Sleep & Mental Health, Part 2: Sleep History

Welcome to Part 2 of this mini-series on sleep and mental health. In the first part, I talked about the sleep states and cycles we go through, and why they’re important for our overall health and wellbeing. You can read the full post here if you’re interested.

In this post, I’ll explain how and why I often formulate a sleep history with my clients, and share some of the useful insights that can be gained from doing so. You may be surprised by how much information our sleep history can give us, so I hope that this post gives you some useful things to reflect on.

Without further ado, let’s dive into it!

What is a sleep history?

As a therapist, a big part of my job is building up a picture of my clients’ worlds, which includes their current and historic significant relationships, as well as life events and experiences that have impacted on them (consciously and unconsciously). Gathering this information gives me clues about why they may think, feel and behave in the way they do, as well as identifying recurring patterns that may have caused them to become stuck.

If I believe that it will be useful to do so, I will sometimes invite clients to map a timeline of their conscious sleep history, ideally from birth (if they’ve been told stories about this) up to the present day. From this, we get a sense of the patterns and themes around sleep, and the client can add context about what else was happening in their life at the time.

So what information is particularly helpful to collect?

As a newborn

It’s useful to know what sleep was like for my clients when they were newborns. Although this will be from a pre-verbal stage of development, the body will have stored a lot of information from it, which is why they may have physical responses and sensations that they can’t explain in words. This is called ‘somatic experience’, and it’s the “felt” sense we get to certain cues that may not be in our conscious awareness.

Many clients will have been told a small amount of information about what they were like as newborns, which can be particularly insightful. For instance, if a client was told that they were “fussy” or “restless” as a newborn, as well as how the caregiver(s) responded to them (leaving them to cry themselves to sleep, picking them up and rocking them, etc.), we can begin to piece together the messages that the client has carried forward from this.

For example, if they were left to cry themselves to sleep rather than being soothed, it’s likely that they will have internalised a message that they have to take care of themselves and can’t rely on other people for help. We can then explore how the client may continue to play out this process in the here-and-now, and begin to identify changes they could make to address it.

Sleep environments

It’s common for the environment(s) that clients slept in to have been downplayed in significance because it’s unlikely that they had much influence over it, yet this is another factor that is often hugely important.

The space itself is likely to have had an impact on the client’s sleep. It’s useful for me to know if they shared a room or had their own space, whether they moved around a lot or have ever been homeless, and if there’s anything that stands out for them about their experiences.

Clients are often able to recall whether the environment was quiet or loud, as well as whether there were lots of people coming and going during the night. This could explain why they are often woken up by the smallest sounds or are able to sleep pretty much anywhere.

It’s amazing to uncover how much of an impact environment can have, particularly any associations that are made with doors and / or windows. For example, if a client grew up in an environment where they were subject to abuse, they may find that they now sleep with the bedroom door open, or even go as far as taking the door off completely, in order to check who may be trying to get in.

This is why it’s so helpful for me to understand more about a client’s sleep environments; it can open up the discussion in completely unexpected ways.

Getting to sleep

Clients who struggle to get to sleep may find that looking at their sleep history can give them some clues about why.

Many people will have been soothed with music, white noise or quiet talking when they were falling asleep as children, and may find that they still need these things in adulthood. This is because we are hard-wired to seek safety, and if something feels familiar, our brains are likely to associate it with safety.

Some clients say that they have always struggled with getting to sleep, and when we explore why this is the case, it’s often linked to fears and / or anxieties they have. This could be around things like fear of the darkness, not waking up again, “monsters” lurking in the shadows, or anxiety about the next day.

If we can unpick what’s going on and why, we can then work on developing new strategies to make falling asleep easier, and hopefully reduce the fears and anxieties that have been getting in the way.

Dreams & nightmares

I’m fascinated by dreams, and clients will often bring dreams to therapy to explore, which is one of my favourite things! Sometimes clients will talk about dreams and nightmares that have recurred time and time again throughout their lives, or about a particular dream that has confused, upset or frightened them.

It’s very common for clients to struggle to consciously remember dreams, so I may suggest that they keep a dream journal beside the bed. They can use this to jot down anything they can remember about the dream, even if it’s only a word or two, and with practice, it’s likely that they will be able to remember more of their dreams in greater detail.

We can then look for patterns and themes, as well as noticing anything significant that the client may not have been aware they were thinking about. The aim is to tap into the power of the unconscious, as this is where we will usually be able to get to the root of fears and anxieties, and then work on reducing them.

Themes & patterns

Human beings are hard-wired to uncover patterns and links because we want to make sense of a world that can often seem nonsensical. This give us a feeling of control and also helps us to feel safe, but it also means that our brains don’t have to work so hard to make decisions because it can follow the pattern instead.

We make an average of 35,000 decisions every day, so our brains are always looking for shortcuts and ways to reduce the number of decisions it's having to make. This is why we formulate habits; by teaching our brain that, “If this happens, then that is how to respond”, we are minimising the number of decisions it’s making, and therefore it’s able to respond automatically to the cue.

Some of the themes and patterns that can be uncovered from a client’s sleep history are: colours, light and darkness; feelings, whether during sleep in dreams or before and / or after waking up; recurring situations and scenarios (often based on things that feel “unresolved” in the client’s reality), and significant people and places.

Identifying these patterns and themes will usually enable a client to uncover another layer of their process, and even to resolve something they’ve struggled to let go of, or felt burdened with, often for many years.

I hope this post has given you some useful insights into how and why I often formulate a client’s sleep history. In the third and final post for this mini-series, I’ll be talking about dreams, and how and why they can be so helpful in therapy.

If any of the issues in this post resonate for you and you’re interested in exploring your own sleep history, or any other aspect of mental health, feel free to get in touch with me and let’s see if we can work together. You can contact me using the form below, via email to emma@emmapooleytherapy.com, or connect with me on Facebook and Instagram @emmapooleytherapy.