A psychological therapy service
Stress Control Workshop
Session 6
Controlling sleep problems,
wellbeing & controlling the future
Dr Jim White
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
Contents Page
Session 6: Controlling your sleep,
wellbeing & controlling
your future
Session 6 SummaryTick Once Complete
Part A: Controlling your sleep
Getting a good night’s sleep
Step 1: Know your enemy
Step 2: Relaxation
Step 3: Retraining your sleep
Step 4: Sleeping tips
Stress Control: Sleep Diary
Part B: Wellbeing/Controlling your future
Wellbeing
Controlling your future
Controlling your future worksheet
Dr Jim White
2
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
Part A: Controlling your sleep
Reasons for poor sleep
Poor sleep and stress go hand in hand. You don’t sleep well because you are
stressed: you don’t recharge your battery so you are less able to fight stress.
These are all quotes from people who have a sleep problem:
“I wake up and feel that
I’ve hardly slept. I still feel
tired and don’t feel I’ve got
the energy to face the day”
“I’m quite down just now and I
find that I’m awake at 4 in the
morning. And that’s me for the rest
of the night. I’ll not get off again
even though I want to sleep more”
“I have to have a few drinks to
get me off to sleep. But I wake
up within a few hours and
that might be me for hours”
“I can go to bed at night feeling
really tired but as soon as that
light goes out, my mind comes
to life. I can’t shut it down and
get to sleep. I toss and turn and
feel rotten. Joe is fast asleep in
seconds and I’m wide awake”
“I wake up at two in the morning with a load of stupid
thoughts going round and round in my head. I just get up
and I spend half the night in the living room. I can’t tell you
how lonely I feel then. And of course, during the day, I am
walking about half-asleep all the time”
A
Dr Jim White
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
3
Sleep problems can come about for a range of reasons.
Tick the ones that apply to you:
Stress
You may find that you are better as long as you can keep busy and
distracted. When you go to bed, a host of thoughts or worries can
invade your mind. This stops you from sleeping.
Shift work
This can badly affect sleep as your body can’t get into a good sleep
habit.
Age
As we get older, we need less sleep yet often try to sleep for the
same number of hours as we needed when we were younger.
Need to go to the toilet
This is often tied to age. Most people over 60 get up at least once a
night.
Pain
Any illness that results in pain can cause poor sleep.
Surrounds
Sleep can be poor if you live in a noisy street or if the neighbours
are playing music till all hours. Your room and bed may also play a
part.
We will look at ways to overcome some of these later.
Sleep problems and stress often go hand in hand. There are four main types.
You may find you have more than one. Tick the ones that fit your sleep:
Getting off to sleep
You may feel really tired when you get ready for bed. But as soon
as you get into bed, you can’t get off to sleep. You are restless. You
toss and turn. Your body may be tired but your mind is not. Your
mind bursts into life and you can’t switch off. You get more and
more annoyed and stressed.
Dr Jim White
4
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
Staying asleep
You may wake up at different times of the night. You may find it
hard to get back off to sleep.
Waking too early in the morning
You find yourself waking at 4am or 5am and know that you are not
going to get any more sleep even though you want to.
Sleep quality
You feel that you don’t get a good night’s sleep. You may feel you
don’t get into a deep sleep. You may feel restless during the night.
You do not feel refreshed by your sleep.
What happens when we sleep
Sleep is made up of 5 stages. When we first fall asleep, we go into Stage 1
sleep. This is very light sleep.
As you go into Stage 2 and Stage 3, your sleep gets deeper.
By Stage 4, you are in a very deep sleep.
You then go into a stage called Rapid Eye Movement (REM) sleep. This is when
most of our dreams occur. (You will only remember your dreams if you wake up
during this stage).
Once REM sleep is over, you go back to Stage 1 sleep. You go through this cycle
about 4 or 5 times each night.
As you get older, you seem to need less deep sleep. This may be one of the
reasons why older people tend to wake more often during the night.
A lack of REM and Deep sleep can badly affect you during the day.
