Managing Insomnia Lesson 4

Managing Insomnia
Lesson 4
Tackling Remaining Difficulties, Reviewing
Your Skills, and Maintaining Your Gains
Welcome and Lesson Overview
Welcome to the final lesson of the course! By this stage of the course, we hope that you have seen some
improvement in your insomnia. We don’t expect your sleep to be completely better just yet but by the
end of this lesson, we hope that you have all the core skills that you need to improve your insomnia. It’s
now just about tweaking your time in bed prescription and making further changes to any residual sleep-
interfering behaviours and thoughts.
This summary reviews the key points discussed in Lesson 4 and includes tasks for you to work on over
the next 1-2 weeks. In the first half of this lesson you will learn about tweaking your time in bed
prescription (as part of Time in Bed Restriction Therapy); activity scheduling to ensure the right balance
of stimulation to assist with good sleep and getting out of bed in the morning; relaxation techniques to
reduce arousal; and structured problem solving to assist with any further concerns that may be keeping
you up at night. In the second half of the lesson, we will review all of the skills and concepts you
have learned to manage your insomnia and make a plan to maintain your gains into the future.
Topics Covered In This Summary & Action Plan

Here is a list of the topics we will cover in this Summary & Action Plan. Tick these off as you go:
1. Tweaking Your Time in Bed Prescription (page 3)

2. Making the Most out of the Day to Improve Sleep and Help You to Get out of Bed in the
Morning (page 3)
3. Relaxation (page 5)
4. Structured Problem Solving (page 8)
5. Review of Course Skills and Concepts (page 14)
6. Maintaining Your Gains (page 17)
7. Other Sleep Disorders & Getting Additional Support (page 18)
8. Action Plan (page 19)
But first, let’s recap Lesson 3…

In Lesson 3, you learned about limiting the amount of time you spend in bed to improve your sleep
efficiency (Time in Bed Restriction Therapy) as well as two strategies to manage sleep-interfering
thoughts and an active mind – Thought Challenging and Disengaging from Thoughts.
Quick Recap Quiz

A. Name the two ways to manage unhelpful thoughts you learned about last lesson
1. ____________________________ 2. ______________________________
B. “More time in bed helps you to get more sleep.” - True or False?
C. “Reducing time in bed increases sleep drive.” - True or False?
D. The three steps to Thought Challenging are:
R _ _ _ _ _ _ _ _ , C _ _ _ _ _ _ _ _ , and C_ _ _ _ _
E. Name one way you could shift your attention away from unhelpful thoughts?
_______________________________________________________________
WWW.THISWAYUP.ORG.AU 2
Answers to recap quiz. A) Thought challenging and Disengaging from thoughts. B) False. C) True. D) Recognise,
Challenge, and Change. E) There are many ways to shift your attention including getting out of bed and
doing something else as well as trying to think of all of the meals you ate over the past week. See section 5
from Lesson 3 summary.
1. Tweaking your Time in Bed Prescription

If you have been doing Time in Bed Restriction from the last lesson, don’t forget to review your
sleep efficiency each week and to tweak your time in bed prescription until you find your ideal
sleep window.
What was your sleep efficiency over the past week?

_____%
Remember, if your sleep efficiency is 85% or more, increase your time in bed by 15-30 minutes
for the next week. If it is less than 85%, decrease your time in bed by 15-30 minutes. Continue
this process until you find a satisfying sleep window in which your sleep efficiency is at least
85%. That is, until you feel you are getting enough sleep so that you don’t feel too sleepy during
the day and you are not experiencing extended periods of wakefulness during the night.
Did you know?

For many people, their ideal sleep window is less than they originally expected. For example,
many people with insomnia start out in treatment thinking they need 8 hours’ sleep but
come to realise that 7 hours is perfectly adequate for them. Remember, sleep needs are
individual.
2. Making the Most Out of the Day to Improve Sleep and Help You to
Get out of Bed in the Morning
Even people without insomnia experience a groggy feeling in the morning that lasts between 20
to 60 minutes after waking. This is called sleep inertia. Sleep inertia can be intensified when you
haven’t slept well. So it can be helpful to plan ahead of time and schedule activities that help
you overcome sleep inertia.
Exposure to bright light and being active can help reduce sleep inertia.
In addition to this normal sleep inertia, it can be difficult to get out of bed when you don’t have
much to do during the day or anything to look forward to. Sometimes people with insomnia
reduce their activities as they rigidly revolve their lives around their sleep. They may be
reluctant to plan things in case they need to rest to “make up for” sleepless nights. But, we
know that it’s important to ensure adequate activity levels in the day to build up your sleep
drive. One way you can achieve this is by using Activity Planning.
Activity Planning
ACTIVITY PLANNING
Step 1: Plan your activities
Step 1: Plan your
We know that having activities planned in the day, both activities
those that give you a sense of achievement and those that Step 2: Record what
give you a sense of pleasure, is important for maintaining a you actually do
good quality of life and acting as an incentive to help you get Step 3: Review what
you have done
out of bed in the morning.
It can be helpful to make plans in advance so that you don’t just leave it till the day to come up
with what you’re going to do (when motivation for planning may be lower). You can use an
Activity Planner, like the one included at the end of this Summary to use to help you with this.
Otherwise, you might prefer to use your own diary.
If you find it particularly difficult to get out of bed, ensure that you schedule some activities for
the morning that will motivate you to get out of bed.
Every evening, perhaps during your wind-down, set aside 5-10 mins to plan the following day.
Use the “Activity Planner” located at the end of this lesson.
Make sure that you include:

