Goodnight Mind (12 page)

To help you gain some perspective on worries that your insomnia will have catastrophic consequences, consider what advice you would give to a friend or family member in the same position. Would you advise your friend or family member to worry about it? Would you say, “Yes, you’re probably right, you are heading for an early grave…”? Probably not. Most likely you understand that such a statement would only increase your friend or family member’s worry and make sleep even more difficult. You would probably recognize that your friend or family member’s worry was excessive. Since insomnia is a common problem, you probably know quite a few people with insomnia. Do you see disproportionate rates of illness and disability and death among your friends and family members who have trouble sleeping? Would you believe that your friend with insomnia was going to contract a disease or meet an early death just because of her sleep problems? Probably not. These realizations should make it easier for you to respond to friends and family members who anticipate catastrophic consequences of poor sleep in a calm and supportive manner, helping them put things in perspective. Can you consider a similar approach to your own beliefs?

The previous hypothetical exercise highlights two points: first, beliefs about catastrophic outcomes of poor sleep are not very accurate; second, they are not very useful. Worrying makes it more likely that you will be too anxious to sleep well. Moreover, worrying increases muscle tension that leads to physical fatigue, and it uses valuable mental resources, resulting in mental fatigue. Over time, worrying about the consequences of poor sleep may become the main cause of prolonged chronic insomnia. This is an important point that is surprising to most people; that is, irrespective of what initially caused your sleep problems, worrying about sleep may have become the number one factor sustaining your current sleep problems. It is therefore important that you find ways to reduce your worries about sleep. This is not an easy task. We hope that our discussion below will be helpful in this regard.

Challenge Your Beliefs by Doing the Opposite

Sometimes people with sleep problems act in ways that unintentionally strengthen unhelpful beliefs about their sleep. For example, if you believe that you have a limited ability to cope with the daytime consequences of poor sleep and you tend to cancel plans or avoid activities after a poor night’s sleep, then you are reaffirming the idea that you are unable to cope with the sleep loss. If you continue to respond to poor sleep with this strategy, your schedule will become more irregular, you may become less active, and you may even be prone to spending more time in bed; all of these behaviors have been found to prolong the very sleep problems you are trying to solve.

An alternative, and potentially better, approach is to challenge your belief in your limited ability to cope with the daytime consequences of poor sleep by carrying out your regular activities despite the fact that you have not slept well. This may require you to change your mind-set and to use new coping strategies. For example, be sure to eat well and regularly, keep hydrated, plan to take breaks when doing boring or monotonous activities (as we discuss later in this chapter), and be sure to inject some fun into your day as well. Good sleepers take bad nights in stride and proceed with their regularly scheduled activities. If you are unable to follow this advice because you strongly believe that you have a fixed and low amount of energy from which to draw upon during the day, test this belief by spending a week conserving your energy all day, every day. Rest as much as you can and track your hourly energy levels, your mood, and the quality of your sleep. Then spend a week expending your energy. Do the things that you would do if you had slept well even if you feel as if your energy reserve is low. Track your energy levels, your sleep, and your mood for this week too. You will likely be surprised at what you learn.

Fatigue—Don’t Let It Stop You!

Fatigue—feeling mentally, physically, or emotionally tired—is the number one complaint of people with sleep problems. Under normal conditions, resting or taking a nap helps with fatigue; but when difficulty sleeping becomes chronic, resting rarely helps improve energy levels and, as we discussed in the previous paragraph, it may increase the likelihood that your sleep and fatigue problems will continue or worsen.

If you feel mentally fatigued after a poor night’s sleep, you may doubt that you will be able to perform your everyday duties adequately. You may worry that you will make a mistake at work that will cause you to look bad or even to lose your job. If you are responsible for looking after young children, you may worry about whether you will be able to pay close enough attention to keep them safe.

Luckily, we know that although greater effort than usual is required, people with sleep problems continue to perform routine mental tasks normally. Although you may not feel very sharp after a night of poor sleep, you are unlikely to be impaired when performing routine activities. If you are concerned about memory impairment, you may want to use external aids to memory, such as to-do lists, leaving sticky notes in prominent places to remind you to do something, or asking someone to remind you. Sticking to your routines, using such aids when needed, is preferable to calling in sick to work or otherwise avoiding your responsibilities. Remember that, as we discussed in the previous section, avoiding or canceling activities can reinforce the idea that you are incapable of coping with sleep loss, a belief that will increase your anxiety about your sleep problems.

Feeling physically fatigued can make it difficult to get out of bed in the morning, stay out of bed in the evening, exercise or perform normal physical activities, and avoid trying to nap. Whereas normally you would rest to manage fatigue, in the context of sleep problems resting rarely makes you feel better; it may even make you feel more fatigued. This is because inactivity breeds more inactivity. An object at rest tends to stay at rest. Or more succinctly, an object on the couch tends to stay on the couch. Inactivity can have negative effects on sleep and can worsen fatigue. Keep to your normal routine if you can, and address the common causes of fatigue listed later in this chapter.

Some people who sleep poorly tend to assume that when they do not feel well during the day or they perform poorly it must be due to poor sleep, ignoring other possible causes. Don’t make lack of sleep a scapegoat. Have you not, after all, had okay days after a poor night’s sleep? Conversely, have you never felt bad or performed poorly after a good night’s sleep? Does having a really good night’s sleep always prevent feeling bad during the day? The fact is that daytime problems and sleep are not as perfectly related as you might think. Importantly, there are negative consequences to blaming poor mood, fatigue, and concentration problems exclusively on sleep. Here are some tips to help you avoid this trap.

