Dysfunctional Beliefs and Attitudes About Sleep

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Author: Ron Cridland M.D.

Worrying about how you are going to feel tomorrow if you do not sleep well tonight is probably going to make it harder for you to sleep.   If you are reading this article you probably have not slept very well for a while.  You may recall that even after a poor night’s sleep, you can usually function pretty well the next day even though you feel tired.  Thinking about it this way can really take the pressure off your need to sleep tonight.  If you are also investing effort into becoming a good sleeper, even if you do not sleep well tonight, in a few weeks you will probably be sleeping much better by following the recommendations on this website.

The following is a list of common dysfunctional beliefs and self-defeating attitudes taken from the research and writings of psychologist Dr. Charles Morin, PhD.  You have probably had some of these thoughts at one time or another.  If you do relate strongly to one or more of these thoughts, I have added some suggestions towards a helpful and perhaps more realistic way of looking at these issues.  When presented with these thoughts, a cognitive therapist is going to invite the patient to ask themselves three questions:

1. Is this belief about my sleep accurate?  e.g.: Do I always experience daytime impairments after a poor night sleep?
2. What is the evidence supporting this belief?  e.g.: Contrary to my usual thinking, sometimes I function quite well after a poor night.  Sometimes I feel poorly even after a full night’s sleep. 
3. Is there a more productive way to think about my sleep?  e.g.: It is possible that other factors may also be contributing to these daytime consequences.

