Managing Insomnia

Lesson 3
Managing Sleep-Interfering Thoughts and
Behaviours - Part 2
Welcome and Lesson Overview
This summary reviews the key points discussed in Lesson 3 and includes tasks for you to work on
over the next 1-2 weeks.

In this lesson you learn about Time in Bed Restriction Therapy to improve your sleep quality as
well as two key strategies to manage an active mind and worries that keep you up at night –
Thought Challenging and Disengaging from Thoughts.

Topics Covered In This Summary & Action Plan

1. Time in Bed Restriction Therapy (page 3)
2. Managing Worries – The Importance of Thoughts (page 7)
3. Thought Challenging (page 10)
4. Disengaging from Thoughts (page 15)
5. Action Plan (page 18)

But first, let’s quickly review Lesson 2…

In Lesson 2, you learned about strategies for reducing arousal at bedtime. These included
creating positive sleep habits, like the 5 steps involved in Stimulus Control Therapy and the
wind-down routine before bed. You learned about managing unhelpful thoughts by using coping
statements, “worry time”, and reducing sleep effort, to help you feel less frustrated and
“aroused” when going to sleep, and at times when you are unable to sleep.

Quick Recap Quiz

A. What are the 5 steps of Stimulus Control?
1. ____________________________ 4. ___________________________
2. ____________________________ 5. ___________________________
3. ____________________________

B. Name two helpful things you can say to yourself when you are feeling frustrated
about not sleeping:
1. ____________________________
2. ____________________________
C. Write down some helpful changes you have made to your sleep routine over the
previous week:
___________________________________________________________________
___________________________________________________________________

WWW.THISWAYUP.ORG.AU 2
Answers to recap quiz. A) In any order: No napping, Use the bed for sleep and sex only, Get out of bed if you can’t
sleep, Wake up at the same time each day, Go to bed only when sleepy. B) This is individual to you but ideas
include: I can handle this, It’s normal to wake up in the night time, I’ve worried about not getting enough sleep
before and have been just fine. C) This is for your own reflection.

In today’s lesson, we will cover Time in Bed Restriction Therapy to improve your sleep quality
and more advanced techniques for managing thoughts that interfere with good sleep.

1. Time in Bed Restriction Therapy

People with insomnia often go to bed early or stay in bed after waking up earlier than planned
in an effort to get more sleep. The problem with that approach is that:

More time in bed does not equal more time asleep.

Spreading your sleep over too large a window doesn’t actually get you more sleep. Rather, it
results in fragmented and poor quality sleep as well as frustration about not sleeping. This only
worsens Conditioned Insomnia (i.e., the association between bed and wakefulness).

Time in Bed Restriction Therapy involves limiting the amount of time you spend in bed. When
you spend less time in bed, your sleep quality will improve. You will fall asleep faster, awake less
frequently and for shorter periods, and stay asleep till your chosen wake time.

Calculate your Sleep Efficiency

The first step to Time in Bed Restriction Therapy is to calculate your Sleep Efficiency. Recall that
Sleep Efficiency is simply the proportion of time in bed that you spend asleep. It’s likely that
your sleep diary indicates that you are spending more time in bed than you are asleep.

A. What is your average Time in Bed (TIB) over the past 1-2 weeks: ____________

B. What is your average Total Sleep Time (TST) over the past 1-2 weeks: ____________

C. Now calculate your Sleep Efficiency, by dividing your response to B by your response to
A, and multiplying this number by 100.

o E.g., TIB = 8; TST = 6. SE = (6 ÷ 8) x 100 = 75%

Sleep efficiency = Total Sleep Time x 100

Time in Bed

My Sleep Efficiency = ______________

[Or simply enter the number from your online sleep diary]

*If your Sleep Efficiency is less than 85%, consider implementing Time in Bed Restriction
Therapy.

