With more and more people struggling to fall asleep and stay asleep, perpetual tiredness and its fair friend ‘tired but wired’ are very common complaints. While sleep medications may offer short term relief, they don’t solve the problem, as very often falling asleep, staying asleep and enjoying replenishing sleep are linked with our perceptions of safety which are more enduring than a few nights’ supply of pills and potions.

Skill #1: Learning to reframe danger

Sleep disturbances are a common byproduct of being alive. From an evolutionary point of view, it makes sense that we would want to be awake and alert if there is the possibility of imminent danger. However, the types of threat many of us tend to face on an ongoing basis are not life and death situations, even if they feel like that in the middle of the night. We have a slight misalignment between biology and reality that trips us up and which requires conscious readjustment.

Usually the initial cause of sleep problems gives way pretty quickly to a more persistent worry about sleep itself, which then becomes a preoccupation during our waking hours and fuels our insomnia. It makes sense that the more we worry about sleeping, the less we are likely to sleep. Sleep is not a project within our control – we cannot make it happen, we have to allow it to happen – thus worry, distress and rigid control are counter to the sleep mechanism and perpetuate the hypervigilant brain-under-threat. There are many approaches to tackling problems with sleeping but by far the most successful (and arguably humane) helps a person to change his/her relationship with sleep and sleeplessness, so that it is no longer a fraught battleground.

The main instruction is to drop the rope and stop the battle. It might be unwelcome to feel tired but it is not a disaster, and many people over history have functioned reasonably well on impoverished sleep. Think of war-times or the lives of new parents. If we can adopt an attitude of restful acceptance of being awake in the night, as opposed to anxious frustration, we are at least issuing an invitation to the possibility of sleeping. Top tips for this include:

  • Catch the catastrophising thoughts and adjust them to realistic ones – remind yourself that because sleep is a biological function, your body will find a way to get the sleep it needs eventually
  • Find ways to enjoy the experience of being awake in the night more: focus on the warmth, cosiness, stillness etc. Make your bedroom into an inviting, sleep friendly space
  • Focus on your breathing and/or the physical sensations of lying in bed
  • Remind yourself that you are safe, and working on cultivating an attitude of restfulness

Skill #2: Boost other energy giving sources

The other top tip that helps to take the pressure off sleep is to bolster the other things in our lives that give us energy and help us to feel replenished. For example, we can increase our intake of water to assist the body, we can partake in regular exercise (even a brisk walk does wonders), we can reduce caffeine, particularly after lunch, ensure we eat regular healthy meals that balance out the blood sugar, and find ways to meditate. Studies show that meditation not only turns down the volume of the threat-brain, but also gives us some of the benefits of deep sleep. Most, importantly, we need to stop constructing our lives around the sleep/wake issue and carry on with our lives even if we feel the discomfort of tiredness. We need to stop the fight and preoccupation with sleep.  

Skill #3: Practice basic sleep hygiene

This means increasing the activities that promote relaxation in the hours before bedtime and decreasing those that promote stimulation. Try to ensure that the 2-3 hours before bed are wind-down hours. Ways in which you might do this are:

  • Write your to-do-list for the next day in the early evening so things you need to remember are not on your mind overnight. This is best done at least a few hours before bed, not immediately before
  • Put down screens, work, planning, difficult conversations etc 2-3 hours before bedtime and focus on things that feel soothing and relaxing such a hot bath, relaxing meditation, music, mindful activity. Believe it or not the urgent deadlines will usually wait until tomorrow
  • Avoid caffeine within at least 6 hours of going to bed
  • Reduce alcohol consumption. While alcohol may help us to fall asleep easily, it actually leads to early wakings and other sleep disturbances.
  • Use the bedroom only for sleep and sex – don’t use the bed as a home office or daytime lazing room. This helps your brain to associate it with those activities only, and not more wakeful ones
  • Design your bedroom to be rest friendly. This might mean better pillows, blackout blinds, adjusting the temperature, ear plugs, eye mask and so forth to make sleep more possible  
  • Try to go to bed and get up at fairly consistent times. Your brain and body will pick up on the routine in time

Further intervention

On a fundamental level, we might need to to look at why we don’t feel safe enough or trusting enough to allow ourselves to let go into sleep. Is our fear of failure and perfectionism getting in the way? Do we struggle to put in the boundaries that we need? Is there something we might need to change or let go of in our lives? Not all sleep problems require this level of examination, but sometimes we might need to look at the bigger issues keeping us awake.

Psychological interventions can help both to reframe danger, and minimize the thinking and behavioural patterns that maintain insomnia and also to examine the deeper issues that might be keeping us awake.