1. I need 8 hours of sleep to feel refreshed and function well during the day.
   • Do you always feel tired and function poorly the next day if you do not get 8 hours of sleep?  In your own experience you can probably recall days when you felt and functioned fairly well even though you did not sleep well the night before.  You may also recall days you did not feel that well even after a normal amount of sleep.  Many people feel they need 8 hours of sleep to feel and function optimally.  However, the normal range is between 7 and 9 hours of sleep per night.  This means that many people feel optimal after only 7 hours of sleep.  Also, some people feel and function quite normally on less than 7 hours although over time they may accumulate a sleep debt that may lead to fatigue and other issues later on.  Even if they do not feel optimum, most people with insomnia feel and function fairly well on less than 7 hours of sleep.  Ultimately you want to get enough sleep to feel rested, whatever that amount is.   Through following the sleep program your first goal is to train yourself to sleep well.  Then you can train yourself to sleep enough to feel rested.  Ironically, the most powerful and natural way of improving and deepening your sleep right away is to go to bed later and restrict your time in bed to the number of hours you can currently sleep.   More on this can be found in the sections entitled, Principles and Process of Reconditioning Good Sleep, or in the Online Insomnia Treatment Program. 
2. When I do not get a proper amount of sleep on a given night, I need to catch up on the next day by napping or on the next night by sleeping longer.
   • Even without napping or getting extra sleep there are probably days when you managed quite well after not getting enough sleep.  Alternatively, sometimes people feel worse after a nap or after trying to sleep longer in the morning.  The problem is that if you nap during the day, you reduce your sleepiness and you may have more difficulty sleeping that night.  This can make you more tired the next day causing a vicious cycle.  If you try to go to bed earlier than you are used to, you may have more trouble falling sleep.  Alternatively, you may wake up and have more trouble returning to sleep.  If you try and sleep-in in the morning your sleep may be more broken and less restorative. The result is that you often end up diluting your sleep and spending more time in bed awake, reinforcing the bed as a place to be awake and making your insomnia problem worse.  Instead of napping or trying to sleep longer, you may be better off by allowing that extra sleepiness to build up in you over a few nights.  Combined with the insomnia program, this extra sleepiness will eventually help make it easier for you to fall asleep at your usual time, stay asleep longer and make your sleep deeper.  
3. I am concerned that chronic insomnia may have serious consequences on my physical health.
   • We know that sleep is important.  Research has shown increased risk of medical disorders in people who chronically sleep less than 7 hours.  We also know that lots of people manage to have long and relatively disease-free lives despite not getting enough sleep.  The point is that although there may be some risk, it does not affect everyone to the same degree.  Instead of worrying about what might happen many years from now, focus on following the sleep program so that in a few months you can become a good sleeper and neutralize these potential risks.
4. I am worried that I may lose control over my abilities to sleep.
   • No one really has control over their ability to sleep.  Sleep is not something that you can MAKE yourself do.  Sleep is something that you LET yourself do.  Sleep is something that happens naturally, all by itself, when the conditions are right.  Sleep is like love or sales.  You cannot make someone love you.  You create the conditions that will perhaps allow love to occur.  You cannot make someone buy your product.  You create the conditions where a client wants to buy your product.  On the other hand, staying awake is something that you can make yourself do especially if you are thinking about not being able to sleep.  Even if you cannot control your sleep, there are lots of things that can influence your sleep both positively and negatively.  Take control over what you can control.  Make sure you stop doing the things that keep you awake and put your effort towards creating the conditions that allow sleep to occur naturally by following the recommendations on this website.
5. After a poor night’s sleep, I know that it will interfere with my daily activities on the next day.
   • Does it always or are there some days where you function fairly normally after a poor night’s sleep?  As discussed in 1, most insomniacs function remarkably well even after many months or years of not sleeping well.  A poor night tonight does not necessarily mean you will not function well tomorrow.  However, worrying about having a poor sleep will probably make your sleep worse.  Use a relaxation technique to distract you from your negative thinking.  Make sure you are following the recommendations on this website.  Get out of bed if you cannot sleep so you are not reinforcing the bed as a place to be awake and frustrated.  Then even if you don’t sleep well tonight, as long as you are not lying in bed feeling frustrated, your insomnia is not getting worse.  Eventually the sleepiness from not sleeping enough will build up in you to the point that it causes you to sleep through the night.
6. To be alert and function well during the day, I believe I would be better off taking a sleeping pill rather than having a poor night’s sleep.
   • There may be situations where you are particularly more likely to sleep poorly such as before an exam or on a business trip.  It is possible that a sleeping pill may help prevent a bad night assuming that you sleep well with this particular medication and that there is time for it to be worn off by the next day.  On the other hand, do you always sleep well when you take a sleeping pill?  Do you always sleep poorly when you do not take a sleeping pill?  Although the Cognitive Behavior Therapy program for insomnia (CBTi) may take a few months to work your way through, research has shown that it works well for 80% of people with the more common forms of insomnia.  This is assuming that there are not any major problems with anxiety, depression, chronic pain or excessive stress.  In fact, according to the research, CBTi actually works better than sleeping pills in the long run.  In addition, the benefit can be life-long whereas the effect of sleeping pills tends to wear off over time.  There are lots of things you can do to help train yourself to become a good sleeper without having to take medication.  If you are already taking medication regularly then it may be better to stay on it for now until you become a good sleeper.  Then it is much easier to get off sleep medication.  For more information on the use of sleeping pills, go to the section entitled, How to Use Sleep Medication While Training to Become a Better Sleeper.
7. When I feel irritable, depressed, or anxious during the day, it is mostly because I did not sleep well the night before.
