The most important first step to improving sleep is to wake up at the same time every single day, including weekends, to regulate your circadian rhythm.
Strictly associate your bed only with sleep and sex; avoid activities like reading, scrolling on your smartphone, or watching TV in bed to strengthen this association.
Restrict the total time you spend in bed to closely match the actual amount of sleep your body is currently producing, typically by adding 30 minutes to your average sleep duration.
If you have insomnia, eliminate daytime naps entirely to build sufficient sleep pressure for nighttime sleep, even if you feel tired from a poor night’s sleep.
Deal with sources of stress and anxiety during the day, as unresolved worries can demand attention and disrupt sleep at night.
Set aside a specific, non-negotiable hour each day (e.g., 4 PM) for ‘scheduled worry time’ to address anxieties, allowing you to defer worries and prevent nighttime disruption.
Keep your bedroom temperature in the mid-60s Fahrenheit (around 18°C) to optimize sleep, and if your feet feel too cold, wear socks.
Avoid using down comforters, quilted items, or duvets, as they can trap heat and disrupt your body’s natural circadian temperature rhythm, which should be coolest at night.
Refrain from eating any food within three hours of your bedtime to support better sleep quality.
During Cognitive Behavioral Therapy for Insomnia (CBTI) treatment, completely abstain from alcohol to minimize perturbations and allow for accurate assessment of sleep patterns.
Discontinue all sleep supplements (e.g., melatonin, ashwagandha) during CBTI treatment to observe your body’s natural sleep patterns without external perturbations, as supplements may be ineffective or counterproductive.
Based on your sleep diary, establish a realistic and consistent wake-up time that aligns with your body’s natural pattern, rather than an aspirational one, and adhere to it daily.
After tracking your sleep for seven days, calculate your average actual sleep time, add 30 minutes, and count backward from your chosen consistent wake-up time to determine your initial restricted bedtime.
If you wake up in the middle of the night and cannot fall back asleep, get out of bed and engage in a mildly boring, non-stimulating activity in another room until you feel sleepy again, then return to bed.
Utilize thought records to question negative or dysfunctional thoughts about sleep; write down the thought, how you feel, evidence for and against it, and then create a balanced thought.
If a specific worry consistently wakes you up, track your degree of belief in that thought throughout the day to realize if its perceived truthfulness changes, diminishing its power at night.
If you have insomnia, remove all sleep trackers during treatment to reduce anxiety and prevent distress caused by device readings, which can misinterpret sleep quality.
When tapering off sleep medications, use a gem scale to precisely measure and reduce doses in very small increments, often by crushing pills and dissolving them in water, to manage dependencies.
Always work with your prescribing physician when planning to change or taper sleep medications, ensuring they are explicitly aware and supportive of the plan.
Before attempting to taper off sleep medications, stabilize your dose to a consistent amount taken at a consistent time, as attempting to quit from an unstable baseline is unlikely to succeed.
If taking sleep medication, eliminate any middle-of-the-night doses and limit intake to a single, consistent dose taken only before bedtime to prevent erratic use.
If a major stressful life event occurs during a medication taper, pause the taper and maintain the current stable dose, resuming only when the stress has subsided.
If you have been prescribed a CPAP machine for sleep apnea, use it every single night, and work with your provider to ensure proper fit and comfort if you are struggling with adherence.
Ask your partner if you snore loudly or gasp for air during the night, as these are signs of potential sleep apnea that should be addressed by a specialist before insomnia treatment.
Stop all caffeine intake, including decaffeinated coffee (which can still contain significant caffeine), by 11 AM to prevent it from negatively impacting the electrical quality of your sleep.
You don’t need to reduce your total caffeine intake, but ensure all of it is consumed before 11 AM to avoid withdrawal symptoms while still improving sleep quality.
Ensure you take all medications at the same time every day and at the optimal time of day (e.g., not stimulating meds before bed) to avoid disrupting your circadian rhythm.
Wear an eye mask, especially if you experience early morning awakenings, as even small amounts of light detected through closed eyelids can signal your body to wake up.
Actively block out any egregious lights in your bedroom, such as alarm clock displays or indicator lights, using methods like electrical tape, to ensure maximum darkness.
The primary issue with screens before bed is often the stimulating content (social media, work emails) rather than just blue light; avoid interactive and stressful digital activities.
If you have difficulty falling asleep and already avoid stimulating content, try wearing ugly, wraparound orange-colored blue-light blocking glasses for two hours before bed for two weeks.
When trying a new sleep intervention, track your sleep using a paper sleep diary for two weeks before and after making the change to empirically assess its effectiveness.