The activities you need to do (e.g., work, pick up the kids from school)
Activities which give you a sense of achievement
Activities which are fun and pleasurable
Physical exercise and other self-care activities (e.g., relaxation)
What are some enjoyable activities you What activities give you a sense of
would like to do more of? achievement?
 See friends  Exercising
 Go to the movies  DIY around the house
 Eat out  Cleaning
 _______________________________  _______________________________
 _______________________________  _______________________________
Remember, overstimulation is not helpful either! It’s important to strike a balance

between under-stimulation and over-stimulation by pacing your activities.
Step 2: Record what you actually do
Put your plan into practice:
1. Check off the activities that you manage to do each day using the Activity Planning
Form. Try to tick these off after you have finished each activity.
2. Record any additional tasks that you did (if applicable).
Step 3: Review what you have done

At the end of each day, rate both your sense of pleasure and achievement for the day (out of 5).
Spend some time reflecting on your activity for the day by asking yourself:
− Take note of which activities you enjoyed and gave you a sense of achievement for that
day.
− Which activities helped to motivate you to get out of bed?
− Which activities helped you to feel more energetic?
− Did you try to do too much/too little?
− Did you get the balance between over-stimulation and under-stimulation right?
− Did you strike a balance between pleasure and achievement?
− Did you cancel something because you felt too tired?
− Would you do anything differently tomorrow?
Tips for Activity Planning:

When you are increasing your activity levels and regular exercise, it is important to:
Be realistic in your expectations.
Do the activities you have planned, even when you don’t feel like it or haven’t slept well.
Remember it’s unhelpful to stay in bed in the morning or cancel activities even when you
haven’t slept well the night before.
Remember that activity often generates energy.
If you can’t think of anything you enjoy, pick one activity that you have enjoyed in the past,
and try it, even if you think that it won’t work!
3. Relaxation
As you now know, the 3 factors that regulate sleep are:
Sleep Drive Circadian Rhythm Arousal
In this section, we will focus further on Arousal. Excessive arousal (e.g., feeling tense or on-
edge) interferes with sleep. We have already discussed how managing worries and stress is key
in reducing arousal. Another way to reduce arousal is by doing relaxation exercises.
Two strategies for relaxation are:
Slow Breathing
Progressive Muscle Relaxation (PMR)
Slow Breathing
Slow breathing can be useful to reduce physiological arousal. By slowing down our breathing, we send
calming messages across our entire physical system. It is important to practise, practise and practise the
slow breathing task – and then practise some more!
STEP 1: A normal resting breathing rate is 10 – 12 breaths per minute. What is yours now? Use a watch
with a second hand (or timer) and count the number of breaths you take over one minute. Write it here:
_______________ breaths per minute
STEP 2: Sit comfortably in a chair. Use a watch with a second hand to time yourself. Breathe in and
out gently through your nose. Rest your hands on your tummy to check that you are using your stomach
muscles (and therefore, your diaphragm) to drive your breathing rather than your upper chest.
STEP 3: Now, do the following exercise:
Breathe in for 4 seconds
Pause for 2 seconds
Breathe out for 6 seconds
As you breathe out, relax your body (you may like to say the word “relax” to yourself).
Do this for 3 minutes and notice the difference in your tension or anxiety.
Try counting your breathing rate for one minute before and after the exercise.
Did your breathing rate drop afterwards?
Write it here: _______________ breaths per minute
SUMMARY: The slow breathing exercise can be done at different times throughout the day. At first
you may need to find a quiet, relaxing place. With practice, it becomes easier and you can use it
whenever and wherever you need to. It takes time to master this skill, so don’t give up! We
recommend that you practise this technique at least 2 times per day every day.
Muscles are designed to remain in a relaxed state until needed to perform some physical
activity. In usual circumstances, muscles do not remain at a high level of tension all the time, but
fluctuate between tension and relaxation according to the demands placed on them by your
daily activities.
Elevated stress and anxiety levels, however, can cause a high degree of muscle tension for
prolonged periods. This is because muscle tension is part of the fight-or-flight system – our
body’s natural response to threatening and stressful situations. Muscles tense in preparation for
the physical activity that fighting or fleeing involves. Unfortunately, long periods of muscle
tension can cause muscle pain, headaches, and fatigue. Ongoing muscle tension may also
contribute to the feelings of constant apprehension, irritability, and jumpiness which many
individuals report.
Progressive muscle relaxation (or PMR) is an exercise that helps you relax your mind and body
by progressively tensing and relaxing different muscle groups in your body. PMR aims to address
some of the physical sensations of tension.
Regular practice of an active relaxation technique is a good way of reducing the level of tension
in your body. Progressive Muscle Relaxation (PMR) has a widespread effect on the nervous
system, and can help to reduce blood pressure and the production of stress hormones. In PMR,
the muscles are relaxed in a progressive manner as you work your way around the body. With
practice, you will be able to better recognise and voluntarily reduce muscle tension.
PMR Audio Recording

