5 June 2020
With any change in your usual daily routine, there can be an impact on the quality and quantity of sleep you get. This blog explores some of the factors that influence sleep, together with how hypnosis can be used to promote better sleep.
Firstly, what is sleep? ‘Sleep’ can be defined as a natural and reversible state of reduced responsiveness to external stimuli and relative inactivity, accompanied by a loss of consciousness. Sleep generally occurs at regular intervals and is homeostatically regulated, where the body aims to maintain a state of internal balance (even when encountering external influences).
What is healthy sleep? We can think of healthy sleep as benefiting our physical and mental health. Yet we often don’t think in terms of healthy sleep; we more often think of good sleep. ‘Good’ sleep is very personal to us as individuals, and reflects our attitudes, behaviours and habitual routines. Common expectations for good sleep, include:
Achieving seven to nine hours sleep on a regular basis.
Waking up feeling refreshed.
Falling asleep within twenty minutes of lying down with the intention of sleeping.
Feeling productive and alert throughout normal waking hours.
No sleep disturbances e.g. waking, restlessness, pauses in breathing, or other indications of disruption.
Sleeping for long periods, without long periods of being awake during our intended sleep period.
Sometimes those beliefs about sleep can be unrealistic and lead to stress due to expectations having not been met. For example, you might have enjoyed ten hours sleep as a teenager, yet in your 50’s you might only physically and mentally need six hours. However, you may feel you are missing out if you are not getting your full ten hours. This stress can then have an impact on your quality of sleep and overall quality of life.
With cognitive hypnosis techniques and talking therapy approaches, such as Rational Emotive Behaviour Therapy (REBT) and Acceptance and Commitment Therapy (ACT), you can explore a client’s unhealthy beliefs about sleep, and help them to develop and engage with more healthy and rational beliefs, thereby leading to less disturbance and a better quality of sleep.
Hypnotherapy and your circadian rhythm
In the brain, your hypothalamus controls your circadian rhythm. Our natural circadian rhythm controls our sleep/wake cycle and is like an internal 24-hour clock. A significant influence on our circadian rhythm is the presence or absence of light. When it is dark, this is signalled to your brain, which then generates the release of the sleep hormone melatonin, making your body tired. This is why night-shift workers can have a more challenging time getting sleep when it is needed.
Exposure to natural light is important for good alignment of our circadian rhythm, as well as having a positive effect on mood and the availability of neurotransmitters such as serotonin (that increase feelings of well-being and happiness). Indeed, light exposure can alter a person’s circadian rhythm. A study suggests that morning light advances our internal clock and evening/night light delays it, suggesting that even a short burst (5 minutes) of bright light can impact on circadian phases. As such, it can be good to avoid turning on bright lights if you get up in the night and certainly avoid checking your emails and social media!
Different types of sleeper
We routinely have times when we are more alert and times when we are more sleepy. Do you know if your client is ‘a lark’ who tends to be more alert first thing in the morning, or an ‘owl’ who is more alert in the evening? A questionnaire, such as the Morningness-Eveningness Questionnaire can be used to gain lots of information about a person’s sleep preferences. Do bear in mind though, that ‘chronotype’ (sleep behaviour type) can change over time according to age. Children may benefit from more sleep or a later/earlier start or end to their day, and the same with the elderly. Some people will naturally prefer very little sleep (wake early and go to bed late) and others will need much more sleep to function well.
There are some myths about sleep types that have been challenged in research in recent years, including Ben Franklin’s “early to bed, early to rise, makes a man healthy, wealthy and wise”, which was challenged by research published in the British Medical Journal in 1998. A study of 1229 adults aged over 65 found no indication that larks were more healthy, wealthy or wise than those with different sleeping patterns. Indeed a 1999 study found that night owls may indeed be wiser than early risers!
However, it might be true that male night owls have a greater sex life! A study in 1992 found that men who preferred to stay out late had greater mating success. However timing of ‘performance’ may have an impact, according to a paper exploring baseball players performance over two years. Larks did better in earlier timed games, whilst owls did better in later games.