Practice progressive muscle relaxation (squeezing and releasing muscle groups throughout your body) for a few minutes in bed before sleep to get out of your head and into your body.
Do not fall asleep while listening to podcasts or other audio, as this can disrupt sleep and is not conducive to healthy sleep habits.
Falling asleep on the couch with distractions like TV noise can fragment early-night sleep, potentially disturbing the quality of the deeper slow-wave sleep prioritized in the first half of the night.
Pay attention to your body’s cues of sleepiness, such as nodding off, heavy eyelids, or warm hands, and go to bed promptly when you notice them.
If you struggle to go to bed when watching TV, sit on an uncomfortable stool instead of a couch to make it less conducive to falling asleep there.
If you need to nap due to illness, do so in your bed, not on the couch, to maintain stimulus control and reinforce the association of your bed with sleep.
If your hands and feet are cold, wear socks or use a small heating pad at the foot of the bed (with auto shut-off) to warm extremities, which can help dump heat from your core and facilitate sleep onset.
Consider taking a warm foot bath before bed, as warming your hands and feet causes vasodilation, helping your body dump heat from its core, which is desirable for falling asleep.
If you feel cold, use cotton blankets instead of heat-trapping comforters; you can layer two or three if needed to maintain warmth without disrupting core body temperature regulation.
For men 45 and up, reduce fluid intake with and after dinner, and consider adding an electrolyte tab to decrease the frequency of waking up to urinate, thereby reducing the risk of not falling back asleep.
When a worry arises outside of your scheduled worry time, write it down and consciously defer dealing with it until your designated worry period, helping to unclutter your day and mind.
Avoid going to bed before your body is naturally ready for sleep; align your bedtime with when your body can actually produce sleep to prevent struggling for hours.
For effective Cognitive Behavioral Therapy for Insomnia (CBTI), adhere strictly to the treatment plan and complete at least four sessions with a therapist, as adherence and duration are critical for success.
To improve adherence and outcomes, take the time to understand the scientific rationale behind each component of Cognitive Behavioral Therapy for Insomnia (CBTI).
If professional CBTI is inaccessible, use the workbook ‘Quiet Your Mind and Get to Sleep’ by Rachel Manber and Colleen Carney for a self-guided approach to the treatment.
Do not take a cold plunge right before bed, as your body will actively work to warm itself back up afterward, counteracting the desired core body temperature drop needed for sleep.
If considering a sauna before bed, be mindful of its effect on your heart rate; if your heart rate remains elevated and you don’t have rapid recovery, it may be counterproductive to sleep onset.
If using a sauna before bed, be mindful of excessive fluid intake afterward, as drinking too much water can lead to increased nighttime urination and disrupt sleep.
Consider the trade-offs of engaging in strenuous exercise (e.g., HIIT, intense spin class) late in the evening if it significantly elevates your heart rate and delays your natural bedtime, as it can disrupt sleep onset and overall sleep duration.
Engaging in relaxing and calming forms of exercise, such as yoga or stretching, in the evening is generally acceptable if it helps you unwind and doesn’t elevate your heart rate for prolonged periods.
If you have a late night, you can sleep in on one day of the weekend by an hour, but not two days in a row, as sleeping in excessively disrupts your sleep schedule and quality.
Avoid trying to ‘make up’ for lost sleep by sleeping in excessively, as this primarily adds light sleep and doesn’t restore deep sleep, further disrupting your circadian rhythm.
You don’t need to know the root cause of your insomnia to begin Cognitive Behavioral Therapy for Insomnia (CBTI), as the treatment focuses on addressing current behaviors that perpetuate the problem.
Don’t delay starting insomnia treatment; there will never be a ‘perfect’ time, and addressing it now is crucial given the difficulties insomnia causes.
When seeking a CBTI therapist, ask if they follow a structured, weekly protocol for 5-8 weeks, including reviewing sleep diaries, as this adherence to the ‘recipe’ is crucial for efficacy.
Utilize the Society of Behavioral Sleep Medicine directory to find a Cognitive Behavioral Therapy for Insomnia (CBTI) provider, as many now offer telemedicine, making treatment more accessible.
When seeking telemedicine CBTI, ensure the provider is licensed in your specific state, or in a state that participates in PsyPact (Psychology Interjurisdictional Compact) if your state is also a member.
Leverage the increased availability of telemedicine to access Cognitive Behavioral Therapy for Insomnia (CBTI), especially if you live in a rural area or have difficulty with in-person appointments.
If you’ve been struggling with sleep problems for at least three months and it’s causing distress or interfering with your life, it’s time to seek professional help.
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