Dr Helen Nightingale

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DR. HELEN'S BLOG

Improving Sleep

Don't forget that there is an excellent sleep book recommended on this site, but this download is to give you some information and recommendations for improving your sleep with out having to read the book. But if you want more info please read the book or contact me on the blog.

Intro to sleep

Sleep is probably the most important need for us after food and water. We can't survive with out it. And if we go for periods with out regular sleep we become troubled and in difficulties. We can't perform properly in any way with out it we can get through the day and do ordinary activities. We will make mistakes and our mood becomes irritable and stroppy. This will continue until we make up our lost sleep. There is a couple of parts of our brain that control our sleep and regulate it.

Usually it is anxiety that disrupts our sleep and that is related to thoughts that interrupt us during periods of light sleep during the night if we have worries during this time.

Everyone's own pattern of sleep will vary and some need more than others. And it also depends on age and our personal sleep patterns both across the night and also the week. There are also chemicals that can change our sleep most importantly alcohol, and mediations. So sleep is a complex issue.

It is also very upsetting to us when our sleep is disturbed.

We know from sleep studies, looking at people who are working shift patterns such as airline pilots and also changes from travelling against time zones that we need a certain amount of sleep every night not only that be we also need certain types of sleep.

Sleep allows our body to repair and rest, so that it recovers both physically, mentally and emotionally. So it is important to understand that if you are tired or fatigued your body tiredness, your mind's inability to think and function and also your mood will feel emotionally flat.

As a psychologist I often ask patients what their sleep is like as this is usually a main indicator for your psychological wellbeing.

One important point to remember is about real sleep. Sometimes we think we have not slept a wink, but this is actually not true (paradoxical sleep) we feel as if we have not slept. But indeed we have.

If you want to sleep better:

First of all start a sleep diary for a couple of weeks to monitor it. This should include time to bed, time you fell asleep and then time you first wake up and the number of disturbances through the night. It is also helpful to record the quality of sleep. Use a scale of 1-10 and then rate the sleep. Also record the time you wake up in the morning and the time you actually got out of bed. Try to record this quite accurately, but don't do it until the morning, (it's not a good idea to be turning on the light and writing things down during the night.)

You are not alone is suffering from insomnia. Tens of thousands have this problem. Its usually acute, that is you have a stressful problem or problems in your life and when you are worrying about them, your sleep is affected. This usually passes. But early insomnia is about getting to sleep and chronic insomnia is about on-going poor sleep patterns for years.

Now you may start trying to set up situations that will increase the chances of having a better nights sleep.

There are a number of main factors you should consider;

  • The environment that you sleep in, the temperature and the conditions that you are sleeping in.
  • Your physical condition
  • But mostly importantly your psychological condition.

Worrying is a key factor, anxiety troubles on your mind, stress and fear are the main contributors, having things playing on your mind.

Medication

This download is about the psychological help needed to sleep better and is not to advise on medication, but remember a couple of truths about medication for sleep :

  • Sleeping medication is effective for short term insomnia.
  • They are unproven over the longer term and sleep problems will return unless the medication is changed or increased in dosage.
  • The beneficial effects of the medication tend to wear off.
  • Such medication does not assist persistent insomnia.
  • As we get older we are less able to break down these compounds in our body and so they need to be discouraged in older adults.
  • Dependency can occur.
  • Alternatives are to take an anti-depressent medication which has a sedative side effect.

Cognitive behavioural therapy shows the best evidence for persistent insomnia. A full assessment and treatment of this problem is available if you see a CBT therapist. Don't forget that there is a link to this website where you can find your nearest therapist.

Try to reduce your worrying before you go to sleep so you can rest your mind peacefully.

If you do wake up during the night, try not to change your heart rate by getting up out of bed.

If you can do not put on the light, make yourself comfortable and keep your heart rate slow and even, manage your breathing and keep it slow and focus on deep regular breathing.

