The Sleep School - 1.5hr Plan for Duc Nguyen by Dr. Guy Meadows (PhD)

Copyright 2015 The Sleep School 1 www.thesleepschool.org

The Sleep School - 1.5 hour plan

Prepared for Duc Nguyen by Dr. Guy Meadows (PhD)

Dr. Guy Meadows (PhD) The Sleep School 28 Bristol Gardens London W9 2JQ t: 07789 070 031 e: [email protected] w: www.thesleepschool.org


Welcome, This booklet is designed to guide you through your 1.5 hour plan so that you may slowly and safely learn how to achieve good quality, natural, non drug based sleep once more. Whilst insomnia may typically start because of a single event or period of time in your life, it is your reaction to it now that keeps it fuelled. The more you struggle with it, the more wakeful you become and the less energy you have to live your life. This plan aims to increase your willingness to experience it and therefore promote sleepiness and boost your energy for living. Improving your sleep does not happen overnight and normally requires continued effort on your part. At some points during the plan it may feel like you are making no progress or even going backwards. During these times I ask you to stick with it and continue to act in the most helpful way towards your sleep, as this will turn the poor nights into a learning experience that will eventually free you from your insomnia. Recovery from insomnia is built on repeated experiences of discovering that the symptoms no longer matter. When enough set backs bring enough such experiences, the feeling of symptoms no longer mattering comes more quickly, is more forceful, and the impact of the old scary memories become weaker and weaker until it is but an echo of former suffering. As fear gradually goes, relaxation and peace will come but it all takes time and belief. With this in mind I ask that you follow the suggested recommendations as closely as possible for a minimum of one month to ensure that you get maximum benefit from the programme and allow the changes that you make to slowly take effect. Above all start to use all your energy to live your life, rather than struggle with your sleep. If you have any questions about any part of the programme please do not hesitate to get in touch. Wishing you the best of sleep, Dr. Guy Meadows (PhD) The Sleep School


Personal Action Plan Your personal action plan is a list of potential factors that have been selected to enable you to improve your relationship with sleep. They are divided into five areas including sleep, awareness, lifestyle, environment and values. Each area is self explanatory and whilst some of the suggestions can be done immediately, others will take time to implement and practice. It is important to remember that this approach is not a quick fix, but rather a gentle process that allows natural sleep to emerge over time. Over the next few weeks and months take time to work through each item and continue practicing all of the recommended exercises. For more information on all of the factors below and when to start implementing the various exercises please read the entire booklet below. Sleep Guidelines - The sleep exercises detailed below include specific information relating to your current sleeping situation, as well as important general sleep education. All of the recommendations are designed to be introduced in a slow and gentle fashion. Please be aware that deciding to change long standing sleep habits can at first feel quite daunting and disruptive to ones current sleep pattern. The key is to find your own pace and slowly implement all of the suggested changes over the coming weeks and months.

1. Read and follow the sleep school guidelines every day. Remember that the more

you struggle to control your insomnia the more you fuel it. By lessening your struggle and coming to terms with the fact that some nights your body will just not want to sleep, you are choosing to allow you body too sleep naturally again and no longer getting in its way. Use your time and energy to engage in actions that take you closer to what you value in life, rather than further away. Accepting that this approach is not a quick fix and trusting in your bodys ability to sleep is the key to fully recovering from your insomnia.

2. Like most other conditions, some people are at a greater risk from insomnia than others. Risks factors include being a worrier, having a family history, being female, having a genetic tendency to stay up late or wake up early (e.g. being an owl or a lark), being full of beans (e.g. hyper personality), and finally increasing age (e.g. >55 years old). As discussed you describe yourself as being a strong Owl, which naturally moves you towards having difficulty falling to sleep and then experiencing difficulties getting up. To counteract this you need to keep your evenings as quiet and dark as possible. Doing so will help to inform your brain that it is ok to fall to sleep and wake up earlier. In the morning it would be good to get lots of light onto your skin and be as active as possible. Buying a light therapy light could also be another option. I recommend the Lumie Zip. As discussed you describe yourself as being a worrier. This means that you have a tendency to over think and so keep the waking center in your brain stimulated in the night. The mindfulness and defusion exercises described later will help you to separate yourself from them and so prevent you from amplifying them further.


3. Additional insomnia causes. In some instances insomnia can be being caused or worsened by additional medical factors unbeknown to the individual such as anemia, hormone or vitamin imbalances, allergies, viral infections or as a side effect from medication. Having a routine blood test from your Doctor can be a helpful way of ruling out any such issues.

4. Keep a healthy and regular sleep wake cycle. Good sleepers will typically go to

bed and get up at roughly the same time four or five nights per week and go to bed and get up a bit later two - three nights per week. A small bit of variation (30mins) will not disturb your sleep wake cycle and if anything make it more adaptable in the long term. Keeping it regular in this way helps to keep the body clock on time and improve sleep quality. Aim to keep to a sleep wake cycle of 12am / 7-8am. Be aware of keeping an irregular sleeping pattern such as constantly changing your sleep and wake times or trying to catch up during the day as this confuses the clock and weakens the drive to sleep at night.

5. If you feel that you would benefit from a 15 - 20 minute power nap a few times a

week this is fine. Even if you are not sleeping taking time out just to lie still can help to recharge batteries and lessen any night time anxiety. Avoid napping for longer than 20 - 30mins and always have them before 3pm.

