On this page, you will find all the resources for the virtual group medical visit Sleeping to CHANGEpain.

Session 1

This session:

  • Highlighted the importance of addressing sleep issues in the face of persistent pain,
  • Provided an overview of the approach we will take in this program,
  • Introduced stimulus control techniques (AKA bed = sleep),
  • Discussed possible reasons for keeping a sleep diary,
  • And, introduced the self-compassion break exercise.

Actions for the Week

1. Watch the following online video (and take notes): Cognitive Therapy for Insomnia (1hr-presentation)

2. If you struggle with falling or staying asleep and are considering working with sleep scheduling (also known as sleep restriction), start your sleep diary using the CBT-i Coach app or one of the templates below.  CBT-i Coach app is helpful because it will give you a sleep prescription (recommended bedtime and wake-up time).  Click here to watch a short video introduction to using the app

Sleep Diary Template – CHANGEpain – PDF
CBTforInsomnia.com Template
National Sleep Foundation Template
American Academy of Sleep Medicine Template

Recommended Interventions from this Session

1. Stimulus Control, or more simply, BED = SLEEP

  • Don’t go to bed until your sleepy
  • Get out of bed if you are not sleeping
  • Get out of bed when you wake up in the morning
  • (And try to get up at the same time every day)
  • Keep your sleep efficiency (time asleep/time in bed) to 85-95%

2. Self-Compassion Break exercise

  • When you notice that you are fretting about your sleep, practice the self-compassion break exercise
  • Use this tool to calm your physiology and develop more emotional awareness
  • Written instructions for this exercise

Additional Resources

Books Recommended by Dr. Christine Korol (listed in the order I would recommend exploring them)
Quiet Your Mind and Get to Sleep: Solutions to Insomnia for Those with Depression, Anxiety or Chronic Pain
The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need
Overcoming Insomnia A Cognitive-Behavioral Therapy Approach Workbook

More on self-compassion
Self-Compassion Guided Practices & Exercises
10 Self-Compassion Practices for COVID-19

Session 2

This session:

  • Introduced sleep scheduling/restriction intervention
  • Discussed the psychophysiology of emotions and relevance to sleep
  • Provided a structured exercise for exploring emotion regulation
  • Thoroughly reviewed behaviours that support sleep
  • And, discussed the value of tracking and reflecting on sleep-enhancing behaviours

Actions for the Week

1. Complete a minimum of 3 reflections this week on the fear of not sleeping (or whatever difficult emotion comes up for you most around the struggle to sleep). Fear of not sleeping reflection exercise template

Recommended Interventions from this Session

1. Sleep Scheduling (or Sleep Restriction) – for insomnia

  • Sleeping on a schedule that restricts your time in bed
  • If you use the CBT-i Coach app, you will have a sleep prescription made for you through the app
  • Alternatively, revisit the Cognitive Therapy for Insomnia video at the 35-minute mark and follow the same process Dr. Korol outlines to set your schedule.
  • Here are very brief instructions for doing it yourself:
    • Use the information from your sleep journal to figure out how much sleep you get per night on average
    • Add 30 minutes to your average sleep hours. (This will be your sleep window unless it is less than 5.5hrs. You will give yourself a minimum of 5.5hrs in bed.)
    • Set your wake-up time
    • Set your bedtime based on your sleep window (For example, if you are sleeping 6hrs on average and setting a 7am wake up time, you would set a 12:30am bedtime.)’
  • If you think this intervention would help you, but you are worried about the sleep deprivation, this article might help: Putting the Fear of Sleeplessness to Rest

2. Sleep-enhancing behaviours

3. Emotion Regulation

  • Emotion regulation skills help us influence our emotional state for the better
  • The ability to move out of emotions like frustration and anxiety can be very helpful for sleep
  • Cognitive reframing techniques and mindfulness practice are good tools for developing these skills

Additional Resources

Diet
Caffeine and Adenosine (article)