Dr Jim White
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
5
Daytime effects of poor sleep
You need to sleep to recharge your batteries - both body and mind. If you
don’t do this then you will drag yourself through the day. You may feel
tired, lethargic, irritable, less vigilant, take longer to react, make more
mistakes, have poor concentration and poor memory. You just don’t feel
‘with it’. If your sleep is poor for some time, you will find it much harder
to learn new tasks.
You may have a vicious circle - stress may cause you to sleep poorly, poor
sleep causes more stress and so on....
Stress
Poor sleep
Controlling stress should help improve your sleep. You can also improve
your stress by controlling your sleeping problems. This is a positive circle.
The next section will show you how to do this.
Controlling your stress
Getting a better night’s sleep
Dr Jim White
6
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
This handout will teach you how to assess and then treat your sleep
problem. You will learn to do this in 4 steps:
STEP 1: Know your enemy
STEP 2: Relaxation
STEP 3: Retraining your sleeping
STEP 4: Sleeping tips
Step 1: Know your enemy
You will find diary forms on pages 14 and 15. Each form asks you 7 questions:
1. When did you try to go to sleep?
2. How long did it take you to fall asleep?
3. How often did you wake up last night?
4. How long did it take you to get back to sleep each time?
5. When did you wake?
6. When did you get up?
7. How was your sleep last night?
TASK
Fill out a diary form each morning for at least three weeks. This will help you
know your enemy better. In turn, you will find it easier to know exactly what
the problem is and how best to fight it.
The diary will also let you track your progress while using the techniques.
Dr Jim White
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
7
Step 2: Relaxation
Use either a relaxation CD or Breathing Retraining. The Breathing should be
used as described in Session 2 booklet.
Follow these four stages if using the CD:
First stage
Learn to relax during the day (see ‘Book 2’ handout).
Second stage
Once you feel tired, get into bed and play the CD in bed. Use Track 1: ‘Deep
Relaxation’
Third stage
Move onto Track 2: ‘Quick Relaxation’ when you feel ready
Fourth stage
Try to get to sleep by relaxing yourself without using the CD
Dr Jim White
8
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
Step 3: Retraining your sleeping
This is a very good way to get rid of the bad habits that can keep poor sleep
going. It is hard to do but well worth it in the end.
You must follow this approach to the letter. There are six stages:
STAGE 1: Don’t go to bed until you feel sleepy
Only go to bed once you start to feel sleepy. Don’t go to bed because
the others are going to bed, or you feel bored or because it is ‘bed-time’.
You must stay up until you feel tired no matter how long this takes.
STAGE 2: Your bedroom is only for sleeping
This step gets rid of the things that keep you from sleeping. While
reading a book seems like a good idea, it is not. If you are reading, you
are not sleeping, so it must go. So you should not read, watch TV, listen
to the radio, write letters, phone friends, etc. This does not include sex.
Sex can help relax you and may help you get off to sleep.
As soon as you get into bed, put the light out and try to sleep. Though
you may know good sleepers who read in bed or watch TV, you must
do these things outside the bedroom at least until you get on top of the
problems.
STAGE 3: If you don’t fall asleep in 20 minutes, get up
If you are not asleep in 20 minutes, you may not be asleep in 50. So
after 20 minutes, go back to the living room. Don’t watch TV. Don’t eat
or drink. Read a magazine, listen to relaxing music. You must stay in the
living room until you feel tired again no matter how long this takes.
When you feel sleepy, go back to bed.
At the start, you will be up many times each night. It is hard to get out of
a warm bed but you must do this.
Dr Jim White
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
9
STAGE 4: Repeat (and repeat and repeat)
Repeat step 3 again and again if you have to. So you have 20 minutes
each time to get off to sleep. If you don’t - it’s back to the living room.
STAGE 5: Get up early each morning
Get up no later than 8.30am. Set the alarm and as soon as it goes off,
get up and out the bedroom.
Even if you feel that you have hardly slept a wink, you must follow this
to the letter. You should also try to do this seven days a week, i.e. no lieins at the weekend until you get this problem sorted out.
