Sleep Problems
When Ellen MacArthur sailed solo round the world in 72 days, she slept for five-and-a-half hours a day, broken into short naps, averaged at 36 minutes, making her sleep/ wake pattern look like a barcode. She had enlisted the help of a neurologist - an expert on sleep and alertness management. What they showed is how much our sleep can be disrupted.
While few of us face such extreme circumstances as Ellen MacArthur, disrupted sleep can take root easily. Stress, irregular work hours, and habits such as late-night screen time can push us into a pattern that feels chaotic and can begin to look like MacArthur’s “bar-code” sleep pattern. Over time, the cumulative effect can lead to cognitive impairments, mood disturbances, and affect our physical health.
As a psychologist, I’ve seen countless clients with sleep problems. I still use the evidence-based methods developed by Colin Espie to help. By employing his strategies, I have seen the impact that proper sleep hygiene can bring, even for individuals who have struggled with chronic insomnia for decades. It’s definitely not for the faint hearted: it’s a really tough form of treatment, demanding commitment and a willingness to endure the temporary discomfort that comes with retraining your body’s natural rhythms.
Rebuilding a Good Sleep Pattern
Colin Espie, a psychologist renowned for his work on sleep, dedicated much of his career to developing practical strategies for treating insomnia and sleep disruptions. His approach is based on cognitive-behavioural therapy for insomnia (CBT-I), which focuses on addressing the behavioural, cognitive, and environmental factors that contribute to chronic sleep problems.
Espie’s method stands in contrast to medication, which often masks symptoms without addressing underlying causes. While sleeping tablets can offer temporary remission, they typically don’t restore the body’s natural sleep pattern and can lead to dependency. By contrast, CBT-I works by gradually recalibrating the body’s sleep-wake cycle and teaching the brain to associate bed with restful sleep, instead of with anxiety, frustration and despair.
The cornerstone of Espie’s approach involves several key components:
Sleep Restriction Therapy: This method limits the time an individual spends in bed to only the hours they genuinely sleep. For instance, a client might be instructed to restrict their sleep to a window between 12:30 a.m. and 6:00 a.m., even if they initially sleep less than that.
Stimulus Control: Espie’s strategy also includes training clients to break the negative associations between being in bed and being awake. This means only using the bed for sleep and leaving the bedroom if you find yourself awake for more than 15-20 minutes.
Sleep Hygiene and Cognitive Restructuring: Clients learn about good sleep practices, such as avoiding caffeine and screens before bed, establishing a wind-down routine, and challenging negative beliefs about sleep.
The Hard Path to Better Sleep
I always prepare clients for the gruelling nature of CBT-I. It is not a quick fix. In fact, the first week or two can feel pretty horrific. Sleep restriction can lead to real exhaustion as the body adjusts to a more limited sleep window. Clients often report feeling even more sleep-deprived initially, as their already disrupted sleep pattern is squeezed into tighter confines. And this can be where resilience is really tested.
Regardless of how tired you may feel during the day, you need to resist the urge to nap - even when overwhelmed by fatigue. Add to that the need to maintain regular physical activity to promote overall sleep quality and it’s made even more difficult. The process is exhausting and can sometimes lead to days of severe sleep deprivation before improvement begins to take hold.
The Turning Point: Reclaiming Natural Sleep
The perseverance, however, is worth it. If you can endure the challenging early stages, you will find that your body begins to relearn the art of sleeping. The brain starts associating bed with sleep, and the tight sleep window forces you to consolidate sleep into more efficient periods. Slowly, sleep starts to return to a natural rhythm, even for those who have lived with disrupted sleep for years.
I recall one client who came to me after decades of severe sleep difficulties. She pushed through weeks of exhaustion - and tearfulness – questioning whether it would ever work. Finally, she woke one morning having had six solid hours of uninterrupted sleep—for the first time in years. Gradually, her natural sleep rhythm came more consistent. With it she also gained more energy, clearer thinking and a much-improved mood. She wrote me a card after to say how her life had been transformed – but reminded me that I really need to emphasise how tough – but also how worth it – the process is.
Conclusion
The sustainable success of CBT-I lies in its ability to address the root of sleep issues. Medications, while sometimes necessary for acute insomnia, rarely correct the behaviours and thought patterns that perpetuate chronic sleep issues. Espie’s approach helps clients take charge of their sleep, reshaping their habits and attitudes through scientifically grounded techniques.
In my practice, I have seen people rediscover a natural sleep rhythm that they believed was long gone. The process is demanding, and it can be emotionally and physically draining. But for those willing to commit, it can have huge benefits to mental health.