How can the time needed to fall asleep be shortened?

There are lots of different things that will help. One thing to remember is that it’s not just a matter of changing what a person might do once they get into bed (although there are certainly things that will help.) They need to also think about what they do during the day,

during the evening and at bedtime. The things to do are set out as a checklist. What is really important is that most of these things need to be done for at least three weeks. Poor sleepers are great at saying that they have tried ‘everything’ and

‘nothing works’. Just as antibiotics won’t kill all the bacteria in just one or two days – don’t expect this

program to work straight away. Persistence and a positive attitude are everything.

Good sleep depends more on what

happens before bed than in bed.

Another important point is that many poor sleepers feel they take hours to get to sleep. Yet when they are tested in a sleep clinic

almost all are asleep within 20-30 minutes, they are not good at judging how long they are awake for. It’s not because of the different setting in the clinic for sleep, as care is taken to have them sleep many nights in the sleep clinic to adjust. It is likely to be because of misperceptions about sleep⁸² or because their higher level of anxiety changes the perception of time.

Anxiety can make time slow down.

A poor sleeper doesn’t need to do everything set out below for three weeks (e.g. the warm bath may not suit every night) but most are not optional. After three weeks they can start to think about which ones are more important. By then they will have more insight into what helps get off to sleep. Three weeks may sound like a long time, however the time will pass whether they continue to have poor sleep or improving sleep.

Bedroom

Get rid of the clock by your bedside Have a comfortable mattress

Don’t overheat with heavy bedclothes Reduce noise

Ensure there are no disturbances such as pets Feel secure (a night light might be helpful)⁸³

Daytime

Have predictable (routine) going to bed and getting up times Don’t sleep in long in the mornings (not even on weekends)

Have no naps – they take the edge off the sleep pressure you need Set aside a ‘worry time’ if you tend to take your worries to bed If you don’t get much exercise try to get out and walk during the day Evening

Avoid all caffeine after 4pm⁸⁴

Don’t have a heavy meal late at night

Any alcohol should be in moderate amounts only, preferable with food⁸⁵

Don’t do major exercise at this time of day

Don’t do activities that make it hard for you to unwind (eg nothing too exciting or upsetting)

Don’t fall asleep on the couch, not even for a minute

83 see Q6.5 about night time fears

84 See Q3.3 on the effects of caffeine on sleep

Bedtime

Get ready for bed in good time and wait for a wave of sleepiness – we have one about every 90 minutes – learn to recognise yours Have a warm milk drink (it contains a substance that may make you

drowsy) or camomile tea (takes a few weeks to works best⁸⁶) Take vitamin and mineral supplements if necessary. Lack of

necessary things in your diet may be making you feel stressed and unable to sleep⁸⁷.

Enjoy a warm bath (a shower is OK too– but a good warm soak is more relaxing)

Do relaxing activities you enjoy (eg music, TV, computer games, Gameboy, magazine, or novel – not school-work if it stresses you) Think positively about getting into your snug, calm bed

In bed

Make sure your feet are not too hot or too cold (a hot water bottle may help)

Remember your attitude about your sleep is very important – any anxious thoughts or worries need to be gently pushed aside.

Control your emotions and any tendency to worry.⁸⁸

Once in bed your only job is to do a couple of things. Take your time- there is no hurry- the night is yours now.

The first step is some muscle relaxation that starts at your toes and ends at your head. (See Box 4.1 below for a description of this or Appendix C if you want to make yourself a recording to relax in bed with.) We might think that it’s easy to relax but many people need to learn how to do it first, like riding a skateboard, and this takes time.

86 See Q4.5 about alternative therapies

87 See Q4.4 about non prescription tablets

The second step is to say to yourself a series of ‘feel good’

statements. These could be things like ‘Resting in bed is nice.’ ‘I feel calm.’ Only use words that make you feel good, like - snug, nice, rest, pleasant, good, cosy, comfortable, safe. Avoid any words about stress, worry, anxious, sadness, or fear. These are what we call ‘negative’ words and have no place whatsoever in bed. If you find some unwelcome thoughts creeping in try to gently push them aside and replace them straight away with a ‘positive’

sentence.

It sounds a bit weird but it will help you relax and feel better if you make yourself smile a little as you lie in bed in the dark- no-one will see you. For reasons that we don’t understand the physical action of smiling has all sorts of good effects on the mind and makes us feel better.

If you are not moving into a pleasant sleepy state, repeat the second step. Remember all these tips may take time to work for you and you need to keep doing them for at least three weeks.

Box 4.1 Muscle relaxation

Lie on your back and put your arms by your side. Relax your feet so they fall outwards.

Take three slow, deep breaths and notice how the air moves in and out of your lungs.

Think about your toes and tense them while counting up to three. Then slowly release the tension from them. Now, working upwards from your toes, tense and release each part of your body in turn. Keep your eyes gently closed. Take one or two slow deep breaths when moving between different body parts.