To listen to the recording, please go to the following link and follow the on-screen instructions
(Ctrl+Click to follow link; or copy and paste into your browser).
https://thiswayup.org.au/wp-content/uploads/2017/01/Progressive-Muscle-Relaxation.mp3
Download and save the file to your computer in an easy-to-access location. You can transfer the
audio file to the music or audio library on your smartphone of MP3 player. The entire PMR
sequence should take you about 15 minutes to complete. You may also like to print out the
written instructions from the “Progressive Muscle Relaxation Instructions”, which also includes
further information on PMR, and can be found at the end of this Summary.
SUMMARY: Both Slow Breathing and PRM aim to decrease the strong physical feelings of
arousal and tension that occur in our bodies. Some people prefer one over the other or you may
prefer an entirely different form of relaxation. There is no right or wrong way to relax. Simply
choose the approach that works best for you.
Remember, relaxation techniques can be helpful to reduce overall levels of arousal that
can impair sleep. But, make sure that you don’t use relaxation strategies to try to sleep.
Trying to sleep only increases arousal. Rather, focus on overall winding down.
4. Structured Problem Solving
We have already seen how thought challenging and disengaging from thoughts can be helpful
ways to manage worries that increase arousal and interfere with sleep. A final tool to manage
stress and worry is Structured Problem Solving.
Active problem solving is different to worry. Worry is typically a passive, unhelpful process
where we flip from one worry to the next without fully processing the thoughts. They just go
round and round in your head. In contrast, active problem solving is when we spend some time
thinking about what we can do to solve, or partially solve a specific problem that is troubling us.
It’s easy to get overwhelmed and caught up in a problem, and not know how to move forward.
Often the hardest thing is getting started. Problem Solving is particularly helpful for negative
thoughts that are realistic. It can help you focus on what you can do to make things better,
rather than worrying about the problem.
Structured Problem Solving is a way to get started on dealing with a concern in a proactive and
effective way. It involves 6 key steps:
STRUCTURED PROBLEM SOLVING

1. Identify the problem
2. Generate possible solutions
3. Evaluate the solutions
4. Choose a solution
5. Make a plan to implement the solution
6. Review your progress
Step 1: Identify the problem

Identify one specific problem that is causing you difficulty, which you are finding hard to resolve
and is causing you stress or worry.
Get a clear definition of the problem and make the problem as specific as possible.
Only consider one problem at a time. If other problems arise in the course of the problem
solving session, set them aside for a problem solving session in the future.
Avoid attempting to solve the problem at this stage.
Step 2: Generate solutions through brainstorming

Brainstorm as many possible solutions as you can.
Rather than trying to think of the best or ideal solution, list any ideas that come to mind,
including those which may not be useful or may even be absurd.
Use your imagination! Even though a solution may seem ridiculous at first, the idea may
help to generate better solutions than those that are more immediately obvious.
At this stage of problem solving, do not evaluate the solutions, simply list them.
Step 3: Evaluate the solutions
Briefly consider the advantages and disadvantages of each solution.
You don’t always need to write these points down but it may help if the problem is complex.
Just quickly run through the list of solutions, noting the strengths and weaknesses of each.
No solution will be ideal since every good idea will have some faults. The aim is simply to
consider the advantages and disadvantages of each option.
Step 4: Choose the optimal solution

Pick a solution or a combination of solutions which will solve the problem.
It is often helpful to choose a solution that can be readily applied and which is not too
difficult to implement, even though this solution may not be the ideal solution.
 That way you can get started straight away.
 This approach is preferable to choosing a solution which is doomed to failure
because you have been overly ambitious.
Step 5: Planning
A detailed plan of action will increase the likelihood that the problem will be solved. Even if your
solution is excellent, it will not be of any use if it is not put into practice.
Plan out step-by-step how you will carry out your solution, and when you will do it.
To help make a plan, consider the following questions:
 Do you have all the necessary resources (e.g., time, skills, information,
equipment) or do you need to arrange them?
 Do you have the agreement or cooperation of other people who might be
involved in the plan?
 Do you know exactly what needs to be done, and when you will do it?
Remember, although the problem may not be solved immediately, the solution might have
made a difference, and what is learned from this attempt might be useful the second time
around.
Step 6: Review your progress

