Written by Greg Potter, PhD
Oct. 1, 2019
In the last blog, we considered some behaviors you can use to help you sleep through the night. This built on the strategies we reviewed in the first post in this series. We’re now going to turn our attention to how to get to sleep fast if you’re prone to lying in bed wondering whether you’re ever going to nod off. Unsurprisingly, a racing mind is often at the core of difficulty falling asleep. Sure enough, addressing sleep-related thoughts is one of the key components of the cornerstone insomnia treatment: cognitive behavioral therapy. So, let’s start with what you can do about stinking thinking.
If you have insomnia, you’re probably experiencing a deluge of negative sleep-related thoughts.
If I don’t sleep well tonight, I’m going to be useless at work tomorrow.
It’s 3 AM and I’m still awake. Only 3 hours before I need to get up, so if I don’t fall asleep soon I’m gonna be knackered when I’m up.
This type of “attentional bias” to sleep problems is a prominent characteristic of insomnia, and if such utterances are familiar, pause and think about whether they are in fact true.
Contemplate the fact that you don’t control your thoughts - they emerge whether you like them or not, whether they’re rational or not.
As you reflect on your thoughts, you’ll probably realise that many of your maladaptive thoughts aren’t grounded in reality, that you’re unnecessarily catastrophizing about something that is readily amenable to improvement. And just think about this: If despite your best efforts you currently aren’t sleeping as much as you’d like, you have even more time on your hands to do everything you’d like to achieve!
Popularised by Viktor Frankl, author of the exceptional book Man’s Search for Meaning, paradoxical intention entails confronting the fear of the negative consequences of staying awake. While no cognitive therapy works for everyone who has insomnia, paradoxical intention is one of the more effective cognitive therapies for people who have this disorder.
How can you try paradoxical intention?
If you find yourself in bed and unable to sleep, stay relaxed and keep your eyes open. Try to keep your eyes open for just a little longer. As time goes by, congratulate yourself on staying awake but relaxed. You’ll likely find that when you next awake you’re surprised by how bad you were at staying awake.
If you find your mind wandering to all of the things you have to get done in the coming days, try making a to-do list within a couple of hours of bedtime. This has been shown to speed entry into sleep during transient insomnia. If you try this, list everything that you need to get done the next day that could weigh on your mind. Think of this as a way to offload onto the page any anticipation and/or anxieties trapped within you. If there’s otherwise something percolating in your noggin, you might want to note some thoughts about that subject too. This is also a prime time to reflect on things that went well that day or that you’re otherwise grateful for. When you’re done, keep your notebook by your bedside in case you wake up and think of something you wish you’d noted.
The surge in the popularity of mindfulness meditation in recent years is remarkable. But mindfulness isn’t just another fad, for when practised intelligently and systematically it can lead to an impressive array of health benefits.
Over the years there have been multiple cognitive and behavioural models of insomnia. Recently, there has been much discussion about the roles of thinking about thinking (“metacognition”) in insomnia. Given the effects of mindfulness on one’s capacity for metacognition, it’s no surprise that mindfulness meditation is a useful adjunct to insomnia treatment too.
A central premise of mindfulness meditation is that if you train yourself to be more aware of the present moment, more self-compassionate, and to accept things as they are, you can be less reactive to your mental and physical states, thereby reducing your suffering. Mindfulness training teaches its students to welcome thoughts as if they are guests in one’s house, regardless of the contents of the thoughts. Through mindfulness training, you can learn to insert a pause between your experiences and your subsequent responses. During this shift, you have the ability to change your attitude to your experiences, giving you space to respond adaptively, not reactively.
How is this relevant to insomnia?
People who have insomnia are often unaware of their maladaptive cognitive and behavioural reactions to their sleep difficulties. If you have insomnia, you may find yourself clasping onto rigid beliefs about sleep. Perhaps you attempt to force yourself to nod off, a habit that may ultimately work against you. Maybe you find yourself focusing on the adverse consequences of poor sleep, and you’re probably inclined to do what you can to avoid those consequences. For example, if you think getting as much sleep as possible today is essential to performing well tomorrow, you may decide to skip a social event you’d committed to try and catch up on sleep. Or perhaps you’ve stopped relying on internal cues of sleepiness and have shifted to external cues such as time of day when deciding when to go to bed.