Don't forget that although insomnia is not a specific medical disorder, it is a risk factor for the development of depression and there is evidence that people with sleep problems have more physical health problems and are more prone to illness. So it is well worth trying to overcome this problem. A good night's sleep is such a wonderful experience.

Lastly this advice can be read in more detail in a really excellent short book called overcoming insomnia and sleep problems by Colin Espie. It is the best book about sleep I have read. Everything I have mentioned here and much more is in this book, Including ways to assess your sleep pattern and a complete comprehensive range of techniques to try.

More about Worry

Worry is probably one of the most important psychological factors that causes the greatest difficulties in psychological well -being.

Worry is the core feature of most psychological mood problems.

38% of people worry every day, it affects our moods and sleep.

It also causes general and specific anxiety.

When we are not worrying we are usually at our best, both in mood, activities and achievements.

Chronic worrying is likely to lead to depression.

Remember negative emotions are caused by resentful worrying such as jealousy and anger.

For example someone is trying to steal my husband.

So how can we stop worrying?

Well we can't eliminate worrying completely it's a human condition, but we can improve it by taking some control over it.

Worrying is a form of emotional avoidance of feeling. And if worrying is something that makes sense to you, you will believe it helps you solve problems.

You believe that the world is dangerous, and that you are unable to cope.

Worrying help you think about the worst possible outcomes. And you believe that when you are worrying then you are not anxious.

First of all we need to be aware of how much time we spend worrying

Try and become aware of it. To raise your awareness, trying a daily recording of all your worries.

Try writing down your worrying thoughts. And look at them. Next record how much of time you spend worrying.

Keep a worry diary for one week.

Go through your worries and decide which are realistic and which are ridiculous.

Which ones are based on evidence and which ones are fantasy.

Then you need to ask yourself a set of repeating questions:

  • If this actually happened, then what would happen?
  • If that happened, then what would happen ?

If that happened, then what would happen. ?? this spiral type questioning ( socratic) can lead you down the irrational pathway of thinking that you may have. Such questioning will make you challenge your thinking in an rational way.This is an important CB technique called socratic questioning.

Another technique is as follows :

Consider the worse case scenario ( the worse fear that you have ) write it down. Now you need to ask yourself what is the realistic likelihood of this actually happening???

Try and make it real by casting a percentage on it of how much you believe it might really happen. Such as a bet, is it 20 or 2 or 0.1 % likelyhood and then balance this against the amount of time you are spending worrying about this happening.

An example of this type of fear or worry is flying in a plane or leaving home for a holiday.

In this example we are not denying that bad things are not going to happen, life is unpredictable and things will happen, that?s part of life.

But can worrying about them help you ? No....... it can really ruin your life, and worrying about it can be worse more so than the actual problem.

Worry also entails two other aspects : The need to control
: And the inability to tolerate uncertainty.

Uncertainty is about negative or dangerous outcomes.

We know that chronic worriers have a positive view of worry, and they can believe that worrying has a positive outcome.

Worriers say that they are ready for anything, and they are good at coping, but there is no evidence for this.

More about Anxiety

Anxiety is probably the most notorious of all psychological problems and causes people the most difficulties because of fearful and intrusive thoughts, these can be so disruptive that people think they are going mad.

Anxiety is caused mostly by worrying and apprehensive thoughts. such as " what if ......."
These Cognitions ( thoughts ) intrude into our minds and disrupt our ordinary thinking.

Then there are unpleasant physical symptoms associated with anxiety such as restlessness, fatigue, difficulty with concentration, irritability, muscle tension and insomnia.

But the key factor is worrying ( what psychologists call the major trans diagnostic factor ), and when worry occurs about a range of issues, or a variety of events, we call it general anxiety.

Other anxiety forms concentrate on specific worries, or specific issues,
e.g. In Panic disorder the worry is focused on panic attacks.
e.g. In Social anxiety, the worry focuses on embarrassment in public.
e.g. In OCD - the worry focuses on contamination or the fear of contamination from dirt, or germs .
e.g. In Health anxiety is the focus of worrying about possible illness.

