Workbook for session 4
Improving Your Sleep
Putting it all together
Controlling your future
Stress affects sleep and the quality of our sleep can affect
how we cope with stress. Session 4 teaches you how boost your
self-confidence by retraining your sleep
Session 4 will also review your learning and encourage you
to continue to work hard at putting it into action
Sponsored by Charlie Waller Institute from a donation made by the
James Wentworth Stanley Memorial Foundation
© Dr Jim White 2007
www.talkinttherapies.berkshire.nhs.uk
“I can go to bed at night feeling dog tired but as soon as that light goes out, my
mind comes to life. I can’t shut it down and get to sleep. I toss and turn and
feel rotten. Joe is fast asleep in seconds and I’m wide awake”
“I wake up at two in the morning with a load of stupid thoughts going round and round
in my head. I just get up and I spend half the night in the living room. I can't tell you
how lonely I feel then. And of course, during the day, I am walking about half-asleep
all the time"
“I’m quite down just now and I find that I’m awake at 4 in the morning. And
that’s me for the rest of the night. I’ll not get back to sleep again even though I
want to sleep more”
“I have to take a few drinks to get me off to sleep. But I wake up within a few hours
and that might be me for hours”
“I wake up and feel that I’ve hardly slept. I still feel tired and don’t feel I’ve got
the energy to face the day”
These are all quotes from people who have a sleep problem.
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Reasons for poor sleep
Sleep problems can come about for a range of reasons. Tick the ones that apply to you:
Stress
You may find that you are better as long as you can keep busy and distracted. When
you go to bed, a host of thoughts or worries can invade your mind. This stops you
from sleeping.
Shift work
This can badly affect sleep as your body can’t get into a good sleep habit.
Age
As we get older, we need less sleep yet often try to sleep for the same number of
hours as we needed when we were younger.
Need to go to the toilet
This is often tied to age. Most people over 60 get up at least once a night
Pain
Any illness that results in pain can cause poor sleep
Surroundings
Sleep can be poor if you live in a noisy street or if the neighbours are playing music till
all hours. Your room and bed may also play a part.
We will look at ways to overcome some of these later.
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Sleep problems and stress often go hand in hand. There are four main types. You may find
you have more than one. Tick the ones that fit your sleep:
Getting off to sleep
You may feel dog tired when you get ready for bed. But as soon as you get
into bed, you can’t get off to sleep. You are restless. You toss and turn. Your
body may be tired but you mind is not. Your mind bursts into life and you can’t
switch off. You get more and more annoyed and stressed.
Staying asleep
You may wake up at different times of the night. You may find it hard to get
back to sleep.
Waking too early in the morning
You find yourself waking at 4am or 5am and know that you are not going to get
any more sleep even though you want to.
Sleep quality
You feel that you don’t get a good night’s sleep. You may feel you don’t get
into a deep sleep. You may feel restless during the night. You do not feel
refreshed by your sleep.
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
What happens when we sleep?
Sleep is made up of 5 stages. When we first fall asleep, we go into Stage 1 sleep. This is
very light sleep.
As you go into Stage 2 and Stage 3, your sleep gets deeper.
By Stage 4, you are in a very deep sleep.
You then go into a stage called Rapid Eye Movement (REM) sleep. This is when most of our
dreams occur. (You will only remember your dreams if you wake up during this stage).
Once REM sleep is over, you go back to Stage 1 sleep. You go through this cycle about 4 or
5 times each night.
As you get older, you seem to need less deep sleep. This may be one of the reasons why
older people tend to wake more often during the night.
A lack of REM and Deep sleep can badly affect you during the day.
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Daytime effects of poor sleep
You need to sleep to recharge your batteries - both body and mind. If you don’t do this then
you will drag yourself through the day. You may feel like a half-shut knife. You may feel tired,
lethargic, irritable, less vigilant, take longer to react, make more mistakes, have poor
concentration and poor memory. You just don’t feel ‘with it’. If your sleep is poor for some
time, you will find it much harder to learn new tasks.
You may have a vicious circle - stress may cause you to sleep poorly, poor sleep causes
more stress and so on....
Stress
Poor sleep
Controlling stress should help improve your sleep. You can also improve your stress by
controlling your sleeping problems. This is a positive circle. The next section will show you
how to do this.
Controlling your stress
Getting a better sleep
