Damon Ashworth Psychology

Tag: sleep

Debunking Common Misconceptions About Sleep

Struggling with sleep? You’re not alone. But what if some of your thoughts about sleep were actually making things worse? The DBAS-16 (Dysfunctional Beliefs and Attitudes about Sleep) questionnaire identifies common, yet misguided, assumptions that can fuel hyper-arousal and insomnia.

I’ll use my expertise in sleep and psychology to help challenge these beliefs. Let’s see if we can replace these unhelpful sleep beliefs with a healthier, science-backed mindset.

1. “I need 8 hours of sleep to feel refreshed and function well during the day.”

Challenge: While 7-9 hours of sleep per night is the general recommendation for adults, individual needs vary. A longitudinal study followed people’s sleep and health for several years. It found that people who slept 7 hours per night were healthier on average than those who slept 8-9 hours. Some people do need less sleep than the average, while others need more.

Focusing too much on getting a fixed amount of sleep each night can create stress. This stress then makes achieving that sleep harder. It’s better to understand your individual sleep needs over time. Then aim to be in bed for not much more than that each night. By improving your sleep quality, regularity, and timing, you can also feel better the next day. You can achieve this even if you aren’t sleeping longer each night.

2. “When I don’t get the proper amount of sleep on a given night, I need to catch up the next day by napping or the next night by sleeping longer.”

Challenge: While occasional naps can be refreshing, try not to focus on getting extra sleep during the day. Long naps will reduce your sleep pressure for the next night. If you really have to nap, have one before 4 pm and for less than 30 minutes. This way, it won’t disrupt your sleep as much for the next night.

Fixating on sleep during the day can keep insomnia going. This habit can also disrupt your natural sleep cycle. Try to engage in fulfilling activities instead. Consistently maintaining a sleep schedule is better than constantly trying to compensate for lost sleep. Your brain and body will then help you to feel more alert during the day and more sleepy at nighttime.

3. “I am concerned that chronic insomnia may have serious consequences on my
physical health.“

Challenge: While long-term sleep issues can have health effects, excessive worry about them can make sleep problems worse. Insufficient sleep can increase the risk of accidents and reduce productivity during the day. However, performance on tasks in people with insomnia is often better than we expect.

Small improvements in sleep habits can mitigate risks and help restore healthier sleep patterns over time. Worrying less about the negative impacts of not sleeping can reduce arousal levels and lead to better sleep too.

4. “I am worried that I may lose control over my abilities to sleep.”

Challenge: Sleep is not something you control – it’s something you allow. As an involuntary process, the more you try to force sleep, the more elusive it can become.

Instead, focus on doing things to wind down and relax at the end of the day. Focus on consistency and going to bed at similar times each night and waking up at similar times each morning. Try to only be in bed if you are sleepy and for not much longer than you need for sleep. If you do this at times that are ideal for your inner body clock, even better. Accept that you may have an occasional bad night of sleep. By following this approach, it is likely to lead to better and not worse sleep over time.

5. “After a poor night’s sleep, I know it will interfere with my activities the next day.“

Challenge: Feeling tired is natural. However, studies show that people with insomnia often perform better than they expect, even after a poor sleep.

Worrying about fatigue can make it worse. Trust yourself to manage getting through the day. You can hopefully do what you need to do the next day. This is true even after imperfect sleep, and even if you feel tired or fatigued.

6. “To be alert and function well during the day, I believe I would be better off taking a sleeping pill rather than having a poor night’s sleep.“

Challenge: Sleeping pills can provide you short-term relief. Especially if you are going through a really hard time that is likely to last for less than two weeks.

However, sleeping pills do not address the root causes of chronic insomnia. Additionally, they can lead to dependence over time. Therefore, they are not recommended to be taken regularly for more than 2-4 weeks.

Behavioral strategies, such as Cognitive Behavioral Therapy for Insomnia (CBT-I), are more effective than sleeping pills. They don’t result in rebound insomnia once the treatment finishes, and they improve sleep in the long term. Prioritizing good sleep habits over medication can lead to more sustainable, restorative sleep.

7. “When I feel irritable, depressed, or anxious during the day, it is mostly because I did not sleep well the night before.“

Challenge: While poor sleep can affect mood, emotions are influenced by multiple factors, including stress, lifestyle, and thought patterns. Blaming all negative emotions on sleep can lead to much more anxiety about sleep.

Instead, if you aren’t feeling great, try engaging in mood-boosting activities. Spend time with people that you like. Exercise and get out into nature. Do something creative or fun. Seek excitement, awe, or joy. Write down things that you feel grateful for. Learn stress management and mindfulness skills. All of these strategies can help improve emotional well-being, even after a rough night of sleep.

8. “When I sleep poorly one night, I know it will disturb my sleep schedule for the
whole week.“

Challenge: One bad night does not define your entire sleep pattern. If you sleep poorly on one night, your sleep pressure will be a lot higher for the next night. Your brain will then try to make it easier for you to sleep deeply and well. This is to help compensate for the poor night of sleep the night before. If you can keep your stress and worry in check, you are likely to sleep better after a poor night.

