Getting to Sleep

A Self-Management Program For Overcoming Insomnia

©2005 by Health Psychology Associates

All Rights Reserved.

 Insomnia is a common problem, especially with individuals who are suffering from pain or illness. Insomnia has been shown to be associated with a vairety of health problems, including reduced functioning of the immune system, increased irritability, increased pain, diffculties with concentration and weight gain.

Fortunately, there are many effective treatments for insomnia. Some of the treatments for insomnia rely on medications, while others involve the use of a variety of self-management techniques. Recent research has shown that self-management techniques for controlling insomnia in some cases can work even better than approaches using medications. (See research)

Here are some things you can do to help yourself fall asleep:

  1. If you have a pain condition, ask your physician or physical therapist about their recommendations (e.g. what position, types of pillows, use of hand splints, etc.)
  2. Eliminate caffeine from your diet (coffee, tea, soft drinks), especially after noon. Decaffeinated drinks are fine. If you use a lot of caffeine, decrease it over a week or two to avoid headaches.
  3. If possible, increase your level of activity to help you get tired. This may be difficult if you have an illness or injury. Ask your physician about what is safe for you to do.
  4. Decide what time you would like to go to sleep, and when you would like to get up. This will be the goal that we aim for.
  5. Even if you are tired, avoid naps. Napping will usually just make it more difficult to fall asleep in the evening. Also, avoid spending time in bed when you are not sleeping. Try to reserve being in bed for sleeping and intimacy.
  6. Earlier in the evening, before you go to bed, make a list of things you will need to do tomorrow or in the near future. Once you have made the list, put it away and focus on relaxing. You can start working on your list again tomorrow, and you will have more energy to tackle your list if you get some sleep.
  7. Get into a calming bedtime routine that you start 30-60 minutes before your desired bedtime. Avoid watching tense or scary movies, or other highly stimulating activities. Find some activities that you find calming, and that take your mind off of things that are bothering you. This could include using a relaxation CD, reading, taking a hot bath, having a warm drink (such as decaf tea or milk), or listening to music. Avoid using alcohol to feel drowsy — it tends to contribute to waking up in the middle of the night.
  8. Go to bed when you get drowsy. You may want to continue your relaxation exercises on your CD. Many people find the breathing techniques to be the most helpful ones. If you fall asleep, great!
  9. If you have not fallen asleep after 20 minutes or so, don’t allow yourself to lay in bed and get frustrated. Get up, and repeat #6 until you feel drowsy. Starting a movie is often not helpful — you may be tempted to stay up to see the end of it! In contrast, reading will often make your eyes feel heavy.
  10. If you wake up in the middle of the night, repeat #6-8.
  11. Whether you sleep well or not, get up at the desired time each day. Don’t sleep in, even if you slept poorly. You will probably feel very tired the next day, but that will make it easier to fall asleep the next night. In contrast, sleeping in will only make it more difficult to fall asleep in the future.
  12. As you continue with this routine, it will encourage your body to get in to a more normal rhythm of sleeping and being awake.
  13. If you have tried the above and continue to have difficulties sleeping, discuss this with your physician.

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