Acceptance & Commitment Therapy for improving sleep
Suffering from difficulty sleeping can lead to varying degrees of distress and a range of problems. When sleep difficulties arise, it’s natural for us to seek relief and try to reduce the suffering it causes. As a result, most people will try various approaches to resolve the issue.
For bad sleepers this can result in trying all sorts of different strategies to help our sleep and reduce the difficult feelings that come with poor sleep. The chances are most people who’ve suffered from long term sleep problems will have already tried or come across using some of the following strategies to help them sleep:
Sleep hygiene tips (e.g. exercising & avoiding caffeine)
Sleep promoting supplements
Relaxation techniques (e.g. breathing exercises & meditation)
Sleeping pills (prescribed & over the counter)
Trying to tough it out
Alcohol and or cannabis
Distraction techniques (e.g. listening to things)
Strict bedtime routines and rules (e.g. getting out of bed if you can’t sleep)
If you’re currently using any of these strategies and they’re working for you and helping you to sleep and live the life you want, then great. However, what if they’re not working for you and your life?
If you’re reading this article it’s likely that you’ve tried some of them, maybe even most of them, and they aren’t working. Perhaps some are giving short term relief but don’t seem to be offering a long term solution. Or maybe they do work to an extent, but aren’t helping you to live the life you want and seem to be restricting you.
Chances are, you want to sleep like a good sleeper: naturally and consistently, without needing pills, remedies, rigid rules, or anything else to fall asleep. Perhaps you’re feeling stuck, not making progress, and unsure of what to do about your sleep difficulties. Acceptance & Commitment Therapy (ACT) could be an alternative option for those who find themselves in this situation.
ACT Introduction
ACT is a type of psychological therapy that was created back in the 1980s that’s been used to help people with all sorts of difficulties. There’s a great deal of scientific evidence to support the effectiveness of ACT for a range of psychological and physiological problems and there have been more than 3000 scientific studies and over 1000 carefully randomised controlled trials completed on it. Among the 400 or so different types of psychological therapies available, ACT stands out as one of the most effective.
ACT can specifically be particularly great at helping people with difficulty sleeping. Whether the sleep problems are short-term or chronic, ACT can be very effective. Organisations such as the UK’s National Institute of Health and Care Excellence (NICE) and the US’s Department of Health and Human Services (HSS) give it their stamp of approval for treating insomnia related sleep problems.
But here’s something to point out early: ACT needs to be done the right way and whilst it’s simple and straightforward in nature, it’s not enough to just read about it or watch videos on it. Much like most therapies, to get the best results you need to have genuine conversations with others who know what it’s like and get personalised help in a real heart-to-heart conversation with someone trained in ACT.
How ACT helps you sleep
People can struggle to sleep and suffer from poor sleep for a multitude of reasons. However, often a core reason is because of experiencing anxiety, stress, worry and other negative thoughts and feelings at night, which keeps people alert and awake. These can then lead to some developing problematic habits and negative behaviours around sleep, which can perpetuate the issue.
Everyone experiences difficult emotions at night sometimes, such as anxiety, stress and worry etc. Whilst for many this doesn’t happen too often, or at least their sleep doesn’t suffer regularly, for others difficult thoughts and feelings can routinely disrupt sleep and lead to long term sleep problems.
As humans, our natural instinct is to try to eliminate the negative thoughts and feelings that keep us awake at night in an effort to feel calmer. We also often spend a great deal of time trying to solve the problems we face in our lives. On the surface, this makes sense: if you can relax at night, you should be able to sleep; if you can solve the issues you’re facing, there isn’t much left to think about. Hence people try various methods to relax to help them fall asleep and a long time problem solving in their minds. But typically they don’t get good results and still struggle with sleep. What if trying to relax at night might not be the best answer?
ACT teaches us a different way. Instead of trying to stop these thoughts or push these feelings away, ACT helps us to handle them in an accepting way. By not trying to stop or struggle with difficult thoughts and feelings at night, we don’t let them have so much control over us and thus they affect our sleep less.
Furthermore ACT helps us to stay present in the midst of all the problem solving our minds do at night. It helps us avoid getting caught up in ruminations about the past or lost in worries about issues that haven’t happened yet.
Paradoxically ACT isn’t about focusing on forcing a good night’s sleep. The likelihood is you’ve probably already been trying to get a good night’s sleep, doing your best and trying everything, but how’s that going?
ACT is about taking control of our lives, even when we’re struggling with sleep. It’s about not letting a lack of sleep define who we are or allowing the emotions that come with insomnia to hold us back from pursuing the life we want. It helps us to be more at ease and less bothered by the tricky thoughts and feelings that insomnia brings.