9. “Without an adequate night’s sleep, I can hardly function the next day.“

Challenge: While sleep is important, the body is resilient. Many people still function well after a poor night of sleep. Things will feel like they require more effort, and you probably won’t feel as motivated to do things. You might even crave more junk food. However, performance studies show that people with insomnia’s functioning is better than they think it will be.

Energy levels fluctuate naturally throughout the day, and movement, hydration, and good nutrition can help maintain alertness. Try to focus on what you can do during the day to help you to function well. Even when you feel unmotivated.

10. “I can’t ever predict whether I’ll have a good or poor night’s sleep.“

Challenge: Some variation in sleep is normal. But this doesn’t mean that sleep is completely unpredictable.

You can improve the predictability of your sleep by maintaining a consistent bedtime routine. Sleep at the right times for you. Wind down and relax before bedtime, and wait until you feel sleepy before going to bed.

11. “I have little ability to manage the negative consequences of disturbed sleep.“

Challenge: You have more resilience than you think. Focus on what feels achievable during the day after a poor night of sleep. If your capacity feels like a 5/10, get through as many of the easier tasks on your to-do-list as possible.

By doing what you can, looking after yourself and managing your stress well, it is possible to navigate occasional poor sleep. It also increases your chances of getting things back on track with your sleep going forward.

12. “When I feel tired, have no energy, or just seem not to function well during the
day, it is generally because I did not sleep well the night before.“

Challenge: Our daytime performance and energy levels naturally fluctuate during the day. For most people, it is very common to have a post-lunch dip. Some countries even take siestas during this time rather than trying to push through or ignore how they are feeling. Try not to attribute everything to how you slept the night before.

Instead, focus on what you can do in the moment. Take a break. Get some fresh air. Have a drink of water or a healthy snack. Engage in an enjoyable or creative activity. Try to shift the focus away from your sleep and see if it reduces insomnia’s control on your life.

13. “I believe insomnia is essentially the result of a chemical imbalance.“

Challenge: Brain chemistry plays a role in sleep. However, insomnia is often driven by behavioral, cognitive, and emotional factors. It is not merely caused by a simple chemical imbalance. By saying it is an imbalance, you imply it is out of your control. You indicate there is nothing you can do.

The science does not support this. CBT-I and other non-medication approaches can be highly effective in addressing the underlying causes of insomnia and improving your sleep. Focus on what you can do.

14. “I feel insomnia is ruining my ability to enjoy life and prevents me from doing
what I want.“

Challenge: Insomnia can be frustrating, but it doesn’t have to define your life. Many people with sleep issues still find joy in their days. Shifting focus away from sleep struggles can improve overall well-being and even sleep itself.

15. “Medication is probably the only solution to sleeplessness.“

Challenge: While medication can help in certain cases, non-medication approaches—especially CBT-I — are often more effective for long-term sleep improvement. Stimulus control, sleep restriction, progressive muscle relaxation and paradoxical intention can also make a significant difference. They are all empirically supported interventions for insomnia.

16. “I avoid or cancel obligations (social, family) after a poor night’s sleep.“

Challenge: Avoiding activities due to poor sleep can reinforce sleep-related fears. If you say that you can’t function without perfect sleep, it will fuel your anxiety. By engaging in your normal activities, even when you are tired, it can help you to re-frame your sleep-related fears.

So the next time you don’t sleep well, try not to cancel your plans the next day. Go out and do it anyway, and see how it goes. Then afterwards, ask yourself: 1. how did it go? 2. was it as bad as I thought it would be? and 3. what does this mean for a similar situation next time?

Final Thoughts

Many of our beliefs about sleep are shaped by misinformation, anxiety, and unrealistic expectations. By challenging these unhelpful attitudes, you can reduce stress around sleep and improve your overall sleep quality.

If you struggle with persistent sleep issues, consider seeking out a psychologist for CBT-I. It is considered the gold standard or first line treatment for breaking the cycle of insomnia.

What do you think?

Do you strongly agree with any of these common unhelpful beliefs about sleep? Let me know in the comments!

October 20, 2025
How to Watch the 2024 Paris Olympics Live from Abroad Without Turning Into a Sleep-Deprived Zombie!
The 2024 Paris Olympics have begun. For sports lovers and patriotic people worldwide, it can involve lots of time glued to the couch checking out the live action.

For people living overseas like myself, it can also mean some serious sleep disruption for the next 16 days. Especially if you prefer to watch an event live when it is happening, rather than having to record the events overnight and then watch the replay when it most suits you.

I don’t know about you, but there can be something special about watching an event live. As much as I try to tell myself that it is similar, watching a replay of an NBA or AFL game when the result is already out there and only one click away doesn’t feel quite the same.