6. The evening is a time for slowing down. Simple acts such as switching off your

phone, stopping working or checking emails all help to instruct your brain that sleep is on its way. Aim to set a cut off time such as 9pm from when these activities stop and you engage in more quiet time such as watching TV, listening to the radio, reading or chatting etc.

7. Pottering around for about 30 minutes before going to bed is a healthy way to prepare for sleep rather than moving straight from the TV or computer. This is not rocket science and will not guarantee you a good night and should never be used in that way. What it does do is simply allow you to slow down and create some separation between your day and your night. A normal sleeper will use this time to prepare for the next day, brush their teeth and put on their bedclothes. If they have time they might read a little, but nothing serious and just because they enjoy it and not to get them to sleep or avoid their thoughts. Once they are ready they will turn out the light and allow sleep to come.

8. If you find yourself awake in bed remember that you always have a choice to how

you react to your insomnia. You can choose to fight it, avoid it, try to get rid of it or lie there resigned to it, all of which will just keep you stuck with it. Alternatively you can accept that at this moment in time your body does not want to sleep (because it has learnt to keep you awake). In doing so you can observe your reaction to being awake and choose to respond skillfully in the moment by practicing your mindful breathing, observing your surroundings, or simply enjoying the comfort of your bed. The main focus is to practice being in bed, remembering that you still get a lot of rest and recovery from just lying awake and


being still. However if you do feel overly anxious and need to have a break then sit on the side of the bed rather than leaving the bedroom altogether.

9. In the morning get out of bed as close to your desired time as possible and get

light (natural or artificial) onto the skin, have a shower / go for a walk to tell your body clock that it is morning. However if it is the weekend and you want to lie in bed awake, read the newspapers or have breakfast, then please do so as this will not affect your sleep. The only thing to avoid is getting into the habit of lying in bed every day trying to catch up on lost sleep as this confuses the body clock.

10. Start to notice the difference between everyday sleep disturbing events such as traveling, illness or Uni/life stress and an actual sleep disorder such as chronic insomnia. When you suffer or have suffered from insomnia it is very easy to fall into the sabotaging trap whereby you think that every sleep disturbance will result in the return of poor sleep. Learn to look at disturbances in an objective manner and resist the urge to struggle against them.

Awareness Guidelines - The awareness exercises detailed below require gentle practice everyday for them to be effective. Do them once and they will have no effect what so ever. Commit to practicing them for a few minutes everyday and your awareness of the present moment and your ability to respond skillfully to poor sleep and life stress will improve. These exercises on designed to be ongoing, irrespective of whether you are sleeping well or not. Ideally the bulk of your practice should be performed during the daytime, with gentle night time practice occurring intermittently in response to wakefulness or night time stress.

Mindfulness Exercises

11. Start to notice the difference between your Thinking Mind and your Observing Mind. Make time everyday to come out of your mind and into your body and your environment. Do this by taking 20 30 seconds several times a day to notice your senses (e.g. what you can hear, feel, smell, see and taste) at that moment in time. Set yourself a challenge of noticing three of each sense at a time. If your mind wanders off onto a thought gently thank it and return back to your observing.

12. Notice the difference between describing and evaluating. Notice that when you

describe or observe you are simply listing the raw facts as they appear in reality. In doing so you are being objective and non judgment and therefore lack any emotional attachment. In contrast, when you evaluate you are giving your opinion, being subjective or adding judgment to something and therefore are no longer based in reality. For example, my heart is beating fast could be an objective description, whereas, I think I am going to have a heart attack is an unhelpful subjective evaluation not based in reality. Start to notice how your judgmental tendencies can fuel wakefulness in the middle of the night and choose instead to adopt a more descriptive and objective view of your poor sleep.


13. Perform mindful breathing exercise for 3 minutes 3 times per day. Pay attention

to the movement of your breath (or any other part of your body such as your eyes, heart, muscles etc). Simply describe in your mind what you notice moment by moment such as I can feel the movement of my chest as I breathe or the air rushing in and out of my nose. If your mind wanders off, which it will, gently bring it back to your breath. The aim is to be aware of wandering and be able to choose to return your mind back to the present moment, rather than trying to remain focused on one thing. If you find yourself in bed with a racing mind practice for a few minutes to ground yourself back to the present moment. Being mindful is not designed to get you to sleep or relax you, but rather to help you notice your thoughts and let go of them.

14. Perform mindful daily chores such as brushing your teeth every day and follow the mindful living guidelines e.g. when possible do just one thing at a time and focus all of your awareness onto that one thing (see additional information).

15. Remember that scientific research shows that 10 minutes of mindfulness practice

per day for eight weeks can create a significant reduction in the volume of the worry center of your brain and increase in the rational thinking and calm center of your brain.

Cognitive Defusion Exercises

16. Start noticing all your unhelpful thoughts related to sleep and life that occur automatically in the night and day such as

What am I going to do in the future? How am I going to transfer? I need to fall to sleep I will do badly in my exams How much better would my life be if I could sleep better? Im going to have a bad day tomorrow Ill fail my degrees Start recording your Top 10 Unhelpful Thoughts (see below) to familiarize yourself with them in a friendly way rather than fighting against them and fueling them. Being mindfully aware of your thoughts is the first step to responding skillfully to them and letting go of your insomnia.

17. Start to notice all of your thoughts that pop into your head and begin to step back from them and see them for what they are..just thoughts. Practice using the various defusion techniques to help you with this process such as prefixing your thoughts with the descriptive sentence I am having the thought that.. in front of every unhelpful thought that pops into your head. Try singing the thoughts that pop into your head to the tune of Happy Birthday or Jingle bells or say them in the voice of a funny cartoon character such as Donald Duck or Mickey Mouse as


this will help you to realise that they are not the literal truth and break the strong associations that you have formed with them.

