Read an Excerpt
"I’m sitting in front of the television at night, feeling so tired that I can barely keep my eyes open. But the moment my head hits the pillow, I’m wide awake!" —Brett
"I don’t know what’s wrong with me. I don’t feel all that stressed during the day, but when I lie in bed at night, all I can think about are the millions of things I need to do tomorrow at work, at home, with my kids…my mind just won’t shut off." —Lori
"I fall asleep fine at the beginning of the night, but then I wake up around 3 or 4 a.m. and cannot fall back asleep. I’m not sure what wakes me up. Sometimes I have to go the bathroom, but I don’t think that’s it. I just lie in bed, staring at the clock, wondering why I can’t sleep straight through the night like my husband lying next to me!" —Suzanne
"I’m just not tired when I get into bed. I don’t know what’s wrong with me. I used to sleep seven to eight hours per night and never had a problem. But ever since my son was born, I have problems falling asleep and staying asleep. It’s aggravating, because I need my energy during the day in order to be productive." —Beth
"My wife says that it started after I changed jobs, and maybe she’s right. I’m really not sure, but all I know is that I wake up in the middle of the night with my heart pounding, have trouble breathing, and then feel angry that I can’t fall back asleep. I’ve been to my doctor and a specialist, and there’s nothing wrong with my heart. I don’t know why I get so worked up, but it needs to stop!" —Dave
"I’ve taken nearly every sleeping pill you can imagine. They all seem to work fine at first, but after a couple of weeks, I’m back to where I started: trouble falling asleep for hours on end, and then once I do fall asleep, I wake up after one or two hours. Why don’t these medications work better for me?" —Karen
"I don’t feel depressed, and I don’t think I’m anxious. I just don’t understand why I can’t sleep. I lie in bed at night thinking about how long it will take me to fall asleep. There’s nothing else on my mind, but the hours are just ticking away." —Chris
Do these words sound familiar to you? If so, you’re not alone. Recent research indicates that nearly one-third of Americans suffer from insomnia at some point during their lives (Ohayon 2002). Although it may feel frustrating to be one of those people, take heart: Effective treatment that doesn’t involve medications is available to you, here, within these pages. This workbook is designed to help you overcome your insomnia at home, in a step-by-step approach that involves your active participation. You will need to devote time to reading this book thoroughly, filling out the questionnaires, and doing the exercises and other activities recommended, all of which will help you achieve a successful night’s sleep.
There are different types of insomnia, including trouble falling asleep, trouble staying asleep, and early morning awakenings. Insomnia can be short term, lasting from a few days to a few weeks. It can also be chronic, lasting months or even years on end. The severity of insomnia can also vary, from occasional bad nights that occur once or twice per week to significant problems sleeping five to seven nights per week. Insomnia can mean waking up once each night or several times per night and having trouble falling back asleep, or it can mean lying in bed trying to fall asleep for thirty minutes or three hours. In other words, insomnia can vary from person to person. And even if you don’t have insomnia, you may not be completely satisfied with your sleep and may be interested in improving it. If so, you too will find this book helpful. The techniques in this book can help anyone sleep more soundly.
Like most things, overcoming insomnia doesn’t just happen overnight. But if you stick with the suggestions and guidelines in this book, you should start sleeping better soon. Depending on what the root cause of your sleep problem is, it may take anywhere from a few days to several weeks before you see positive changes in your sleep patterns. The most important thing is not to give up in the early stages. Give your mind and body a chance to overcome insomnia in a way that doesn’t rely on medications, herbs, or supplements by using the cognitive behavioral methods outlined in this workbook.
Cognitive behavioral therapy is a type of psychological treatment that focuses on behaviors and ways of thinking and the role that they play in creating and maintaining certain patterns in a person’s life. When these patterns are maladaptive, they cause problems. The key is to identify and change the problematic behaviors and thoughts. The sleep program in this book includes both behavioral and cognitive aspects, with specific chapters focusing on various behaviors and thoughts that may be contributing to your sleep problem and offering techniques to modify or change them. Behavioral approaches include improving your sleep hygiene (chapter 4), practicing relaxation techniques (chapter 5), using sleep logs (chapter 6), and implementing stimulus control and sleep restriction (chapter 7). The primary cognitive approach involves controlling anxiety and irrational thoughts (chapter 8). Chapter 9 discusses both behavioral and cognitive techniques for managing daytime stress and maintaining a healthy lifestyle.