But what about the eight hour time difference between Melbourne and Paris? Or the nine hour time difference between Paris and Los Angeles and San Francisco? It might come down to a preference to experience the event live but sacrifice some sleep, or to watch the replay and potentially having the results spoiled by well meaning friends or family. Or even social media or the news.

The easiest and probably best option for people that want to preserve their sleep at night and energy levels during the day is to record the events you want to see or use streaming services that allow you to watch the replays at times that best suit you.

For certain events and certain people, that just might not do. I know that there were a few of my friends that made sure that they were awake to support the Matildas at 3am this morning. Some of them that already work in hospitality until fairly late just stayed up until the game and slept afterwards. For others that work the standard 9am to 5pm, they would have woken up early and would already be feeling pretty tired in their first few hours of work.

Strategies for Managing Sleep During the Olympics

1. Know Your Body Clock:
- Morning People (“Larks”): Try to wake up early to watch events. Have a short nap of under 30 minutes during the day if needed. Go to bed a bit earlier than usual the following night if you are feeling sleepy, but then get up at your usual time the day after.
- Evening People (“Night Owls”): Stay up to watch events and sleep in a bit later (but not too late) if possible. Have a short nap of under 30 minutes during the day if needed. Go to bed at your usual time the night after.
2. Minimize Disruption:
- If you stay up later than usual, limit your sleep-in to a maximum of 30 minutes later per extra hour that you have been awake for to avoid disrupting your sleep cycle too much. For example, if you normally sleep from midnight to 8am, but are awake until 4am, try to only sleep in until 10am.
- If you wake up earlier than usual, try to go to bed a maximum of 30 minutes earlier for each hour of less sleep you have had the next night to maintain your regular sleep routine. For example, if you normally sleep from 10pm until 6am, but then wake up at 4am, try to sleep the next night between 9pm and 6am (as long as you feel sleepy around 9pm).
3. Plan for Recovery:
- After a late night or early morning, expect to feel more tired and possibly irritable the next day. Get back into your regular sleep schedule as quickly as possible to help recover and get back on track as soon as possible.
- Avoid staying up all night multiple times, as it can have a compounded negative effect on your sleep and overall health.
4. Prioritise Safety:
- If you’re too tired to drive, consider using public transport rather than driving.
- If you need to perform tasks that could be risky or unsafe or require lots of concentration, consider taking a day off work if possible.
Four Key Aspects of a Good Night’s Sleep

Dr Matthew Walker, a sleep scientist and author of the mega selling book, ‘Why We Sleep’, mentioned in a podcast that I was listening to recently the four things that he thinks are important for sleep over time. He called this “QQRT”.

Q: Ideally, we want a certain quantity of sleep. For most adults, this is likely to be somewhere between 6 and 9 hours a night. 7 hours a night is often found to be the healthiest in longitudinal studies, but sleep needs vary a bit from person to person, so see what tends to make you feel the way that you would like to during the day and aim for that. Remember that quantity is only one of the four elements of a good night’s sleep, so doing the other three things right can help people to feel better the next day even if they obtain less sleep than they would like to.

Q: We want to do things to improve our sleep quality. For me, that is minimising my alcohol intake, doing things to wind down and relax before sleep, not eating too large a meal too close to bedtime, waiting until I feel sleepy before going to bed, and only being in bed for a maximum 8.5 hours each night.

R: We want to have good regularity in when we sleep from night to night. For me, that means going to bed between 11 to 11:30pm most nights and waking up between 7 and 7:30am seven days a week. If someone’s sleep schedule has lots of variability in it across the week, it will be much harder for their brain to help them to sleep when they want to at night, and help them to be alert and function well when they would like to during the day. Social jetlag is a real phenomenon, and can happen if someone’s weekend sleep schedule varies a lot from their weekday sleep schedule.

T: Finally, we want to be sleeping at the right time for ourselves and our internal body clock. A “lark” might sleep best between 9pm and 5am. An “owl” might sleep best between 1am and 9am. Think about what 8 hour window in a 24-hour cycle is likely to be when your body and brain most want you to sleep, and try to sleep and wake up around those times. For me, it is between 11:15pm and 7:15am. If you can do this, you will find it a lot easier over time to feel sleepy and sleep well in bed, and feel alert and perform well during the day.

Conclusion

Ultimately, the key is balance. If watching live events is a priority, be mindful of how it affects your sleep and adjust your routine to mitigate any negative impact. If the sleep disruption outweighs the enjoyment, consider replays and avoid unnecessary fatigue. Enjoy the Olympics and make sure to take care of your well-being in the process!

If you’d like to hear a radio segment that I was a part of on ABC discussing this topic, here is the link.

Dr Damon Ashworth

Clinical Psychologist
July 26, 2024
If You’re Not Sleeping Well, Your Sleep Hygiene Is Probably Not the Answer

If you’ve ever experienced difficulty getting to sleep at night, you may have heard about the importance of ‘sleep hygiene.’