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Getting a good night’s sleep
This handout will teach you how to assess and then treat your sleep problem. You will learn
to do this in 4 steps:
STEP 1: know your enemy
STEP 2: relaxation
STEP 3: retraining your sleeping
STEP 4: sleeping tips
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Know your enemy
You will find diary forms at the back of this handout. Each form lasts for 4 nights and asks
you 7 questions:
1. When did you try to go to sleep?
2. How long did it take you to fall asleep?
3. How often did you wake up last night?
4. How long did it take you to get back to sleep each time?
5. When did you wake?
6. When did you get up?
7. How was your sleep last night?
Fill them out each morning for at least three weeks. This will help you know your enemy
better. In turn, you will find it easier to know exactly what the problem is and how best to
fight it.
The Diary will also let you track your progress while using the techniques.
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Relaxation
Use either your relaxation CD or Breathing Retraining. The Breathing should be used as
described in that handout.
Follow these four stages if using the CD:
First stage
Learn to relax during the day (see ‘Controlling your Body’ workbook).
Second stage
Once you feel tired, go into bed and play the relaxation CD in bed. Use ‘Deep Relaxation’
Third stage
Move onto ‘Rapid Relaxation’ when you feel ready
Fourth stage
Try to get to sleep by relaxing yourself without using the CD
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Retraining your sleeping
This is a very good way to get rid of the bad habits that can keep poor sleep going. It is hard
to do but well worth it in the end.
You must follow this approach to the letter. There are six stages:
STAGE 1: Don't go to bed until you feel sleepy
Only go to bed once you start to feel sleepy. Don't go to bed because the others are going to
bed, or you feel bored or because it is 'bed-time'. You must stay up until you feel tired no
matter how long this takes.
STAGE 2: Your bedroom is only for sleeping
This step gets rid of the things that keep you from sleep. While reading a book seems like a
good idea, it is not. If you are reading, you are not sleeping, so it must go. So you should not
read, watch TV, listen to the radio, write letters, phone friends, etc. This does not include
sex. Sex can help relax you and may help you get off to sleep.
As soon as you get into bed, put the light out and try to sleep. Though you may know good
sleepers who read in bed or watch TV, you must do these things outside the bedroom at
least until you get on top of the problems.
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
STAGE 3: If you don’t fall asleep in 25 minutes, get up
If you are not asleep in 25 minutes, you may not be asleep in 50. So after 25 minutes, go
back to the living room. Don’t watch TV. Don't eat or drink. Try reading a magazine or
listening to relaxing music. You must stay in the living room until you feel tired again no
matter how long this takes. When you feel sleepy, go back to bed.
At the start, you will be up many times each night. It is hard to get out of a warm bed but you
must do this.
STAGE 4: Repeat (and repeat and repeat)
Repeat step 3 again and again if you have to. So you have 25 minutes each time to get to
sleep. If you don't - it's back to the living room.
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
STAGE 5: Get up early each morning
Get up no later than 8.30am. Set the alarm and as soon as it goes off, get up and out the
bedroom.
Even if you feel that you have hardly slept a wink, you must follow this to the letter. You
should also try to do this seven days a week, i.e. no lie-ins at the weekend until you get this
problem sorted out.
STAGE 6: Don’t try to catch up on sleep
You may want to nap during the day to catch up on lost sleep, e.g. after a meal. Don’t do it.
Save the sleep for bedtime.
Work out when you most want to sleep during the day. Then work out a way of dealing with
this - go out for a walk, phone a friend, etc.
KEEP AT IT
This is a very good approach but it is also a hard one to follow. It makes great demands on
you. It is very tempting to stay in bed after 25 minutes, to have along lie or to have an
afternoon nap because you can hardly keep your eyes open. Fight these urges the whole
way.
Don't expect rapid change. Your poor sleep may have built up over a long time. So it will
take time to get better.
To help you along the way, the next few pages offer tips to help your sleep:
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Sleeping tips
Your bedroom
Make sure the bed and room are warm. If your bed is past its best and if you can afford
it, think about getting a new one. The same goes for your pillows. Are the curtains heavy
enough to keep the room dark?
Noise
It might be hard to stop noise from outside the house. Make sure you control as much
noise inside the house as you can.
Your partner
If your partner snores or is restless, ask if he or she could move to another room if you
