by Josh Dredze, Psy.D
When people come in for therapy, sleep is generally a footnote among reported symptoms. “I’m worried about my job and am having difficulty with my parents – and by the way, I can’t sleep.” Focus is placed on stressors and psychological symptoms of stress, but generally, we view sleep as a secondary or less significant problem. I, in this case, am no exception. I’ll think, I’m behind on work, feel out of touch with friends, and…I guess I haven’t been sleeping well.
This past week, trainees at the Institute had the pleasure to attend a seminar by Dr. Mark Terjesen about cognitive-behavioral therapy for sleep. He spoke about how too often, sleep is de-prioritized. We fail to realize that sleep is not just secondary to the problem, but part of the problem itself. When we sleep, we are more irritable, less efficient, and are more likely to be reactive. I know this to be all too true for myself. Over the course of a week, intentions of getting 7 to 8 hours a night turn into 5 to 6, and I find myself catching up on sleep on the weekend. This means that by Thursday or Friday, I’m dragging more and am not at my best. In turn, small problems become medium problems and medium challenges are big ones. The good news is that RE&CBT, have a lot to say about improving sleep.
Let’s look at our beliefs. If it’s 11 pm and I had meant to start getting ready for bed at 10 pm, I’ll think: “Oh man. I’m going to be so tired tomorrow. It’ll be horrible.” Lying in bed, if I wake up at night, may be littered with worry: “Arg. I’m going to be so tired tomorrow. Why can’t I sleep!”
First, we can apply Dr. Ellis’s elegant solution: What if I am tired tomorrow? It’ll be annoying. I may be irritable, but, it won’t be the end of the world. I’ll manage, have an extra cup of coffee (at your own risk : ), and get through my day. The worst-case scenario will still be manageable. What about worrying in bed when I can’t sleep? Dr. Terjesen recommended Dr. Ellis’s functional approach for dealing with such unhelpful beliefs. How does making myself worried help me in this situation? Is it really beneficial or is it just causing me to sleep less?
Sleep is an ongoing challenge, and, for some, it’s more of an issue than for others. Through our seminar, I was able to learn how principles of REBT can help us better address irrational beliefs associated with sleep difficulties. Coupling cognitive approaches with a sustained, effective, sleep routine (behavioral changes) can provide important benefits for improving our sleep and making us more effective people (without all the yawns).