   • It is possible that people will feel more irritable, depressed, or anxious the day after not sleeping well.  On the other hand, some people get a degree of euphoria the day after not enough sleep.  In fact, there is research showing sleep deprivation has an antidepressant effect.  The problem is that the effect is not sustainable.  Eventually the subject becomes too sleepy to continue to stay awake and after a full night’s sleep the antidepressant effect is lost.  On the other hand, having a bad day can cause your sleep to be disturbed that night.  So, what is cause and what is effect?  The point is that your mood is not always negatively impacted by poor sleep and sometimes your poor sleep is affected by your mood and other factors.
8. When I sleep poorly on one night, I know it will disturb my sleep schedule for the whole week.
   • If you have a bad night you may anticipate having difficulty the next night.  If you think that way, then because of worrying about your sleep it can become a self-fulfilling prophesy.  It could take a week before your sleep debt accumulates to the point where you end up having a good sleep despite your negative thinking.  However, it is quite unusual to have 7 poor nights just because of one poor night.  Is it possible that you are exaggerating?  Another way of looking at this is that if you have a good night it seems that you are more likely to have a good night the next night based on the same logic.  If you think about having a good night every night, then you will probably have a lot less bad nights.
9. Without an adequate night’s sleep, I can hardly function the next day.
   • It is true that it can sometimes take a lot of effort to function the day after a poor night’s sleep.  This is particularly true if this has been going on a long time and you have developed chronic fatigue.  However, ask yourself, “Are you this dysfunctional every time you sleep poorly?”  “Are there some days it may take more effort, but you manage to function reasonably well?”  It is usually best to try and carry on the next day as usual even if you are tired.  Think of this fatigue as temporary as you work towards becoming a good sleeper.  Imagine you are at the end of a marathon and the finish line is in site.  Do not give up.  You are almost there.
10. I cannot ever predict whether I’ll have a good or poor night’s sleep.
    • Certainly, good nights or poor nights may sometimes seem to happen for no apparent reason.  However, chances are that you are aware of some things that pretty consistently make your sleep worse.  You may also be aware of some things that consistently help your sleep.  Could the idea that you have absolutely no influence on your sleep be a bit of an over-exaggeration?  The more you read what is in this website and better understand cause and effect, the more influence you can have over your sleep.
11. I have little ability to manage the negative consequences of disturbed sleep.
    • You have probably had plenty of bad nights so far.  Are you not usually able to manage the next day?  What is the worst that can happen tomorrow if you do not sleep well tonight?  You have to accept that you may have a bad night tonight and you are probably going to have a few more in the future.  You have managed so far.  You will probably continue to manage in the future.  Instead of focusing on the negative consequences, you could focus on the good things you are doing with the sleep program that are going to improve your sleep over the next few weeks.  You can also focus on a relaxation technique to distract your mind from your negative thoughts.
12. When I feel tired, have no energy, or just seem not to function well during the day, it is generally because I did not sleep well the night before.
    • There are many factors that can affect your energy and function during the day besides how you slept the night before.  These include your general health, diet, fitness level, work intensity and stress level.  Did you exercise today?  Are you tired from that?  Did you eat a heavy meal at lunch?  Are you sluggish from that?  Are you tired and procrastinating because you do not like the project you are working on?  If you were working on a project that you found more interesting, would you feel as tired?
13. I believe insomnia is essentially the result of a chemical imbalance.
    • The implication is that there are external causes out of your control.  Regardless of the original trigger for your insomnia there are lots of things that can influence your sleep both positively and negatively and some if not most of these things are under your control.  As discussed under item 6, the non-pharmacological treatment of insomnia with CBTi can be very effective at improving insomnia.
14. I feel insomnia is ruining my ability to enjoy life and prevents me from doing what I want.
    • Insomnia can certainly make life harder.  When people have trouble with their sleep, they sometimes focus too much on it at the expense of other aspects of their lives.  They can end up making their sleep worse by over-emphasizing how much their fatigue is affecting their days.  They can make their sleep worse by worrying and catastrophizing about how bad things will be tomorrow if they do not sleep well tonight.  You should sleep to live, not live to sleep.  Even if you do not sleep well, you can still live.  Yes, it’s hard.  In the meantime, focus some of the energy you do have into following the sleep program and controlling the things you can control rather worrying about the things you cannot.
15. Medication is probably the only solution to sleeplessness.
    • Perhaps medication is the only thing that has worked for you up until now.  You have probably even tried some of the sleep hygiene things and found they did not work.  I see about 1000 patients a year.  About half have some degree of insomnia and are given “The Program for Improved Sleep” handout.  In the past, patients would often come back and say, “I tried this before.  It doesn’t work for me.”  The comment, “It doesn’t work for me” is frustrating and amusing to me at the same time.  As we go through the items on the handout, it turns out that they are doing only some of the sleep hygiene things like keeping a regular bedtime, avoiding caffeine, no TV before bed, etc.  Then I would ask them, “Are you doing a relaxation technique every night when you go to bed?”  “No.”  Are using relaxation to help you turn your mind off and go back to sleep during the night?  “No.”  Have you turned the clock away so you can’t see it?”  “No.”  “Are you getting up if you can’t sleep?”  “No.”  “Are you using the alarm so you don’t have to think about when to get up?”  “No.”  “Well then you are not following the program.” Patients seem to see the things that they are already doing but for some reason overlook the things that they are not doing which are the reasons why they are still not sleeping yet.  The bottom line is that the program works if you do it but you have to do all of it at the same time, not just the parts you were doing previously.  I believe it was Einstein who said, "The definition of insanity is doing the same thing over and over again but expecting different results."  This website is here to help you do it differently.
16. I avoid or cancel obligations (social, family) after a poor night’s sleep.
    • As discussed under item 14, even if you do not sleep well and feel tired you should still try to live your life.  Otherwise, your life ends up revolving around your sleep.  Keeping active during your day may actually help you sleep better at night as long as you don’t over do it.  Do not give up on your life.  Follow the recommendations on this web site, become a better sleeper, and carry on.