WWW.THISWAYUP.ORG.AU 3
 TIME IN BED RESTRICTION THERAPY
Step 1: Determine your average Total Sleep Time over the past 1-2 weeks (see your
answer to B above): ______ hours
− Add 30 minutes to this time, and this will be the amount of time you will stay in
bed for.
Time in Bed Prescription: _______ hours.
E.g., If your average Total Sleep Time is 6 hours, your Time in Bed Prescription is 6.5 hours.
Do not restrict your Time in Bed to less than 5.5 hours.
Step 2: Choose a wake up time. Make sure you choose a time that you can realistically
stick to every day of the week, including weekends.
Wake up time: _________
Step 3: Determine your bedtime, by subtracting your Time in Bed Prescription from your
wake up time.
Bedtime: _________
E.g., If your chosen wake up time is 7am and your Time in Bed Prescription is 6.5 hrs, your
Bedtime would be 12.30am.
Step 4: In a week, review your average Sleep Efficiency over the next 7 days. If your Sleep
Efficiency is 85% or higher, extend your time in bed by 30 minutes by bringing your
bedtime earlier. Keep this sleep window for the week and review again.

Step 5: Repeat Step 4 until you find your ideal sleep window. If your average Sleep
Efficiency drops below 85%, simply reduce your time in bed by 15-30 minute increments
each week until you find your ideal sleep window.

Important Considerations when practising Time in Bed Restriction Therapy:

Time in Bed Restriction Therapy is often one of the most challenging components of CBT-I.
Remember that this initial restriction is only temporary. As we have discussed, this course is like
boot camp for your sleep. There may be some short-term pain for long-term gain.
In the first week or so, you will likely feel more tired. This is a good thing! We want to harness your
sleep drive so that you fall asleep faster and experience fewer and shorter awakenings in the night.
Be sure to stick to your chosen wake up time and not to nap during the day. Building sleep
pressure is essential to the Time in Bed Restriction approach.
Do not restrict your time in bed to less than 5.5 hours.
If you have trouble staying up until your prescribed bedtime, consider planning activities to keep
occupied, such as watching TV (as long as you won’t doze!) or doing a hobby (e.g., crafts, building
model aeroplanes).
Remember not to fall asleep on the couch or anywhere else other than your bed.
The focus of this approach is on sleep quality first and foremost. Over time, you will extend your
sleep window, allowing you to increase sleep quantity.
Much like Stimulus Control Therapy, this approach will strengthen the association between bed
and sleep.

WWW.THISWAYUP.ORG.AU 4
 As discussed last week, do not lie in bed awake for extended periods. If you cannot sleep, get out
of bed and return when you feel sleepy.
If you spend a lot of time napping in the day (> 1 hour), you can include this in your calculation of
your total sleep time.
Time in Bed Restriction Therapy is not appropriate for all people. If you operate heavy machinery
or there are other safety concerns related to daytime sleepiness, this approach may not be suitable
for you.

FAQs about Time in Bed Restriction Therapy

Q: Limiting my time in bed to only 6 hours sounds crazy. Are you serious?
If your time in bed prescription is 6 hours, that means you have only been sleeping on average 5
and half hours over the past week. Take a moment to consider whether you would prefer 5.5
hours’ sleep over 9 hours in bed or 5.5 hours’ sleep over only 6 hours in bed? Almost everyone
would choose the latter. This results in deeper, better quality sleep.

And remember, as your sleep quality improves, you will gradually increase your sleep window
and each time, this additional period in bed will be filled with sleep, rather than wake.

Q: What if I don’t sleep or if it still takes me hours to fall asleep?

Initially, you may indeed have some nights of insomnia like you do now. However, we know that
our brains are designed to easily compensate for reduced sleep on subsequent nights. That is,
after decreased rest, sleep is enhanced and more effective than usual. As a result, each hour of
lost sleep does not need to be replaced.

Therefore, full recovery from one or more sleepless nights does not take as long as might be
expected. As an example, a night with no sleep, losing 7-8 hours, can be compensated for with
an additional 3 hours sleep the next night. Compensation for two hours less sleep a night over a
fortnight could require no more than an additional three hours sleep on the first night of
recovery and an additional two hours on the subsequent recovery night.