Acceptance at night
Our brains have evolved to be a built-in worry machine, always on the lookout for dangers and what to do about them. This system is what’s helped humans survive throughout history. We inherently worry about what might cause us harm, even if the threat is minimal and not an actual physical threat.
Automatically our brains work on the basis of ‘better safe than sorry’. From a survival perspective worrying about something is more likely to keep you safe, than forgetting and relaxing about it. Your brain is a pro at spotting possible threats and trying to figure out how to deal with them.
When it comes to a difficulty sleeping, the brain treats being unable to sleep as a threat. It perceives the lack of sleep as a threat to you because it makes you feel bad and affects your ability to perform at your best in daily life. The word ‘threat’ might sound a bit strong, as a bad night itself won’t physically harm you, but your brain still becomes hypervigilant because of it. Therefore it starts to worry more and more about this problem and what to do about it. The more it worries and tries to solve the problem, the harder it becomes to fall asleep, creating even more worry and so on. It can be like a snowball rolling down a hill, getting bigger and bigger.
In the image below you’ll see some typical worrying thoughts that we experience at night when we can’t sleep. These thoughts are often along a theme of either trying to predict what will happen, ruminating over what’s already happened or of general hopelessness. For most people suffering from bad sleep you can almost predict that these thoughts will pop up at night, when the ‘worry machine’ seems to be most active.
Most of us, instead of being open to and sitting with these hard thoughts and feelings, naturally want to escape them. We instinctively want to get rid of the uncomfortable feelings of anxiety, worry and stress etc, and find a quick fix to help us fall asleep. We might turn to using sleep aids or other strategies to find relief and help us do this. But in the long run, these solutions might not work and might even make things worse.
In response to a difficulty sleeping this hard wired response kicks in, manifesting itself typically as worry, anxiety and stress etc. So when we get worried, anxious or fearful about our sleep, that’s normal and to be expected. Therefore the anxiety, worry and stress that we experience from poor sleep isn’t because we’re malfunctioning, but because our brains are functioning as they’ve evolved to.
The strange thing is, the secret to a good night’s sleep is often the opposite of what we think. Instead of trying to get rid of or get a grip of the noisy difficult thoughts and feelings, we could instead lean towards being okay with them being present. Initially we may think of insomnia as a problem to overcome, fix and struggle with. However, it’s actually okay and possible to open up to being awake at night and to allow the feelings this brings to happen without struggling or battling with them, even if it’s uncomfortable.
In ACT, Acceptance means being willing to feel whatever thoughts and feelings bubble up inside us at night, even if they seem to be bad ones and ones that keep us awake. ACT helps us to not hide from the things that keep us awake and not miss out on life because of them. Embracing these feelings might be a little scary, but can be helped through using tools based on mindfulness and self-compassion. This leads to a more fulfilling life and is a way of living that reflects who we truly are and what we value. Coincidentally also leading to better sleep.
Commitment to your values
Think of the things that mean the most to you, like family, friends, your job or your passions. These are likely the things that you value in life most and want to be the best version of yourself for. Interestingly though, despite what you might instinctively think, sleeping itself isn’t actually something that you value in life. We think we value a good night’s sleep, but actually good quality sleep just helps us to enjoy doing the things that we really value and love in our daily lives more.
The easiest way to portray this is to give you the following analogy. If I could wave my magic wand and make you feel like you’d had the best night’s sleep, feeling fully refreshed and well in yourself, but having only slept for three hours each night, would you be happy with that? If the answer is yes then you’ll begin to appreciate that it’s not the quantity of sleep that we value, but how it makes us feel and able to do the other things in life.
Importantly you can still pursue what you value in life and try to be the sort of person you want to be despite sleeping badly. The opposite also applies, you can sleep fantastically and not be living a life true to your values. Even though there’s no question that suffering from bad sleep makes life harder, you can still try to be the kind of parent, partner, friend or colleague in life that you want to be. ACT helps to give you the tools and skills you need to do this, despite the difficult thoughts and feelings that can get in the way.
Committing to pursuing what’s important to us in life doesn’t always mean we should force ourselves to push through relentlessly after sleepless nights with sheer willpower. The goal isn’t to grit our teeth and bear it, but rather to approach the issue with mindfulness, compassion and kindness towards ourself. There’s a big difference between tolerance and acceptance, and ACT always aims towards the latter.
The ACT Choice Point
Let’s look at a helpful tool from ACT called ‘the choice point’ to help you understand a bit more about how ACT can practically help your sleep.