This stage needs to be planned in advance. It is an opportunity to assess progress by
determining what has been achieved and what still needs to be done. Often, problems are
not completely solved after the first round of Structured Problem Solving. Use this step to
reflect on what you have learned, and to make plans for your next solution. If there is more
you need to do or achieve, start the Structured Problem Solving process again.
Remember to use the Structured Problem Solving Worksheet (below) to help you apply
the technique. Set aside some time to work on one problem at a time. It may also be
useful to enlist the help of a friend or family member with this – sometimes another
person can think of a solution you may not have considered.
Structured Problem Solving Form - Example
Before you fill in your own worksheet, let’s revise Leo’s problem solving from today’s Lesson.
Leo’s Responses
Step 1: What is the Dad’s health is deteriorating. The goal is to work out a plan for his
problem? Think about this longer-term care.
carefully and write down
exactly what the problem is
– the more narrowly you
can define it, the better.
Step 2: List all possible 1. Keep Dad at his own home and keep monitoring for any
solutions. Put down all changes.
ideas, even bad ones. 2. Talk to Dad’s doctor to get his opinion.
3. Put Dad in a nursing home.
Remember not to evaluate
4. Get a full-time carer to live in with Dad.
at this stage. 5. Ask Dad to come and live with us.
6. Visit Dad daily after work.
Step 3: Evaluate each Pros Cons

possible solution. Quickly
go down the list of all 1. Easy, won’t upset Dad. He could injure himself or get
possible solutions and lost. Could be very serious.
consider the advantages
and disadvantages of each 2. Quick to do; he probably has a lot of Doctor may think I’m wasting his
experience with these kinds of things and time; he may not have any
one.
could be helpful. advice. Doesn’t really solve the
problem. Still need to take further
action.
3. Dad will be safe and I will know he is Dad will be very upset and may
being looked after. refuse. It will be time-consuming
to find the right place and move
Dad.
4. Dad will be safe. Costly. Dad won’t like the idea of

having a stranger living with him.
5. Dad will be safe most of the time. No care for him while we are at
work. Could be difficult for the
rest of the family to adjust.
6. Will be nice for Dad and reassuring for Dad lives far away and I will miss
me. out on seeing the kids in the
evening. It will be a big rush and
not fair to Ali.
Step 4: Choose the best or I will first call Dad’s doctor to make an appointment to get his advice.
most practical solution.
Choose the solution that
can be carried out to most
easily solve (or begin to
solve) the problem.
Step 5: Plan how to carry 1. Ask Dad if he is OK with me talking to his doctor (tonight)
out the best solution. Plan 2. Book an appointment with Dad’s doctor (tomorrow).
out step-by step how you 3. Write down my questions in advance of the appointment.
4. Express my concerns to the doctor and ask for his opinion about
will carry out your solution,
appropriate supports and solutions for Dad.
and when you will do it. 5. Discuss the outcome with Ali and Dad.
Set aside a time to do Step This weekend.

6 (review of progress):
Step 6: Review progress. The doctor thought that Dad did need extra support but that he
Focus on the things you probably didn’t need to go into a home just yet. I spoke to Dad and Ali
have achieved first, and be about him moving in with us and us getting a carer to come to the
pleased with any progress house on days we are at work. Dad was a little reluctant but he has
you have made. Next, come around to the idea. I think it’s going to be an adjustment for all of
consider what still needs to us.
be done. You may wish to
The next step is to get movers and organise a carer. I decided to call
complete the worksheet
again to help you keep Carers’ Australia for advice on that.
moving forward.
What has been achieved?

What still needs to be
done?
Structured Problem Solving Form – Your copy
Fill in each step of the worksheet to begin to address one of your problems.
Your Responses
Step 1: What is the

problem? Think about this
carefully and write down
exactly what the problem is
– the more narrowly you
can define it, the better.
Step 2: List all possible

solutions. Put down all
ideas, even bad ones.
Remember not to evaluate
at this stage.
Step 3: Evaluate each Pros Cons

possible solution. Quickly
go down the list of all
possible solutions and
consider the advantages
and disadvantages of each
one.
Step 4: Choose the best or

most practical solution.
Choose the solution that
can be carried out to most
easily solve (or begin to
solve) the problem.
Step 5: Plan how to carry
out the best solution. Plan
out step-by step how you
will carry out your solution,
and when you will do it.
Set aside a time to do Step

6 (review of progress):
Step 6: Review progress.

Focus on the things you
have achieved first, and be
pleased with any progress
you have made. Next,
consider what still needs to
be done. You may wish to
complete the worksheet
again to help you keep
moving forward.
What has been achieved?