The average length of duration of this problem before treatment is about 25 years.

Up to about 5% of the population experience this difficulty.

There are definitely inheritance factors indicated (about 30%)

There is a central role in Generalised Anxiety Disorder caused by worrying.

To manage anxiety better the key issue is to challenging worrying thoughts

It is also helpful to use anxiety reduction techniques such as relaxation and meditation, these will manage your mind better.

Check out your beliefs about worrying, this is important. Most people will have positive and negative beliefs about worrying, such as , if I worry about everything that can go wrong, I wont be surprised and I am ready for it. Or I am tempting fate if I don?t worry, , worrying will make me crazy.

It is helpful to consider the nature of your thinking about worrying, and understand what your beliefs are about worrying, the benefits and the price you pay.

Try giving yourself permission not to worry;
Let go of a worry, by talking to yourself ( internal dialogue, eg. say to yourself this is getting boring, there is nothing more I can do , so let it go).

Worry should only be productive.
Identify if it is OK. Or unhelpful.
Challenging avoidance of activities or thoughts about your worries.

So to help yourself, record and write down your thoughts and worrying, the content of each on a recoding sheet supplied on this website then challenge the worry in realistic way, what can really happen, what is the likelihood of this fear really happening, what is the evidence for my fear, put it in perspective.

Coping with Christmas

This is to let everyone know that I shall shortly be putting some self-help advice on this blog about coping with Christmas.

It will include some guidelines about the stress of Christmas, and how to manage it, There will also be some guidelines about coping with families and alcohol consumption over Christmas. Watch this space. Best wishes Helen

In Development

Over the next few months, new downloads will appear on this website. So keep an eye on this website. You can put this website into your favourites box.

In development at the moment are the following :

COPING WITH CHRISTMAS Lauched december 18th 2007 ( completed )

MANAGING YOUR ALCOHOL INTAKE AND STILL HAVING FUN ( ready January 2008)

COPING WITH STALKING ( when someone will not leave you alone)

COPING WITH OBSESSIVE COMPULSIVE DISORDERS. ( THIS IS COMPLETED AND THE mp3 HAS BEEN UPLOADED ON TO THE WEBSITE. APRIL 2009)

EMOTIONAL REGULATION. this will be based on DBT and available APRIL 2009

The importance of recording thoughts and behaviours in a diary in order to raise your awareness

One of the most important aspects, and one which is pointed out to be crucial in all of the research evidence, is that people are requested to go away between session with their therapist and complete homework.

If people fail to do the recordings we know it is significant and will not help them progress throught their treatment.

However one of the stumbling blocks of CBT can be that people will not carry out the daily recordings or keep a diary.

The recordings may cover a number of things. such as recording your behaviour, recording your thoughts, or recording your emotions and thoughts and rating them on a scale of 0- 10.
It is a very important part of the work you need to do in cognitive therapy. You can use the recording sheets that are available on this website and you can down load from this website.

If you are not a reader and find reading difficult then the podcasts will guide you through what you need to do.

Hope this is helpful

Helen

latest on Dialectical Behavioural Therapy. ( emotional regulation strategies )

I have just returned from an update workshop on DBT and it was run by Prof Tom LYNCH from Exeter University. What a marvellous workshop. April 2009 I even have a certificate for attendance. for 7 hours of CPD.

For people who are concerned about patterns of unhelpful behaviour and personality issues DBT ( first introduced by Marsha Lenihan 1995) is a very helpful therapy approach.

The main theme of this therapy is to manage and regulate your emotions better. Emotional regulation is key. This type of therapy is mostly based in Learning theory and Behavioural managment ( my orginal background was in behavioural therapy ) and so I am very comfortable with this approach.

This whole approach looks at the behaviour that is driven by emotions, some which are difficult for people to manage or control, such as Anger, jealousy, hostility, fear and envy.