Picture this: you’re lying in bed, worrying about something, getting stressed about it and you can’t fall asleep. Perhaps you’re getting anxious about not falling asleep itself and what might happen if you don’t sleep. You’re stuck in a cycle of negative thoughts that keep whirring around in your mind. Or maybe you’re feeling consumed and wrapped up in difficult feelings of anxiety, frustration or panic. This is where the choice point tool comes into play.
When difficult thoughts and feelings arise within us at night, there’s a choice we can make. Firstly we need to recognise that we can’t stop these thoughts and feelings arising in the first place. As I’ve already mentioned, it’s expected that when struggling with sleep, feeling somewhat anxious, stressed and worried at night is a normal reaction. Whatever you try, tricky thoughts and feelings will usually find a way to reappear at night.
However, what we do have is more control over how we respond to these thoughts and feelings when they show up. We have a choice over how much we let these thoughts and feelings influence our behaviours in life. We have the ability to not let difficult feelings bother us as much or stop us from doing the things most important to us.
Getting Hooked:
When a worrisome thought pops up, such as “I’ll never sleep tonight,” “I won’t cope tomorrow if I don’t’ sleep,” or “why can’t I sleep?” Our natural tendency is to focus our attention on them, to let them grab us and hook us in. These thoughts might then carry us away and cause us to get lost in them, resulting in us spending lots of time dwelling on them. Sometimes these racing thoughts can keep us up for hours.
When you get consumed by these thoughts, you’re getting ‘hooked.’ You become more bothered and stressed and less relaxed, making sleep less likely. Getting ‘hooked’ by these negative thoughts tends to spiral into more negative thinking. This tends to perpetuate feelings such as anxiety too, making you feel even less relaxed.
Importantly ‘getting hooked’ by difficult thoughts and feelings is normal, natural and to be expected. It happens to us all, myself included, and we will never not get ‘hooked’ at times. However, using skills learnt through ACT, we can start to notice and realise when we do get ‘hooked’.
Unhooking Yourself:
When we notice we’ve been hooked we then have a choice. Instead of getting carried away or lost in these thoughts and feelings, you can ‘unhook’ yourself. You can create some distance between you and them, getting to see them for all that they really are, simply thoughts and feelings. You can recognise these troubling thoughts and feelings as temporary, something you don’t need to struggle with, get wrapped up in or let control your actions.
So how do you ‘unhook’ yourself? It might sound a bit abstract, but it can be simple with the right tools. ACT provides specific techniques, often based on mindfulness exercises, that you can learn to help you let go of these thoughts and feelings and not get so wrapped up in them. It might sound easier said than done, but with practice, it becomes more doable.
On the choice point diagram, you’ll see the phrases “away from sleep” and “towards sleep.” But let’s look at what replacing them with “away from your values” and “towards your values” means.
Think about a time when you had a negative sleep related thought like “I won’t be able to do that important thing tomorrow because I’ll be too tired.” This thought might ‘hook’ you and make you feel stuck, leading you to cancel what you originally wanted to do or take part in. In other words, you’re moving away from what you value because you’re letting that unhelpful thought around sleep control your behaviour.
But what if you could ‘unhook’ yourself from that thought? Recognise the thought for all that it is, just words and images popping up in your head, and something that you don’t have to buy into and can let go of. It’s about still going ahead and to do that important thing tomorrow which you value, despite the negative thoughts bad sleep brings. You might still feel tired or worried, but that hasn’t stopped you focusing your attention on what’s truly important to you.
The ACT Hexaflex
The diagram below is called the ACT Hexaflex, which is a model designed to represent the six different core principles that ACT covers to help people. The descriptions of each principle have been adjusted to give you an idea of how they link to sleep, as ACT can be used for many different issues.
Don’t be put off if you think the diagram and jargon looks a bit complicated. Rest assured that ACT is both relatively simple and straightforward to apply in a coaching setting. You’ll never need to understand what the bits of the diagram all mean to get the benefits of ACT to help you sleep.
There’s also a few things to bear in mind about the Hexaflex. Firstly it’s just a model. It can’t get even close to fully capturing how the different ACT principles and tools can help you in reality, but it’s an overview. Secondly, not everyone’s sleep troubles are the same. Your problem with sleep might be different from someone else’s. So, the Hexaflex may need to be tailored to fit your unique situation. Some parts of it might be more relevant to you than others and some parts might not apply to you.
Struggling with sleep? I can help
Let me help you to identify the root cause of your difficulty sleeping and help you to resolve the issue using Acceptance & Commitment Therapy (ACT).
ACT is an approach that is:
✔︎ Drug and gimmick free
✔︎ Clinically proven and endorsed by NICE
✔︎ Mindfulness-based
✔︎ Tailored to your sleep issue
✔︎ Simple and gives quick results
Complete my free online course as a starting point to see how I can help you through ACT.