Several studies exploring novelty-seeking and ‘bad’ habits, such as smoking and alcohol consumption found that owls are less likely to stop smoking and consume more alcohol and other stimulants (e.g. coffee) than larks. This is interesting as both nicotine and alcohol can impact on quality of sleep. Could this be why larks (‘morningness’) can be more proactive and associated with agreeableness and conscientiousness, whereas night owls are more predisposed to procrastination?
Could it be beneficial for the client and/or therapist to establish their chronotype and schedule therapy to optimise their potential performance? For clients, quite possibly, although timing the session can also benefit the therapist’s creativity. Author, Daniel Pink, suggests there can be a 20% variance in cognitive task performance. Lark hypnotherapists may find it easier to engage in analytical tasks and make decisions in the early part of the morning, whilst they are likely to be more insightful and creative in the later afternoon and early evening. In contrast, owl hypnotherapists do better with insight and creativity in the morning and analysis and decision-making in the late afternoon or early evening.
Sleep and hypnotherapy
Having not enough sleep can be as unhelpful on cognitive performance as having no sleep at all. Interestingly, you might be the last to know this is happening, as cognitive performance can drop without you being aware of it and, according to research, we tend to over-estimate how much sleep we have had.
Poor sleep is a common reason for clients to seek hypnotherapy. One estimate suggest that 1 in 3 adults don’t get enough sleep and it was found that people who were unable to work had lower healthy sleep duration. This is particularly relevant during the present Coronavirus issues and can add to a general baseline of stress. This then can impair cognitive function, which can further add to stress, particularly if someone is having to adapt their way of working (e.g. from home) or find other ways to occupy their time. For example, someone may wish to make use of their free time to study, yet find it difficult to focus when fatigued.
Fatigue can be mental or physical in origin, with mental or physical contributory factors. For example, someone may be physically tired as a result of a virus, yet talk of psychological and social stress from family responsibilities. In addition, a lack of stimulation (e.g. in a monotonous situation/routine) can be as fatigue-inducing as a tiring situation.
Helping clients to get better sleep can have many health benefits, as sleep duration is associated with cardiovascular disease, diabetes, hypertension, mental health issues and obesity. A hypnotherapist conducting an initial consultation (or ‘intake’) for a client presenting with any psychological or physiological issue will commonly explore lifestyle factors, including sleep. It is at this point that improving sleep may become a higher priority for the client. In addition, when quality of sleep improves, clients can notice a positive change in their presenting issue.
During any change in routine there can be an adjustment process of adaptation, starting with disconnecting with old ways and beginning new ways of acting. These are repeated until life feels more predictable. This is a time that can feel very uncertain. There can be a sense of lack of control and uncertainty. Keeping a diary can help recognise thoughts and emotions.
It is at this point that the hypnotherapist can help a client with a range of behavioural and cognitive strategies, working to develop beneficial habits and positive coping strategies and ways of thinking. In addition, the use of future pacing can help the client use their imagination to explore potential responses and select the most appropriate ways of responding to new situations. Then, beyond the hypnotherapy session, teaching the client self-hypnosis enables the client to use their imagination to fine tune and practice their new ways of responding.
When people start to feel more settled in their new routine there can be a sense of despondency and loss for their old lifestyle routines. At this point, clients may feel unmotivated and lacking the mental energy to engage in positive change. At this point, it can be useful to help clients define a clear routine and structure to their week, as well as setting short and long-term goals. If someone is particularly demotivated, it can be better to encourage simple, small tasks, with breaks in-between, rather than large tasks which can appear too daunting. For example, (1) having a shower, (2) drying hair, (3) getting dressed, rather than one single task of ‘getting ready’.
This same ‘chunking’ approach can be taught to clients for them to use to address anxious thoughts. Anxiety can lead to fatigue and poor sleep. Additional poor sleep can then make people feel even more tired and anxious! Therefore, addressing anxious thoughts can be useful, whether it is using cognitive therapies (such as CBT or REBT), or mindfulness and meditation approaches. Some hypnotherapists might only wish to address unhelpful or irrational thoughts in the therapy room. However, by teaching a client how to address their own thoughts, there are several benefits. Firstly, the unhelpful thought can be immediately addressed, rather than perhaps having to wait a week for their next therapy session. Secondly, by addressing the thought immediately, it is less likely to be repeated, and thus doesn’t get strengthened. Also, it is much more empowering for the client to be able to address their own thoughts and helps promote emotional responsibility and autonomous change.