Avoid Appraising Your Sleep within an Hour of Waking Up

During the first thirty to sixty minutes after waking up, you may be experiencing what is called sleep inertia or sleep drunkenness. Feeling groggy and tired upon waking may have nothing to do with the amount or quality of your sleep. You may have woken up from a deep stage of sleep. You may have awoken from a dream. Your body clock type may also contribute to sleep inertia. In comparison to a morning person (an “early bird”), who tends to feel wide awake and alert upon awakening, a night person (a “night owl”) takes a long time to feel optimally alert. All of the above, and more, are possible explanations for feeling poor upon waking up in the morning. It would therefore be a mistake to conclude that feeling bad in the morning means that your sleep was of poor quality or insufficient.

Imagine that two men, Dan and Stan, have both been awakened by an alarm from a deep stage of sleep. Dan thinks:
Whew, I’m sleepy; I must have been in a deep sleep. I’d better get into the shower and shake this feeling off.
Stan thinks:
Whew, I’m sleepy; I must have had another bad night. I’d better stay in bed and try to get more sleep.
Which of these reactions would likely lead to feeling worse during the day? Who will have greater sleep anxiety—Dan or Stan? Which of the two is more likely to have sleep problems in the future?

Address the Common Causes of Fatigue

There are many reasons for feeling tired other than insufficient or poor-quality sleep. The good news is that most of these factors are well within your control and may be simple to fix. Understand the following common causes of fatigue and address them.

The “boomerang” effect of caffeine.
You may rely on caffeinated beverages like energy drinks, pop, tea, or coffee to make you feel more alert when you feel fatigued. These beverages may initially help you feel an energy boost. However, you may later experience a drop in energy, or a caffeine “crash.” Worse is the fact that the crash may be (mis)interpreted as due to your sleep problems, rather than the metabolism of the caffeine, which is entirely unrelated to sleep. In other words, you may have felt tired mid-morning and had a latte to keep you going, then several hours later felt tired again and thought, “I can’t take how my problems sleeping make me feel tired all the time.” This and other inaccurate attributions increase your anxiety about sleep, making it difficult for you to approach sleep in a casual, effortless way (like a good sleeper; see chapter 8). Moreover, if later in the day you continue consuming caffeine, it might directly interfere with your ability to fall asleep, depending on how close it is to your bedtime and how sensitive you are to the alerting effects of caffeine. Consider cutting back or eliminating your caffeine intake.

The “post-lunch dip.
” Have you ever noticed a dip in your energy, alertness, or mood in the early part of the afternoon? Most people blame this phenomenon on a big lunch. However, you should know that your level of alertness is controlled in part by your body clock. Your body temperature naturally rises and falls over a twenty-four-hour course, and you are most sleepy when your temperature is falling. The most prominent dip in temperature occurs at night, but there is one brief occasion during the day when most people’s body temperature falls slightly, usually sometime between noon and three. This dip in energy levels is temporary. Now consider two ways of reacting to this dip:

1. Believing that this midday energy dip means that your fatigue is increasing and this is a sign that you did not sleep well or for long enough
   
2. Believing that it is a brief, temporary natural dip that is unrelated to your sleep problems
   

Which of these two reactions will produce more anxiety about sleep? Which is more likely to result in helpful, adaptive behaviors? Given the earlier discussion about caffeine, which of these two reactions is going to lead people to re-caffeinate after lunch? If you can weather the “post-lunch dip” without caffeine, you will see your energy levels naturally rise again and you will be more likely to get good sleep later.

Inactivity.
What do you feel like doing when you are tired? Probably not much at all. When you are tired, it makes sense to rest; however, when you have chronic sleep problems, this natural inclination to rest leads to greater levels of fatigue. In physics, as we noted above, an object at rest tends to stay at rest, because of inertia. The same is true of people who stay at rest. Why? Because inactivity breeds more fatigue, until it is difficult to do anything.

When you engage in physical activity, your metabolism speeds up and your body releases endorphins, both of which give you more energy. Exercise has health and sleep benefits, but overactivity and physical exertion can produce fatigue, so try to find a balance. Movement and regular light physical activity is a good start to reduce fatigue and improve sleep.

Poor nutrition or irregular meals.
You need appropriate nutrients from foods in order to maintain energy in your body. Certain weight-loss diets, such as those low in carbohydrates, can deprive your body of vital nutrients and fuel that you need to get through the day.

Eat too little and your blood sugar will fall; eat too much and your blood sugar will spike. A diet high in sugar will negatively impact your blood sugar levels and result in high levels of fatigue and mental cloudiness. Eating regular, well-portioned meals will manage fatigue related to blood sugar levels.

Irregular bowel movements are linked with many health problems and symptoms like fatigue. When you are constipated, toxins in your body are not being eliminated properly. The toxins can thus build up and demand more of your body’s energy to process and store. Constipation often can be alleviated with changes in diet. Talk about recurring constipation with your health care provider.

12 can be associated with high levels of fatigue.
If you have had anemia in the past, it is important to note that anemia can and in fact often does return.

Dehydration.
Your body is composed mostly of water, and you need to keep it replenished. You may or may not need eight glasses every day, but the fact is that people tend to not drink enough water. If your water intake is too low, you can become dehydrated, which affects your energy levels. Preventing dehydration, which is very important for your general health, is thus also an effective fatigue management strategy. Note that caffeinated beverages have a diuretic (dehydrating) effect, so caffeine drinkers need even more water than others to compensate.

Boredom.
Boredom is often underestimated as a source of fatigue. If you don’t believe that engaging in mundane activities without adequate breaks can be fatiguing, think of how it feels to stare at a computer screen for hours on end. There is nothing physically taxing about using a computer, and you are resting in a chair while doing it, so why does it make you feel so tired? The reason is because levels of sustained activity can cause muscle soreness and eye strain and lead to mental and physical fatigue. Take frequent breaks from mundane activities, particularly those involving your eyes.