Just like ‘dental hygiene’ is about recommendations that help you to look after the health of your teeth, sleep hygiene is about doing the right things to ensure a good night’s sleep.

The problem with sleep hygiene recommendations, though, is that everyone seems to have their unique list of the essential things you need to do to sleep well at night.

A 2003 review study attempted to define sleep hygiene recommendations and found 19 different rules across seven studies.

I don’t know about you, but if I am already worried about my sleep, following 19 different rules each night probably won’t be relaxing. The more stressed and tense I am, the lower my sleep quality could be, even if I practice good sleep hygiene.

For this reason, little evidence supports sleep hygiene as an effective strategy for significantly improving your sleep.

For example, someone may have bought an expensive bed and pillows, worn earplugs and eye masks, stayed away from caffeine, and slept poorly. However, another person might not do any of these things but feel confident about their ability to sleep, go to bed when they feel sleepy at night and sleep excellently.

How our brains work, particularly our fear circuit, can keep us up at night. All it takes is a few horrible nights of sleep where someone sees the negative consequences that not sleeping can have. They then begin to lose confidence in their natural ability to switch off and let sleep come once they are in bed. They then try to force themselves to sleep, sometimes well before their natural body clock is ready for sleep.

Once sleeping difficulties begin, a person’s brain is likely to perceive not sleeping well or enough as a threat. Our brain’s fear centre activates and triggers the fight-or-flight mechanism in response to the perceived threat. Changes occur in the brain and body to prepare the person to attack or run away from the danger. But if the threat is not sleeping, how helpful is the fight-or-flight response in helping that person drift off to sleep?

Unfortunately, the fear of not sleeping well can become the very thing that prevents people from sleeping well. By feeling like you need to worry about 19 things every night in order to sleep well, this fear probably isn’t going to improve.

Chronic insomnia is a big problem in our society, and sleep difficulties impact at least 30 percent of us. However, unless you are not prioritising sleep enough, making you worry more about the sleep you’re not getting enough of each night will not help you sleep any better.

Instead of focusing on all the sleep hygiene tips, see if there is one or two things that you could try that you think could make a big difference for you. Let’s say that you are drinking five cups of coffee a day. Maybe it would be worth cutting it down a bit or having your last coffee before 2pm. If you are already not drinking much caffeine and only having it in the mornings, being more strict about it probably won’t be worth it. Instead, see if there is something else that could be more helpful, such as having a regular wake time each day, waiting until you feel sleepy before going to bed, or getting some morning sunlight exposure.

By trying one or two things at a time, you are likely to be less overwhelmed. You are also going to be more likely to stick to any changes that you try, and then see if it makes any positive difference for you. If it doesn’t, switch your focus to something else that you think might help, try it for at least a week, and then review. If you keep doing it this, eventually you will learn what does and doesn’t work for you, and be able to turn to the most helpful strategies for you when you really need it.

If you aren’t sleeping well and haven’t been for some time, it might be worth getting some expert help. Cognitive Behavioural Therapy for Insomnia (CBT-I) is the gold standard treatment for people with difficulties falling asleep, remaining asleep, and not feeling refreshed during the day. A lot of research has shown that it can help people improve in as little as two sessions of treatment, and improvements are often maintained one year later. Sleeping pills can sometimes help in the short term, but your insomnia is likely to come back as soon as you stop taking them, and they’re not recommended on a long-term basis.

If you can’t find a sleep physician or psychologist trained in CBT-I, there are also some good online CBT-I courses that can teach you all the skills you need. If that doesn’t help, please check out my latest book, Deliberately Better Sleep. It will help you set up your own sleep experiment tailored to you as an individual and assess how much difference it makes for you. Most importantly, it will help you regain confidence in your sleep so that if you ever have a poor night’s sleep, you will understand why and what you can do about it.

Dr Damon Ashworth, Clinical Psychologist and Author of Deliberately Better Sleep.

May 25, 2023
Sleep Medicine Recommends Only Five Strategies for Insomnia
If you have tried my sleeping tips from the prior article and your sleep is still problematic, there are several things that you can do.

The safest option is to go and see your medical doctor or GP and get a referral to a Sleep Physician. They will be able to do a more comprehensive sleep study with you and see if you have any underlying sleep conditions impacting your sleep and feel. You may have to do a polysomnography (PSG) or sleep study to rule out conditions like sleep apnea, restless legs syndrome, periodic limb movement disorder, delayed sleep phase disorder, narcolepsy or idiopathic hypersomnia.

            If it’s unlikely that you have any of the above sleep disorders, you may have insomnia. As many as 33% of people have sleep problems, and between six to ten percent have serious enough sleep concerns to warrant a diagnosis of chronic insomnia. Once you have had it for a few months, it may not get better on its own without treatment or applying the right strategies to your sleep.

