6th February 2020 Category George Maxwell
Why you just can’t sleep – Emotional regulation and Sleep hygiene
Insomnia and disturbed sleep can make us feel awful, particularly if it is a regular occurrence. Sleep disturbance is also a significant feature of many common mental health problems including depression, anxiety disorders and post-traumatic stress disorder and can contribute greatly to the distress that we feel.
In this article and the accompanying video, I’m going to take you through a model which we can use to understand why our emotional state contributes to poor sleep. I’m going to talk about Emotional Regulation and then highlight a number of behavioural techniques which you can easily apply which have been shown to be an effective treatment for poor sleep.
Emotional regulation for sleep
What do we mean by emotional regulation and how is it relevant to sleep?
Emotional regulation is a term we use in therapy to describe any processes that we can apply to enable us to understand, accept and modify emotions as necessary. For instance, if we notice that we are anxious a lot of the time, then a goal of therapy might be to equip you with resources to regulate this anxiety emotion so that it doesn’t interfere with your life.
The image below shows us one model of emotional regulation:
Although a simplification, this model shows us that there are three main emotional states that our body we find itself in some configuration of at any point in time: Threat, Drive and Safeness.
The Threat system is evolved for keeping us safe from danger. It is activated when we are experiencing, or anticipate experiencing danger. It activates our fight or flight system and gives us all of the physical resources that we need to escape from danger.
The Drive system is evolved to motivate us to move towards resources. For our ancestors, seeking out new resources (food, mates, shelter) was costly in terms of energy and risk. The drive system emerged as a way of keeping us motivated to seek out new things for our survival. In the present day our drive system is activated when we are accessing things which give us a sense of reward, achievement and pleasure. When we are not accessing such things, the drive system is reduced meaning that we may feel unrewarded, flat, or unmotivated. In depression, our drive system is not being activated and, conversely, if we are struggling with addictive behaviours (gambling, drugs, sex/porn) then our drive system is likely running the show.
The safeness system is evolved to enable us to feel secure, soothed and safe, primarily in the company of others and in a social context. Again, for our ancestors, the safeness system was important because there was safety in groups. If one of our ancestors was not part of the tribe, then there would be increased risk. Further, because compared to other animals we have a much larger brain size, humans evolved the need to give birth to much more immature young. Compare a human baby to that of a cow, horse or even a chimpanzee and you will see that humans are essentially defenseless, unable to walk, cling to their mothers and feed themselves. This means that we had to evolve a capacity to actually care for each other, to feels safe in each others company and to bond.
So, with this model in mind, we now need to think about how it applies to sleep.
The threat of a poor nights sleep
Think back to the last time you had difficulty sleeping. Can you remember what that was like? What your body felt like, what your mind was doing?
Often when we are struggling with sleep problems, we find that our mind starts to get involved and think about all the ways that our poor night’s sleep is going to affect us tomorrow. Our mind is a fantastic problem solving tool, literally able to have a good go at any problem that is placed in front of us. One of the problems with it however, is that it is sometimes just a little bit too helpful.
Our minds will often try to work out the problem of poor sleep. It can at times do this by suggesting all of the problems associated with poor sleep and how it is going to impact upon your functioning tomorrow and the longer term.
Thoughts like: “What if I don’t get to sleep tonight?”, “What if I can’t get up for work tomorrow.?” and “What if I’m like this forever?”
Thoughts like these are all about the threats associated with not sleeping. Our mind is thinking through these threats and, as a consequence, this will activate our Threat response. Because our threat response is now active, we will experience the release of adrenaline, stress hormones and changes in our body such as increased heartrate, physical tension and more shallow breathing, none of which are conducive to a good nights sleep.
Essentially, because we are treating poor sleep as a threat, our body activates the threat response. There is very little chance of us getting to sleep while the threat response is active.
Treating sleep as a goal
In addition to the threat system getting in the way of a good sleep, we now turn our attention to the drive system.
As I mentioned earlier, the drive system is a motivational system which is activated to give us the resources to pursue resources like food, sex, shelter, etc. When the system is activated, our body responds with all of the internal resources required to get out there and acquire new stuff.
All well and good.
However, let’s think about how we then apply this to sleep. If we treat sleep as something to be achieved and attained, then inevitably, the drive system is going to get activated. You may have experienced those particularly difficult nights when you’re looking at the clock aiming to get sleep before a certain time. This will never work.
Your body has now become awake in pursuit of this goal called sleep.
