Insomnia can be incredibly frustrating and all-encompassing. It is one of the most common symptoms that individuals can become obsessed or hyper focused on. Ruminations about “what went wrong?” or “maybe if I try this?” or “let me list all of the things that are going wrong because of my insomnia” can fester and plague your mind.
There’s no doubt that sleep is important for overall health and mood, but the interventions for sleep must be carefully planned so as to not further hormone disruptions, mood symptoms (such as anxiety or panic), or negative thought patterns. Before we discuss interventions it’s most important to know that anxiety or “mental hyperarousal” is frequently the driver of insomnia. (This hyperarousal can also include mania symptoms, OCD thoughts, or depression ruminations.) Yes, lacking good sleep can further the anxiety or mood symptoms during the day, but the actual solution is to target the unregulated emotions and thoughts that are causing the adrenaline rush to be felt at night. So, rather than hyperfocus on the sleep itself, we need to focus on the mood, thoughts, and lifestyle that takes place outside of sleep. So what are the appropriate interventions? We break them down into physical and cognitive categories:
1. Physical Interventions - these are focused on habits, routines, and ways you can take care of your physical body.
a. Move your body for 30 minutes each day - you get to choose your exercise. Preferably something that increases your heart rate consistently so that you get to work off the anxious energy and adrenaline rushing in your system. This can be a jog, fast-paced walk, HIIT training, boxing, etc. This helps your body experience healthy stress and fatigue and can take your body out of survival mode.
b. Get 30 minutes of morning sunlight - Before 11AM, the sun releases blue light that helps restore your circadian rhythm (sleep-wake cycle). In order to absorb blue light, you must have your naked eye exposed to the air. This means no sunglasses, contacts, glasses, or windows. This blue light penetrates through fog, clouds, rain, snow. So even if it’s a colder day, you still reap the benefits of blue light! Add this routine to your morning breakfast, morning coffee, or morning walk to make it a little more attainable.
c. Limit screen time - screens (in addition to the sun) release blue light and can cause your brain to be far too overstimulated….especially when you spend >2 hours per day on the screen, or are exposed past 11AM. If you have to be on a screen for work/school, you can put on a blue-light filter to limit exposure for your eyes. For recreation, avoid screen-related activities, especially close to bed time. We recommend avoiding screens for up to an hour before bed to allow your brain to decompress and wind down.
d. Avoid mood or mind-altering substances - drugs and alcohol wreak havoc on your sleep, especially REM sleep and should be avoided. REM sleep is especially important for emotional repair, so when you drink or use substances before bed, you decrease your brain’s ability to process the day’s emotions. This means that you will also be more likely to wake up feeling drained, anxious, unmotivated, down, and unrested.
e. Eat enough calories - if your body is not well-nourished with enough calories or nutrient-rich foods, it will have trouble resting and sleeping at night. Simply put, your body will be in a state of emergency and survival mode, keeping you up so that you can “hunt and gather” more food.
f. Get up at the same time every day - regardless of when you actually fall asleep, keep your same morning and daytime routine. This helps your body’s inner clock. You will likely feel tired when you implement this, especially if you get less than 4 hours of sleep some nights, but that’s ok. Feeling tired is ok. Over time, that fatigue that builds up will help you gain more hours of sleep at night. Specialists call this “building up a sleep appetite.”
g. Don’t nap - napping during daytime hours cuts into your sleep appetite and decreases your body’s need for sleep at night. As mentioned earlier, let your body feel tired and don’t give in to nap urges!
h. Avoid the bed if you’re not sleeping - do not spend your leisure time laying or sitting on your bed. And in general, try to avoid your bedroom as well. Your brain makes associations very easily, and you want your brain to associate your bed and bedroom with overnight sleep. This also means that if you are tossing and turning for more than 30 minutes overnight, it’s time to get out of bed and do something else (preferably something relaxing) - such as yoga, reading, stretching, listening to a podcast. If you feel that tired cue hit, go back to bed and give it another 30 minutes to see if you will sleep.
i. Have a wind-down routine - this routine is typically within the 30-60 minute window before your intended bedtime. A wind-down routine includes practicing calming and soothing activities to prepare your body and mind for bed. This helps to cue your brain to start releasing melatonin. Examples of activities can include: warm shower/bath, reading a book, skincare routine, journaling, meditation, prayer, changing into pajamas, or other hygienic activities. It’s important that in this routine you are not on a screen such as watching TV, scrolling the phone, etc.
2. Cognitive Interventions - these are focused on regulating your thoughts and practicing self compassion.
a. Let go of achieving perfect sleep - when you have experienced insomnia over a significant period of time, it’s easy to catastrophize what it is doing to your body. But obsessing over getting enough hours ends up being counterproductive because of the anxiety it induces. This doesn’t mean that you give up trying to support your body, but that you learn acceptance for where your body is currently, knowing it’s going to be a journey and will take time.
b. Challenge negative thoughts - whether it’s spiraling negative ruminations, predicting negative future outcomes, or catastrophic negative thoughts, it’s time to turn down the dial on those thought patterns and replace them with positive, validating ones. This can be listing gratitudes, positive affirmations, setting positive intentions, wins for the day, or simply rephrasing your fears to be more realistic and neutral. For example: “I don’t know what my sleep will look like tonight, but I celebrate the ways I took care of myself and showed up for myself today. I will do the same tomorrow”. Thoughts affect your feelings which impact your hormones. So setting boundaries with your thoughts is important to supporting sleep hormones.
c. Fill your life with other things outside of your ailments - if your whole day is spent worrying about whether you will sleep at night, you can almost guarantee you will get poor sleep. Filling your mind and your habits with things that bring you life, joy, and color helps prevent you from feeling like you’re in prison from your symptoms. Sometimes you will need to force yourself - especially if you feel tired or anxious - but do it anyway. This can be something simple like sharing a meal with a loved one, spending 30 minutes doing a creative hobby, going for a hike, or whatever is typically enjoyable for you.
d. Stop fighting yourself - remember that it’s not about being at war with your body, it’s about learning it and taking care of it. The less you try to fight with yourself, the more peace you will be able to experience, even on the bad days.
These interventions are more important than any sleep aid or tranquilizer. While medication can be a helpful tool in the short-term, it is not the ultimate solution. And unfortunately, many sleep aids come with side effects…. Some even can worsen your mood or hormones long-term. So don’t avoid the lifestyle and cognitive work - it’s worth it!