            Everyone will tell you what they think is the solution to sleep problems, from earplugs to eye masks, comfy pillows, new beds and weighted blankets. However, there are still only five strategies with enough evidence to be empirically supported insomnia strategies by the American Academy of Sleep Medicine (AASM). If you think you have insomnia and want to improve your sleep, please try one of these five strategies: Cognitive behavioural therapy for insomnia (CBT-I), sleep restriction, stimulus control, progressive muscle relaxation, and paradoxical intention.

Photo by Alex Green on Pexels.com

STRATEGY 1: COGNITIVE BEHAVIOURAL THERAPY FOR INSOMNIA

CBT-I consists of four main components. Psychoeducation, sleep scheduling, relaxation techniques and cognitive techniques. Together, these four components target all three underlying sleep mechanisms. CBT-I has sleep scheduling to improve homeostatic pressure and circadian rhythms. It encourages people to get morning sunlight and remain off bright screens before bed to strengthen circadian rhythms. It also teaches relaxation strategies to help people learn how to relax and reduce their arousal levels. Finally, CBT-I teaches cognitive strategies to help people to challenge their unhelpful beliefs about sleep and further reduce their arousal levels.

            If you want to try CBT-I, you can check out my Udemy course ‘Improve Your Sleep with CBT for Insomnia’. I’ve also seen the positive results published on other online CBT-I courses such as Sleepio or Somryst. CBT-I Coach tries to teach some of these strategies at no cost, including what times are best for you to go to bed and wake up if you do sleep restriction. If you’d prefer in-person CBT-I, you can search on the internet and see if there are any psychologists or behavioural sleep medicine specialists who specialise in CBT-I.

Photo by Teresa Howes on Pexels.com

STRATEGY 2: SLEEP RESTRICTION

Sleep restriction is a strategy that increases homeostatic pressure by reducing your time in bed each night to only the amount of time you are sleeping. It also helps to strengthen your circadian rhythms by improving the regularity of when you go to bed at night and rise from bed in the morning, seven days a week. However, it is important that you set your sleep times at the right time for your body clock to be the most effective. Morning people would better choose earlier to bed and rise times, whereas evening people will need to stay up later and get up later.

            Sleep restriction can increase distress and arousal levels initially. It can be especially difficult for people with chronic insomnia, who are already worried about not getting enough sleep and the consequences they will feel and face during the day. This can make it very hard for people to initially try and even harder to fall asleep or remain asleep at night. Once they sleep better, their arousal levels can drop significantly, as the individual can begin seeing how effective this strategy is.

Sleep restriction instructions are as follows:
1. Determine your average total sleep time over the past 1-2 weeks. If it is less than five hours per night, say it is five hours.
2. Add 30 minutes to this amount. The total is your new time in bed prescription. Only spend this time in bed every night for the next two weeks.
3. Figure out when you would like to wake up seven days a week. It is your rise time or time to get up each morning. Set the alarm to help you wake up at this time. When the alarm goes off, get out of bed and try not to sleep again until the next night.
4. Minus your time in bed allocation from your rise time to figure out your bedtime. For example, if you wake up at 6 am and are meant to be in bed for 6 hours and 30 minutes every night, aim to go to bed around 11:30 pm.
5. For sleep restriction to be maximally effective, bedtime should be approximate rather than absolute. For example, if it is 11:15 pm and you notice many sleepiness signs, go to bed rather than wait until 11:30 pm. On the other hand, if it is 11:30 pm and you are wide awake, wait up a little until you feel a bit sleepier. Then go to bed.
6. Once you have your bedtime, rise time and time in bed prescription, track your sleep for the next two weeks using a sleep diary or activity tracker. Then figure out your sleep efficiency, which is the percentage of your time in bed spent sleeping.
  - If your sleep efficiency for the next two weeks is under 85%, cut your bedtime by a further 15 minutes each night. If it is between 85-90%, keep your time in bed prescription as it is.
  - If it is above 90%, extend your time in bed by 15 minutes each night.
7. Keep tracking for another two weeks and repeat until your sleep efficiency is between 85-90% regularly.
Photo by Lina Kivaka on Pexels.com

STRATEGY 3: STIMULUS CONTROL

Stimulus control is a strategy that ensures that your homeostatic pressure is high enough when you are going to sleep by encouraging you to get up at the same time every morning, seven days a week, no matter how well you have slept. By not napping during the day, your homeostatic pressure also remains high. Not going to bed until you feel sleepy means that you won’t go to bed until your brain and body are ready for sleep, which reduces how much time you spend in bed awake. Being out of bed whenever you can’t sleep for 20 minutes also means that you’ll never spend excessive time in bed awake each night.

            Stimulus control also helps to strengthen your circadian rhythm with the regular rising time in the mornings and only going to bed when you feel sleepy. Stimulus control is better than sleep restriction if you strictly follow both of the rules as they are written. Stimulus control helps you to find out when your brain and body most want you to go to sleep, as opposed to going to sleep at the same time every night.

