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STOP WORRYING AND GO TO SLEEP: HOW TO PUT INSOMNIA TO BED FOR GOOD Copyright © 2015 by Clinical Psychologist, Dr. Steven Orma www.drorma.com

All rights reserved. You do NOT have permission to copy, re-distribute, resell, auction, or otherwise give away copies of Stop Worrying and Go To Sleep: How to Put Insomnia to Bed for Good, whether in eBook or physical book format. EBooks are protected by international copyright laws. If you attempt to do any of the above methods of distributing this eBook, you are in violation of international copyright laws and are subject to fines and imprisonment. Copyright infringement is a serious crime with fines starting at $150,000 and up, including potential imprisonment upon conviction. DO NOT risk getting yourself in legal trouble by illegally distributing this eBook. You DO have permission to print one copy of this eBook for your own use, or copy the pdf file for the eBook to a back-up drive or CD for your own file back-up use.

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Introduction ............................................................................................................................... 4

How to Use This Book .............................................................................................................. 5

1. Framing Sleep as a Pleasant Experience ...................................................................... 6

2. Myths About Sleep and Insomnia ................................................................................... 8

3. The Cause of Insomnia .................................................................................................... 11

4. Motivation: A Surprising Question .............................................................................. 12

5. Make Your Bed a Cue for Sleep ..................................................................................... 18

6. Making Sleep More Efficient .......................................................................................... 23

7. Tackling Worry .................................................................................................................. 25

8. Decreasing Stress .............................................................................................................. 35

9. Imagining Yourself as a Good Sleeper ....................................................................... 42

10. Your Sleep Surroundings ............................................................................................. 46

11. Relaxation Exercises...................................................................................................... 49

12. Exercise and Sleep .......................................................................................................... 58

13. Sleeping Pills and Herbal Remedies ........................................................................ 62

14. Food, Stimulants, and Alcohol .................................................................................... 65

15. Other Possible Insomnia Triggers ............................................................................ 69

16. Preventing Relapse ........................................................................................................ 72

Sleep Cheat Sheet ................................................................................................................... 74

Frequently Asked Questions .............................................................................................. 75

Mental Health Resources .................................................................................................... 77

About the Author ................................................................................................................... 78

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Introduction

Let’s face it: insomnia sucks. That’s not a very elegant way of putting it, but it summarizes the experience perfectly. As a licensed clinical psychologist specializing in insomnia and anxiety, I have seen countless individuals struggle through the painful experience of not being able to sleep. In addition, I have personally experienced insomnia myself, which made me firsthand aware how unpleasant poor sleep can be and how it can negatively impact your energy and mood. After researching and trying existing insomnia programs, I discovered several problems and elements lacking:

Not enough skills for managing anxiety, negative thinking and rumination Required tedious sleep habit recording/calculating Too much clinical jargon Too much unnecessary information Viewing sleep only as a “necessary” activity, rather than framing it as an

enjoyable experience that can enhance your life

Struggling through these flawed programs, many people give up and continue to suffer needlessly. My determination to create a better insomnia program and help people sleep soundly motivated me to write this book. Using scientifically studied, proven techniques that have helped thousands of insomnia sufferers in combination with my own proprietary method, this book nixes the superfluous and provides the essentials you need to improve sleep. My approach makes applying the skills simple and easy, includes many helpful tools for managing negative and worrisome thoughts, and shows you how to positively reframe sleep. In addition to making the process more streamlined and user-friendly, I offer the unique perspective of both a clinical psychologist and a former insomnia sufferer. Proven sleep techniques and how to apply them are presented in conjunction with useful tips, preferences, and insights, which I personally found immensely helpful in the process of overcoming insomnia. And you know what? It all works. It worked for me and it will work for you. This program does take commitment and effort. But if you learn, apply, and make the techniques a regular habit of your waking and sleeping life, your efforts will pay off and you will soon be sleeping better.

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How to Use This Book

Chapters 1-4 put you in the right frame of mind for tackling insomnia. From debunking common sleep myths to examining your motivation, these initial chapters cover key information on understanding insomnia which plays a crucial role in easing anxiety and improving sleep.

Chapters 5-12 arm you with active tools and techniques that will radically change your sleep. You’ll learn how to make your bed a cue for sleep (rather than anxious wakefulness); identify, manage, and eliminate worrisome thoughts that contribute to poor sleep; and gain powerful de-stressing techniques, from mind dumping to visualization to relaxation.

Chapters 13-16 cover additional factors that can disturb sleep and contribute to insomnia including: sleep medication, drugs, alcohol, and food; medical, psychological, and lifestyle issues; other sleep disorders; and important life events. This section also reviews how to maintain good sleep over time and prevent slipping back into old sleep-disturbing patterns.

Throughout the book I’ve included personal tips and insights from my experience in overcoming insomnia. While not required for learning the techniques, they should help in normalizing your insomnia experience and in applying the material more productively.

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1. Framing Sleep as a Pleasant Experience

We spend a third of our lives sleeping. That’s nearly 26 years! But while most of us try to make our waking lives as fulfilling as possible, few of us give thought to making our sleeping lives as enjoyable. Rather than viewing sleep as the positive, rejuvenating, pleasurable activity that it should be, sleep is usually perceived as a mundane maintenance activity. For those who have trouble sleeping, the perspective can become even more negative. Sleep becomes a stressful, anxiety-ridden, even tortuous activity. Just the thought of sleep or the anticipation of it can bring anxiety and dread.

But while a great majority of us will experience sleep trouble over the course of our lives—from the occasional poor night’s sleep to severe or chronic insomnia—one vital aspect ultimately determines how we will experience sleep forever. And that is: how we think about sleep.

Framing is a term used in Cognitive Behavioral Therapy (CBT), a well-researched form of psychotherapy that looks at how our thinking affects our emotions, behavior, and bodily sensations. How we frame things, like sleep, means how we think about them. And how we think about something, no matter what it is, will profoundly affect our experience of it.

For instance, let’s say you have to give a speech in front of a large group. One way to think about it is: “What if I mess up? What if I go blank and embarrass myself? They’ll all think I’m an idiot and I’ll look like a fool.” These thoughts will make you extremely anxious, dread the speech, and result in physical sensations like sweating, rapid heart rate, difficulty focusing and muscle tension. Most likely you won’t perform well.

Or you could think: “I’m well prepared. The audience is excited to hear me speak and even if I make mistakes they will understand and not care. They are on my side and I will just do my best and enjoy it.” These thoughts will make you feel more relaxed, comfortable, excited and optimistic and you will likely perform better.

You might also picture things in your mind. We think in images as well as in words. You might see yourself standing on the podium relaxed, speaking with ease and confidence, the audience interested. Or, you might see yourself frozen, panicking and the audience laughing at you.

The situation (giving a speech) is the same in both scenarios, but how we frame it creates a radically different experience mentally, emotionally and physically.

Sleep is no different. Sleep does not cause any particular reactions in us: It’s how we perceive sleep that creates the reaction.

You might say: “But my perception of sleep is based on my terrible experience of it. How can I think positively about sleep if I’ve had so many horrible nights of it?”

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It is understandable to feel this way, and it is the core of this program to address this question. Read on to learn how to positively frame your sleep and change not only your perception, but also your entire sleep approach—no matter how negative your experience of it has been up to now.

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2. Myths About Sleep and Insomnia

While you certainly don’t need to know sleep science to overcome insomnia, learning just a few important facts about the process can help ease a great deal of anxiety and increase your sleep self-confidence and control. Check your knowledge against these common myths:

Myth #1: Everyone needs eight hours of sleep.

False: Most people believe we need eight hours of sleep to function well during the day and remain healthy. The truth is that we all require different sleep amounts. Just as we have different heights, eye color, and metabolisms, we all require varying lengths of sleep. Some people may only require four hours (like Thomas Edison—a famous short sleeper) others ten and some seven.

The eight hour myth is a major anxiety source for many. “I better get eight hours or I will be a zombie tomorrow.” I experienced this worry and the anxiety it caused continually impeded my sleep. If I didn’t get eight hours (which is considered the norm) I would anticipate not feeling well the next day. And guess what? I didn’t. This is the power of the mind over the body.

So how do you know how many hours you need? Once you start applying the program techniques and your sleep starts to normalize, you’ll learn what works best for you. For now, just let the expectation go that you have to get eight hours of sleep.

Myth #2: If you don’t sleep well, you won’t be able to function the next day.

False: This fallacy is one of the most common anxiety-causing beliefs about sleep. Personally, it was one of my biggest worries and negative sleep contributors (see Chapter 7). Let’s say that you do require eight hours, or seven, or even ten, and you get less, does that mean you will be an utter disaster the next day? No.

Core Sleep Numerous research studies on students, physicians, transatlantic sailors, astronauts, medical residents and others prove that if you get a minimum of five and a half hours of sleep, your daytime performance will not be significantly affected, even over many months of poor sleep. This five and a half hours is referred to as core sleep.

Your core sleep is all you need to get your required stage three sleep (or deep sleep), the most vital stage for physical recovery and daytime functioning. The good news is that even if those five and a half hours are interrupted or obtained in smaller blocks, you’ll still meet your minimum sleep. Sure, you might feel tired or irritable the next day, but you will be able to function.

Personal Insight: I learned about core sleep firsthand when I took my psychologist licensing exams. I was so worried about not sleeping well and performing at a high level that I only slept four hours (less than core sleep) the night before both exams. One

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exam was over four hours long staring at a computer screen. But despite minimal sleep and not feeling my best, I performed well and passed both exams!

Knowing about core sleep significantly contributed to helping me overcome insomnia. It has allowed me to stop worrying about how many hours I sleep, which decreased my anxiety and, consequently, I sleep longer and better.

So what if you do get less than five and a half hours of sleep? Your sleep system will do everything it can to make up for it the next night. If you have a poor night’s sleep, you can feel good knowing that the pressure to sleep will be even greater the next night and your body will work harder to compensate for lost sleep (especially deep sleep).

Unfortunately, poor behaviors (e.g., naps, sleeping in, taking sleeping pills, and many more—covered in Chapter 5 and Chapter 13) that are innocently adopted to compensate for sleep loss can impede your body’s natural reaction to make up for lack of sleep and can actually make insomnia worse.

Myth #3: Insomnia causes depression and anxiety (or visa versa).

False: While it’s true that many depressed or anxious individuals also have trouble sleeping and develop insomnia, it does not mean one causes the other. Anxiety and depression can certainly be one of many contributing factors to poor sleep, but that’s not the same as causing it. In fact, many people with depression have hypersomnia (sleeping too much). And others with anxiety or depression sleep just fine.

However, insomnia can affect your mood and energy. It can make you feel irritable, frustrated, anxious, sad and less motivated. Physically, it leads to fatigue, stress and muscle tension. While you can still function, these feelings decrease your happiness and enjoyment of life. But this alone won’t cause clinical depression or anxiety.

Myth #4: If you feel tired in the morning it’s because you didn’t sleep enough.

This is not necessarily true. Outside of the number of hours you sleep, there are several factors that can contribute to feeling tired even after many hours of sleep. These include poor quality sleep, too much sleep, stress (Chapter 8), diet and alcohol (Chapter 14), and others.

Myth #5: Your daytime functioning is dependent solely on how you sleep.

False: In conjunction with myth #3, some people make the mistake of attributing how they feel during the day solely to insomnia. But factors such as general physical health, medical or psychological issues, alcohol, drugs, diet, medication, and how we think all affect daytime functioning and mood.

If you experience insomnia and feel tired, fatigued, depressed, anxious, or otherwise poor during the day, it’s important to look at other factors that may be causing these

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symptoms. This might require seeing your medical doctor or a mental health professional for an assessment to rule out any other problems affecting your sleep.

Myth #6: How you feel during the day is purely a physical issue.

False: Feeling tired, fatigued, sad or irritable after a poor night’s sleep is common. However, these feelings can be made worse or better by your expectation of how you will feel that day. As we discussed previously, your thinking and imagination profoundly affect how you feel emotionally and physically, whether you had a poor or good night’s sleep. If you didn’t sleep well, and you expect to feel terrible as a result, there is a good chance of having that experience.

If, however, you learn to have a positive (and reasonable) expectation of how you will feel, even after a poor night’s sleep, you will likely feel much better that day.

There are many strategies in this program for changing what you think and picture, to not only improve your sleep, but also have a better day after a night of insomnia. Read on to learn how.

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3. The Cause of Insomnia

Almost everyone experiences poor sleep at some point in his or her life. You might have trouble falling asleep, staying asleep, poor quality sleep or a combination of these. Normal life events can trigger it. Both positive events (a wedding, a vacation, starting a new job) and negative events (a divorce, job loss, the death of a loved one) can create excitement or stress that impacts your sleep.

For some, once the exciting event or stressor has passed, normal sleep returns. For others, a short-term sleep issue turns into a chronic sleep nightmare.

Why? People react differently to sleep interruptions. Some think nothing about a temporary sleep disruption, attribute it to current events, and have the confident expectation that their sleep will soon return to normal.

Others, however, start to worry and a brief period of sleep loss turns into something more chronic. This is the pattern that usually takes place:

You have a few poor nights’ sleep (a normal occurrence or triggered by something) and start to worry and get frustrated when the not falling or staying asleep continues. You start to dread going to sleep and worry even before you get into bed that you won’t sleep, which creates more anxiety and stress, making sleeping more difficult, leading to more frustration and worry.

Then, in order to compensate for all this sleep disruption, frustration, and worry, you start to adopt behaviors you think will help, such as: going to bed earlier, sleeping later, spending more time in bed to “make up” for lost sleep, drinking alcohol to fall sleep, taking sleeping pills, trying “harder” to sleep, being less active during the day to compensate for tiredness and taking naps. All of these behaviors may help with sleep in the short-run, but long-term they will only increase poor sleep, anxiety, and stress.

Eventually, because of so many sleepless and frustrating hours and nights in bed, your mind and body start to associate sleeplessness with your bed and bedroom. Instead of your bed becoming a signal for pleasant rest, it becomes a cue for anxiety, frustration, and wakefulness.

When you add in the daily stressors of work, family, or financial pressures, you have the perfect cocktail for insomnia: anxiety about sleep + poor sleep behaviors + life stress.

Once these factors are in place, a pattern of insomnia sets in, unless something changes.

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4. Motivation: A Surprising Question

Whether you’ve suffered from insomnia for years or recently starting experiencing sleep trouble, I have one important question to ask before we move forward:

If you could snap your fingers and instantly make your insomnia disappear completely and permanently, with no effort at all, sleeping deeply and soundly tonight, and every night, waking up feeling rested and refreshed, would you do it?

