Information for Patients about Insomnia

One of the more troubling experiences for depressed and anxious patients is insomnia. Some people experience difficulty falling asleep (onset insomnia or anxiety), while others wake several times during the early morning hours (early-morning insomnia or depression). Usually, as depression and anxiety lift, insomnia decreases and sleep is more restful. However, a number of cognitive-behavioral interventions may assist in the treatment of insomnia.

Before you attempt any interventions, you should record some baseline information about the number of hours per night that you sleep and the number of times that you wake. You can then compare your sleep over the next month or two with the baseline measure.

  • Develop regular sleep times. Go to bed and get out of bed at about the same time, regardless of how tired you are. Also avoid naps.
  • Use your bed only for sleep and sex. Insomnia is often the result of increased arousal preceding bedtime and while lying awake in bed. Many who have insomnia use the bed for reading, talking on the phone, and worrying; as a result, the bed is associated with arousal (anxiety). Read or talk on the phone in another room. If you have friends who call late at night, tell them not to call after a specific hour. Avoid anxiety arousal during the hour before bedtime (for instance, avoid arguments and challenging tasks).
  • Sleep is often disturbed by urinary urgency. Reduce or eliminate liquid intake several hours before bedtime. Avoid all caffeine products, heavy foods, and liquor. If necessary, consult a nutritionist to assist in planning a change in diet.
  • Do not try to fall asleep — this will only increase your frustration and anxiety. Paradoxically, a very effective way of increasing sleep is to practice giving up trying to fall asleep. You can say to yourself, “I’ll give up trying to get to sleep and just concentrate on the relaxing feelings in my body.”
  • If you are lying awake at night for more than 15 minutes, get up and go in the other room. Write down your negative automatic thoughts and challenge them. Typical automatic thoughts are “1’11 never get to sleep,” “If I don’t get enough sleep, I won’t be able to function,” “I need to get to sleep immediately,” and “1’11 get sick from not getting enough sleep.” The most likely consequence of not getting enough sleep is that you will feel tired and irritable. Although these are uncomfortable inconveniences, they are not catastrophic.
  • Your therapist can teach systematic relaxation and breathing, which will enhance your restfulness. Try to make your mind go blank. Count backward by threes from 100 or 1,000, as slowly as possible. Visualize a relaxing scene-for example, snow falling on a house in the woods at night.

Because your disturbed sleep patterns have taken a long time to learn, it may take you awhile to unlearn them. Do not expect immediate results.