The Basics of Insomnia

Generally, insomnia is defined by a lack of proper sleep for over a month with symptoms of fatigue, decreased motivation, decreased concentration, and loss of appetite. The cause of insomnia varies, including but not limited to day-to-day stress, psychological illnesses, or side effects of medication.

The hours of sleep required for a healthy lifestyle varies from person to person. Some people will feel sleepy during the day even after 8 hours of sleep and some people will function perfectly fine on just 3 hours of sleep. It’s also known that our necessary sleep time for health changes with age. It’s natural to require less sleep as we age, so sleeping difficulties are less of a concern when we age. These natural changes are not indicative of insomnia.

Check out the article below for more details on the basics of insomnia.

When we experience continuous sleepless nights, many of us try to spend more time in bed to maximize rest. However, this may lead our brain to signal our “place of sleep” (a.k.a the bed) as a place of activity or wakefulness, leading to further sleeplessness.

“Sleep scheduling,” allows the brain to understand the bed as a place reserved only for sleeping. The following points become important to achieve this:
・Spend time outside of bed until you actually feel sleepy
・Do not try and go to bed until you actually feel sleepy
・If you are struggling to sleep, get out of bed

What is Sleep Scheduling?

Sleep scheduling is an effective approach for people who experience daytime discomforts due to long term insomnia. If you are not currently experiencing any symptoms of insomnia, be careful as this may disrupt your sleep cycle.

1. Understand Sleep Efficiency

Before we implement a sleep schedule, we must first understand our sleep habits. It’s important to know how long it actually takes to fall asleep once we get into bed and how long the sleep felt when we wake up the next morning. A good way to do this is by keeping a “sleep journal” to record our everyday sleep habits. Once there’s a good understanding of our sleep habits, we can calculate sleep efficiency (the ratio of our actual sleep over time spent in bed). Use the equation below to calculate your sleep efficiency.

For example, if you got in bed at 10:00 PM and woke up at 8:00 AM the next morning, you will have spent 10 hours in bed. Within that time, let’s say you felt like you actually got 6 hours of sleep. In this case, your sleep efficiency would be 60%. The goal is to achieve an average of 85% or more for adequate weekly sleep efficiency.

2. Go To Bed Later to Improve Sleep Efficiency

Once we grasp a good idea of sleep efficiency, adjust bedtime to 15 – 30 minutes before the actual sleep time in order to get closer to the 85% average sleep efficiency. If, as in the example above, you sleep for 6 hours and wake up at 8:00 AM, you should adjust bedtime to be at 1:30 – 1:45 AM. Until then, spend time outside of the bedroom to condition your body and brain to believe that the bed is strictly for sleeping only.

3. Gradually Lengthen Sleep Hours

Once the average weekly sleep efficiency exceeds 85%, gradually increase sleep time by either going to bed 15 minutes earlier or waking up 15 minutes later. Aim for a sleep duration that will not negatively impact daytime activities. These adjustments to our sleeping habits may temporarily make us go to bed later and wake up earlier. However, concentrated sleep hours can improve our subjective satisfaction towards sleep quality

Sleep scheduling can be an effective way to improve insomnia, but the root cause of it still needs to be addressed. If insomnia is caused by illness or side effects of medication, we should make improvements based on the guidance of a professional doctor. Make sure to carefully determine the cause of sleeplessness, before taking appropriate measures for improvement.

Better Sleep Habits Lead to More Fulfillment

Sleep is a vital behavior to our health that sustains life. Sleep also occupies one-third of our lives. Good sleep habits help us maintain good physical and mental health. It contributes to our ability to reach full potential and further grow.

It’s not easy to change the lifestyle we already have to adjust for better sleep. Although, with its benefits of creating a healthier and more fulfilling life, it will be well worth the effort.

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Image: Unsplash
References:
Munezawa, T., & Mishima, K. (2009). Cognitive Behavior Therapy for Insomnia. Journal of Mental Health, 55, 71-78.

National Center of Neurology and Psychiatry. Support Manual for Sleep Disorders and Sleep Problems. Retrieved from: https://www.ncnp.go.jp/nimh/behavior/phn/sleep_manual.pdf

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What Is Cognitive Behavior Therapy (CBT)?

Cognitive Behavior Therapy (CBT) is a type of talk therapy that focuses on a person’s cognitive distortions (e.g. thoughts, beliefs, and attitudes) and behaviors, to improve emotional regulation.

For example, when something occurs in our life, we make decisions and judgments based on our past experiences. The reactional thoughts we immediately have are called automated thoughts. These automated thoughts are usually grounded and rational. However, when people are under extreme stress or exhaustion, these thoughts distort negatively. This issue can be solved by focusing on these thoughts to understand what is realistic and not. The repeated process of this can create a balance within our mental thoughts.

Still, this is not an easy process. It requires a trained professionals’ guidance to provide the insight and perspectives needed. In reality, there are not enough professionals to handle the rising demands of mental health assistance that are required.

Therefore, online sessions are becoming a popular way to provide CBT for those in need to increase the number of patients that can be taken care of. The effects of online versus in-person sessions have been an interest of study for researchers.

Online CBT Sessions

Among the online CBT sessions, there is research particularly looking into how artificial intelligence (AI) might be helpful for facilitation.

A company divided their testers into 3 groups and tried CBT in the following different ways:

Group 1: An online CBT session with no other person involved. The user just answers questions and learns on their own without any feedback.

Group 2: The user receives advice through an AI capable of natural language processing. The AI will provide advice based on what the user has written and show empathy through the facial expressions of a woman that appears on the monitor. If the user is vague in their description, the AI asks to rewrite their answers.

Group 3: A control group where they do nothing.

What were the effects of these different methods?

The Surprising Effects of AI

Results showed that Group 1 had the best immediate short-term results for relieving depression, but many did not stick to the sessions after a while. On the other hand, Group 2 had better results in the long run with a significant reduction in severely depressed patients.

Why would Group 2 have a better long-term outcome when there was no immediate effect?

Feedback Creates Motivation

A survey asked why people quit their online CBT sessions and most answered, “I don’t understand what I’m doing” or “I want feedback.”

In Group 2, the natural language processing AI was able to empathize with their users and gave feedback that they needed to rewrite their answers if the content was weak. This kind of feedback is thought to be the reason why users felt the motivation to continue.

Online CBT Sessions Have Low Immediate Effect

There were low immediate improvements felt through online CBT sessions. Why is this? There are a few possible reasons:

• There were limits to the natural language processing and the AI was not able to empathize with the user sufficiently
• When users were asked to “rewrite,” it seemed like they were being corrected
• The correction to rewrite answers wasn’t necessarily the best way to understand feelings

Find A CBT Session Fit For You

There are still improvements to be made, but CBT through AI has big potential to significantly improve symptoms of depression. If the AI evolves enough to empathize and give better advice, many people can benefit from its use.

It’s not that far into the future that our online technology will become essential in meeting our individual mental needs.

References:

Mirai, S., Sekizawa, Y., & Takebayashi, Y. (2017, May 23–26). Can Artificial Intelligence Heal Human Hearts?：A randomized controlled trial on the effects of internet-based cognitive behavioral therapy with natural language processing on depression [Presentation]. The 31st Annual Conference of the Japanese Society for Artificial Intelligence, Aichi, Japan. https://www.ai-gakkai.or.jp/jsai2017/webprogram/2017/pdf/98.pdf

Cognitive behavioral therapy. (2016, September 8). National Center for Biotechnology Information, U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK279297/

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