If you immediately answered “yes,” I would say, not so fast. Let’s dig a little deeper. Sometimes we undermine our best intentions with thoughts we hold subconsciously. Perhaps you’ve had some of these thoughts:

I’ve had insomnia so long it has become a part of my identity and giving it up would be like giving up a part of myself.

I get extra affection, care and sympathy when I tell others about my insomnia and suffering and I might not get that attention anymore if I give up my insomnia.

I feel like there’s something wrong with me that it's taken so long to overcome insomnia (note: that’s simply not true!), so it’s “easier” to just keep struggling with it.

I convinced myself that I was born with insomnia so letting go of this belief will be scary and difficult.

I might be using insomnia to avoid being more productive, social, or ambitious, because of anxiety or fear, and curing it will force me to face these challenges.

I worry about what I will do with all the extra energy and time I will have without the distraction of insomnia.

Some or none of these may be true for you. The point is that you may be ambivalent about overcoming your insomnia. I see it all the time in my therapy practice. Someone who has suffered with depression for decades comes in sincerely wanting help, but subconsciously a part of them wants to hold onto the depression. Unknowingly, they fight against recovery because they have not resolved this inner conflict. The problem is they are not consciously aware of the resistance or ambivalence.

This may or may not be true for you regarding your insomnia. You may have no doubts and want to sleep better. But just to make sure, I highly recommend doing a helpful exercise that will allow you to identify if there is any resistance that might keep you, or has kept you, from resolving your insomnia.

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If there is resistance, then this exercise will tell you specifically what it is so you can address it. If you aren’t ambivalent, the exercise will only reinforce your motivation and arm you even more for success.

Exercise: Cost/Benefit Analysis

I suggest doing two Cost/Benefit Analyses (CB), using the forms on the following pages, which you can print out.

The first CB is looking at the advantages and disadvantages of keeping your insomnia. This may sound strange, but many times there are reasons to keep negative behaviors, problems and emotions even though we know they’re hurting us.

Simply list all the advantages of keeping your insomnia. The advantages may not be logical, so don’t put down what you think you’re supposed to say, but what you actually feel are the advantages. The advantages might be physical, emotional, mental or relational. Then list all the disadvantages of keeping your insomnia.

You must be completely honest with yourself and provide enough time to really think about it. No one will see it and you can shred it afterwards.

After filling out both columns, ask yourself: Which way do I lean—towards the advantages or disadvantages? Then give each side a numerical rating based on your answer. For example, if you feel strongly that the disadvantages greatly outweigh the advantages, you might rate the disadvantages 90 and the advantages 10 (i.e., 90% of you feels keeping your insomnia is a disadvantage while 10% of you sees a tiny advantage in keeping it). The numbers should add up to 100 (see Sample Form on next page). Or you might be more ambivalent and see both advantages and disadvantages, so would rate both sides 50.

The second CB is looking at the advantages and disadvantages of overcoming your insomnia. It’s helpful to look at the positives and negatives of both choices (keeping it or overcoming it) in order to give you the full picture of how you feel. Then rate each column as before out of 100.

The numerical rating is how you feel emotionally about the pros and cons of keeping your insomnia or overcoming it. Putting a number to it helps to quantify your emotion and tell you which way you lean. This is important because it tells you how motivated you are to overcome your insomnia. If you see more advantages to keeping your insomnia, or are ambivalent, it is unlikely you will be motivated enough to change it. This is because part of you doesn’t want to change.

If, however, you feel the advantages of overcoming your insomnia are greater than the disadvantages, you are ready to begin the program.

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Now that you’ve completed both worksheets, you should have a clear picture of your motivation: either wanting to overcome the insomnia, or not. If you scored 50/50, this means you are ambivalent and not ready to make changes, even if logically you know it would be good for you. To increase your motivation, you need to think of more positive advantages to overcoming insomnia and/or more negative disadvantages of not changing.

It’s important to have reasons to change that are emotionally compelling to you, not that just make logical sense. If you are not emotionally committed to the process, then this, nor any other program will work, because you won’t have the required desire to do what’s necessary to change. This program does require some work. The work is not hard, but it does take a little time, effort, and commitment to learn and apply the tools and skills consistently as you move forward. If you do, I am confident you will overcome your insomnia and sleep soundly. Sometimes people want to change but aren’t ready, or willing, to put in the effort required. If you’re feeling this way, it’s okay to put this program aside for another day.

If, however, you have found that you have little or no ambivalence and are ready to learn some powerful and life-changing skills to achieve sound, refreshing sleep, then let’s dive in and begin.

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5. Make Your Bed a Cue for Sleep

At present, your bed and bedroom are associated with sleeplessness, anxiety and frustration. Even if you feel exhausted and can barely keep your eyes open, the moment you get into bed, you become alert and suddenly can’t sleep. Why? Because you’ve spent so many hours and nights tossing and turning in that bed, getting frustrated and anxious that your sleep environment has become a cue for sleeplessness.

We need to reverse this pattern by making the bed a cue for sleep, so when your head hits the pillow, you quickly fall into a deep and satisfying slumber.

The most effective way to do this is by changing the sleep behaviors that initially caused the problem. As mentioned earlier, in order to compensate for poor sleep, you’ve likely (mistakenly) adopted behaviors that have deteriorated your sleep over time and are now reinforcing the sleeplessness associated with your bed and bedroom.

The following techniques developed by psychologist Dr. Richard Bootzin are easy to apply and extremely effective. They helped me, and countless others, overcome insomnia and restore good sleep. In fact, there is no way to achieve consistent good sleep without making these changes because the lack of these healthy sleep habits is a big part of why you aren’t sleeping well.

Change #1: Establish a nightly bedtime routine.

Start your nighttime routine about an hour before going to sleep. Tasks can include brushing your teeth, putting on bedtime clothes, reading or listening to something relaxing or non-stimulating (no horror novels or heavy metal music), meditating, deep breathing or other relaxation exercises. Avoid electronic gadgets (computer, tablet, smartphone), vigorous physical activity, job-related work, a big meal, and serious discussions with your partner, as all of these will wake you up.

Keep your routine consistent, even while travelling, if possible. After a few weeks, it will become a new habit and your body will start to associate this routine with sleep and actually begin falling asleep as you perform your routine, even before getting into bed.

Change #2: Only get into bed when you are sleepy.

Even if you’ve completed your nightly routine and it’s your designated bedtime, if you are not sleepy, do not get into bed. “Sleepy” means you are nodding off or having a hard time staying awake. It does not necessarily mean feeling tired; you might feel exhausted, but your body could still be alert and not ready to sleep. This is especially true if you haven’t had a chance to wind down or are still stressed. Stay up even if it gets late.

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Personal Tip: You might worry, “It’s getting late and I won’t get enough sleep. I better go to bed or I’ll be exhausted tomorrow.” I had this worry too. But worrying will only raise your anxiety and make it harder to sleep. It’s true you might get less sleep, but that sleep will likely be of better quality. And if you wake up tired the next morning, remember you can still function and your body will feel more pressure to sleep the next night and compensate for lost deep sleep.

Change #3: Use your bed only for sleep and sex.

Do not use your bed for work, serious relationship talks, eating, reading, watching TV, surfing the Internet, talking on the phone, journaling, worrying or any other activity other than sleep or sex.

Again, you want your bed to be associated only with sleep. Sex is allowed because your bed is usually the most convenient and common place to do it and because it can relax you enough to fall asleep. All other activities can trigger emotions, stress, or alertness which will only keep you awake and become linked with your bed/bedroom.

It’s also not a good idea to work in your bedroom, even at a separate desk. All of the above activities should be performed in another room (if you live in a studio, then create a separate area away from the bed where you can work).

Change #4: Get out of bed if you can’t fall asleep.

If you are not asleep after about 20-30 minutes, then get out of bed and go into another room. You can just approximate this time, rather than keeping an eye on the clock.

Personal Tip: You may worry that by getting out of bed you’ll become more awake, but this won’t happen. I had the same worry every time I couldn’t sleep. But when I got up, I always became more tired (following Change #5).

You might also worry you’ll be wasting precious sleep time by getting up and, if you just “try harder,” you’ll get to sleep. Believe me, you’ll only get more frustrated, become more awake and strengthen the sleeplessness-bed association. By not remaining in bed, you’ll get tired quicker and actually save those precious sleep minutes.

Change #5: Once out of bed do something boring or relaxing.

Read a dull book (textbooks are great for this!), or watch a boring TV program (PBS usually does the trick). Do something relaxing like listening to calming music or relaxation exercises such as meditation, deep breathing or guided visualization (covered in-depth in Chapter 11). Keep the lights off or dim. Don’t go on the computer, because your brain may think it’s daytime. Avoid physical activity, as it will wake you up more. And be sure not to drift off on the couch.

Personal Tip: I found that if I framed this late night period as “extra free time,” I came to enjoy the quiet and peace, and not worry that I was awake. With no distractions or

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phone calls, it’s the perfect occasion for some personal chill time. Once I started thinking about it this way, the worry of not falling asleep dissipated, which helped me fall asleep. To keep me company on sleepless nights, I used the time to read Les Misérables and other interesting but not too suspenseful or scary fiction.

Change #6: Get back into bed when you are sleepy.

Only return to bed when you are sleepy or nodding off. Once in bed, if you don’t fall asleep within 20-30 minutes, get back out of bed. This may seem counterintuitive, as your goal is to sleep, not be up. But this process will tire you out and break the negative association between your bed and wakefulness. Repeat steps 4-6 as many times as needed until you fall asleep in bed. If you wake up in the middle of the night and don’t fall back to sleep in 20-30 minutes, then follow the same steps.

Change # 7: Establish a regular wake-up time.

This technique is vital for establishing a regular sleep pattern and overcoming insomnia. Set your alarm (or whatever you require) to wake you up at a regular time everyday. Do this on weekends too. Get up even if you slept poorly or had little sleep. Do not hit the snooze button. Get up immediately. You are trying to establish a regular, automatic, sleep-wake cycle. If you sleep in (one of those disruptive sleep behaviors), then you will stay stuck in the insomnia cycle.

Personal Tip: Especially on weekends or if you have the luxury of sleeping in and don’t have to get up, sticking to a regular wake-up time can be particularly challenging. I worked from home two days a week and it was tempting to sleep longer on those days to make up for lost sleep. But if you do, you won’t sleep well the next night and you won’t make progress.

So, force yourself to get up, shower, exercise, get coffee, whatever you have to do to wake up. I found that once I was up and going, I was fine. I felt the tiredness the most in the afternoon, but I could always function and do my work. Learning you can get through the day and do what you need to (job, school, etc.) on limited sleep, builds your confidence and decreases worry of not sleeping well, which results in lower anxiety and better sleep.

Change # 8: Don’t nap during the day.

There is disagreement on this behavior change. Some say strictly no napping. Some say it’s okay to nap, as long as it’s not longer than 45-minutes and before 4:00pm (otherwise you’ll be groggy and less tired for sleep that night).

Personal Tip: I tried both napping and not. My findings revealed that if I resisted nodding off even when I really wanted to, the desire to nap went away after a few weeks once my sleep-wake cycle was reestablished. Now, I don’t nap at all. Experiment and find what works best for you.

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Measuring your progress

As noted in the introduction, one thing I found tedious and unnecessary in other insomnia programs is the requirement to fill out detailed sleep logs, record nightly sleep data and perform different calculations. This may work for some, but for me, it made the process less appealing and more stressful. Ultimately I found it was unnecessary in overcoming insomnia and I stopped filling out the sleep logs after the second week.

However, measuring your progress is important. Measuring something (it doesn’t matter what) makes you conscious of your goal to sleep better and gives you actual data so you can see your progress. This has the effect of increasing motivation and success.

I created an extremely simple Sleep Rating form (on the next page) that you can fill out each morning during the program to measure your sleep quality. It literally takes five seconds to fill out and provides a valuable measure to track your progress.

If you don’t want to use this form, choose whatever you want to measure, just choose something. It could be the time you get into bed, time you got up, one thing you did that day to help you sleep better (like exercise), or anything else you want to record that’s easy.

Print out several copies of this form and start using it (or your own measure) tomorrow morning. Then use it every morning until your sleep is back to normal.

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Sleep Rating Form

Date:

How did you sleep last night?

_____Great _____Okay _____Poorly

Date:

How did you sleep last night?

_____Great _____Okay _____Poorly

Date:

How did you sleep last night?

_____Great _____Okay _____Poorly

Date:

How did you sleep last night?

_____Great _____Okay _____Poorly

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6. Making Sleep More Efficient

It’s not the time you spend in bed that matters, it’s how much, and how well, you sleep while in bed that does. Many people spend too much time in bed and/or sleep longer than they need to, which actually lowers their sleep quality. This is why you can sleep ten hours and still wake up tired.

To overcome insomnia, increase your sleep quality and strengthen your sleep-bed association, you must make your sleep more efficient. Sleep efficiency is achieved by taking these three actions: 1) actually sleeping while in bed; 2) minimizing the time awake in bed; and 3) sleeping only as long as needed to fulfill your body’s requirements.

Here are the steps to make your sleep more efficient:

Step 1. Estimate the average time you are actually sleeping while in bed each night. Don’t worry about being exact.

Step 2. Estimate the total time you spend in bed each night, from bedtime to when you rise in the morning (don’t include the time you get up during the night).

Step 3. Calculate the difference between Steps 1 and 2. So, if you are averaging 5 hours of sleep per night and spending 8 hours in bed, the difference is 3 hours (i.e., 3 hours you’re in bed not sleeping!).

Step 4. Change the pattern. Decrease your “in bed not sleeping time” by remaining in bed only one hour beyond your average sleep time. So, if you average 5 hours of sleep per night, you should spend (at most) only 6 hours in bed.

To illustrate this point, if you’ve been sleeping 5 hours per night and your regular wake-up time is 6:00am, do not get into bed earlier than midnight (which would be your target bedtime—i.e., the earliest you should get into bed). This gives you six hours to sleep (an hour more than you’ve been averaging) and will make your sleep more efficient because you’re spending the majority of your “in bed time” actually sleeping. On the contrary, allocating too many sleep hours will prolong the time you spend in bed awake, exacerbating insomnia and maintaining the sleeplessness-bed association.

While the new midnight bedtime may sound extreme if you typically hit the sack around 10:00pm, the change will pay off in better quality sleep and strengthen your bed as a cue for sleep.

Personal Tip: What do you do if you can barely keep your eyes open, but it’s not yet your target bedtime? I encountered this problem: my initial bedtime was 10:30pm. But on some nights, I started to nod off on the couch at 9:00pm, making it near torture to stay awake until 10:30pm.

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In this situation, if you’re starting to doze within an hour or less of your target bedtime - go to sleep. It makes no sense to stay up another hour. This process should not be strenuous, but gradual and easy, otherwise you associate strain with sleep.

