How to Deal with Insomnia
Dr. Jade Wu
Dr. Wu is a licensed clinical psychologist specializing in behavioral sleep medicine with degrees from Cornell University and Boston University. She also completed her medical psychology residency and clinical fellowship at Duke University School of Medicine.
The sun is coming up and you’ve been staring at the ceiling all night.
You begin to panic about getting through the day ahead after a restless night. “I’ll sleep tonight,” you tell yourself as you get yourself out of bed and out the door. Then you spend the whole day worrying you won’t get the sleep you need tonight.
This cycle is the reality of living with chronic insomnia. It’s a painful struggle.
Although good sleep is top-of-mind for insomniacs, this does not mean they have the right sleep-promoting behaviors. Insomniacs often have counterproductive thought processes and behaviors when it comes to sleep.
1. Stimulus Control
Stimulus control is an evidence-based approach to alleviating insomnia.
If you’ve been living with chronic insomnia for a while, you might start to fear your bedroom. People with insomnia develop negative feelings (and often unconscious negative associations) about their beds and bedrooms. When you repeatedly lie in bed fearful of not sleeping, it makes the bedroom an unpleasant place to be. A method called stimulus control therapy can help you develop new associations with your bed and bedroom.
- Don’t go to bed until you are sleepy.
- Use the bed only for sleep. Choose another spot for reading and watching TV, and don’t eat in bed. Choose a separate, designated spot for worrying and ruminating. Only sit in this area when you are spending time worrying.
- If you are awake after approximately 20 minutes in bed, it’s time to get up and do something else. Go to another room and do something other than trying to sleep like reading or listening to a podcast. Head back to bed when you are sleepy. If you are awake for about 20 minutes again, repeat the process again.
- Don’t watch the clock to see if 20 minutes have passed. It’s more important to go by your feeling–if you are feeling frustrated, anxious, or simply wide awake, get out of bed regardless of how long you’ve been lying there.
- Remember, the point is not that getting out of bed will help you fall asleep. It may not. The point is to help retrain your brain to think of the bed as a sleepy place.
- Set an alarm to wake up at the same time each day, including weekends.
You might not notice improvements immediately. In fact, you may very well stay up for a long while during the night at first. But if you use stimulus control consistently, your brain will learn to associate the bed and bedroom with only sleep, and no longer with wakefulness and negative feelings. When stimulus control is practiced nightly, sleep will improve.
2. Progressive Muscle Relaxation for Chronic Insomnia
Progressive relaxation works by relaxing one muscle group at a time. Relaxing each muscle slowly calms and relaxes the whole body. Progressive muscle relaxation can be effective for insomnia as well as anxiety in general.
- Start with your facial muscles. Squeeze them tight for two seconds, and then relax them completely. Repeat this a few times until the muscles feel loose and relaxed.
- Repeat this sequence for all your other muscle groups. You can try the following sequence, but it’s OK if you forget this list. Just squeeze and tighten all your muscles for a few seconds, then relax them before moving onto the next muscle group.
- Jaw and neck.
- Upper arms, lower arms, fingers.
- Chest, stomach.
- Buttocks, thighs, knees, calves, and feet.
- Repeat the sequence for as long as you desire. Include breathing exercises if that feels good.
- Try to practice this during the day instead of at bedtime. Sometimes, using tools like this to try to chase down sleep can backfire because you’re giving yourself too much pressure to fall asleep.
3. Time-in-bed Restriction (aka, Sleep Restriction) Therapy
Chronic insomnia is a burden to bear.
Over time, struggling to sleep can become an obsession. If you have insomnia, you might stay in bed longer than you should. You’re trying to make up for lost sleep. Yet staying in bed too long actually worsens your insomnia. When you stay in bed longer, you lie awake longer and teach your brain that the bed is a wakeful place. Plus, your sleep schedule may be disrupted, making it harder to fall asleep the next night.
Sleep restriction therapy can help your body increase its natural sleep drive. Your sleep drive is like a balloon that fills up over the course of a day–the longer you go without being in bed, the more you fill your balloon and the fuller your balloon by bedtime, the better you’ll sleep. By limiting your time in bed, you will have plenty of opportunities to build sleep drive during the day and be ready for good quality sleep at night.
- Keep a sleep journal for two weeks. Average the amount of hours you sleep each night.
- Use this number to determine how long you will be allowed to stay in bed. Take your average sleep duration and add 30 minutes. This will be your allowed time in bed.
- For example, if you sleep 6 hours/night on average, you will be allowed to be in bed for 6 hours and 30 minutes.
- Avoid daytime napping. This will sap your sleep drive.
- Wake up at the same time every morning, regardless of how much good sleep you got the night before.
- After 1-2 weeks, if you’ve been falling asleep quickly and not spending too much time awake during the night, and you are sleepy before bedtime, you can add 15 minutes to your allowable time in bed.
- Continue to add 15-minute increments each week until you’re finding yourself having insomnia again, at which point you’ll know that you’re again spending too much time in bed. Shorten your time in bed window by 15 minutes.
- While you do this, make sure to also practice stimulus control (e.g., get out of bed if you can’t fall asleep).
Sleep restriction therapy has been studied with good results. This type of therapy isn’t recommended for people with bipolar disorder or seizure disorders, especially if these conditions are exacerbated by lack of sleep.
4. Cognitive Behavioral Therapy for Insomnia
Chronic insomnia is a vicious cycle. Your sleep patterns are a mess. You can’t sleep, so you worry you can’t sleep, so then you can’t sleep again.
