The Sleep Prescription

Dr. Aric Prather is the author of The Sleep Prescription. In this 15-minute talk, Dr. Prather will share powerful solutions he uses to help his patients achieve healing and restorative sleep. Going beyond the obvious solutions, Dr. Prather shares surprisingly simple yet deeply effective techniques that will help you lie back and let sleep work its magic.

Transcript

Hi, My name is Eric Prather and I'm a sleep psychologist at the University of California, San Francisco. And I'm a sleep evangelist. I love sleep. I love talking about it. I love doing it. I love trying to help people sleep better. I'm also the author of The Sleep Prescription, Which is a book that attempts to distill the principles of cognitive behavioral therapy for insomnia, Or CBTI. CBTI is the first line treatment for insomnia, Though unfortunately it's often not the first thing that people try. In our short time together, I want to talk through some strategies that are known to help people even with the most difficult sleep challenges. So before we get into that, Why is sleep so important? If you're listening to this, There's a pretty good chance that you already think your sleep is worth investing in. But sometimes we don't know what to do. Sometimes we don't know how to get it, Get there, Or get it back if it's gone off track. And when we think about how important our sleep is, We often think about what it does for our health. So how much sleep do we need? Well, This is kind of a tricky question, Though the American Academy of Sleep Medicine recommends at least seven hours per night on average for an adult to maintain optimal health. And we know from the literature that when people get insufficient amounts of sleep, This is usually when people are getting six or five hours of sleep on average, They're at increased risk for a whole host of negative health outcomes. This includes things in the cardiovascular system, Like the development of cardiovascular disease or atherosclerosis, Hypertension, The development of cardiometabolic disorders like type 2 diabetes. There's even growing evidence that insufficient amounts of sleep may be a contributor to the development of neurodegenerative diseases like Alzheimer's disease. So we know we should get more. In the short term, We also notice kind of significant effects when we're kind of under-slept. So when people get less sleep than they need, People tend to be crankier, Their mood is lower, It's harder to regulate our emotions. We know that when people get more sleep, They're better parents, They're better partners, They're more empathetic. You know, We're better capable to take on the slings and arrows of the day, The stress. And so it's critical to try to protect our sleep. The good news is that there are ways in which we can improve our sleep. And it has to do with getting out of our own way. And that's okay. You know, When we have bad nights of sleep, Oftentimes we try to kind of change our behaviors because sleep has become unpredictable. Maybe it's unpredictable for you. There's certainly times where it's been unpredictable for me. And in those instances, We're kind of on defense. We're chasing sleep because we don't know what happened. We don't know where it went and how to get it back. And that's not to say that some people have even bigger challenges. It's just to communicate that sleep is what's called a biological imperative, Which means that it's necessary for survival. And because of that, Our body has critical regulatory processes that ensure that sleep happens. But oftentimes, Because we change our behaviors to try to get sleep back, Those behaviors actually undermine how sleep works. I always say that sleep is something that we never think about how it works at all until it stops. And then when it stops, We're desperately trying to figure it out. We're kind of trying to kind of become hyper-focused on how to get our sleep back. And often that's the problem. That amount of effort that we're putting in actually makes it harder to sleep. And so, You know, How do we address this? Well, The opportunities to get our sleep back on track don't arise in the minutes or even hours before we slip into bed. They actually arise as soon as we open our eyes. So that's what I want to talk about. What can we do during the day leading up to bedtime to actually put us in a better position to get that good restorative rest? All right. So where do we start? Let's start when we wake up. It turns out that one of the biggest changes that someone can make to try to get their sleep back on track is to maintain a stable wake time seven days a week. And I know that's hard, Right? We like sleeping in on the weekends, Right? We like trying to make up that sleep. And that's understandable. You know, If our weeks are kind of contracted and we're not getting the sleep we need and we have the opportunity to make it up on the weekend, That is not a bad idea. We are learning more about the role of sleep debt and what that might mean for our health or something called social jet lag and kind of the shifting of our times that when we wake up and when we go to bed. But you know, Sometimes we got to do what's right for us to get that sleep we need. What I'm saying is that if you're having a hard time sleeping and this is like difficulty falling asleep, Difficulty staying asleep, And you're looking for solutions, This is something that you can focus on. And I also want to point out that I'm saying we're focusing on when we wake up in the morning. And that's really intentional because we want to focus on things that we can control. And for people with insomnia, They've often heard things like, You know, Try to have a stable bedtime. And that can cause some problems, Right? Because imagine you have insomnia, You're waiting for bedtime, Your sleep doctor or someone has told you, Okay, We'll try to keep it consistent. And you know, Your bedtime is say 1030 at night. But at 1025, You're not sleepy, Right? It's click, You know, The clock is ticking closer and closer to 1030. That can be really anxiety provoking. And that's not what we want. We want to focus on what we can control. And sleep is not something we make happen. Sleep is something that comes to us. Sleep washes over us. And so we don't want to put extra effort because the more that we try, The more we end up pushing sleep away. However, If we maintain a stable wake time, We end up using the same source of amount of energy throughout the day, We'll end up getting sleepy around the same time each night, Okay? So we maintain that stable wake time seven days a week that will kind of set in motion the amount of energy and the sleepiness that will build up across the day, Allowing us to feel sleepy around the same time each night. The other thing it does is it helps in train our circadian rhythm. So we have an internal clock, Right? And I like to think of it as kind of in the context of sleep around alertness, Right? And it kind of builds across the day. We're more alert. And then as the sun goes down and melatonin starts being released from our brain under darkness, We get sleepy. Keeping a consistent wake time will make things