[ezgeez]

Insomnia becomes entrenched when you start identifying it as a problem and actively expending effort to fix it; i.e. when ‘sleep’ is viewed as another task that can be ‘performed’.

Sleep cannot be directly controlled or influenced. It does not respond well to action. You can only allow sleep to happen while finding something else to distract yourself with.

This means asking yourself the question, while in bed, ‘what would I be doing in bed if I wasn’t trying to sleep?’

More broadly you could ask yourself, ‘what would I be doing with my life if I wasn’t trying to fix the insomnia? What gives me pleasure in life and how can I get more of it?’

The focus is thus shifted from fixing to coping, in the sense of giving up trying to control the situation but finding ways to accept it, to include it, to stay with it while getting on with something more personally pleasurable. This can be considered in the short-term scale (i.e. what happens on a sleepless night) as well as the long-term (how you live your life).

Identifying valued (personally pleasurable) activities, or broader ways of living, and going after them is a well established approach in mainstream schools of psychotherapy such as Behavioural Activation and Acceptance Commitment Therapy. In fact it is one of the key components employed at the Sleep School in London.

Free meditation, such as ACEM or mindfulness, offers a formal way to practice ‘sitting with’ uncomfortable thoughts and feelings without acting on them. It helps you to accept and include such events while teaching you to gently move your attention elsewhere. It helps you take the ‘goal-oriented’, evaluative or ‘active’ part out of your thinking.

A key idea from meditation in the context of insomnia or anxiety disorders is that having anxious, racing or panicking thoughts or feelings is not the problem. The problem is acting on them in some way, either by trying to expel them or thinking of ways to address them or ‘fix’ them.

Accepting and ‘including’ insomnia in your life instead of attempting to eradicate it is an important part of overcoming it. Chronic insomniacs display an ‘attentional bias’ relative to insomnia. For them, one or two bad nights verify their worst suspicions of a chronic and inescapable blight. This prompts them to throw even more effort into their sleep, thus perpetuating the insomnia. But normal sleepers think nothing of it. They know that sleep quality varies in response to life’s different stresses and events.

Spending more and more time trying to ‘fix’ insomnia brings other self-perpetuating forces into play.

For one, more and more of your life is consumed fighting the insomnia: time is spent learning relaxation techniques, reading books on the subject, browsing online for therapies etc. You lose sight of what really matters in life, of what really gives you pleasure. This can lead to depression, which itself reinforces the insomnia. It is the opposite of ‘Behavioural Activation’.

Also, harmful ‘conditioned responses’ start to become established: After spending so many nights filled with rituals and techniques to go to sleep, bed-time and the bedroom now become cues for anxiety and arousal.

Based on the above principle, the traditional ‘stimulus control therapy’ for insomnia stipulates that you should get out of bed if you are spending too much time trying to fall asleep, and get back into bed once you are sleepy again. I personally suspect that you don’t have to follow this to the letter. I think what’s important is that, instead of filling your sleepless nights with frantic effort, you think of something self-soothing to do instead. This way, even if you don’t manage to sleep, you are still establishing positive conditioning that will help you in the long run.

What does everybody else think?

[BobbyP]

Some good ideas here! I'm going to try them out tonight, as last night was not good. I've been trying to wean myself away from Xanax, which I take at least once a week to help me get back to sleep when I wake up at 11 or 12. So I toughed it out last night but have been very sleepy all day today — but at least not “hung over” from the Xanax.

[bigula]

I think this approach is spot on. It's more or less what I am trying to do myself. When unhelpful thoughts occur I tell myself “there's a time and a place for dealing with that and it's not now”. I try and find some enjoyment in the moment instead. I really didn;t find it helpful to keep getting up and doing something boring until I felt sleepy again – how helpful can it be to get up four times in the night? Too frustrating.

[ezgeez]

Hey bigula,

It's very encouraging to hear that you reached similar conclusions. I'd be very interested to know how you get on.

[ezgeez]

Here is an interesting outline on the use of mindfulness meditation for insomnia:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3060715/

[Daf]

I totally agree.

Occasionally I will get up in the night if I cannot sleep and I have got stressed about it.

But surely it is far better, as the poster says, to adopt an accepting approach to it – “here is it, its OK, I feel the wakefulness and the anxiety that come with it, but I will welcome them all in”

I know Guy Meadows and the acceptance commitment therapy approach think that getting up in the night and then going back to bed half an hour later has its limits.

If we can accept this strange condition, stop googling solutions (FFS, we know there aren’t any!) and start living despite insomnia, we make the problem shrink on its own a bit. It can lose its power.

 

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