Because the way you think about sleep affects your sleep, addressing unhelpful thoughts can help. This is an integral part of cognitive behavioral therapy or CBT, which is effective at changing the unhelpful thoughts and behaviors you have around sleep. During CBT, you work with a sleep specialist trained in behavioral sleep medicine to identify the behaviors and thoughts that maintain chronic insomnia, such as spending too much time in bed, keeping an inconsistent schedule, canceling plans due to fear of disrupting sleep, and worrying about sleep. Then you and your therapist build strategies to reshape these patterns.
Your therapist will create a program based on your chronic insomnia behaviors, and it will vary based on your specific needs. For example, it might be as brief as one treatment session or may require up to 8 sessions. The treatment includes sleep education, cognitive therapy, stimulus control, sleep restriction, and changing sleep habits.
CBT for insomnia will arm you with a set of tools for maintaining healthy sleep throughout your lifetime. Healthcare providers generally prefer CBT over sleeping pills. CBT has no adverse side effects and the benefits can last a lifetime. CBT is available in person and online.
5. Sleep Hygiene for Sleeplessness
Sleep hygiene is a set of behaviors that can help to prevent sleep problems.
“Sleep hygiene itself is not a cure for insomnia,” explains Jade Wu, Ph.D., behavioral medicine researcher and therapist. “In fact, we use it as the placebo condition in clinical trials for insomnia. But although they don’t address the root problems in chronic insomnia, practicing these behaviors may be helpful in maintaining general sleep health once you don’t have insomnia anymore.”
Just like daily dental hygiene helps you stay cavity-free, good sleep hygiene allows you to have healthy rest.
Incorporate some of our tips for better sleep into your day-to-day, and you may notice more restful sleep. Building healthy sleep habits can boost deep, healthy rest.
- Sleep until you feel rested, if possible. Most adults need 7-8 hours of sleep. If you feel sleepy during the day, consider getting up later or going to bed earlier, or learning more about your sleep cycles to determine the best time to wake up.
- Keep a regular sleep schedule. Wake up around the same time each day. Your bedtime may vary slightly each night based on how tired you are, but it’s most important to set your alarm and wake up at the same time each day.
- Don’t force sleep. If you go to bed and aren’t sleepy, your mind will race. Head to bed only after you feel sleepy.
- Have your coffee in the morning and opt for herbal tea after lunch. Caffeine shouldn’t be consumed in the evening because it can make it harder to fall asleep. A cup of coffee isn’t going to ruin your night’s sleep, but some people are more sensitive to caffeine than they realize, which is why it’s best to eliminate it in the evenings.
- Get rid of the TV in your bedroom. Consider leaving your smartphone and tablet out of the bedroom.
- Don’t go to bed with worries on your mind. If something is bothering you, journal about it and defer worrying about it until tomorrow.
- Use exercise for sleep. Research has found exercising can help you doze off faster and get more deep sleep.
How to Deal With Insomnia
Insomnia is so troubling that it’s one of the most common reasons people visit their healthcare provider. You have a strong biological desire to sleep. Yet sometimes your brain interferes with that drive. Your ability to sleep is influenced by many factors in your life. The key to dealing with insomnia is identifying what those factors are and changing them.
Why Do I Have Insomnia?
Some predisposing factors may make you more prone to chronic insomnia:
- Health problems like heartburn, overactive bladder, or shortness of breath.
- Sleep disorders like obstructive sleep apnea and restless legs syndrome.
- Psychiatric medical conditions like anxiety and depression.
- A history of childhood trauma, especially if the trauma occurred at night.
- Medication side effects.
But more importantly, it’s the unhelpful behaviors (e.g., spending too much time in bed) and unhelpful thoughts (e.g., I absolutely have to have 8 hours of sleep) that cause chronic insomnia.
Is Insomnia Curable?
Yes! When you’re an insomniac, it’s easy to feel like you are never going to sleep again. But insomnia is a curable condition. It takes commitment and persistence to follow through with behavioral changes. Consulting with a behavioral sleep medicine specialist (usually a sleep psychologist) will help you figure out what changes you need to make.
If you can be consistent with your new sleep habits and your new outlook on sleep over time, your insomnia will improve. You might have trouble sleeping again in the future, but you’ll know how to deal with insomnia the next time it happens.
How Do You Deal With Severe Insomnia?
When your trouble sleeping is so severe you can’t function, you have to take equally severe action. Sleep restriction therapy is the quickest-acting therapy to reset sleep. It’s especially beneficial for chronic insomnia. If it doesn’t seem to help at all after about two weeks, you may want to consult with a behavioral sleep medicine professional to help assess your sleep problems more fully.
How Can I Fight Insomnia Naturally?
Behavioral changes like the ones listed above are the most natural way to fight insomnia. These changes get to the root of your sleep disturbance. Unlike taking an herb or a sleeping pill, they are free and reusable.
You might identify as an insomniac, but you don’t have to let chronic insomnia ruin your life. You may need to make some behavioral changes, though.
Behavioral therapies are often more effective than sleeping pills and are longer lasting. A combination of stimulus control, relaxation therapy, sleep restriction therapy, and cognitive therapy (all together known as cognitive behavioral therapy for insomnia) is usually most effective. Insomnia feels like it’s going to last forever, but you will get through it and you will sleep again.
This article is for informational purposes and should not replace advice from your doctor or other medical professional.
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