Written by Dr. Daniela Steyn
If you want to sleep better. I can help you.
At Wellness MD, I and my team have helped many clients get optimal sleep. I want to help you sleep better, too. When clients come to us regarding concerns with their weight, mood, hormonal imbalance or when they've lost their joy, we always first look at sleep. Your body needs enough good quality sleep to heal from inflammation, remove toxins you were exposed to during the day, optimize brain function (less forgetfulness and brain fog) and balance your hormones. All the research shows that we need to sleep well to maintain a healthier weight. You need good sleep to lower your cortisol (stress hormone) and glucose levels. Optimal sleep promotes better insulin sensitivity (insulin resistance drives diabetes and abdominal weight gain). When people sleep better, they have higher daytime leptin levels, which results in less food-seeking behaviours.
Healthy sleep duration and quality help with DNA repair and histone modification. During good quality sleep, your body removes cancer cells (Apoptosis and anti-cancer cytokines (IL-1, IL-2, TNF-alpha)).
You need better sleep for better cardiovascular health because, during sleep, your sympathetic tone lowers, which in turn lowers blood pressure.
Effects of Poor Quality Sleep:
When I see patients in the hospital, I often prescribe sleeping meds. It is hard to sleep in a hospital with alarms beeping and nurses coming in and out throughout the night. However, when patients see me in my outpatient clinic, I prefer not to prescribe medication, as medication has not been shown to improve the quality of sleep.
You need to see a doctor to rule out sleep apnea and make sure your difficulty sleeping is not a side effect from other medication you are taking or caffeine (after 2 pm) preventing you from getting a better quality of sleep. Once all medical reasons are excluded, consider CBT.
Cognitive-behavioral therapy for sleep (CBT-I) is a highly effective treatment for sleep disorders, particularly insomnia. It is based on the understanding that our thoughts, feelings, and behaviours can significantly impact our sleep patterns. CBT-I addresses and modifies these factors to improve sleep quality and quantity.
Here are some key components I typically cover over several weeks of cognitive-behavioural therapy for sleep (however, if you implement it today, you will start sleeping better tonight!):
1. Sleep hygiene education
When I see a new patient/client, I first cover the basics. What does good sleep look like? CBT-I begins with educating individuals about healthy sleep habits. This includes maintaining a consistent sleep schedule, creating a comfortable sleep environment, avoiding stimulating substances like caffeine and nicotine close to bedtime, and establishing a relaxing bedtime routine.
2. Stimulus control
This technique involves reestablishing the association between the bed and sleep. I encourage my patients to use the bed only for sleep and intimacy, avoiding engaging in wakeful activities (such as reading or watching TV) in bed. If they cannot fall asleep within a certain period, advise them to get out of bed and do something relaxing in the living room with a dim light until they feel sleepy again.
3. Sleep restriction therapy
This technique restricts the time spent in bed to match the actual amount of sleep obtained. By initially limiting the time spent in bed, sleep restriction therapy aims to increase sleep efficiency and reduce time spent lying awake in bed. Over time, the sleep window is gradually expanded as sleep efficiency improves. I generally recommend that you should spend 90% of the time in bed asleep.
4. How to sleep better with Cognitive Behavioral Therapy (CBT)
CBT-I addresses any negative thoughts or worries related to sleep that may contribute to insomnia. Cognitive techniques help individuals identify and challenge unhelpful beliefs about sleep, such as catastrophic thinking about the consequences of inadequate sleep.
5. Relaxation techniques
Various relaxation techniques, such as progressive muscle relaxation, deep breathing exercises, and mindfulness meditation, are incorporated into CBT-I to promote physical and mental relaxation before bedtime. If you wake in the middle of the night, you can come back to these breathing exercises or meditation rather than think of the following day.
6. Sleep diary
A sleep diary will help you track your sleep patterns and identify potential factors contributing to sleep difficulties. Write down what time you go to bed, wake-up time, time taken to fall asleep, number of awakenings during the night, and subjective sleep quality. Our Wellness MD Clients' smartwatches are paired to their health records so their health coach can see how long they sleep and if they have had deeper restful sleep. I recently attended a Lifestyle Medicine conference with wellness physicians from all over the world. Many love sleep tracking, but many don't due to the inaccuracy of some devices and the need for more electronics. There isn't a right or wrong. If you like to track things and have a smartwatch or Oura ring, go for it. If you don't want to, journalling is just as good.
Trained therapists typically deliver CBT-I in a structured and time-limited format. However, some components of CBT-I can also be self-administered through online programs. Chat with your doctor or email info@wellnessmdhealth.com if you need help finding something local; we might know about resources in your area.
References:
Prasad C, Davis KE, Imrhan V, Juma S, Vijayagopal P. Advanced Glycation End Products and Risks for Chronic Diseases: Intervening Through Lifestyle Modification. Am J Lifestyle Med. 2017 May 15;13(4):384-404. doi: 10.1177/1559827617708991. PMID: 31285723; PMCID: PMC6600625.