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Sleepless in the City

December 2003

Sleepless in the City

I am a single, HIV-positive woman in my mid-forties and I need help! At night when I am in bed trying to fall asleep, I start thinking about all the areas in my life, especially having HIV, that are causing me stress and I can't fall asleep for what seems like hours. The next morning I have trouble getting out of bed. After work, I come straight home and take a long nap, which I know is the wrong thing to do because later, I can't fall sleep at night. I'm all turned around. I have attempted to not sleep in the afternoon, but I still can't sleep at night due to these stressful thoughts, so by the next day I am a zombie. I need to sleep at night but I can't. What can I do to control my stressful thoughts and to get some sleep?

A Response to this Case Study

You have two issues here. One is getting the sleep you need. The second issue is gaining some control over your stressful thoughts. Let's first discuss your lack of sleep. Without sounding too simplistic, sleep is very important, not only for your general health but also for your emotional balance. You are not alone in lacking sleep at night. Many people perceive that they never get the amount of sleep they actually need. However, in your case, it sounds as if your lack of sleep really is influencing your ability to function outside of your employment. Everyone is different in what works for them in terms of sleep improvement, but I can give you a very general guideline to follow, which hopefully this should help you in regaining your ability to sleep well.

While there are medications that might help you, you should first assess whether your body has the ability to function well without adding this additional medication to your daily regimen. To go straight to a psychiatrist and state you can't sleep due to your stressful thoughts about HIV might well result in a prescription. But I would first suggest you attempt to change your behaviors and control your thoughts. It may not sound as simple as taking a pill, but for a real long-term solution, this maybe the best route for you. The bottom line is to always remember that a pattern of sleeping takes some time to create and you must give yourself a good length of time to adjust to a new sleeping structure.

It is clear that sleeping in the afternoon after work is a no-win situation and must be corrected. Medication may sound like an easy fix, but a real behavioral intervention plan that provides motivation to actually correct the problem would, in my opinion, be much more productive in the long run for you and your sleeping pattern. Psychologically speaking, your stressful thoughts may also appear in your mind due to your body's lack of sleepiness and your actual restlessness while waiting to fall asleep, which only could encourage your mind to wander. Your mind wandering would be a natural result since you slept and feel refreshed from your afternoon nap.

The first step would be to look at your daily structure after you are finished at your place of work. After a hard day at work, most of us want to come home for some "downtime." However, downtime is a very different concept than coming home and falling into bed to sleep. After work you still have up to an additional eight hours of "awake" time to structure, and you sound as if your eight hours is rather lacking in structure. In fact it appears that there is no structure after work in your life -- just straight to bed -- then up all night.

Do you have an after-work social life? Where are your fun or pleasurable activities following a full day of work? If you have a partner or children, when do you spend time with them? Start simple but write down a plan of action. Create a list next to the time periods of the day following work, for example:

5:30-6:30 pmGet some exercise
6:30-8:00 pmHave dinner, see a movie, spend quality time with family or friends
8:00-9:30 pmWalk, jog, swim, bowl, pursue a hobby, volunteer
9:30-10:30 pmWork on your computer, clean the house, do home repairs
10:30-11:30 pmGet ready for bed, shower, read

Please think about developing outside interests, and try to be creative in that process. Consider joining groups and developing hobbies and goals. Having a creative, structured hobby after work can lower your stress and give you a sense of accomplishment. The ultimate hobby should be able to take your mind off the stressors that haunt you nightly. Some possibilities would include: painting, sculpture, writing, designing, researching, and volunteering.

Stressful Thoughts in Bed

Remember that your bed should mainly be used for sleeping! Do not use your bed to lie in to watch television, or to lie in while you work on your computer, or to read a book in during the afternoon. In case you feel that you may be overpowered to go to your bed and fall asleep, write down some "escape routes" that you could direct yourself towards. Some examples of such "redirection" would include going outside for a walk, working around the house, or calling a friend on the phone.

Also, be sure to stay away from drinks or food that will keep you up at night. Don't have any caffeine after five o'clock in the afternoon and lower your carbohydrate intake. Remember carbohydrates give you energy to burn and you don't need that when you are about to go to sleep!

Once you are in bed and those stressful thoughts appear, get out of bed! Go to your desk or table and write down in a list what you will do tomorrow to lower your stress in those areas. Once the list is finished, you will understand what you need to do the next day to lower those stressors. Then let it go and realize that there is nothing for you to do now but go back to bed and get some sleep so that you feel rested enough tomorrow to get your list done.

Another suggestion is to get out of bed and and pursue a task in your home that needs to be done. Set a timer for 30 minutes and when finished, or when the 30 minutes are up, return to your bed and attempt to sleep again. In this way you are taking a negative -- not being able to fall asleep -- and then doing something positive and completing a task that needs to be completed. Most people in these situations don't actually want to get out from under the sheets and get up. But it's important to understand that by doing this structured task consistently over time, when you do return to your bed, sleep may come more easily.

In conclusion, there is a solution to the problem of poor sleeping patterns, but it can't be completed in one night. Taking a pill is one way to get to sleep, but for a long-term solution, a behavioral intervention plan is usually needed. The first step is to have the motivation to change your daily structure. Develop a plan of action that you set to the eight hours you have left after work. Your plan of action should include a meal, exercise, quality time with family and friends, socializing, a hobby, education, fun and pleasure. Hopefully in time, your evenings will become so structured and enjoyable that you will look forward to sleeping at your correct time and in addition your stress should have been lowered. Good Luck!

J. Buzz von OrnsteinerJ. Buzz von Ornsteiner, Ph.D. is a psychologist and behavioral consultant in New York City and writes the "Psychologically Speaking" column.

This article was provided by Body Positive. It is a part of the publication Body Positive.
See Also
Guide to Conquering the Fear, Shame and Anxiety of HIV
Trauma: Frozen Moments, Frozen Lives
More on Coping With Stress and Anxiety