Research shows that difficulty with sleep affects up to 30 percent of all adults these days, and that the vast majority of these go untreated. If you are struggling with insomnia, you have probably tried many things to beat it. The irony is that often the things we try to “beat” insomnia take us deeper into the struggle, as we may end up feeling frustrated, defeated and even more anxious. Sleep is about letting go and letting yourself rest, so approaching sleep like it’s a task you are working hard on usually has the opposite effect from what you are hoping for. Nonetheless, I have helped many people get better at sleep and I want to share the wisdom with you!
Welcome to the Wonderful World of Insomnia
Psychology Today defines insomnia as the following: “Insomnia is the feeling of inadequate or poor-quality sleep because of one or more of the following: trouble falling asleep (initial insomnia); trouble remaining asleep through the night (middle insomnia); waking up too early (terminal insomnia); or nonrestorative sleep that does not leave a person feeling rested after an adequate duration of sleep.” One important thing to notice about this definition is this: if you are wondering if your experience qualifies as insomnia, the most important factor is your subjective experience of how your sleep patterns are affecting you. So if you have the feeling of inadequate or poor quality sleep or do not feel rested after an adequate duration of sleep, it might be helpful to you to identify your experience as insomnia and seek treatment accordingly.
My Formula for Sleep Success
Despite how downright aggravating it can be to have a hard time sleeping, it is possible to sleep again! When I work with clients in psychotherapy who struggle with sleep, I recommend approaching sleep with a three- pronged approach. This “formula” includes the following steps:
Rule out any underlying medical conditions that may be causing insomnia (**see note below**)
Maximize any and all lifestyle changes and practical tips that will help you sleep.
Identify the underlying emotions and thoughts keeping you awake and address them.
These steps can be done simultaneously or one after the other. For some people, one of them in particular ends up making more of a difference than the others to their individual challenges. But in using all three, we can be confident that we will make progress no matter what.
High quality therapy, especially utilizing cognitive behavioral therapy, is the best way to work toward goal #3. This is a highly individualized and sometimes complex process that is best undertaken with the support of a trained mental health professional with significant experience treating insomnia (I am one of these- click here to contact me for a free consultation).
For our purposes today I want to focus on step #2. It’s the most straightforward, you can put these tips into practice immediately and you don’t need any special training or expertise to experiment with it. As a reminder, step # 2 is:
Maximize any and all lifestyle changes and practical tips that will help you sleep.
When I struggled with insomnia for many years, I wanted to bite off the head of ONE more person who told me to “limit screen time to one hour before bed” or “take a bath and use some aromatherapy”. I really believed that my difficulty sleeping was beyond practical repair and that my anxiety would always prevail. But once I became willing to change some of my behavior and stick with it- even though I was skeptical about how well it would work- I discovered that my own particular “cocktail” of behavioral changes really did make a difference.
The Master List and How to Use It
Here is a long (and I mean long) list of tricks and tips that I have gathered over the years, both from my own experience struggling with sleep and from the experiences of clients.
Here’s how to use this list: If any of these stand out to you, try implementing them consistently for at least two weeks (this is key- don’t just try it for one night and then decide it doesn’t work). You may also need to combine 4, 5 or 6 new ideas and stick with them for a while to see how they work in combination. Sleep struggles are very individualized so it’s worth experimenting with as many lifestyle changes as you can think of to see what might work for you. I always frame this part of the formula as an “experiment” because it’s not about “success” or “failure”, but simply about what works for you.
Eliminate caffeine from your diet, or try to finish drinking it earlier in the day (for example, no caffeine after 12pm). Caffeine stays in your system for 4-6 hours after you consume it, even if you do not believe it affects you.
Try reading fiction- a good novel to absorb you but not something too page turning that you will get too involved. Get a Kindle Paperwhite so that you can turn out all the lights while you do said reading.
Listen to the Sleep With Me podcast- I love this podcast. It’s a similar idea to reading fiction- the host uses a droning voice to tell a story in each episode that is interesting enough to get you involved but not so interesting that you stay alert to hear the outcome. The description is “A Lulling, Droning, Boring Bedtime Story to Distract Your Racing Mind”. That pretty much sums it up.
Exercise- It doesn’t matter what you do, just make it a habit to get your body moving. Often sleeplessness is the result of having a “tired” mind but a wired body, because we spend so much time sitting and being sedentary. Cardio, yoga or strength training might be what you need. Experiment with what time of day exercise works best for you. It is often recommended that you exercise earlier in the day when working on sleep, but I personally do better exercising in the evening as a way of calming down. Do what works for you.
Get serious about your sleep conditions. And I mean SERIOUS. Your friends might think you're nuts but I'm giving you permission. Consider the following: Blackout curtains (I sleep with two layers, for good measure), a good mattress (the firmer the better, for most people), breathable sheets, ear plugs (don’t buy them at the drug store- these are the good ones), a sound machine (this is the gold standard), lower the temperature in your house (experts say 60 to 67 degrees is ideal for sleep). Also make sure that ALL light in your bedroom is off or hidden. I have been known to cover alarm clocks and power indicator lights on tvs with blankets when staying in hotels. Stuff a blanket under the door if light coming in from another room reaches you.