So, with a little bit of sleep deprivation, your sleep drive will increase and help you to naturally
fall asleep with fewer awakenings. Are you willing to sacrifice a few nights’ sleep for the longer
term, sustained gains?

Q: I feel anxious about limiting my time in bed. Are you sure this is a good idea?
We know that when you have come to do this course to get more sleep, it can sound strange to
suggest that you spend less time in bed. However, remember that more time in bed does not
equate with more sleep. Rather, it results in restlessness and fragmented, shallow sleep. There
is good evidence showing the effectiveness of Time in Bed Restriction Therapy.

Over the first week, you will feel more sleepy which will increase your sleep drive and make
it easier to fall asleep and stay asleep. However, as you know, anxiety can override this
natural process. That is, even if your sleep drive is high, if you are feeling anxious, this will
increase your arousal levels and make it harder to sleep. Consider taking more of an
acceptance-based approach to less than ideal sleep (as discussed last Lesson) or using the
strategies below (section 3) to manage worries about sleep, so as to reduce your anxiety. Most
people find that it is worth
WWW.THISWAYUP.ORG.AU 5
sacrificing a couple of nights’ sleep to gain better sleep long term. However, if you still feel too
anxious, then Time in Bed Restriction may not be appropriate for you. Instead, be conscientious
in implementing all of the other techniques outlined in this course.

Q: I’ve got lots going on right now with work and family so maybe now isn’t the best time for
me to do this. What do you think?
We agree that it’s important to try out this technique when you are most likely to succeed. If
you are anxious about the impact on work and other commitments, it may be tricky for you to
fully commit to this technique. However, consider whether any time will feel like the “perfect”
time to do this technique.

Remember, Time in Bed Restriction is temporary. Although you will likely feel a little more
sleepy in the first few days, you only need to stick to this approach for about 2-3 weeks.
Consider also how sleep deprived you are currently – Are you still managing to get through most
things you need to? If yes, is this going to be much worse?

Consider the pros and cons to implementing this approach versus maintaining the status quo
and then make a decision on whether to implement this technique. If you need to postpone
implementing it for a week or two, that’s perfectly fine. But once you do decide to do this
technique, stick to your routine consistently to achieve the best results.

Now, is a great time to have a break!

We’ve covered a lot so far in this lesson. We suggest that you take a
little break at this point to think through how you will start using
“Time in Bed Restriction Therapy” to tackle your insomnia.
When you come back, we will cover strategies for managing
unhelpful thoughts that interfere with your sleep.

WWW.THISWAYUP.ORG.AU 6
2. Managing Worries – The Importance of Thoughts
In Lesson 1, you learned that our thoughts, feelings, and behaviours interact to maintain
insomnia:
We have discussed ways to change some unhelpful behaviours using Sleep Hygiene, Stimulus
Control, and Time in Bed Restriction. In the second half of this lesson, the focus is on thoughts
that keep us up at night.

Thoughts are important because they affect the way we feel.

There are many different types of thoughts (negative, positive, neutral), and particular types of
thoughts often lead to particular emotions. Let’s consider the following example.

Example 1: You have arranged to meet a friend for coffee at 3:00pm. It is now 3:15pm. You
are waiting at the café, and your friend has not arrived.

Three people in the same situation may have entirely different thoughts and feelings.

Thought Feeling
“Oh no, my friend must have been in an
Person 1 Anxious and Worried
accident.”

Person 2 “My friend isn’t coming because they don’t like Angry, Hurt, and Depressed
me anymore. I’ve been stood up.”

Person 3 “My friend has probably been held up at work Neutral

and will probably be here soon.”

What would you think in this situation?

................................................................................................................................................................

……………………………………………………………………………………………………………………………………………………………

WWW.THISWAYUP.ORG.AU 7
Example 2: You are lying in bed one night and hear a loud thump outside.

Three different people in the same situation may have entirely different thoughts and feelings.

Thought Feeling

Person 1 “It must be a burglar” Anxious, Frightened

Person 2 “It was just the cat next door jumping down Neutral
from the fence”

Person 3 “It’s my neighbour deliberately trying to make Annoyed

noise so I don’t sleep”

What would you think in this situation?

