Get Back to Sleep

My son recently asked me if sheep “count humans” when they can’t sleep. After entertaining this ridiculous imagery, I wondered if there are animals other than humans that struggle to fall asleep. I found a study of rats that showed insomnia-like behavior after they were moved to unfamiliar cages. “Stress has a significant impact on sleep–wake behavior in all animals,” writes Georgina Cano, lead author of the rat study. “The immediate effect of exposure to a stressor is increased wakefulness and arousal, as an adaptive response to ensure survival by fully reacting to a potentially harmful stimulus.”

This is what happens to humans too. It starts with a stressful event that causes sleep disruption. But after a couple of restless nights and sleepy days, the object of worry morphs from the initial stressor to worry about sleep itself. And the more we worry about sleep, the more elusive it becomes and the more frustrated we get. Our minds tend to get in the way. Before long, the anxiety about not sleeping triggers a stress response and increases vigilance and arousal in the mind and body, further driving sleep away. If this becomes a pattern, our bodies learn to anticipate being wakeful and frustrated as soon as we go to bed. This is called conditioned arousal.

But instead of going down the rabbit hole of worrying about worrying about not sleeping, let’s explore what we can do to get back to sleep!

First, we need to adjust our attitude and expectations. Those who struggle with sleep frequently fear that they will be dysfunctional the next day. However, thinking back to all the preceding sleepless nights, most people realize that they were actually able to function pretty well on not much sleep. And it’s a catch-22 because the more we pressurize our expectations of “needed sleep,” the harder it is to get. So, if we let go of the fixed idea that we need a certain number of hours of sleep, we become more likely to get those hours.

Along these same lines is the concept of trying softer. We frequently are told to try harder. Learning new

skills requires perseverance and hard work. This serves us well in many pursuits and is the foundation of most Type A success. However, in learning to be a better sleeper, it leads to frustration and failure. It’s no surprise that Type A driven people tend to be those who struggle with sleep. So, for all the Type As in the world (myself included), this is a practice in underachieving. Have you ever noticed that the best sleepers don’t seem to try very hard? A piece of their success may be in their casual attitude and lack of attention to sleep.

If the first part of trying softer is non-striving, the equally important second part is kindness. As with all mindful practice, bringing a friendly and gentle attitude to the struggle is essential. This can take some practice. Often, before we are even aware of what is happening, judgement has already kicked in. Maybe it’s a voice whispering “you’re a terrible sleeper” or a feeling of failure. The key here is to recognize this judgement and negativity and re-write the narrative to one of acceptance and kindness. You might find it helpful to put your hand over your heart when you become aware of a judgement and focus on the warmth you feel between your hand and chest.

So far I have recommended letting go of your expectations about sleep, not trying so hard, and being nice to yourself. This is the scaffolding of good sleep, but there are also many tips and tools that can be helpful.

An effective and almost too-easy-to-believe technique is constructive worry. It is a practice of keeping a worry journal. For 5-10 minutes before getting into bed, you simply write down all of your thoughts and worries on one side of a page and on the other side you write the next step to take for each noted worry. You are not trying to solve the whole problem, just the next small step towards resolution. Don’t worry about the writing, just get it all down on paper. By downloading this worry from brain to paper before you get into bed, you train your brain to manage worries before bed, not in bed. By writing them down, you release your brain from having to continually remind you of the worries, and by writing the next action steps, you shift your focus to working on solutions, rather than ruminating on the problems. It takes a couple of weeks to really work, but once you’ve retrained your brain, often you can stop keeping the worry journal and maintain the improved sleep.

Meditation has been shown to improve sleep quality and decrease the time it takes to fall asleep. Even a 5 minute meditation at any point in the day will benefit your sleep. It does this by promoting relaxation and counteracting stress. Its works not by ridding the mind of thoughts, but simply to bring non-judgmental awareness to them and strengthening less reactive patterns. Each time you notice that your mind has wandered is a moment of mindfulness; a chance to bring your attention back, and this is a win!

Another simple and useful is tool is to use your body temperature to your advantage. To fall asleep, the core body temperature must drop by about a degree Fahrenheit. That is one reason that it is so hard to sleep in a hot room. By taking a hot shower, bath or a sauna about an hour before bedtime, you can temporarily elevate your body temperature. As you are getting into bed, it will be naturally falling, setting you up for a smooth transition.

Magnesium has become known as “the sleep mineral.” It helps your brain maintain healthy levels of GABA, a neurotransmitter that helps calm down your brain and initiate sleep. It also reduces cortisol, the stress hormone responsible for anxiety. It’s estimated that about 30% of Americans are chronically magnesium deficient. Magnesium comes from green leafy vegetables, beans, nuts, seeds, and whole grains. Supplements are also an option, but some of them will cause diarrhea (notably magnesium citrate). Magnesium glycinate has the fewest bowel side effects. An effective alternative to oral intake is to get your magnesium through your skin. Epsom salts are magnesium salts and can be added to the hot bath you’re going to take an hour before bed.

Melatonin is the body’s signal that it is night time, but it does not generate sleep. It provides a gentle nudge towards sleepiness but is often not enough to overcome worry or conditioned arousal. It is generally not recommended as a chronic medication for those who struggle falling asleep, except in specific populations such as children with autism or ADHD. It can also be useful for shifting time zones or sleep schedules. Dosing for kids between 6-12 should be 1-3mg and for kids 12 and over it can go up to 5 mg about 30 minutes before bedtime.

This is just a beginning, a couple of thoughts and ideas to help you get back to sleep. For me, magnesium, meditation, and constructive worry have been game changers! However, if you continue to struggle, more help is available. Cognitive behavioral therapy for insomnia (CBT-I) has been proven to be very effective. You also may want to see your primary care provider to screen for sleep disorders like obstructive sleep apnea.

References

Cano, G, Mochizuki, T, and Super CB. Journal of Neuroscience 1 October 2008, 28 (40) 10167-10184; DOI: https://doi.org/10.1523/JNEUROSCI.1809-08.2008

Macedo, D. (2021) The Sleep Fix. New York: HarperCollins.

Pacheco D and Rehman A. (2022). Meditation for Sleep. National Sleep Foundation. https://www.sleepfoundation.org/meditation-for-sleep

Winter, WC. (2017) The Sleep Solution. New York: Penguin Random House.