Stress Control Session Five: Monday 11th May

Welcome back to session five of stress control. This is a really busy session. We are going to be looking at controlling panicky feelings and getting a good night's sleep. But before we do that, let's do a quick recap of session four. We looked at actions and divided them into two, avoidance and behavior. We asked the question, what do you do if you fall off a horse? Because everyone knows the answer. And what you do if you fall off a horse is exactly what we do with any stressful avoidance. We face our fears and get back onto the horse or get back into the situation as soon as we can. There was a second big message though and that was at session four we should be starting to pull the course together force the jigsaw to form so that we begin to see the big picture. Now we'll keep doing that in this session but we also looked at stepping out of your comfort zone. So if you remember our birds, our yellow bird was really anxious obviously and decided to play safe. And the important thing as the bluebird says is it's time to take a risk. And we looked at problem solving, a very powerful skill which can make huge changes. And if you remember the example we used in that session of Sam and his son John. So today in the first part we will look at controlling panicky feelings. Have a break, come back and we'll look at getting a good night's sleep. And where we are? Well, we will obviously do something to get a good night's sleep and recharge the batteries. We will do a lot about this idea of feeling overwhelmed. And as always, everything we do today, as in all other sessions, are designed to help boost our self-confidence and self-esteem. So, let's focus on panicky feelings. So, the big picture, you can now start to see that the vicious circle is slowing down and losing a good deal of its strength. And of course, the positive circle is now beginning to look much more powerful, really building up ahead of steam as we begin hopefully to feel that we can get the world under better control with a lot of practice of course. We will continue the idea of pulling the course together today. So at some point I am likely to mention fightlight. I will mention relaxation whether it's belly breathing or progressive relaxation. We'll look again at the idea of vigilance and how that impacts uh on panicky feelings and how we can best use the controlling your thoughts skills to control these feelings. So let's look at this further. The two most important facts about panic are, and I don't need to say this to anyone who's experienced a panic, is they can be terrifying. But, and you will find this very hard to believe in the middle of a panic, they are not dangerous. Where does the word come from? Well, it comes from the Greek god Pan, who was a giant, half man, halfgoat. And in Greek mythology, the story says that Pan was a very mischievous god and liked to hide in remote mountain passes, waiting for passers by. Pan would jump out in front of them, a gigantic halfman, halfgoat, and literally terrify them to death. Well, a panic won't terrify you to death, but you will feel terrified during that. And let's look at how Fabiana describes panic. — It comes on so quickly and just seems to explode in my mind and body. I pace up and down and know I losing control and there is nothing I can do to stop it. It is so bad that every time I have a panic, I think I'm going to die. And after it has passed, I just feel so exhausted and weepy. — So let's make sense of panics by dividing them into thoughts, actions, and body. In terms of thoughts, you will experience a strong sense of intense fear, losing control and that there's nothing you can do to

stop this. and a strong sense that something awful is about to happen to you. The roughly half of all people who experience panic will not be able to say what that awful thing is. It will just be a vague sense of dread. But for the other half, they will often say something like this. I'm losing my mind. I'm having a heart attack. I'm going to die. I'm going to faint. There's an intense focus on your body so that you're acutely aware of what's happening to your heart. For example, you may find in the middle of a panic that you are confused. It's very hard to think your way out of the situation. Or you may feel that you're about to do something stupid. Now, think of all of those thoughts. If anyone believes any of those thoughts even for a short space of time, would it make your panic worse? The answer is of course. If I thought I was going to have a heart attack, do something stupid, it would simply add to the existing stress. Let's think about this in terms of actions. And just as we did in the previous session, we divide this into avoidance and escape and behavior. So if we look at avoidance, first of all, many people will avoid being alone out of fear of what might happen to them if there's not someone there to help. There may be a sense that you can go a certain distance from your home, but not further. You may avoid busy places uh as much as you can out of a fear of what might happen to you there. But one of the other things that tends to happen with panic is that you desperately try to keep your body as calm as possible. So you may find yourself avoiding exertion. So you don't run up the stairs because when you run up the stairs, you're aware that it has some impact on your body. But you may also try to avoid becoming emotional. Well, let's go back to session three. And if you remember, then we discussed penguins. In particular, we said, "Don't think of a skateboarding penguin. " And of course, many of us ended up thinking of a skateboarding penguin. So the more you try to stop becoming emotional, the more likely you are to become emotional. So exactly what we said in session three, think penguin if you want. Let's think about behavior. You may find when you're feeling panicky is that you're very fidgety. You can't sit at peace. Now this is largely because these panic feelings are the purest form of fight flight. You may want to run. And again, that's get away from everyone. When you feel like this, when you feel panicky, you tend to be much more irritable, snappy, and angry. You may find yourself yawning a great deal. Now, hold on to this because I'm coming back to this later. You may also find yourself sighing a lot. Hold on to that as well because this could be a really useful sign. Let's think of the body. Well, the signs of panic are really just the same uh as those of anxiety, but much stronger. It's not unusual for your heart rate to double uh when you're feeling panicky. And although that's not dangerous, it does have a marked effect on your body. And it's not surprising that many people jump to the wrong conclusions when that happens. You will tend to be highly aware of what's happening to your body and that's due to vigilance. And when we look at these common body signs, we've really seen all of them before back in session one. But it is the strength of the signs that uh tend to be much worse. If we think about three types of panicky feelings. So first of all, it's the ones you think you can predict. So we have the audience here at the theater or in the cinema. How are you likely to handle that? Well, if you think if I go to the cinema and if I sit in the middle of the row, I will panic. Normally what uh people do is they avoid going to the cinema or the theater. Well, think back to last week about