have one until you start to sleep better. He or she must move - not you - as you must
learn to sleep well in your own bed.
Exercise
Exercise can help you sleep better. Do this in the morning, afternoon or early evening. A
brisk walk for 20-30 minutes is as good as anything. But don’t do your exercise in the
three hours before bed.
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Relax before bed
Try to slow down in the hour before going to bed. Have a hot bath; listen to music, read a
book. If you work on the back-shift or are studying for exams, don't go straight to bed
from your work. Give yourself time to switch off. Try to build up a relaxed routine
Caffeine
Caffeine is a stimulant. You get it in tea, coffee, fizzy drinks, energy drinks and tablets,
some headache tablets and pain killers. Try to cut down your caffeine intake across the
day. Try to cut out as much as you can in the later afternoon and evening.
Smoking
Nicotine, like caffeine, is a stimulant. Don't smoke in the three hours before bedtime.
Never smoke during the night if you wake up. If you are a heavy smoker, you would be
best to give it up. Ask your GP for help.
Alcohol
If you rely on a night-cap to get off to sleep, you must stop this now. It may well get you
over to sleep. But as the alcohol level in your blood drops, it will wake you again in 2-4
hours. It will then be hard to get back to sleep. It also disrupts sleep rhythms and cuts
down your REM and deep sleep. Alcohol may keep stress alive and this, in turn, helps
keep your sleep poor.
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Warm milky drinks
The old wives were right! Ovaltine, Horlicks or warm milk may help you get more deep
sleep. Drink these instead of tea and coffee at night.
Food
Try not to eat for about two hours before going to bed. Your body starts to work to digest
the food. You want it to be slowing down. If you are hungry, take a very light snack. Try
not to eat during the night if you wake up.
Drink
Try to drink as little as you can in the evening. This may stop you from waking to go to
the toilet during the night.
Your sleeping needs
Most of us sleep around 7-8 hours each night. On the whole, we need less sleep as we
grow older. Yet older people still try to sleep 7-8 hours. This may explain why many older
people wake up in the latter parts of sleep. The amount of sleep also depends on your
life-style. If you have young children who keep you on the go all day, you may need
more sleep. If you are not active during the day, you may need less. Some people seem
to thrive on only 4 hours a night.
So you have to find your own level. This may mean changing habits such as going to
bed at the same time each night.
Start to get a grip on your sleep by filling out the sleep diary first thing each morning.
Keep filling them in as you use these ideas. You will then be able to see your
progress.
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© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Stress Control: Sleep diary
When did you How long did How often did
try to go to it take you to you
wake
sleep?
fall asleep?
during
the
night?
How long did When
did When
it take to get you wake?
you
back to sleep
up?
each time?
EXAMPLE
10.45
1) 25 min
2) 60 min
85 minutes
twice
7.15
8am
did How was your sleep last night?
get
Usual - was restless and getting angry with
myself. Didn’t feel rested at all when I woke.
Couldn’t stop thinking about work.
Night 1
Night 2
Night 3
Night 4
Night 5
15
© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Stress Control: Sleep diary
When did you try
to go to sleep?
EXAMPLE
10.45
How long did it
take you to fall
asleep?
85 minutes
How often did
you wake during
the night?
twice
How long did it
take to get back
to sleep each
time?
When did you
wake?
When did you
get up?
How was your sleep last night?
1) 25 min
2) 60 min
7.15
8am
Usual - was restless and getting angry with
myself. Didn’t feel rested at all when I woke.
Couldn’t stop thinking about work.
Night 1
Night 2
Night 3
Night 4
Night 5
16
© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Stress Control: Sleep diary
When did you try
to go to sleep?
EXAMPLE
10.45
How long did it
take you to fall
asleep?
85 minutes
How often did
you wake during
the night?
twice
How long did it
take to get back
to sleep each
time?
When did you
wake?
When did you
get up?
How was your sleep last night?
1) 25 min
2) 60 min
7.15
8am
Usual - was restless and getting angry with
myself. Didn’t feel rested at all when I woke.
Couldn’t stop thinking about work.
Night 1
Night 2
Night 3
Night 4
Night 5
17
© Dr Jim White 2007
www.talkingtherapies.berskhire.nhs.uk
Controlling your future
You have now learned a lot about stress and a lot about how to fight it.
Now you are at a crossroads. One road leads to control over your
stress. The other leads back to square one. This step will help you find
the right road.
If you do this, you will head down the first road. If you don’t, you might
end up back where you started.
These ideas will help you go down the right road:
Dealing with set-backs