Stress
Cortisol and its Effects on Your Sleep (article)

Light/Dark Exposure
The importance of early-day light for improved sleep (12-minute video)
Why screen time can disrupt sleep (article)
Evening screen time can sabotage sleep (article)
Light Therapy Lamps — brand sold at Costco for a reasonable price

 

Session 3

This session:

  • Discussed the importance of identifying and challenging unhelpful sleep thoughts
  • Introduced the Thought Record exercise and plan for habituating helpful thoughts
  • Highlighted some strategies for supporting success with stimulus control and sleep scheduling
  • Discussed the foundational importance of stress management
  • And, practiced an exercise to support falling and returning to sleep

Actions for the Week

1. Actively challenge your negative sleep thoughts.

Use the Thought Record Exercise to challenge at least 1 unhelpful sleep thought this week. As you progress in challenging your thoughts, use this Record of Helpful Sleep Thoughts to remind yourself of these new ways of thinking. There are also additional resources below that may help you with this work.

2. To support stimulus control interventions, write down 5-10 things you can do when you get out of bed at night. Try to think of activities that are more enjoyable than tossing and turning in bed. (For ideas, see the CBT-i Coach app: Tools > Create New Sleep Habits > Get Out of Bed When You Can’t Sleep)

3. If you are working with sleep scheduling, write down 5-10 things you can do to keep your self awake. For each idea, consider how likely it is to work and whether it might prevent you from getting sleepy (e.g. screen use). (For ideas, see the CBT-i Coach app: Tools > Create New Sleep Habits > Go to Bed Only When Sleepy)

Recommended Interventions from this Session

1. Cognitive Reframing

  • Cognitive reframing (or cognitive restructuring) is a process where we discover, challenge, and modify or replace unhelpful thoughts
  • One type of unhelpful sleep thoughts are thoughts that bring about an aroused emotional state (such as anxious or frustrated) that decrease our chances of falling asleep
  • Thoughts that forecast a difficult day because of our sleep are another type of unhelpful sleep thoughts
  • Cognitive therapy techniques (such as the Thought Record Exercise) and mindfulness practice are both tools that can help us become more aware of our unhelpful thoughts and change them to more helpful thoughts

2. Stress Management/Relaxation Training

  • To sleep well, your system needs to be in a relaxed state. You may have heard terms like parasympathetic, relaxation response, or rest & digest to describe this state.
  • Attending to the calm state of your system involves more than doing a relaxation practice. It is about how we live our lives.
  • If you don’t already have a daily relaxation practice, make this commitment moving forward. Here are our recommended guidelines:
    • Minimum 20-minute relaxation practice during the day
    • Attending to calming your system through mini-relaxations and cognitive reframing throughout the day
    • Relaxation practice before bed
  • If you need more support in this area, consider CHANGEpain’s GMV’s: 9-week Relaxation program with Sarah Jamieson, and 9-week Mindfulness-Based Stress Reduction program with Dr. Devon Christie

3. Develop a Return-to-Sleep practice

  • Waking up at night is normal and not something we can completely control, but waking up is not a significant issue if one is able to get back to sleep
  • The cognitive reframing tools (including positive sleep thoughts) and relaxation practices that we looked at in this session are particularly helpful tools for supporting return-to-sleep.
  • Over time, try different things and learn more about what helps you to get back to sleep.
  • When you wake up at night, work with your return to sleep practice, and if you are still unable to sleep, get out of bed

Example of a self-guided Return-to-Sleep practice

Here is a list of the steps of the return-to-sleep practice discussed in class:

  • Acknowledge your surroundings with a quality of acceptance
  • Notice how you are feeling physically, mentally, and emotionally
  • Set an intention to let go of anything that does not support sleep (e.g., I am ready to let go of this tension and fall asleep. I am ready to let go of these thoughts and fall asleep.)
  • Scan through your body and for each part:
    • Make adjustments to increase comfort
    • Encourage the release of tension with each exhale breath
    • Silently repeat for the appropriate body part: “My ____ are safe and ready to rest.”
  • After completing the whole body scan, bring your awareness to your whole body. Encourage your whole body to soften into the support beneath you with each exhale breath. Silently repeat to yourself: “My body is safe and ready to rest.”

