People used to deal with it more relaxed, says psychotherapist Dr. Beate Paterok. And explains here how to change your own attitude towards the night.
Do you send a woman who comes to you with sleep problems to the doctor first?
Dr Beate Paterok: There are over 80 different sleep disorders in the international classification, so medical evaluation is always the first step. The thyroid gland can play a role, or iron deficiency, which can cause so-called restless legs, or typical menopausal symptoms such as sweats and hot flashes. But this simple model – cause found, cause fixed, sleep is good again – very often doesn’t work. The women who come to my practice have already had everything checked out and are perhaps taking hormones – but still don’t sleep.
Does the number one killer of sleep remain, i.e. stress?
The interesting thing is that menopausal women often say that the most stressful phase of their lives is actually behind them, for example because the children are no longer so small and they have more time for themselves. Just last week, a teacher told me that she was able to reduce her hours at work, really enjoys it, and now has more time for yoga and her friends. But the chronic sleep disorder remained.
How do you start treatment in such a case?
First let’s start with the backstory. In around 50 to 70 percent of cases there is actually a identifiable cause, such as a stressful life situation or hormonal change, but in 50 percent there is not or you cannot remember. A sleep disorder becomes chronic relatively quickly and then persists, even if triggering factors change. Because we all develop fears: There’s something wrong with me. I really need to get back to sleep. Now, on top of my stress, I can’t sleep. What will the next day be like? I can manage my workload.
Lying awake at night really comes from hell.
The night is an invitation for worries and ruminations. You are shielded from light, from noises, from other people and alone with yourself and your thoughts in the darkness. This is also why there is a general misperception about our sleep. In addition, our brain is built in such a way that the sleep software works as an ancient biological system and yet higher centers think “I’m not sleeping”. We all underestimate our sleep times and overestimate our waking times compared to objective sleep laboratory data.
So we spend more time sleeping than we realize.
Of course, you have to work this out in discussions, otherwise the women won’t feel understood, saying: “I’m not imagining it.” But the suffering is not primarily caused by the lack of sleep, but by our evaluation. Sleep is subject to pressure to perform; There is often a lack of acceptance that some things change over the course of life. Instead, we assume, “My sleep needs to stay the way it used to so I can function like it used to.” Even 200 years ago, when there weren’t enough beds, people were much more flexible when it came to sleep.
And how do you get out of there?
First of all, explain what happens at night and what is normal. It’s about correcting the basic assumptions that trigger the fear of the sleep disorder. Only then will we discuss behavioral therapy options.
People need to go to therapy?
It’s about behavioral therapy. Many people come with the idea that there is something deeply wrong with them, for example from childhood, and that they can find out about it through discussions in therapy and so the sleep disorder disappears. While this can sometimes be the case, studies show that psychotherapy that works on old causes or childhood does not change the current sleep disorder.
Instead, it’s about what you can do about it here and now.
Exactly, a very pragmatic behavioral therapy approach, whether you call it sleep hygiene or sleep training. What you often read in the press, namely that it is about the right mattress or a room that absolutely has to be completely dark and quiet, is not sleep hygiene in the scientific sense.
What does that entail then?
A fixed sleep rhythm and a relatively narrow sleep window. We prefer to talk about the window rather than the sleep time, which patients always focus on. It’s not just the length that matters, but also the quality. When it comes to therapeutically influencing sleep, you start with a narrow sleep window and gradually expand it. If you have been diagnosed with chronic insomnia, ideally with someone accompanied.
If I want to do something myself, I could, for example, regularly go to bed at eleven and get up at six.
That would be a good measure, even for the weekend. The fixed get-up times are the more important factor. The poorer sleep from Sunday to Monday is not caused by worrying about the work week, but because your sleep rhythm changes at the weekend. Many people think that they then have to catch up on sleep and sleep it off.
What else can help?
Exposure to light in the morning is very good as a boost of freshness, but also because it stimulates melatonin production later for the night. Then exercise, because stress hormones are reduced, and relaxation exercises, depending on which method you like, to reduce stress levels during the day. You don’t have to relax after 8 p.m. to get a good night’s sleep. But if, for example, you always perform activities in the same order half an hour before bedtime, you are harnessing the power of conditioning.
How quickly does sleep improve again through such measures?
During psychotherapy, we see very strong effects after just three weeks for some people, but you should give yourself six to twelve weeks. Regularity is important.
Overall, anything that is boring is obviously good for sleep.
Yes, but the attribution of causes remains crucial. I often ask my patients whether they remember times when they slept little for positive reasons. When you were newly in love or traveling in an exciting country, you slept very little and still felt full of energy. What is stressful is that they are now focusing on the negative effects of the sleep disorder. This realization can be very relieving.
Dr. Beate Paterok has a psychotherapy practice in Münster with her husband Tilmann Müller. The guide “Successful sleep training” (Hogrefe) comes from both of them. You can hear the conversation in full length in the episode “Awake too? Sleep better in midlife” of the BRIGITTE podcast “Meno an ich”.