Dr. B's Blog

Sleep and health

When a client first gets started in therapy, we often try to “go back to basics.” That is, recalibrating those things that tend to get off center when things get hard:

  • sleep
  • exercise
  • eating
  • medication use

Specifically referred to as the “ABC Please” skills in DBT, we try to do what we can to reduce negative emotion[1], we try to re-implement those things that don’t take a lot time to do and provide a great deal of benefit over the near term. Sleep is one of those:

There’s a syndrome called sleep inertia which is the cognitive impairment, disorientation, and groggy feeling we experience when we first awake from sleep. Sleep inertia can negatively impact the brain’s ability to think clearly and our ability to function effectively in performing tasks right after we wake up (Donatelle, 2009). Just think about the challenge it takes to brush your teeth when you wake up after only four or five hours of sleep.

I’ve never heard of “sleep inertia” but I’m not a sleep guy. I just know that it’s important. The term makes conceptual sense, even if it’s just a fancy name for begin groggy.

The stages of sleep include: wakefulness, drowsiness, light sleep, and deeper sleep. It is in the deeper sleep phase where rapid eye movement (REM) sleep occurs. REM sleep is absolutely essential. In fact, missing REM sleep is responsible for our feeling groggy and sleep deprived (Donatelle, 2009).

I recommend that my patients get through at least 2 REM cycles of sleep/night in order to feel well rested. At the very least, make sure you get through at least one REM cycle. For most people, that’s about 4 hours or so.

There are so many little things that you can do to adjust your life to make it a bit better. None of them may be earth-shattering changes, but taken together, they can make a big difference.


[1]: This is the "ABC Please" skill in the emotion regulation module. In the currently published manual (Linehan, 1993), the skill is referred to as "PLEASE MASTER" but it's going to be changed in the next version.