18. Start to name and greet your thoughts when they arrive to help distance them from you such as

Hello, Bad Day, Failure, Problem Solving or What if thoughts or Thank

you mind, I thought you guys would show up. After all of these distancing exercises just allow the thought to pass by taking your attention to something else (such as your breath). If or when the thought pops back in simply repeat the process as many times as you can.

19. Start to mindfully acknowledge your thoughts as they pop into your head by

asking yourself a helpful question (e.g. Did this thought just pop into my head? or Is this an old story and have I heard it before? or Does this thought help me take effective action?). Hopefully by asking yourself these questions you will be able to look at your unhelpful thoughts in a more rational way and start to let them go without buying into every one. Pick three helpful questions from the list below and write them on a piece of paper and carry them about your person all the time. Then when you notice unhelpful thoughts popping into your head remind yourself of the questions to help you stand back from them. Remember that a thought is just a thought and that you always have a choice of how you wish to respond to them.

20. Notice your uncomfortable emotions (Frustration, Anxiety, Anger, Stress) and your reactions to them. For example if your response is to get rid of them because you do not like how they make you feel you may be inadvertently strengthening them and increasing their future frequency. This action is typically born out of fear, which activates the survival mode of your brain telling it to remember the thing you so desperately want to get rid of. Emotions are just a flood of chemicals rushing through our body and it is only us who label them as good or bad. Imagine they are like the ocean in that they go up and down and we have no control over them, other than simply riding with them. So the next time you experience uncomfortable emotions avoid trying to get rid of them and instead sit them for a little while. Observe them in an objective manner and describe how they rise and then fall and how they actually do not hurt you even though they may feel uncomfortable.

21. Avoid trying to change or overly struggling with the discomfort associated with

your insomnia such as feelings of tiredness, as this only tends to only make it worse. Instead choose to simply observe the feeling without reacting to it and accept that whilst you dont like it being there it is ok and it cant hurt you. Describe every sensation that you experience as it arises in a non-judgmental fashion and as if you were an impartial witness to the whole event (e.g. In this moment I am experiencing the following emotions, physical sensations and


urgesetc.). Remember to do this with unwanted night time and daytime sensations. For example, objectively describing daytime tiredness helps to prevent unnecessary amplification of the symptoms, allowing you to get on with your day. If you notice your mind beginning to judge your experience and potentially inflame the discomfort, simply thank it for these thoughts and then gently come back to the describing mode. If you want you can also make space for the sensations in your mind rather than trying to tie them down or get rid of them, almost as if you are making them a smaller part of a bigger picture. Use this approach to sit with your unhelpful urges such as the need to do something to fix your insomnia such as take a pill or get out of bed. Rather than buying into it, use your new noticing and welcoming tools to watch the urge rise up and then crash like a wave.

Lifestyle Guidelines - The lifestyle changes detailed below are things that are within your control and so can be modified as quickly as you wish.

22. Notice unhelpful behavioral patterns that you perform in order to cope with your insomnia, which could inadvertently be part of the problem. These include playing on your phone or constantly tossing and turning. Remember your reaction to your insomnia determines your insomnia. The more you buy into it, fight it or try to avoid it, the more your fear it and the greater power it has over you. In addition the more you try to fix it by searching for a solution the more you keep yourself attached to it. Realizing this enables you to start letting go of struggling with it. It wont stop the automatic reactions occurring but it will reduce the amount, which you engage with them and prevent you from strengthening them yet further. Choosing to solely observe what is going on in your mind and body and accept them in a friendly and gently manner is one of the most powerful non-doing actions that you can take in times of stress.

23. It is perfectly normal to go to the toilet once per night. However, when you

become an insomniac there is a tendency to get into the habit of going multiple times. This typically occurs because of the diuretic effect of anxiety, coupled with the arrival of unhelpful thoughts such as I should go to the toilet now otherwise it will disturb my sleep later. Unfortunately buying into such thoughts and urges simply perpetuates further toilet trips leading to further disturbed sleep and anxiety. To break the cycle aim to watch and welcome all of the thoughts and urges that show up, rather than buying into them.

24. Always eat a healthy breakfast, lunch and dinner (even if just a small amount) as

mealtimes act as a vital marker to your body clock and keep it on time.

25. Avoid clock watching and continuously calculating how much time you have left to sleep as this can promote feelings of anxiety and consequently increased wakefulness. As a temporary measure and if needed hide the clock under the bed or out of sight and reach. However realise that it is your reaction to the clock that is the problem and not the clock itself. Observe your reaction to looking at the time and mindfully choose to respond in a way that does not promote further


wakefulness. Remember you cant change the time and fighting against it will only push the chance of sleep further away.

26. Notice yourself beating yourself up due to poor sleep. Poor sleep is a habit and

beating yourself up because of it only helps to strengthen it. So when you have a bad night and notice yourself giving yourself a hard time, choose instead to give yourself a break. Remember to start letting go of your insomnia rather than trying to control it by approaching it with an attitude of playfulness, curiosity and interest.

Environmental Guidelines - The environmental changes detailed below are things that are within your control and so can be modified as quickly as you wish. No changes required. Values Guidelines - Committing to your values or that which is important to you requires daily action. Every day commit to making small actions that take you closer to what is important to you in life, whilst living with your insomnia.

