Struggling with insomnia? Here are 6 ways to get better sleep

Poor sleep has troubled minds for centuries. Linked to stress, anxiety and performance fears, insomnia has beleaguered everyone from Judy Garland and Marilyn Monroe, who the day before she died had complained of being unable to sleep, to Abraham Lincoln and Winston Churchill, who famously slept just four hours a night (although he was also well known for his afternoon naps). Bill Clinton, meanwhile, struggled to sleep more than five hours a night during his presidency, commenting: “Every important mistake I've made in my life, I've made because I was too tired.”

Entertaining the entire world (Monroe’s problems apparently began as a result of stage fright) and leading a country through a war rank pretty high on the stress barometer, but any increase in anxiety and stress can cause insomnia. Short-term factors might include exams and ruminating over things you said or didn’t say in an argument. Long-term factors might include prolonged difficult periods at work—or out of work—caring for a baby, worrying about a loved one’s health, or our current anxiety-inducing reality during a global health pandemic.

Lying in bed is often the first chance we give ourselves to process whatever is causing us stress. “We live incredibly busy lives and all sorts of things happen to us that make us anxious, angry, irritated—there are decisions we have to make—and because we're so busy all the time, we rarely have a chance to sit with our thoughts and process these things,” says South African psychiatrist Dr Hugh Selsick, founder, director and lead clinician of one of the world’s most prestigious insomnia clinics in London. “When we think we're doing nothing, what we're usually doing is watching TV, checking our phone and emails and so on, so for most of us, the first opportunity we have to do absolutely nothing with no distractions is when we get into bed and turn out the light. It's not surprising that all of these thoughts, feelings and decisions that have been building up during the day then come flooding into our brains.”

Just as this build up of stress and anxiety gets in the way of our sleep, being sleep deprived makes us much less able to cope with the same stress and anxiety the next day—triggering an all too familiar vicious cycle. So, how do our brains cope with stress after a bad night?

“When you are sleep deprived the front part of the brain, the prefrontal cortex—which acts almost like the CEO of the brain, it's very good at making high-level, executive control decisions—is shut down by sleep deprivation, or at least significantly impaired,” says Matthew Walker, author of the bestselling book Why We Sleep. “The emotional centres of the brain are then left unregulated, and they amp up their activity because the prefrontal cortex acts like the brake pedal to your emotional and anxiety gas pedal.” Hence feeling overwhelmed, emotional and unable to cope with stress when you’ve slept badly.

Luckily, there are things you can do about: here are six tips to help you get a better night’s sleep.

1. Don’t try so hard

“If you ask good sleepers how they sleep, they generally say, ‘I dunno, it just happens’,” Selsick says. “Good sleepers don't try to sleep, sleep is something that happens to them. When someone has insomnia they spend a lot of time and energy reaching for sleep, and that makes sleep more elusive.” Selsick quotes the Austrian psychiatrist and neurologist Viktor Frankl, who wrote: “Sleep [is like] a dove which has landed near one’s hand and stays there as long as one does not pay any attention to it; if one attempts to grab it, it quickly flies away.”

Trying to stay awake can, ironically, be a more effective strategy for insomniacs. Part of the cognitive behavioural programme at Selsick’s clinic involves getting out of bed if you’re still feeling wired after 15 minutes and going into another room to sit in a cosy chair (sit, don’t lie down), to read or listen to something a bit boring and wait until you feel sleepy, then go back to bed. If you’re not asleep within 15 minutes, get up again. It’s painful, but effective.

2. Wake up at the same time every day, including weekends

Catching up on sleep by lying in at the weekend is not going to help you in the long run. Selsick uses the analogy of filling up a tank with sleepiness, so the longer you are awake during the day, the more your tank of sleepiness fills up, and by the time you go to bed, the tank is full and you fall asleep quickly. “So if I wake up at 7am, I fill up my tank and I have a high enough sleep drive to sleep at 11pm. But if the next day I wake up at 10am, my tank only reaches full at 2am. That creates very unpredictable and fragmented sleep.”

Selsick continues: “The prime synchroniser of our body clock is the first light we get in the morning, so if you're getting your first dose of daylight at a different time every day, your body doesn't know where it is in time. Whereas if you get up at the same time every day and you get exposed to light at the same time, that helps to synchronise your internal body clock. In practice if you sleep in on the weekend, because you're getting that dose of light later, you're effectively jet-lagging yourself.” People often assume they sleep badly on a Sunday because of work anxiety, but actually, it could just be because they slept later than usual.

3. Process your thoughts before bed

“Worry journals do seem to help,” says Walker. “There was a study a few years back that measured the speed at which a group of people fell asleep, then they had them begin ‘worry journals’ to get all their concerns down on paper. They found that for some of the individuals, that ritual of writing things down actually helped them fall asleep in almost half the normal time.”

Selsick advocates writing the journal an hour or two before bed: “Allow those thoughts to come into your mind, think about how you feel, make decisions, make plans, and get that processing done before bed.” On his clinic’s CBT programme, patients are encouraged to keep a ‘Worry Tree’ with three columns including what went well that day, under ‘Good’, what didn’t go well and what you’re worried about under ‘Bad’, and then an actionable ‘To Do’ list, that specifically addresses things in the ‘Bad’ column. For example, if you’re worried about delivering a work presentation, you might write ‘spend an hour practicing presentation from 1 to 2pm’ or if you have long-term worry about a loved one’s health, you might write ‘call Dad for a chat tomorrow’. You can’t solve the world’s problems before bed, but you can make a personally actionable plan.

4. The warm-bath effect—lower your body temperature

“You will always find it easier to fall asleep in a room that's too cold than too hot,” says Walker. “Your brain and your body need to drop their core temperature by about one degree celsius throughout the night to fall asleep easily and to stay asleep.” So, crack open a window, invest in air conditioning or a fan. Having a warm bath before bed is a well-known tip, but it’s not because it’s a nice, relaxing thing to do, as many assume. A warm bath ultimately cools down the body, preparing you for sleep, as Walker explains: “What happens with a warm bath is it brings all the blood to the surface of your skin, away from the core of your body, and when you get out of the bath, your core body temperature actually plummets.”

5. Try visualisation while in bed

“If you think in a verbal fashion prior to sleep onset, it delays your sleep,” says Selsick. “Visualisation can dilute the verbal aspect of your thinking.” Use your imagination to take yourself on a long walk through a beautiful place (somewhere you’ve been before). Pay close attention to your senses—what does the air smell like? Can you hear birds or the sound of your foot crunching leaves? Imagine walking up to a tree and putting your hand on the bark, feeling its texture and its coolness. Continue with this visualisation, going into as much detail as possible, until, hopefully, you drift off beyond the trees.

6. Integrate mindfulness into your daily routine

“Sleep is not like a light switch, we shouldn't expect it to be,” Walker concludes. “Sleep is much more like landing a plane, it takes the brain some time to descend down onto the terra firma of good sleep.” He recommends a programme of meditation over the course of a few weeks as a way of relaxing an anxious or stressed mind, so that when you get into bed, you’re generally feeling calmer.

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