Don’t expect progress to be easy or smooth. Set-backs are common. You should aim to
slowly increase the number of good days and decrease the number of bad days.

Try to predict when a set-back is more likely - if there are problems in the house, stress
at work, after drinking too much, etc. Work out ways to prevent it.

Don’t panic if you have a set-back. Accept what is going-on. Stand back and work out
why you are having the set-back. Then work out what you can do about it.

Don’t see a set-back as putting you back at square one. If you have taken five steps
forward and a set-back puts you back one step, you are still four steps up on the deal.
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© Dr Jim White 2007
www.talkingtherapies.berkshire.nhs.uk
Let others help you

Express your feelings to them and get things off your chest. Choose people you can trust
to help you. Be comforted by their concern. Listen to their advice. If the advice is sound,
act on it.
Learn to pat yourself on the back

If you have reached any of the goals you have set. If you faced and then solved a
problem. If you fought back worry then you deserve praise - give yourself some straight
away.
Build up supports

Stress can build up when you lack a range of supports in your life. If you have problems
in one area of your life, you can lean on other supports until you sort out the problem.
The moral is: don’t put all your eggs in one basket.
Make sure you keep relationships strong. Build up new interests, new hobbies. Work on
your social life. Make sure you have a structure to your day or week.
Watch for problems creeping up

Watch that old bad habits don’t creep in to your life. These could be to do with avoiding,
cutting yourself off from others, drinking to control stress. Jump in and stop these dead.
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© Dr Jim White 2007
www.talkingtherapies.berkshire.nhs.uk
Look into the future

Face problems that lie in the future. Don’t just worry about the problems - work out how
you are going to deal with them. Never just wait to see what happens. You must take
control.