Emotional responsibility can help a client engage more in new situations, even if they are perceived as undesirable or unpleasant. Furthermore, whilst during times of uncertainty clients may say they feel suspended or paused, there are still opportunities to make plans, and an empowered client is more able to do so. Indeed, having short-term SMART goals can help with creating a structure which can be psychologically supportive. More medium-term goals can be formulated which are flexible and offer a range of options that acknowledge the present uncertainty, yet show there is some control over decision-making. As part of any hypnotherapy session a therapist can help a client to define clear and meaningful goals, not just for the session itself, but for the client’s ongoing benefit.
Sleep tips for clients
When addressing sleep issues with a client, in addition to work within hypnosis, a therapist may offer some practical help and advice too.
Boosting production of melatonin
The hormone responsible for sleepiness is melatonin. This is naturally produced when it starts to get dark. However, our modern lives, with blue light from screens and artificial lights tend to interrupt that production. For short-term sleep disturbances, some people will take supplements, such as melatonin tablets. Also, tart cherry juice which has been talked about for a while (although the NHS suggest that there may be a difference between fresh and concentrate juice). It can be useful to check whether the client is taking any sleep aids, whether prescribed or not, as some can cause daytime sleepiness as well, which may impair their hypnosis experience.
One practical measure that can be suggested to aid melatonin production is for clients to make their room as dark as possible. It is possible to buy great blackout curtains and blinds. Some also offer a reduction in solar heating, so will help to keep the room cool. Most people will sleep better in cool (although not uncomfortably cold) rooms. If a client is unable to blackout the room (e.g. when travelling), then a comfortable eye mask can be really helpful.
Moderating screen time
On the topic of reducing light at bedtime, it is recognised that the blue light from phones/tablets/computer screens can interfere with the body’s ability to produce melatonin. It can be natural to want to keep up to date with the latest developments in the world. Yet the light from a mobile device, and the stimulation from reading news and engaging in social media can prevent the mind calming. If you find that your client is getting stressed from being online too often or too late at night, and it is impairing their sleep, then it may be helpful to discuss with them how they can keep up to date with everything they need to, yet perhaps have a specific time (long before bed-time) to do this, rather than last thing at night. This means they can let their thoughts be occupied by other matters and process any negative thoughts well before they settle down for the night.
Develop a daily and weekly routine
For most people, a daily routine gives your internal clock something to map the passing of time against. Have you ever been working really hard at a 9-5 job and then you go away on holiday and feel really out-of-sorts just lounging around on the beach? It is your body adapting to a new normal. This adjustment to ‘new normality’ can take a couple of weeks for some. Then, you return home and your old routine suddenly seems more difficult and you need to get used to it again. At times of change, a hypnotherapist can help a client to develop a new and positive routine and better connect to their direction in life.
We know that having a consistent ‘going to sleep’ routine, where you do the same things at the same time each night (e.g. bath, read, turn down lights, relaxation activity), develops a conditioned response. The mind and body learn that those steps in the routine mean it is time to go to sleep and, as you start to become more relaxed your circadian rhythm can start to release hormones that will reduce your sense of alertness and promote feelings of sleepiness. However, it’s not just bed-time routines that will benefit a client here.
If a client normally works Monday to Friday and they do different things each week night, with leisure time at weekends, then keeping that weekly routine, as far as possible, can be beneficial. It can give a sense of reliable normality. A creative approach may be needed at times, such as currently with the COVID-19 situation. For example, if they are not able to meet up with their usual Wednesday night book club, explore whether they can do this online via Zoom or Skype. Or, if they usually have a gym buddy and can’t get to the gym, perhaps they could do a workout via Facetime, or have a social-distancing calisthenics workout in the garden/park, so they can still get that sense of collaborative competition.
