Congratulations! You have taken action to improve your sleep. You have read this book. You have created a personalized sleep program. You have implemented this program, and modified it as needed. You have learned what works best for you to promote restorative sleep. Now what? This chapter will help you transition from your sleep program and maintain your gains. We will also address what to do if insomnia starts to creep back into your life. Worksheet 14.1 will help you pull together the work you do in this chapter.
You are likely wondering how long you will need to continue with your personalized sleep program. Is this your new forever? The answer to this question is yes and no. The “yes” answer has to do with your relationship with your sleep. Yes, we want your new perspective about sleep to stay with you. This program has encouraged you to shift from the “fix it now” focus to the “support it over time” focus. We certainly hope this is your new forever. This paradigm shift will allow you to recognize what needs to be done to promote your sleep over your lifetime. This new relationship with sleep will help you quickly recognize when you are pulled into the struggle spiral with sleep. It will help you put down the rope. You will no longer try to control your sleep; as a result, your sleep will have less control over you.
The “no” answer has to do with your day-to-day choices around your sleep. No, you do not have to stick to your personalized sleep program for life. Once you have reliable, restorative sleep, you will naturally consider returning to some of your old habits and patterns, such as reading in bed or sleeping longer when you can. If you are not feeling a strong pull in this direction, then we encourage you to continue with your program. It is working, after all. However, if you do want to make some changes, we have some recommendations.
You probably made at least one change that just feels “right.” Even if you resisted it at first, you can tell that this change supports restorative sleep. Going back to your old habit may feel good, in an indulgent kind of way, but you have a strong sense that this would ultimately be unhelpful. Examples from our clients include having a wind-down routine at bedtime, using the bed only for sleep and sex, having a consistent wake time, and using cognitive strategies to quiet their minds.
Based on what we know about sleep physiology, here are our top three recommendations of habits to continue:
Although these are our typical recommendations, everyone is different. You are not “typical.” You are you. What aspects of your program do you want to make your way of life? Record your answers on worksheet 14.1.
Healthy Habits to Continue. These are some of the things I want to continue to do to support restorative sleep and a positive relationship with sleep (for example, maintain a consistent wake time, practice mindfulness):
When to Take Precautions. Things that may trigger disrupted sleep in the future include (for example, work stress, relationship stress, travel, physical illness):
Preventive Steps. If any of these triggers are present, I can do these things to make myself less vulnerable to a sleep disruption (for example, have a more regular sleep schedule, decrease caffeine, prioritize my nightly bedtime routine/buffer):
If I have a LAPSE (a temporary sleep disruption)…
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…I may have these thoughts that could start an insomnia spiral: |
I want to respond with these more helpful thoughts: |
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…I may be tempted to engage in these compensatory behaviors: |
I can instead choose these more effective behaviors: |
If I have a RELAPSE (longer-term sleep disruption), these are the action steps I will take (for example, stimulus control, decrease struggle/increase acceptance, set designated worry time, make a new treatment plan):
Some of the behaviors that were helpful as you “worked a program” for insomnia will seem less important to continue. Perhaps you would like to take an occasional nap, sleep in on weekends, and drink more caffeine. Changing several things at once creates more stress for your body than does making one change. It also makes it difficult to assess the effect of each change on your sleep.
Start with the behavior you most want to change. Track your sleep and how you are feeling during the day. After a couple of weeks, take a moment to review the information you have gathered. If your sleep is less restorative, ask yourself if what you gained is worth this setback. Also ask yourself what you think will happen to your sleep if you continue with this particular deviation from your program. If the cost has been great enough, or you see danger ahead, you can return to your program.
If, on the other hand, your sleep is stable after making a move away from your program, then you can take on the next change you want to make. Repeat this process, always tracking the effect so you can make an informed decision about how to best support your sleep moving forward.
Most people stop using a sleep log once they are sleeping better. We encourage you to make flexible use of this tool moving forward. You may decide to complete it for one week each month. This will give you a snapshot of your current sleep habits. For example, you will see how consistent versus erratic your sleep-wake schedule is. If it has strayed from the degree of consistency that best supports your sleep, you can quickly self-correct, before you even experience sleep disruption.
You also may want to return to tracking your sleep at the first signs of any sleep disruption, or even when you are facing potential precipitating events. Finally, use a sleep log when you want to see the effect of a change, such as changing medications or your sleep schedule.