avoidance. It helps in the short term. It makes you worse in the long term. Facing your fears short term, but makes you better in the long term. Allowing your confidence and self-esteem to grow. There's the more common out of the blue panics. Now, of course, these are more frightening because you have no ability to predict these. Now, later on when we look at the role of breathing, I'll make some suggestions which might suggest that these might not be completely unpredictable. Let's see. And the third type of panic is nighttime panics. These I think are really truly uh frightening because you wake up in the panic attack often in the earlier part of the night and the image that I've chosen there is very deliberate i. e. an open window. One of the strong symptoms you get with nighttime panic is breathlessness and a lot of people because they're aware of that symptom will very deliberately sleep with the window open. They wake up. They feel breathless and panicky. They rush to the window and go, they take a huge breath in because they feel that's the right thing to do. Well, later on when we look at the role of hyperventilation, we'll see that that's exactly the wrong thing to do. Let's look at the role of breathing before we go on and talk about hyperventilation. Now very simply we need oxygen to live. We breathe in oxygen. It goes down into our lungs. It goes into our bloodstream and it feeds the millions and millions of cells in our body. The cells gobble up the oxygen. They convert it into waste which is carbon dioxide. They push the waste back into the bloodstream into the lungs and you breathe out carbon dioxide. Breathe in oxygen, And our bodies tend to cope well when there's a nice balance in the bloodstream between oxygen and carbon dioxide. And the rate of breathing should be dependent on the level of energy that you need. So if you're playing five aside football, you need a lot of energy. So when you're playing, you should be breathing much quicker and deeper. The oxygen going into your lungs, into your bloodstream. The cells are hungry for more energy. So they gobble up all of the oxygen convert all of it back into carbon dioxide, push it back into your bloodstream, push it into your lungs, and you breathe it out. A couple of hours later, you're back home and you're sitting in front of the TV. You're not using up as much energy. So, the cells don't need as much oxygen. You still do the same oxygen down into your lungs, into your bloodstream, into your cells, eaten up, back into your bloodstream, lungs, breathe out, but it's simply happening at a much reduced level. So, when you're playing five aides, you're taking in a lot of oxygen, but because your body needs all of this energy, it's all gobbled up by the cells. It's all converted back into carbon dioxide, and you breathe out a lot of carbon dioxide. In other words, you've got a nice balance between the amount of oxygen going in and the amount of carbon dioxide going out. If you're watching TV, it's the same, but it's much slower and you're not taking in anything like the same amount of oxygen because you don't need to. It goes into your lungs, goes into your bloodstream, goes to the cells, your cells gobble it up, convert it to carbon dioxide, which you eventually breathe out. It's the same level. And what you've got again is a nice balance between the amount of oxygen going in out. Balance being the key to life here. The problems happen with hyperventilation. Hyper meaning too much. Ventilation meaning breathing. It's when you start to breathe too fast for your needs. Now that's very good for fight flight, right? That's why we have the ability to do it. If you suddenly need a burst of oxygen to run away from that bear, then it makes sense to take in a vast amount of oxygen really quickly. But if you do that, it's important that the cells gobble up all of the oxygen and then