more predictable for that internal rhythm and thus our system will work better. So that's the first thing. The second thing that I want to emphasize is how we control our worries throughout the day. So worry is something that absolutely can get in the way of sleep, Right? Who hasn't woken up in the middle of the night and your brain kind of becomes really active? And it's never active about really positive things in our lives. It tends to be those negative things, The things like you wish you had done differently or the things that are happening tomorrow that you're concerned about. Or maybe you're worried about the fact that you're not sleeping. All of those things can get in the way of sleep, Right? That mental effort is not compatible with sleeping. And one way in which we can try to address this is actually in a preventative way. And so this is in kind of scheduling out time in our lives to actually do just that, Just worry. So we call this scheduled worry time. So scheduled worry time can happen kind of, You know, Sometime during the day where you have a break, Right? So you have to schedule and say 15 minutes of your day. You go sit somewhere, Maybe you write it down and you just spend that time worrying. And it means actually being intentional about it. You gave yourself 15 minutes, You worry. You feel like you don't have anything to worry about. No, You sit that 15 minutes and you worry. And you use that time. But when that clock is up, Then you're done. It helps compartmentalize this experience. And over time, What it can do is in the middle of the night or when you're going to bed, If those worries crop up, You say, Look, I actually already did this today. I scheduled it in my planner. I did the worrying and I have it scheduled for tomorrow. And so I am not in the right space to do this. That kind of self-talk can help kind of redirect and allow you to kind of let those worries slide off. The other strategy is something called constructive worry. Now this one's a little bit more problem and solution focused. And so I'm going to kind of walk through what the exercise is and I think you should try it to see if it's helpful for you. So what you do is you get a piece of paper and you kind of number it, Say, One to three and the numbers correspond to the problems that you want to focus on. So you want to sit down, Write out the specific problem that you're having, And then identify what is the first next step to addressing that problem. And this would be considered the solution, Right? It doesn't have to be the final solution to the problem since most problems take multiple steps but it's a step towards it, Right? You know, If it turns out that you know exactly how to fix the problem, You can write that down. If the problem is so big and there's no solution, Of course, Write that down. But you want to kind of number out kind of the first, Say, One to two next steps to addressing this problem. You do this for, Say, The three problems that you've identified and then you do something that's really important, At least I think is important for this exercise to be, You know, Really extra effective. It's to actually fold up the piece of paper, You know, And noting the ritual of, Look, You've spent time focusing on these problems and identifying next step solutions. You fold it up and then you put it by your bedside. And what this does is that if you wake up in the middle of the night and those problems come up, You can see that piece of paper and say, Look, I've already addressed the next steps of this problem when I was thinking more clearly. The truth is, Right, That none of us are really in the best sort of mindset to tackle these types of problems in the middle of the night. Like we're just not cognitively there. We might jump to conclusions. We might kind of catastrophize about them. And so we want to do it when our cognitive faculties are more kind of set and ready to tackle these challenges. And so you say, You know, I've already done this and you can kind of roll back over and try to go back to sleep. Now all of these practices take time. They take, You know, Some effort. They take persistence and habit forming. But for people that have worries, This can be a good solution to try to address those issues. Now the final thing that I'll mention is that what happens if your mind is just really active in the middle of the night? Like you're kind of, Your mind is worrying around and, You know, It doesn't seem, You know, These strategies that we tried don't seem to be working. Well, The thing that I want to emphasize is you don't want to spend excess time in bed with an active mind. The bed is actually a really critical environmental trigger to bring on sleepiness. But when people spend extra time in bed, And we're talking, You know, 30, 60, 90 minutes in bed, Kind of, You know, With their mind spinning, That actually confuses the body. It actually makes it so that the body doesn't know that it's supposed to be sleeping in bed. And that actually becomes a place of maybe worrying. In fact, Really commonly, You know, Patients in our clinic will tell me, You know, I was feeling really sleepy and then I got in bed and my brain woke up. And that same thing can happen in the middle of the night. And what that is is that's a conditioned arousal that has developed because of all the worrying that people have done in bed. And so we need to address that. And the way in which you address it is actually getting yourself out of bed. And this can be hard. No one likes it. But getting yourself out of bed, Kind of going somewhere quiet and winding back down until you feel sleepy again. You can read, You can listen to music, You can do insight timer, What have you, Until you begin to feel sleepy. And then you want to get back in bed and try again. And what you're doing is breaking that relationship of this angstiness and anxiety with the bed, Kind of removing yourself from the situation. And then when you feel sleepy again, You're kind of repairing that relationship. And over time, That will lead to kind of the bed again being this powerful trigger to let your body let go and rest and sleep. So we talked about a number of things. We talked about maintaining a stable wake time. We talked about scheduling worry. We talked about constructive worry. And then we talked about kind of getting out of bed when you're not able to sleep until you can wind down and get back in bed to kind of repair that relationship. All of those things are critical and have been shown to be helpful in helping people get their sleep back on track. So I hope that it works for you. And I hope that you sleep well.

Reviews

Will return did drop off listening thank you. 🙏🏼❤️

I’m very impressed. I’ve been an insomniac for 34 years and I am going to buy your book. However I do think it’s important for people to know that melatonin production drops when you age, and taking a melatonin supplement at 3am can help. Also “Vagus breathing” is really helpful, ie deep breathing that stimulates the vagus nerve and calms the nervous system.

Fell asleep 😴

Great lesson. Thank you for the reminders of the intelligence and sensitivity of CBTI.

Thank you!