................................................................................................................................................................

……………………………………………………………………………………………………………………………………………………………

These simple examples illustrate that the way that we interpret a situation can have a big
impact upon the way we feel. Often we assume that it is the situation itself that causes us to
feel a certain way. You can see that in the same situation, we can have different emotions
depending on what we think. Indeed, it is the way we think about the situation that really
affects the way we feel about it.

Here are some other common examples of how different thoughts lead to
different emotions:

Thought Feeling
I am a failure Depressed

I’m going crazy Frightened

This treatment won’t work Hopeless

She’s taken advantage of me Angry

He doesn’t understand Irritated, Lonely

I don’t need to be perfect Motivated

Tomorrow is going to a disaster Anxious

if I don’t get to sleep now

I can cope with my anxiety Relieved

I put in a good effort Happy, Proud

WWW.THISWAYUP.ORG.AU 8
Why are thoughts important in insomnia?
Thoughts are important in insomnia because some unhelpful thoughts and thinking patterns can
keep us up at night. For example, we saw that Leo often worried that he wouldn’t function well
at work because he hadn’t slept enough and he also worried about meeting deadlines and
looking after the kids. He experienced both sleep worry and general worry.

Remember…
− General worry = worry about things that are causing you stress, like work and family.
− Sleep worry = worry about the consequences of not sleeping.

Many types of thoughts can keep you up at night. These include (Tick off the ones that apply to
you):
 Worry – Thoughts about all the bad things that could happen in the
future. This often includes a lot of “What ifs?” (e.g., “What if I don’t get my
work done?”, “What if Jim is in an accident?”)

 Rumination – Thinking over and over about negative experiences in the

past, and dwelling on the “Whys?” (like, “Why am I feeling like this?”;
“Why isn’t my sleep better?”)

 Automatic negative thoughts – Unpleasant or Did you know?

unhelpful thoughts or images that pop into your A common unhelpful thinking
head in response to everyday situations (e.g., “I’m pattern that many people with
hopeless at this”) insomnia get trapped in is
catastrophising. This is when
 Or simply an overactive mind racing with lots of you ‘think the worst’.
thoughts

The good news is that unhelpful thinking can be changed so that you feel less worried
about things that keep you up... the first step in being able to change negative thinking
is to recognise it!

How do I identify my thoughts?

Sometimes, you may not be aware of the types of things you are thinking about. You may simply
perceive an active mind at nighttime.

Keep a notepad by your bed to jot down any thoughts that you have. This is
helpful for two reasons:

WWW.THISWAYUP.ORG.AU 9
 (1) It can assist you in reducing your worry about the particular concern as you
have noted it down and can postpone addressing it until the morning.
(2) It can give you insight into the types of thoughts that are keeping you up so
that you can deal with them more effectively by using the techniques outlined
below.

3. Challenging Unhelpful Thoughts

Once you have recognised your thoughts, you can decide whether your thoughts are realistic or
not by using Thought Challenging.

THOUGHT CHALLENGING
Step 1: Recognise
Recognise and identify your thinking – What am I worried or upset about?

Step 2: Challenge
Evaluate your thoughts by looking at all the facts and evidence (e.g., “think like a
lawyer”). Is my thought true and factual, or is it inaccurate, or unhelpful?

Step 3: Change
Change unhelpful thoughts to be more accurate, balanced and helpful thoughts.

When challenging your thoughts:

Consider the evidence
You challenge thoughts by thinking about the evidence that doesn’t support your worrying
prediction. For example, you might have the thought “If I don’t sleep, I’ll never get any work
done”. So, to challenge that, you would think about evidence that doesn't support that
thought. For example, there have probably been other times that you haven’t slept well but still
managed to get some work done. Even if you didn’t get every last thing done, it probably didn’t
matter that much in the end anyway. That’s evidence that contradicts your initial worry
thought.