Note: If you get into bed earlier, you will likely wake up earlier, in which case - don’t stay in bed. I found that by rising as soon as my eyes opened, even when I awoke earlier, I was able to stay up until 10:30pm (my target bedtime) the next night, eventually creating a consistent pattern of getting sleepy at the same time.

If, however, you find yourself nodding off at 6:00pm, you should not go to sleep. Instead, engage in an activity to wake yourself up like exercise, a brisk walk, surfing the Internet, taking a shower, watching an action movie, or reading an exciting thriller. (Note: Don’t exercise within three hours of your bedtime as it could keep you awake.)

Step 5. Continue to consistently apply the eight changes for making your bed a cue for sleep (Chapter 5).

Step 6. As your sleep normalizes over the next few weeks, you can gradually go to bed earlier (but keep your wake-up time the same). If you were initially going to bed at midnight, you can now retire at 11:30pm. As long as you continue to fall asleep quickly (within 20 minutes) and sleep through the night (with minimal awake time), you can continue to add back time in 30-minute increments.

Step 7. If you begin to have trouble falling asleep or staying asleep, stop adding back time. The goal is to figure out how many hours of sleep you need and then only spend that amount of time in bed.

Don’t assume you need eight hours of sleep, or any other particular amount. It may be less or more. Once your sleep normalizes (over the course of this program) you will know how much sleep is right for you.

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7. Tackling Worry

Worry is a major inhibitor to sleep. You might be worried about falling asleep, staying asleep, or what will happen if you don’t sleep. You may dread going to sleep even hours before you’re in bed because you anticipate it to be a negative experience.

You may worry about other things as well, like your job, relationships, health, money and the economy. Many people worry about the fact that they’re worrying. All this worry creates anxiety. And anxiety is the enemy of sleep.

Worry is a concern that something negative or threatening will happen in the future. “What if I fail?” “What if say something stupid?” “What if the plane crashes?” are all worries. Worry is future-focused fear. The thing you’re worried about hasn’t occurred yet, but the expectation of it causes anxiety. Worry is a thought, and anxiety is the emotion that comes from the thought. Common worries about sleep include: “I’m not going to sleep again tonight,” “What if I don’t get enough hours—I’ll feel awful tomorrow,” or “I’ll never get over my insomnia.” These are all negative expectations that cause anxiety—increased alertness, rapid heart rate, elevated blood pressure, upset stomach, muscle tension, and other symptoms. Your anxiety is preparing you for something negative (i.e., not sleeping), and the physical changes that result keep you awake.

If you have insomnia, you’ve encountered many difficult nights of sleep and have justifiable reason to believe you won’t sleep again. However, this thinking can result in an endless cycle of worry, anxiety, poor sleep, then more worry, anxiety, and poor sleep. To stop the cycle you must defeat the worry (which will also eliminate the anxiety).

This chapter will give you the tools to handle worries about sleep and other anxiety-causing thoughts that interfere with your sleep.

Defeating Worry About Sleep

Step 1: Identify your sleep worries.

You must first know what your specific sleep worries are before you can defeat them. Some common worries are noted above, but everyone’s worry varies.

Get a pad of paper and pen (you can do this on a computer too, but it’s usually more effective hand-written).

Ask yourself these questions to draw out your worries:

What are my worries about sleep?

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What goes through my mind before I get into bed?

What goes through my mind once in bed (especially if I can’t fall asleep)?

If my anxiety about sleep could talk, what would it say? (This may sound silly, but it works quite well in drawing out your thoughts and putting your anxiety into words.)

What are my biggest fears about sleep/insomnia?

Answer these questions without censoring yourself or negatively judging what you write down.

Step 2: Use Skills to Defeat the Worry.

Start by choosing one of the worries you wrote down.

Skill #1—Examine the evidence

A worry is just a thought, an expectation of what might or could happen. It is not necessarily a fact. Actually, most of the worries people have don’t ever happen, especially the big ones. And even when they do happen, the outcome is rarely, if ever, as bad as expected.

In order to know whether a worry is true or not, you must examine the facts (“facts” do not include what you think or feel). Pretend you are testifying in court and you have to present the most accurate and convincing evidence. First identify all the evidence that supports your worry. Then identify all the evidence that doesn’t support your worry. Do this all on paper.

Example:

Worry: “I won’t be able to fall asleep.”

Evidence to support worry: there have been many nights when I couldn’t fall asleep.

Evidence against worry: there have been many nights when I have fallen asleep and done so quickly; and others where it took me a while to fall asleep, but I eventually did; in fact, I can only remember three nights in my life when I didn’t sleep at all.

Replace old worry with new, more accurate thought: “Although sometimes I have trouble, I almost always (with few exceptions) eventually fall asleep, and sometimes I fall asleep fast.”

The goal for the “accurate thought” is not to state an overly positive belief that doesn’t fit the evidence, like “I am certain I will always fall asleep quickly and easily.” This doesn’t fit the facts, and you won’t believe it, as sometimes you do have trouble falling asleep. But the new, more accurate thought is usually more positive then your worry, which will lower (or even eliminate) your anxiety and help you sleep better.

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What if you have tons of evidence to support your worry, and none to dispute it? It would be rare with sleep worries to not have any evidence against it. For example, even if you can’t remember ever falling asleep quickly and easily (which is highly unlikely), it doesn’t mean it’s not possible and you couldn’t learn how. So, your evidence against the worry could be: “changing the quality of my sleep is possible because people do it all the time; millions of people have suffered from insomnia and overcame it; I can’t predict the future.”

Then your new, more accurate thought might be: “Although I’ve struggled with sleep all my life, I am learning skills that will improve my sleep, just as millions of other people have.”

Skill #2—Talk back to the worry

Worry is just negative thoughts that got stored in your mind at some point and have become a habit. But you always have the power to talk back and change your own thoughts if they are false, negatively biased, or exaggerated.

If we use the example worry: “I won’t be able to fall asleep,” you would talk back to this worry (out loud or on paper) doing your best to defeat it.

For example, when you notice the worry, “I won’t be able to fall asleep,” you might say back to it: “I have on some occasions been able to fall asleep quickly and easily. I have also learned new skills that will help me to sleep better now and continue to improve over time. Sleep is a natural process wired into my body. I only need to learn how to let it happen. Millions of people have had problems with sleep and have overcome them. I am no exception.”

Use your own words and logic to obliterate the thought or make it seem ridiculous or exaggerated. Only use arguments that ring true for you, otherwise you won’t believe it. You can even role-play with a friend or partner, switching back and forth between being the negative voice and the positive one. I do this exercise with my clients all the time and it’s extremely powerful and effective. It can feel liberating to knock down your own negative thoughts. Use this skill with all of your sleep worries.

Skill #3—Think through the worst-case scenario

Many times it is not the immediate worry that causes the most anxiety but what will happen if that worry comes true. For instance, if you worry you won’t be able to fall asleep, your real concern might be feeling awful the next day, not performing well at work, or getting sick.

Ask yourself: “What is my biggest fear if I don’t fall asleep tonight?

Let’s say your answer is: “I won’t be able to perform at work and I’ll get fired.” Many people, when they have a worry like this, focus only on the negative things that might happen if the worry comes true. As a result, they become extremely anxious.

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Or, they might try to push the worry away and not think about it because it’s upsetting. Either way, the worry never gets resolved and it usually comes back.

Instead of avoiding your biggest fear, really think through in detail what you will do if the worst happens. Ask yourself: What will I do? What have I done in the past? How will I handle it?” It is best to do this on paper. You might write: “It will be very disappointing if this happens, but I will survive. I can find another job. I am very resourceful when I need to be. I have some savings that can tie me over. I have gotten jobs in the past and I can find another. I can pare down my spending for a while to reduce living expenses. I have faced challenges before and have overcome them. Etc.”

Again, use your own thought process and create a plan that makes sense to you. Make it as detailed as you want and place it somewhere you can easily refer back to in case the concern returns (although once you think it through, this information will be stored in your mind). The situation (losing your job) may be upsetting, but the point is for you to realize that you will handle it and you will know how you will handle it. Ideally, this knowledge should help lower your anxiety significantly.

Skill #4—Notice what actually happens

Most of what we worry about never happens and, even when it does, it’s rarely as bad as we imagine it will be. Think about all the things you worry about (and have worried about) and ask yourself how often it came to fruition. And if it did, was it as bad as you thought it would be? And if so, were you able to handle it?

Once you start identifying and becoming more aware of your specific worries, notice how often they actually happen. And if they do come true, notice if it was as bad as you anticipated it to be. You’ll find that things usually work out much more positively then you expect.

Personal Tip: One of my biggest worries was not being able to function the next day in my job if I didn’t get enough sleep. This worry, of course, made me anxious, which contributed to poor sleep. Once this happened a number of times (even a couple nights with NO sleep), I noticed that I always got through the day and performed just fine in my job. I might not have felt my best, but no one seemed to notice and nothing bad happened. This built my confidence because I knew that even if I didn’t sleep well (or at all) I would be fine. My worry and anxiety about sleep decreased, which consequently led to better sleep.

Skill #5—Use humor

Laughter has a way of lightening up something that is serious or anxiety provoking, which tends to undercut the worry and take away its power. One way to do this is to exaggerate your worries.

If your worry is: “I’ll never overcome this insomnia.” Say to yourself: “Yes, that’s true. In fact, I’m probably the worst sleeper in my entire state, maybe in the entire

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country. I would win a gold medal in the bad-sleepers Olympics. Top scientists will want to study me to learn how I sleep so poorly and what techniques I use. I’ll be on the cover of Time magazine with the headline: ‘Worst sleeper in the universe.’”

See what you can come up with. This is a paradoxical technique. Sometimes when you fully embrace your problem, it takes away its power because you’re no longer fighting it.

Skill #6—Notice the positive

You may think, “There are no positives with my insomnia. It’s all negative.” This is not to minimize the obvious negatives of insomnia. But we can tend to focus only on what isn’t going well. You may notice when you don’t fall asleep, or how many times you woke up, or how horrible you felt the next day.

But do you also notice when things go well? Do you take note when you have a good night’s sleep, fall asleep reasonably fast, feel good the next day, or see some (even small) improvements in your sleep as a result of applying the skills in this program? It’s crucial to notice the things that go well, as it will strengthen and increase these positive changes over time.

Personal Tip: I focused on creating positive thoughts, even for the times I couldn’t sleep. I got to enjoy the late night or early morning. It was quiet, peaceful and I could read a good book or get some work done. I learned to embrace this time instead of fight it, which paradoxically improved my sleep, because I wasn’t worried about it or framing it as a negative thing (which eliminated my anxiety about it).

Skill #7—Pie chart

Sometimes, as noted above, we tend to focus on the negative or worst-case scenario and block out the positives. This exercise will help you to gain a complete picture of your situation.

Use the pie chart on the next page. In one wedge, write down a worry you have about sleep, such as “I’ll be up the whole night.” This is where many people with sleep problems stop. They have a negative expectation and disregard all other possibilities of how things could turn out. In addition to a negative outcome, there might be many other potential outcomes that range from less negative to quite positive.

For example, other possibilities of how your night could go include: “I will sleep okay tonight.” “I will sleep fantastic tonight.” “I will sleep good tonight.” “I will sleep well for part of the night and badly the rest,” etc. These are all possible outcomes that are different (and better) than your current worry. There is almost always more than one possible outcome to a situation. Write all the possibilities you can think of in the pie chart.

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Defeating Non-Sleep Worries

Sometimes what keeps us up at night is worry or racing thoughts (also called rumination) about non-sleep issues. You get into bed, ready for sleep, and a worry pops into your mind, which leads to another worry, then another, and it keeps going, sometimes lasting for hours. It causes anxiety and frustration, which keeps your body awake and stops you from sleeping.

The worry can be about anything: your job, school, a relationship, what you said to someone that day, an upcoming speech, your health, or even worry about the fact that you’re worrying. Whatever it is, it’s impossible to sleep in this state.

Most people think it’s worry that is keeping them up and preventing sleep. This is usually not the case. Rather it’s not being tired enough for sleep, so your mind is awake and active and starts to think which, of course, does keep you awake. If you typically stay in bed when this happens, then you unknowingly create an association between your bed and worry, with your mind starting to race as soon as your head hits the pillow.

What and how we think can become a habit. If we tend to worry a lot, it becomes an automatic part of our thinking. This is not genetic, it’s learned and just like any other habit you need certain skills to change and resolve it.

How to stop worrying in bed.

1) Make sure you are applying all eight changes from Chapter 5 (i.e., establishing a nightly routine, going to bed only when tired, etc.).

2) Get out of bed if you haven’t fallen asleep within 20-30 minutes.

3) Once out of bed, do a Mind Dump: grab a pad and pen, and dump out all of your worries onto the page without stopping. Write down every last thing weighing on your mind until there’s nothing left.

4) Then tell yourself you will deal with it tomorrow and put the pad aside.

5) If you are tired now, go back to bed. If not, do another activity (like reading) until you are sleepy.

The following day, start addressing the worries you wrote down using the following steps:

Step 1: Notice your worry.

Before you can change any habit, you have to first be conscious of it. When we have a habit, we do it unconsciously (like biting our nails or holding our bodies in certain ways). To change it, you have to first notice it, in the moment, so you can intervene.

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For the next week, tell yourself that you want to notice when you are worrying (whether in or out of bed). Many times, just noticing your worry tends to slow it down because now you are conscious of it.

Step 2: Do a Mind Dump.

Get a pad and pen and dump out all of your worries onto the page without stopping. Write down every last thing weighing on your mind until there’s nothing left. You may have to write for several minutes.

This exercise allows you to get all your worries out of your head and onto paper. It should create some relief just doing this. Once on paper, you can deal with each concern one at a time.

Step 3: Distinguish whether the worry is productive or unproductive.

Sometimes worry is warranted when there are valid reasons for concern and you have the power to do something about it. For example, if you live in parts of the Midwestern U.S., it makes sense to worry about tornadoes because they’re a real threat. Or, if you know your company is downsizing, worrying about being laid off is justified, as it is a possibility. This is called productive worry.

Unproductive worry is concern about something that: 1) you have no reason to be concerned about (i.e., there’s no evidence to justify worry); 2) you have no direct control over; or 3) you have already taken precautions for and there’s nothing more you can do. If you live in California and you worry about hurricanes, this is unproductive because California doesn’t get hurricanes (earthquakes are another story). Unproductive worries are things outside of your control, such as the choices of other people, what will happen to you in thirty years, what happens when you die, or a mistake you made in the past.

Now, go through every worry you wrote down in your mind dump and mark each with a P (productive) or U (unproductive).

Step 4: Take action on productive worries.

