November 26, 2011

Keeping a Sleep Diary

Depression and anxiety go hand in hand with sleep problems.  By no means a hard and fast rule, its common to find that people with an anxiety disorders have trouble falling asleep while people struggling with depression have trouble staying asleep.  The reverse trend is seen also or some blend of both.

What comes first, the chicken or the egg?  Do persistent sleep difficulties cause depression and anxiety?  Or does the disorder come first causing insomnia?  I have seen what appears to be both cases.  Sometimes a very stressful life event occurs (death of a loved one, birth of a child) and sleep disorders present as a result.  Other times a patient will present with a history of poor sleep that has persisted so long that panic disorder is now seen by day.  

No matter the origin, targeting more hours and better quality sleep is a typical treatment goal in cognitive behavioral therapy.  Changing one's sleep routine is a great example of a behavioral goal.  Eliminating caffeine is another.  Cognitive goals include meditation, visualization exercises, and thought replacement.  

Here's an example of a typical thought that teaches your brain to stay awake:  

What time is it?  I'll never get enough sleep! 

But you can help ease your mind into restful sleep by changing that thought to, 

I can calm my mind and think about a beautiful sunset.  


I am thinking of all the things I am grateful for.  I am grateful for ... and start a list while deep breathing (another behavioral technique).  

Regardless of your sleep troubles, keeping a Sleep Diary is a great way to show your doctor or therapist exactly what your patterns of sleep (and non-sleep) are.  Here is a list of various sleep aspects we professionals like to assess:  

1) Time you went to bed and woke up;
2) Total sleep hours;
3) Quality of sleep (e.g., soundly, restless, exhausted in the morning);
4) Times that you were awake during the night and what you did (e.g. stayed in bed with eyes closed or got up, had a glass of milk and meditated);
5) Amount of caffeine or alcohol you consumed and times of consumption;
6) Types of food and drink and times of consumption;
7) Feelings - happiness, sadness, stress, anxiety;
8) Drugs or medications taken, amount and times taken;
9) Stressful events and particular worry thoughts ongoing, that day or pre-bedtime. 

You can copy or download an example of a sleep diary, here or here.   

In addition to keeping a sleep diary you can review this list of tips for improving your sleep.  Look to see which of the helpful sleep habits are part of your routine and which are habits you routinely break or have never practiced.  These steps are a way to use your time while you search for a qualified psychologist, sleep expert or physician and help your doctor help you toward finding sleep solutions.  

Insomnia painting by Micheal Lemus Fletchall, here.  

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