STAGE 6: Don’t try to catch up on sleep
You may want to nap during the day to catch up on lost sleep, e.g. after
a meal. Don’t do it. Save the sleep for bedtime.
Work out when you most want to sleep during the day. Then work out a
way of dealing with this - go out for a walk, phone a friend, etc.
KEEP AT IT
This is a very good approach but it is also a hard one to follow. It makes great
demands on you. It is very tempting to stay in bed after 20 minutes, to have
a long lie in or to have an afternoon nap because you can hardly keep your
eyes open. Fight these urges the whole way.
Don’t expect rapid change. Your poor sleep may have built up over a long
time. So it will take time to get better.
To help you along the way, the next few pages offer tips to help your sleep:
Dr Jim White
10
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
Step 4: Sleeping tips
1
Your bedroom
Make sure the bed and room are warm. If your bed is past its best and if
you can afford it, think about getting a new one or mattress topper. The
same goes for your pillows. Are the curtains heavy enough to keep the
room dark?
2
Noise
It might be hard to stop noise from outside the house. Make sure you
control as much noise inside the house as you can.
3
Your partner
If your partner snores or is restless, ask if he or she could move to
another room if you have one until you start to sleep better. He or she
must move - not you - as you must learn to sleep well in your own bed.
4
Exercise
Exercise can help you sleep better. Do this in the morning, afternoon or
early evening. Don’t do it in the three hours before bed. A brisk walk for
30 minutes is as good as anything.
5
Relax before bed
Try to slow down in the hour before going to bed. Have a hot bath,
listen to music, read a book. If you work on the late shift or are studying
for exams, don’t go straight to bed from your work. Give yourself time
to switch off. Try to build up a relaxed routine.
Dr Jim White
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
11
6
Caffeine
Caffeine is a stimulant. You get it in tea, coffee, fizzy drinks, energy
drinks and tablets, some headache tablets and pain killers. Try to cut
down your caffeine intake across the day. Try to cut out as much as you
can in the late afternoon and evening.
7
Smoking
Nicotine, like caffeine, is a stimulant. Don’t smoke in the three hours
before bedtime. Never smoke during the night if you wake up. If you are
a heavy smoker, you would be best to give it up. Ask your GP for help.
8
Alcohol
If you rely on a night-cap to get off to sleep, you must stop this now.
It may well get you off to sleep, but as the alcohol level in your blood
drops, it will wake you again in 2-4 hours. It will then be hard to get off
to sleep again. It also disrupts sleep rhythms and cuts down your REM
and deep sleep. Alcohol may keep stress alive and this, in turn, helps
keep your sleep poor.
9
Warm milky drinks
Ovaltine, Horlicks or warm milk may help you get more deep sleep. Drink
these instead of tea and coffee at night.
10
Food
Try not to eat for about two hours before going to bed. Your body starts
to work to digest the food. You want it to be slowing down. If you are
hungry, have a very light snack. Try not to eat during the night if you
wake up.
Dr Jim White
12
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
11
Drink
Try to drink as little as you can in the evening. This may stop you from
waking to go to the toilet during the night.
12
Your sleeping needs
Most of us sleep around 7-8 hours each night. On the whole, we need
less sleep as we grow older. Yet older people still try to sleep 7-8 hours.
This may explain why many older people wake up in the latter parts of
sleep. The amount of sleep also depends on your life-style. If you have
young children who keep you on the go all day, you may need more
sleep. If you are not active during the day, you may need less. Some
people seem to thrive on only 4 hours a night.
So you have to find your own level. This may mean changing habits such
as going to bed at the same time each night.
Start to get a grip on your sleep by filling out the sleep diary first thing each
morning. Keep filling them in as you use these ideas. You will then be able to
see your progress.
Dr Jim White
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
13
Stress Control: Sleep diary
When did
you try to
go to sleep?
How long
did it take
you to fall
asleep?
