Insomnia

no sleep

Photo: Carlos Martz

Whatever its cause, few things interfere with our waking lives like the inability to sleep at night. Insomnia has multiple causes: anxiety, depression, and medications, just to name a few. I find myself unable to sleep when I’m excited about something (if I’m anxious, I drop off right away—unlike most of my patients). Some people have primary insomnia, meaning we can’t identify any precipitating cause. These people tend to report a lifelong struggle with falling asleep.

Studies show good sleep hygiene in most cases is just as effective as sleeping pills, which in general are only moderately helpful. But one study suggests a counterintuitive method that I’ve personally found quite helpful: making a list of everything for which I feel grateful.

Feeling gratitude seems to improve sleep by reducing negative thoughts at bedtime. Gratitude, in other words, is distracting—and distraction is especially helpful in combatting insomnia given the fact that once a person develops insomnia, anxiety over an inability to sleep itself promotes wakefulness. Any technique that distracts us from worry, in fact, is useful.

This was suggested in a study by Nancy Digdon and Amy Koble, who took forty-one undergraduates with poor sleep due to disruptive thoughts and taught them one of three interventions designed to distract them: constructive worry, imagery distraction, and gratitude. Constructive worry “involved setting aside 15 minutes earlier in the day (before 8:00 p.m.) to write out worries and concerns that were likely to interfere with sleep and steps toward their solution. If students started to worry at bedtime, they could remind themselves that they had already devoted time to these concerns, and that they could do so again tomorrow when they were less tired and better able to think of good solutions.”

Imagery distraction involved having the subjects “close their eyes and imagine a situation that was interesting and engaging, but also pleasant and relaxing (such as a holiday, beautiful summer afternoon of leisure, or a special family occasion), but not too arousing (such as a sexual encounter or an exciting sporting event).”

Participants in the gratitude intervention arm were told that “people’s moods at bedtime can affect how easily they fall asleep. When people are under stress, it is common to be preoccupied with worries and concerns, and to ignore recent positive experiences. If people shift their attention so that they spend more time thinking about positive events, then people should be in a better mood at bedtime and be able to fall asleep more easily.” They were then instructed to “schedule a daily 15-minute session in the early evening when they could write about a positive event that has occurred lately or that they anticipated would happen in the near future. They were to write about the event itself, and about how they felt at the time… their writing would be private, and for their benefit only. They were asked to write about events rather than just think about them because the intervention would be more effective when done in writing than just in their heads. Writing leads to a deeper level of processing that has a more prolonged effect on moods.”

The study showed that all three interventions decreased the participants’ level of pre-sleep arousal. Though this didn’t lead to the participants falling asleep more quickly, it did lead to a better quality of sleep. In my case, thinking back over the things that happened during the day for which I feel grateful as I’m lying in bed (as opposed to writing them down before bed) has proven a remarkably effective technique. Imagery distraction works for me not quite as well, and constructive worry not at all (but this may be because, as I mentioned, anxiety isn’t what keeps me awake). If you suffer from insomnia, I’d offer these techniques as things to try to see which, if any, work for you.

Next Week: What Makes A True Friend, Redux

6 comments to Insomnia

  • Tara

    Thanks, I’m going to try it! I have been having terrible insomnia due to anxiety and depression lately.

  • Maren

    Kind of defeatist to use 41 undergraduates in an insomnia study. They would all have similar academic, social backgrounds, in addition to being intelligent and affluent enough to attend college.

    That’s a waste of a study… do a study on divorced people or unemployed people or those with high stress jobs. The findings would be completely different.

    During my undergrad years, these techniques might have worked for me, but they won’t now. I’ve been battling insomnia for well over a decade and never found any relief.

  • To salve anxiety before sleep, I lie down and tell myself I may allow any thought to enter my mind, but I may not allow it a full minute—I “cut it in half,” and devote the other 30 seconds to nothingness (or to the next thought which pops up), and so on. This is a regulated form of thought management.

    Eventually, no more anxieties come to mind, and like Xeno’s runner, one does stay up ’til morning (the end of the race, or, sleep cycle). Soon, the mind is emptied and sleep enters.

    This is my mini meditation.

  • Andrea Pelfrey

    Counting my breaths down from 10 to 1 has become my most cherished insomnia reliever. If I find my mind wandering away, I bring the thoughts gently back to the breath and the downward count, beginning back at 10 should a second countdown be required. I had a severe insomnia problem for years but through this training in the past 10 years I rarely have to deal with it, and the majority of nights I don’t recall getting down to one, much less having to start over.

  • I just reviewed my post, and speaking of Xeno, I meant to say, “One does NOT stay up til morning”; IOW, eventually, one empties one’s mind of the intrusive thoughts.

    I’ve also found yogic breathing techniques to be helpful, esp. the 4-7-8 formula (4 in via nose; hold for 7; exhale through mouth for 8.) You’ll fall right, off, promise!

    We must prioritize disengagement, too. I just read the below excerpt fr. Dr. Daniel Goleman (“Focus”):

    “Failure to drop one focus and move on to others can, for example, leave the mind lost in repeating loops of chronic anxiety. At clinical extremes it means being lost in helplessness, hopelessness, and self-pity in depression; or panic and catastrophizing in anxiety disorders; or countless repetitions of ritualistic thoughts or acts (touch the door fifty times before leaving) in obsessive-compulsive disorder. The power to disengage our attention from one thing and move it to another is essential for well-being.”

  • Judy

    I have suffered from insomnia for 14 years. I did the prescribed medications for about 8 years. Finally decided to discontinue all of the medications and just try to sleep again. That proved to be an effort in futility. Did that for 5 nights and was like all of you know a zombie during the day. Then a friend who was supporting me through all this simply said, “You know, the best way to fall asleep is to try not to.” I couldn’t believe that something as simple as that would work, but it did. That enabled me to not worry about it and I fell asleep quickly. I wake up every few hours, but I am sleeping and dreaming like I used to and without medications! Each night I am sleeping for longer and longer periods of time.

    Judy: Yes, this is called a paradoxical intervention. It works because often with insomnia you develop “performance anxiety” around falling asleep, which itself prevents you from falling asleep. Lying in bed genuinely attempting to stay awake often prevents that performance anxiety from arising and paradoxically helps people fall asleep. Glad it worked for you!

    Alex

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