So we can see with the help of this emotional regulation model that treating poor sleep as something that is threatening to us and treating sleep as something to be achieved are both unhelpful orientations to a good night sleep.
This leaves us with just one aspect of our emotion left: The safeness system.
The safeness system and sleep
Sleep requires us to feel relaxed and in order to feel relaxed, we need to access our safeness system. So, how do we do this?
One massively effective way is to use imagery as a way of accessing all of the positive emotions that we associate with safeness. Think of a place that you associate with feelings of calm, peace, safeness and relaxation. This can be a place that you have been to, a place at home or another, even entirely fictional, place that you can imagine. Get lost in your imagine. Try to get in touch with all of the sights, sounds, sensations and emotions that you associate with the place.
It’s important to remember that we don’t want to activate the drive system here. We have to forget about the “goal” of getting to sleep and instead, almost passively, lean into the imagination of our safe place.
Another way of accessing the safeness system is to use our physiology to tap into the physical state needed to get to sleep. If you imagine that, when we are anxious about not getting enough sleep (the threat system) or motivated to achieve the goal of sleep (the drive system), then our body is awake. We breath more rapidly and more shallow and there is more physical tension throughout our body.
We can modify this through changing our breathing. When we are alert, and breathing more rapidly and shallow, the ration of oxygen to carbon dioxide increases in favour of the oxygen. Oxygen has an excitatory and stimulating effect on the body and brain. It literally makes us more alert and awake. Carbon dioxide however has a more sedating, calming effect. Therefore, by changing our breathing to a less rapid, deeper process, we will increase the carbon dioxide ratio in the body and increase the chances of us getting to sleep.
There are many ways that people have been taught “relaxed breathing” and, to be honest, when people show me how they think relaxed breathing should look, it is often incorrect or incredibly overcomplicated. It needs to be simple and easy to do.
This is how I teach people relaxed breathing:
First, put one hand on your chest and one hand down on your belly. Take a look down notice how you breathe normally. People often notice that their chest and shoulders are doing most of the moving.
Try to relax your chest and keep your shoulders nice and still. Still looking down, try to take a nice, gentle breath into your belly. Gently push your diaphragm out a little.
Don’t worry about how long the breath lasts for, don’t count it. Just breathe in as much as it feels comfortable, into the belly and then let it back out again. Try to do this in a nice, relaxed and slow way.
Practice this style of breathing for 10 minutes, twice daily. This allows you to get really used to the diaphragmatic breathing process so that it becomes more automatic when you try to sleep.
To really get into the Safeness system for sleep, practice using both of these strategies when you get into bed. Diaphragmatic breathing first and then lean into that safe place imagery.
Essential “sleep hygiene” rules for better sleep
So, now we understand a little about how our emotions can impact upon our ability to sleep. Next, I’m going to list some of the fundamental behaviours which have been shown to have an effect on sleep as well. In Cognitive Behavioural Therapy, we usually refer to the following principles as being “Sleep hygiene.”
- The “Golden Rule.” The bedroom should only be used for sleep or sex. If you find yourself using your bedroom for other activities such as watching T.V., reading, gaming, etc. then your mind and body will begin to associate the bedroom as being a place of wakefulness and activity. Take all of these activities, as much as possible, into another location so that your bedroom can be used for it’s primary purpose.
- If you are not asleep after 20 minutes, rather than laying awake in bed, get up and go into another room. Do something which is not very stimulating until you feel sleepy again, then go back to bed. Repeat this process. This works because, just like rule 1, you are educating your mind and body with the idea that the bedroom is primarily for sleep. In insomnia, the mind has learned to associate the bed as being a place of unpleasant wakefulness, thereby activating either the threat or drive systems.
- Establish as much routine as possible with regards to sleep. Make it a priority to get up at the same time each day, regardless of how much or how little sleep you have had.
- Avoid napping. If you find yourself really needing to sleep during the daytime, try to take a short walk, start a conversation or engage in any other activity to avoid the urge to nap. Again, routine is key.
- Watch what you drink. Caffeinated drinks such as coffee, tea, energy drinks and cola type drinks will all contribute to wakefulness and difficulties in sleeping. If you are struggling with sleep, then minimise these types of drinks as much as possible.
- Watch what you eat. Avoid eating late meals and if you must eat, make it a light snack which is carbohydrate based. Avoid excessively sugary foods.
- Make your bedroom environment as quiet, dark and comfortable as possible. Blackout blinds to block out any light from outside, earplugs if necessary and blankets that are appropriate to the temperature of the room are all considerations for that good night’s sleep.