What to do if you can’t sleep.

Image of a nighttime scene of a sign with the letter “B”

I’m going to disclose a bit about myself - I’ve struggled with sleep for many years. I’m talking about weeks and weeks of not being able to fall asleep, stay asleep or having sleep that was restless and not refreshing. Many of my clients are challenged by it too. While most start therapy to address anxiety, they often report insomnia as well. Their sleep patterns have deteriorated, their active minds keep them from falling asleep or wake them up in the middle of the night, and they find themselves dreading nighttime. 

If insomnia is something you struggle with you probably have your own story of what it’s like not to get good sleep and all the anxious thoughts that show up around this. The good news is that there are lots of things you can do to move back to healthier and more restful sleep. It can be helpful to identify what makes sleep problematic for you and try some of the ideas I mention below to see if you notice a difference.

Get your body on a regular schedule to get more sleep  

This one isn’t easy for everyone but I think it is important. You can train your body to get sleepy and wake up at a regular time. You probably already know this is true because if you’ve experienced traveling to a different time zone for an extended period of time, you know that your body will eventually move to that time zone. There are two pieces you need to identify: 1) how much sleep you need to feel good and 2) the ideal time to sleep and wake based on your life situation.   

Once you’ve established a set schedule for sleep, you will need to find ways to support it.  This could mean refraining from activities that interfere with falling and staying asleep such as taking naps and afternoon caffeine. It also could mean not using a snooze button in the morning so that you get up consistently. Finally, it means sticking to your sleep schedule, especially on weekends or days that you don’t have to get up or go to sleep at a specific time  

Sometimes you will have to reset your sleep patterns by being willing to have some discomfort. After a night of little sleep, the temptation to nap may be great, but you also may know that napping interferes with your sleep pattern. Being willing to have an uncomfortable day of fatigue and irritability may be worth it if it allows your body to fall asleep at a regular time.

If you can’t sleep, get up.

A good rule of thumb is that if you don’t fall asleep in 15-20 minutes (or can’t fall back asleep when you wake up) you should get up and do something relaxing. This is important because the longer you stay in bed tossing and turning the more likely you are to become frustrated and anxious. Identify activities that are relaxing or even slightly boring. This is not a time to watch exciting movies or play video games. When you begin to feel sleepy, you can return to bed.

Create an environment that encourages sleep.

There are lots of things that can contribute to a good night sleep, this is often referred to as sleep hygiene. 

Think about where you sleep. It can be helpful to create a restful environment, one that your mind associates with sleep. This may mean removing activities other than sleep (and sex) from the bedroom. Can you control environmental factors like light, sound and temperature to better facilitate sleep? Many of my clients find it helpful to create a quiet room or space that is only used for sleep. Watching TV, playing video games, even reading, gets moved out of the bedroom. 

Think about choices you make about your body and the effect on sleep. An obvious one is exercise - the more exercise you get, the better you sleep. But also think about food, alcohol, and other substances and the effect they have on your sleep. Self-care related to sleep may mean limiting certain foods or substances. 

Finally, create an environment that allows your brain to wind down before you go to bed. This could mean limiting device usage such as TV, phones, and tablets. Identity ways to relax your body with a hot bath, some relaxation breathing or meditation. Create rituals that let your body relax and your mind slow down. 

Learn how to relate to anxious thoughts.

For many people who are challenged by insomnia, and especially those who deal with anxiety, it is important to address the thoughts that often show up and find ways to relate to these thoughts differently. You may find yourself reviewing the day and struggling with what happened or dreading what might come the next day. Or you might start having anxious thoughts about not being to be able to sleep!

When these thoughts show up it is important to have a strategy for reducing struggle with them. It can be helpful to start with relaxing your nervous system to help quiet your mind. It can also help to find ways to struggle less with the anxious thoughts that show up. This could include creating space between yourself and the thoughts, restructuring the thoughts, and getting back into the present moment. Ultimately, it is about finding ways that the anxious thoughts have less impact on you. 

All of the above steps can offer relief from insomnia and the anxiety that often accompanies it. Being thoughtful of what sleep ideally looks like, creating an environment that promotes it, and addressing the challenging thoughts that cause distress can all lead to more restful sleep.