Counselling and psychotherapy for sleep problems

So much of counselling and psychotherapy deals with thoughts, feelings and reasons for states of being from an internal perspective. However, the physical health of our brain is so important too. We know from neurogenesis (the process by which new neurons are formed in the brain) that a holy trinity of a balanced diet, physical exercise and sleep are vital for positive brain health. However, sleep is the preeminent force in this health trinity but is so often neglected, and indeed rarely features in assessments for new clients in counselling and psychotherapy.

A huge contributing factor for good brain health is ensuring that we get sufficient levels of sleep. Lack of sleep lets toxic brain cell-killing substances build up in our brains. But when we get healthy sleep our cerebral spinal fluid flushes out proteins called amyloid beta and tau, Alzheimer’s toxins. See research findings from Penn State University reported in the journal PLOS Biology in 2021

Our brains need restorative sleep. We sleep for a rich litany of functions. The guideline from Sleep Foundation in America is that we should be getting around 8 hours of sleep, although some of us will need more. There is no one size fits all, a bit like shoe size. Whilst the range is between 7 and 9 hours, it is important to pay attention to your own individual needs by assessing how you feel on different amounts of sleep. It is also important to note that one’s quality of life is a big determinant of whether one is getting sufficient sleep rather than a prescriptive set number of hours. Therefore, important questions surround sleep quality and how the quality of your sleep impacts on your functioning throughout your day as well as how your sleep impacts on your partner.

Seeking help for sleep problems

Specialist sleep disorders centres deal with the investigation and treatment of what might be termed the disorders of sleep. These might include apnoea, causes of excessive sleepiness such as narcolepsy and other neurological disorders, unusual behaviours during sleep such as sleepwalking and acting out dreams and disorders associated with your body clocks and circadian rhythm. Your GP should be the first point of contact if you have such concerns about your sleep. They could refer you to a specialist centre for further investigations, if appropriate.

Counselling and psychotherapy can offer the opportunity to examine and improve emotional regulation throughout the course of your day with a view to improving sleep quality. The perpetuating factors involved in sleep problems could be explored. Do you, for instance, find it difficult to set boundaries and to say ‘no’ to demands at work, at home or in your social life? Are you overly concerned with completing all tasks in daily to-do lists before sleep? Perhaps you have a very demanding job and a 24/7 culture at work. Are there difficult feelings being avoided and busyness becomes a form of avoidance? Or, it might be that you struggle with stimulus control before bedtime.

It is possible to explore such issues within a private and confidential space so that more positive life choices may be made. Improving sleep quality might not be an easy task but removing some of the more obvious barriers to better sleep will help. Journaling your waking thoughts, feelings, and concerns, has a proven mental health benefit and the same appears to be true for dreams.

Here are 5 suggestions for improving your sleep quality:

1. Maintain a regular sleep routine

Try to set an anchor time. This is the time you get up each morning. Try to stick to this set time every day, even at the weekend. This could be a way of understanding your sleep threshold and working out how much sleep you need by stretching the amount of time you aim to be asleep for. What is termed as ‘sleep efficiency’ is understanding the number of minutes you are in bed for and the number of minutes asleep. Sleep diaries are a way of working out your rate of sleep efficiency and can help to identify problem areas.

Setting a regular anchor time will, obviously, be very difficult if your working arrangements involve shift patterns or co-locating. This is where you might need specialist advice.

2. Boost physical exercise

The increase and decrease in blood pressure within one 24 hour period due to physical and mental activity levels is largely influenced by the release of hormones, particularly cortisol and melatonin. Exposure to bright light is one proposed method of re-regulating what is called circadian rhythmicity (although there is no proper substitute for bright daylight). The use of physical exercise may also serve as a viable option for restoring dysregulated circadian rhythms. Your circadian rhythms can influence hormone release, eating habits and digestion, sleep-wake cycles, body temperature in addition to other important bodily functions.

You may be pressed for time with a demanding job and home responsibilities but physical exercise can be incorporated into your daily life. Can you, for example, get off the train or bus one stop before home and walk the rest of the journey, if safe to do so? Or, can you take the stairs instead of the lift at work? You need not have to go to the gym in order to get physical exercise, although the higher the intensity of your exercise regime, the better for your sleep. The best time to exercise is late afternoon.

3. Create a buffer zone before sleep

Are you winding down for sleep? Can you create a buffer zone (of at least one hour) where you actively engage in more mindful practices and avoid screen time interaction or overly stimulating activities. Could you think of implementing a relaxation period, possibly involving a yoga or meditation practice, where the emphasis is on deep relaxation?

The important aspect of a buffer zone is that you mindfully commit to a period of time to purposely slow down and to try to switch off. Aim to avoid stimulating your brain during this period. Ideally, you should not be working on to-to lists at this time or even thinking about the next day’s tasks.

Creating an effective buffer zone before sleep can be very difficult as so many factors are involved especially if you have to deal with incessant emails for work. However, sometimes it can be a choice about what you prioritise and what you drop in your day.

4. Assign the bedroom exclusively as a place of sleep

Your bedroom should be associated with the minimum number of tasks. It is, therefore, a good idea to review what you do in your bedroom. Do you go to your bedroom at times during the day or evening, for instance, to read, relax, rest on bed, to have privacy, to practice yoga, to use your laptop, to watch television, to use social media on your phone or to eat? Your brain might become confused when you retire at night if it has to choose between a multitude of tasks.

If your bedroom is confined to essential tasks such as sleep, engaging in intimacy and perhaps getting dressed, for example, then your brain has less options to consider when you retire at night. When you try to go to sleep at night your brain will more likely associate the bedroom with falling asleep, especially if your activities are aligned with your circadian rhythm.

Your bedroom should be dark and also enjoy a temperate temperature, (around 18 degrees celsius), and you should be sleeping on a comfortable mattress and pillows.

5. See sleep within a 24 hour frame

Sleep should be seen across a 24 hour period. This might seem like an obvious statement. However, so often sleep is something which we consider only when we retire at the end of the day. It is important to consider the impact of activities in the earlier parts of our day on our sleep. Therefore, try to avoid naps during the day (or at least after 3pm) and stay away from caffeine from mid afternoon as caffeine blocks the receptors for the sleep fuel hormone adenosine. Also, try to restrict the amount of alcohol you consume two to three hours before sleep and try not to go to bed hungry.

Be mindful of stimulus control before sleep. Anxieties and stresses should ideally be dealt with over the course of the day rather than allowing them to build up when you are seeking to retire at night.

Sleep needs to be made a priority in your day. It should not be something you think about after everything else is done. Sleep, and preparation for sleep, should rather be your focus. So much of the stresses and anxieties from our day may seem unavoidable (such as having to deal with difficult people at work, for example) but a useful exercise in therapy could be to look at what stressor or trigger you can actually control. Sleep quality will improve when the stresses and worries being brought into the night are better dealt with during the course of the day.

Noel Bell is a UKCP accredited psychotherapist and is available for counselling and psychotherapy. He can be contacted on 07852407140 or noel@noelbell.net