It’s helpful to think like a lawyer (or a scientist) when you’re challenging your thoughts. The
best lawyers and scientists generally don’t use feelings or opinions to win their argument –
they stick to the facts (the evidence). Sticking to the facts can help you to avoid unhelpful
thinking styles such as catastrophising (thinking the worst) and mind reading (making
assumptions about what other people are thinking).

WWW.THISWAYUP.ORG.AU 10
 Think about the probability and cost
Probability: How likely is it that what you are worried about will happen?
Being sleep deprived can make you feel more anxious and people who are anxious typically
overestimate the chance that the bad thing will happen. When you consider the evidence, you
often find that what you were worried about happening is not as likely as you first thought.

Cost: The other thing to consider is how bad it would be if what you worried about came true?
Ask yourself, what is the worst thing that could happen? Even if this feared outcome did occur,
how bad would it be compared to the other terrible things that could happen in life (E.g., being
in a bad car accident, a loved one dying)? Would the things you care about still be intact? E.g.,
would your family still love you? Will you care about this next week, next year, in 5 years? This
step is about putting things in perspective.

For example, someone with insomnia may worry – “What if I fall asleep while listening to my
boss’ presentation?”. Ask yourself – how likely is this? And if it did happen, how bad would it be?

Helpfulness
Did you know?
The final thing to consider is how helpful is it to think in
Often people think that if they
this way? Although, some of your worries may in fact be
worry, they will come up with a
realistic, it’s important to consider whether worrying
good solution. But, typically,
about these concerns is helpful or not. For example,
when people worry, they simply
does worrying about not getting your work done help
jump from one worry to the next
you get it done or does it just make you feel more
without any resolution.
anxious? How helpful is it to worry about things out of
your control? It is important to distinguish
between constructive problem
solving (where you actually
Sometimes people find it difficult to disengage from dedicate time to consider an
unhelpful thoughts because they think that by worrying issue that is worrying you and
about a concern, they’ll come up with a solution or feel how you can resolve it) and
prepared for negative events or even prevent something unhelpful worry (where you
bad from happening in the future. If this applies to you, simply ruminate about the thing
remind yourself that worry isn’t helpful, particularly in the that is troubling you). More on
middle of the night and shift your attention to something this in Lesson 4!
else.

Here are some questions that might be helpful for you to challenge unhelpful
thinking:
 What is the evidence that these thoughts aren’t 100% true?
 Has this ever happened before?
 What happened last time I worried about this?
 Am I jumping to conclusions that are not completely justified by the evidence?
 What’s an alternative explanation? Are there any other ways to view this situation?

WWW.THISWAYUP.ORG.AU 11
  Is what I believe the only or best way to explain what is going on?
 What would someone I respect think in this situation?
 What is the worst thing that could happen, and how bad would that really
be? Would I cope?
 What’s the best thing that could happen?
 What is most likely to happen?
 When I have had this prediction in the past, what did I think about that
helped me to feel better?
 Would it still be so bad in a week/month/year?
 What are the pros (advantages) and cons (disadvantages) of thinking this way?

What you should know about Thought Challenging:

− Challenging unhelpful thinking can be difficult at first – often it feels forced and
superficial but the more you practise, the more automatic these non-anxious thoughts
become.
− In order to master this skill, it’s important to set aside some time to deliberately work
through a thought challenging record. We don’t expect you to master it immediately.
Over time, you may not need to sit down with a pen and paper. Once you become an
expert, you will be able to simply ask yourself some of the questions in your head and
be able to consider alternatives more readily.
− It’s often hardest to try thought challenging when you’re feeling highly stressed or
anxious or in the middle of the night. Therefore, we recommend that you first practise
thought challenging when you are feeling calm.
− Thoughts and unhelpful thinking styles are like habits. Like any other habit, you need
lots of practice to be able to change them effectively.
− Thought challenging is not about blind positive or wishful thinking. It is about realistic
thinking.
− If your thoughts in a particular situation are realistic, then other techniques such as
Structured Problem Solving (which we discuss in Lesson 4), may be more helpful.
− Use the Thought Challenging Worksheet at the end of this lesson to help you.