27. Be aware of changing your life to cope with your insomnia. Every day commit to

small actions that take you closer to living by your values such as being in a loving relationship, spending time with your family, socializing with your friends, doing activities you enjoy, performing the best you can at University and keeping healthy by exercising regularly and eating well. Performing such positive behaviours is a habit, whereby the more you do, the more you want to do. The aim is to use your energy towards that which is important to you in life, rather than using it to struggle with sleep and other life stresses. Remember each moment is a new moment that can be enjoyed in the present, rather than been caught up in the past or constantly living life for the future.

28. Valued Living Diary. Aim to keep a valued living diary whereby you log all of the small actions that you perform everyday that move you towards living a valued life (e.g. met up with a friend, went to the gym, did some mindfulness practice etc).

29. Starting the plan can always be challenging because the sudden increased awareness can make you see everything that you might have been avoiding or trying to fight against for some time. Whilst things may appear initially worse, the suffering is not mindless since your actions are no longer fueling your insomnia. Mindful suffering is different in that you are non-judgmentally observing everything that goes on in your mind and body moment by moment. Whether it is unhelpful thoughts or unwanted emotion you allow them all in as if they were old friends and practice letting go of them by either returning back to your breath or focusing on simple sensory observations like the feel of your pillow on your face. This gentle and curious act of observing your fears and then 'letting go' of them sends a powerful message to your brain telling it that sleep is no longer a threat


and that it is ok to sleep naturally once more. Please remember that the techniques are purely designed to observe what is going on in the present moment and are not designed to get you to sleep or relax you. Whether you observe chaos or calm your reaction should be the same and it is only this acceptance of your insomnia that will weaken it over time and allow you to sleep naturally once more.

30. Head towards your values rather than away from them. Imagine you are driving a bus and the direction it is heading is what you value in life (e.g. what really matters to you in life). On the bus you have some passengers, which represent your thoughts, memories, emotions, and physical sensations that you have picked up throughout your life. Some of the passengers will be the kind gentle people who are very good to you and lovely to have along for the ride (good memories etc). Other passengers are a gang of thugs (your painful thoughts, emotions, memories, sensations etc) who are intent on causing trouble and distracting you from driving (e.g. towards your values). It is likely that you have spent much time trying to make these passengers get off the bus, or change their appearance or hide them somewhere out of sight. You have probably also stopped the bus and struggled to throw them off only to find they get straight back on again. What you might have noticed is that in stopping the bus to deal with these thugs you are no longer heading in the direction of your values and therefore you have effectively put your life on hold! This programme is about living now and living fully with (not in spite of) your past, your memories, and your fears. What I am hoping you are learning over time is how to be on the bus comfortably with all of your passengers - distinct from them and yet willing to carry them on the journey.

31. The return of poor sleep. As your sleep improves it is very easy to fall into the sabotage controlling trap. This is where after a period of good sleep your sleep suddenly worsens. Out of desperation you start to use all of the observing tools to try and control the problem and make your sleep improve, something that only results in pushing it further away. It is important to remember that your mind has a library dedicated to poor sleep and your brain cant help to refer back to it given the right stimulation. For example, if your insomnia began when you started a new job, it is likely to worry about it again if you ever decide to change jobs. In reality such thoughts are just thoughts and it is only your unwillingness to experience them and then attempts to control them that result in your insomnia amplifying. The key to being a normal sleeper is being able to watch and welcome such sabotages and let them go.


The Sleep School Guidelines

The Sleep School approaches insomnia with a sense of increased awareness, acceptance and a non judging attitude. It relies on you accepting and letting go of your insomnia in order to allow your brains innate sleep ability to emerge by itself and for you to get on and live your life.

Insomnia feeds on your fear of not sleeping and how it will affect your ability to live your life. As a result you struggle to control it by engaging in many activites designed to help you sleep or cope with not sleeping and the discomfort that it brings. Sadly such attempts to solve the problem often become part of the problem, and the nighttime struggle inadvertaintly wakes you up more and becomes learnt over time. As desperation sets in you commit more and more of your time to the overcoming your insomnia and therefore have less energy to live your life, the very thing you are struggling to preserve!

Our approach is designed to increase your willingness to experience your insomnia, whilst making positive actions towards living your life. The theory being that when you can accept poor sleep and start living your life, you struggle less against it and therefore promote natural sleepiness and create more energy to get on and live a rich and meaniful life.

The Sleep Schools approach goes against our modern desire to try and solve the problem of why we cant sleep. It recognises that your body knows how to sleep and that the only thing preventing you from sleeping is you. It understands that people who sleep well do nothing when attempting to fall to sleep and therefore once you can stop trying to sleep then and only then will you sleep. The guidelines below are designed to help you facilitate your bodies natural mindful ability to sleep and when possible must be read and followed everyday.

Guidelines

1. Accept that I am awake and that my bodyclock does not want to sleep at this moment in time.

2. Accept that forcing, wanting or trying to make myself sleep will not help me to sleep.

3. Accept that fighting, avoiding or trying to get rid of my insomnia will only fuel my insomnia.

4. Accept that thinking about past poor quality sleep will not help me to sleep. Remember the past has been and gone and there is nothing I can do to change it.


5. Accept that worrying about the future, for example how bad I could feel tomorrow if I dont sleep will not help me to sleep. Remember let the future take care of itself.

6. Accept that nothing else exists other than the present moment and that I have a choice of how I would like to respond in this moment. Remember following knee jerk habitual reactions is not the only choice.

