TORONTO - For those who face difficulties with falling asleep or catching quality zzz's, the path toward a good night's rest begins long before their head hits the pillow.
A Ryerson University researcher has co-written a new book to help those with insomnia put persistent problems with restless nights and sleep deprivation to bed.
It's not the issue of having one bad night that makes insomnia a lingering issue, but how people respond to their challenges by perhaps taking a sleeping pill, having a glass of wine or ramping up their caffeine intake, noted Colleen Carney, co-author of "Goodnight Mind" (Raincoast Books).
"Your body would just recover, it would reset itself. But people become quite anxious about it, and this is actually what causes chronic insomnia," said Carney, associate professor and director of the Sleep and Depression Laboratory at Ryerson.
"It's what we do in order to cope with the problem that actually causes a chronic problem," she added.
Carney's lab offers free cognitive behavioural therapy as part of its research program, and draws on techniques used to treat insomnia patients in "Goodnight Mind." CBT is a form of psychotherapy or psychological treatment designed to help individuals recognize the connection between specific thoughts, conditions or symptoms and the effect their thinking has on emotions and behaviour.
Carney collaborated on the book with Rachel Manber, director of the Insomnia and Behavioral Sleep Medicine Program at Stanford University.
They outlined relaxation techniques to help settle the body, such as belly breathing, yoga, meditation and listening to soothing sounds. The strategies all feed into the book's main goal: helping people quiet their minds by addressing noisy thoughts which may interfere with sleep.
"I think people ... start to become frustrated when they're trying to get to sleep and they can't shut their mind off. Or more often, the thing that brings people to see me is the way they feel during the day," said Carney.
"They're just saying: 'This is crazy, I just feel tired all the time.' And with insomnia, they feel tired, but they feel wired at the same time. This is why people with insomnia are pretty amazing at coping with it."
Individuals with insomnia often find their bodies are revved up or "hyper-aroused," allowing them to still function and perform cognitive tasks, noted Carney.
"They're just kind of going through the day like a zombie," she said. "This is probably one of the ways that makes them susceptible to stress-related conditions like an anxiety disorder, like alcohol abuse or like depression; because over time, this would just grate on you again and again and again."
Carney said one reason minds are noisy is a result of an "overwhelmingly plugged-in" lifestyle, which is why it's key to curtail digital distractions. She recommended setting aside devices at least an hour before bed to help decompress.
The authors also suggested scheduling a "worry time" of roughly 20 to 30 minutes to outline concerns along with potential next steps or solutions. If worries still persist at bedtime and people find themselves lying wide awake, they recommended getting up and leaving the room and not returning until sleepiness sets in and concerns clouding the mind have subsided.
Carney said the focus should be sleep quality rather than duration, which is why the adage of getting eight hours of shut-eye is a myth. Getting enough deep sleep — longer stretches of continuous or uninterrupted slumber — leaves individuals feeling better rested.
People with insomnia actually have normal sleep lengths — anywhere between six to nine hours —but often have an impairment in their depth of sleep, said Carney. While some may assume making up for lost sleep with a quick doze could help, naps are a no-no for those with insomnia.
"They're not getting into those deeper stages. So to nap wipes out the drive that they've been accumulating most of the day and then they don't get it that night," said Carney. "It continues that cycle of having light sleep, which is something that they don't want."
Carney said individuals should only head to bed if they have a reasonable expectation they'll fall asleep and stay asleep relatively quickly — like within 30 minutes. Establishing a rise time is key because it's within their control, she noted.
"We actually have an internal clock that's a little bit longer than 24 hours, so it does need things to set it, and rise time actually sets it. If you have a regular rise time, it will help it."
Some people will need to sleep later on weekends because they're short-changed during the week, but they should still limit the amount of extra lie-in time to 60 to 90 minutes, said Carney.
"If on the weekend you vary your schedule by two, three hours, you change what time melatonin is released in your brain," she said. "You produce this mismatch between what time your body thinks it is and what time the input in the environment is telling you what time it is, and you get symptoms. So it's like taking a trip but not going anywhere."
For people with insomnia, however, sleeping in isn't an option because it shortens the build for deep sleep. And hours spent in bed during the morning "aren't particularly restorative," the authors wrote. Being physically active can also build more sleep drive and increase deep sleep, as can limiting or reducing caffeine, they noted.
"Once (your system) resets and it's obvious and you sleep most of the time, then let's start expanding and giving you more sleep," said Carney.