Action is key for eliminating worry. Choose one thing on your productive worry list (ideally the most important), and take action. For example, if you worry that you’re spending too much money and putting your family at financial risk, then the action might be calculating on paper what you’re earning versus what you’re spending. Or, hire someone to do it. Either way, resolve the worry by doing something. If you don’t, the worry will remain.

Then, go to the next productive worry on the list and do the same.

You can also ask yourself: “What can I do right now to address this worry?” If you are concerned about losing your job because your company is laying people off you could: talk to your boss to see where you stand; review your finances; create a back-

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up plan if you lose your job (e.g., update your resume, start searching for other jobs, etc.).

Well-thought out action reduces or eliminates worry by providing a sense of control, while protecting you from a potentially negative event.

Step 5: Schedule worry time.

Give yourself ten minutes a few times each day to worry your butt off. Try as hard as you can to freak yourself out. This may sound counterintuitive, but when you consciously try to worry, it gives you control over it and paradoxically tends to reduce it. In addition, it helps to ease anxiety knowing you will give the worry attention at some specific point.

When it’s not worry time, return to your life and don’t focus on those thoughts until your next scheduled worry time.

Step 6: Schedule thinking time.

Many people worry when they get into bed because they haven’t given themselves the time to wind down and process the day. So when they get into bed, their minds are still going.

Plan out time each day to do any necessary thinking/problem solving/choice making. Doing this a few hours before going to sleep is ideal. Write down the things you need to take care of and then make a plan for taking care of them. If you keep putting it off, it will just pile up and create more worry.

Much of our worry comes from indecision and inaction. If you have trouble making decisions and this is what you worry about, then learning to make decisions will be extremely helpful for reducing your worry (see Step 7).

Thinking time is active. Think about (ideally on paper) what you need to do and then create a plan of action based on importance and urgency. Anything unimportant or non-urgent can be put aside. Then take action (make a decision, take a step towards a goal, plan time to work on a project, etc.). Making decisions and taking action (after an appropriate amount of thought) is a major antidote to worry and anxiety, because it builds self-confidence (the opposite of chronic anxiety) and keeps your mind uncluttered with things to worry about.

Step 7: Make decisions and take action.

You can do this by giving the situation the appropriate amount of thought (“appropriate” is contextual—deciding what to eat for dinner shouldn’t take as long as deciding which job to take), and using whatever tools will help (such as the cost/benefit analysis you did earlier). Then, make a decision and act on it as soon as possible.

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Don’t wait until you are absolutely sure. You will rarely, if ever, have perfect information. If you wait until “it feels right,” you will never make a decision or act. Becoming confident in making decisions comes from, well, making decisions, and acting on them. If you make a mistake (which everyone does), you will learn from it and make a better decision next time.

Step 8: Let go of unproductive worry.

Unproductive worry is a huge waste of time and emotional upset. Here are two ways to let it go:

1. Once you notice your unproductive worry, tell yourself, “This is a waste of my time. There’s nothing I can do about it now, so I must just accept it, adjust to it, move on and focus instead on the things within my control.”

2. Worry is just thoughts. There is no requirement to do anything when these thoughts enter your mind.

When you notice your worry, just let it be there. Don’t try to stop it or push it away. It will only make the worry stronger (like trying not to think of a pink elephant). Just notice the thoughts with the attitude: “Oh that’s interesting, a worry just went through my mind” and move on with whatever you’re doing. This is also true of any anxiety you feel as a result of the worry. Just notice your heart rate go up, or your palms get sweaty, but don’t try to stop it. Instead, gently shift your mind to something else more fun or productive, not giving the worry or anxiety any importance.

Here’s a helpful metaphor: Picture yourself sitting on the bank of a raging river. As you observe the river, you see a large log flowing down through the rapids. That large log is your worry and you have a choice. You can jump on the log and let it take you for a ride; or, you can watch it go by and disappear. You always have this choice and power.

This technique will lessen or stop the unproductive worry and anxiety, because you are not fighting it or giving it importance, but letting it fade on its own. If it’s a productive worry, you can use this skill to put it aside for later when you have time to think about and resolve it.

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8. Decreasing Stress

Feeling stressed when you go to sleep will keep you up. Stress activates and makes the body alert and awake, so it’s vital to learn how to lower stress both during the day and in the evening prior to sleep. Stress is a general term for anything that places a physical strain or pressure on your body. It can come from outside sources like your job, a relationship, traffic, overload from too many tasks, the weather, etc. Or it can come from internal sources, like your thoughts (worry), your emotions (anxiety, anger), or having an illness or injury. Most people experience both types of stress.

Stress is not necessarily bad. Exercise and sex cause stress. So do rollercoasters, first dates, weddings, travel and other usually positive experiences. What we are targeting is the stress that impedes your functioning and enjoyment of life and disrupts your sleep.

Here are several effective ways to manage stress:

1) If you’re overloaded, remove some of the load.

One common cause of stress is taking on more than you can handle.

Solution: cut down or cut out activities, tasks and relationships that are not as important or that are creating an excessive amount of stress. (“Excessive” is an extended level of stress of 6 or higher on a 1-10 scale. You can assess this by asking yourself what your level of stress is at any given moment).

How:

Write down everything you do in a week. Sometimes this alone will shock you by seeing just how much you have on your plate.

Rank all of these tasks in a list from most to least important (i.e., first, second, third, etc.)

Then start with a blank schedule and place each item in order of importance into the schedule making sure you allow sufficient time for each, as well as time for rest/fun in the evenings. Once you have filled up your time, whatever is left on your list must be cut.

This exercise shouldn’t take more than an hour or two and can be broken up over several days, if needed. Taking the time to do this will actually save you tons of time (and lower your stress) as soon as it’s completed and implemented.

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Common Objections for Removing Some of the Workload:

“I don’t have time to complete this exercise.”

If you feel you don’t have time to do this exercise, then you need to do it more than anyone. If something will lower your stress, and help you sleep better, then why wouldn’t you make the time to do it?“

But everything is important.”

Everything may be important, but it can’t all be equally important. Some things are more important than others. It’s vital to know what you value most, and in what order you value it, in order to know what to keep and what to cut. This may take some thinking.

You are also limited by time. You cannot take on fifty hobbies, have a hundred close friends and work ten jobs. So choose the things you enjoy the most and which are of highest value to you at this time in your life. This may change over time, so you can adjust, but now you must cut.

I have worked with many stressed-out clients and every time they experimented with cutting things out they never regretted it and didn’t miss the things they eliminated. They felt relief and wondered why they hadn’t done it sooner. As a result, they had less stress and more time and energy to enjoy what was most important.

“But I have high standards for myself.”

If you feel you must do everything “perfectly,” always be the best, be a veritable superman or superwoman, and anything that falls short of this is failure, then you have set unreasonably high standards for yourself.

A human being can only do so much. You only have so much time and energy. If you try to fight this, it will create an enormous amount of stress, which will lower your performance and efficiency (not to mention your enjoyment of life), and negatively impact your sleep.

Standards are contextual, based on many factors (your time, energy, knowledge, competing values, goals, etc.). Being selective about what you take on and working smarter, not harder, will help you be your best while also keeping stress at bay.

The goal should be enjoyment of life and attaining the things most important to you, not trying to meet some unrealistic perfection.

“But I don’t want to upset anyone.”

One of the most powerful skills for lowering stress is the ability to say “no” to others. This is a required skill for anyone who wants to manage their time and stress. You simply cannot do everything people ask you to do and it’s up to you to set the boundary.

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This applies to both your work and personal life, to your boss/co-workers, as well as your friends/family.

Again, you only have so much time and energy. This means you have to be very selective about where you spend it, which means knowing what’s most important to you. Ideally, most of your time and energy should go to your most important values.

What stops most people from saying “no” is the fear of upsetting others or concern they will think badly of you.

For the people who actually respect and value you, this won’t be the case. Reasonable people understand that you have limited time and resources and a life outside of them and will understand. They may be initially disappointed, but they will get over it and find someone else to ask (or do it themselves).

Most people respect individuals who value themselves enough to set boundaries and don’t respect those who are doormats or people pleasers.

Think about when you have asked someone for help on a work project or invited a friend to a party and they said no. Did you think badly of them? My guess is you understood, even if initially disappointed, and it did not affect your relationship.

But what if they do resent it or think badly of you? Then you should ask yourself if this is a worthwhile friend, relative or co-worker. If they always expect you to do everything they ask, then they aren’t respecting your time or values. If so, this may be an area to do some cutting.

2) Set aside time to wind down.

Even after applying these stress-relieving skills, you will still experience some stress, as it is a part of life.

Solution: Set aside time every evening to relax and decompress.

How:

Schedule at least an hour (2-3 hours is ideal) every evening to relax and de-stress. It is vital that you carve out this time in your schedule; otherwise it will likely fill with something else.

The activity can be anything that helps you to relax and decompress, like reading, watching TV, knitting, making love, taking a bath, meditating.

Make sure not to do anything that will wake you up (like those activities mentioned in Chapter 5 under “Change #1: Establish a nightly bedtime routine”).

Protect this time (this is where saying “no” is vital).

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Common Objections for Setting Aside Time to Wind Down: “I don’t have the time.”

Managing stress (and sleeping better) requires valuing yourself. Everyone has the same amount of time (24 hours/day); it’s how you allot your time that matters. If something is important enough, you will find the time for it. And downtime is vital for managing stress and sleeping better.

Ask yourself this: “If I were counseling a friend or loved one about healthy living, would I tell them to work night and day without taking any breaks or rest?” My guess is that the answer would be an unqualified “no.” Apply the same good advice to yourself.

“I don’t really need it.”

Everyone needs time to rest and refuel. There is no way around this. You are not a robot (but even robots need recharging). Not taking time to rest on a daily basis leads to fatigue, illness, reduced motivation, burnout, lowered performance and sleep problems. It will catch up to you—it always does.

Not only is it physically necessary, but downtime is also required for happiness and enjoyment of life. All work and no play will leave you feeling dissatisfied, unmotivated and possibly depressed. What is all that work for anyway? Yes, to achieve and be productive and get the life you want. But what’s the point if you never get to enjoy it?

“I’m afraid I won’t be as productive.”

It may seem like the more time you work, the more productive you’ll be, but this is simply not true. Paradoxically, limiting the amount of time you dedicate to work will actually make you more productive. This has been studied.

When you set a time limit for how much you work, your mind looks for ways to get it done. If you know you have more time to accomplish something, you are likely to use all of that time, or wait until the last minute (like cramming for a test).

Moreover, it’s not just how long you work, but how efficient. The more tired you are, the less efficient you will be. If you don’t rest, your tiredness and fatigue will slow your brain down and you’ll have a harder time thinking and remaining alert and focused.

“I feel guilty if I’m not working.”

This concern is common and is related to the “unreasonable standards” problem mentioned. Ask yourself: “Is it reasonable to expect that you should always be working and never take a break to just relax or have fun?” Is this what you would expect from your friends, kids, or spouse? If not, why is it any different for you?

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If you understand this logically, but can’t seem to get rid of the guilt, then you must challenge the underlying belief (which you adopted at some point) that relaxing means you are being lazy or not a good person (you can use Skill #1—Examine the evidence from Chapter 7 to help challenge this belief).

3) Take good care of yourself.

By going through this program for improved sleep, you are taking a big step towards better self-care. This goal should be applied to not only your sleep, but all aspects of your life.

Solution: Take good care of yourself physically, mentally, and emotionally.

How:

Eat well (see tips about food in Chapter 14). This is not a book on nutrition, but for the purposes of stress management, it is important that you do eat. Many busy people skip meals, or eat less than adequate, impacting energy and stress levels. If you don’t eat enough, you won’t have the fuel needed to function and this will place increased stress on your body and impact sleep.

When sick, take the time to rest and recover. Don’t “work through it,” as it will just take longer for you to get better, raise your stress, and disrupt your sleep.

Take vacations. Taking time off periodically from work for a week or more is vital for recovering from built-up stress. A couple of hours “chilling” at night and time off on weekends (which you should also do) are important for basic maintenance, but it’s not enough over time to fully manage stress and fatigue. Taking a vacation gets you out of your usual environment (ideally away from your electronic devices) and gives you extended time to rest and refuel, physically and psychologically. It doesn’t have to be extravagant—there are many low-cost options for travel that will work just fine.

Engage in a hobby. Leisure activities you can do in the evening and/or on weekends are a great way to de-stress and add more enjoyment to your life. Choose the one(s) that appeal to you most.

Spend time with friends and family (but only the ones you like!). Socializing with people you enjoy can be fun and relaxing. This includes romantic time with your partner, dating or hanging out with friends and family. However, make sure you thoughtfully choose the people you spend time with. If they only increase your stress, then limit your time with them, or even cut them out if it’s a toxic relationship.

Exercise (See benefits in Chapter 12. Exercise and Sleep).

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Get a massage or have a spa day. Most people enjoy a good massage or spending time in a spa, but don’t treat themselves. While it can be expensive, there are usually inexpensive options, especially in larger cities. You can also do it as a special reward once or twice a year.

Make love. Sex is not only vital for a healthy romantic relationship, but also lowers stress. If you are currently not in a relationship, you can self-pleasure and still get stress-reducing benefits.

If you are suffering from a mental health problem, get help or help yourself. Everyone experiences anxiety or feels sad sometimes. That’s a normal part of life. But if you’re feeling this way most of the time, and having difficulty getting out of bed, interacting with others, working, going to school, or enjoying your life, then it may be something more serious that should be addressed. You can seek out a qualified professional and/or utilize the many excellent books available for overcoming these issues (see Mental Health Resources at the end of this book).

Common Objections for Taking Good Care of Yourself: “I don’t have the time.”

Sound familiar? Yep, there’s that time-factor concern again. But ask yourself: “What kind of life do I want? One where I’m working all the time without fun or relaxation? How do I want to feel on a daily, weekly, yearly basis? Stressed out, tired, or even burned out? Or energized, happy, and relaxed? If you want to fully enjoy your life and feel good (physically and emotionally), it is vital to have a balance between work, fun and rest. Listen to your body, mind and emotions to find that “right” balance for you. If you do, I guarantee you will sleep better.

“I have to put others first.”

I hear this frequently in my therapy practice. Valuing the people in your life (your kids, partner, friends, co-workers, parents) and wanting to be there for them and support them is wonderful. However, if you are putting others first (and yourself last) to the point of feeling stressed-out, overwhelmed, chronically tired and maybe even depressed, then you are not giving yourself enough attention.

Here are a few of the many reasons why putting others first at your own expense is unhealthy for you (and the ones you love):

It builds up resentment towards the other person, which is toxic to relationships.

You may be imposing your help on someone who doesn’t want or need it. As a result, they may assume you view them as incapable, which they might

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internalize and start to believe.

It leaves you unhappy (and possibly depressed) because you are not getting your needs met.