How This Book Is Organized
This workbook offers a hands-on approach to the treatment of insomnia. You may not have a sleep specialist available to you where you live, or you may not have the time or resources to see a specialist in person. For that reason, this workbook is intended to replicate the experience of working with an insomnia sleep specialist, from the initial consultation and assessment of the nature of your sleep problem to instruction in cognitive behavioral approaches and other techniques for improving your sleep. There will be questionnaires and activities for you to do along the way. These are the same types of questions and approaches that a sleep specialist would use in face-to-face appointments. Using this workbook, you can take charge of improving your sleep.
To give you a better idea of what to expect as you work through this book, here’s a breakdown of the chapters and what they’ll include. Chapter 1 discusses the fundamentals of sleep, with information on typical sleep patterns, sleep in different stages of life, the effects of sleep deprivation, and common myths about sleep. Chapter 2 describes the different types of insomnia, including common psychological and medical causes, and other sleep disorders that may be affecting your ability to sleep. It also discusses sleep and aging. Because sleeping medications are so widely used but also so potentially problematic, chapter 3 provides information on medications for insomnia, including over-the-counter drugs, herbal remedies, and prescription sleeping pills. It discusses how sleeping aids may be causing problems for you, and when and how to safely stop taking sleeping medications.
The treatment portion of the book begins in chapter 4, with a review of sleep hygiene and important ways to change some of your behaviors so that they help promote sleep. Chapter 5 emphasizes the importance of relaxation and describes specific relaxation techniques that you can learn and practice. Chapter 6 explains sleep logs and how to use them to record data about your sleep. The information you gather is important, and you’ll use it as you continue working through the book. Chapter 7 explains stimulus control and sleep restriction. These techniques are a key part of the approach in this book. They can be used to alter your sleep patterns, and chapter 7 will explain exactly how to do this. Chapter 8 moves on to cognitive factors that may be making your sleep worse and provides you with ways to control any anxiety and irrational thought processes that may be interfering with your sleep. Chapter 9 will help you manage daily stress and maintain a healthy lifestyle. Beyond helping improve your sleep, this will enhance your overall well-being. The final treatment chapter (chapter 10) is devoted to preventing relapse and offers tips on how to handle an occasional bad night.
The two remaining chapters cover other areas of interest in the realm of sleep. Chapter 11 describes parasomnias, or abnormal behaviors during sleep. These include sleepwalking, sleep terrors (also called night terrors), confusional arousals, sleep-related eating disorder, REM sleep behavior disorder, and nightmare disorder. Chapter 12 focuses on issues that may affect women’s sleep, such as PMS, pregnancy, and menopause. Lastly, there is a resources section with useful websites and places to buy relaxation CDs.
Who I Am and Why I Wrote This Book
You may be wondering why I decided to write a workbook on insomnia. Since I first started working in the field of sleep medicine, I’ve been amazed at how many people have trouble sleeping. Everywhere I go, people ask me questions about sleep. Some of the most frequent questions include "How many hours of sleep do I need each night?" "What’s causing me to toss and turn for an hour while I’m trying to fall asleep?" "Can napping during the day affect my sleep at night?" "Why do I feel wide awake when I get into bed each night, and why I am waking up during the night?"
With insomnia being such a widespread problem, I decided to write a self-help book on insomnia in a workbook format to answer some of these questions and provide solutions for difficulties with sleeping. The workbook format allows you, the reader, to actively participate in learning about and improving your sleep rather than just passively turning the pages.
I am a licensed clinical psychologist and board-certified sleep medicine specialist, but I’m also a working mother, wife, and activist in my community. I’m the type of person who loves to be busy, but I also know the importance of slowing down and simply enjoying life. I know how hard it can be to achieve and maintain that "perfect balance" in your life—the kind of balance that allows you to feel fulfilled in your work and daily activities and to also feel calm and at peace with the world around you. This book is a way for me to use my experience and expertise to help people with one of the most vital and important things we do every day: sleep—and sleep well so that we can maintain happy, healthy lives.