Hide your alarm clock. Insomnia gains further leverage when you begin to be worried about sleeping itself. Many people find themselves lying in bed thinking, “If I can fall asleep right now, I’ll at least get 6 hours of sleep”. One hour later, “If I can fall asleep right now, I can get 5 hours of sleep…”. Don’t look at the clock and just focus on relaxing.
Focus on relaxing rather than sleeping. Sleep is a byproduct of being in a relaxed state, not something that we can force to happen directly. And trying to force something to happen that doesn’t lend itself to being forced is a trap- you will never win. Instead, take a deep breath and do whatever puts you into a relaxed frame of mind. Allow sleep to flow from this.
Stop your Netflix binge in its tracks. Seriously- if you are in the middle of a cliff hanging series, start stopping episodes in the middle rather than at the end. The end of episodes is generally manufactured to keep you watching.
Keep a routine. Get out of bed at the same time every day, no matter what you have going on. Go to bed (or at least put yourself into “resting mode”) at the same time every night no matter what. And while you are working toward this routine, do not allow yourself to nap or “sneak sleep” at other times of day.
Practice gratitude at bedtime. I am a big advocate for journaling. Journaling about your day, thoughts and feelings might be helpful for you at bedtime as a way of closing out the day. For others, self-reflective journaling about the day gets them more revved up and is counterproductive for sleep. In any case, reviewing the things that you are grateful for from the day is a low stress way of checking in with yourself and getting into a more relaxed mindset. If you sleep with a partner, make a habit of sharing your gratitude lists with one another in bed. Gratitude has been proven to reduce stress and increase life satisfaction. It’s hard to think about stressful things and be grateful at the same time. This journal is a simple way to start.
Get out of bed. If you have tried to sleep for 20-30 minutes with no luck, get up and do something calming. Try to reserve your bed only for sleep and sex. I have heard people suggest to stand beside your bed with your eyes closed in the dark until you want to fall asleep. I’ve never tried this myself but imagine it would work!
Pay attention to your natural rythms. Your natural sleep time may not align with the “bedtime” you have decided on. After my sleep had been greatly improved for some time, I realized that I have a window for sleepiness around 10-10:30 pm and that I fall asleep more easily when I go to bed at that time than when I stay up until 11 or later. When I do, it is much more of a fight to calm my body than it would have been earlier. This may take some experimentation. I recommend using the free Morningness-Eveningness Questionnaire as a good starting point for trying different times.
Do something to ritualize setting aside sleep-interfering thoughts. For example, if you are someone who lays in bed worrying about tasks that you need to do the next day, keep a notepad beside your bed. As these task items pop into your head, jot them down and let them stay on the notepad. If you are someone who rehearses the pros and cons for a big decision, or tries to rehearse a conversation you need to have with someone tomorrow, practice allowing yourself to table that topic until the morning. Maybe develop a mantra that helps you to do this, like “if this is still important to me in the morning, I will deal with it then”. Or visualize placing these thoughts in a file folder or a container that will be opened and tackled when you wake up in the morning.
Agree with your partner to table serious discussions. Similar to the tip above: make a shared commitment to not discussing big items that may be emotionally laden after a certain time at night. This is a good rule for both your sleep and your relationship, as having a big argument before sleeping is detrimental to both. Make this a team effort; come up with a cue word or a practice to interrupt a discussion that might be moving in an intense direction, like “can we finish talking about this tomorrow morning?”.
Wishing You the Rewards of Rest
What did I leave out? If I omitted something that you already know works for you, keep that in your "cocktail" and try to add some of the above. Sleep struggles can be SO frustrating, but they do not have to defeat you. With some self-reflection, open mindedness and willingness to change your behavior, you can be rewarded with improved sleep. Who knows- you might even wake up one day to call yourself a “good sleeper”, as I do these days (trust me, I never would have imagined that to be possible several years ago!). Try some of these ideas and see how they work for you. Sweet dreams, my friends.
**It is important to talk with your doctor as a first line in treating insomnia. The reason for this is that you may have a legitimate medical condition that no amount of camomile tea is going to overcome. For example, restless leg syndrome and sleep apnea are two chronic sleep interferers that once identified can be treated appropriately. Ruling out an underlying medical condition, a primary care doctor may prescribe a sleeping medication that can temporarily assist with getting to or staying asleep. I highly recommend that folks struggling with insomnia take advantage of medication when appopriate to bridge the occasional sleepless night. However, it is very important to recognize that in countless medical trials, medication for sleeplessness has been shown to perform worse than a certain type of psychotherapy (cognitive behavioral therapy, which is the approach I use with insomnia). Medication does NOT “cure” insomnia. Depression and anxiety contribute to insomnia, but these should be treated differently with medication and therapy than insomnia alone.