Insomnia demystified - A Sleep Psychologist's Guide (Part 4)

This is the last in a series of four articles explaining how chronic insomnia develops and what you can do to get relief from it.

In the last article, we laid out the logic of why cognitive-behavioural therapy (CBT) is one of the most effective strategies for treating insomnia. We discussed how the treatment is extremely helpful in combatting unhelpful thoughts and beliefs about sleep by systematically challenging and replacing them with more balanced views.

This final installment of the series will cover an alternative strategy that insomnia sufferers can use to handle thoughts – namely, mindfulness. Mindfulness is the practice of focusing on what is going on in the present moment, treating the experiences that arise with openness, curiosity, and non-judgment. Put more simply, it is about trying to see things as they are rather than focusing on how you feel they should be.

A cognitive approach to dealing with a thought might be: “What evidence do I have for this? How strongly do I believe in it?”

A mindfulness-based approach might sound more like: “I just noticed that I’m worrying about my poor sleep again. Let’s see what happens if I just let that thought be rather than entertaining it.”

When practiced regularly, mindfulness can be a great way to sort through the cacophony of thoughts that are constantly flowing through our minds. For insomnia sufferers, this can be a helpful skill both in the night and in the day.

Daytime thoughts

Insomnia is traditionally thought of as a nighttime problem. However, by definition, much of the impairment due to insomnia happens during the day, with decreased alertness, irritability, and difficulty concentrating among its consequences.

Dr. Jason Ong, creator of the Mindfulness-Based Therapy for Insomnia program, speaks of the "territory" of insomnia, that the disorder can encompass thoughts, feelings, and the way we deal with these thoughts and feelings during both the day and the night. Indeed, studies have shown that worry and repetitive thoughts during the day can also affect nocturnal sleep.

When was the last time you noticed you were worrying? Was it almost immediately, or had you worked yourself up emotionally before realizing that it was happening? One of the great benefits of mindfulness is that we start to notice anxious thoughts more often and can catch them before they spiral out of control. Being aware of our thoughts (and that they are just thoughts, not reality) gives us many more options for how to deal with them. We can ask ourselves: “Is it useful for me to worry now?” Very often, the answer is: No.

Nighttime thoughts

People with insomnia often lie in bed at night with their minds going at 100 miles an hour. Sometimes the thoughts are about the stress in their lives, reliving the day that has past or planning for the next one. Sometimes the thoughts are about sleep itself:

• “I feel so sleepy…why am I not asleep yet?”

• “If I don’t get to sleep soon, I’m going to feel awful tomorrow.”

• “It’s 1:30 now, maybe I can still salvage tonight if I fall asleep in the next 30 minutes.”

The instinct when such thoughts arise is often to entertain or believe them. Understandably, this can be distressing, which in turn makes it even harder to fall asleep.

A counterintuitive option that does not often occur to people is to simply accept that the thoughts are there and wait to see what happens. Admittedly, sometimes they may persist or recur. Other times, they might go away.

In mindfulness training, we help people not to get too attached to what eventually happens with our thoughts. Instead, we ask that they approach the experience with curiosity and without preconceived expectations of what could occur. When done consistently and genuinely, taking this attitude is what helps many individuals out of these “thought spirals” and towards better quality sleep.

Several studies have now shown that both in-person and app-based can reduce insomnia symptoms and sleep disturbances. Mindfulness techniques can be a useful supplement to amplify the effects of cognitive-behavioural therapy, especially for those who are experiencing high levels of anxiety and arousal at night.

If sleeping poorly has become a bothersome issue for you, we have deep experience in providing tailored mindfulness interventions to improve your sleep quality. Drop us a line to book an appointment for your personalized plan to beat insomnia and regain the restful nights you deserve!