What still needs to be
done?
A final note on problem solving…

When you have come up with a solution, break it down into small, manageable steps and just
get started! Simply starting to implement your solution, even if it’s not perfect, will give you a
better sense of control over your situation.
It is also likely to help you to feel that your current difficulties are more tangible. Having a good
sense of your problem and goal makes it much easier to manage than simply being concerned
with vague worries “floating” in your head.
5. Review of Course Skills and Concepts
Throughout this course, you have learned many skills and concepts to help you to get your sleep
back on track and overcome insomnia. Some of the ideas will have resonated more than others
and we expect that you will still be working on many of the skills at this time.
Let’s review…
Our sleep is regulated by 3 key factors:
i. Sleep drive
Our “appetite” for sleep which increases throughout the day after we wake up.
ii. Circadian rhythm
Our internal body clock.
iii. Our arousal system
Which is influenced by strong emotions (e.g., anxiety, excitement), an active mind, and
body tension.
In order to get better sleep, you need to engage in behaviours that promote sleep, manage
stress and anxiety, reduce arousal, and develop helpful ways to think about sleep.
Both unhelpful behaviours and thoughts contribute to insomnia.

But, these are changeable!
BEHAVIOURAL APPROACHES TO MANAGE INSOMNIA
(1) Sleep hygiene
Habits that promote good sleep such as exercise (but not too close to bed), not drinking caffeine
or alcohol close to bed time, and getting bright light exposure at the same time each morning.
(2) Stimulus control – pair the bed with sleep!

− Keep the bed for sleep only
− No napping (except for safety concerns)
− Wake up at the same time each day
− Only go to bed when sleepy
− If you can’t sleep, get up and do something else
(3) Time in bed restriction

Use this technique to temporarily limit the time you spend in bed to your average total sleep
time over the past 1-2 weeks. This will improve the quality of your sleep and help to retrain your
body to sleep in bed.
(4) Wind-down routine

Establish a routine before bed to help your body relax and prepare for sleep.
(5) Activity planning

If you find it difficult to get out of bed in the morning, plan activities the night before to ensure
you are more motivated to get out of bed. Ensure a balance between over- and under-
stimulation.
Remember, it’s important not to cancel activities after a poor night’s sleep.
(6) Relaxation
Relaxation strategies can help you to reduce your overall levels of arousal. Slow Breathing can
be done anytime, anywhere. Progressive Muscle Relaxation helps you relax your mind and body
by progressively tensing and relaxing different muscle groups in your body.
COGNITIVE CONCEPTS AND TECHNIQUES TO MANAGE INSOMNIA
(1) Trying to sleep increases arousal making it harder to sleep.
Remember the finger trap analogy and reduce sleep effort.
(2) General worry and sleep worry can interfere with sleep.
General worry = worry about life stressors. Sleep worry = worry about the consequences of poor
sleep. It’s common for people with insomnia to “catastrophise” about not getting enough sleep.
This only increases arousal, making it harder to sleep.
(3) Thought challenging

Thought challenging can be helpful to deal with unhelpful thoughts by considering the evidence
against the thought as well as the probability and cost of the feared outcome. Then come up
with an alternative, more helpful thought.
(4) Disengage from thoughts

Use mindfulness strategies like thinking of your thoughts as trains to disengage from unhelpful
rumination and worry. Labelling thoughts (“I’m having the thought…) can also be useful.
(5) Shift attention away from unhelpful thoughts

It’s helpful to shift your attention away from unhelpful thoughts when your mind is active. You
can shift your attention by reading, listening to a podcast, getting out of bed, or thinking of
something fairly boring but that takes mental effort (e.g., the meals you ate over the week).
(6) Right before bed and the middle of the night are not good times for thinking
straight!
At these times, try to postpone your worries and shift your attention to something else. If you
are lying in bed and can’t shut off your thoughts or worries, get out of bed.
(7) Worry Time

Previously, you may have found that your first opportunity to process the day’s events was
when your head hit the pillow. No wonder it was hard to sleep! Some people find it helpful to
designate a specific time earlier in the evening to think about concerns. You could try using
Worry Time or using a journal to “brain dump” stressors from the day.
(8) Problem solving