7. Recognise this awake time as an opportunity to practice my mindfulness exercises. Use the time to get to know my insomnia and respond skillfully to it in a way that takes me closer to what really matters to me in life.

8. Every day commit to making small actions that take you closer to what you value in your life such as your health, work, family, friends and community.


The Vicious Cycle of Insomnia

Many of us experience poor sleep on a regular basis simply due to the rollercoaster ride that is life. Anything from a stressful day at work, an argument with a friend or the loss of a loved one can be the cause of such sleeplessness. Alternatively it could be something as annoying as noisy neighbours, excessive jet leg or as a result of an operation or pregnancy. Whatever the initial cause, it is normally only short lasting and not the explanation for the continued poor sleep that is chronic insomnia.

Chronic insomnia is the vicious cycle where by the more sleepless nights you experience the more you worry about not sleeping which causes you to have more sleepless nights. It is like being stuck in quicksand where the more you panic and struggle to get out the further down you sink. To escape quicksand you need to remain calm and very slowly make skilful moves to place yourself onto the surface where you can then move to the side. Similarly to get a good nights sleep you need to be able to remain calm and trust in the fact that your body knows how to sleep and will do so if you let it.

Sleep Myths

Myth 1. You need eight hours sleep every night

Eight is the average number of sleeping hours suggested by scientists that humans need to maintain daily optimum performance. Whilst this figure is true, it is just an average like the fact that the average UK male shoe is a size nine. This does not mean that everyone fits a size nine shoe and similarly not everyone needs eight hours sleep. Ask anyone how many hours sleep they need and you will get a range from three to twelve. Individual variation suggests that some people need more than others. This does not mean that people who sleep more have better brains or are more successful in life, it simply means that they need more sleep to feel good and function well during the day. Interestingly most people believe they need more sleep than they actually do and ironically worrying about not getting enough sleep is one of the biggest causes of poor sleep. This programme will help you to focus on promoting good sleep rather than spending all of your time worrying about poor sleep.

Myth 2. People who sleep normally do not have bad nights

If you suffer from insomnia it is very easy to believe that everyone else sleeps perfectly one hundred percent of the time. This is a complete myth and statistics show that eighty percent of the population will experience poor sleep at some point in their lives. In fact if you ask most people they will tell you that they regularly experience average quality sleep and that it is far from perfect. Expecting sleep perfection is often a large source of anxiety for most insomniacs. This programme will help you to realise that some poor


sleep is an inevitable part of life and that anxiety about poor sleep only helps to make things worse.

Myth 3. If you cant sleep there must be something wrong with you

Chronic insomnia affects ten percent of the UK population. This means that one in every ten people where you work or live are suffering just like you. Based on myth 2 it would appear that suffering from poor sleep is actually quite normal and that sleeping well is in the minority. This said just because you cant sleep does not mean that there is something wrong with you. Everyone can sleep and often have done for long periods of their lives with no problems at all. Whilst the cause of poor sleeping is normally due to a single event occurring in ones life such as the loss of a loved one, stress at work, noisy neighbours or jetlag. The thing that keeps it going is the worry about not sleeping and that there must be something wrong with you. As you have probably already noticed it becomes a self-fulfilling prophecy where the more you worry about not sleeping, the less you sleep. This programme is about noticing such worry and learning how to let go it and get on with your life.

Myth 4. Sleep is a natural process and you should be able to control it

Sleep is a natural process that every human does automatically from the day they are born. This means that when it does not happen we can get very annoyed or anxious as this is something that we should be able to do and if not should be able to fix. Unfortunately whilst this fix it attitude may work in the external world such as if your car breaks down you simply find someone to fix and carry on with life, it does not work so well in the internal world. For example you might be listening to a song on the radio, but cant recall its name and the more you try too, the further away it goes, until a few hours later when it pops in when you have stopped thinking about it. Sleep is exactly the same, your body knows how to sleep but the more you try to fix the problem and make yourself sleep the further away it goes. This programme is about learning to let go of trying to fix your sleep problem and allow it to come naturally.

Myth 5. If you dont sleep you will die

Sleep is vital for the human body and without it you will die. However this situation will never arise because your brains protective mechanisms will force you into sleep. The longest ever recorded period of wakefulness is 11 days and after this they were reported to be medically fit and health and returned to a normal sleep wake cycle immediately. Whilst death appears unlikely, recent evidence does suggest that poor sleep over a prolonged period of time could lead to increases in weight, higher blood pressure and diabetes, although the exact reasons why the risk is lower in people who sleep is not known. What we do know is that after a poor nights sleep we feel tired and are more emotional as a consequence. This means that we find it harder to rationalise


unhelpful thoughts and find it easy to create catastrophic fantasies about dying because of sleep loss. This programme helps to avoid unskillful states such as worrying about poor sleep and instead look towards promoting skilful actions that will improve sleep and allow you to get on with your life.

What Is Normal Sleep?

When recovering from insomnia it can be very easy to set your sights on trying to achieve eight hours of deep sleep every night. Unfortunately this is not possible and trying to do so will often result in more frustration and wakefulness. The following sleep hypnogram and questions are designed to give you a good understanding of what is normal sleep. Look at the graph and answer the following questions (See below for the answers).

1. What is the total length of time spent sleeping? 2. How many times does the person wake in the night? 3. How long is each sleep cycle and how many does the person have? 4. What type of sleep is recorded most during the night? 5. Roughly when and how much time is spent in deep sleep (stage 3 - 4)? 6. Roughly when and how much time is spent in REM sleep?

