Many of us struggle with sleep at some point in our lives, whether that is too little, trouble falling or staying asleep, or generally not feeling well rested upon waking. There is plenty of research that demonstrates how essential sleep is for physical and mental well-being. And for those diagnosed with mood disorders, difficulties with sleep are associated with even more significant impacts such as risk for depressive or manic episodes, substance use relapse, increased suicidality, and an overall impact on emotion regulation. Generally, continued sleep disturbance can both serve as a cause and contribute to maintenance of mental health concerns.
According to the American Psychiatric Association, there is no one set number of hours an individual is supposed to sleep each night, as it greatly depends on the person. However, a good rule of thumb is an average of seven to nine hours nightly. And while it is helpful to know your goal number of sleeping hours before establishing a nightly routine, you first need to target ways to overcome barriers that stand in the way of a restful 7-9 hours.
For those struggling with mood disorders or other mental health conditions, barriers to sleep may include rumination, catastrophizing thought patterns, frequent nightmares, substance use, or lack of routine. Dialectical Behavior Therapy (DBT) offers a sleep hygiene protocol to help overcome these obstacles. First, establish a consistent sleep schedule. And yes, that means even on the weekends or days off of work and school. Not only is the timing important, but also ritual before bedtime. Engaging in the same behaviors at the same time each night will help your mind and body reinforce for yourself that you are ready for sleep. Part of your daily and nightly routine should include avoidance of certain things several hours before bed, such as caffeine, heavy meals, or intense exercise. Something to add into your routine is attending to your senses and practicing self-soothing. This could include quieting your space, playing white noise, using calming essential oils, or adjusting the temperature so you feel most comfortable. Some trial and error may be necessary to find what works best to help you wind down for sleep.
The unfortunate fact for those who struggle with worried thoughts keeping them up most, is that sometimes self-soothing is not sufficient. While a more regular, consistent routine is more likely to lead to restful sleep, there are some other contingencies to fall back onto. For some, worried thoughts may lead to catastrophizing which in turns leads to tossing and turning. Catastrophizing in the context of sleep can sound like: “Ugh, if I don’t fall asleep right this second, I’m only going to get a couple of hours, and then I’ll be exhausted,” or “I’m going to be so miserable if I only get 4 hours of sleep.” While those statements may have some truth behind them, they are also certain to continue feeding insomnia. In these cases, it can be helpful to get out of bed and try a quiet activity like reading or listening to relaxing music. Once you feel drowsy, return to bed and pick up where you left off on your bedtime routine. Other DBT skills may also be useful, such as the TIP skills. Splashing cold water on your face followed by paced breathing is a nearly foolproof method for reducing rumination and physical symptoms of anxiety.
You may still not feel convinced, or have experienced quite pervasive rumination. However, yes, there are more DBT skills for when that happens. If you feel the problem you are ruminating on is solvable, get up and solve it. It is likely you will feel better once that is done. If it is not solvable, identify whether or not there is a threat and if that threat is indeed a catastrophe. Work through how you would cope in that moment should the catastrophe happen. The idea is to feel prepared and therefore less worried about how you would manage anticipated difficulties.
To reiterate, there are many ways to tackle sleep disturbances. It may take a bit of effort, or opposite action, to activate these solutions, but the payoff is worth it. Sleeping well and feeling rested is only going to benefit your mental and physical well-being.
