CNWL Talking Therapies

Managing
your sleep
Workbook
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Facts about sleep
Sleep is such an important part of our lives, yet
many of us don’t pay much attention to it. It is
usually not until we have problems with sleep that
we notice it and start to try to understand the nature
of sleep. As well as humans, other mammals,
reptiles and birds all sleep- some animals sleep in
many short bursts, while others, like humans, prefer
to sleep in one long block.

The Stages of Sleep

REM rapid-eye-movement sleep:

This type of sleep occurs for about 25% of the

night, and is characterized by electrical activation of
the brain, very relaxed muscles and body becoming
immobile, and rapid eye movements as the eyes
dart back and forth under closed eyelids. REM
sleep provides energy to the brain and body and
supports daytime performance. Dreams often occur
during REM sleep, although they can occur at any
stage.

NREM non-rapid-eye-movement sleep:

This type of sleep occurs during the other 75% of

the time, and can be further broken down into 4
stages:

• Stage 1: this stage is light sleep, between being

awake and falling asleep

• Stage 2: this stage is the onset of sleep, when the

person begins to become disengaged from their
surroundings. Body temperature drops and
breathing and heart rate become regular.

• Stages 3 & 4: These stages are the deepest and

most restorative sleep, known as ‘delta sleep’.
Stage 3 is a transition into Stage 4, or ‘true delta.’
During these stages, blood pressure drops,
breathing becomes slower, muscles are relaxed
and receiving more blood supply, tissue growth and
repair occurs, and hormones are released
(including growth hormone, which is why growing
teenagers need to sleep more).

Role and Function of Sleep

Sleep is essential to humans, just like air, water and
food. When necessary, people can cope without
sleep for periods of time, but the longer we are
awake the stronger the urge to sleep becomes.

The exact role and function of sleep has been a

topic of debate for researchers, but most agree that
sleep serves a restorative purpose, both
psychologically and physiologically. It is thought
that delta sleep (stages 3 & 4) is most involved with
restoring the body and physical energy, while REM
sleep is most important for restoring mental function
such as memory and concentration. Sleep is
important for general physical health, restoring
energy, repairing injuries or illness, growth,
psychological well-being and mood, concentration,
memory, work performance, and getting along with
others.

How much sleep do we need?

We may think that if we’re not getting 7 to 8 hours
of sleep every night, then there is something wrong.
But there’s not! Sleep, like many things, is unique to
the individual- some people need 6, while others
may need 10. It’s more about making sure you’re
getting good quality sleep than it is about the
amount of sleep. It’s all healthy if it’s what feels
right for you!

Good sleepers usually take less than 30 minutes to

fall asleep at the beginning of the night and will
wake up once or twice during the night. In other
words, it is unrealistic to expect to fall asleep
immediately on getting into bed or to never wake up
at all during the night. Even the best sleepers in the
world don’t achieve this!

Also, everybody, even the best sleepers, will have a

night now and then when it takes them a long time
to get to sleep. This is often triggered by a stressful
event and will usually pass after a night or two.
Similarly, everybody will have a night now and then
when they find it difficult to get back to sleep after
waking in the middle of the night.

Effects of Lack of Sleep

When we experience poor sleep, not only do we
feel tired but lack of sleep or poor sleep quality can
have other effects including:
• Poor attention, concentration and memory
• Irritability and other mood disturbances
(like feeling down or feeling anxious about
sleep)
• Impaired judgement and reaction time
• Poor physical coordination (dangerous
for driving)
The seriousness of these effects depends on how
bad the sleep deprivation is (e.g. less sleep vs. no
sleep; one night’s poor sleep vs. chronic problems)
and the tasks and responsibilities of the day. If you
have ongoing problems with sleep, it is important to
seek help.

How do problems with sleep start and

become chronic:
We can’t always pinpoint why or when sleep
problems start but often they are triggered by
certain events such as stress or ill health. However,
when sleep problems become chronic, often the
initial cause is no longer an issue yet the sleep
problem is still there.

The reason for this is because we adopt thinking

patterns, behaviours and habits that help us cope
with sleep problems and these can actually end up
maintaining sleep problems once they have
developed.

These are the most commonly reported difficulties

with sleep. Which can you relate to?
 taking a long time to get to sleep
 waking up a lot during the night
 waking up early and not being able to return
to sleep
 not feeling refreshed after sleep
How are we maintaining our sleep
problems?
Having insomnia or any sleep problems can cause
tiredness and exhaustion, lack of energy and
motivation. Often what happens is that because we
aren’t sleeping for long enough we do
compensatory behaviours to try and sleep and
cope with the tiredness. Can you relate to any of
these?

 going to bed early

 staying in bed for longer
 sleeping through alarms when you can e.g.
at the weekends
 napping in the day

These things we do feel like we are giving

ourselves more of a chance to rest and increases
our opportunity for sleep. However, what it
sometimes ends up doing is it increases our
body’s associations with being in bed and
being awake, which fragments our sleep. This is
because when we are ready for sleep or wake in
the middle of the night then we automatically
associate this with the usual struggles of trying to
get to sleep unsuccessfully.

