numerous dysfunctional beliefs about sleep. Thoughts listed on page 71 are just a few common examples of what I hear every day from my patients.

    Â Â  I know if I don’t get eight hours of sleep I’ll be miserable all week.
    Â Â  Insomnia is going to severely impact my health.
    Â Â  I just know I won’t be able to function.
    Â Â  I’m going to lose my job.
    Is it any wonder that these people cannot get good sleep? In fact, these negative experiences and counterproductive behaviors stimulate the production of stress hormones, making sleepless nights even worse. Cognitive restructuring challenges the person to validate the reality of his or her proclamations.
    A sleep specialist may challenge or query in friendly ways: “Let’s get a reality check. Show me the evidence for that belief. Let’s track your week and see how that thought plays out.” The point is to empower the patient to notice and observe, record, write or keep track, and then be accountable to report and process the findings with the sleep expert. CBT is based on the premise that incorrect thoughts lead to emotional suffering and habitual thoughts become embellished. A diary or record of the thoughts and feelings helps you identify and change the habits that do not work for you (see