Here are a few of the many reasons why putting yourself first is healthy for you (and the ones you love):

You will be a great model of self-respect and self-care for people around you.

You will sleep better, because you will be less stressed and more at peace.

You will be able to say “no” to others and set proper boundaries, which will allow you to manage your time and energy more effectively.

You will feel more benevolent towards others.

You will feel better and be happier.

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9. Imagining Yourself as a Good Sleeper

Notice the huge difference between these two thoughts: 1) “I am having trouble sleeping”; and 2) “I am a bad sleeper.” The first thought implies the problem is situational, temporary and solvable. The second is a fundamental statement about who you are as a person. It’s labeling yourself as a bad sleeper and it becomes a part of your self-image.

The mind is powerful. How you picture yourself in your mind actually creates who you become because your mind turns those beliefs and images into emotions and actions.

For example, if you truly believe you will be successful at something, feel it emotionally, see it vividly in your mind and then act on it, it is highly likely to become reality (assuming it’s something that’s possible).

Imagery can be used as a tool for success and changing one’s self-image. Visualization (a skill that uses imagery for positive change) is used frequently in sports, business and for accomplishing almost any goal. It has been proven time and again to be extremely effective.

Legendary golfers Jack Nicklaus and Tiger Woods, boxer Muhammad Ali and Olympians Mary Lou Retton and Lindsey Vonn, all credit visualization for much of their success. Celebrities such as Jim Carrey, Will Smith, Oprah Winfrey, Arnold Schwarzenegger and Bill Gates also credit the use of mental imagery for their achievements.

Using visualization to sleep better

Just as using your creative imagination works in sports and business, it also works in changing your sleep self-image.

If you imagine yourself as a particular kind of person, whether smart or intelligent, brave or cowardly, coordinated or clumsy, then those images of yourself become a self-fulfilling prophecy. The images cause you to think, feel and act in a way that is consistent with that image and it eventually becomes true.

This is what can happen with sleep. You begin seeing yourself as a poor sleeper or an “insomniac”, picturing yourself tossing and turning in bed, lying awake at night, frustrated and anxious and feeling exhausted the next morning. Those images have a powerful effect on your thoughts, feelings and behavior, which then affect your sleep, reinforcing the image of you as a poor sleeper. And the cycle just continues—unless those images are changed to ones of you sleeping well.

It’s not that you are doing this on purpose. It just becomes an expectation after an initial bout of poor sleep. And then it grows worse if what you expect (in the form of pictures in your mind) is that you will struggle with sleep.

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How visualization works

Our brain and body do not know the difference between something we actually experience and something we picture vividly in our minds and feel physically and emotionally. Both create the same physiological reactions. This has been proven in many studies and it is easy to observe in yourself.

A simple example is worry. When you worry, you picture something negative happening in the future, such as failing a test or getting rejected by someone. You see the event happening vividly and your body responds with increased heart rate, sweating, tension and other physical reactions. The event is not actually happening; you’re simply imagining it in your mind. You may even be in a calm, safe setting when you picture it. But your brain thinks it is real because what you are picturing is so real and detailed that it causes your body to prepare physically for a threat.

The point is that your brain believes it’s real, because it only responds to what you tell it in the form of pictures and thoughts (whether those pictures and thoughts are fact or fiction).

Visualization works in the same way as in this example—only for the positive. When you picture yourself being successful, confident, happy, or able to sleep well, your brain and body respond as if it is real. Then your subconscious* mind begins searching for ways to make it happen by sending up thoughts, images, emotions and actions for you to take, which move you toward what you have imagined. The result is a feeling of certainty that you will achieve or become what you have imagined and that becomes a self-fulfilling process.

* What I mean by your “subconscious” is the part of your mind where 99.99% of all your knowledge, beliefs and memories are stored. All of this data is accessible and changeable.

How to visualize for good sleep:

1) Choose a specific goal. For example, “I want to sleep soundly and deeply every night and wake up feeling rested and refreshed.”

2) State the goal positively. Phrase it like the example above, not in the negative, “I don’t want to have insomnia.”

3) Find a quiet place to sit or lie down. Choose a place where noises or other people will not disturb you. Lie down on a couch or sit in a comfortable chair. (Don’t do this in your bed or bedroom. The goal here is not to sleep, but to start creating the belief at an emotional level that you are a good sleeper.)

4) Close your eyes, relax, and let go. Take a few deep breaths and let them out slowly. Feel the tension start to release from your body. Then breathe naturally and easy.

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5) Picture yourself on a large screen. Pretend you’re in a movie theater. There’s a large movie screen stretched out in front of you and you see yourself on the screen.

6) Imagine the outcome you want. It’s vital when visualizing that you picture yourself having already achieved your goal. See yourself on the screen acting and feeling as the sleeper you want to be (see the sample visualization below).

7) Do this everyday for 30 minutes. It is important to make this a daily part of your routine. It is helpful to have a set time in your schedule for it. If you can’t do 30 minutes, then do at least 10. The time usually goes fast when you do it.

Note: I suggest doing visualization in the evening, at least a couple of hours before bedtime. If you start falling asleep as you do the visualization (which might happen), then stop. You don’t want to fall asleep before bedtime on the couch or somewhere other than your bed. If every time you do it you start nodding off, then that’s a good thing. It means you can use this as a way to fall asleep. Then, just do the visualization after you get into bed to go to sleep, using it more as a sleep-aid than a self-image changer. If you start sleeping better as a result, then the outcome will be the same.

Personal Tip: I use visualization every evening (around 6:00 or 7:00pm) for 30 minutes, and I love it! I use it for all of the goals and changes I want to achieve in my life and self-image. Not only is it effective (I used visualization to write this eBook), it’s fun picturing yourself living the life you want, being the person you want to be and experiencing it physically and emotionally. It also has the added benefit of relaxing and centering you.

Sample visualization for sleeping well

Once you are comfortable, sitting or lying down with your eyes closed, picture a large movie screen in front of you. See yourself on the screen. See yourself dressed for bed in whatever you normally wear. You are sitting on the couch reading a relaxing book (or whatever you normally do). See as many details as you can: the color of your shirt, the room you’re in, the book you are reading, etc. You appear very sleepy and can barely keep your eyes open. You can see yourself nodding off, closing your eyes, your body is relaxed, looking like you are weighed down and desperate to sleep. You have no tension, no worries. You are too tired to think. You can see this in your face as you watch yourself on the screen. Then you see yourself put down the book, slowly get up, and lumber into your bedroom, trying to lift your heavy legs because you are so sleepy. You can’t wait to get into bed, close your eyes and sleep. You see yourself entering your bedroom. The room is dark, the fan or air conditioner is on, and the room is cool. The bed looks extremely comfortable and inviting, and it is quiet. You see yourself pull back the covers, then get into bed, slip under the covers and lay your head on the soft pillow. You can see how you look so pleasantly relieved to be in bed, feeling fortunate to lie down on such comfortable soft sheets and feel so warm and safe under the covers, your

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body feeling heavy and relaxed, and as you see yourself close your eyes, a pleasant and serene expression forms on your face. You appear utterly relaxed and motionless. You watch yourself breathing slowly, deeply, seeing the blanket rise and fall with your easy breaths, until you see yourself drift off to sleep, effortlessly and you watch yourself for a few more minutes, just sleeping, peacefully. You do not stir and the same serene expression remains on your face as you drift into a deep, satisfying sleep.

Then the frame slowly changes to morning and you see yourself sleeping soundly. Then you see yourself gently stir and open your eyes. You smile and feel refreshed and rejuvenated. You see yourself sit up easily, feeling rested and filled with energy and you happily get out of bed and stretch your arms up high above your head, your entire body feeling good and you are ready for the day.

Some tips

This visualization is just one example of what you could picture. It’s important to personalize it to fit your particular sleep goals, sleep environment and the kind of sleeper you want to be. What you should visualize is the ideal way you would like to sleep in as much detail as possible, particularly focusing on your senses and how you feel emotionally and physically.

Once you start visualizing, you must trust that it will work. Don’t try to force what you picture in your visualization into your daily life. It will happen naturally, almost without effort. Just continue to follow the guidelines in the book and your subconscious mind (guided by your visualization) will handle the rest.

This is not a mystical or magical thing; it’s simply the way your mind works. You picture the outcome you want (sleeping well), and your mind figures out how to make it happen, then sends you thoughts, images, emotions and actions that will lead you to your goal. The visualization will also make you feel more optimistic about becoming a good sleeper and more motivated to take the actions necessary to achieve that outcome.

Of course, things will not always go perfectly as you move towards sleeping better. Your mind and body learn by trying things, then adjusting, so you can be more effective the next time. Eventually, you will learn exactly what your body needs, making it an automatic part of your life.

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10. Your Sleep Surroundings

The environment in which you sleep can have a significant impact on the quality of your sleep. Here’s how to optimize your sleep surroundings:

1. Keep your bedroom cool and your bed warm.

Your body temperature plays an important role in your sleep. Therefore, a warm room can raise your body temperature and make it more difficult to sleep. Research has shown that about 65 degrees Fahrenheit is the optimal temperature for sleep.

In the summer, keep your shades or curtains closed during the day to keep out sunlight that heats the room. Then open the windows at night to cool your room off and circulate air. You can leave the windows open as you sleep if there isn’t any bothersome outside noise. An air conditioner or fan is also helpful, particularly in hotter climates.

In the winter, turn the heat down or off at night so it’s cool in your bedroom. Make sure to keep yourself warm in bed using the right amount of blankets (but not too warm). And be mindful of what you wear (or don’t wear)—make sure it keeps you warm, but not enough so you perspire, which will disturb your sleep.

2. Keep your bedroom dark.

Sleeping in a dark room is important for melatonin release and activating your sleep system. You can use blackout shades or a sleep mask if needed. Use a nightlight in the bathroom instead of the regular light to prevent light exposure in the middle of the night.

Personal Tip: Cover your alarm clock if it emits light. Mine is bright and I cover it with a T-shirt in order to darken the room. Blocking the light also prevents you from clock-watching, reducing anxiety about what time it is and how long you’ve been sleeping.

3. Keep your bedroom quiet.

Noise disturbs sleep. Even if you are sound asleep, your brain is still aware of what is going on around you and can hear noises. This is especially true in the latter half of the night when your sleep is lighter.

We all respond to different noises, so what wakes one person up might not wake up another. This is because what sound we respond to is based upon its personal and emotional meaning to us. So, a new mother might awaken from the sound of her baby crying, but not by loud traffic noise outside.

The noise that bothers us most is varying or sudden noise. Most people adjust to noise that is constant or consistent, like living by a freeway or airport. But variant noise (a barking dog, birds chirping, a noisy neighbor) can jolt you in your sleep, wake you up and you may not even remember in the morning that it happened.

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Nonetheless, it disturbs your sleep and you can wake up feeling tired even after several hours of sleep.

Moreover, the poorer you sleep, the more sensitive you will be to sound, so it is vital to keep your bedroom as noise-free as possible.

Ways to minimize noise:

Close your windows if there is outside noise Wear ear plugs Use a sound machine (like rain or ocean waves) Put on relaxing sleep music (YouTube has hours of it for free) Use a fan or air conditioner (creates white noise)

White noise is a huge help for drowning out variant noise that comes from inside or outside your home. It creates a constant, ambient sound that masks other sounds, making it easier to sleep.

If you have a partner who snores and this is one reason why you can’t sleep, then you can urge your partner to get treatment for it. If your partner refuses to get help, you can ask him or her to sleep in another room. This may sound harsh or extreme, but this is not a small issue. Good sleep is vital to a happy and healthy life.

If you have a partner who moves around or gets up a lot and this is affecting your sleep, here are some things you can do:

Use a separate sheet and blanket (which is also good if your body temperature differs from your partner)

Get a larger bed or separate twin beds

Personal Tip: I use a California-King, Tempur-Pedic bed and pillow and I love it! I have had it for 14 years. It minimizes movement if you share your bed with someone. So when my wife shifts in her sleep or gets up in the night, I don’t feel it because the bed barely moves.

We also use separate blankets (we don’t use a top sheet), which prevents us from disturbing each other when we move about. I can also control my body temperature by using a heavier or lighter blanket than my wife. This tip won’t just help your sleep, it will help your relationship!

4. Make your bed comfortable.

A cozy, inviting bed is much more likely to make you look forward to sleep, creating a positive bed/sleep association. It’s important to choose the type of bed, pillow, and bedding that makes you most comfortable, such as firmness or softness of your mattress, thread count of sheets and types of fabrics. This is where you spend a third of your life, so it’s worth it to invest a little money to make it as comfortable as possible.

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5. Make your bedroom an oasis for sleep.

The more inviting your bedroom is, the more it becomes associated with restfulness and calmness. The more peaceful your place of sleep feels, the more likely you will look forward to sleep and have a restful night. Here are some suggestions:

Put up soothing photographs (a Caribbean beach, a waterfall, a desert) or keep your walls bare

Use a warm or calming paint color Keep your room clean and uncluttered Remove all work/school-related items (e.g., books, desk) Keep electronics out (TV, computer, smartphone) Use scents like lavender, roses or jasmine (one study showed that smell can

affect your dreams: more positive dreams with good smells, more negative dreams with unpleasant smells)

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11. Relaxation Exercises

Being able to relax is a requirement for falling asleep. If you are tense or restless, you are in the opposite state needed for sleep. Sleeping is about letting go and allowing your body to do what it’s designed for and to do it without effort.

Not everyone who has insomnia has trouble relaxing. Some people feel totally relaxed, but still don’t sleep. This is usually because they’re not tired enough for sleep.

We all relax in different ways, such as hobbies, watching TV, reading, and listening to music. In addition, there are many exercises used specifically for inducing relaxation.

Some people love relaxation exercises and others don’t. It’s a matter of personal preference. Experiment and choose one relaxation exercise you like and stick with it for a few weeks. It may take a little time to learn and get used to, but once you do, it can be extremely beneficial, not only for sleep, but also for your daily life.

These exercises can be used as an aid for falling asleep, or as a daily relaxation practice. If used during the day, try to avoid falling asleep, as taking naps will impede your nightly sleep.

Exercise 1: Diaphragmatic Breathing

When we get stressed or anxious, we tend to breathe from the chest, with our airflow becoming shallow and more rapid. This is due to tensing and contracting our muscles, resulting in less oxygen. Enough to keep us alive, but not enough for ideal functioning and staying relaxed.

When you’re relaxed, you breathe from the diaphragm. The diaphragm is a dome-shaped sheet of muscle, located below your lungs. When you inhale, the “dome” blows up like a balloon, expands the chest cavity and pulls air into the lungs. When you exhale, the diaphragm relaxes and the dome deflates. You can easily see diaphragmatic breathing by watching a baby breathe as he or she sleeps.

