Cognitive Behavioral Therapy for Insomnia (CBTi) is one of the best treatments available for insomnia. In this video, we’ll look at what CBTi is and how it works.
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Do you have trouble getting up in the morning? Do you keep hitting the snooze button until you finally have to drag yourself out of bed?
That was me all throughout university and medical training. It’s one of the reasons I became so interested in sleep science and became a sleep specialist.
The good news is that you don’t have to become a sleep specialist to make your mornings go more smoothly. Here are a few simple tricks can make it easier for you to get up and get going.
Here are 5 things you can do, before you even get out of bed, to help you wake up more easily
1. Don’t set your alarm clock for too early
This might sound counterintuitive — isn’t the point to get up earlier? Setting your alarm for too early disrupts those precious moments of REM sleep we get in the hourly hours of the morning. This will make you even more foggy and tired in the morning. If you’re one of those people who sets your alarm for one or two hours ahead of your required wake time, try this: allow yourself to sleep a little longer and set your alarm for a more reasonable time, within 15 minutes of the time you actually need to get up.
2. Let there be light
As soon as your alarm goes off, reach over to open up the blinds or curtains, or switch on the lights to full brightness. Think of bright light as nature’s alarm clock. A good dose of bright light in the morning will put a stop on your brain’s secretion of melatonin and help to reset your body clock (circadian rhythm). If you really want to get your circadian rhythm on track, do this at the same time every morning.
3. Sit up & stretch in bed
Stretching first thing will help get the blood flowing and wake up your muscles. If your body feels really heavy, simply sit up with your spine straight. Next, add on a stretch or two. Start by raising your arms over your head, reaching toward the ceiling. Then, stretch forward in a child’s pose while you’re still in bed. The act of sitting up and moving is another way to signal to your brain that it’s time to wake up and will help reset the circadian rhythm.
4. Listen to upbeat music
Many of us tend to grab our phones first thing in the morning and start scrolling through the news or emails. Not only would this make a person not want to get out of bed, it also sets the tone for the day by affecting motivation, stress levels, and mood. Listening to upbeat music helps to reduce blood pressure and levels of the stress hormone cortisol, and will give you a little boost of motivation to get up.
5. Drink water
Are you a member of the “don’t talk to me until I’ve had my coffee” tribe? Whether you tend to start your day with a cup of coffee or a green smoothie, I always recommend having a glass of water first. Approximately 60% of the body is composed of water and we need to stay hydrated to keep our organs functioning optimally. Overnight, we naturally become dehydrated, which contributes to feelings of fatigue and lethargy. Keep a bottle of water on your nightstand and enjoy a refreshing drink of water before you even get out of bed.
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If you have trouble sleeping, going to bed can start to feel overwhelming and sometimes downright stressful. There’s so much information out there about supplements and pills for insomnia, cutting down on caffeine, finding the perfect mattress, not watching TV in bed, getting the right kind of noise cancelling ear plugs, and so on. Although some of these things can help, it won’t do any good unless you understand why you’re not sleeping in the first place.
Whenever I see someone in my practice for sleep issues, the first thing we try to figure out is what’s causing their difficulty sleeping. Until we understand that, focusing on sleep hygiene measures can feel like an endlessly frustrating game.
These are four common causes of poor sleep quality that everyone should know about
This is one of the most common causes of insomnia, it both precedes and perpetuates sleep problems. Stress leads to a state of “hyperarousal”. Think of this as your nervous system in overdrive. Physical symptoms of hyperarousal include shortness of breath, heart palpitations, or feeling “wired” or edgey. Hyperarousal is also associated with cognitive symptoms like excessive worrying, ruminating, or an inability to turn your mind off when you go to bed. When left untreated, stress then leads to anxiety about not sleeping, which then feeds into the sleep issues. The act of going to sleep then shifts from a passive to an active process. This is why trying to use sleep medications, substances, cocktails of sleep supplements for stress-related insomnia don’t work in the long run, because they only address the physical symptoms of insomnia without actually dealing with the root cause.
2. Irregular sleep times
Our internal body clock, called the circadian rhythm, regulates our sleep-wake patterns. Going to bed and waking up at different times everyday confuses the body clock and contributes to insomnia and poor sleep quality. It creates a jet lag-like state called social jet lag. Shift workers are at particular risk of this. Irregular sleep times lead to issues with feeling heavy or foggy, getting sleepy at the wrong times, or feeling “wired but tired”. Realigning the body clock to ensure that it is on a regular schedule and aligned with our body’s “sleep drive” is a crucial step in restoring healthy sleep.
3. Delayed sleep phase syndrome (DSPS)
A “night owl” sleep pattern is a common sleep issue that is often misdiagnosed as insomnia. Around the time of puberty, melatonin secretion is delayed by 2 hours. DSPS causes an inability to fall asleep, but once asleep, people sleep well and tend to wake up too late. This explains why lots of teenagers and young adults have so much trouble getting to sleep on time and then getting up for class. Many people grow out of this as adults, but it may persist into adulthood. DSPS is often misdiagnosed as depression, ADHD, chronic fatigue syndrome, or fibromyalgia, and people may be prescribed medications unnecessarily.