            Like sleep restriction, stimulus control can also initially increase distress and arousal levels, especially for people with chronic insomnia. People with insomnia tend to already be worried about not getting enough sleep and the potential consequences they will feel and face during the day if they do not get enough sleep or have to be out of bed during their usual time in bed. This can make it very hard for people to initially try stimulus control and even harder for them to fall asleep or remain asleep at night.

            Once you begin sleeping better through stimulus control, your arousal levels can drop significantly, as you can begin seeing how effective this strategy is. It also means that you will no longer have to get out of bed after 20 minutes of being awake if you fall asleep regularly within this time, which will likely reduce your worries further. The better you sleep at night and the less tired you feel during the day, the less you will feel the need to sleep in longer in the morning or nap during the day. So, the more effective stimulus control becomes as a strategy, the lower your arousal levels.

The stimulus control instructions are as follows:
1. Only go to bed when sleepy,
2. Wake up at the same time every day,
3. Only use the bed/bedroom for sleep and sex,
4. Avoid naps during the day, and
5. Sit up or get out of bed if you cannot fall asleep within about 20 minutes of retiring to bed.
6. If you have to get up at night, do something calming or relaxing until you feel sleepy again, and then lie back in bed for sleep. Ideally, this activity during the night should not involve bright light, rigorous exercise or be too cognitively demanding.
Photo by Ketut Subiyanto on Pexels.com

STRATEGY 4: PARADOXICAL INTENTION

Paradoxical intention is probably the least used strategy that is effective for chronic insomnia. This is because it is quite counter-intuitive and, therefore, a hard sell to patients that are already struggling with less sleep than they would like. It also doesn’t target circadian rhythms or sleep pressure directly. Paradoxical intention instead indirectly targets both of these sleep mechanisms by helping patients to take off all the pressure they put on themselves to sleep.

As long as the individual follows the recommended paradoxical intention instructions, it can reduce sleep effort, performance anxiety and hyper-arousal levels. This allows homeostatic pressure and circadian rhythms to work better for the individual, as long as they have been up for long enough during the day and are going to bed at the right time for their internal body clock.

The instructions for paradoxical intention are as follows:
1. Go to bed at your usual bedtime.
2. Lie down in bed with the lights off.
3. Don’t read or look at your phone or anything else.
4. Try to see if you can stay awake for “just a little bit longer” without doing anything to force yourself to stay awake.
5. If you are still awake, congratulate yourself for successfully achieving your goal. Then, don’t look at the time on the clock and keep focusing on staying awake for “a little bit longer”.
6. Keep this up all night if you have to. But, whatever you do, do not try and force yourself to sleep and keep trying to stay awake “just a little bit longer”.
Photo by Kelvin Valerio on Pexels.com

STRATEGY 5: PROGRESSIVE MUSCLE RELAXATION

Progressive muscle relaxation is a sleep strategy that predominantly reduces how much physical tension someone feels before bed. Spending much of the day stressed or worried can lead to physical tension, especially around the neck, shoulders and upper back area.

Progressive muscle relaxation can also reduce cognitive arousal levels by helping individuals focus on different parts of their bodies and become more aware of their feelings. It is, therefore, a much better cognitive strategy than either suppression or worry.

Progressive muscle relaxation really doesn’t help with someone’s homeostatic pressure or circadian rhythms. It is an intervention that specifically targets someone’s hyper-arousal, particularly any physical tension they feel. It can help people feel more relaxed and calmer; therefore, the other two sleep components can work effectively and help them sleep enough at the right times.

PMR instructions are as follows:
1. Tense the muscles in your arms, bringing your hands towards your shoulders to feel your biceps tighten. Then take a deep breath through your nose and down into your stomach. Then relax your arms as you breathe out the air through your mouth. Next, let your hands hang down by your side and give them a shake. Then repeat one more time by tensing, breathing and relaxing your arms.
2. Then tense the muscles in your face, including the ones in your forehead, nose, jaw and around your eyes. Notice the tension. Then take in a deep breath through your nose and into your belly. Relax all the muscles in your face as you breathe all the air out through your mouth. Let your facial muscles droop as your jaw hangs loose. Then repeat one more time.
3. Tense the muscles in your neck by bringing your shoulders up to your head. Hold this pose tight for a few seconds. Then take a deep breath through your nose into your stomach. Pause for a second or two. Then breathe all the air out through your mouth as you relax your neck and let your shoulders drop. Next, move your head around slowly in a circular motion if this helps you to relax your neck. Then repeat once more.
4. Tense the muscles in your stomach and back, bringing your abdomen closer to your spine. Hold this for a second, then take a deep breath into your belly while keeping your stomach and back tense. It may make it a little harder to breathe in as deeply as with the other muscle groups. Then breathe all the air out of your mouth as you slump down and push your belly out. Repeat one more time.
5. Tense the muscles in your buttocks and thighs, squeezing them tightly. Take a deep breath, pause, and relax these muscles as you breathe all the air out. Shift back and forth from left to right in your seat, then repeat.
6. Lastly, stretch out your legs and tense your calves and feet, bringing your toes back towards your body. Breathe in, pause, breathe out and relax your calves and feet. Shake out your legs, and then repeat one last time.
Photo by Pixabay on Pexels.com

HOW DO YOU KNOW WHAT TO TRY FIRST?