convert it into carbon dioxide. But if you're not running away from the bear, you lose the balance. So you're breathing fast enough to run away from that bear when in fact all you're doing is standing still as a nervous speaker. So not burning up the energy to anything like the same degree. And what happens then is you're taking in so much oxygen but you're not converting it. So therefore you're experiencing a drop in your carbon dioxide levels. Now, when you lose that balance between oxygen and carbon dioxide, there's a drop in the acid level in the blood. None of this is dangerous. Some blood vessels will narrow for a while and the oxygen becomes sticky and sticks to your blood. Now, this may cause many of the signs of panic because less blood is reaching your brain. Again, not dangerous, but it may leave you feeling, and let's see if this accords with your experience of panic, dizzy, breathless, confused, right? Unable to think as clearly as you would want to, blurred vision, choking feeling, and sometimes a sense of unreality. So, uh, an example of that could be you kind of might feel the walls are coming in on you a bit or when you're walking across a solid floor, it feels as if you're walking on cotton wool or walking on air. It can be quite disturbing uh to experience that. It also results in less blood reaching other parts of your body and that can result in increased heart rate as your heart's a pump. is trying to pump blood more quickly to those parts. You might get numbness and tingling particularly in your fingertips or your toes sometimes uh around the nose and mouth. Your muscles f might feel quite stiff and your hands can feel quite cold and clammy. So the body's now working hard and that results in you feeling hot, flushed, sweaty. common reports from people who feel panicky, but they also start to say they yawn and sigh a lot. Remember when we threw up those images? I said hang on to those. We'll explain those later. You may find your body's full of aches and pains and you may just feel really tired. And let me emphasize once again, none of this is dangerous, but it feels horrible. Now let's take this slide quite slowly because this is a really important slide. Now these symptoms are not caused by stress. They are caused by hyperventilation. They're caused by you breathing too quickly for your needs. But the hyperventilation may be caused by stress. But that's not enough to trigger the panic. The panic feeling comes because of the way you interpret the symptoms. Let's build up a model here. So you start to feel panicky. You start to increase your breathing. This is fight flight. You start to take in too much oxygen which isn't converted by the cells because they don't want to gobble it up. So you drop your levels of carbon dioxide in your body that leads to the kind of unpleasant symptoms that I've just described. And at this point the interpretation becomes critical. Let me give you an example of this because we've now created a vicious circle yet again. Here's the importance of interpretation. And I'm going to tell you a story from my own career. Many years ago when this model appeared, I was working in Lannarchshire in Scotland and uh one of our team Mary uh trained in this model. She came back and it was Mary's job to train us in how to do it. So we all got together one day. We are all sitting around the table ground floor uh in a local hospital and Mary explained all of this model to us. She explained how we hyperventilate. She explained the kind of feelings that we would have. Uh she talked about the importance of the interpretation and she said, "But I think we we've got to demonstrate this. " And she suggested

that we should breathe really quickly. In other words, hyperventilate for 2 minutes. And she asked us after 2 minutes of doing this, right? Then we'll close our eyes, just focus on what's happening to our body. She gave us a checklist of symptoms. And she said, "Right, just, you know, once we've did this test, tick the boxes of the symptoms that you've got and then we'll have a chat about it. " Well, I was always very enthusiastic when it came to these training events. So, uh, we hyperventilated, or rather I hyperventilated. So, I was around this table going just hyperventilating at a phenomenal rate. Uh, what I didn't really notice was that none of my esteemed colleagues were doing the same thing because they had a much better strategy. And their strategy was let's just sit back and see what happens to Jim which turned out to be a really good strategy because after 2 minutes I had never felt as bad in my life. I've never had a panic attack thank goodness but my goodness that gave me such an insight because I suddenly had filled my body with so much oxygen and I'd lost this carbon dioxide. So, I had really strong and unpleasant symptoms. I remember or was told that I'd gone chalk white. I was drenched in sweat. I can remember holding on to the arms of the chair cuz I thought I was just going to fall over. I had a real feeling that I was going to be sick as well. I was still trying to be very brave and fill out my checklist. But unfortunately, I now had a symptom called tetany where my hand had become a claw and I couldn't even pick up the pain. Never mind that my entire body was shaking. A couple of hours later, I was still unwilling to drive my car cuz I felt so bad. But I didn't have a panic attack. And the reason was because of my interpretation. In other words, I knew exactly why I felt like this. Mary had told us that if we breathe quickly for 2 minutes, it would result in the kind of unpleasant symptoms that I was getting. And anyway, the symptoms that were on the checklist were exactly the same ones that I was having. So, I had no great concerns that something really terrible was going to happen to me. Mary was and remains my friend. I knew she would not do something bad to me. So therefore, my common sense voice remained well in control. And because control, I didn't have the panicky feeling. And because feeling, I didn't complete the vicious circle and my common sense voice remained well in control. But compare that to different interpretation. Let's just imagine that instead of hyperventilating like right, which doesn't happen all that much. Let's just say you're someone who normally breathes 10 times a minute. So every minute that passes, 10 amounts of oxygen go down into your lungs, into your bloodstream, go to your cells. Your cells gobble it all up, convert it all into waste, carbon dioxide, push it back into your bloodstream, lungs, and you breathe out the carbon dioxide. You've got a nice balance, in other words, between the oxygen and the carbon dioxide, but you're a bit stressed. This is 2:00 in the afternoon. You're a bit stressed at work, and you start to breathe 11 times a minute. No big deal. You're not going to notice that. But think what's happening there. For every minute that passes, you have one extra amount of oxygen that's going into your lungs, into your bloodstream, but is not being gobbled up and therefore converted by the cells. So after 1 minute, you've got one extra amount of oxygen and one lesser amount of carbon dioxide because the oxygen hasn't been converted. After 2 minutes, you've got two amounts of additional oxygen, two fewer amounts of carbon dioxide. 3 minutes, three extra amounts, three fewer amounts. 27 minutes, 27 additional amounts of oxygen, 27 fewer amounts of carbon dioxide. 2 hours and