Take a few moments now to write down one or two negative or unhelpful
thoughts you would like to practise challenging:

……………………………………………………………………………………………………………………………………………………………………………………..…………………………….…

……………………………………………………………………………………………………………………………………………………………………………………..…………………………….…

……………………………………………………………………………………………………………………………………………………………………………………..…………………………….…

WWW.THISWAYUP.ORG.AU 12
Thought Challenging Worksheet – Sleep Worry Example

Leo’s Responses Your Responses

1. Situation Lying in bed the night before a big

What is the situation that is client meeting.
upsetting you? What has
happened?
Now I’m awake, I’ll never get back
2. Thoughts
to sleep. I’m going to make a bad
What are your thoughts about this
impression with the client if I look
situation? What is going through
half asleep and I won’t be on the
your mind? What are you worried
ball to answer questions. My boss
will happen?
will be upset with me.

Anxious
3. Feelings
How do you feel? Worried
E.g., angry, sad, happy, surprised,
ashamed, scared, guilty, joyful,
anxious, disgusted, annoyed.
I’ve had client meetings in the past
4. Challenge the accuracy of the
after I haven’t slept well and they
thought
went fine. I know my stuff and am
What is the evidence that these
usually able to answer most
thoughts aren’t 100% true? Has this
questions. Even if I don’t get any
ever happened before? What is the
sleep, the probability of me
probability and cost of the feared
completely stuffing up the meeting
outcome? If it did happen, would I
is low. Even if I completely mess up
cope?
the meeting, it’s unlikely I’ll lose my
job or anything terrible will happen.

I don’t like feeling half asleep but it’s

5. Reconsider: Change unhelpful
likely I’ll still function ok in the
thoughts into something more
meeting, even if I don’t get any
helpful
sleep. There are worse things than
messing up a meeting.

Do something to distract myself

6. Move Forward
from my anxious thoughts. Get up
What can you do now to help
and read a book and come back to
yourself?
bed when I start to feel sleepy.

WWW.THISWAYUP.ORG.AU 13
Thought Challenging Worksheet – General Worry Example
Leo’s Responses Your Responses
My son, Jim, got a bad mark on his
1. Situation
exam.
What is the situation that is
upsetting you? What has
happened?

What if he fails his final exams and

2. Thoughts
doesn’t get into uni?
What are your thoughts about this
situation? What is going through
your mind? What are you worried
will happen?

3. Feelings
How do you feel?
E.g., angry, sad, happy, surprised,
ashamed, scared, guilty, joyful,
anxious, disgusted, annoyed.
4. Challenge the accuracy of
the thought
What is the evidence that these
thoughts aren’t 100% true? Has
this ever happened before? What
is the probability and cost of the
feared outcome? If it did happen,
would I cope?
5. Reconsider: Change
unhelpful thoughts into
something more helpful
6. Move Forward
What can you do now to help
yourself?
Anxious
Worried
Ashamed
Guilty
Jim has always passed his exams. One
bad mark doesn’t mean he’s going to
fail his final exams. Given he does
pretty well in most subjects, it’s
unlikely he’s going to get a really bad
final mark. And, even if he did, there
would be other ways for him to try to
get into the course he wants to do.
Jim would be upset but we would all
cope. It’s not nearly as bad as some
other terrible things that could
happen.
It’s incredibly unlikely that Jim will fail
his final exams just because he got
one bad mark. Even if he didn’t get
into his course, we would find
another way for him to get into uni. I
can only support him to study and the
rest is out of our control.
Remind myself that there’s no point
me worrying about things I can’t
control. Make a note to chat to Jim
tomorrow about whether he needs
any extra support. Distract myself by
listening to a podcast, knowing that
there’s nothing I can do right now
about this worry.

A blank Thought Challenging Form can be found at the end of this summary and action plan.