Figure 1. Sleep Hypnogram

1. What is the total length of time spent sleeping? 8hrs. The average amount of time that humans spend sleeping is 7-8hr hours. However, the range is 4 10hrs, which means that how much sleep you need is a very individual thing.

2. How many times does the person wake in the night? The person wakes up twice. It is quite natural for humans to wake in the night for short periods of time. Humans sleep in 90 110 minute cycles during which they go from waking into


light, deep and then REM sleep and then either back to waking or back into light sleep. This cyclical system is an evolutionary protective mechanism designed to allow humans to sleep and yet still wake up on regular intervals to check for danger. It is the perceived threat and hyper arousal associated with insomnia that causes such nocturnal awakenings to be extended.

3. How long is each sleep cycle and how many do they have? The average

length of each cycle is 90 minutes and the person has 5 sleep cycles. The number of cycles is dependent on the amount of time a person sleeps for, but on average it will be 4 to 5 per night.

4. What type of sleep is recorded most during the night? Light sleep is the most

common stage of sleep. Humans experience light and deep sleep and Rapid Eye Movement (REM) Sleep. Deep sleep is when you do most of your growth and repair, whilst REM or dreaming sleep is when you store most of your memories.

5. Roughly when and how much time is spent in deep sleep (stage 3 - 4)?

Deep sleep accounts for only 20% of sleep and occurs in the first third of the night. Most people speak about getting more deep sleep, when in fact it only makes up a small percentage of the total night.

6. Roughly when and how much time is spent in REM sleep? REM accounts for

only 25% of sleep and occurs during the latter part of the night and early morning. Due to the dreaming, it is a very light and active stage of sleep, which is why many people complain of being easily woken from it. Most people finish their sleep with REM and as a result can often remember their dreams. If dreams have been particularly active people can wake up feeling exhausted and unrefreshed. If you are sleep deprived then the amount of REM you experience increases, which means you get even more light and dreamy sleep and feel even more unrefreshed.


Mindfulness

The aim of mindfulness is to simply increase present moment awareness and allow us to make a mindful choice in response to a situation rather than simply responding automatically and mindlessly. Responding mindfully to wakefulness in the middle of the night by using the exercises below sends a strong message to your body suggesting that there is nothing left to fear about sleep and that it is ok to sleep. This message is directly opposite to that supplied by familiar patterns of panic or resentment, which only help to fuel wakefulness.

Exercise 1. Mindful Observing

Most of us are very aware of our ability to think as this plays an integral part of our daily life and can sometimes be so active that we wish we could find the off switch. Lesser known is the observing mind, which notices everything, that goes on including the thoughts you are thinking and the sensations you feel. Interestingly by developing the observing mind you can learn to work with the thinking mind in a way that can help it to calm down or feel like it is switched off.

Start to notice the difference between your thinking mind and your Observing mind. Make time everyday to come out of your mind and into your body and your environment. Do this by observing your senses (sight, smell, taste, touch and sound) for 20 30 seconds several times a day. This exercise is all about noticing what it going on right now rather than trying to change anything or think about things (e.g. observing vs. thinking). Use this exercise if your mind is particularly busy and just wont switch off. If your mind does wander off onto a thought, simply thank it and return back to your observing.

Exercise 2. Mindful Breathing

The regularity of our breath makes it an excellent anchor to the present moment and our continuous connection with it wherever we go makes it a great mindfulness tool. At its most basic level, mindful breathing offers us a connection to the present moment and an escape from our automatic lifestyles. Taken further, regular mindful breathing practice allows us to become an impartial witness to our own moment by moment thoughts, feelings, behaviours and physical sensations, thus offering us the choice as to how we would like to respond rather than relying on old knee jerk responses.

Step 1 - Focus your attention on your breath. For example focus on the rise and fall of your abdominal wall or expansion and contraction of your rib cage, as air comes in and out of your lungs. Breathe at a natural relaxed pace, not too fast or too slow.

Step 2 - Each time you notice your mind has wandered off from your breath, gently return it back to your breath and congratulate yourself for returning back to the present


moment. If your mind keeps wandering off, which it can do, simply keep bringing it back in a gentle and playful manner. You might find that you start to get annoyed at your inability to remain focussed and the fact that your mind always wants to be somewhere else. If this happens do not worry, it is only natural for the mind to wander, in fact it is quite unnatural to have a mind free from thoughts. The aim is not to block out your thoughts, but instead it is to allow them to come in, notice them for what they are and then gently allow them to pass, almost like the clouds passing in the sky. Once you have finished with a thought gently return your mind back to your breath and continue the mindful breathing practice. Remember that it is completely natural to have thoughts and that trying to control them or block them out is like trying to stop your heart beating with your mind.

Practice Notes - When practicing mindful breathing it is also important to be aware of your body, so adopting a good erect posture whether sitting, lying or standing is essential. Whilst practice can be done anywhere or for any length of time, when first starting your mind training it is good to follow some formal guidelines. It is recommended that you allot three periods of three minutes from your day to perform mindful breathing practice (e.g. in the early morning, midday and during the evening). Practicing at different times of day offers the benefit experiencing your breath and ultimately your mind at different moments. Remember mindful breathing simply allows you to observe what is present at that moment in time and therefore comparison between times is not needed or does not matter.

Mindful breathing practice can also be done once you first get into bed or if you find yourself awake in the middle of the night. It is important to note that you are NOT doing this to get you to sleep or to help you relax instead you are simply doing it to be in the present moment. As soon as you start to use mindful breathing as a tool to help you sleep, you are once again trying to sleep and hence pushing it further away.