Active problem solving is helpful to manage concerns, in contrast to passive worry. Remember
the motto – Break it down and just get started!
6. Maintaining Your Gains Moving Forward
The first thing to keep in mind is that everyone has an occasional night of poor sleep.
The main thing is not to become stressed about it. If you experience a period of difficulty with
sleep again, remember that you now have all the skills that you need to get back on track.
What have been the most helpful skills or ideas that have helped your sleep?
(Tick them off)
 Not napping
 Waking up at the same time each day
 Not catastrophising when I can’t sleep
 Having a wind-down period
 Getting out of bed when I can’t sleep or have an active mind
 Managing worries and stress
− Challenging thoughts
− Disengaging from thoughts
− Problem solving
− Shifting attention
− Worry time/Postponing worries
− Journaling
 Keeping the bed for sleep and intimacy only
 Reducing time in bed (Time in Bed Restriction)
 Relaxation techniques
 Reducing coffee intake
 Not drinking too close to bed
 Exercising
 Not cancelling activities after a bad night’s sleep
 Doing more in my day
 Doing less in my day or pacing activities
 Other:___________________________________________________________________
________________________________________________________________________
What would you like to keep working on or improving? What can you do to achieve this?
______________________________________________________________________________
______________________________________________________________________________
By doing this course, you have now become your own sleep coach and you know which
strategies and ideas work best for you. So, if you do begin to experience difficulties with
insomnia again, simply review the skills that you have ticked off in the list above and start
implementing them again to get your sleep back on track.
Please remember that it is normal to have a few nights of poor sleep every now and then,
particularly if you are going through a stressful life period. The key is not to catastrophise about
it and to simply review these skills and to continue to use them. We recommend that you keep
this list somewhere you can easily access.
FAQ: Do I have to follow these guidelines forever?
Taking a flexible approach to sleep is usually the best policy! Many people with insomnia become too
“hung up” on their sleep. For example, as we saw with Leo, he spent a lot of his time thinking about
sleep. He would cancel plans when he hadn’t slept well and then stress out about getting enough sleep
each night, trying everything to get to sleep. This only made him more anxious about his sleep, which in
turn, made it harder for him to sleep.
So, it’s important not to be too rigid about the sleep guidelines we’ve discussed. At the same time, if
certain approaches have been helpful to you, it seems sensible to keep on going as you have been. It’s
best to think of your new skills and the ideas we have discussed as sleep habits. If you want to change
something you are currently doing, the best approach it to experiment with it. For example, if you want
to sleep in a little on the weekend, you could try to sleep in for an extra 30 minutes or so. If that affects
your sleep on the next night, then you know that you’re better off sticking to your usual schedule. If not,
then you can enjoy your extra 30 minute lie in!
You don’t need to continue keeping a sleep diary after the completion of the course but if you do
experience another extended period of poor sleep in the future, it’s a good idea to start keeping the
sleep diary again so that you can get a sense of what you need to do to get your sleep back on track.
7. Other Sleep Disorders & Getting Additional Help

Insomnia is the most common sleep disorder but there are many others such as Sleep Apnea,
Restless Legs Syndrome, and Nightmares. For further information on these disorders, see the
Sleep Health Foundation Factsheet on Common Sleep Disorders -
http://www.sleephealthfoundation.org.au/public-information/fact-sheets-a-z/219-common-
sleep-disorders.html
If you feel you need further support with your insomnia or other sleep disorder, we encourage
you to see your GP who may refer you to a local clinical psychologist for further assistance in
implementing the strategies outlined in this course or to a specialist doctor for additional
assessment and treatment.
If you live in Australia and would like to access treatment with a Clinical Psychologist or a
Psychiatrist, you can do so by getting a referral from your General Practitioner. Under the
Medicare Better Access Scheme, rebates are available which may cover some of the costs of
seeing a Clinical Psychologist or a Psychiatrist. Alternatively, you can contact the mental health
service at your local hospital to access their service, which is usually free. Finally, you may wish
to use the “Find a Psychologist” search tool on the Australian Psychological Society webpage -
www.psychology.org.au/FindaPsychologist/
If you would like help with symptoms of anxiety and/or depression, you might be interested in
some of our other courses, which have been developed to help people with stress, symptoms of
anxiety, and symptoms of depression.
At www.thiswayup.org.au we have a wide range of courses available,
including:
- Coping with Stress - Mindfulness-based CBT for Depression

- Intro to Mindfulness & Anxiety
- Depression - Mixed Anxiety & Depression
- Depression (Chinese) - Obsessive Compulsive Disorder
- Generalised Anxiety Disorder - Panic Disorder
- Health Anxiety - Posttraumatic Stress Disorder (PTSD)
- Social Phobia
8. Your Action Plan

Congratulations on completing the Managing Insomnia course!
Your tasks to do following this lesson are:
 Review Lesson 4 slides again.
 Print out, complete, and re-read this lesson summary.
 Complete the Maintaining Your Gains Moving Forward section and keep this in a safe
place for future reference.
 Print out all the materials from the course so that you can review them in the future. You
will have another 90 days to access the materials from the course online.
All the best going forward!
The Team from This Way Up.
www.thiswayup.org.au
Bibliography
Andrews, G. (2003). The treatment of anxiety disorders: Clinician guides and patient manuals. Cambridge University
Press.
Manber, R., & Carney, C. E. (2015). Treatment Plans and Interventions for Insomnia: A Case Formulation Approach.
Guilford Publications
Sleep Diary - Complete This Every Morning
(or use the electronic version on your dashboard when you log in to your course)
In the morning, fill out the information Night Tuesday _______ _______ ______ _______ _______ _______ _______
for the prior night. Date 25/03 / / / / / / /
1. Yesterday, I napped from ___ to ___ 1:50pm to

(Note the times of all naps) 2:30pm
2. What time did you go to bed last night? 10:45pm
3. What time did you try to go to sleep/turn off the lights? 11:15pm
4. How many minutes did it take for you to fall asleep after turning
40 min.
out the lights?
5. How many times was your sleep interrupted last night, not
2
counting your final awakening?
6. In total, how long did these awakenings last? 60 min.
7. How many times did you leave your bed last night? 1
8. What was the time of your final awakening? 6:15am
9. What time had you planned to wake up at? 6:30am
10. What time did you get out of bed for the day? 6:45am
11. Did you take any over-the-counter or prescription medication(s) Medication:

to help you sleep last night? Relaxo, 5mg
12. What was the quality of your sleep?

