Getting Better Rest

The importance of rest and sleep cannot be underestimated.

Lack of alertness, impaired memory, increased vulnerability to emotional dysregulation, and even overeating are associated with short term sleep deprivation.

The human body needs sleep. Adults aged 18-65 need 7-9 hours of sleep daily for maximum health and daily performance. In the U.S., 11% of adults report they get insufficient sleep every night.

Chronic lack of sleep is associated with physical illness including high blood pressure, diabetes, heart attack, heart failure or stroke. Other potential problems include obesity, depression, reduced immune system function and lower sex drive.

Many people who meet criteria for BPD, also meet criteria for a sleep disorder. With treatment for BPD, the sleep disorder may subside as a person develops goals and life activities that require getting up each morning and feeling more interested, engaged, and hopeful. However, many people will suffer from lack of sleep that are not caused exclusively by emotional dysregulation.

What to do? If you or a loved one really wants to improve the quality of your mental alertness by improving your sleep, HOW can you do it?

DBT offers some classic protocols for getting better rest. In addition there are some concepts from MBTI, an evidenced-based program, Mindfulness-Based Treatment for Insomnia which I would like to share with you.

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DBT Sleep Hygiene Protocol

TO INCREASE THE LIKELIHOOD OF REST and/or SLEEP:

1. Develop and follow a consistent sleep schedule even on weekends. Go to bed and get up at the same time each day, with +/- 8 hours of bedrest between going to bed and getting up. Avoid anything longer than a 10-minute nap during the day.

2. Do not use your bed in the daytime for things like watching TV, talking on the phone, or reading.

3. Avoid caffeine, nicotine, alcohol, heavy meals, and exercise after noon and especially before going to sleep.

4. When preparing to sleep, turn off the light, and keep the room quiet and the temperature comfortable and relatively cool. Try an electric blanket if you are cold; putting your feet outside of the blanket or turning on a fan directed toward your bed if you are hot; or wearing a sleeping mask, using earplugs, or turning on a “white noise” machine if needed.

5. Give yourself half an hour to at most an hour to fall asleep. If it doesn’t work, evaluate whether you are calm, or anxious (even if only “background anxiety”), or ruminating.

6. Do not catastrophize. Remind yourself that you need rest, and aim for reverie (i.e., dreaminess) and resting your brain. Sell yourself on the idea that staying awake is not a catastrophe. Do not decide to give up on sleeping for the night and get up for the “day.”

7. If you are calm but wide awake: Get out of bed; go to another room and read a book or do some other activity that will not wake you up further. As you begin to get tired and/or sleepy, go back to bed.

8. Try a light snack (e.g., an apple).

IF YOU ARE ANXIOUS OR RUMINATING

9. Use the cold water TIP skill. Get right back in bed and do the paced breathing TiP skill.

Remember, if you have any medical condition, get medical approval before using cold water.

10. Try the 9–0 meditation practice. Breathe in deeply and breathe out slowly, saying in your mind the number 9. On the next breath out, say 8; then say 7; and so on until you breathe out saying 0. Then start over, but this time start with 8 (instead of 9) as you breathe out, followed by 7, and so on until you reach 0. Next start with 6 as you breathe out, and so on to 0. Then start with 5, then with 4, and so on until you have gone all the way down to starting with 1. (If you get lost, start over with the last number you remember.) Continue until you fall asleep.

11. Focus on the bodily sensation of the rumination (rumination is often escape from difficult emotional sensations).

12. Reassure yourself that worries in the middle of the night are just “middle-of-the-night- thinking,” and that in the morning you will think and feel differently.

13. Read an emotionally engrossing novel for a few minutes until you feel somewhat tired. Then stop reading, close your eyes, and try to continue the novel in your head.

14. If rumination doesn’t stop, follow these guidelines: “If it’s solvable, solve it. If it is insolvable, go deep into the worry all the way to the “catastrophe”—the very worst outcome you can imagine—and then imagine coping ahead with the catastrophe. (See Emotion Regulation Handout 19: Build Mastery and Cope Ahead.)

15. If nothing else works, with eyes closed, listen to public radio (BBC, NPR, etc.) at low volume (use headphones if necessary). Public radio is a good choice for this, because there is little fluctuation in voice tone or volume.

From DBT Skills Training Handouts and Worksheets,

Second Edition, by Marsha M. Linehan.

Copyright 2015 by Marsha M. Linehan.

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IF YOU SUFFER FROM CHRONIC INSOMNIA

“Circadian” cycle - The natural cycle of physical, mental, and behavior changes that the body goes through in a 24-hour cycle. Circadian rhythms are mostly affected by light and darkness and are controlled by a small area in the middle of the brain.

1. Keep in mind, the brain is able to fall asleep without any intervention. All human brains are capable of this.

2. Trying hard or straining to sleep is counterproductive and can interfere with brain systems.

3. To sleep we need to be continuously awake for a certain period of time.

4. Circadian schedules promote sleep at night and wakefulness / activity during the day.

5. Bedtime is NOT the key to regulating the “inner clock”.

6. The key to regulating circadian schedules is the time you wake up and expose yourself to light.

7. Reducing light 1-2 hours before bedtime is also helpful to adjust and support circadian schedules.

From Mindfulness-Based Therapy for Insomnia by Jason C. Ong,

Copyright 2017 by the American Psychological Association.

The fact that we cannot sleep is usually not the problem! The problem is often that we are awake and restless at night, mentally suffering and complaining to ourselves that we cannot sleep. Then we are tired and grouchy during the day, mentally suffering and criticizing ourselves that we are not alert and clear minded. Perhaps radical acceptance of our states of tiredness or alertness, without complaints or criticism or judgement, might be the first step toward changing these patterns.

So, if you want better rest, decide upon your regular bedtime and wake up time in advance , according to the schedule that works best for you and then stick to the plan. Get up at the same time every morning, regardless of how you slept. Practice radical acceptance of feeling tired during the day while doing your daily activities. Trust your body to sleep more the next night. Then go to bed and get up at the appointed hours each and every day.