Many people who have personality issues do not come forward for help. Those who have severe issues such as self harm or body dismorphic disorder often present for help as they feel that they have responses that others do not. So they ask for help. The people with personality issues often do not present except if they are dependant. They only present when they have lost their loved one. But it may be others who need assistance because they are causing havoc to everyone else who do not come forward. Those in their family and around them well and truly know that the person has a problem . Its the old problem that if you dont recognise you have a problem then you wont realise you can be helped. People with personality problems will have a history of disruptive relationships and problems with interpersonal relationships and have long standing problems regulating impulses and emotions.

DBT is a therapy which focuses on emotional regulation and acceptance. the key to these two aspects of treatment is reducing ones arousal levels and also problem solving to find better ways of responding.

Usually people with personality problems are more sensitive than most and they respond or over respond to cues that are offered either from others or from in the enviroment.

IN DBT , the first thing to do is structure the treatment and then problem solve and that is what I offer my clients who request Dialectical therapy. We do not necessarily focus on the cognitions .( as occurs in CBT)

So primarily in DBT we shall focus on the reduction of emotional dysregulation and increase behavioural control, and then move onto reviewing alternative and more suitable ways of responding.

sometimes DBT is offered for people who are emotionally constricted, that means they know only a few or one way to respond to emotional dysregulation, such as cutting themselves or self harming in some other way, ie. reducing their food intake. In these circumstances it is as important to reduce the emotional over-control and increase their behavioral flexibilty.

I will return to this again. DBT works well in conjuction with mindfulness and distress tolerance. This is because Mindfulnees alters our action tendancies.

A Dialectic is a way of thinking. Anything that is important has an opposite.. So to be a dependant there is an independance factor which is under exposed or expressed.

Take with you this guide. : When you have a high emotional response to something, put it on hold and sleep on it over night. This will allow the emotion to die down and give you an opportunity to repair the unhelpful emotion before it drives an unhelpful behaviour. Remember emotions wont kill you BUT the your reaction to the emotion will put you at risk.V

I will return to this.

Partying at midnight following a transatlantic flight

This is Professor Arron Beck. ( Tim Beck) and Dr Helen Nightingale. Tim was still partying at midnight following a transatlantic flight. His energy levels remain incredibly high and enthusiastic.

Latest developments in CBT

Some further thoughts about new developments in CBT :

DBT this is called Dialectical Behaviour Therapy

DBT is helpful for people with very enduring and chronic problems associated with personality issues, it maybe helpful to consider DBT which is a form of cognitive therapy aimed at emotional regulation.

ACT

Acceptance and Commitment Therapy (ACT). ACT focuses on altering the function of the thought, so that the influence of thoughts is minimised in the impact they can have on our lives.

Thoughts may be useful for helping our understanding or predicting our actions. But ACT interventions focus on the interactions with the individual's experience, thinking and behaviour. Not just what is going on in our heads.

Mindfulness training is an important aspect of Acceptance therapy

ACT suggests that it might be unhelpful to try and "think our way out of a hole that our thinking has got us into ". So in fact, we focus on the context of our thoughts and not the content. In doing this, the impact that the thought is having on other behaviour patterns may be more important to the individual's life.

In ACT you need to: increase your range of responses (behavioural flexibility), i.e. do more things you consider personally important.

To engage in behaviour that serves your values and understand that your values are principles that you want your life to stand for, in this situation the therapist may ask you to identify your sense of purpose, thereby clarifying your beliefs as to what your life is about. This may include your way and style of living : this maybe in terms of family, friends, self-development, health, community and spirituality.

The key feature of ACT iis the role of mindfulness and how it acts to promote the importance of ongoing, non-judgmental contact with the present moment; it is unsurprising that ACT encourages the practice of mindfulness.

Mindfulness encourages individuals to increase their ability to pay attention to what is taking placed in the present by focusing on their thoughts, feelings and bodily sensations and behavioural urges.

Without such awareness, behaviour often automatically follows the urges that result from an individual's confusion with negative private experiences.
Being aware of what is going on in the present moment allows individuals the opportunity to move in the direction of their values.

This information has been taken from the book by Steve Hayes, ( see ref on book list)

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