How Can We Help?
In addition to tapering sleep medication, it is very important to find better long-term ways of eliminating insomnia that don’t involve drugs. Substituting alcohol to help you sleep for example, is a bad idea. One area of help may require you to change pre-sleep behavior that promotes insomnia, such as watching bright TV or other displays on electronic devices, not eating just before bed, etc. Additionally, evaluating your sleep situation is important. For example, poor ventilation,sleeping on a badly worn-out mattress, nightime noise outside your home, etc., can often contribute to insomnia.
Many people I treat who have trouble falling asleep report, “….I can’t shut my brain off to fall asleep”. What I find interesting is that they invariably have a conflict about sleeping: They experience rational trains of thought, e.g., “I need to get to sleep”, “I want to sleep”; “It is midnight; for ‘heaven’s sake’ go to sleep!” etc. However, other trains of thought seem to indirectly demand that they stay awake. That is, the person wants to review the events of the day. They may want to figure out what they have to do tomorrow. They may want to conduct replays of conversations they had recently, trying to figure out what they should have said or done differently. They may simply worry about problems they are having at work, in a relationship. So, at bedtime, their insomnia is often related to a conflict about actually sleeping.
In the event you are experiencing some of the above, the following may be helpful: It is sometimes helpful to write down your to-do list or schedule for the next day BEFORE you climb into bed. You may find that an affirmative self-validation is helpful when you are done: “O.K., I have written everything down I have to do. I should not have to think about it anymore tonight. I should trust what I’ve written down, let it go, because I need to sleep”. If your insomnia is related to your desire to review a recent conversation you had (instant replays), it is critical you do it outside your bedroom, well before you try to go to bed. As you have probably been told, lying in bed should be strictly reserved for sleep or sex, nothing else (no videos, etc.). If you find yourself slipping into an instant replay, get out of bed and set a timer to limit your review, reminding yourself you can think about this tomorrow as well.
Insomnia that relates to your desire to think, worry, problem-solve, review events etc., always involve a level of anxiety symptoms. Therefore, psychologists will usually coach you to use relaxation techniques. You can read about relaxation training in hundreds of online websites and posts. The methods vary a bit. Some may teach you how focus on internal physiological experiences of the moment e.g., your breathing, how tense or relaxed different muscle groups feel “right now”. What I find very interesting is that patients can learn to do these things in my office (practice), but when they go to bed, compliance is very low. It is though any of their anxiety-related trains of thought (e.g., thinking, worrying, problem-solving) want to dominate the moment and patients really don’t want to focus on the relaxation techniques. Therefore, they tend report during the next appointment that the things we practiced “don’t work” or that they forgot to do them. The remedy is to get them to practice the techniques at home in the evening, prior to going to bed, to rehearse the skills. This makes the transition to doing them in bed, at bedtime, more likely. So, keep in mind that your tendency to think, worry, problem-solve etc., at night, is something that may be a difficult thing to change because your brain is tricking you into believing you “must” stay awake and keep thinking, problem-solving etc., before you can sleep.
As we have emphasized so far, it is hard to help people taper off of their sleep medication if they don’t have another way of dealing with their insomnia. The behavioral techniques and issues outlined above take lots of practice, and you may experience many starts-and-stops along the way. However, the best available research suggests they can definitely help. Many insomniacs find they have to begin to accept the idea that changing sleep-related habits and behavior will take time. Interestingly, an significant irony is usually in play with insomnia: While you want to stop having insomnia, part of your brain may not want to give up the behaviors that promoted it in the first place (watching TV in bed, eating in bed, thinking/worrying/problem-solving).
Some other behavioral skills you can try that are known to effectively combat insomnia and help change faulty sleep hygiene behavior include: 1) formal relaxation training, used when you lie down to go to sleep (see relaxation training links on YouTube). 2) Practicing deep breathing, combined with self-guided imagery e.g., take rhythmic breaths, slowly, and try to picture in your mind your body “letting go” of tension and stress as you breath out. 4) If you have stayed up late at night often enough, you have no doubt been able to identify certain “ideal” times for you to fall sleep. We have all had the experience of feeling sleeping at some point in the evening, but then forcing ourselves to stay awake for awhile—after which poing we may stop feeling so sleepy. When this occurs, it means we have stayed awake past our ideal time for falling asleep, dictated by what is called our circadian rhythm. Many people experience a sleepiness episode or “readiness” to sleep around 2 p.m., a common point of sleep readiness associated with peoples’ circadian rhythm in the afternoon. It is important to try to time your bedtime hour with the ideal sleepiness phase of your evening and not press yourself to stay awake beyond it.
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Copyright 2019 David M. Stein, Ph.D. Readers are welcome to link to this article. Copying this article without the written permission of the author is not permitted. Copying the article and presenting it on another website without appropriately crediting the present author and linking to this website is considered plagiarism. This action will be reported to state or provincial licensing boards as an ethics violation.