WWW.THISWAYUP.ORG.AU 14
When you don’t have time to work through a thought challenging record, here is an express way
to quickly challenge your worries:

EXPRESS THOUGHT CHALLENGING

1. What am I worried will happen?
_______________________________________________________________
_______________________________________________________________
2. What is the realistic probability of the feared negative outcome?
_______________________________________________________________
_______________________________________________________________
3. Even if the bad outcome were to occur, what is the cost? How bad would it really
be? Would I cope?
______________________________________________________
______________________________________________________

4. Disengaging from Thoughts

So far we have discussed using thought challenging for managing unrealistic or unhelpful worries.
However, not all thinking is worry. Sometimes your mind might simply be alert. It might be travelling
down memory lane, planning, or imagining something in the future. In this case, there might not be
anything to “challenge” as such, so another helpful skill to learn is to be able to “disengage” or “let go” of
thinking and quieten your mind. This skill is also helpful to manage worries that come to us in the middle
of the night, when we’re not very good at being completely rational!

1.

DISENGAGING FROM THOUGHTS

Step 1: Acknowledge
Acknowledge that there is nothing further you can do in that moment.
Step 2: Disengage
Unhook your attention from the thought.
Step 3: Distract
Shift your attention to something else.

Step 1: Acknowledge
Recognise that your thinking is unhelpful at this time and make a decision to let go
of the repetitive thoughts.

WWW.THISWAYUP.ORG.AU 15
Step 2: Disengage from your thoughts
Imagine your thoughts are like trains
One way of not engaging with worries is to think of your thoughts as like trains.
When a train comes, you have a choice – You can either get on the train or you can choose to
stay on the platform.

If you get on the train, you are choosing to engage with the thought. If you stay on the platform,
the train may come by again but then again, you can choose whether you get on the train or
stay on the platform and watch the thought go past. Sometimes you might mindlessly get on the
train without thinking. That is, you might find yourself dwelling on an unhelpful thought without
realising it. That’s OK; you can simply choose to get off the train at the next station.

This is different to trying to suppress your thoughts, which we know just doesn’t work. When
you try not to think of something, it tends to come back stronger. To illustrate this idea, let’s do
a little experiment… For the next minute, close your eyes and try not to think about pink
elephants. Think about anything else you like but don’t think about pink elephants... What
happened? Most (all!) people find that although they may not have had a single thought about a
pink elephant in the last year, as soon as they try not to think about pink elephants, they end up
thinking about them!
Trying not to think about something doesn’t often work but mindfulness of thoughts is different
to suppressing them. You are not actively trying not to think about your worries. Rather, you
are acknowledging the thought but then choosing not to elaborate on it.
It’s kind of like an inflatable beach ball. If you try to push it down under the water, it pops back
up. But you have another choice which is to let the beach ball just float around while you get on
with swimming. The thought is still there but you don’t need to play or fight with it.

Label your thoughts

Another thing you can do when you visualise your thoughts as trains is to name them or label
them by adding the prefix, “I’m having the thought…”. For example, “Here is a thoughts about
work” or “I’m having the thought that I can’t sleep”, “I’m having the thought that I won’t be able
to get back to sleep now”, or “I’m having the worry about messing up at work tomorrow”.

Label the thought or sensation non-judgementally, without evaluating it as good

or bad or annoying, etc.

Step 3: Distract and Shift Attention

Once you have labelled the thought and decided not to engage with it further, the
next step is to shift your attention to something else.

WWW.THISWAYUP.ORG.AU 16
Here are some things you could do to help shift your attention when you have an active mind in
bed (Tick off the ones you might like to try):
 Get up and do something else: For example, read.
 Do something distracting in bed: For example, listen to a podcast.
 Do a mental task that will take some cognitive effort: For example, try to recall all of the
meals you ate over the last week or all of the outfits you wore over the last week. Or,
count backwards in sevens.
 Bring your attention to something concrete or factual, and fairly boring: For example,
ask yourself questions such as “What do I need to buy at the supermarket?”,
“What am I going to wear tomorrow?”, “What can I make for dinner?”, etc.
 Acknowledge that you feel anxious or down, but coach yourself through it: For example,
“I know I’m feeling anxious about not being asleep. That’s understandable but there’s no
need to get too worked up. I’m practising the skills from the course and my sleep will
improve over time.” Try to recall some other helpful statements from Lesson 2. E.g., “It’s
OK that I’m awake now. Sleep will come when it’s ready.”, “The odd night of poor sleep
won’t hurt me.” “I’ve been feeling a bit down lately but I’ve had times like this before. I
know it will pass.”
 Postpone your worry: For example, jot the thought down on a piece of paper and decide
to come back to it in the morning. Or, postpone thinking about the thought until “Worry
time” the next day.
 Tune into your senses: Sequentially tune into the 5 different senses of touch,
smell, sight, hearing, and taste and ask yourself “What are the different sounds I
can hear?” or if there is some light, label all of the things you can see in the
room.