Exercise 3. Mindful Daily Chores

Performing daily chores mindfully is another way to practice using your mind rather than the mind using you. Just like our thoughts, we can also do day-to-day activities automatically, meaning we have very little awareness of doing them or the consequences of our actions. Often we can be doing something and yet be a million miles away from the activity in hand. More often this happens with activities that we repeat on a daily basis such as brushing our teeth or eating. However the more disconnected we become from the present moment, the more it can start to happen with everything we do in life. Living life like this is likened to being on automatic pilot, where we are living our life but not aware of what is happening to us.


Approaching activities in a mindful way means approaching them with a beginners mind, one that is curious, investigative, playful and non-judging. One that is completely open to every experience moment by moment. Practicing being mindful when doing our daily chores enables us to become aware of when we on automatic pilot and allows us to return back to the present moment.

Step 1 - Choose an activity that you perform once or twice everyday (see list below for ideas) and approach it with a beginners mind. Allow yourself to sensually experience the activity by noticing how it feels, tastes, sounds, looks and smells moment by moment.

Step 2 - Focus your complete attention onto what you are doing and if your mind wanders off from what you are doing, which it probably will do, simply bring it back. If it keeps wandering off, then simply keep bringing it back and remember that every time you do you are beginning to use your mind rather than your mind using you.

Practice Notes - Choose one of the following mindful daily chores below and mindfully practice it every day for one week before choosing another activity.

Brushing teeth

Eating food

Drinking water

Shaving

Showering

Walking

Cleaning

Driving


Thoughts

Top 10 Unhelpful Thoughts

As you become more aware you will probably have a good idea of some of your regularly occurring unhelpful thoughts. Making a list of them further helps to alert you to their presence as they flash automatically through your mind and can help to see them for what they really are, which is just thoughts and start to let them go rather than becoming emotionally entangled with them.

Make a list of your top 10 daily unhelpful automatic thoughts or as many as you can:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Add more here...


Fighting, Avoiding, Changing Thoughts When an unhelpful thought pops into your head there is a tendency to want to fight it, avoid it or change it because we do not like its presence. Hopefully by now you are learning that whilst this automatic reaction may feel most natural it is not the most skillful response and often results in a worsening of the situation. Fighting your thoughts could be likened to a mental game of tug of war where the harder you pull the greater the opposition will resist leading to a never ending battle in your head. Basically fighting thoughts fuels thoughts meaning they come back stronger and more frequent.

Positively Challenging Thoughts

Challenging our unhelpful thoughts by creating positive ones to rebut them is another common method used to gain control over unhelpful thoughts. Unfortunately whilst thinking positively can sometimes be helpful it can easily turn into another mental tug of war where every unhelpful thought is endlessly rebutted with a positive and with no end in sight.

In addition, positive statements often use past experience to predict the future in a positive way. For example, I have had two good nights out of four so far this week so there is a chance I might sleep well again tonight. Whilst it is important be aware of the positive fact that you can sleep well especially since it is very easy to look towards the negative side of things, it is vital to remember that this fact is in the past and should not be used to predict the future. After all, the past has been and gone and there is nothing you can do to change it and the only thing that exists is the present. By focusing on the present you are bringing yourself into reality and enabling rational choices to be made based on your actual experiences at this moment in time.

The simple act of challenging unhelpful thoughts could also be part of the problem since it places unwanted emphasis on something that is just a thought. For example choosing to rebut an unhelpful thought with a positive suggests that there is actually some form of truth or reality to the unhelpful statement when often there is not.

Thoughts Are Just Thoughts

Thoughts are just sounds, words, stories, bits of language passing through our heads. Learning to look at them in this way helps to break the emotional attachment and reactionary behaviour that ceratin thoughts have over us. Treating thoughts as just thoughts means that they can no longer hurt us any more.


What Are Thoughts?

It is very easy to take all of the thoughts that pop into our heads as gospel, no matter how they make us feel or behave. For example we start to believe the following:

Thoughts are reality: what were thinking is actually present, here and now!

Thoughts are the truth: we literally believe them!

Thoughts are important: we take them seriously, and give them our full attention!

Thoughts are orders: we automatically obey them!

Thoughts are wise: we assume they know best and we follow their advice!

Being more aware of your thoughts can allow you to realise that the statements above are not true and can help you to start questioning them and realise the following:

Thoughts are merely sounds, words, stories, bits of language, passing through our heads.

Thoughts may or may not be true: we dont automatically believe them.

Thoughts may or may not be important: we pay attention only if they are helpful.

Thoughts are not orders: We dont have to obey them.

Thoughts may or may not be wise: We dont automatically follow their advice.

Basically thoughts are just thoughts and if they can be looked at in this way you can choose to answer and respond to them how you wish rather than looking from them and always following the same knee jerk reactions time after time.

Next time you notice a unhelpful automatic thought or image flashing through your mind, gently hold on to it and start to question it and realise it for what it truly is..just a bit of sound or some words passing through your head or an old story that you have told yourself countless times.


Defusion Techniques

In the middle of the night it is very easy to be completely fused with your thoughts so much so that you believe that they are reality, truthful and are orders that must be obeyed. This means that when thoughts such as I wont sleep tonight pop into your head, you struggle against them, which inevitably wakes you up more. The following techniques are designed to help you see your thoughts for what they really are and to increase your willingness to experience them in the middle of the night and therefore lessen the power they hold over you.

