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DBT - Sleep Hygiene Protocol

DBT - Sleep Hygiene Protocol - Emotion Regulation Handout 20B.1

When You Can’t Sleep, What to Do Instead of Ruminating

To Increase the Likelihood of Restfulness/Sleep

  1. Develop and follow a consistent sleep schedule even on weekends. Go to bed and get up at the same times each day, and avoid anything longer than a 10-minute nap during the day.

  2. Do not use your bed in the daytime for things like watching TV, talking on the phone, or reading.

  3. Avoid caffeine, nicotine, alcohol, heavy meals, and exercise late in the day before going to sleep.

  4. When prepared to sleep, turn off the light, and keep the room quiet and the temperature comfortable and relatively cool. Try an electric blanket if you are cold; putting your feet outside of the blanket or turning on a fan directed toward your bed if you are hot; or wearing a sleeping mask, using earplugs, or turning on a “white noise” machine if needed.

  5. Give yourself half an hour to at most an hour to fall asleep. If it doesn’t work, evaluate whether you are calm, or anxious (even if only “background anxiety”), or ruminating.

  6. Do not catastrophize. Remind yourself that you need rest, and aim for reverie (i.e., dreaminess) and resting your brain. Sell yourself on the idea that staying awake is not a catastrophe. Do not decide to give up on sleeping for the night and get up for the “day.”

If You Are Calm but Wide Awake

  1. Get out of bed; go to another room and read a book or do some other activity that will not wake you up further. As you begin to get tired and/or sleepy, go back to bed.

  2. Try a light snack (e.g., an apple).

If You Are Anxious or Ruminating

  1. Use the cold water TIP skill. Get right back in bed and do the paced breathing TIP skill. (See Distress Tolerance Handout 6: TIP Skills: Changing Your Body Chemistry.) Remember, if you have any medical condition, get medical approval before using cold water.

  2. Try the 9–0 meditation practice. Breathe in deeply and breathe out slowly, saying in your mind the number 9. On the next breath out, say 8; then say 7; and so on until you breathe out saying 0. Then start over, but this time start with 8 (instead of 9) as you breathe out, followed by 7, and so on until you reach 0. Next start with 6 as you breathe out, and so on to 0. Then start with 5, then with 4, and so on until you have gone all the way down to starting with 1. (If you get lost, start over with the last number you remember.) Continue until you fall asleep.

  3. Focus on the bodily sensation of the rumination (rumination is often escape from difficult emotional sensations).

  4. Reassure yourself that worries in the middle of the night are just “middle-of-the-night-thinking,” and that in the morning you will think and feel differently.

  5. Read an emotionally engrossing novel for a few minutes until you feel somewhat tired. Then stop reading, close your eyes, and try to continue the novel in your head.

  6. If rumination doesn’t stop, follow these guidelines: “If it’s solvable, solve it. If it is insolvable, go deep into the worry all the way to the “catastrophe”—the very worst outcome you can imagine—and then imagine coping ahead with the catastrophe. (See Emotion Regulation Handout 19: Build Mastery and Cope Ahead.)

If nothing else works, with eyes closed, listen to public radio (BBC, NPR , etc.) at low volume (use headphones if necessary). Public radio is a good choice for this, because there is little fluctuation in voice tone or volume.

v1.1 10-Mar-2022

  1. DBT Skills Training Handouts and Worksheets, Second Edition.
    Dr. Marsha Linehan.
    Emotional Regulation Handout 20B pg. 259 ↩︎