When helping clients overcome insomnia and sleep issues, it might seem that you are looking at the very fine detail of a client’s life and considering aspects that the client would normally resolve for themselves. Sometimes, a therapist taking an external view of a problem can help a client get a new perspective. This flexible approach then offers a way of responding to future problems that a client can learn to apply for themselves.
Increase physical activity
Having a range of exercise activities built into your daily routine can add variety into your schedule. Although the same weights or treadmill routine might get the exercise box ticked, you are working the same muscles each day. Instead, if possible, it can be helpful to mix up your workouts and include both aerobic and resistance activities. Perhaps go for a walk one day, do cardio the next, then weights, then stretching. Whilst a research study in 2019 found that evening exercise doesn’t negatively affect sleep (they found the opposite), they do suggest that it is better to schedule vigorous exercise at least one hour before bed to avoid sleep disturbances.
For clients who are reluctant to formally exercise, some session time might be spent exploring alternative ways of being active. It is surprising how much energy it takes to vigorously scrub a bathroom or clean all the windows in a house. There is then the immediate added benefit of a clean home which is instant evidence of achievement, as well as the expended energy resulting in better sleep. This then can motivate other activity.
Reduce stress and increase relaxation
Asking a client about their daily routine can give great insight into potential stressors and also what they are doing to reduce their stress. Any change in lifestyle or personal circumstances can have an impact on stress levels and the production of stress hormones such as cortisol. Whilst cortisol levels generally fall in the evening, high stress can prevent that happening and sleep can be disrupted. Over time, this can lead to ‘sleep-debt’ with an impact on quality of life when chronically sleep deprived. The impact on mental and physical performance can be significant, such as affecting memory, and even immunity.
For students, sleep after learning was found to reduce the amount of forgetting. You will find that there are many studies which indicate how memory is aided by sleep, some studies suggesting that sleep helps maintain memory traces. For example, a sleep period within three hours of a learning event was more helpful in memory recall than sleeping ten hours later. Interestingly the same study explored the role of sleep in neuronal plasticity.
Just as students may have periods where they are cramming for an assignment or exam, some client’s work schedules may be very busy during their normal week. At the time of the coronavirus, with some people being expected to home-school their children and maintain a full work day (in the same amount of time), there can be a high level of exhaustion by the weekend. This can lead to ‘sleep debt’. Where someone is in sleep debt during the week (burning the candle at both ends) there can be a habitual variation in weekend sleeping patterns. In addition, very long awake periods can create significant drops in performance.
If someone is finding it hard to ‘switch off’ at bed-time, then writing out their thoughts (or audio recording them), at least an hour before bed can help ‘download’ their concerns and allow them to start to unwind. For some clients it can be helpful to keep a stress diary. However, this just focuses on what isn’t wanted (i.e. the stress!). It can be more helpful to introduce some relaxation activities (e.g. breathing, self-hypnosis) and then suggest a client writes down what triggers their stress and how they used their relaxation approaches to reduce their stress. This is more action-based and focuses on the solution, rather than the problem, yet still provides insight as to the stress triggers.
Keeping a work-life balance
A common observation of the self-employed and those new to working at home, is the challenge of keeping work separate from their leisure time. If you get into the habit of working whilst on the sofa you will start to associate the sofa with work, not just socialising or relaxation. It can then become a little too easy to just answer an email or two during the ad-break between TV shows, then, before you know it, you have worked two more hours than planned. Wherever possible, create a separate area just for work, such as in the corner of a guest room. If you have to use a kitchen or dining table, it can be helpful to have a clear desk approach, so that all signs of work are packed away at the end of the working day. This is particularly important at times of stress. People can feel under pressure to produce work, yet the stress negatively affects their performance, so they work longer hours to compensate, and performance drops even more, as they are tired. Sometimes you may wish to have a discussion with a client about how to balance their work with the rest of their life, so they are able to be productive, yet have enough ‘left in the tank’ that they can still enjoy their life. This helps avoid burnout.
Increase nutrition and reduce stimulants
Whilst alcohol is perceived as a relaxant, it can have a disruptive effective on sleep. Although people can feel they fall asleep quicker, as the alcohol is processed by the body it can interrupt REM sleep. This lack of deep sleep can make people feel less rested when they do wake.
