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Synopsis: Sleep problems are one of the most challenging and frustrating things that many people deal with on a regular basis. Accepting insomnia is a critical component of improving your sleep and not letting it control your emotions. This article explains 16 ways to improve your sleep and several backup strategies if healthy sleep habits are not enough.
BY KRISTA DAVID, MD / 1.26.2020; No. 12 / 7 min read
Disclaimer: Yes, I am a physician, but I’m not your doctor and this article does not create a doctor-patient relationship. This article is for educational purposes and should not be seen as medical advice. You should consult with your physician before you rely on this information. This post also contains affiliate links. Please click this LINK for the full disclaimer.
Why do I have insomnia?
Everyone has trouble sleeping from time to time. When we have trouble sleeping, it’s natural to behave in ways that actually end up fueling more insomnia, such as worrying about our sleep, using electronic devices during the night and napping in the day. By using the 16 tips below, it is possible to break this cycle. One of the most important tips – one that most sleep handouts neglect to talk about – is, ironically, the importance of accepting insomnia.
Why would I accept insomnia?
Accepting insomnia sounds crazy, but one of the most important things you can do to improve your sleep is to let go of the need to control your sleep. This may sound impossible. People who regularly struggle with insomnia often have a negative cascade of thoughts prior to sleep: “I can’t sleep! I hate just tossing and turning and worrying and I’m so frustrated! If I don’t sleep tonight, I’ll be no good tomorrow. What if I fail my test or lose my job or can’t function because I’m sleep deprived?”
Notice the emotions? There is a lot of fear and anger surrounding insomnia. The negative cascade of thoughts (sometimes referred to as catastrophic thinking) usually starts with the need to control sleep and involves a person imagining a horrible outcome due to insomnia. Implementing the following sleep habits can help you sleep well, but the real secret to dealing with insomnia is to tell yourself that you can cope if you don’t sleep well.
How can I cope?
One of the best ways to cope with difficult situations is by replacing negative thoughts. Tough issues like insomnia can be worsened by unbalanced thoughts. Working on balancing your thoughts (also called cognitive reframing) can help. This typically involves telling yourself things that you know to be true even if you don’t really believe them. Examples of balanced thoughts regarding insomnia include:
It’s not the end of the world if I don’t sleep well.
I don’t have to control my sleep.
I’ve gotten through the day before when I didn’t sleep much.
I’ve done what’s in my control to improve my sleep, but I cannot force the outcome.
Some days my sleep is better and some days it is worse.
Betsy’s story
When “Betsy” came to see me, she was at her wit’s end because of insomnia. Her insomnia had started over a several-week period when she’d had to care during the night for her sick children, and later, her sick dog. By the time everyone was healthy, Betsy was waking to the slightest sound and lying awake in bed for hours during the night. Her exhaustion and frustration led her to seek a sleep medication, even though she was fearful of side effects.
Betsy told me how she always woke at 2:30 am and stared at the ceiling, filled with frustration that she was lying there awake again. Sometimes she turned the TV on to cope and pass the time until she fell back asleep. Because of her fatigue, she couldn’t get up as early as usual and had stopped exercising. She was consuming more alcohol in the evening because she thought it might help her sleep.
I told Betsy that we would consider medication if necessary, but it first made sense to implement behavioral changes, as most of the time these result in improved sleep, without the side effects of medication. Healthy sleep strategies could be used at any point in Betsy’s life, while Betsy might not always have medication with her.
When Betsy reviewed the healthy sleep strategies, she said there was no way she could stop herself from checking the time when she woke up at night – the urge was just too strong. She was skeptical of learning to “roll over and go back to sleep.” I let her know that by checking the clock when we wake, we actually train ourselves to wake at that time. She agreed to try turning her clock away, avoiding alcohol and getting up to do a quiet activity if she couldn’t sleep. She even agreed to practice accepting it when she couldn’t sleep.
I saw Betsy for follow-up a month later. She reported her sleep was greatly improved and she was again getting up and exercising in the morning (which in turn helped her to sleep at night). Betsy expressed satisfaction at having learned strategies to overcome insomnia and she felt better equipped to deal with any future sleep troubles.
16 tips to sleep well
Here are some of the best sleep strategies. Look through the list and see what changes you can make in order to sleep better.
Get up and go to bed at the same time every day, even on weekends. If you have a regular sleep cycle and get up at the same time every day, you are likely to feel sleepy by bedtime.
If you can't fall asleep within about 20 minutes, or if you wake during the night and cannot get back to sleep within about 20 minutes, get up and leave the bedroom and do a calm activity until you feel sleepy (keep the lights dim, eat a light snack, read something boring).
