Getting 8 hours of sleep is number 1 advice on all sources relating to managing depression. But why?
What effect does lack of sleep have on our mental health?
I came across a really interesting article on the BBC website the other day which I thought gives some insight: “Just a few nights of bad sleep upsets your brain” by Dr Michael Mosley on BBC.
In the article they explain how the team of Trust Me I’m a Doctor teamed up with sleep scientists at the University of Oxford to run a small experiment.
They recruited four volunteers who normally sleep soundly. They fitted them with devices to monitor their sleep. They let them sleep for 8 hours for the first 3 nights but only 4 hours for the next 3 nights.
Each day the volunteers filled in a psychological questionnaire designed to reveal any changes in their mood or emotions and also kept video diaries.
The results were quite telling. The team recorded increases in anxiety, depression, stress, paranoia and feelings of mistrust about other people.
Interestingly one of the volunteers felt absolutely fine even though the test on him showed that his positive emotions fell sharply after two nights of disturbed sleep, while negative emotions began to rise. So even though he felt OK there were signs that he was, mentally, beginning to suffer.
‘Stuck’ in negative thoughts
This small experiment reflects the results of a much bigger study on the impact of sleep deprivation on mental health.
Researchers recruited more than 3,700 university students from across the UK who had reported problems sleeping and randomised them into two groups.
One group received 6 sessions of online CBT (cognitive behavioural therapy) aimed at improving their sleep; the other group got standard advice.
Ten weeks into the study, the students who received CBT reported a halving in rates of insomnia, accompanied by significant improvements in scores for depression and anxiety, plus big reductions in paranoia and hallucinations.
This is thought to be the largest ever randomised controlled trial of a psychological treatment for mental health, and it strongly suggests that insomnia can cause mental health problems rather than simply be a consequence of them.
Daniel Freeman, professor of clinical psychology at Oxford University, who led that study thinks one of the reasons why sleep deprivation is so bad for our brains is because it encourages repetitive negative thinking. “We have more negative thoughts when we’re sleep-deprived and we get stuck in them,” he said.
Reassuringly he doesn’t think a few nights of bad sleep mean you will become mentally ill. But he does think it increases the risk.
“It’s certainly not inevitable,” he said. “In any one night, one in three people is having difficulty sleeping, perhaps 5% to 10% of the general population has insomnia, and many people get on with their lives and they cope with it. But it does raise the risk of a whole range of mental health difficulties.”
The positive side of this research is it implies that helping people get a good night’s sleep will go a long way to helping improve our sense of well-being.
So how do we go about improving our sleep?
There are many tips out there on how to improve your sleep. Here are some things you can do to help yourself get a good restful night.
Change your Environment
Are there any helpful changes you can make?
- Bedroom too light
- Bedroom too hot or too cold – our bedroom needs to be cool
- Bedroom too noisy
- Bed too uncomfortable
- Partner keeping you awake? (snoring, restless etc)
- TV, computer, tablet or mobile in your bedroom
Making changes to our environment so that our bedrooms become a restful place for sleeping. Remove excess light (particularly blue light), make sure the temperature is right, and check the bed and pillow are comfortable. If you cannot reduce the noise, then consider ear-plugs designed for sleep use. Remove TV and device screens from your bedroom, and read from a conventional book rather than an e-book on a back-lit screen.
Change your Behaviour
- Practice mindful breathing before going to bed.
- Do not go without sleep for a long time if you can help it. Keep to a regular pattern of going to bed and getting up at the same time every day, whether you are tired or not.
- Keep bed for sleep and sex. No watching television, browsing the internet or checking your email or social media.
- Get some exercise during the day. Try some regular swimming or walking. Avoid exercise late in the evening.
- Reduce the caffeine (tea, coffee, some soft drinks) in the evening. Try a milky drink instead.
- Don’t drink a lot of alcohol. It may help you fall asleep, but you are more likely to wake up during the night.
- Don’t eat or drink a lot late at night. Try to have your evening meal early rather than late.
- If you have had a bad night, resist the temptation to sleep the next day which will make it harder to get off to sleep the following night.
- When something is troubling you and there is nothing you can do about it right away, try writing it down before going to bed and then tell yourself to deal with it tomorrow.
- If you cannot sleep, don’t lie there worrying about it. Get up and do something you find relaxing like reading or listening to quiet music. After a while you should feel tired enough to go to bed again.
- Keep a sleep diary for a week. Then you can look back and notice what helps you sleep better and what doesn’t, so you can make positive changes and do more of what helps, and less of what doesn’t. If nothing seemed to help, try something different.
- Avoid clock watching when in bed and put your attention somewhere restful.