There are two ways of dealing with unhelpful thinking:

Challenge them or disengage from them by shifting attention.
1. Thought Challenging:
− Identify – worrying thoughts.
− Challenge – the accuracy: Probability, cost, evidence.
− Change – to a more helpful thought.
2. Disengaging from Thoughts:
− Acknowledge – that there is nothing further you can do in that moment.
− Disengage – from the thoughts (e.g., by picturing them like trains going past).
− Distract – Shift your attention to something else.

You’ll be able to let go some thoughts more easily than others. If you’re still tossing
and turning after 15-20 minutes, get out of bed.

WWW.THISWAYUP.ORG.AU 17
Did you know?
Sometimes people find it difficult to disengage from unhelpful thoughts because they think
that by worrying about a concern, they’ll come up with a solution or feel prepared for negative
events or even prevent something bad from happening in the future.
If this applies to you, remind yourself that worry isn’t helpful, particularly in the middle of the
night and shift your attention to something else.

5. Your Action Plan

Your tasks to do following this lesson are:
 Review Lesson 3 slides again.
 Print out, complete, and re-read this lesson summary.
 Begin Time in Bed Restriction if appropriate for you.
 Practise Thought Challenging.
 Practise disengaging from unhelpful thoughts.
 Fill out your sleep diary every morning.
− Calculate your average Sleep Efficiency over the week.

Please schedule a time to complete the final lesson of the course in your diary. It will become
available in 5 days. It is important that you read this lesson summary and complete the
homework tasks before you go onto Lesson 4.

In the next Lesson, we will briefly cover structured problem solving to further assist in managing
an active mind at night, activity scheduling to assist in getting out of bed in the morning, and
relaxation to reduce arousal. We will then review all the skills and concepts from the course and
make a plan for maintaining your gains moving forward. Good luck!

The Team from This Way Up.

www.thiswayup.org.au

Bibliography
Drug and Alcohol Services South Australia. Insomnia Management Kit: Instructions for GPs. ‘Sleep Problems’ -
www.sahealth.sa.gov.au

Manber, R., & Carney, C. E. (2015). Treatment Plans and Interventions for Insomnia: A Case Formulation Approach.
Guilford Publications.

Harris, R. (2009). ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment Therapy. New
Harbinger Publications, Inc.

WWW.THISWAYUP.ORG.AU 18
Your Thought Challenging Worksheet

Your Responses

1. Situation
What is the situation that is
upsetting you? What has
happened?

2. Thoughts
What are your thoughts about
this situation? What is going
through your mind? What are
you worried will happen?

3. Feelings
How do you feel?
E.g. angry, sad, happy, surprised,
ashamed, scared, guilty, joyful,
anxious, disgusted, annoyed.

4. Challenge the accuracy of

the thought
What is the evidence that these
thoughts aren’t 100% true? Has
this ever happened before?
What is the probability and cost
of the feared outcome? If it did
happen, would I cope?

5. Reconsider: Change
unhelpful thoughts into
something more helpful

6. Move Forward
What can you do now to help
yourself?

WWW.THISWAYUP.ORG.AU 19
 Sleep Diary - Complete This Every Morning Week: ______
(or use the electronic version on your dashboard when you log in to your course)
Example

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.

WWW.THISWAYUP.ORG.AU 20