A Self-Led Medication-Free Guide to Improve Your Sleep
Written by: Angela Rozema
October 18, 2022
The article below provides 7 steps to improve your sleep and all of these can be attempted without prior skill or knowledge. Just keep in mind self-help can be challenging. If you find it isn’t working that doesn’t mean that the process is broken, you might just need some help. Contact a therapist and they can work with you to find the best way to help you get better sleep! Secondly, this is a Cognitive Behavioural Therapy (CBT) based intervention. That means that it works well for self-management and like with all things, might not work for you. Don’t be afraid to try other methods and seek support from a registered therapist.
NOTE: If you are taking sleep medication, you can still do the things listed here as this is completely medication free. If you decide you wish to change your medication, always consult a medical professional first.
Step 1: Start a sleep log
A sleep log is a way to obtain your baseline. This will give you a starting point from which to determine if the changes you make help or hinder improving your sleep. You can do this on your phone, a piece of paper, or any other method that works for you to create a log that you add to each morning. The key is timing. Try to record your sleep log first thing while it’s fresh in your memory. What should you record? Things like:
- The date
- What time you went to bed
- What time you woke up
- What time you got out of bed
- Hours of sleep (this might be a calculation considering your estimates of awake time)
- Hours in bed
- Sleep interruptions
- How long it took to fall asleep
- What you did just before bed
- What you did if you were up for a length of time
- Rate your sleep quality (do you feel rested?)
- Stresses from your day/week
- Dietary changes (ex. Ate out, had fried foods, etc.)
- Anything else you feel is important
Remember this is your log, it can be as detailed or simple as you want, but you’re going to want to have enough information that once you start your intervention you can see the changes. There are several apps to help with logging your sleep, check them out and their ratings before choosing which one you wish to try. Once you have about a week’s worth of data, move on to step 2.
Step 2: Analyze your sleep hygiene
This should be conducted after you have a 7-day baseline of your current sleep patterns. Review this list of sleep best practices to see if there are areas you can improve on.
Unplug for at least 1 hour before bed
Turn off and remove electronic devices from your immediate space. The light waves they produce, and the activities performed can interfere with sleep cycles. In addition, there is evidence that there can be added stress from social interactions or the fear of missing out (FOMO). If you set a routine that, you unplug each night before bed, this can reduce stress and set a healthy electronic boundary improving your sleep.
Avoid Caffeine for at least 6-8 hours before bed
Most of us are aware that caffeine can wake us up. Caffeine is a stimulant and even if you think it doesn’t affect you, chances are it does. Am I suggesting you completely cut it out? No, but try slowly backing off your caffeine consumption until you have a good 6 to 8-hour gap before bedtime. Maybe eventually you will want to remove caffeine from your diet, but you can make that choice later.
Avoid Nicotine before bed
Nicotine is also a stimulant. You might be thinking, “Smoking helps me relax.” That is true. For most people nicotine will relax them at first, but nicotine is tricky! After it builds up in the system it has a stimulating effect and that means you might wake up in the middle of the night – unrested and frustrated! To improve your sleep, try and back it off a little at a time so your last nicotine is a few hours before bedtime.
Avoid alcohol after supper
Alcohol may cause you to feel sleepy but unfortunately, it is linked with disturbed sleep. Once again, if you have a rule to not consume alcohol after supper this will reduce the impact on your sleep quality.
Sleep medications lose their effectiveness quickly
Again, check with your doctor or pharmacist if you’re taking any medications before you change them! This is very important. However, if you are taking over-the-counter sleep aids it might be wise to stop using them to improve sleep. They become less effective the more you use them, and some can create a dependency. Even if your medication is over the counter, ask the pharmacist how best to wean off it.
Get regular exercise
Try and get 20 minutes of medium-intensity exercise daily more than 2 hours before bedtime. It is linked to improving circadian rhythms and better sleep quality.
Hot baths
Spending around 20 minutes in a hot bath a couple of hours before bed has been shown to aid in sleep.
Create a bedroom atmosphere that promotes sleep
This means, avoiding using your bedroom for work, watching TV, hanging out, etc. Ensure the room is dark at sleep time, and quiet. You can use a sound machine to help if there are background noises. It can also help to remove clocks so that you are not tempted to watch the clock.
Eating
Avoid eating excessively late at night but, don’t go to bed hungry either. If you need to have a snack, do so but ensure it is light and does not include caffeine, alcohol, etc.
Avoid napping
Napping might seem like a good idea, you are tired after all, but it doesn’t help in the long run. Fighting through the tiredness will help show your body that it needs to sleep at night. Just remember if you’re sick this rule may not apply.
