If none of these strategies work, there may be a psychological basis for your sleep difficulties.
Before reaching for an ambien or bottle of Benadryl, read about these psychological remedies first.
Are you giving yourself enough time to fall asleep?
When I ask my patients if they are having difficulty sleeping, several will tell me that they cannot fall asleep. In cases such as this, I have discovered that my patients will lay down, close their eyes, and if they are still awake 5 to 10 minutes later, they become frustrated that they are not yet sleeping. What many people fail to realize is that falling asleep is a gradual process. The sleep cycle is actually a series of five stages, with varying degrees of deepness.
The initial stage marks the transition from relaxed wakefulness to sleep as breathing becomes slower and deeper. As this is not a deep stage of sleep, you can be awakened quickly and will report that you had not been sleeping. Interestingly, this is the sleep stage where you are most likely to experience the “hypnic jerk,” – that involuntary twitch that resembles your body’s startle response.
After about five minutes, you enter stage 2. This stage lasts approximately 20 minutes. You are more relaxed, less responsive to your environment, although still relatively easy to awake. But if you are awakened now, you will most likely report you were asleep.
It is not until you reach stages 3 and 4, approximately 25 minutes after closing your eyes, that your heart rate and body temperature decrease, and you are no longer easily awakened.
About an hour after going to sleep, you enter the fifth stage, or REM sleep. At this point, the sleep stages reverse, moving from stage 4, to 3 to 2. Instead of hitting stage 1, you enter a state of Rapid Eye Movement (REM) under the eyelids. It is in this stage of sleep you are likely to have dreams that you will remember. Breathing and heart rate are fast and irregular. All muscles, except those you need for respiration are paralyzed, so, despite what they show in movies, you can not physical reenact what you are dreaming.
After the REM cycle, we return to stage 2, and the process is repeated throughout the night.
The message here is that it is important to give yourself ample time to fall asleep. But there is a catch-22: you want to try to sleep for approximately 20-25 minutes. At that point, if you are still awake, get out of bed and do something else. Some experts say to read a book or watch TV, but note that the some researchers have found that the artificial light from electronic devices such as an ipad can actually increase insomnia.
Are you having racing thoughts?
Often, no matter how physically tired we are, our mental activity can leave us wide-awake. Pay attention to the thoughts that you are having at night when you are trying to fall asleep. This can give you insight into what is preventing you from sleeping – is it generalized anxiety? Are you worried about something specific? Once you are aware of what the specific thoughts are, you can come up with an intervention to either a) stop the thoughts or b) fix the situation you are concerned about.
Once you have some clarity related to the thoughts that are plaguing you at bedtime, here are some helpful interventions:
Are you worried about things you have to do tomorrow?
If so, try making a to-do list before laying down. Organizing your day and making a list of obligations can help relieve the anxiety associated with a hectic upcoming 24 hours. Writing the list can provide a release of the tension and worry as well as a creative outlet as you organize and plan.
Are you worried and anxious in general?
If that's the case, relaxation therapy can be beneficial. Try a relaxation technique or meditating when getting into bed. Guided meditation encourages deep breathing can be helpful to reduce anxiety, release tension and help signal to the body that it is time for sleep. Free meditations can be found on YouTube..
Soft music or relaxing sounds can also help. Soothing sounds such as ocean waves, rain or nature sounds, when paired with deep breathing can have the same therapeutic effects. The free app, Relax Melodies, is a great source of soft sounds.
Whatever your source of sounds is, close your eyes and listen. At the same time, pay attention to your breathing. Are you breathing from your chest or deep in your diaphragm? Make sure you are taking deep, slow breaths from your diaphragm to get the benefits of relaxation. (For tips on deep breathing, click here).
Are your thoughts creating more stress?
Are your thought patterns related to sleeping causing more damage? Are you thinking: I need to get 8 hours of sleep everynight; If I don't get enough sleep my presentation tomorrow will be a disaster; There is something wrong with me that I can’t sleep. These thoughts can trigger anxiety, which in turn can keep you awake. Try distracting yourself:
- Mental Exercises: Mind games can be helpful, such as the A to Z game. Pick a category, (such as foods or boys first names), and list an example for each letter of the alphabet.
- Imagery: Imagery is a great tool for distraction because it requires you to imagine a relaxing scene. While laying down with your eyes closed, concentrate on slow, deep breaths. Once you are relaxed, imagine lying somewhere calming, such as a beach (or a boat, or sitting in the woods, or any place else you find relaxing) and picture all of the finite details: the sound of the waves crashing on the shore, the feel of the sand under your fingers and toes, the sound of a seagull squacking, and maybe the smell of funnel cake wafting from the nearby boardwalk. Move through the scene slowly, and try to coordinate all five senses. What do you see? Hear? Smell? Feel? Taste? Look to the left – what do you see there? Alternatively, you can imagine an earlier experience and try to recall all of the minute details. For example, during anxiety attacks, a previous patient of mine will do a mental walk-through of an old vacation home, describing to herself every detail of each piece of furniture, the color of the carpets, the pattern of the wallpaper etc.
Still can’t sleep?
Consider therapy, specifically, cognitive behavioral therapy. Research shows that psychotherapy can be more effective in treating insomnia than medication. The reason? Anxiety is one of the most common triggers for insomnia, and therapy can help the individual develop effective strategies and interventions for coping with it. Therapy can also help troubleshoot ineffective sleeping habits and replace them with more efficient bedtime rituals.