Based on what I have written above, trying CBT-I is good if you think all three underlying sleep mechanisms are an issue. CBT-I is also the most recommended if you currently have some beliefs about sleep that are unhelpful for you.

            If your sleep pressure is not high enough at night when going to bed, but your arousal levels are okay, try sleep restriction. Try stimulus control if your circadian rhythms impact your sleep or if you spend lots of time awake in bed each night. Stimulus control can help to recondition your bed by feeling calm and sleepy and sleeping well over time, so it can be a helpful strategy in several ways.

            If elevated arousal levels are your main issue, but you are doing okay otherwise, give progressive muscle relaxation a proper go. If you find that you are putting in too much effort to try to sleep at night and your pre-sleep arousal is too high, I would recommend trying paradoxical intention first.

            No matter what you try, try it every night for at least a week, ideally two, before deciding if it is the right or wrong strategy. Both stimulus control and sleep restriction are difficult and anxiety-provoking initially. Still, they can have some of the largest improvements for you and your sleep if you stick to the instructions over time. Even a year after people have completed a course of CBT-I treatment, the best predictor of who continues to sleep well is individuals who still follow the sleep restriction and stimulus control rules.

Dr Damon Ashworth

Clinical Psychologist
September 12, 2022
The Importance of Sleep for Good Mental Health
Sleep difficulties are a feature of nearly every mental health difficulty, including depression, anxiety, trauma, substance use issues, bipolar disorder and psychosis or schizophrenia. Take Depression for example. Up to 90% of individuals with Depression have sleep difficulties, and two out of every three have significant enough sleep problems to also have a diagnosis of Insomnia.

Worse still, Insomnia does not tend to go away on its own without appropriate treatment. This is because once people start to sleep poorly, they tend to develop ways of thinking and behaving around sleep that make their problems worse over the long run.

Fortunately, there is a treatment out there that can improve your sleep. It’s called Cognitive Behavioural Therapy for Insomnia (CBT-I), which directly targets these unhelpful thoughts and behaviours around sleep.

CBT-I is an effective treatment for insomnia, with many studies showing it to be similar to sleeping pills at improving sleep in the short-term, and much more effective than sleeping pills at improving sleep in the long-term.

Research shows that CBT-I consistently reduces the time taken to get to sleep, decreases the amount of time spent awake during the night, and improves sleep quality and efficiency, with improvements persisting after treatment finishes. This is unlike sleeping pills, which typically lead to sleep difficulties coming back once people with insomnia stop taking them.

Sleeping pills are also not recommended for use beyond 2-4 weeks at a time, because they stop working after a while and people need to take bigger doses over time to get the same effects. Sometimes doctors prescribe them more because they think they will work faster for patients, but even one session of CBT-I has been shown to make a significant difference to one’s sleep at night!

CBT for Insomnia consists of four main components:
1. Psychoeducation: This provides people with helpful information around sleep, including homeostatic pressure, circadian rhythms, hyper-arousal and sleep hygiene recommendations. Sleep hygiene means having a comfortable bedroom environment, minimising light exposure before bed, exercising during the day, minimising caffeine and alcohol and doing things to wind down or manage worries before bed.
1. Sleep scheduling: This provides people with helpful information on when they should be going to bed at night, the time they should be arising from bed in the morning, and the ideal amount of time that they should be in bed for each night. Stimulus control and sleep restriction are the two main interventions included in sleep scheduling, and both are scientifically supported for improving sleep quality and sleep efficiency if done properly.
1. Relaxation techniques: Because hyper-arousal plays a huge role in Insomnia, it is important to help people develop strategies to quieten the mind and calm the body, during the day, before bed and in bed. Relaxation techniques can include imagery training, meditation, biofeedback training, deep and slow breathing and progressive muscle relaxation.
1. Cognitive Therapy: This provides people with the skills to challenge their unhelpful or unrealistic beliefs about sleep. A lot of individuals with Insomnia attribute all of their tiredness, mood difficulties or poor performance at work to their sleep difficulties, and this puts too much pressure on them to get a good night’s sleep. It is therefore important to get them to see the other factors that may contribute to how they feel during the day, present them with data that challenges their fears, and help them to develop realistic expectations about their sleep.
In Vanuatu, there is currently only one psychologist located at the Mind Care Unit in Port Vila who is trained in CBT-I. Please come down to receive this effective treatment if you or a family member is struggling with poor sleep. Until then, there are other sleep strategies that you can try:

BEST SLEEP INTERVENTIONS OVERALL

In 2017, Dr Damon Ashworth, Clinical Psychologist and Sleep Researcher, ran 26 two-week experiments on his sleep to determine which interventions were most helpful for him.