Additional Resources

Challenging Thoughts
CBTforInsomnia – Positive Sleep Thoughts
CBTforInsomnia – Challenging Negative Sleep Thoughts

Relaxation
Body Scan for Sleep
Guided Yoga Nidra for Sleep

Many meditation apps have a range of guided practices for sleep — click here for 30 days free access to the Ten Percent Happier app (which has guided practices for sleep), the Calm app also has “Sleep Stories” which are quite popular (click here to access some of them on YouTube)

 

Session 4

This session:

  • Offered on-going support for recommended interventions
  • Introduced the basics of sleep physiology
  • Discussed the key sleep issues being addressed through this program: insomnia and non-restorative sleep
  • Provided an introduction to mindfulness and discussed its relevance as a sleep intervention

Actions for the Week

1. Review this page and any notes you have taken.  Identify any unanswered questions and bring them to the final session.

Recommended Interventions from this Session

1. Sleep Education

2. Mindfulness Practice

Additional Resources

Mindfulness
Mindfulness meditation helps fight insomnia, improves sleep
How Mindfulness Improves Sleep
Mindfulness Coach App (free)
UCLA Mindful App (free)
Waking Up App (free to those who can’t afford it)

 

Session 5

This session:

  • Offered on-going support for recommended interventions
  • Discussed of sleep medications, including guidelines for use and guidelines for tapering (click here for notes from this portion of the session)
  • Overviewed possible areas to seek further professional support
  • Highlighted role of the microbiome in sleep
  • Emphasized importance of brief action planning and goal setting moving forward

Recommended Interventions from this Session

1. Supporting gut health

  • Poor sleep has been found to disrupt the health of our gut microbiome, and an unhealthy state of our gut microbiome has been found to disrupt sleep.
  • Research looking at the relationship between the gut and sleep is new, but given the various ways supporting gut health has been found to support our health, it is great area to explore.
  • In her 12-week Central Sensitization program, CHANGEpain’s Dr. Alexandra Perel-Winkler discusses gut health

2. Further professional support

  • If you haven’t done so already, you may want to consider the following:
    • Physician assessment for possible undiagnosed sleep issues
    • Pharmacist review of medications (including OTC) for possible contributing factors to disrupted sleep
    • Support from various other clinicians navigating conditions, such as depression, anxiety, and PTSD, that may affect sleep
    • Physician or pharmacist guidance and support tapering sleep medication use
    • Functional medicine or naturopath support for gut health, hormones, and more

3. Brief Action Planning & Goal Setting

  • This 5-week session recommended far more interventions than is realistic to work with in this short window of time
  • Continuing to work in the direction of improving sleep will require forethought
  • Consider setting goals and using Brief Action Planning (reading from Empowering You to CHANGEpain)
  • Explore habit change strategies to support this work

Additional Resources

Microbiome
How gut microbiome is affected by circadian rhythm and sleep deprivation
Good Sleep = Good Gut?

Habit Change
HabitShare App (free)
CHANGEpain – Habit Change Strategies
How to Build a New Habit: This is Your Strategy Guide (by James Clear)

CHANGEpain Patient Recommended Sleep Resources

Below is a collection of sleep-related resources recommended by people who took this program.

Michael Sealey YouTube Channel
Tara Brach – Community Wisdom on Sleep
Christiane Wolf – Guided Meditations
Down Dog App (or YouTube Channel) – chair yoga, yoga nidra
Sleep Cycle App
Meditainment – free meditation for natural sleep
Calm App
Yoga Nidra – Meditation & Guided Relaxation
Guided Sleep Meditations – Tracks to Relax