If your client is unable to fall asleep in the first place, it may be that they are having too many stimulants (e.g. caffeine, nicotine). If so, then it can be helpful to stop any caffeine consumption at least 6 hours before their planned sleep time. Also, whilst it can be tempting to drink tea or coffee as a boost when we are tired, drinking water can be more effective in boosting cognitive performance. Being dehydrated, even slightly, can make people perform less well in cognitive tasks and can make us feel sleepy. For a non-caffeinated boost, peppermint tea can be helpful.
Many people consider that eating heavy meals before bed can keep some people awake, yet going to bed when hungry can also affect sleep for others – it’s about finding the right balance for each individual. As well as meal size and timing, the food you are eating will also make a difference. If you have high sugar food (e.g. sweets, chocolate) just before bed, you might find you are buzzing with energy. White bread, refined pasta and cakes/biscuits can all reduce serotonin levels and impair sleep. As well as sugar, some foods can cause heartburn, which can also disrupt sleep. So, it can be helpful to avoid fatty, fried, spicy, rich or heavy food late at night.
In contrast, a handful of almonds and walnuts (that contain melatonin) can help you sleep more soundly, as can food that is high in lean protein as they contain the amino acid tryptophan, which can increase serotonin levels. Interestingly, some fruit can also help. It is said that if, for a month, you eat two kiwi fruit a night before bed you can increase the duration of your sleep. However, people can sometimes find citrus fruit and fizzy drinks trigger sleep time indigestion, so again, it will work for some, but less well for others.
Meal timing can also be a factor. Some people are more susceptible to changes in regular meal times, whether this is starting a new diet (e.g. intermittent fasting), a change in routine (e.g. weekends/ holidays), or a other factors (e.g. quarantine). Recent research indicates late meals in particular can have an influence on circadian rhythms. Interestingly, the same research found that late meals impacted on glucose metabolism as well. It can be helpful to adjust what you eating according to changes in your circumstances. For example, if you are very active two days a week, then eat to fuel those two days, but avoid carrying that eating style over to the other five days. Having a regular eating schedule can be helpful though, both for general metabolic performance and circadian rhythms.
The power of naps
Do naps help or hinder our ability to sleep well? For some they can be almost magical, for others, they result in prolonged sleepiness. Sir Winston Churchill apparently had a two-hour nap every afternoon, which enabled him to get by on a mere four hours sleep each night. In contrast, Albert Einstein is reported to have needed 10 hours sleep a night as well as daytime naps.
In some countries naps are commonplace. Indeed, a longitudinal study of 23,681 Greek participants (over six years) found those taking a nap just three times a week had a 37% lower risk of dying from heart disease. The study also found that the results were even stronger for working men.
A daytime nap (up to 30 minutes) can help boost alertness, mood and performance for some people, as well as reducing stress, improving perception, stamina, motor skills and accuracy. There is also some evidence that napping can be a positive aid in weight loss and can even enhance your sex life! Some research suggests short naps (5-15 minutes) are thought to have benefits for a short period (1-3 hours) of time, whilst longer naps (over 30 minutes) can, for some, produce an initial sleep inertia (drowsiness), but then improved cognitive performance for longer periods of time. So, a short ‘cat nap’ may be helpful now and then!
So, whether the client seeks the help of a hypnotherapist to address a primary sleep issue, or deal with a sleep problem that is a result of something else (e.g. anxiety), there is much that can be offered to that client. Behavioural hypnotherapy can help develop useful sleep habits, and cognitive hypnotherapy can address any limiting beliefs that impair someone’s ability to sleep well. Furthermore, a solution-focused approach can enable a client to explore their wider sleep behaviours and develop good sleep hygiene which balancing many different aspects of their life, ultimately, helping the client achieve and maintain healthy sleep.
We hope that this blog about sleep and hypnosis has been helpful. If you have any questions about this topic or anything else for that matter, do please get in touch, because we’re always happy to help!
– written by Dr Kate Beaven-Marks