He gave each intervention a score out of 100, based on how effective he found the strategy (25 points), how easy it was to apply and use the strategy (25 points), and how much scientific evidence there was that showed that this strategy could improve sleep (50 points).

Here are all of the sleep interventions he tested, ranked from best to worst based on their overall score out of 100:

High Distinction
1. Stimulus control = 85/100
2. Winding down before sleep = 85/100
3. Sleep restriction = 81/100
4. Relaxation strategies pre-sleep = 81/100
Distinction
1. Meditation = 77/100
2. No alcohol = 75/100
3. Wearing blue-light blocking glasses before sleep = 75/100
4. Listening to music in the evening = 73/100
5. Yoga/Pilates = 72/100
6. Constructive worry or writing down plans = 71/100
Credit
1. Avoiding TV before bed = 69/100
2. Melatonin = 68/100
3. Aromatherapy = 68/100
4. Sauna or hot bath in the evening = 68/100
5. Morning sunlight = 65/100
6. Reading or listening to audiobooks pre-sleep = 63/100
7. Exercise during the day = 61/100
Pass
1. No caffeine = 58/100
2. Food that helps sleep = 57/100
3. Controlling temperature = 57/100
4. Massage in the afternoon = 57/100
5. Comfort of sleep surface = 56/100
6. Sleeping alone = 53/100
7. Creativity in the evening = 52/100
Sleep Recommendations

(Stepanski & Wyatt, 2003)
1. Decrease time in bed – Sleep efficiency is a better predictor of satisfaction with sleep and daytime mood than total sleep time. So if you only get 7 hours of sleep per night, spend 7.5 hours of time in bed. This will allow for better sleep over time.
2. Regular bedtime and arising time – Reducing variability in your sleep can make a huge difference in how long it takes you to get to sleep, how restful a sleep you have, and how refreshed you feel in the morning. Have a set bedtime, and whenever you feel sleepy around this time, go to bed. Then set an alarm so that you can wake up at the same time each day. If you want to sleep in on weekends, allow yourself no more than one hour later than you usually wake up. Following this regardless of how much sleep you get helps to strengthen your circadian rhythms and build up your homeostatic pressure to ensure better sleep over time.
3. Exercise – Vigorous exercise prior to bedtime is actually unhelpful for sleep, but expending more energy during the day is likely to lead to better quality sleep at night. The earlier in the day it is done, the greater the effect it will have.
4. Less caffeine and alcohol – Minimise these substances where possible, especially within 4 hours of bedtime as they both have significant effects on sleep quality. Alcohol can reduce worries and result in getting to sleep quicker, but results in poorer sleep quality in the second half of the night. Alcohol can also can lead to more snoring due to the loosening of the throat muscles. Caffeine boosts cortisol levels, a.k.a. stress, and results in less deep sleep and more awakenings.
5. Do not try to sleep – It is something that has to come on naturally. The harder you try to get to sleep, the less likely you will be able to, as trying activates the autonomic nervous system, which also increase how stressed you feel. The more you allow yourself to relax, the more likely sleep is.
6. Do not keep looking at your phone or alarm clock during the night – If your alarm is set, then there is no need to know the time in bed. This will only increase performance anxiety if you look and see that you have not slept for very long. Put it in a draw, cover it with a shirt, or face it the other way.
7. Keep naps short – Napping during the day reduces your pressure for sleep by the time you get into bed at night. If you have to nap, keep it less than 30 minutes so that you don’t go into a deep sleep, and do it before 4pm so that sleep pressure can build up again by the time you go to bed that night.
8. Engage in relaxing activities before bed – Just like waking up, going to sleep is a transitional process. Don’t expect that your mind will shut off immediately as soon as you get into bed. Whatever it is, do something relaxing as a pre-bed routine. Watch some T.V., read a book, listen to some music, have a hot bath, practice yoga, mindfulness or relaxation techniques. Then maintain that relaxed state in bed and allow sleep to come.
9. Use the bedroom only for sleep and sex – This means no reading, eating, internet surfing, game playing, phones, T.V., planning, worrying etc. in bed. Want bed = sleep.
10. Make worry list before bed – To prevent your mind from racing in bed, reflect on the day about 2 hours before you want to sleep, write down any worries, concerns or problems you may have, create a to-do-list, or plan for the day ahead. Then if thoughts come up in bed, remind yourself that you have already sorted them out or that they can wait until tomorrow.
11. Leave the bed if awake – Sometimes no matter what we try, you may find yourself awake in bed. If you do not fall to sleep within what feels like 20 minutes, get up, go to another room, and do something relaxing until you are sleepy before returning to bed. Over time, this will recondition the bed with sleepiness rather than frustration and allow you to fall asleep quickly. If you are worried that you may never sleep if this was the case, give it a try for a week. It may be the most difficult recommendation to follow initially, but it produces long-lasting results quickly.
Dr Damon Ashworth

Clinical Psychologist
May 8, 2019