The example below shows a vicious cycle of

insomnia and how these associations can occur
 It’s nearly time for bed. You get into bed
early to try to make up for last night’s
poor sleep.

Behaviour
Check the clock to see
Thoughts how much time you Thoughts
This sleeping have before morning. I’ve been tired all
problem is getting Try hard to get to day! Why am I
worse. How late is it sleep. suddenly wide
now? awake now?

Emotions Emotions
Anxiety, Anxiety,
worry, worry
frustration
Behaviour
Try hard to
Thoughts get to sleep
This isn’t working.
It will be another
miserable night.
Thoughts
I can’t sleep with
Behaviour
my mind racing
Try sifting through
through what I
your problems to
need to do this
settle your mind
week
Getting to know your sleep

Before we tackle new sleeping tips, it can be useful

to keep a diary (like the one at the end of this
booklet) - it’s helpful to get an accurate idea about
your sleep, instead of making assumptions. Once
you’ve recorded your sleep patterns, you can start
to figure out how to incorporate more helpful
bedtime routines. Try to keep the diary again in a
few months once you’ve had a chance to make
some changes to your sleeping patterns and see if
you can notice a difference in the diary.

Preparing for sleep

We want to associate going to bed with feeling
sleepy so that the body starts to physically prepare
us for going to sleep. We can do this by only being
in bed when we feel sleepy or are sleeping. This
therefore increases the association between bed
and sleeping and decreases the association
between bed and being awake or frustrated. Having
an association between bed and sleeping will then
mean your body starts to feel sleepy around
bedtime and you should get to sleep quicker, stay
asleep more easily and go back to sleep quickly if
you wake in the night.

We want to make sure that we don’t spend time in

bed unless our intention is to go to sleep. We may
read or watch TV in bed before going to sleep but
this increases our association with our bedroom
with being awake, so try to do these things in
another room before going to sleep.

To prepare for sleep it’s also important to build up a

need for sleep during the day. Think about your
daily routine – how much time do you spend using
up energy? If the answer is ‘not much’ then this is a
good place to start. Increasing our daily activity is
important for building up a need for sleep come the
end of the day.

Wind down routine

It’s important that we have a wind-down routine in
place before we go to sleep. This helps to create a
sense of calm before bed and becomes a good
indication for our bodies that we are about to go to
sleep. It is recommended that you spend a
minimum of 30 minutes winding down before bed.
Use this time to do something relaxing like read a
book, have a warm bath or engage in self-care
activities. It should avoid any electronic devices,
watching TV and exercise.

Sleep Hygiene

Sleep hygiene is the term used to describe good

sleeping habits. Below, you’ll find a few more tips to
help with sleep.
10 rules for improved sleep:

1. No caffeine 4 hours before bedtimes and

when waking during the night

2. Avoid alcohol at bedtimes, usually at

least 4 hours before

3. Avoid smoking close to bedtime and

when waking during the night

4. Avoid heavy meals before bedtimes (a

light snack is advised if hungry)

5. Avoid exercise 2 hours before bedtime

6. Keep a comfortable bedroom temperature

7. Keep your bedroom calm, clean and

comfortable

8. Keep your bedroom quiet and dark

9. Keep your bedroom mainly for sleeping.

Avoid watching TV, listening to music or
the radio, working on your laptop or
eating in the bedroom

10. Try to keep a regular time for getting up

Sleep Bootcamp

Hopefully you will notice an improvement in your

sleep from implementing the tips on the previous
pages. If you are still struggling with your sleep,
then you can move on to the next stage. Sleep boot
camp is about building up your need for sleep and
so your sleep may feel like it gets worse before it
gets better. Discuss this with your therapist so that
you can best prepare for it.

1. Leave an hour to wind down before bed

 During this time you should do

something relaxing but, where
possible, NOT in your bedroom. E.g.
reading, chatting, relaxation activities.

2. Go to bed only when you feel sleepy and

have an intention to fall asleep

3. If you can’t fall asleep within roughly 20

minutes then get up and do something
relaxing (or boring) in another room.

 Estimate what feels like 20 minutes,

don’t look at a clock.
 Only return to bed when you feel
sleepy again. If you still can’t fall
asleep again in roughly 20 minutes
then repeat the same cycle of getting
up and only return to bed when you
are feeling sleepy again.
4. Keep the bedroom for sleep and sex only.

5. Use an alarm clock to maintain a regular

waking time in the morning

 It is important to keep the same

waking time at weekends, as well as
in the week, to help sync the
biological clock, especially for
individuals with sleep difficulties
 Once your alarm has gone off you
then need to also get out of bed
even if you are still tired

6. Do not nap during the day