Keep a regular sleep schedule
It’s the weekend, so you can sleep in, right? Wrong, well at least you probably shouldn’t as far as your sleep is concerned. Keeping the same wake-up schedule helps your body maintain its circadian rhythm. That means you can fall asleep at the desired time more consistently.
OK, so now that you have looked over these sleep hygiene guidelines you know how to make some changes to your sleep. The best approach is to try one thing or perhaps two for one week and see if any improvements are noted. These improvements might be in your sleep efficiency (calculation is in Step 4) or how you feel. Try to avoid changing everything all at once. It can be challenging to maintain, and you might find you get discouraged more quickly and end up giving up! Besides, you won’t know what change helped so if you take the slower, steadier approach you may have more success. So, what’s the first change recommended?
Step 3: Only stay in bed for your typical sleeping hours
What!? Yep, you read that right – even if you typically only sleep for 4 hours, don’t stay in bed longer than those 4 hours. What this does is it trains your body to use the time it has in bed to sleep. When you can’t sleep your mind wanders and you likely lie there frustrated. This can create negative thoughts and feelings towards your bed and sleeping. By following this for several days, you should find that you will hit the pillow and fall quickly to sleep. Here are some further steps to take to change the way bed and sleeping are perceived by your brain:
- Go to bed when you’re sleepy (at night).
- Use your bed for sleep or bedroom activities, not watching TV (as an example)
- If you haven’t fallen asleep in about 15 minutes, get out of bed and do a quiet sedentary activity such as reading a paper book, writing in a paper book, or other non-electronic or stimulating activities.
- Get up at a regular time
- Hide your clock
- Avoid napping
Step 4: Keep doing sleep logs with this new change
Further, you might want to add a column where you determine your sleep efficiency.
Average total sleep from log: ______
Determine wake up time: _______
Then decide on bedtime: _______
Calculate sleep efficiency: Time asleep ÷ Time in bed = ______
Example: Calculate sleeping hours:
8 hrs – 2 hrs awake – 30 min. wake ups = 5.5 hrs of sleep
Time in bed 8 hrs
Efficiency = Time asleep ÷ Time in bed
= 5.5 hrs ÷ 8 hrs
= 0.6875 x 100%
= 68.75% efficiency
Step 5: After 1 week, is your sleep efficiency is greater than 85%?
If it is, you can increase your time in bed by 15 – 20 minutes. If not, don’t worry it can take a while to improve sleep. Reduce your time in bed by 15 – 20 minutes if your efficiency is less than 70%, otherwise stay the course. Do some problem-solving, have you noticed any of those bad sleep hygiene behaviours creeping in, or maybe something you missed before? Review the guide above to see if there are any strategies you can try to help improve your sleep.
Step 6: Challenge your negative sleep thoughts
Often when we don’t get enough sleep it causes us to worry about things such as, “If I don’t get to sleep now, I’m not going to function tomorrow.” Or simply, “Oh my gosh, just go to sleep already.” These thoughts can lead us to have negative emotions and images about sleep itself. Challenging this thinking, allows us to have a more balanced thought. By using balanced thinking, we can strengthen our ability to tolerate a bad night’s sleep. To do this create a chart where you will have two columns. The first will have the original negative thought and the second will have a balanced way of looking at it. Here’s an example:
| Negative thought | Balanced thought |
| “If I don’t get to sleep now, I’m not going to function tomorrow.” | Even if I don’t get to sleep now, I’ll still be able to function in the morning. I’ve done it before. |
Once you have a balanced thought for each negative thought you have at night, the key will be to remind yourself of them when they pop into your head. At first, this might be challenging, and it might be helpful to have a quick read-through of them before you go to sleep. As you practice, it’ll get easier, and eventually, the goal is for you to not have negative thoughts running through your head.
Step 7: Maintenance and relapse prevention
Keep up your new sleep routine once you have one that works! Make notes for yourself along the way of things that help and things that hinder. If you experience a setback or find your sleep becoming less restful, go back to the first steps and check on your sleep efficiency. Have you slipped from 90-100% and now it’s somewhere near 60-70% or worse? Are old habits creeping back in? It happens and that’s OK, you can keep trying but don’t be afraid to ask for help. Contact a therapist and get some professional support. If you’d like to continue with CBT look for a therapist who specializes or has extra training. If you’re in Ontario and are interested in online therapy, feel free to reach out to my office and schedule a free 15-minute consultation.
That’s it. Those are the 7 main steps to help you combat sleep issues using CBT! Good night and sleep well!
This article was written by Angela Rozema, a Registered Psychotherapist in Ontario based on the CBTi methods of Richard R. Bootzin and Charles Morin. This article is intended as a tool to be used by individuals wishing to improve their sleep through non-medicinal methods. It does not replace the advice and guidance of a medical doctor or a psychotherapist and should be used only for its intended purpose.