Remember to use your sleep log with an attitude of curiosity, not hypervigilance. You are simply collecting data. This data will help you use effectiveness to guide your choices.
Consider all you have learned about sleep and about your own insomnia spiral. What types of life events are most likely to disrupt your sleep? Work stress? Relationship stress? Being awoken night after night by others (for example, a baby or sick family member)? Physical pain or illness? Record your answers on worksheet 14.1.
One of the most common sleep disruptors is a schedule change. Pay attention. Are the holidays coming up? Do you have travel plans? Is Daylight Savings Time starting or ending? Is your work schedule changing drastically? To maintain your gains, prepare for schedule changes. For example, consider shifting your sleep schedule slowly rather than all at once. Or stay on your normal sleep-wake schedule even when you have time off from work or school.
When trying to determine how you want to handle the situations that put you at risk for sleep disruption, remember the sweet spot. Be watchful, but not hypervigilant. Take proactive steps to keep yourself on track, without being overly controlling and getting into a tug of war.
Did we just say do not get into a tug of war? What we meant to say is, notice when you get in a tug of war! Then drop the rope, before you get sucked down the insomnia spiral.
We all experience sleep disruption from time to time. A night or two of too little sleep or of poor-quality sleep is to be expected. We call a temporary setback a “lapse.” If your brain responds to a lapse by sounding the alarms, or with “quick fix” compensatory behaviors, then a lapse can turn into a “relapse”—a full return of insomnia.
Use worksheet 14.1 to prepare for the lapses you are sure to experience. What types of negative thoughts will your mind likely serve up? Will you jump to the conclusion that insomnia is back and here to stay? Will you struggle rather than accept your experience, telling yourself that you have to sleep, now? Will you worry about how you will get through tomorrow? Consider how you want to talk back to these negative thoughts. What are more realistic or helpful thoughts? How can you lean into your experience rather than struggle against it?
Now do the same exercise for behaviors. Will you have the urge to spend more time in bed to “make up” for the lost sleep? What would be a more effective choice?
We are optimistic that the knowledge and skills you gained using this workbook will help you ride out brief sleep disruptions without getting caught up in an insomnia spiral. But what if you do experience a relapse?
This is when we encourage you to return to a full CBT-ACT for insomnia program. The quicker the better. It takes less effort to stop a train that is slowly rolling out of the station than to stop a train that has been going full throttle for miles. Similarly, you want to stop the insomnia spiral before it picks up too much speed. Be prepared by knowing what parts of your program you are likely to use, based on your past experience. Go ahead and record this on worksheet 14.1.
If a lot of time has passed, or if your insomnia is of a different flavor, you may want to work through chapter 5 to develop a new plan. All of the worksheets are available electronically if you want fresh copies.
We also can think of lapses and relapses in terms of your behaviors, rather than of your sleep itself. That is, you can revert back to sleep-interfering behaviors but then quickly correct (a lapse), or you can get sucked into old patterns for weeks or months (a relapse).
Lapses are the unavoidable result of living your life fully. As odd as this may sound, they are the key to your continued success. These natural fluctuations are a sign of flexibility. And this flexibility is necessary for a long-term sustainable relationship with sleep.
For example, if you spend the weekend with some friends you may choose to stay up late each night and sleep in each morning. You may even take a nap. If you return to your usual schedule Monday morning, then you had a brief lapse into potentially sleep-interfering behaviors. And this lapse was in the service of spending meaningful time with friends. You let sleep support living.
But you also let sleep support living by quickly getting back to a more consistent schedule. This promotes restorative sleep over the long term, which promotes a better quality of life. Now imagine that your one weekend of flexibility turns into weeks of an erratic sleep schedule. Your behavioral lapse has turned into a relapse. This is more risky. There is a greater chance that you will lose gains in your sleep. Ironically, the more poorly you are sleeping, the more you will start to revolve your life around sleep.
We are back to the idea of the sweet spot. We encourage you to be flexible enough to support a rich and vital life, but not so flexible that you are undermining your body’s natural ability to sleep.
Anything you care about requires some nurturing. Sleep is no exception. Continue to promote restorative sleep throughout your life. Keep doing the things that support your body’s natural ability to sleep. Be aware of what may disrupt your sleep, and take precautions when these potential triggers are present. When you first experience sleep disruption, respond, but do not overrespond. If insomnia returns in full force, return to your CBT-ACT program. And, through it all, try to be willing to have whatever this particular night brings.