This exercise is simple and designed to help you return your breathing to the diaphragm and establish slower, deeper breaths, the way you would be breathing if you were completely relaxed. It trains you to become conscious of your breathing and to notice when you are tensing up and breathing from the chest, so you can adjust and let go.

How to do it:

1. Sit or recline in a chair or sofa. 2. Place one hand flat on your abdomen (just above the belly button) and one

hand flat on your chest.

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3. Take a few slow, deep breaths in and out (through your nose or mouth, whichever feels most natural).

4. Notice which of your hands is moving up and down. It should be the lower hand, the one over your abdomen (where the diaphragm is). The hand on your chest should remain still as you do this exercise.

5. Once you get the hang of it, you can remove your hands and relax them, then continue taking in slow, deep breaths, feeling your belly expanding like a balloon as you inhale and deflating as you exhale.

6. Inhale for three seconds and exhale for six to ten seconds. Easy, deep, slow, relaxing breaths.

7. While exhaling, gently tighten your core and contract your abdominals, which will push the air more effectively out of your lungs.

8. Continue breathing deeply for a few minutes. You can also close your eyes. As you breathe, feel your body relax and let go with each exhale.

You can start by doing diaphragmatic breathing for just a few minutes at least twice a day. You will usually feel calmer and sometimes even sleepy after doing this exercise. You can gradually increase the time to five or ten minutes as you get more comfortable.

Personal Tip: You can do this exercise anywhere and no one knows you’re doing it.

Exercise2: Progressive Muscle Relaxation

Progressive muscle relaxation involves deliberately tensing then relaxing various muscle groups for the purpose of becoming more aware of the contrast between tension and relaxation. When muscles are first tensed, they relax more deeply when released, creating a deeper relaxation.

Between the tensioning of each muscle, you will also take a deep breath, hold it, and let it go. Over time, this technique will allow you to create relaxation quickly and at will.

Through practice, you will gain a greater sensitivity and awareness of your body’s tension, which will allow you to maintain relaxation more easily.

Note: If you have any injuries, do not tense the muscles in that area.

How to do it:

1. Find a quiet, comfortable place where you can recline or lie down. Make sure your entire body is supported.

2. Chose a place and time where you won’t be distracted or interrupted.

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3. Make sure you’re wearing comfortable, loose-fitting clothing. You can loosen your belt, tie or whatever’s needed to get more comfortable.

4. Keep your legs and arms uncrossed, legs slightly apart, arms and hands gently resting at your sides or on your thighs.

5. Close your eyes and let your body go. Take a deep breath in and let it out slowly, feeling your body sink into the chair like a rag doll.

6. As you tighten each muscle group in the following steps, tighten them as much as possible, while keeping the rest of your body relaxed.

7. Forehead. Start by wrinkling up your forehead, keeping it tight and really noticing how the tension feels. Keep the rest of your body relaxed. Hold for 10 seconds, then release, feeling the tension melt away from your forehead. Take a deep breath. Hold it for 5 seconds, feeling the tension in your chest and abdomen, then let it go slowly as you sink more deeply into the chair (or whatever you’re lying on), feeling the tension disappear even more from your forehead. (Note: You can adjust the time you hold your breath to feel most comfortable)

8. Eyes. Close your eyes as tightly as you can, squeezing them shut. Keep the rest of your body relaxed. Hold the tightness for 10 seconds, then relax and feel the tension release from your eyes. Take a deep breath. Hold it for 5 seconds, feeling the tension in your chest and abdomen, then let it go slowly, as you feel your eye muscles become softer and more relaxed.

9. Tongue. Close your mouth and push your tongue against the roof of your mouth, digging it in, and hold the tension for 10 seconds, really noticing the tension in your tongue. Then relax and let go. Take a deep breath. Hold it for 5 seconds, feel the tension, then let it out slowly, and let your tongue rest easy.

10. Mouth. Open your mouth as wide as you can, feeling the tension in your jaw, and hold it for 10 seconds. Then let go and relax, letting the tension release and your jaw drop down. Take a deep breath. Hold it for 5 seconds, then let it out slowly, and notice the muscles in your forehead, eyes, tongue, and mouth, making sure they are all relaxed (if not, re-tense and release the ones that aren’t).

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11. Neck. Slowly push your head against the back of your chair (or whatever you are lying on), feeling the tension in your neck, keeping the rest of your body relaxed. Hold for 10 seconds, then release. Relax for 10 seconds. Then slowly bend your head forward, dropping your chin to your chest and hold it for 10 seconds, feeling the tension in the back of your neck, then release. Relax for 10 seconds. Then turn your head to the right as far as you can while keeping your shoulders relaxed, hold it there for 10 seconds, then bring your head back to neutral and relax for 10 seconds. Then turn your head to the left as far as you can while keeping your shoulders relaxed, hold it there for 10 seconds, then bring your head back to neutral. Take a deep breath. Hold it for 5 seconds, then let it out slowly, noticing the muscles in your neck relax even more deeply.

12. Chest. Take in a deep breath filling your lungs up completely, tighten your chest muscles, feel the tension in your ribs. Hold for 10 seconds, then release and let out your breath, feeling the tension relax and melt away from your chest. Take a deep breath. Hold it for 5 seconds, then let it out slowly, noticing the muscles in your chest further release and let go.

13. Back. Arch your back as if you had a pillow under the lower part of your back, feeling the tension in your back, and hold it for 10 seconds. Then release and let the tension go from your back. Take a deep breath. Hold it for 5 seconds, then let it out slowly, noticing your back relax even more.

14. Shoulders. Shrug your shoulders as if you were trying to touch your ears with your shoulders. Hold for 10 seconds, keeping the rest of your body relaxed, then release. Take a deep breath. Hold it for 5 seconds, then let it out slowly, and notice the muscles in your face, neck, chest, back, and shoulders, making sure they are all relaxed (if not, re-tense and release the ones that aren’t).

15. Biceps and triceps. Tense your biceps by bending your elbow and bringing your hands toward your shoulder, then hold for 10 seconds. Really feel the tension in your biceps, then release and relax for 10 seconds. Then tense your triceps by straightening your arms out and tightening the backs of your upper arms and hold for 10 seconds. Then release and let your arms relax. Take a deep breath. Hold it for 5 seconds, then let it out slowly, feeling your arms completely let go and become heavy.

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16. Hands. Squeeze your hands into tight fists and hold for 10 seconds. Then release and let your fingers relax and open. Take a deep breath. Hold it for 5 seconds, then let it out slowly, feeling your hands and fingers completely relax.

17. Stomach. Tighten your abdominal muscles as if you were pushing your bellybutton inward toward your spine, making your stomach hard. Notice the tension and hold for 10 seconds. Then release and let go of all that tension. Take a deep breath. Hold it for 5 seconds, then let it out slowly, feeling your stomach completely relax.

18. Buttocks and thighs. Concentrate on your buttocks and thighs. Tense the muscles in these areas all at once, keeping them as tight as possible while relaxing the rest of your body. Hold it for 10 seconds, then relax and let go of the tension. Take a deep breath. Hold it for 5 seconds, then let it out slowly, feeling your buttocks and thighs further relax and let go.

19. Feet and calves. Point your toes as hard as you can, feeling it in the muscles of your feet and calves. Hold for 10 seconds, then release. Take a deep breath. Hold it for 5 seconds, then let it out slowly, feeling your feet and calves totally relax.

20. Toes. Curl your toes down, making them as tense as possible, without tensing your legs. Hold for 10 seconds, really feeling the tightness in your toes. Then release and relax, wiggling your toes a little to let go of any tension. Take a deep breath. Hold it for 5 seconds, then let it out slowly, feeling your entire body completely relax and let go, with all tension vanishing.

Do a quick scan of your body from head to toe. All tension should be gone. If there are areas that are still tense or tight, re-tense and release them until all tension is gone.

Exercise 3: Meditation

Meditation is a method for calming the mind and body by focusing your attention on something. There are numerous types of meditation (e.g., transcendental, mindfulness, relaxation response), but I will just go over a few different practices, which is all you need.

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How to do it:

Step 1: Sit and get comfortable.

Start by sitting in a comfortable position. It’s ideal if it’s quiet, though it’s not required, as you can meditate even if there’s noise (like in an airport).

Close your eyes and let your body relax. Loosen any tight clothing. Do a quick scan of your body and let go of any places you are holding or tensing. Then, focus your attention on your breathing, taking a few deep, slow breaths, exhaling slowly, letting your body relax each time you exhale.

Step 2: Choose a focus.

There are several ways to focus your mind during meditation.

1. Focus on your breathing—As you sit quietly and comfortably, notice your breathing, as the air goes in and out of your nose or mouth, or the sound of your breath.

2. Repeat a word—Choose a word and repeat it in your mind, effortlessly and silently on the exhale, as you continue breathing naturally and easily. Some common words to use: peace, relax, calm, serene, silent. It doesn’t matter what word. The purpose is to focus your mind on one simple thing in order to let go of everything else.

3. Focus on an enjoyable or relaxing place—a beach, a mountain retreat, a favorite vacation spot, a beautiful location in nature.

4. Focus on your senses—Notice what you hear, smell and feel. What noises do you hear inside and outside? What is the temperature in the room, or do you feel a breeze if outside? Just notice and be aware of these sensations; do not think about them or judge them.

As you focus on one of the above, continue to breathe easily and naturally.

Step 3: If your mind wanders, gently bring it back.

If your mind wanders (and it will) to other things (thoughts, worries, noises, bodily sensations), gently bring your attention back to your chosen focus. This is a normal part of meditation and happens to everyone, especially during the first part of the meditation when your mind may need to wind down. It’s the way the mind works, so don’t get frustrated or think you’re doing it wrong. Just keep bringing your attention back to your focus, whenever you notice a shift to something else.

Step 4: Don’t try to relax.

Your body and mind will relax on their own when they’re ready. Don’t try to force it. If you do, it will have the opposite effect (which is also the case when you “try” to go

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to sleep). Instead, just let the relaxation happen in its own time. Either way, you will still get benefits.

Step 5: Meditate for 10-20 minutes a day.

Meditate once a day for about 10-20 minutes (or longer if you want). Choose a time that you can do it consistently, like first thing in the morning, or in the evening a few hours before bedtime.

Exercise 4: Imagery

Just as we used imagery in Chapter 9 to help change your sleep image, it can also be an effective way to relax. It involves focusing your mind on a place you find serene and calming, in vivid sensorial detail.

How to do it:

Begin in the same way as the other relaxation exercises. Sit or lie down in a comfortable position. Choose a quiet place where you won’t be disturbed or interrupted. Loosen any tight clothing. Do a scan of your body and let go of any areas that you’re holding onto. Breathe easily and naturally as you let your body relax and let go. Do this for about a minute until you feel more relaxed.

Begin focusing on your image. Your image can be any place that you find relaxing, calm, or peaceful. It can be a real place like a favorite vacation spot, a place in nature you love, or a place where you feel safe. It can also be a place you invent, like floating on a cloud, being at a five-star spa, or lying on a tropical beach. The possibilities are limitless. Just use your imagination.

Picture the place in vivid detail, focusing particularly on your senses and how you feel physically and emotionally. What are you wearing? What are you sitting or lying on? How does it feel against your body? What is around you? What do you see, smell, taste, feel, and hear? The more detail you include, the more your mind will think it’s real, and the more powerful, pleasurable and relaxing it will be.

You can guide yourself in your own mind or you can write it out and then record it with your voice (or ask a friend with a soothing voice) and listen to as you do it. Then you can listen to it anywhere you go with a pair of headphones.

Do this imagery exercise for about 20-30 minutes daily.

Here is a sample script you can use as a guide.

Once you are relaxed and seated with your eyes closed, breathing easily and naturally, let your thoughts of your daily life gently drift away, as you begin to picture in your mind that you are walking down a narrow, winding pathway of white sand. There are green, tropical plants on both sides of the path covered with flowers in bright colors—reds, oranges, and yellows. You can smell their sweetness in the air. You can feel the warm, soft sand under your bare feet as you walk. You are wearing a comfortable

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bathing suit. The temperature is warm, exactly as you like it. You continue walking down the path and can hear the ocean waves crashing nearby as you approach the beach.

A moment later, the path ends and you arrive at a beautiful, secluded beach. You see it stretches out for miles in both directions. Then you gaze out over the sand towards the water and see and hear the waves crashing onto the sand, creating white foam. You see the turquoise sea extending endlessly into the horizon. A few small sailboats move in the distance. The sun is shining brightly above in a cloudless blue sky and, as you look up, you can feel its warmth on your face. The warmth relaxes and soothes you and you feel even more at peace.

You begin to walk across the sand, towards the water, feeling your bare feet sinking into the deep, white sand. It is warm and soothing on your feet. You reach the water and smell the salty ocean air and feel the mist from a crashing wave, as the water rolls up the sand and gently covers your feet. The water feels warm and inviting and tickles your feet and ankles.

You gaze out at the water and see the sun reflecting off of it making the water shimmer like silver. You see a flying fish jump out of the water, flapping its fins, then dives back into the water. You take a deep breath in and let it out, becoming even calmer and more still. You are very present in this moment, able to be there and appreciate the profound natural beauty and tranquility. You feel happy and light, free of any concerns. Everything feels right and good.

After a moment, you turn and start slowly strolling down the beach. You remain near the water, and every minute or so, a gentle, warm sheet of water washes over your feet and ankles. Your feet sink into the wet, pliable sand, creating footprints. As you walk, you can see far down the beach. It is deserted and serene. Your muscles and limbs feel relaxed and loose as you walk, any last tension in your body melts away, and you start to feel renewed and rejuvenated. You can’t help but smile.

You walk for a while longer then see a chaise lounge up on the sand nearby. You walk up a gentle slope to the dry, soft sand. The chaise is empty and inviting. It has a soft, tan cushion and a thick white towel laid out on it. You walk over and lie down on it feeling your body sink into the cushion. It feels cool and comfortable against your body and you close your eyes and let your body completely go, feeling the chaise support you, as if you were drifting weightlessly on a cloud. You are now completely relaxed and at peace. Everything inside you is still. Your breathing has slowed and is now easy and effortless.

You can continue to lie on the beach as long as you like and, when you’re ready, you can gently open your eyes and slowly bring your attention back to the room you are in, while holding onto that total relaxation and calmness.

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Make relaxation a normal part of your daily routine.

If you like one of the relaxation exercises, it’s best to make it part of your normal, daily life, like brushing your teeth. Find a time of day when you can practice it regularly, like in the morning when you wake up, midday during your lunch break, or in the evening after dinner (not too close to bedtime). Put it into your schedule at first so you are conscious of it and plan for it until it becomes habit. If you don’t, you are likely to forget or not do it, as something else will surely pop up to fill the time.