Change your Thinking
Worrying about not sleeping will keep you awake! Rather than put your focus of attention on the worrying thoughts, notice that they are just thoughts, then put your attention somewhere restful, use mindful breathing, or any other relaxation technique.
If you’re worrying about a particular problem, write it down, and tell yourself you can sort it in the morning.
But what I found particularly interesting in this article was the reference to CBT. Unfortunately the article did not give any more details so I went and did a little research on this myself and this is what I found.
How Cognitive Behavioural Therapy can improve your sleep
Cognitive behavioural therapy (CBT) will help you develop habits that promote a healthy pattern of sleep. Following are the most common forms of CBT to improve your sleep:
A stimulus is anything that causes a response. The goal of this method is for you to have a positive response when you get into bed at night. It is used for people who toss and turn in bed, unable to fall asleep. When this happens for many nights, you begin to get frustrated. You may even dread bedtime, expecting to toss and turn for hours. Bedtime and even your bed itself are causing you to have a negative response.
This method teaches you to use the bed only for sleep and for sex. You are not to read, watch TV, or do anything else in bed. You are also taught to go to bed only when you feel very sleepy. If you are not asleep after about 20 minutes, then you are to get out of bed to do something else relaxing. When you feel sleepy again, then you return to bed.
Over time, this method helps you to fall asleep more quickly after you get into bed. You begin to have a positive response toward going to bed at night. Instead of being frustrating, it becomes relaxing and restful.
This method sets strict limits on the time you spend in bed each night. The initial limit used is the same as the amount of sleep you tend to get on a nightly basis. For example, you may only get five hours of sleep even though you spend seven hours in bed at night. Two hours in bed are spent trying to fall asleep or go back to sleep after waking up. In this case, your initial limit would be to spend only five hours in bed at night. This means that you would be likely to get less than five hours of sleep.
This sleep loss will make you even more tired at first. But it will also help you fall asleep faster and wake up fewer times in the night. This gives you a solid period of sleep and a more stable sleep pattern. As your sleep improves, the limit on your time in bed is slowly increased. The goal is to reach the point where you get the amount of sleep you need without reducing the quality of your sleep.
Relaxation Training and Biofeedback
Relaxation training teaches you how to relax both your mind and your body. This helps you to reduce any anxiety or tension that keeps you awake in bed. This method can be used both during the day and at bedtime. It involves training you how to better control the following functions:
- Muscle relaxation
- Mental focusing
Biofeedback may be used along with relaxation training. The process of sleep is more complex than it may seem. It involves such things as your brain, your breathing, your heart and your muscles. Biofeedback teaches you how to raise or lower various signs of how your body is working. You are given the details of certain indicators in your body. Biofeedback can provide details on such things as the following:
- Muscle tension
- Brain waves
- Blood pressure
- Heart rate
- Body temperature
In order to sleep better, you are taught how to change either your muscle tension or your brain waves. You wear a device that signals to you the level of your muscle tension or brain wave frequency. You then try to change that level in a way that will help you sleep. The device uses a gauge, visual images or sounds to tell you how your level is changing.
These methods require you to focus and concentrate in order to see results. Some people may quickly learn the methods in just a few sessions. Others may need many sessions to master the techniques.
Cognitive Control and Psychotherapy
These methods are used to help you identify attitudes and beliefs that hinder your sleep. These negative thoughts involve worries and stress that keep you awake. A therapist helps you process your thoughts and feelings about sleep.
You learn ways to overcome negative thoughts and promote positive attitudes and beliefs. This might involve setting a “worry time” in the afternoon or early evening. This is a time when you review the day and plan for tomorrow. You focus on getting all of your worries out of your system. At the end of this time you feel “free” to relax. This helps your mind to be at rest when you go to bed.
Another method is to use guided imagery. You imagine that you are in a story. In your mind you try to picture what things look, feel, and sound like. You try to make it as real as possible. This keeps your mind from thinking about other concerns. You stop “trying” to go to sleep. As a result, your mind settles down and stops racing. This allows your body to relax and go to sleep.
Sleep Hygiene Training
This method of therapy is used to correct things you do on a regular basis that disturb your sleep. Sleep hygiene consists of basic habits and tips that help you develop a pattern of healthy sleep. Disturbed sleep will often be caused by more than one thing that you do. To improve your sleep, you will need to improve all of these habits.
For example, a man begins a regular exercise routine. He hopes that it will help him sleep better. After a while he becomes frustrated. He is still having a hard time falling asleep at night. This is because he continues to drink caffeine in the evening. He also takes long naps in the afternoon. Even though he corrected one habit, the other actions keep him from sleeping well.
You need to learn how to practice good sleep hygiene on a regular basis. This will greatly improve your chance of sleeping well at night.
Have you noticed the relationship between the quality of your sleep and your mood the next day? Let me know what your experience is!
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