4. Breathing issues
Obstructive Sleep Apnea (OSA). This is a condition that affects nearly 1 billion people worldwide. It’s estimated that in North America, up to 30% of males and up to 15% of females have OSA. It affects all genders, ages, and body types, from infants to the elderly. Signs and symptoms include snoring, waking up with dry mouth or a headache, restless sleep, teeth grinding, jaw clenching, mouth breathing, unrefreshing sleep, choking or gasping in sleep, and difficulty falling or staying asleep. Left untreated, OSA can cause long term sleep issues, difficulty losing weight, anxiety, depression, ADHD-like symptoms, and even cardiovascular issues like high blood pressure, heart disease, and increased risk of stroke.
At IntraBalance, we specialize in finding the root cause of your sleep problems and providing you with effective and personalized interventions to sleep better and wake up feeling refreshed.
If you want to learn more about how to optimize your sleep, get our FREE sleep guide.
Every living creature, from deep sea fishes to microscopic single-celled terrestrial organisms, has an innate biological clock. For us surface dwellers, our rhythms undulate to the beat of the earth’s dark and light cycles.
Disturbances in the circadian rhythm can result in metabolic diseases, obesity, cancer, and mental health disorders. Despite the growing appreciation of chronobiology, circadian disorders are frequently missed in clinical practice.
Delayed Sleep Phase Syndrome (DSPS), also known as Delayed Sleep-Wake Phase Disorder, is one of the most commonly encountered circadian rhythm disorders in clinical practice and is often misdiagnosed as sleep-onset insomnia. DSPS should be suspected in those who complain of consistent patterns of sleep onset significantly later than the desired or conventional time. Patients with DSPS may also complain of problems with social and occupational functioning such as chronic tardiness to work or school, impaired academic or work performance, conflicts with parents or partners regarding wake time, and sleep deprivation. Common psychiatric comorbidities include depression, seasonal affective disorder, bipolar I disorder, obsessive compulsive disorder, and attention deficit hyperactivity disorder. A higher degree of circadian misalignment may be correlated with more severe depression and poorer response to treatment with antidepressant medications. Furthermore, it has been shown that patients with DSPS have a threefold higher prevalence of comorbid seasonal affective disorder compared to controls.
So, how do we differentiate DSPS from insomnia? A good clinical history is the cornerstone of psychiatric diagnosis and the diagnosis of DSPS is no different.
Diagnostic criteria according to the third edition of the International Classification of Sleep Disorders (ICSD-3) is as follows:
- The phase of the major sleep episode shows a significant delay in relation to the desired or required sleep time and wake-up time, as evidenced by a chronic or recurrent complaint by the patient or a caregiver of inability to fall asleep and difficulty awakening at a desired or required clock time.
- The symptoms are present for at least three months.
- When patients are allowed to choose their ad libitum schedule, they will exhibit improved sleep quality and duration for age and maintain a delayed phase of the 24-hour sleep-wake pattern.
- Sleep log and, whenever possible, actigraphy monitoring for at least seven days demonstrate a delay in the timing of the habitual sleep period. Both work or school days and free days must be included within this monitoring.
- The sleep disturbance is not better explained by another current sleep disorder, medical or neurological disorder, mental disorder, medication use, or substance use disorder.
Zeitgebers and lifestyle should be also assessed including use of caffeine and stimulants, diet, the timing of meals, exercise, work/school/activity schedules, evening light exposure, and use of screens. Sleep diaries are useful adjunct to the clinical history and are recommended to evaluate the sleep schedule. The AASM sleep diary is free to download and provides two weeks’ worth of data. Actigraphy provides an accurate measure of sleep-wake cycles but may not be readily available in clinical practice. Polysomnography is not indicated unless there is clinical suspicion for another sleep disorder such as obstructive sleep apnea.
Once a diagnosis is established, behavioral modifications should be initiated in order to facilitate advancement of the circadian phase. Patients should be advised to minimize use of stimulants, avoid daytime naps, reduce light and screen exposure in the evenings, and avoid stimulating activities at least 2 hours before the time of desired sleep onset. Along with behavioral changes, melatonin and light are powerful body clock regulators that may be considered in the treatment plan. Short-term (<3 months) use of melatonin at a dose of 0.5mg, timed strategically 1.5 to 2 hours before the desired time of sleep onset can “pull” sleep earlier. Morning light therapy with a light box is effective for “pushing” back the wake time. It is recommended that patients start with using the light box at their natural wake time, then advance use of the box by 15 to 30 minutes each morning until the target wake time is reached. Use of hypnotics or sleep aids is not recommended. Consistency in following these strategies is the key to successfully shifting the sleep-wake cycle to align with one’s work or school schedule.
Difficulty with sleep and insomnia doesn’t have to be overwhelming. Figuring out the root cause of the sleep issues is the first step in getting restful sleep. In this video, we’ll look at 4 common causes of sleep issues.
At IntraBalance Integrative Psychiatry & Sleep, we specialize in getting to the root of cause of sleep issues, helping you find rest and restore balance. Holistic. Science-based. Personalized care. Proven results.