You will start to see benefits in your daily life, feeling calmer and more relaxed during the day and able to relax faster when you become tense or stressed. The longer and more regularly you practice these relaxation techniques, the more effective they will become and the easier it will be to fall and stay asleep, adding to and strengthening the changes and skills you are already applying.

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12. Exercise and Sleep

Exercise

The benefits of exercise are widely known: better overall health, decreased risk of disease, stronger and more flexible muscles and joints, increased energy and many more. But few talk about how exercise benefits sleep.

People with chronic sleep problems tend to be more sedentary and a lack of physical activity during the day can lead to poorer sleep.

Here are the reasons why exercise helps you sleep better:

1. Exercise raises your body temperature.

Most people think that their normal body temperature is 98.6 degrees Fahrenheit, and that it stays at this level throughout the day, unless they’re sick. Actually, 98.6 is the average body temperature. It usually varies up to one and a half degrees over the course of the day following a circadian rhythm (circadian means “about a day”), and can be affected by age, hormones and other factors.

Your body temperature is highest in the midafternoon, and then reaches its peak around 6:00pm. It is at its lowest point in the early morning.

Exercise raises your body temperature, which causes a more intense drop in body temp for several hours following exercise. This more dramatic drop in body temperature helps you fall and stay asleep.

Personal Tip: For optimal effect on body temperature, exercise three to six hours before going to sleep. And do not exercise less than three hours before bedtime, as it won’t give your body enough time to cool down, which can keep you up.

Personally, I exercise between 3:00pm-5:00pm and go to sleep around 10:00pm on most nights. I have found exercising at this time a great stress reliever, as well as tiring me out and setting me up for a good night’s sleep.

2. Exercise places stress on your body.

Stress is usually considered harmful. But when you exercise, you deliberately place stress on your body, which makes you stronger and fitter.

The stress you get from exercise tires you out. Your brain and body compensates for this increased demand by making you sleep deeper, and more soundly, to restore and rejuvenate you.

3. Exercise increases your exposure to sunlight.

Light and darkness directly affect your circadian rhythm, which regulates your body temperature and sleep on a 24-hour clock. When you are exposed to bright light, your body temperature increases and the release of melatonin (a naturally

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occurring hormone in your body that promotes sleep) is decreased, causing wakefulness. Conversely, when it’s dark, melatonin levels increase and promote sleep.

However, there’s one problem. The invention of the light bulb, which has provided us countless benefits, has also affected our sleep patterns. Artificial light reduces our daily exposure to sunlight during the day and limits the amount of darkness we get at night. This can disturb our circadian rhythm, body temperature, levels of melatonin and cause sleep problems.

The solution: Take control of your light!

Exercising outside is a fantastic way to increase your exposure to sunlight. Not only will you get the physical benefits and increased body temperature, but you will also maintain your body’s natural circadian rhythm and normal melatonin release, which will improve your energy, mood and alertness during the day and promote better sleep at night.

Here are some other tips for taking control of your light to maintain your circadian rhythm and maximize good sleep:

As soon as you awake, open the blinds Go for a morning walk Sit by a window that lets in light during the day Dim or shut off the lights at work or at home after sunset Refrain from using electronics (computer, smartphone) an hour before

bedtime Sleep in a pitch dark room (you can use black-out shades or a sleep mask) Don’t wear sunglasses—they block the natural light and decrease the affects

of sunlight on your body’s sleep system

Personal Tip: When I was experiencing insomnia, I stopped wearing sunglasses. You may think, “But I am so used to them. The light will be too bright without them. And hey, I look pretty cool too.” You may look cool, but unless you need to wear sunglasses for a vision problem, or to prevent severe reflection, you don’t need them.

I had been wearing sunglasses all my life until I had insomnia. It took just a few weeks to adjust and I haven’t worn them since.

4. Exercise reduces overall stress.

Even though exercise places stress on your body, it is only for a brief period, and then your bodily stress decreases. Exercise loosens your muscles and can reduce symptoms of depression and anxiety. Anxiety and stress keep you awake, so reducing them will help you fall and stay asleep.

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Type of Exercise

It doesn’t matter what kind of exercise you do. Anything that tires you out is good. It doesn’t have to be rigorous either. A brisk walk for 30 minutes will do the trick. I recommend exercising at least four times a week (outside whenever possible) on a regular basis to get the full sleep benefits.

Personal Tip: On nights you don’t sleep well, you will be tempted to skip exercise the next day. You may think, “I’m tired and don’t have the energy.” That’s what I thought and was tempted to not exercise on those days and “just rest.”

But even if you are tired and only sleep a couple hours (or not at all), stick to your exercise schedule (the exception would be if you are sick). It may be harder, but it will still have all the benefits noted, as well as creating more pressure on your body to sleep that night.

Alternatives to exercise and exposure to sunlight

A hot bath:

If you are unable to exercise for some reason (an injury, sickness), one great alternative is a hot bath. Like exercise, a hot bath raises your body temperature, then causes it to steeply decrease (a good thing!) from the time you bathe to the time you go to sleep. It’s also relaxing. .

It’s important to make the bath hot and keep it hot for 20-30 minutes as you soak. You can also use a Jacuzzi. You should do this about two hours before bedtime, because the temperature drop happens more quickly after a bath than after exercise. Don’t take it any closer than two hours before bedtime or your body temperature may not have time to drop enough for sleep.

Light therapy:

For people who live in overcast or northern climates, and get limited natural sunlight, the use of a light therapy device can be an alternative for regulating your circadian rhythm and sleep cycle (though it is not as effective as getting natural light). Light therapy involves sitting near a device that emits bright light that simulates outdoor light. You use it for about 15 to 45 minutes each morning, while doing work or other tasks.

Being Active:

In addition to exercise, an active lifestyle will help your sleep. Being active means engaging in life with both mind and body. Pursue the career of your dreams, take up hobbies you enjoy, go out with friends, travel, play sports for fun, make love, enjoy the arts, read, learn, and spend time with family. Challenge yourself both physically and intellectually. The more active you are in this respect, the more rewarding life will be, and the more satisfied and tired you will be at the end of your day. The more

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satisfied and active you are in your life, the more peace of mind you will have at night when you get into bed and the better you will sleep.

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13. Sleeping Pills and Herbal Remedies

Sleeping Pills: To Use Or Not To Use

According to the Centers for Disease Control, about 9 million Americans use prescription sleeping pills. This doesn’t include the many who use over-the-counter remedies.

It can be appropriate to take a sleeping pill (through consultation with your doctor) under certain circumstances: the death of a loved one, when suffering from a medical ailment, when you have severe jet lag, but only for the short-term and, preferably, not every night.

However, if your goal is to conquer insomnia, then discontinuing the use of sleeping pills is a necessity*. This is true whether you are taking a prescription medication like Ambien or Xanax or an over-the counter remedy like Nyquil or Excedrin PM.

(* Note: I am not a medical doctor and cannot provide medical advice, so it is

important that if you are currently taking medication for sleep, to consult with

your doctor first about whether you should discontinue its use, and if so, how

to do it safely.)

Seven reasons why you should stop taking sleeping pills:

1) Because they don’t treat insomnia, they only treat its symptoms. Insomnia, as noted, is caused by your worried thoughts, dysfunctional behaviors and stress. Medication can help you relax, reduce anxiety and make you drowsy, but it can’t address the source of your insomnia. As the saying goes, “Pills don’t teach skills.” Neither do they teach you to change your negative sleep behaviors, thoughts or stress patterns.

2) They reinforce two false ideas: that how well you sleep is out of your control and that you are dependent on something external to cure it. Both of these ideas will ultimately increase your anxiety and the feeling of being out of control, which will worsen your insomnia.

3) You can become dependent on them. This means you will build up a tolerance for them requiring you to take more of the drug to get the same effect. You might also get withdrawal symptoms if you stop taking them (this is especially true of benzodiazepines like Xanax and Valium), which can be dangerous.

4) You can become psychologically addicted. This means you become mentally and emotionally dependent on pills, even if there’s no physical dependence. You will feel that you have to take your pills to sleep, and if you don’t, you won’t be able to sleep, making you feel completely at the mercy of your meds.

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5) They can become very expensive. You not only have to pay for your pills, but also your doctor visits and refills. And this cost will increase over time as you need higher and higher doses of the drug.

6) They can have many unpleasant side effects:

Headache

Diarrhea

Constipation

Heartburn

Stomach pain or tenderness

Difficulty keeping balance

Strange dreams

Dry mouth or throat

Changes in appetite

Burning or tingling in the hands, arms, feet or legs

Uncontrollable shaking of a body part

Gas

Drowsiness

Weakness

Dizziness

Hallucinations

Memory problems

Sexual dysfunction

7) They can create feelings of helplessness, guilt, hopelessness, desperation and

lowered self-esteem. Many people take sleep medications because they feel they have

no other alternative to beating insomnia. Doctors also easily prescribe them. You

should not feel guilty or ashamed for taking them. The point of this chapter is not to

make you feel bad, but to give you useful information about the risks of taking

sleeping pills and to assure you that you don’t need them to overcome your insomnia.

This book shows you how.

Herbal Remedies: Don’t Waste Your Money

Many people take herbal remedies to help them sleep. These include melatonin, valerian root, kava, chamomile, hops, lavender and passionflower. The problem is that there’s little if any scientific evidence that they’re effective for insomnia.

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Some of my clients take an herbal supplement to help them sleep. Some say it helps, but it doesn’t eliminate their insomnia. Others say it doesn’t help at all. When it does “work” they don’t know whether it’s the herbal remedy, some other change (in diet, lifestyle, etc.), or the placebo effect that caused the change.

The placebo effect is a perceived or actual improvement of a condition caused by a person’s belief. It plays a role in all medical treatments. This is the power of your mind over your body. If you really believe something (like an herb) will help your insomnia, then many times it will (to some degree), but only temporarily. This is because your thoughts actually change your brain and body chemistry.

If the placebo effect is the cause of their improved sleep, then it is the person’s belief that gets the credit, not the herbal remedy.

So what’s the harm in using an herb if it seems to help? As with taking sleeping pills, it reinforces the belief that your insomnia is out of your control and that you must rely on something external to resolve it.

And just because these remedies are so-called “natural” or “herbal,” doesn’t mean they are safe and without risks. They all have potential negative side effects and can interact dangerously with other medications. The fact that they haven’t been well researched also means we don’t know too much about them. Do you really want to ingest a substance into your body that you know little to nothing about?

Most importantly, you don’t need them to achieve better sleep!

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14. Food, Stimulants, and Alcohol

What you put into your body affects how you sleep. The following are tips for how to eat, drink and be merry without compromising your sleep.

Food

Although there hasn’t been a lot of research on how food affects sleep, there is evidence that certain foods are sleep helpers and others sleep inhibitors.

Tip #1: Avoid or minimize foods that give you gas, acid reflux (GERD) or indigestion.

Otherwise, they may keep you up.

This includes tomatoes, garlic, onion, spicy foods, peppermint, chocolate, carbonated beverages, alcohol, dairy products, fried foods, monosodium glutamate (MSG) and foods high in fat (cheese, avocadoes, and steak).

Also, avoid foods high in sugar and processed carbohydrates, because they raise your blood sugar and can give you a burst of energy that inhibits sleep. And once your blood sugar drops back down you may get hungry in the middle of the night.

Food affects everyone differently, so you need to be mindful about which foods upset your stomach and which don’t and then avoid the ones that do, especially in the evening.

Tip #2: Avoid a big meal before bedtime.

Many people with busy schedules or who work late tend to eat later, sometimes very late. If that’s you, plan to eat earlier, then eat a light snack closer to bedtime.

Eating a big meal before sleep causes your body to begin digesting the meal, increasing your metabolism and making you more alert. It may also be uncomfortable to get into bed full, which will disturb your sleep.

Tip #3: Don’t go to bed hungry.

Going to bed hungry raises the risk of you waking up in the night craving food. If you’re feeling hungry before bed, have a light snack. A low-glycemic food (i.e., foods that have little impact on blood sugar levels) is best.

Personal Tip: For a late-night snack, I personally enjoy a Granny Smith apple and almond butter or a small amount of raw almonds, macadamias, cashews or Brazil nuts.

Tip #4: Reduce your intake of liquids at night.

Drinking too much liquid in the evening can create the need to urinate during the night, disrupting your sleep.

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Foods That Promote Sleep?

There are foods that are purported to make you sleepy, but there is very little, if any, evidence to support it. These foods include bananas, sweet potatoes, jasmine rice, whole-grain cereals, and cherry juice. Foods such as milk and turkey are also said to help you sleep because they contain tryptophan, an amino acid claimed to promote drowsiness.

I include these only because some people may wonder about them. Because of the lack of evidence, I don’t recommend any particular foods that might help you sleep. You can certainly experiment to see if any help, but it is unlikely to have a significant enough effect to make you sleep if you have insomnia. I’ve tried a couple of them (bananas and milk) and they did nothing for me.

Also, remember that your ability to sleep is not dependent on external sources (drugs, food, etc.), but on changing the thoughts and behavior patterns that disrupt your sleep—things you can learn to have total control over.

Stimulants

Stimulants are a class of drugs that can temporarily increase alertness, focus, attention, wakefulness, energy, and improve mood. They elevate heart rate, respiration and blood pressure. They can also be an impediment to sleep.

Caffeine

Caffeine is a widely consumed stimulant found in coffee, tea, soft drinks, energy drinks, chocolate, ice cream (coffee and chocolate flavors), gum, over-the-counter pain relievers, weight loss products and some energy waters.

The challenge is that it can be difficult to assess the amount of caffeine in certain products because there’s no requirement for manufacturers to list caffeine content on nutrition labels. You can reference Caffeine Informer to find the average amount of caffeine in particular foods, or just follow the guidelines below.

Caffeine has greatly varying effects on people. Some can down a double-espresso right before bed and sleep like a baby. Others will be up all night with the jitters with just a small cup of coffee.

Caffeine can also produce anxiety-like symptoms, such as shakiness, nervousness and sweaty palms, or exacerbate an already existing anxiety or panic disorder, so be extra careful if you are already on the anxious side.

Some Guidelines for Caffeine

If you’re like me, you enjoy coffee in the morning. It’s hot, tastes great, wakes you up, and gives that little boost of energy and alertness that gets you going. Others prefer tea or an energy drink.

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Generally, having one or two cups of coffee (a cup being 8 ounces) in the morning shouldn’t affect your sleep at night. Two cups is about 200mg of caffeine. But avoid having any after lunch (about 1:00pm), because it takes several hours for it to get out of your system. This goes as well for energy drinks, sodas, and tea. These all have varying amounts of caffeine, so you will need to assess with each how much they contain.

