Getting off the Insomnia Train
At night, as soon as the sun begins to fade and darkness falls, you begin to dread going to bed because you know you won’t be able to fall asleep for several hours. You begin to worry about another restless night of sleep. Even when you try to think positively about getting a good night’s sleep, you have difficulty blocking negative thoughts such as, “Here we go again, I’m never going to fall asleep tonight” and “If I don’t sleep tonight, how am I going to make it through the day tomorrow?”
The longer you lie in bed awake, the more anxious and alert you become. You constantly peek at the clock and count down the time until your alarm is going to go off. On top of your sleep worries, you worry about your kid’s grades, your new business, and an upcoming deadline for your project. You think, “I’ll never be able to get the project in on time if I don’t start sleeping better.”
Insomnia’s Vicious Cycle
If you’re having trouble sleeping, you know that it’s easy to become consumed with thoughts about sleep. You question the best time to get into bed. Once your head hits the pillow, you feel anxious about not being able to fall asleep. Your body may start to tense up, and your mind starts racing. And of course, you can’t fall asleep when you want to. Because you feel so tired, you try different strategies like going to bed earlier, later, or taking medications but nothing seems to help.
This vicious cycle is called psychophysiological insomnia. It may initially start off with a couple of poor sleep nights but then becomes a pattern. It could be triggered by different situations like an illness, recent family life events, or travel. Suddenly you are on this train that seems headed nowhere good. People who suffer from psychophysiological insomnia are focused on, and may even become obsessed with, their sleep problem. Unfortunately, the more worried and anxious you are about your sleep one night, the more difficulty you’ll have getting to sleep the next night, and so on and so on.
What are the Long-Term Effects of Insomnia?
Psychophysiological insomnia is a form of chronic insomnia, marked by difficulties falling asleep, staying asleep, or early morning awakening, accompanied by your mind racing at bedtime. Our brains start making negative associations between sleep and bed. Instead of a healthy relationship between our sleep and bed, our beds then become a place of worry and anxiety. It causes daytime symptoms like fatigue, malaise, and physical symptoms over time. This experience is typically present for several months, differentiating it from short-term insomnia. With short-term insomnia, you might have a few nights of poor sleep, related to stress. But this is pretty normal, especially in response to stressful life events. However, once the sleep problem starts becoming the predominant issue in your life, what you thought was short-term develops into chronic insomnia, often this particular form — psychophysiological insomnia.
You start trying very hard to fall asleep. You worry constantly about the impact poor sleep has on your day and function. You may start spending more time in bed doing other activities like spending time on your phone or watching TV. Out of frustration, you may try sleep aids and alcohol to get some sleep. In some situations, medical or mental issues can also trigger insomnia and would need to be addressed to fully treat psychological insomnia. If left unaddressed, insomnia can cause a lot of negative effects on our mood, and mental and physical well-being. There are studies showing increased fatigue, anxiety, depression, and an increased risk of heart disease, hypertension, and obesity.
How to Get Off the Insomnia Train?
There are several practical steps you can take to stop the vicious cycle of insomnia. The gold standard for treating insomnia in adults (and some studies have shown effectiveness in adolescents) is called cognitive behavioral therapy for insomnia (CBT-I). This treatment is based on the fact that our thoughts and the way we act affect how we sleep. CBT-I helps you change your thoughts and behaviors to ensure you get restful sleep. Essentially, you are taught to retrain the parts of your brain that affect your sleep and target specific behaviors that negatively impact your sleep. CBT-I is provided by certain certified specialists including behavioral sleep psychologists, sleep physicians, and certain mental health providers. Since not many people are certified to provide this specific therapy, the wait time to see a specialist may be long. Here are a few tips I suggest starting with:
Practice Healthy Sleep Habits: These are also sleep hygiene habits. I will stop here by emphasizing that healthy sleep habits themselves may not be sufficient to address your insomnia but is a good foundation. You may already have found some sleep hygiene tips and tried them without much success, but I recommend maintaining these healthy habits. My framework CREATE healthy sleep habits is a great place to start and these include;
CONSISTENT: Sleep time and wake time. Oftentimes, you may want to sleep in, especially after a night of poor sleep. Unfortunately, this can worsen your sleep the next night. The goal is to build sleep pressure, which accumulates over the course of the day when you are awake, helping you have a better sleep drive at bedtime.
ROUTINE: A calm, relaxing bedtime routine is helpful to cue your body to sleep. After a busy day, you don’t just want to plop yourself into bed, but rather have 2 or 3 pleasant activities before bed.
ENVIRONMENT: A sleep environment can make or break our sleep. Make sure you have one that is cool, dark, and noise-free.
ASSIGN: Avoid any activities other than sleeping and having sex in bed. Watching TV, eating, reading, and worrying should occur outside of the bedroom. We will talk more about this in our stimulus control section.
TACKLE TECHNOLOGY: Devices like our TV, cell phones, and laptops emit a blue wavelength light that suppresses melatonin production in our brains, making it harder to fall asleep. In some unique situations, particularly for people with chronic insomnia, who need sleep restriction, using some light TV show to stay awake may be considered. In this situation, you have to be working with a specialist who treats patients with insomnia.
ELIMINATE: Avoid coffee several hours before bedtime. You also want to limit alcohol. Alcohol may put you to sleep, but it causes fragmented sleep. Exercise is very beneficial for sleep, however, you want to limit any strenuous activity to about 2 hours before bedtime.
Stimulus Control: This is a method used to address insomnia by limiting the time spent in bed awake. The goal of stimulus control is to help you associate the bed and bedroom with sleep only. It may sound simple, but it’s not. As you may know all too well, people who have trouble falling asleep at night may come to dread bedtime and get anxious and frustrated as soon as they get into bed. This can make any association with your bed far from relaxing. There is no point lying there and getting all worked up about not sleeping. After you have been in bed for about 20 minutes (this is an estimate because you should not be watching the clock!), get out of bed and do something boring. Ideally, you shouldn’t have a clock or watch in your room. How would you know if it’s been 20 minutes?! Great questions! I would focus more on how you feel rather than the absolute number. If you feel your mind is starting to race and you are tossing and turning in bed, get out sooner. Decide on some pleasantly boring/relaxing activities to do when you get up. Think crossword puzzles, reading an old newspaper, folding and unfolding laundry. Avoid chores, homework, or things that may be more frustrating. The goal is to get you calm and relaxed, taking your focus off your lack of sleep. Once you start feeling sleepy again, go back to bed. No matter how long it takes to fall back asleep, make sure you avoid sleeping in too much and try to get up at the same time you typically would.
Relaxation Activities: Nurturing yourself and practicing self-care are fundamental to curbing insomnia. If you are a busy professional and a mom, you have so many obligations that you forget yourself. Find activities that curb stress and participate in these regularly. Examples include:
Meditation
Breathing exercises
Yoga
Exercises
Journaling
Speak with Your Doctor: If you have attempted these steps for about 2 weeks and things don’t seem to improve, it is time to speak to your physician. Also, if you have symptoms that may be suggestive of an underlying medical or mental disorder, these need to be addressed. Your doctor can help you decide on the next steps which can include seeing a sleep specialist, starting medications, and also treating any underlying sleep disorder.
By following these steps, you can break free from the cycle of insomnia and get back to enjoying restful sleep. If you need additional support, consider reaching out to a sleep doctor or visiting a sleep clinic. Remember, sound sleep is crucial for your overall health and well-being.
I would love to help you get off the insomnia train through my 1:1 coaching program. Schedule a free chat with me here and let’s put insomnia to rest!
