ACT and its impact on sleeplessness, especially in the winter months

What is sleeplessness?

Sleeplessness is the inability to fall asleep, stay asleep, or wake earlier than desired. Everyone will occasionally experience this, but it is when it becomes a repeating pattern that it can cause problems. When sleeplessness becomes habitual it turns into insomnia, which “is a clinical disorder that affects 10% of the general population” (Saldaña et al., 2023, p. 1). Insomnia is known to impact mental and physical health, and getting good sleep is incredibly important in order to support your health. Insomnia does not generally cause mental or physical ill health, however, it can magnify symptoms, and make it harder to manage existing health issues. However, extreme lack of sleep can be dangerous and can lead to severe mental disturbances such as hallucinations. People with severe insomnia sometimes require urgent intervention.

Sleep can be elusive, and can be harder during the winter months when it can tie into seasonal affective disorder (SAD), which can have links to depression. Seasonal affective disorder (SAD), affects around 2 million people in the UK (NHS Inform, 2023).

Getting good sleep 101

We live in an increasingly connected and busy world. Busyness is seen as a sign of honour, long working days on little sleep are seen as brag-worthy triumphs, but sleep is imperative. Without good sleep, our cognitive function is reduced. The signs on the motorway that read “Take a break, tiredness kills” are there for a reason. Many health conditions are made worse by lack of sleep. Depression is intrinsically linked with sleep, “results show that the genetic predisposition to short-sleep was strongly associated with the onset of depression over the average 8-year period” (Hamilton et al., 2023, p. 4)

Working to manage our own sleeplessness can help, and we encourage sufferers to take some basic steps in order to improve the chances of good quality sleep. These include measures such as practicing good sleep hygiene strategies like only using your bedroom for sleeping or sexual activity and reducing screen time before bedtime. While one might think that sleeping during the dark winter months would be easier than the brightness of midsummer, actually the winter can bring sleep issues, such as increased tiredness, insomnia, or hypersomnia. If you are waking up tired in the dark winter mornings, try turning on a light, to help your brain understand that it is morning. It can be harder to exercise during the winter, but try to include exercise into your daily routine, the benefits are shown in research. “Results from this study indicate that a sixteen week program of moderate intensity aerobic physical activity plus sleep hygiene education is effective in improving self reported sleep quality, mood and quality of life in older adults with chronic insomnia” (Reid et al. 2010, p. 6). Where sleep hygiene has been improved, but a client is still struggling with insomnia, ACT, Acceptance Commitment Therapy, can be extremely helpful in improving sleep.

How can ACT help to provide strategies and techniques for working with sleeplessness?

Traditionally CBT has been used to treat sleep disorders, however, there is a high drop-out rate among participants, “some studies have suggested that 14% to 40% of individuals drop out of CBT-I treatment altogether” (Saldaña et al., 2023, p. 3). This has led to therapists using ACT as a more effective way to work with clients’ sleep disorders. The heart of ACT lies in accepting your current state. One of the greatest stressors of insomnia is fighting to sleep. With ACT you start by developing acceptance strategies to help lean into your sleepless state and this immediately leads to reduced stress, a lower heart rate, reduced blood pressure, and greater relaxation. All these physical markers will help our body drift off to sleep. Fighting, or negatively evaluating our sleeplessness draws our attention to it, which can be detrimental to sleep.

The beautiful metaphor of comparing sleeping to surfing is, “You wait for the waves. There is nothing you can do to make the waves come faster or stronger. You wait for whatever wave you get that day. That is our parallel to sleep” (Saldaña et al. 2023). This perfectly encapsulates the essence of ACT and shows why it is so effective as a treatment for sleep disorders. Research shows “The results of this study indicate that ACT has a significant effect on primary and comorbid insomnia and sleep quality, and therefore, it can be used as an appropriate treatment method to control and improve insomnia.” (Salari et al. 2020) This research confirms earlier conjecture that stated, “We hypothesise that ACT specifically treating insomnia will not only improve sleep-related outcomes but also other aspects of the patient’s life, in line with the transdiagnostic proposal of ACT.” (Paulos-Guarnieri et al., 2012). As sleep disorders become more prevalent through our society, with around one-third of all adults report experiencing significant sleep-related issues (Kline, 2014) we need increasingly effective tools to work with the clients in our care.

Join us for an ACT course, specifically designed for sleeplessness

Here at Contextual Consulting, we provide training courses for therapists and mental health professionals, to increase their knowledge, and resources, to be able to better help their clients. Whether you are working with private clients, or provide group sessions for mental health charities, ACT, can give you another tool to help your clients. This ACT training course is targeted at how ACT can help with sleeplessness, but given the crossover of sleep disorders with other mental health issues, working with clients to improve their sleep, will bring increased benefits for their mental and physical health. If you want to expand your knowledge and increase the range of resources you can use with your clients, join our ACT training course. To learn more about ACT and sleeplessness or to sign up for our training course, please visit ACT for insomnia and sleep difficulties taking place on the 24th and 25th April 2024.

References:

NHS Inform. (2023, January 4). Beating the winter blues. NHS Inform. https://www.nhsinform.scot/healthy-living/mental-wellbeing/low-mood-and-depression/beating-the-winter-blues/

Saldaña, K. S., McGowan, S. K., & Martin, J. L. (2023). Acceptance and ommitment Therapy as an adjunct or alternative treatment to Cognitive Behavioral Therapy for insomnia. Sleep Medicine Clinics18, 73–83. doi:10.1016/j.jsmc.2022.09.003.

Hamilton, O.S., Steptoe, A., and Ajnakina, O., (2023). Polygenic predisposition, sleep duration, and depression: evidence from a prospective population-based cohort Transl Psychiatry. 2023; 13: 323. doi: 10.1038/s41398-023-02622-z

Kline, C. (2014) The bidirectional relationship between exercise and sleep: Implications for exercise adherence and sleep improvement, Ph.D. Am J Lifestyle Med.  8, 375–379. doi: 10.1177/1559827614544437

Reid K. J., Baron K. G., Lu B., Naylor E., Wolfe L. & Zee, P. C. (2010) Aerobic exercise improves self reported sleep and quality of life in older adults with insomnia. Sleep Med. 11, 934–940 doi:10.1016/j.sleep.2010.04.014.

Salari, N., Khazaie, H., Hosseinian-Far, A., Khaledi-Paveh, B., Ghasemi, H., Mohammadi, M., & Shohaimi, S. (2020). The effect of acceptance and commitment therapy on insomnia and sleep quality: A systematic review. BMC Neurology20(1). https://doi.org/10.1186/s12883-020-01883-1

‌Paulos-Guarnieri, L., Linares, I., M., P., El Rafihi-Ferreira, R.,  Evidence and characteristics of Acceptance and Commitment Therapy (ACT)-based interventions for insomnia: A systematic review of randomized and non-randomized trials. Journal of Contextual Behavioral Science Volume 23, January 2022, Pages 1-14 https://doi.org/10.1016/j.jcbs.2021.11.001

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