By beginning mindfulness training you can improve your ability to non-judgmentally observe rigid, negative sleep-related thoughts without reacting to them, boosting your psychological “flexibility”. During the daytime, you can learn to remain rooted in the present without letting thoughts about how you slept last night affect your current actions. And even if you are sleepy at this time, mindfulness can support your equanimity in the face of fatigue. At night, mindfulness training will likely benefit you too, by strengthening your ability to identify your bodily cues that signal when you are actually ready to go to sleep.
Okay, so how can you reap these benefits?
We don’t know much about things such as how different meditation apps compare or the best time(s) of day at which to meditate, but many people find that meditating shortly after waking is most practical. Regarding apps, I think Waking Up is meaningfully better than other apps I’ve tried. Of the free apps out there, Insight Timer has some high-quality content and useful tools too. These apps aren’t sleep-specific, but I’m confident that using them will help many people sleep better. There are of course numerous excellent mindfulness teachers who run in-person events too, and in-person training is worth exploring if you have the time and the will. Because I don’t know where you live, it’s hard to point you in the direction of teachers though, I’m afraid.
Please note that the metacognitive model of insomnia is not just about mindfulness and acceptance though - it is also about using your values to guide your behaviors. If your anxiety about your poor sleep is affecting your commitment to important aspects of your life, you may benefit from taking some time to clarify your core values.
If you truly value being a good friend and it’s your buddy’s birthday on Friday night, you’re not going to skip the party entirely to try and catch up on sleep, right?
There are some simple tools out there to help you identify your core values. As a starting point, try the bull’s eye (page 3) and/or the Life Compass (page 5) exercise(s) in this resource. Doing so may be time very well spent for you!
Okay, hopefully, some of the above help you with your cognitions. But what about other common impediments to falling sleep?
Many people who have insomnia are particularly highly attuned to their bodily sensations.
Am I falling asleep?
Man, my heart is pounding… again.
If you can relate to this problem, you’ll probably find visualisation useful. Visualisation is a skill that you should first hone during the daytime. To try it, imagine a scene that you find deeply relaxing.
Where are you?
Who are you with?
What can you see?
What can you hear?
What can you smell?
What can you taste?
What can you feel on your skin?
Rehearse this scene as vividly as you can each day. Then, when you’re proficient at conjuring this relaxing alternative world in your mind, you can call on it in bed when your heart starts hammering.
Our ruminations leave indelible traces in our biology, a stark example of which is muscle tension arising from anxiety. In turn, this tension can impair sleep.
It’s been several decades since scientists first showed that deliberately and sequentially tensing and relaxing skeletal muscles can help alleviate muscular discomfort and speed sleep onset. This technique is known as progressive muscle relaxation. So, if you regularly experience this kind of bodily tension, why not try progressive muscle relaxation?
There are numerous scripts and audio files available online that you can use to familiarise yourself with this technique (try this one). Then, once you have memorised the technique you can use it as and when is necessary.
I’ve elaborated previously on some core tenets of sleep hygiene here and here, as has Megan here. So, I won’t be a broken record in this blog. What I will do, however, is give you one more tip you can try to help you wind down in the couple of hours before bedtime: listen to relaxing music.
It’s an obvious tip, but music is also surprisingly effective at improving the sleep of people who have insomnia. So, in the last hour or so before bed, remove any distractions, dim the lights, and pop on some quiet, chilled tunes for half an hour or so to wind down your day. Strings and piano melodies do the trick for me.
That’s all for now. Honestly, it’s tricky to help people with negative sleep-related thoughts via blogs alone, and if you want to find out more about how to address your negative cogitations then you might find this book helpful. Speaking of cogitations, thanks to Chris and Simon Marshall for their useful input on this blog.
In the final blog in this series, we’ll review what to do about some sources of sleep disturbances that are particularly problematic among athletes.
If you think you are doing everything right and are still having trouble sleeping, why not book a free starter session with NBT? During the session, we’ll take a look at your history and share how we’d work with you.