15 minutes. Well, work that out for yourself. The trouble is after 2 hours 15 minutes. You may well be home. You may be preparing a meal. You may be making yourself a cup of tea. You may be sitting in front of the TV. And all of these symptoms start to appear. Well, what's your interpretation going to be now? Probably something like, "I'm going to faint. Something awful is about to happen to me. " Your stressed voice is going to be in control because you don't have a good explanation. You're unlikely at that point to say, "I wonder if for the past two hours, 15 minutes, I've been very slowly adding to the amount of oxygen and losing the amount of carbon dioxide in my bloodstream. It kind of makes sense to jump to a much more emotional interpretation. And if you do, it will lead to a panicky feeling. And if you do that, you complete your vicious circle. So interpretation is critical here. So hyperventilation can come on quickly. So when you do it in the way that I do it, it comes on really quickly, but it's more likely to come on much more slowly. So you can get to the point where you take an extra breath. That's the straw that breaks the camel's back. And maybe what you see as an out ofthe blue panic in fact would have been predictable had you been aware of this slow progression where you're slowly losing carbon dioxide. Let's look at some of the signs of hyperventilation to see if this might explain some of the symptoms that you are having. So, when you feel stressed, do you feel lightheaded or dizzy? Do you feel you're going to faint? Do you yawn, sigh, or gulp in air? Remember what's happening. Yawning and sighing are early warning signs of hyperventilation. Therefore, if you get those signs, you could jump in and do something about them. Do you feel short of breath? Do you feel your breathing is shallow or that your breathing speeds up? You become aware of chest pains, either shooting pains or like a band of tension uh around the chest and you get a numb or tingling feeling around the nose andor your mouth and or in your fingers and toes. Well, if you're answering no to all of those, then hyperventilation is not playing any role at all and uh therefore you don't have to focus too much on this. If you're answering yes to several or a lot of those, then it would suggest that hyperventilation is playing a role. And in some ways that's good news because it becomes a lot easier to control those feelings particularly when you combine it with the other skills that you've been learning on the course so far. So if we think about controlling your body belly breathing which is a way of slowing down your autonomic nervous system including your breathing becomes really useful. Progressive relaxation uh allows you to do this too. Well, I think most people if you ask them how do you control panic, they would say you breathe into a paper bag and we can kind of understand uh why people say that. This something which we used to recommend some years ago but we now realize there's more to it than this. So when does that help and when doesn't it help? Well, the feelings about using a paper bag is you're staying in your comfort zone here. So, people were getting used to carrying a paper bag around with them, but we now feel that it's more to do with the comfort zone, and it's probably more trouble than it's worth. So our recommendation now is not to use a paper bag but rather focus on the skills that we're teaching uh here in terms of controlling your thoughts. Build the foundation use big five challenges. So for example, what are the chances? What's the worst thing? Am I right to think that I think are really good challenges for panic and breaking stress up. So you work out where panics are more likely to happen. you prepare to face that you're facing your fears here. You face up and then you review

it. And in terms of actions, well, you're certainly facing your fears and you're being careful about the comfort zone here. So, remember the lady that we talked about in the last session who was carrying the bottle of dasipam about with her? That was not helpful because she was really saying the only reason why I'm coping is because I've got this with me. You want to get rid of those. And remember I talked about nighttime panics, people sleeping with the window open. Well, taking a big deep breath is the worst thing you can do. So, sleeping with the open window is not what you want to do. There's more than enough air in the room anyway. So, try not to do that. So, think about all of those skills. think about how we can now combine the skills that we've been learning in the class so far. But we can also help reduce the risks of panic. So let's look at some of the things which make panic more likely. First of all, tiredness. Well, after the break today, we're going to learn better ways of getting a good night's sleep. So, we're going to do something about that immediately. Panic is more likely when our blood sugar levels drop. Now, nothing to do with diabetes here, just normal low blood sugar. The way that you uh stop that happening is to eat something on a regular basis. Uh and I think the experts here say you should eat something every 3 hours. It doesn't have to be much. One biscuit, one slice of toast is more than enough to get your blood sugar levels back to whatever normal is for you. You might be thinking at nighttime you're sleeping for 8 hours. Well, your blood sugar level drops much more slowly when you're sleeping. So, it doesn't matter as much, but it is important when you wake up that you are eating something. So, please don't skip breakfast. But again, one biscuit, one slice of toast more than enough. The morning or the day after the night before can be important. So if you are drinking a lot uh on the Friday, you may have to take extra precautions on the Saturday because you might be a bit more vulnerable. If that's a significant problem, well worth thinking about just not having too much alcohol. Uh illness can uh make us more prone to panic as well, but of course there's not all that much we can do about that. caffeine. There's something Let's go straight back to session two when we looked at the role of caffeine. So hopefully if you felt that caffeine was playing a role in your stress, you've now cut it back considerably. So you may already have got rid of that risk factor. When women are premenstrual, there's a natural drop in carbon dioxide levels. So therefore, if we're thinking about this as a as the gap between oxygen and carbon dioxide, u you're already lowered down. So it doesn't take as much to uh reach the point that it may produce symptoms. Nothing you can do about that, of course. Uh and not much you can do about being menopausal, uh which again can be a risk factor for uh panic. By far the most important and strong factor involved in predicting panic is simply stress. So the more you are able to do to control your stress using all the skills you've learned so far on the course, the less likely you will be to panic. So, watch out for those risk factors and control the ones that you can in order to cope better with the ones that you can't. So, that has us reached the end of controlling panicky feelings. Hopefully, that's been useful for you. Time for a break just to recharge the batteries a bit and come back in 10 minutes and we'll look at sleep.

