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Daniel Erichsen

Jun 04
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3 things to do when you are awake at night

By cognitive behavioral therapy, cognitive behavioral therapy for insomnia, healthy sleep, insomnia

Out of all the questions about sleep, perhaps the single most common one is this – What should I do when I wake up at night? And this is no surprise. You could argue that insomnia at its core is about being awake when you should be asleep. And you typically want to be asleep a night.

So what are these three things you should do when this ain’t happening? Before we go there, we need to spend a few moments on sleep physiology to make sure the answer makes sense.

Think about that person you know who sleeps fantastic. Your friend/spouse/family member who’s asleep before their head hits the pillow. The one you’re envious of. Imagine asking them what they do to sleep so well. Most likely they’d simply reply with a shrug and a confused look. And that response is super important.

Sleep is a passive process. Sleep only happens when there’s no effort. The more you try/want/hope to sleep, the less you get.

That covered, let’s get to it!

1. Accept reality

When you wake up and become aware of being awake at night, yet again, your instinct is naturally to do something to make yourself fall back asleep. Perhaps listen to a soothing podcast, close your eyes and still your mind or count down from 100 in steps of 7.

This may seem like a sensible thing to do. Your brain is awake and active, and you want it to become relaxed and sleep. The only problem with this approach is that you’re trying to make yourself sleep. And the more you try, the more awake you become.

The first thing to do when you are awake at night is in fact a what not to do. And a very important one too – do not do anything that you hope will make you fall asleep.

This includes obvious ones like closing your eyes hard and trying to force your brain to shut down but also more camouflaged attempts like reading a boring book. You can’t fool your brain. If you’re picking up the most boring book you know, you’re trying to make yourself fall asleep.

2. Take an inner journey

If you’re awake in bed, but feel comfortable under those warm blankets and don’t want to be anywhere else, then go somewhere nice using your imagination.

Think of a pleasant memory or a tropical beach or anything else that makes you feel good.

If this comes easy to you, then just stay in bed and enjoy the imagery you’re creating. If your thoughts easily drift off, so will you soon enough.

3. Do something fun!

If taking that inner journey isn’t actually taking you anywhere, if you keep thinking of how you’re awake when you should be asleep, then you have to do something else to redirect your thoughts. What is most important when you decide what to do is this – you have to do something enjoyable!

Read a page turner. Listen to a podcast you’ve been dying to catch up on. See what happens in the next episode of that Netflix show.

You think that this would wake you up even more. But it will do the opposite. Because when you’re not afraid of waking up, your brain stops treating awakenings as something to get excited about.

In fact, when you get to a point where you genuinely look forward to waking up – you no longer do!

There you have it. This is your playbook. Now you no longer have to wonder what to do when you’re awake at night, which is in itself super important. Because the deliberation and ponder of whether to do this or that in itself produces so much anxiety and insomnia.

So go ahead and pick that activity you’ll get to enjoy when you’re awake. Customize your playbook. Start using it today and sleep better in no time!

Dec 12
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You are special – your insomnia is not

By cognitive behavioral therapy for insomnia, healthy sleep, insomnia

Most with trouble sleeping feel that their situation is different, often strange and even bizarre. And it’s not hard to see why this is the case. We shall explore this in a second because it is very important. Believing that your insomnia is unique takes to down a path of looking for a unique underlying reason and treatment. A journey that only leads to more confusion and frustration. Believing that your insomnia is ordinary on the other hand, leads you to see how the approach described here, that works for so many others, will also work for you.

Let’s start at the very beginning – someone going through a series of sleepless nights. From the inside perspective, not sleeping for a stretch of time can seem very strange. Sleeping being something very natural, like eating or thinking, it can seem bizarre that it just isn’t happening.

But as mentioned, this is just the beginning.

Next, having become a bit worried and perplexed, one may want to try to do something about the fact that sleep isn’t happening. Surely taking some melatonin and keeping the bedroom dark should take care of it.

When nothing changes, perplexed becomes confused. When even more efforts make no difference. Confused becomes clueless. And the insomnia at this point starts seeming strange and unique. One may conclude that it is in fact an unusual form because it didn’t respond to anything or because of other circumstances including:

  • You have not trouble falling asleep, just staying asleep
  • You don’t feel sleepy during the day
  • Your insomnia started after menopause
  • You have not trouble staying asleep, just falling asleep
  • Everyone in your family has it
  • You’ve had trouble sleeping all your life

Here’s the thing, we are all unique human beings. Our experiences are unique and many circumstances surrounding our troubles sleeping are unique – but the insomnia isn’t.

Either there’s too little gas or too much braking going on. You’re not sleepy enough and hyperarousal is keeping you from sleeping.