3
(1 = Very poor, 2 = Poor, 3 = Fair, 4 = Good , 5 = Very Good).
Comments (if applicable) I have a cold
Time in bed 8hr
Total sleep time 5hr,20min.
Activity Planner: Example
Instructions: During the week, complete this sheet to show the main activities you do for each hour. Include things like watching TV, preparing dinner, cleaning the
house, sleeping, etc. At the end of each day rate your sense of Pleasure and Achievement on a scale from 1 to 5.
1 = no pleasure/achievement, 2 = minimal, 3 = moderate, 4 = high, 5 = very high.
Activity Planner: Your Copy
Instructions: During the week, complete this sheet to show the main activities you do for each hour. Include things like watching TV, preparing dinner, cleaning the house,
sleeping, etc. At the end of each day, rate your sense of Pleasure and Achievement on a scale from 1 to 5.
1 = no pleasure/achievement, 2 = minimal, 3 = moderate, 4 = high, 5 = very high.
NOTE: Use this form to help you plan and monitor your own activities (Just try it for 3 days to see how it can help). 22
How to do PMR
The PMR technique involves tensing and relaxing the major muscle groups in your body in a systematic
and progressive manner. You can do this by following the set of exercises below. Work your way around
your body, one exercise after the next.
Allow yourself about 15 minutes to do all the exercises. Over time, you will learn the sequence and won’t
need to keep referring to the scripted procedure.
Tips for Relaxation

Ideally, relaxation training should be practised daily at home.
Find a quiet space where you won’t be interrupted for about 15 minutes.
Dim the lights if possible.
Practise at a regular time during the day if you can, and preferably not straight after eating.
Find a comfortable position – You may find it more comfortable to sit in a chair that is
slightly tilted back and support your feet on a foot rest, if you would prefer not to lie down.
The most important thing is that you feel comfortable.
Leave your eyes open or close them, whichever you prefer.
Don’t tense your muscles too tightly – PMR should not be uncomfortable or painful. Try to
tense your muscles to about 60-70% of their capacity.
Don’t worry if your mind wanders during PMR – this is normal at first. If your mind
wanders, just let go of the thought that has distracted you and bring your attention gently
back to the exercise you were doing.
Try not to put pressure on yourself or grow impatient if you don’t achieve the result you
were after in each session. Some people feel distressed and anxious during relaxation
exercises. This can be because they feel anxious about “wasting time” or simply because
they are not used to feeling relaxed.
Remind yourself that relaxation training is a valuable use of time because it will assist you in
your recovery. If you are not used to feeling relaxed, this is all the more reason to keep
practising – in time you will start to find relaxation training an enjoyable and beneficial
exercise.
Remember, PMR needs to be practised regularly in order to provide maximum benefit.
PMR – Written Instructions
First, find a comfortable position and allow your attention to focus only on your body.
Close your eyes or let them rest lightly on a spot in front of you.
Let’s start with a few relaxing breaths.
Take a deep breath through your abdomen, hold for a few seconds, and exhale slowly.
As you breathe notice your stomach rise and your lungs fill with air.
As you exhale, imagine the tension in your body being released and flowing out of your body.
And again, inhale…..and exhale.
Feel your body already relaxing. As you go through each step, remember to keep breathing.
Now let’s begin…
Forehead and scalp

Move your attention to your forehead. As you inhale, tighten the muscles in your forehead by raising
your eyebrows as high as you can. Hold for about five seconds. And release. As you release, feel the
muscles of the forehead relaxing.
Pause for about 10 seconds – Breath in... and breath out.
Eyes
Next, tighten your eye muscles by squinting your eyelids tightly shut. Hold for about 5 seconds, and
release.
Facial muscles
Move your attention to your facial muscles. Furrow your eyebrows and purse your lips together
tightly. Try to pull all of your facial muscles towards your nose. Hold for about five seconds. And
release. As you release, feel the relaxation of the facial muscles.
Now smile widely, feeling your mouth and cheeks tense. Hold for about 5 seconds, and release,
appreciating the softness in your face.
Pause for about 10 seconds – Breath in... and breath out
Jaw
Now bring your awareness to your jaw. Clench your jaw tightly, feeling the tension in the surrounding
muscles of your jaw. Hold to about five seconds. And release. Feel the tension in your jaw ebb away.
Neck and shoulders