Yeah. Nice.

Wow. Yeah. Hey. More heat. Hello, welcome back. And we're on to part two. Part two is all about getting a good night's sleep. Let's take a quick look at the big picture. Well, you see the vicious circle now is really losing a lot of its energy while the positive circle is becoming a good deal stronger. That doesn't necessarily mean that you should be feeling a lot better at this stage. It simply says all of these pieces are now in place. So we're going to look at sleep in two steps. It's really important to understand what's going on in sleep. So part one is all about that. And then the second part we're going to divide into sleeping tips and retraining your sleep.

Why do we sleep? Well, it helps young ones to grow. So babies spend 17 18 hours a day sleeping. So there's something really important going on in sleep that's allowing the baby's mind and body to develop. But obviously it repairs our tired bodies. We can't go without sleep for any great length of time. It seems in very complex ways that we certainly don't fully understand. It sorts out our thoughts and our memories and it certainly boosts our well-being. So, getting a good night's sleep is really good to keep stress down and keep well-being up. Let's look at different types of sleep problem. And I've identified, I think, five obvious ones. And here's examples of each. Uh, this gentleman says, "I can go to bed feeling dog tired, but as soon as that light goes out, my mind comes to life. I toss and turn and feel rotten. My wife's fast asleep in seconds and I'm wide awake. " And I think that's probably a description of a sleep problem that a lot of you would recognize. This idea of no matter how tired you feel getting into bed, it's when you switch that light out that your brain just seems to come to life. Or this lady says, "No matter how long I sleep, I still feel I need more. I guess my bed's the only place I feel safe. If I'm there, I don't have to face the day. " And you can see the way the poor sleep is in some way being affected by what's going on during the day. But because she's not sleeping well during the night, it's probably then adding to stress the next day as well. And this one's to do with early wakening. I'm awake at 4 or 5:00 and even though I'm desperate to sleep more, I can't. Then the depression hits me like a ton of bricks and I know I'm in for another hellish day. Again, you can see the way that daytime problems, in this case depression, are associated with this early wakening. And this lady saying, "I can get over to sleep not too badly, but I wake up after an hour or so and just can't get back over. I'm up and down half the night. It really gets me down. " I think being awake when you feel the rest of the world is asleep is a really miserable feeling to have. And I would imagine this lady would identify with that. And this young man says, "I wake up and feel I've hardly slept. I still feel tired and I don't feel I've got the energy to face the day. " So, there's something going on here about the quality of sleep that this man's getting. So, these are five different types of sleep problem. And of course, it's very common to have more than one of those. Let's look at some reasons for poor sleep. Well, stress is such an important factor which stops us from sleeping well. But there are others. For example, shift work, particularly night shift. You know, we are designed to sleep in the dark and our body clocks get really confused when we're trying to sleep at odd hours uh in the day. If you can, do try to avoid shift work, but a lot of people can't. So, if you can't, you maybe have to put extra work into getting decent sleeps during the day. As we get older, we need less deep sleep and we just need less sleep generally. But I'll say a wee bit more about that because it's not quite as simple. This might be age related but might not be. But we may need to get up to go to the toilet during the night and clearly that's breaking into our sleep pattern. And again, possibly age related, possibly not, but pain, particularly the more chronic conditions like arthritis, for example, can be a factor in keeping us awake or wakening us up during the night. Noisy surrounds, obviously, if the noise is coming from within your house, is it something you can do something about? If the noise is coming from out with your house, you may well be stuck with it, unfortunately. But poor routine. This is something you can certainly do. Uh I'm going to say something about using for example your phone in bed. Uh but you want to have a good routine. You want to uh largely go to bed at roughly the same time each night and roughly get up at the same time each morning. So you're training your body to get into a particular