But it is also important to know how caffeine affects you. It may not be bothering your sleep at all, or it may be a significant factor. The best way to tell is to cut back on your caffeine intake, or cut it out completely, and see if you sleep better (you may experience some withdrawal symptoms if you consume a lot of caffeine, which will affect your sleep until they pass). Once good sleep returns for a consistent period of time, you can slowly add caffeine back and see its effects.

Also avoid, later in the day, the foods and drugs noted with caffeine. They may contain less caffeine than coffee, but they can still affect your sleep, especially if you are caffeine sensitive.

Personal Tip: I love coffee in the morning and have found that I can have 16-20 ounces of it up to about 1:00pm and it won’t affect my sleep. I also love dark chocolate in the evening after dinner. As noted, chocolate contains caffeine and can cause acid reflux, but it has had no negative effects on me.

The rule here is if there’s something you really enjoy (like coffee or chocolate), experiment to see if it affects your sleep by removing it and seeing if it improves your sleep. Give it at least a couple weeks for your body to adjust to being without it. If it has no effect, then go back to enjoying it. When I had insomnia, for instance, I stopped eating chocolate for a couple weeks, but it had no effect on my sleep, so I allowed myself to have it again. I love science!

Nicotine

Many are unaware that nicotine is a stimulant that causes symptoms similar to caffeine. Many people smoke to relax or take a break, and psychologically, it may temporarily have this effect. However, it will also stimulate the body.

Everyone knows the many harmful and life-threatening effects of smoking cigarettes and other tobacco products, but there is little talk about how it impacts sleep. Many smokers report poor sleep. If they smoke before bed, the stimulating affects can keep them up. They can also have withdrawal symptoms in the night that wake them up with cravings, causing lighter, more restless sleep.

A recent study showed how smoking affects both your lungs and “body clock” during sleep, disrupting normal sleep patterns.

You can guess what my recommendation is: quit smoking. But if you’re not ready or willing to quit, an alternative is to reduce the amount you smoke and avoid smoking

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at least an hour before bedtime. This is not ideal, but it should have some beneficial effect on your sleep.

Alcohol

Many people drink in the evening or have a shot of alcohol to help them get to sleep. And “it works.” It reduces anxiety and relaxes them—temporarily, and helps them fall asleep.

But using alcohol for sleep is a big mistake.

Although alcohol will help you fall asleep, ultimately it will significantly disrupt your sleep. In the early part of the night, it impedes both deep and REM (dream) sleep, the two most important stages of sleep for restoring the body. And once the alcohol is metabolized and its effects wear off, your sleep becomes lighter and you are more easily awakened.

Because alcohol suppresses REM sleep in the beginning of the night, when the alcohol wears off, you can experience “REM-rebound,” causing intense dreams or nightmares in the latter part of the night. It can also cause a frequent need to urinate, as well as dehydration, headaches and heartburn.

Alcohol can also make you snore loudly and exacerbate sleep apnea because it relaxes the muscles in the throat.

The result is that you will wake up insufficiently rested and feel tired throughout the day.

Some people self-medicate with alcohol, using it like they would a sleeping pill. This puts them at risk of becoming dependent on it, just as with sleeping pills, craving it both physically and psychologically, feeling they are helpless to resolve their insomnia without it.

Personal Tip: I like to have a glass of red wine in the evening with dinner one or two nights a week (usually Friday and Saturday). Generally, this is fine because I provide enough time for my body to metabolize the one glass of alcohol before I go to sleep. Allow about 1-3 hours per drink for it to metabolize (however, time varies by drink size, alcohol concentration and your metabolism). And limit it to no more than two drinks.

So, if you enjoy a drink in the evening, you can still indulge, unless you are drinking too much or too late.

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15. Other Possible Insomnia Triggers

There are many things that can contribute to poor sleep and lead to the development of insomnia. These include medical, psychological, substance, and lifestyle issues, other sleep disorders and important life events. I do not consider these causes of chronic or long-term insomnia (as I believe insomnia to be primarily a result of negative thinking and behaviors), but it is important to rule out and/or address these issues if they’re affecting your sleep:

Medical Issues

Acid Reflux Allergies Asthma Cancer Chronic Fatigue Syndrome Chronic or Severe Pain Coughing or Congestion (Persistent) Dementia Diabetes Fibromyalgia Frequent Urination Heart Disease HIV Hypertension Hyperthyroidism Irritable Bowel Syndrome Migraines or Headaches Shortness of Breath Ulcers Medications for Medical Problems ACE Inhibitors (hypertension, congestive heart failure) Alpha-blockers (hypertension, Raynaud’s disease) Angiotensin II-Receptor Blockers (hypertension) Beta-blockers (cardiac arrhythmia, heart attack, anxiety) Corticosteroids (anti-inflammatory, immunosuppressant) Glucosamine/Chondroitin (joint disorders) H1 Antagonists (allergies) Statins (high cholesterol) Medications for Psychiatric Problems Antidepressants/SSRIs (Celexa, Prozac) Antipsychotics (Abilify, Seroquel)

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Stimulants (Adderall, Concerta) All of these medications affect each person differently. Some people may have their sleep affected while others don’t. Please consult with your prescribing physician about possible sleep-related side effects.

Psychological Issues Bipolar Disorder Depression Generalized Anxiety/Chronic Worry Schizophrenia *Insomnia is considered its own psychological issue and frequently exists apart from any other mental health problem, such as depression or anxiety. I see many clients for anxiety and depression who also have insomnia, but also ones who don’t. Poor sleep may coincide with depression, anxiety, or other mental health issues, but in my experience this isn’t always the case.

However, since some mental health problems can exacerbate insomnia, it is important to see a qualified mental health professional if you think you might be experiencing one.

Over-The-Counter Medications Many Cough and Cold Medications Medications with Caffeine (Anacin, Excedrin, NoDoz) Sudafed (pseudoephedrine) Elicit Drugs Amphetamines Cocaine Methamphetamines Alcohol, Caffeine, and Nicotine

All of these can negatively affect sleep (see Chapter 14).

Lifestyle Factors Jet Lag Shift Work

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Other Sleep Disorders Breathing-Related Sleep Disorders (sleep apnea) Circadian Rhythm Sleep-Wake Disorders Narcolepsy Parasomnias Rapid Eye Movement Sleep Behavior Disorder Restless Legs Syndrome

*A qualified sleep specialist, psychologist, or physician can diagnose or rule-out these sleep disorders.

Upsetting or Exciting Events

Birth of a child Upcoming wedding Death of a loved one Job loss Divorce Economic downturn

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16. Preventing Relapse

Once you restore restful sleep, you will still (like everyone) have occasional poor nights of sleep. This is normal. A stressor may come up, such as moving to a new home and, as a result, your sleep gets thrown off a bit. The most important thing is to know that this is normal, and not to react with the following: “Oh great, here it goes again. I’ll never get over this insomnia. I’ll be stuck with it forever.”

These thoughts will only raise your anxiety, create a negative expectation about sleep, which will then impede your sleep. This can turn into a downward spiral, taking you back to where you were before. To prevent this, it is vital for you to know now how you will react if you have a poor night’s sleep, whether that’s tomorrow or a year from now.

Ways to Prevent Relapse

1. Keep using what you’ve learned.

Make the changes and tools in this program a regular part of your life, so they become automatic. The techniques are not just for overcoming insomnia, but also for having and maintaining good sleep.

2. Answer this question on paper.

“If I have a poor night’s sleep and I have negative thoughts like above, how can I respond to these thoughts?”

Your response might be: “I just had one or a few poor night’s of sleep. That is normal for everyone and to be expected. I can’t always expect to sleep perfectly, every night for the rest of my life. I’ve had bad nights of sleep before and was able to improve my sleep. What can I do now to get back on track? What is it that caused these couple of nights of poor sleep? Am I using the skills I learned, or have I slipped? Is there a current stressor? Or, is it just the occasional poor night of sleep everyone experiences? No big deal, it’s only temporary and I’ll be sleeping well again soon.”

Use your own words and reasoning, something that would convince you down the line if you needed this to combat negative thoughts about sleep. Then, save it on your computer or print it out and keep it in case you need it.

3. Don’t start (or restart) any disruptive sleep behaviors.

You might be tempted after one or more poor nights of sleep to do something to compensate. This might be taking a sleeping pill, taking a nap, sleeping in, going to bed early, drinking alcohol to fall asleep, etc. Although these may “work” temporarily, they will end up worsening your sleep and put you back on track for insomnia.

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Instead, try to determine the problem. Possible problems could be a medical issue, something stressful in your life, an exciting upcoming event, a mental health issue, or just slipping back into unhelpful sleep behaviors like drinking too much caffeine or watching TV in bed. Do your best to figure out the culprit and take action to address it. If you don’t find anything, it’s probably just the normal occasional poor sleep that everyone experiences.

On the next page is a “Sleep Cheat Sheet” you can print to use as an easy reference for all the skills, guidelines, and tools included in this program. Happy sleeping!

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Sleep Cheat Sheet

1. Establish a nightly bedtime routine.

2. Only get into bed when you are sleepy.

3. Use your bed only for sleep and sex.

4. Get out of bed if you can’t fall asleep.

5. Once out of bed do something boring or relaxing.

6. Get back into bed once sleepy.

7. Get up at the same time every day.

8. Don’t nap.

9. Avoid substances (foods, drinks, drugs) that will disturb your sleep.

10. Reduce or eliminate caffeine and cigarettes.

11. Exercise regularly (but not within three hours of sleep).

12. Expose yourself to plenty of natural sunlight (or a substitute).

13. Keep bed and bedroom comfortable, dark, cool and quiet.

14. Keep stress at a low level.

15. Relax regularly (doing nothing, fun activities or a relaxation exercise).

16. Visualize great sleep.

17. Tackle your worry.

18. Know that occasional poor sleep is normal—don’t freak out about it.

19. Enjoy your sleep!

20. Make numbers 1-19 a regular part of your life.

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Frequently Asked Questions

1. How long will it take to overcome my insomnia?

On average, it will take about six weeks to overcome your insomnia and fully restore your normal sleep pattern. Some will see results immediately after they begin implementing the changes in Chapter 5. For others it will take a few weeks to begin seeing results. It took me about three weeks before I saw some improvements and seven weeks for full recovery. It takes some time for your body to adjust to the changes in behavior, daily activity, etc. This will throw off your sleep for a short period, but this is temporary and your body will adjust to it, then your sleep will normalize and become better consistently.

2. What if it’s not working and my sleep isn’t improving?

Make sure you give it enough time. Your body needs a few weeks to adjust to all the changes. The more changes you make, the more time your body and mind need to adjust. Once the changes become familiar, your body will come to expect them, and you will start to sleep better.

If, however, it’s been six weeks, and you’ve been applying all the skills and tools in this program consistently, and your sleep still has not improved, then it may mean there’s something else affecting your sleep. This may be a medical or psychological issue, a medication issue, or another sleep problem (like sleep apnea). It would be important to get evaluated by your doctor or a sleep specialist to accurately diagnose the issue, so you can take steps to resolve it.

3. How come some people can practice poor sleep behaviors and still sleep like a baby?

There are some people who can drink a triple espresso right before bed, or practice other poor sleep behaviors, and still sleep well and wake up refreshed. These people are probably the exception. It is likely they have very strong sleep systems (i.e., a strong bodily drive to sleep), and/or a weaker wakefulness system, whereas other people have the opposite, causing more sleep trouble.

Everyone is different. The same diet will affect each person differently, just as the same medication will. Don’t worry about how other people are sleeping. You have to figure out what works for you and do that.

4. Do I have to rigidly stick with the program?

In short, yes. Particularly until you return to good sleep. Once there, you can experiment with relaxing on certain aspects or adding things back that you enjoy. For instance, if you enjoy watching TV in bed, you can try adding that back in (but only that) once you’re sleeping well for several weeks. But, notice how this affects

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your sleep. If, as a result, you start having trouble sleeping again, then go back to eliminating TV in bed and keep it eliminated. If there is no negative effect, then keep it.

Don’t think of this program as “rigid” rules you have to follow. If you do, you won’t use them, at least not for long. Anything done out of duty or imposed on yourself won’t last. You will rebel. Instead, think of these as healthy changes you have chosen to adopt to improve your sleep and life and that you want to maintain because it benefits you (in good sleep and well-being).

5. Will I always need the same amount of sleep to feel rested?

No. There will be an average amount of sleep that you will generally require for rest and recovery. Let’s say you generally need about seven hours of sleep. This does not mean you will require exactly seven hours each and every night to be rested. Some nights you might need seven and a half, some six and a half, and some seven, all averaging out to about seven hours per night. How long you sleep (and how much sleep you need each night) depends on many factors, such as how tired you are, how you’ve been sleeping lately, how hard you exercised that day, your stress level, changes in environment (like temperature), etc. This is important to keep in mind so you don’t get anxious or worried if you sleep a half hour less or more than usual.

6. Do I really have to get up at my regular wake-up time on weekends too?

It’s okay to sleep up to an hour longer on weekends, but no more than that; otherwise, you’ll throw off your body clock and have trouble falling asleep Sunday night or the early part of the week. The most common cause of “Sunday night insomnia” is changing your normal sleep patterns on the weekends. It’s not caused, as most people think, by anxiety or dread about the coming workweek. Most people stay up later on Friday and Saturday nights, then sleep in over the weekend. This disrupts their sleep. Another contributor is that many people drink more alcohol on weekends, which also affects sleep. So when Sunday night comes around, they have trouble falling and staying asleep, and they wake up tired Monday morning.

Even if you go to bed at 3:00am, follow this guideline. You will feel tired the next day, but you will sleep great the next night and not disturb your sleep schedule.

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Mental Health Resources

Mind Over Mood: Change How You Feel by Changing the Way You Think, by Dennis Greenberger and Christine Padesky

The Feeling Good Handbook, by David Burns

When Panic Attacks: The New, Drug-Free Anxiety Therapy That Can Change Your Life, by David Burns

The Anxiety & Phobia Workbook, by Edmund Bourne

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About the Author

Dr. Steven Orma is a San Francisco-based licensed clinical psychologist specializing in the treatment of insomnia and anxiety. He is frequently featured in the media for his mental health expertise including ABC News, MSNBC, Fast Company, Women’s Health, Shape, Men’s Journal, and more. Dr. Orma holds a Doctor of Psychology degree and a Master’s degree in clinical psychology from San Francisco’s Alliant International University. He has a Bachelor’s degree from the University of California, San Diego. He has an extensive clinical background treating extreme anxiety, stress, depression and sleep problems, from helping PTSD war vets to students, moms, young professionals, entrepreneurs and more. Dr. Orma maintains an online therapy and coaching practice and welcomes you to contact him at drorma@drorma.com with any questions or to schedule a consultation.