Now bring your focus to your neck and shoulders. Gently pull your head back as if to look at the
ceiling. Hold for about 5 seconds, and release, feeling the tension melting away.
Now shrug your shoulders towards your ears. Feel the tension in the surrounding muscles. Hold for
about five seconds.
Pause for about 10 seconds – Breath in... and breath out. In…and out. Let go of all the stress. In…and
out.
Upper back/shoulders
Now bring your awareness to between your shoulder blades. Tense your upper back by pulling your
shoulders back trying to make your shoulder blades touch. Hold for about 5 seconds, and release.
Arms
Now, move your attention to your arms. Tightly, but without straining, clench your fists and hold for
about 5 seconds, and release.
Now, flex your biceps. Draw your forearms towards your shoulders, switching on your bicep muscles.
Feel that build-up of tension. Hold for about 5 seconds, and release, enjoying that feeling of limpness.
Now tighten your triceps by extending your arms out and locking your elbows. Hold for about 5
seconds, and release.
Chest & Stomach

Now bring your attention to your upper chest. Tighten your chest by taking a deep breath in, hold for
about 5 seconds, and exhale, blowing out all the tension.
Gently arch your lower back. Hold for about 5 seconds, relax.
Pause for about 10 seconds – Breath in... and breath out. Feel the limpness in your upper body letting
go of the tension and stress, and relax.
Buttocks
Now bring your awareness to your buttocks area. Squeeze your buttocks together, tightening the
muscles. Hold (for five seconds)… And release. Feel the tension fall away… imagine your hips falling
loose.
Thighs
Now bring your attention to your thigh muscles. Tighten your thighs by pressing your knees together,
as if you were holding a penny between them. Hold for about 5 seconds…and release.
Calves
Now bring your awareness lower down to your calf muscles. Tighten your calf muscles by pointing
your toes. Hold for about five seconds. And release.
Feet
Now bring your focus to your feet. Flex your feet, pulling your toes towards you and feeling the
tension in your calves. Hold for about 5 seconds, and relax, feel the weight of your legs sinking down.
Now, tighten your feet by curling your toes toward the ground. Hold for about 5 seconds, and
release. Feel the tension in your feet flow away.
Now imagine a wave of relaxation slowly spreading through your body beginning at your feet and
going all the way up to the top of your head. Feel the weight of your relaxed body. Breathe in…and
out…in…out….in…out.
Is there any tension left in your body? If there is, go back to this muscle group and tense, holding for
about five seconds. And release. Breathe in… and out.

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What are the main topics covered in the lesson summary?

What are the main topics covered in the lesson summary?

What should you do each week to tweak your time in bed prescription?

What should you do each week to tweak your time in bed prescription?

Managing Insomnia

Topics Covered In This Summary & Action Plan

1. Tweaking Your Time in Bed Prescription (page 3)

But first, let’s recap Lesson 3…

Quick Recap Quiz

1. Tweaking your Time in Bed Prescription

What was your sleep efficiency over the past week?

Did you know?

Make sure that you include:

Remember, overstimulation is not helpful either! It’s important to strike a balance

Step 3: Review what you have done

Tips for Activity Planning:

Sleep Drive Circadian Rhythm Arousal

Two strategies for relaxation are:

Progressive Muscle Relaxation (PMR)

_______________ breaths per minute

STEP 3: Now, do the following exercise:

Breathe in for 4 seconds

Pause for 2 seconds

Breathe out for 6 seconds

Did your breathing rate drop afterwards?

Write it here: _______________ breaths per minute

PMR Audio Recording

STRUCTURED PROBLEM SOLVING

Step 1: Identify the problem

Step 2: Generate solutions through brainstorming

Step 4: Choose the optimal solution

Step 6: Review your progress

Step 3: Evaluate each Pros Cons

4. Dad will be safe. Costly. Dad won’t like the idea of

Set aside a time to do Step This weekend.

What has been achieved?

Step 1: What is the

Step 2: List all possible

Step 3: Evaluate each Pros Cons

Step 4: Choose the best or

Set aside a time to do Step

Step 6: Review progress.

What has been achieved?

A final note on problem solving…

Our sleep is regulated by 3 key factors:

Both unhelpful behaviours and thoughts contribute to insomnia.

(2) Stimulus control – pair the bed with sleep!

(3) Time in bed restriction

(4) Wind-down routine

(5) Activity planning

(3) Thought challenging

(4) Disengage from thoughts

(5) Shift attention away from unhelpful thoughts

(7) Worry Time

(8) Problem solving

7. Other Sleep Disorders & Getting Additional Help

- Coping with Stress - Mindfulness-based CBT for Depression

8. Your Action Plan

All the best going forward!

1. Yesterday, I napped from _ to _ 1:50pm to