habit. Let's look at what happens when we sleep. And we have to understand the sleep cycle. So when you fall asleep, you're in stage one sleep. It's very light sleep. It's not particularly good for us, but it's the first step. And if we stay asleep, we go into slightly deeper sleep in stage two. Then we're getting into much deeper sleep. And by the time we get to stage four, we're in really deep sleep. This is fantastic for us. Really good. It repairs our bodies after the exertions of the day. And if you ever watch someone sleeping, you always know when they're in deep sleep because they just look so relaxed. It looks as though they're sinking down into the bed. They're hardly moving. Their breathing is really slow. If we were demotachines, it would just look as though the whole body was really quite relaxed. But then after stage four, after this lovely deep sleep, we go into a really strange and complicated type of sleep called REM sleep, which stands for rapid eye movement. So-called because your eyes moving about rapidly underneath your eyelids. This is the stage of sleep where most of your dreaming happens. Now what the purpose is of dreaming different people have different views on but we think this is a really important stage of sleep when we sort out all of our thoughts and memories. But whereas in deep sleep when the person just looks so relaxed in rapid eye movement sleep it's the exact opposite. the person will appear to be quite twitchy. And if you look at the brain patterns, there's obviously lots of things going on in the brain during this period. But while they are twitchy, what they don't do is make all that much uh movement because while you're in rapid eye movement sleep, the body is paralyzed by the brain. It actually can't move all that much. And it's thought that this is to stop you acting out your dreams. So if you're dreaming of running down a road, you don't want to run and slam into the bedroom wall. So you go into this almost voluntary state of paralysis which completely uh changes as soon as you go into the next uh sleep cycle. So you're going through this sleep cycle. It lasts usually about 90 minutes to 2 hours. And what we know is it's so important to be getting deep sleep and rapid eye movement sleep. And these cycles are going on throughout the night. So as soon as you finish the first sleep cycle, which finishes with rapid eye movement sleep, you go back to stage one sleep in your second cycle. stage one, stage two, stage three, stage four, deep sleep, rapid eye movement sleep, and into your third cycle and maybe into your fourth cycle as well. Now, you get most deep sleep during the first stage of the night and you get more rapid eye movement sleep earlier in the morning. So, it's really important to combine this so you get enough deep sleep first thing and enough rapid eye movement sleep later on. So, hopefully that tells you a bit more about sleep. What's more important really is doing something about it. And we're going to start with sleeping tips. divide these into four. But before we do that, just a quick word about sleeping tablets. I think it's highly unlikely your doctor is giving you sleeping tablets for any length of time. Now, they may work for a few nights, but they won't work in the long term. They often change the type of sleep we get. For example, it cuts down on deep sleep. the kind of sleep we really want. And if you do take them for too long, you'll end up getting what's called rebound insomnia, where it in fact completely turns 180° and instead of helping you get to sleep, it helps you stay awake uh instead. So, sleeping tablets are really not a great idea. There are much better ways to control your sleep. So, let's look firstly at the bedroom. important to get fresh air into the room. So, at some stage during the day, can you get the windows open and just replenish the fresh air?

We quite like a certain temperature when we uh sleep. So, we call this the Goldilocks principle. Not too hot, not too cold because when it's too hot, you tend to be more restless. You get less dream sleep, REM sleep, and likely to wake more often. too cold, harder to get to sleep as you would imagine and possibly you get more nightmares. So just right is about 18 degrees Celsius. And the same goes for you. So it's quite important to keep your body temperature at about that. So if you're having a hot bath or a hot shower, it can be an idea to do that maybe an hour before you go to bed. So it just gives your body time for your body temperature to come back down to normal. We think about your bed. We're spending a third of our life in bed. So it does make sense that we are able to spend a decent amount of money on getting a good mattress, good pillows and a good duvet. So if you can afford it and if you feel you need to get a better mattress etc. H I would suggest that that's something you consider. We are designed to sleep in the dark, so it's important that our curtains are blocking out as much light as possible, particularly as the spring and summer come in and the nights lengthen. So, blackout blinds or heavy curtains will help us sleep a bit better. Obviously, you want to cut down on as much noise as possible. So, if the noise is coming from your house, can you ask other people to be more considerate? If the noise is coming from outside, you're probably a lot more limited in what you can do about that. There is an old trick uh which I'm not sure would work for me, but it it's something you might want to experiment with, and that's using white noise. You know, that crackly noise that you get from old radios when they're tuned off of the station. White noise seems to be very good at soaking up other noises. So, if there's nothing better you can do, think of using white noise. So, if you've got an old radio, you can use that. But also, there are white noise apps that you can easily download to your phone uh or computer. I think there's CDs of white noise as well. So, you're considering everything you can do to cut back on the amount of noise you're having to put up with. You also want to consider getting your body calm. How can you do this? Well, exercise. Not immediately before bedtime, though, because you want your body to be calming down, but exercise in the early evening is a good idea. Food, not too much late at night. slice of toast, fine, but not a big meal and then jump into bed because your digestive system has to wake up in order to digest your meal. You want your body to be calming down as much as possible. Obviously, you want to cut back on the amount of liquid you're drinking as the night wears on to make it less likely that you wake up to go to the toilet during the night. Caffeine. What the experts are now saying about caffeine, which I think is really strict, is that you should be cutting out caffeine from about mid afternoon onwards, but certainly not having a can of Red Bull at 10:00 at night, for example, if you plan to jump into bed at 11. Warm milky drinks. There actually is something in the old wife's tale here. I don't understand what it is, but the milk has to be hot. So, you might want to think about mixing it with something like Horix Ovaltine, but hot milk on its own uh would give you this benefit. Try to avoid anything to do with nicotine for a couple of hours before sleeping. So, whether it's cigarettes, whether it's vaping, uh you may be using nicotine patches. Nicotine is a stimulant and it's stimulating your central nervous system. So just at the point where you want your body to be slowing down, the nicotine is kind of speeding it up. So if possible, probably try to stop smoking anyway if you wanted to, but certainly for a couple of hours before going to bed, try to get that nicotine out of your system. Alcohol can get you to sleep, but it will change the type of sleep you get, and it will often also wake you up. And if you're relying on alcohol to get a good night's sleep, then that's a problem in itself.

