Research & Articles

“If you can’t sleep, then get up and do something instead of lying there worrying. It’s the worry that gets you, not the lack of sleep.

– Dale Carnegie

Carnegie’s quote taps into the heart of the matter – worry about sleep. The worry so many people know all too well. Lying in bed hoping and struggling to fall asleep. Sometimes it is more than worry. Sometimes it is panic. Panic due to feeling out of control. Panic about the dire consequences if you keep missing out on sleep.

This worry can pervade your waking hours. Even during the day, you can find yourself apprehensive about the possibility of another difficult night of sleep.

Unfortunately, telling yourself to stop worrying rarely works. Just reading Carnegie’s good advice will not magically turn a person into someone who no longer “worries” about sleep. If it were only that simple.

So, what to do? It’s not a problem easily ignored. It forces you to pay attention. You could continue doing what you are doing. If so, you can probably expect about\ the same results. Or you can try something different. But what should you try?

We believe your best bet is to choose a treatment that is supported by highquality research. That research strongly points to Cognitive Behavioral Therapy for Insomnia (CBT-I). In the pages below, you will see that reputable scientific and medical organizations judge CBT-I to be the treatment of choice for insomnia. Our recommendation is, therefore, that you should try CBT-I for sleep problems that cause distress or interfere with your life.

To give CBT-I a fair chance of helping you, it should be done properly. Optimally, you should obtain assistance from a licensed practitioner who is trained to administer CBT-I. Unfortunately, that may not be possible, which is the primary reason we wrote this book. The SomniSkills Workbook was written to mimic, as much as possible, the treatment program that would be provided by a trained CBTI practitioner.

For the best outcome, it is best to follow the step-by-step instructions in the Workbook. We have worked hard to make those instructions easy to follow. But even if you are not ready to commit to following all the instructions, you will benefit from simply reading the SomniSkills Workbook. It will give you an excellent idea of what CBT-I is all about. You will learn exactly what the experts are recommending. You are also bound to learn some useful information about insomnia and how to cope with it.

Finally, we want to make four important points about the SomniSkills Workbook:

  1. This book was written for anyone who wants to improve their sleep. Don’t concern yourself with whether you meet the diagnostic criteria for “insomnia.” For our purposes, the term “insomnia” refers to sleep problems that are upsetting or interfere with a person’s life. If that describes your problem with sleep, then you are likely to benefit from the SomniSkills Workbook.
  2. We do not believe in a one-size-fits-all approach. Everyone is different. A variety of factors can contribute to sleep problems. The causes of your sleep problems may not be the same as the causes of another person’s. The SomniSkills Workbook offers a tool called the “Formulator.” The Formulator enables you to identify the factors contributing to your sleep problems. Then you will be guided to create a personalized treatment plan designed to address those factors.
  3. You do not have to give up sleep medication to benefit from CBT-I. Many people depend on sleep medication. Many do not want to give up sleep medication until there is a better alternative. You DO NOT have to give up sleep medication to benefit from learning the SomniSkills taught in this Workbook. We devote an entire chapter to the use of sleep medication.
  4. The guiding principle of CBT-I is that you can control how well you sleep. Getting a good night’s sleep is not a mysterious, uncontrollable event. You can do something about it! It basically comes down to changing habits. The goal is to rid yourself of habits that interfere with a good night’s sleep, while developing habits that improve sleep. We call the beneficial habits, SomniSkills. The steps to learning the SomniSkills are not difficult. Anyone can do them. It requires more than just reading an inspirational quote like Dale Carnegie’s. But the benefits are available to those who persist.

Many people believe that insomnia will hurt their performance the following day. You may be surprised to find that there is no clear scientific support for that belief. Here are two quotes from scientists who reviewed the research:

“Results from the present review challenge the assumption that daytime functioning deficits are associated with insomnia. Objectively measured daytime sleepiness is not elevated in people with insomnia, and most cognitive/psychomotor tasks do not indicate deficits in people with insomnia.”

“Yet, while subjective complaints of impaired wake-time functioning are well documented, consistent objective evidence of these impairments has proved elusive, particularly with regard to cognitive functioning.”Do you doubt these conclusions? If so, please consider the possibility that your doubts may be due to what is called “confirmation bias.” Confirmation bias refers to the tendency to notice events that confirm our pre-existing beliefs. Everyone is prone to confirmation bias.

Here is how it would work in the present case: You are more likely to notice and remember the times when your daytime functioning was not so great after a poor night’s sleep. But you are less likely to notice and remember the times when your daytime functioning was fine after a bad night’s sleep. Also, you are less likely to notice and remember the times when your daytime functioning was not so great after a good night’s sleep.

Riedel & Lichstein (2000). Insomnia and daytime functioning. Sleep Medicine Reviews, 4(3), 277-298.

Shekleton, Rogers & Rajaratman (2010). Searching for the daytime impairments of primary insomnia. Sleep Medicine Reviews, 14 (1), 47–60.

People often make “predictions” about their future. Whenever we expect something to happen, we are basically making a prediction. For example, we often expect (predict) that we will feel certain ways in future situations, such as the dentist’s office, on a date, in a job interview, flying in a plane.

Predicting a dreadful day due to a poor night’s sleep is another example of making a prediction.

There is a lot of research on how accurately we can predict how we will feel in the future. The research provides some good and bad news. The good news is that the future is usually not as bad as our negative predictions suggest. Why? Because unexpected things happen to make the experience less negative. For example, you might expect a terrible day at work after a bad night’s sleep. But unexpected positive events often occur. You might receive some unanticipated good news. Or you may have an unexpectedly satisfying social interaction. Or you might find that your performance at work was better than you expected. Or you might feel less tired than you expect. The bottom line is that unexpected positive things often happen to make negative predictions less accurate.

The bad news that the same is true for our positive predictions. They too are also often not accurate. Why? Because something unexpected often happens that makes the event not as positive as we expect. For example, suppose we have great expectations about an upcoming trip to an amusement park. But the bus is late, it is very crowded, it rains, the lines are long.  It turns out the event is not quite as positive as you expected. Likewise, the day after a good night’s sleep may not be as great as you expect. You might sleep so well that you oversleep. You might feel groggy from so much sleep. Or something entirely unexpected might happen to spoil your positive expectation.

The bottom line is that the day after a bad night’s sleep is often not as terrible as we expect. Likewise, the day after a good night’s sleep is often not as great as we expect.

The Stimulus Control Procedure is an important part of CBT-I and  the SomniSkills Program. A great deal of scientific research has demonstrated that Stimulus Control is an effection procedure for the treatment of insomnia

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