Don’t check the clock when you wake at night, as checking the time reinforces the habit of waking. If your alarm hasn’t gone off, it doesn’t matter what time it is – it’s just time to sleep.
Learn to roll over and go back to sleep. It is normal for people to wake enough to shift position in bed several times during the night, but they may not even remember waking because it was so brief and they didn’t fully awaken. If you are having insomnia in the middle of the night, it is important to learn to avoid turning your mind on when you wake during the night, and instead to simply roll over and go back to sleep.
Exercise regularly, but not right before bed. When people increase their level of physical activity, it almost always improves their sleep. However, vigorous exercise right before bed can interfere with falling asleep.
Use your bed only for sleeping, so when you go to bed, you know it is time to sleep. Do not watch television, surf the Internet, do homework, pay your bills, or have emotional conversations in bed. Sex should be the only activity in bed other than sleep.
Make sure your bed and bedroom are quiet, dark and comfortable. A cool room temperature can help you sleep, and if ambient noise is a problem, try using a fan or other source of white noise or listening to calm, quiet music.
Avoid caffeine, nicotine and alcohol for at least 4 to 6 hours before bed. Caffeine and nicotine are stimulants. While alcohol may initially make you feel sleepy, when it starts leaving your system you are likely to have fragmented sleep.
Avoid napping during the day, so that you are sleepy at bedtime. If you must nap, keep it short.
Practice relaxation techniques before bed, or after you get in a comfortable position in bed. This can relax your body and slow your mind and allow you to fall asleep.
Try listening to sleep stories. Through a podcast or app, you can listen to a person telling a story with a non-engaging plot or no plot at all. These stories can help people to distract themselves from their own thoughts and worries and drift off to sleep.
Avoid watching television, playing video games, or using a computer or smartphone just before bed or when you wake at night, as these are all engaging activities and the light from the screen tells your brain it is time to be awake.
Don't take your worries to bed. It is sometimes helpful to designate a “worry period” earlier in the day or to write down your concerns so you can stop focusing on them. Try using relaxation techniques in bed; then you can focus on relaxing instead of focusing on worries.
If you are spending a lot more time in bed than you are spending asleep, reduce the amount of time you are in bed to the amount of time you have actually been sleeping, then gradually increase the time so that you continue to sleep most of the time you are in bed.
Try a weighted blanket. People often find that the weight helps them to feel safe and secure and helps their body to feel heavy and relaxed, which helps them fall – and stay – asleep.
Practice accepting how you sleep. Implement the above habits that can help you sleep well, but let go of the need to control your sleep. Tell yourself that you can cope if you don’t sleep well.
Click HERE for a downloadable pdf of the above Healthy Sleep Habits.
You have tried all of the above strategies and still cannot sleep. Now what?
If you have tried changing your sleep habits and continue to struggle with frequent insomnia, it might be time to seek the help of an expert.
Meeting with a therapist trained in CBT-I: Cognitive Behavioral Therapy for Insomnia (CBT-I) includes sleep assessments, the use of a sleep diary and regular meetings with a therapist trained in helping people with insomnia. One of the main strategies in CBT-I is to avoid negative sleep habits such as daytime napping through the strategy of Sleep Restriction Therapy and preventing relapse once you start making progress.
Meeting with a psychiatrist: In some cases, insomnia is linked to another treatable mental health condition, such as depression, anxiety, PTSD or bipolar disorder. Healthy sleep strategies can still be helpful in these situations, but you also might benefit from more specialized evaluation and treatment. Even if no other mental disorder is present, a psychiatrist may be able to rule out other conditions and treat your sleep disorder with medication.
Sleep study: If your sleep doesn’t improve with implementing our 16 tips or you just don’t feel rested no matter how much sleep you got, you might benefit from a sleep study, which can help diagnose treatable conditions such as sleep apnea and restless leg syndrome.
The journey – dealing with insomnia
Having insomnia can be one of the most difficult things to cope with because we truly need restful sleep. You may be exhausted, frustrated and anxious about your sleep. Try letting go of the need to control your sleep and just take the healthy steps that improve your chances of sleeping well. You can get to the point where you no longer dread nighttime, where you experience freedom from anxiety and anger related to your sleep. Develop the discipline of healthy sleep habits and then practice acceptance, even when you have insomnia.
For further reading, check out:
Len’s article, “Finding Quality Psychotherapy – Moving Beyond Talk Therapy”
Len’s article, “Finding a Good Psychiatrist”
Why We Sleep: Unlocking the Power of Sleep and Dreams by Walker
Change Your Schedule, Change Your Life by Kshirsagar and Seaton (See Len’s Book Review)
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