What can you do to get your mind cam? Well, I'm going to talk about worry time. I've always thought worry time is a really dafted idea. But the reason why I still teach it in stress control is because so many people have told me they have found that this has worked brilliantly for them. So I'm going to tell you about it and you make up your own mind as to whether it might work for you or not. The idea behind worry time is that you set aside half an hour, preferably in the evening, and that's the time that you do all your worrying. So, let's say you set aside 8 to 8:30. Two things. You start to worry about something in the morning. You've got to stop yourself. This isn't my worry time. I will worry about this at 8:00. Come 8:00, you're feeling perfectly relaxed, perfectly happy, but this is your worry time. So, it's important that you switch off the television, stop whatever you're doing, and you try to worry about the thing you were starting to worry about that morning. I mean, it sounds really uh quite strange, but some people just really love it. So, if it doesn't work for you, then just get rid of it. focus on all of the other tips that I'm giving you. But if it does work for you, brilliant and do it and keep it going. The old adage, never go to bed on an argument. Try not to use relaxation. So perhaps you want to uh try your deep relaxation in bed. Maybe you want to switch that to quick relaxation, but then try to do it on your own. So, you've had the relaxation going now since session two. You may feel you're able to do this on your own. You might want to use the belly breathing. Uh, in any case, get your actions calm. So, this comes back to routine. So try to go to bed at roughly the same time and this slide will take forever. Try to get up at roughly the same time as well. Come on dog. Keep going. Made it. So there does seem to be an advantage into training our bodies that there are certain times when we're asleep and awake. Think about some kind of relaxation before bed. Now, I've suggested progressive relaxation or belly breathing, but you could also consider listening to nice music, reading a book, or as I say, some kind of relaxation. Now, you'll notice that I don't have computers or tablets or TV on that. And I'm going to say why uh in a minute. Now, think back to when you were a child or if you are a parent, think back to when your children were young and the importance of having a bedtime routine. So, uh you know, maybe a bath, then maybe a kickabout, then get into your jammies and then maybe read a bedtime story. And it was all designed to say to the child, look, the day's frantic activity is coming to an end. it's time to slow down. And once you've got to that point, it's easier then just to tip over into sleep. Well, that may be really important for children, but it's really important for us as well. And I think sometimes we forget that having a good routine at bedtime would be really helpful. So think about what you do maybe in the half hour before you go to bed and think whether you could bring some kind of relaxed routine into play there. People really like this one and that is your partner. So say for example your partner does this Now, I'm not advocating that you actually do that, but it can feel really annoying. Well, the good news here is that if you are learning to sleep better, then you've got to learn in your own bed. So the good news is you can push your partner out of bed. You can send him or her off to the spare room or off to the city so that you can learn to sleep in your own bed. And it's largely up to you if you let your partner back in again. I was saying earlier that it's really useful to have some kind of relaxed

routine. So you could be reading a book or you could be listening to music doing your relaxation. And I said try not to use computers, tablets, phones, television. And the reason for that is we're moving further and further away from our kind of natural state here. We are designed to sleep in the dark, but we're also designed as darkness slowly falls to get ready to sleep. As it gets dark, our brains start to release something called melatonin. Now, the role of melatonin is to kind of set up other processes in the body which will get us over to sleep. If we interrupt that sequence, for example, by having a lot of really bright light, the brain stops releasing as much melatonin. And if we don't have too much melatonin released, these other processes don't begin. And therefore, it's much harder to get over to sleep. So, if possible, what we want you to do is to let your world slowly grow dark. So, cut down on the amount of lights that are on. You know if you are using your phone uh cut back on the brilliance of the display etc. But if possible try to avoid those kind of electronic devices maybe for at least half an hour before you try to go to bed. So try to limit the tech and I appreciate that is a complete waste of breath because it is so hard not to do this. Uh, so if you know that you're not going to do that, then you might want to apply the blue light filter, which will take the harshness of the light off and give you a kind of better yellowy color to it. So check with your phone to see if that's been installed or I'm sure you're able to install it from an app somewhere. So how much sleep do we need? Well, okay, everyone's different, but on average, adults should be aiming for 7 to eight hours a night. Teenagers need more, 8 to 10 hours. What we certainly know now is sleeping for a lot less or a lot more is bad for you. It's bad for your mental health, but we now think it can be bad for your physical health as well. So I think we should be aiming for 7 to 8 hours. And I mentioned earlier that the older we get, we need less sleep and we get less deep sleep. But we have to consider that thinking about lifestyle as well. So here we've got a 20-year-old couch potato. Well, he's just sitting on the sati all day doing nothing. He's not using up much energy. He actually doesn't need all that much sleep compared to this man. This man is called Fuja Singh. Uh this is him at the age of 100 crossing the finishing line of the Toronto Marathon. This is an extraordinary man uh who I see has just reached his 109th birthday. Uh and it's fascinating. you've gone to Wikipedia uh and read about this astonishing man. He took up running actually pretty late in life. Um and he now uh tours the seek temples the gajuaras and he tries to encourage young people to take up exercise and I have a friend who took up running solely because Mr. Singh came to the temple in Glasgow. So he's having an astonishing impact uh on young people as well as setting an astonishing example as to what people can do even very late uh in their lives. So that's sleeping tips. All of those are really sensible. Most of them are pretty straightforward to do and I would expect that many of them uh could be quite helpful to you. But if you have a good going sleep problem, right, if this is going back a long time and you really feel this is a serious problem, of course, use all the sleeping tips. But I'm now going to teach you about an other way to handle this. This is called retraining your sleep. And this is excellent. But the reason why I've left it to last is because this is quite hard to do. It really requires quite a lot of motivation. However, I would say if you are not sleeping well, it is such a