Don’t leave things to chance - think and plan ahead. Use the ‘Controlling your future'
form on the next page. Most of all:
Believe in yourself
20
© Dr Jim White 2007
www.talkingtherapies.berkshire.nhs.uk
Controlling your future
Now that you have learned a lot about stress, the hard work must begin. It is like passing
your driving test - you know what to do but you have to practise hard before you will become
a good driver. Over the next few weeks and months, you should keep an eye on your
progress using this form.
End of the first week:
End of the first month:
End of the second month:
End of the third month:
21
© Dr Jim White 2007
www.talkingtherapies.berkshire.nhs.uk
20 ways to cope
Read through all these ideas and pick up the one's that best meet your need.
1) Deal with problems on the spot
Don't bottle up your feelings. They will grow and grow inside you until they erupt. This will
weaken your sense of control. So if there are problems at, e.g. work, make sure that you
deal with them on the spot. Use Problem Solving to deal with them.
2) Strong, confiding relationships
Stress often makes us harder to live with. This can weaken relationships. But we know that
strong relationships can help fight stress. So if you have a weak relationship, work hard at
fixing it.
3) Slow down
Don't do things at 100 miles an hour. Eat, walk and drive more slowly. If you don't get as
much done as you would like then it is no big deal. There is always another day.
4) Divide problems up
If you face a huge problem and can see no way to cope with it, see if you can divide it up
into ‘bite sized’ bits. Then tackle the bits one at a time. Problem Solving is very good for this.
5) Must’s and Should’s
"I must see my mother today"; "I should offer to run the football team this year". Work out
what is reasonable for you to achieve and be happy with this - "If I get through all the things I
want to at home, I'll take a run down to my mothers. If not, I'll see her later in the week"; "I
22
© Dr Jim White 2007
www.talkingtherapies.berkshire.nhs.uk
don't get a chance to relax as it is so it's daft to take on more pressure - someone else can
take a turn"
6) Coping with ruts
If you feel your life is in a rut just now - same old routine day in and day out then think about
change. Plan your week-ends - do something different - go for a drive, visit friends, go for a
long walk. Take up new hobbies. Look for challenges. If you can afford it, plan the odd
week-end away as a change of scenery can help.
7) One thing at a time
Think of someone at work cradling a phone between his shoulder blade and ear. With one
hand, he is writing a letter and, with the other, searching through some papers. At the same
time, he is trying to grab a quick snack. He is overloading the system. If you are making a
phone call, make only the call and nothing else. The message is don't keep too many balls
in the air at the one time.
8) Look and sound relaxed
Other people will pick up how you are feeling by seeing your ‘body language’. So try to look
relaxed, e.g. don't sit on the edge of your seat, slow down your speech, relax your
shoulders, don't fidget. Ask those close to you how you act when you are tense so that you
know what changes to make. You will feel better if you know that, on the outside at least,
you are looking calm. Use relaxation to help.
9) Past experience
If you are in a jam, ask yourself if you have been in a similar jam before. How did you deal
with it? If what you did worked, try it again. If it didn't, learn from your mistakes.
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© Dr Jim White 2007
www.talkingtherapies.berkshire.nhs.uk
10) Don’t accept other people’s targets
Do people expect too much of you? If you feel they do, confront this. Have a quiet word and
try to sort this out. If you can’t agree, say 'NO'.
11) Eating
Some people suggest that supplements of vitamins A, C and E help stress but this will not
help unless your diet is very poor. Bear in mind that taking too many vitamins can be as bad
as taking too little.
It may be that you can reduce stress levels in the short term by taking a lot of
carbohydrates (potatoes, rice, pasta, bread, etc.) and cutting down on protein (meat, fish).
So if you face a very stressful day, you might plan to have this meal the night before. But as
you need balance in food, do not stick to a diet like this for more than a few days.
Over the long term, try to eat more healthy foods - get away from fried and fatty food. Cut
down on sugar and salt. Eat fewer sweets and cakes. Eat more fruit, veg and whole-wheat
bread. Don't eat too much.
12) Smoking
Some people find that smoking helps them to relax. But smoking kills. It also floods the body
with nicotine. This stimulates the body and may increase feelings of stress. Try to stop. Ask
your GP for help.
13) Situations out of your control
There are things in life that you can't change - maybe you are out of work, maybe a loved
one is ill. If you accept that you can't do anything to change things for the better, this may
help deal with the stress that remains.
24
© Dr Jim White 2007
www.talkingtherapies.berkshire.nhs.uk
14) Build relaxation into your life
No matter how busy you are, put aside some time each day just for you. Go out for a walk,
phone a friend, do the garden, read a book, watch TV, listen to music. Once you stop using
the tape to relax, try to keep this time for yourself.
15) Prioritise
If you do have a busy life, you must set up your priorities. Decide what has to be done and
decide what can wait. Put these priorities in some order. Number 1 has to be done first
thing, number 2 by 12 o’clock..........number 10 has to be done by the end of the week. Keep
revising your list.
16) Do the worst thing first
If you have a list of things to do, do the one you least want to do first. You can get it out of
the way and the rest of the tasks will be easier to cope with. If you keep putting it off, it will
prey on your mind and may seem a lot worse than it really is. Tie this in with your priority list.
17) Don’t try to be Superman or Wonder woman
Do you try to do it all? succeed at everything?, be the best?. Why? Bear in mind that the
house or your job will still be there long after you are gone. Stick to your good points and
learn to live with your faults. Accept you are not perfect. None of us is.
18) Confide in others
If there are people around whom you can trust, let them know how you feel. They may be
able to see ways out of problems that you have not thought about. In any case, getting
things off your chest can help. It may also help reduce the feelings of being alone that are so
common in stress.
25
© Dr Jim White 2007
www.talkingtherapies.berkshire.nhs.uk
19) Other people’s shoes
Imagine you have a problem. Imagine how you would react if a friend came to you with that
same problem. What advice would you give them? Would that advice work for you?
20) Keep up a routine
If you are off work, make sure you get up early. Make sure you get dressed first thing. Make
sure you eat cooked meals at the right times. As far as you can, make sure you do the same
things that you normally do. Keeping a structure in your day will help hold back the
problems.
Good luck
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© Dr Jim White 2007
www.talkingtherapies.berkshire.nhs.uk