Lately, I suffered from insomnia for about two months during a stressful season. About two to three nights a week I ended up staring at the ceiling for at least 2 hours. At the worst point, it took me six hours to fall asleep.
I had previously not found sleep interesting. It was just something necessary. As a way to improve my own sleep, I listened to podcasts about sleep with researchers like Prof. Matthew Walker (this Sam Harris episode) and Dr. Samer Hattar (from this Andrew Huberman episode). I had always had trouble falling asleep, mostly taking from 20 to 45 minutes. After listening to these podcasts, I applied few of the recommendations as they seemed to ask too much of me. That changed when I started experiencing insomnia.
Insomnia is diagnosed by self-report although sleep studies may be required to rule out other sleep disorders (which may require medical attention). Taken from slide 7 of this document by Prof. Virginia Runko, the DSM-5 defines insomnia as:
- Complaint of sleep quantity or quality associated with problems falling asleep, staying asleep, and/or early morning awakenings
- The sleep problem causes distress and/or some sort of problem at work, with others, etc.
- The sleep problem occurs at least 3 nights/per week and has been going on for at least 3 months
- The sleep problem occurs despite adequate opportunity for sleep
- The insomnia is not better explained by another sleep disorder, is not caused by the effects of a substance, and is not adequately explained by coexisting mental disorders or medical conditions
While you may have experienced insomnia for less than 3 months, it is not too early to get help or learn how to rectify it!
I know that my bout of insomnia was caused by anxiety (as discussed in "Let’s Talk a Bit About Anxiety"). While I am working on learning to accept and reduce anxiety, in times of sleeplessness, direct action on insomnia-related behaviour is also required. There are a number of things that I was doing wrong which helped persist my insomnia. I have now learned that in order to get good sleep, I must follow the following guidelines:
- If after 15 minutes you have not fallen asleep, get up. Do something not too stimulating. I like to read or listen to a podcast. Staying in bed longer than 15 minutes will condition you to link your bed with staying awake and often, the emotions of not falling asleep (anxiety, anger etc). Your bed should only be used for sleep or sex. Classical conditioning is a real thing and affects us all, no matter whether we realize it or not. This was the most critical actionability point for me.
- Have a relaxing routine for 60 minutes or so before your planned bedtime. Avoid screens or at least turn the brightness way down (if on a mac, use QuickShade to lower it further than you normally can) and reduce the blue glow of the screen (NightShift on MacOS or Flux on any other OS)
- Have a consistent bedtime.
- When first starting to regulate your sleep in times of extreme insomnia, do not allow yourself to nap. The fatigue will help you fall asleep in the next sleep period.
- Keep a sleep log to assess and track the quality of your sleep. For insomnia, the important ratio is that of sleeping time to time laying down in bed (awake or asleep). The goal is to reduce as much as possible the awake time in bed. Below is an example of my diary, edited from this excel file created by the University of Pennsylvania Medical School. This online calculator can also help you assess your sleep efficiency on a daily basis.
My post-insomnia night-time routine is now the following:
- Shower and clean teeth while becoming aware of any stressful thoughts.
- Meditate for 10-20 minutes.
- Stretch for 3-5 minutes to relax any tensed muscles.
- Listen to a podcast or read. This helps to get the mind tired.
- Go to bed and do a progressive muscle relaxation, tensing up sections of your body for 5-7 seconds and then relaxing them for 20 seconds. Slowly make your way through your whole body. This helps to relax and feel even more sleepy.
- Fall asleep in less than 10 minutes! If you fail, get up and try again in 30 minutes.
If you have been suffering from insomnia for longer than 3 months, it may be wise to seek a medical evaluation. Sleepless nights will cut your life shorter. A long-term aid to treating insomnia is reducing your stress and a daily 15 minutes routine of cognitive behavioural therapy (CBT) also cannot hurt.
Thanks for reading!