That’s it.

Although it may not seem like it, nothing else matters when it comes to insomnia. Not the coffee, not light exposure, not the neighbor’s cat. Sure, many things can cause some disturbed sleep, but staying up for hours struggling – that’s different. That’s a gas and/or brake problem.

There are many reasons why you may feel that your trouble sleeping is different, strange and unique. It’s not. Neither is the belief that it is different, strange or unique. It is a very common and ordinary belief.

This is not to belittle what you’re going through. Saying that the insomnia is not unique is not saying that it hasn’t had a big impact on your life. But the belief that you have a different kind of insomnia can keep you in a sleepless loop.

You are a unique and special person, but know that your insomnia is ordinary, everyday, uninteresting, regular insomnia. This can make you see how you, just like anyone else with regular insomnia, can go on see progress using the insights and habit changes here.

And that is the path to a place of sleeping well indefinitely.

Dec 11
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The solution to insomnia – whale watching

By cognitive behavioral therapy for insomnia, healthy sleep, insomnia

When we have a problem – we want to solve it. Nothing surprising about that. A strategy that almost always is the right one.

Got a leaky faucet – call the plumber. Annoying headache – take some ibuprofen. Can’t find the car keys – figure out where you most likely put them and look there.

For most problems, the solution likes in taking action and/or figuring out what caused it so that can be addressed.

With insomnia, things are different. It is the process of trying to fix the problem that maintains the problem. To solve it, you have to use a strategy that may go against all your emotions and instincts…

….go whale watching.

When you do something enjoyable like taking in the spectacle of huge water living mammals migrating up the coast, you step away from trying to sleep, wanting to sleep and trying to figure out why you’re not sleeping.

Behavioral activation is the technical term for doing stuff you enjoy. If not whale watching then perhaps baking, synchronized diving or yoga. It really doesn’t matter as long as your attention shifts away from sleep.

Attention is oxygen for insomnia. It cannot survive without us thinking about it, trying to do things to sleep and studying our sleeplessness.

Get that behavioral activation going, leave the insomnia without oxygen, and sleep better forever!

Dec 09
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Keep Hiking

By cognitive behavioral therapy for insomnia, healthy sleep, insomnia

One of the most common questions I get from people is what to do after having started to use the “sleep tight” technique or bedtime restriction and still not getting more ZZZs – what do I do now?

This could be someone that did better initially but then had a night of sleeping almost nothing. It can be someone that has limited time in bed for 3 weeks and hasn’t noticed any changes. Or someone that feels they’ve hit a plateau after some improvement.

Here’s the thing – people with trouble sleeping want to solve that problem. But the attempts at trying to solve it ends up being what keeps sleeplessness going. The instinct when nothing is happening or you’ve had a setback is to tweak things , change direction or try something different. But the best thing do to is the opposite – stay the path.

A really good way to think about this is to imagine yourself hiking up to a mountain top. At the summit is a place of really good sleep.

As you are making your way up, you are very likely to stumble on a root or a rock. That’s expected. If you stop and examine the root that made you trip, if you wonder why it happened, why it is sitting there and how you can avoid this happening again, you’ll never reach the top.

Not reacting, just keep moving forward is the best thing to do.

The less you react when you have a setback or when it feels like progress is slow, the sooner you’ll reach that place of amazing sleep.

Dec 06
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Don’t worry about your health

By healthy sleep, insomnia

Did you know that ash trays are associated with COPD? If not, do know that there is a strong link between the two. There is even a dose-response relationships: the more ash trays someone has, the more likely they are to have COPD.

Does this mean that ash trays cause COPD? That has never been proven. In fact it is believed that it is smoking cigarettes that is the culprit and not those ash trays.

Now what does this have to do with sleep? Quite a bit it turns out.

Sleep is like the ash trays in this example. Many health issues have been associated with sleep duration, but a causal relationship has never been found. And here’s whats really important to know – it is impossible to prove that how much you sleep causes health problems and long sleep is much more strongly linked to mortality than short sleep.

Let’s look at feasibility of proving that short sleep causes Alzheimer’s disease. To prove that one thing causes another you will need a randomized study with two imposed conditions. You would need thousands of people and make half of them sleep deprived and make sure the other half slept a lot. After decades of maintaining both groups short and long sleepers respectively you could look at whether Alzheimer’s happened more in the sleep deprived or non sleep deprived group.

Needless to say – a study like this will never happen. Therefore it is not possible to prove that short sleep causes any disease or health issue.