miserable condition to have. It is well worth considering doing this. You should get signs of improvement reasonably quickly. But let's go through this. So, first rule, you must follow this to the letter. You can't take a night off with this. It's got to be night after night. So, let me tell you about the background to this. This is all about conditioning. So, you might remember Pavlov's dogs where he taught them to associate the sound of a bell with receiving food and they would salivate. Well, this is the way that we apply conditioning to doing something about sleep. And the example I always give here relates to my wife Lillian, right? Lillian sleeps brilliantly. And I think one reason she sleeps brilliantly is because of the associations she has with her bed. So Lillian jumps into bed every night and she tends to say, and this is after 40 years of marriage, she tends to say, "Oh, I love my bed. " But I think that's really important because that is such a good association to have with your bed. So when Lillian leaves the living room at night and makes her way towards the bedroom, everything is working in her favor. Everything in her mind is saying, "I'm going to somewhere that I like. I'm feel safe, where I feel relaxed, where I feel comfortable, where I will get over to sleep, where I will have a good sleep and recharge my batteries. " So long before Lillian even reaches her bed, she's almost halfway to getting a good sleep. Now compare that to someone whose associations with bed are the exact opposite. This is the place where I don't sleep. toss and turn. This is the place where I feel anxious, frustrated, depressed. When that person leaves the living room and makes their way towards the bedroom, everything is now working against them. And it's not surprising that when they get into bed, they are not going to sleep. So we have to change that person's associations. We've got to stop the association of this is the place where I don't sleep. So stage one in this program says you don't go to bed until you feel sleepy. Now, that means if you don't feel sleepy at all, you do not go to bed at all. Now, that's pretty unlikely, but that's how strictly you apply the rule. So, you don't have a bedtime anymore. So, you don't go to bed at the end of the news report or something like that. You go to bed only when you feel tired. It's to give yourself a chance of getting to sleep relatively quickly. So, as soon as you feel sleepy, you're ready for bed, right? You've changed into your pajamas, your nighty, you get into bed as quickly as possible. Your bedroom is only for sleeping. So, you know, most people think reading a book might be a good idea in order to get you over to sleep. Now, if you don't have a great sleep problem, reading a book is absolutely fine. But think about the association. We don't want your association to be this is the place where I read a book awake. The association we want to build is this is the place where I sleep. So you jump into bed, you don't read, you don't eat, you don't drink, you don't check your phone, you don't watch television, you don't listen to the radio. Sexual activity is the one exception because that can be relaxing and following sex. There's particularly in men, there is a chemical release that actually can make sleep more likely, but you jump into bed and you put the lights out immediately. You've now got about 20 25 minutes to fall asleep. Now, we don't want you to uh clockwatch, but just roughly work out what 20 25 minutes would be. If you're not asleep in that time, out your bed, back into the living room. You can see how hard this is. But we don't want the association of this is the place where I

don't sleep. So that's why you only have 20 25 minutes. You go back into the living room. You stay there until you feel sleepy. When you feel sleepy, back into bed, light out immediately. You've got 20 25 minutes. If you're not asleep, back into the living room. Repeat and repeat. Stage five, no matter if you've only slept for a very short period of time, you've got to get out your bed relatively early. I think in the booklets I've suggested 8:30 would be uh the latest time before uh getting up. And stage six is most of us no matter how bad our sleep problems are would be able to sleep in the afternoon. And there's some evidence that actually having a sleep the siesta idea may well be good for us. But we're changing our associations. Our associations are I sleep at nighttime in bed. So no uh afternoon sleeps when you're on this program. And you've got to keep at it. Remember it takes time to change habits but I thoroughly recommend this. It is difficult to do but it is such a good uh approach to change particularly ingrained sleeping habits. So what's our homework? First of all in terms of panicky feelings think about hyperventilation. If hyperventilation is playing a significant role in your stress really focus on the controlled breathing. uh and uh progressive relaxation will be useful as well. Start to combine all the skills that you have learned on stress control uh at this point and reduce the risk factors uh reduce the ones you can reduce in order to go better with the ones that you can't. Second lot of homework relates to getting a good night's sleep and it's doing the sleeping tips and if you feel you need to do more also do the uh retraining your sleep session six coming up final session focus mainly on well-being. So it's a nice session six because we're trying to boost something good namely well-being. We're going to pull everything together so that everything that we've learned in these six sessions makes sense and fits together. And finally, we'll look at controlling your future. If you can, please read over the session six booklets, which is well-being and controlling your future. Thank you once again for attending this session. I hope both parts of it have been useful to you and I look forward to seeing you very soon for the final session.