1. Describing your thoughts Every time you notice an unhelpful thought that pops into your head place the words I am having the thought that.. in front of them. Doing this helps to create distance between you and your thoughts and allows you to see them for what they really are.just thoughts.

2. Musical thoughts Every time you notice the thoughts pop into your head practice singing them to the tune of Happy Birthday or Jingle bells or say them in the voice of a funny cartoon character such as Donald Duck or Homer Simpson as this will help you to realise that they are just thoughts and are not as scary or serious as you first thought. Notice that you are not trying to change the thought in any way or even trivialize it. Instead simply showing it for what it is.just a thought flashing through your head.

3. Greet your thoughts Practice greeting your thoughts in a friendly and inviting

manner. For example, when they arrive say Hello to them and maybe Its good to see you. Being friendly in this way helps to switch off the fear reaction that is currently in place and can in turn reduce the frequency of such unhelpful thoughts. Being playful with them can also help such as highlighting their timely arrival to you waking up in the middle of the night by saying, oh look, I have just woken up and here you all are. Greet all of your thoughts with kind gestures almost as if you are thanking your mind for sending you this thought such as saying thank you mind in your head when you notice a new one pop in. Approach the naming and greeting with an attitude of playfulness and curiosity rather than with resentment and anger.

4. Name Your Thoughts Giving your thoughts shortened names is another way

of bringing a friendly familiarity to them. For example, a thought such as If I dont sleep I wont be able to cope tomorrow could be shortened to My not coping thoughts.

Remember the aim of these techniques is not to get rid of your thoughts rather to allow you to see them for what they are.just words, bits of noise in your head or old stories that you repeat to yourself. Allow them to be there without feeling the need to fight them or trying to block them out. For these techniques to be effective and automatic you must practice them at least 10 - 15 times per day or whenever unhelpful thoughts arise.


Helpful Questions

Outlined below is a list of helpful questions to ask your unhelpful thoughts. It might help to choose two that really work for you and write them on a scrap of paper and keep them in your wallet. Get used to running them through your head every time a unhelpful thought pops in such as what do I get from buying into this thought? or Is this an old story that I have heard before?

Did this thought just pop into my head automatically?

Could I be confusing a thought with a fact?

Am I engaging in crystal ball thinking to predict the future?

Am I overestimating disaster?

Am I expecting perfection or setting my sights too high?

Am I judging myself too hard?

How would I have thought about it at another time or in another mood?

What would I say to someone I cared about who was troubled by this thought, and came to me for advice?

Am I jumping to conclusions or seeing things in black and white?

Am I focused completely on my weaknesses and forgetting my strengths?

Am I trying to mind reading what a person is thinking?

Is this thought in any way helpful?

Is this an old story? Have I heard this one before?

What would I get for buying into this story?

Could this be helpful or is this my mind just babbling on?

Does this thought help me take effective action?

Am I sabotaging my own questioning with yet more unhelpful thoughts?

Am I trying too hard to fix or solve this problem?


Two Countries at War The Insomnia Battle

Imagine you live in a small country that shares a border with a hostile neighbour. There are three possible scenarios for how your country can relate to its neighbour. The worst-case scenario is war. Your country attacks and the other fights back. As both countries get pulled into a major war, the people of both nations suffer. Think of any major war and the huge costs involved, in terms of life, money and well-being.

Another scenario, better than the first but still far from satisfactory, is a temporary truce. Both countries agree to a ceasefire, but there is no reconciliation. Resentment seethes beneath the surface, and there is the constant underlying threat that war will break out again.

The third possibility is genuine peace. You acknowledge your differences, and allow them just to be. This does not get rid of the other country, nor does it mean that you necessarily like it or even want it there. Nor does it mean that you approve of its politics or religion. But because youre no longer at war, you can now use your money and resources to build up the infrastructure of your own country, instead of squandering them on the battlefield.

You and your insomnia could be these two small countries. The first scenario, war, is like the struggle to get to sleep and all of the unhelpful thoughts and feeling associated with it. It is a battle that can never be won, and it consumes a huge amount of time and energy.

The second scenario, a truce, is definitely better, but its still a long way from true acceptance. It is more like a grudging tolerance of poor sleep rather than an outright battle. It is the hope that follows a few good nights that maybe you have cracked it, only to find it return and even worse than before. Its a sense more of resignation than acceptance, of entrapment rather than freedom, of being stuck rather than moving forward.

The third scenario, peace, represents true acceptance. It is the same when you truly accept your insomnia and stop fighting with it. You dont have to like it, want it or approve of all of the unhelpful thoughts and feeling that go with it. You simply make peace with it and let it be. This leaves you free to focus your energy on taking action action that moves your life forward in a direction of value. Remember it is your reaction to your insomnia that keeps you attached to it and learning to let go of struggling is an essential part of your recovery.


Additional Reading and Support

The Sleep Book How to sleep well every night by Dr Guy Meadows published by Orion February 2014 (9.99). This book has been specifically designed to support your 1on1 sessions. Available in print, ebook and audio.

The Sleep School Sleep App (2.99): Currently available on iOS and Android. The audio tracks on the app will guide you through all of the tools learnt during your 1on1 sessions.

The Happiness Trap by Russ Harris: published by Robinson Good ACT textbook

Mindfulness Finding Peace in a Frantic World by Mark Williams and Danny Pennman: Published by Piatikus

The Sleep School - 1.5hr Plan for Duc Nguyen by Dr. Guy Meadows (PhD)

Documents

Transcript of The Sleep School - 1.5hr Plan for Duc Nguyen by Dr. Guy Meadows (PhD)