Looking at the existing link between all cause mortality (dying early for any reason) and sleep duration you find the following – having an estimated sleep duration of more than 7 hours and less than 6 hours are linked to an increased risk. Someone who feels they sleep 8 hours has an equally increased risk as someone estimating 5 hours of sleep.

If the belief is that there is a causal relationship between sleep duration, well then we should be warned not to sleep more than 7 hours. Conveniently for an industry that wants to sell products to make you sleep more, the link between long sleep and premature death is consistently overlooked.

So why is there a link between short and long sleep and premature death?

Probably because health issues can affect how much you estimate sleeping in both directions. Having arthritis and pain can disrupt your sleep and lower your estimated sleep time. Heart failure can make you tired, spend more time in bed and increase the amount of time you feel that you sleep.

Knowing that short sleep has not been shown to cause any health issues can be really reassuring to someone with insomnia.

Because as you know, worrying less is the first step towards sleeping amazing!

Nov 14
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How to decrease sleep anxiety

By Uncategorized

One of the most common things that keep people from sleeping well, or sleeping at all, is the fear of not sleeping – sleep anxiety.

Sometimes this is mostly general anxiety that spills over onto sleep, sometimes the source of the anxiety is strictly that worry of whether or not you will sleep, how much you will sleep and what will happen if you don’t.

If you have mostly sleep anxiety, well then the good new is that it’s not too difficult to get past. Just by spending less time in bed and focusing attention on things not sleep related sleep anxiety decreases as you see that you can sleep and your sleep confidence grows.

If you have more general anxiety, or want to speed up the process of reducing sleep anxiety, then you should try focused journaling.

As you know, with anxiety comes the constant bombardment of thoughts produced by your brain. Without an outlet, it is up to you to react and respond to all the whims of an overactive mind. If all this activity on the other hand can be directed towards a designated time frame, the bombardment will cease.

Here’s what to do:

In the early afternoon, set off 5-10 minutes and grab a pen and paper. During these minutes, try to get every single worry you can retrieve from your mind written down. The more material you find, the more stressors and worries you identify, the better.

Don’t expect anything to change in the first few days. But if you keep going, just like with any exercise, you will start seeing results. When your brain has an outlet, it will bother you less and give you more peace of mind to spend on things you enjoy.

And when you have more peace of mind, good sleep is soon to follow!

Nov 07
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Why sleep hygiene worsens insomnia

By Uncategorized No Comments

If there is one thing pretty much every person with trouble sleeping has come across it is sleep hygiene. This is a series of do’s and don’ts that presumably will help you sleep better. Here are some common ones:

-Go to bed and get out of bed the same time every day

-Avoid screens and light an hour before you go to bed

-Avoiding caffeine close to bedtime

-Make sure your bedroom is cool, 67-68 degrees for optimal sleep

-Keep the noise level low

-Avoid heavy/rich/spicy food close to bedtime

You’ve surely come across several of these recommendations that seem to be an obligatory part of every story or blog post on sleep.

Here’s the problem – not only does none of the above work for someone with insomnia, it creates a huge amount of sleep anxiety that makes it impossible to sleep!

Imagine that you’re having a hard time sleeping and decide to avoid spicy food and to keep the bedroom dark.

If you end up sleeping better initially, which is unlikely, that is very problematic. Because you have now started to believe that there are outside sources for producing sleep. When you have trouble sleeping the next time, you look again to make changes to how you eat or your bedtime environment. Soon you’re wrapped up in a complex belief system where you feel that you have to get 22 things right in order to sleep.

If you end up not sleeping any different, then you feel something is wrong with you because changing what you eat and your bedroom environment “isn’t working”. You go on to try other sleep hygiene recommendations and as nothing you do produces more sleep, you start believing that you have a really bad case of insomnia.

The problem with sleep hygiene is the implication that sleep is complex. A list of recommendations makes you feel as if you have to get all of these things right in order to sleep better. Not sleeping and you feel you must be doing something wrong which leads to a new round of researching things to try.

It is very important for you to know that sleep is not complicated. You have your sleep drive, your bodies need for sleep acting as the gas and hyperarousal, which could be stress or excitement acting as the brake.

We have talked about how to increase the gas and decrease the brake to get more and better sleep. In the next article we will look at how to start doing just that.

For now, know that sleep hygiene doesn’t help anyone with insomnia but in fact produces a lot of sleep anxiety. Instead of trying to follow a bunch of rules and regulations, try to do something fun before you go to bed. Something that makes you look forward to bedtime.

If you dread bedtime, which you probably do if that means avoiding stimulation for hours in a dark, cool, silent room. the likelihood of you sleeping well is slim.

If bedtime in the other hand is something you look forward to, a Netflix show or a great podcast, sleep is bound to happen.