EXAMPLE
10.45
85 minutes
How often
How long
did you
did it take
wake during to get off to
the night?
sleep each
time?
Twice
1) 25 min
2) 60 min
Night 1
Night 2
Night 3
Night 4
Night 5
Dr Jim White
14
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
When did
you wake?
When did
you get up?
7.15
8am
d
p?
How was your sleep last night?
Usual - was restless and getting angry with myself. Didn’t feel rested at all when I
woke. Couldn’t stop thinking about work.
Dr Jim White
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
15
Part B: Wellbeing & Controlling your future
B
Dr Jim White
16
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
Wellbeing
Wellbeing isn’t just about getting control over stress. It is about living life to
your full potential. Here are five great ways to go about it.
……with the people around you. Your family, friends, neighbours,
workmates. Work hard to make and then keep these relationships strong.
Go for a walk or a run. Head outside. Cycle. Do the garden. Dance. Exercising
can make you feel good. Find something you enjoy doing. A brisk 30 minute
walk each day can work wonders for you.
Be curious. Notice the world around you – the views, the sounds, the smells.
Notice the changing seasons. Savour the moment whether you are on the
bus, eating a meal or talking to friends. Be aware of the world around you
and what you are feeling. Reflect on your experiences.
Try something new. Pick up an old interest. Sign up for a course. Take on a
new responsibility at work. Fix something. Learn to cook something new.
Give yourself a challenge. Learning new things builds confidence. And it can
be good fun.
Do something nice for a friend or a stranger. Thank someone. Smile.
Volunteer your time. Join a community group. Look out, as well as in. Seeing
yourself, and your happiness, linked to the wider community, can be very
rewarding and it helps build connections with the people around you.
Dr Jim White
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
17
Controlling your future
These ideas will help you go down the right road:
Dealing with setbacks
•
Don’t expect progress to be easy or smooth. Set-backs are common.
You should aim to slowly increase the number of good days and
decrease the number of bad days.
•
Try to predict when a set-back is more likely - if there are problems
in the house, stress at work, after drinking too much, etc. Work out
ways to prevent it.
•
Don’t panic if you have a set-back. Accept what is going-on. Stand
back and work out why you are having the set-back. Then work out
what you can do about it.
•
Don’t see a set-back as putting you back at square one. If you have
taken five steps forward and a set-back puts you back one step, you
are still four steps up on the deal.
Let others help you
•
Express your feelings to them and get things off your chest. Choose
people you can trust to help you. Be comforted by their concern.
Listen to their advice. If the advice is sound, act on it.
Learn to pat yourself on the back
•
...if you have reached any of the goals you have set. If you faced and
then solved a problem. If you fought back worry, then you deserve
praise - give yourself some straight away.
Dr Jim White
18
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
Build up supports
•
Stress can build up when you lack a range of supports in your life.
If you have problems in one area of your life, you can lean on other
supports until you sort out the problem. The moral is: don’t put all
your eggs in one basket.
•
Make sure you keep relationships strong. Build up new interests, new
hobbies. Work on your social life. Make sure you have a structure to
your day or week.
Watch for problems creeping up
•
Watch that old bad habits don’t creep in to your life. These could
be to do with avoiding, cutting yourself off from others, drinking to
control stress. Jump in and nip it in the bud.
Look into the future
•
Face problems that lie in the future. Don’t just worry about the
problems - work out how you are going to deal with them. Never just
wait to see what happens. You must take control.
•
Don’t leave things to chance - think and plan ahead. Use the
‘Controlling your future’ form on the next page. Most of all:
Believe in yourself!
Dr Jim White
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust
19
Controlling your future - worksheet
Now that you have learned a lot about stress, the hard work must begin. It is
like passing your driving test - you know what to do but you have to practise
hard before you will become a good driver. Over the next few weeks and
months, you should keep an eye on your progress using this form.
End of the first week:
End of the first month:
End of the second month:
End of the third month:
Dr Jim White
20
italk is a service provided in partnership between Solent Mind and
Southern Health NHS Foundation Trust