Are Your Worries About Sleep Turning You into an Insomniac?

Are You Worrying About Not Sleeping?

If you are prone for insomnia, then you are already going to bed preoccupied with getting to sleep quickly and obtaining as much sleep as possible. You also worry about the impact of sleep on your physical health and daytime functioning. These excessive worries and ruminations trigger in you a state of physical arousal and emotional distress through activation of the sympathetic nervous system similar to the fight-or-flight response. This arousal and anxious state then narrows your focus to attend to and monitor for sleep-related cues such as:

• Body sensations for signs consistent with falling asleep: slowing of heart rate and loss of muscle tone. 
• Body sensations for signs inconsistent with falling asleep: heart pounding quickly and muscle tension. 
• Surroundings for signs of not falling asleep: noises outside and inside the house. 
• The clock to see how long it is taking you to fall asleep: “It is 1:30 a.m….I have been trying to sleep for 2 hours and 30 minutes!” 
• The clock to calculate how much sleep you will get: “Oh no…It is already 2 a.m....which means that I will only get 4 hours of sleep tonight.” 

Unfortunately, this monitoring for sleep-related threats then generates more worrisome and irrational thoughts such as, “I am never going to get to sleep,” or “If I can’t get to sleep soon, there is no way I will be able to function tomorrow.” These irrational thoughts reinforce the worrisome thoughts you had before you went to bed, thus creating a vicious cycle.

What Keeps Your Insomnia Going?

Once you have developed insomnia, several exacerbating processes contribute to maintain it. These include:

• Existing irrational beliefs about sleep: For example, “I need to sleep at least 8 hours daily to remain healthy” or “Without an adequate night’s sleep, I can hardly function the next day.” 
• Poor sleep behaviors such as erratic sleep and wake up times, taking day time naps, poor sleep hygiene, etc. 
• Safety behaviors that include strategies that are developed in an attempt to avoid a feared outcome. For example, trying to suppress thoughts interfering with sleep (which paradoxically increases these thoughts), cancelling work and taking an afternoon nap to avoid feeling tired at work (which then causes more insomnia), or drinking alcohol to help you fall asleep (which may help one fall asleep, but results in poor sleep continuity). 

Below are some pointers on a healthy sleep hygiene that will help you self-manage insomnia.

Sleep Hygiene

Sleep hygiene is a term used to describe healthy sleeping habits and avoidance of behaviors that are incompatible with sleep. Sleep hygiene is effective when used in conjunction with other cognitive-behavioral approaches to treat insomnia. Some of the salient features of sleep hygiene are as below:

• Stick to a sleep schedule of the same bedtime and wake-up time, even on the weekends. This keeps your body’s internal clock regulated. 
• Use natural light (that comes through a window) to remind yourself of when it is time to be asleep and awake. This can help you set a healthy sleep-wake cycle. 
• Exercise daily but avoid doing vigorous exercise too late in the evening. 
• If you take naps, keep them short and before 5 p.m. 
• Don’t eat or drink too much when it is close to bedtime. 
• Avoid caffeine (coffee, tea, chocolate, and cola) and nicotine for several hours before bedtime. 
• Wind down before going to bed (e.g., take a warm bath, do light reading, and practice relaxation exercises). 
• Use your bed only for sleep and sex and not for other activities such as watching television or working. Associating your bed with sleep conditions your brain that it is time to wind down and go to sleep. 
• Sleep in a dark, quiet room that isn’t too hot or too cold and is well-ventilated. 
• Reduce external noises that distract you if they can be controlled. If these cannot be eliminated, then try white noise to muffle them. 
• If you are unable to fall asleep within 20 minutes, get up and do something relaxing and then return when you are ready to sleep. This avoids the bed being associated with wakefulness. 
• Reduce stimulating activities at nighttime such as reading something really exciting, surfing the internet, watching an action-packed movie, or engaging in an emotionally charged conversation. 
• Avoid watching the clock when you are having trouble falling asleep as clock watching can be arousing and incompatible with sleep. Instead, when it becomes obvious to you that your state of mind is not conducive to sleeping, then get out of the bed and return to it when you are sleepy. 

A Technique to Help with Bedtime Worry

Bedtime worry about future events is a common cause of difficulty falling asleep. If you lie awake at night because your mind won’t stop racing, then taking five minutes before bedtime to write a to-do list for the next day might get you more shuteye. This technique, though seemingly counterintuitive, is supported by research (Scullin et al., 2018). The possible underlying mechanism behind this technique is that when your write your to-do list, it helps you offload your worries about the future rather than ruminate about them and expressive writing is known to reduce anxiety and depression. The instructions for this exercise are below:

Every day before you go to bed, spend five minutes writing down everything you have to remember to do tomorrow and over the next few days. You can write these in paragraph form or in bullet points. Use all five minutes to think and write about tasks you have to complete tomorrow and in the near future, even if few are coming to you. 

A caveat here is in order. Not all sleep disorders are related to worries and unhealthy sleep hygiene habits. It is prudent to first consult with your primary care or mental health provider to exclude other medical conditions that may be leading to insomnia such as pain or other sleep disorders such as sleep apnea or restless legs syndrome.

To learn more about evidence-based self-management techniques that are proven to work depression, check out Dr. Duggal's Author Page.

HARPREET S. DUGGAL, MD, FAPA

REFERENCES

Scullin, M. K., Krueger, M. L., Ballard, H. K., Pruett, N., & Bliwise, D. L. (2018). The effects of bedtime writing on difficulty falling asleep: a polysomnographic study comparing to-do lists and completed activity lists. Journal of Experimental Psychology: General, 147(1), 139-146.