Elizabeth Bernstein on Getting Better Sleep

On Insomnia

Insomnia often has psychological roots that can be addressed with a psychological approach. In her Mrch 23, 2021 Wall Street Journal article “Can’t Sleep? Here Are Some Surprising Strategies That Actually Work,” Elizabeth Bernstein gives helpful advice of both the psychological and the more straight physiological variety. All the quotations below are from that article.

Psychologically drive sleep problems often have a strong multiplier—a vicious loop. Elizabeth writes:

When we tell ourselves we “can’t sleep” or “won’t be able to function” the next day, we’re causing ourselves a lot of anxiety, which further interferes with our sleep.

As Elizabeth notes, the opposite attitude is saying to yourself something like: “A bad night of sleep is not the end of the world.”

Elizabeth also quotes Wendy Troxel talking about both the vicious loop and some of how the vicious loop might get started. Separating the quotations with added bullets, they are:

  • People who sleep well don’t think about sleep all the time …

  • Our brains have to feel like the world is safe and secure to be able to fall asleep … Sleep is a vulnerable state.

Whether part of getting the vicious loop started or part of keeping it going, brain scans show the brains of insomniacs as being more agitated even while actually asleep:

Daniel J. Buysse … conducted PET scans of people who sleep normally and people with insomnia. In people with insomnia, parts of the brain involved with self-reflection and monitoring the environment show higher levels of activity during sleep compared with normal sleepers.

Given how worrying too much about sleep can cause sleep problems, it is useful to know the diagnostic criteria for clinical insomnia. They are much worse than occasional insomnia:

insomnia … difficulty falling or staying in sleep three or more times a week, and … lasts a month or longer, leading to daytime consequences, such as fatigue, mood changes or difficulty concentrating.

And it should be reassuring that if you ever do get serious insomnia, there are fairly effective psychological treatments:

… the American Academy of Sleep Medicine … recommended a series of treatments collectively known as cognitive behavioral therapy for insomnia, or CBT-I.

…

CBT-I focuses on breaking this loop by helping us change the thoughts and behaviors that are counterproductive. Research shows it may have lasting effects—not just fixing our sleep problems in the present but helping us form a sort of sleep resilience. A study conducted by Dr. Cheng and colleagues and published online in November in the journal Sleep found that people who received CBT-I years ago have been sleeping better and have better mental health during the pandemic than those who did not.

Several psychological approaches are easy enough to try even before you are willing to consult a sleep therapist. Philip Cheng suggests this:

Sometimes we worry because our brain is telling us to not forget something,” says Philip Cheng … If you write your worries down during the day, “when worry comes at night you can tell yourself you’ve already documented it.”

Elizabeth points to cultivating gratitude as something that can help:

… think about the things you are grateful for, or savor your favorite moments from the day. This will train your brain to associate the bed with pleasant thoughts.

And Elizabeth tells the story of an app she has (which she does not name), that uses reverse psychology. The voice on the app intones:

Resist! Resist! Resist the temptation to close your eyes, even as they feel heavier and heavier! Remember your goal here is to remain awake.

My Practice

I don’t have serious sleep problems, but I do try to have good practices in relation to sleep that might be helping me to avoid problems. Here are some things I think can be helpful, but take them all with a grain of salt:

  • Most drugs marketed as sleep aids are quite nasty and to be avoided. The exception is melatonin, which is fairly safe—at least by comparison. The next safest might be benadryl, which is in many cold remedies.

  • It is a myth that everyone needs 8 hours of sleep. By experimentation, I have figured out that I need between 7 and 7 and a quarter hours. How can you determine how much you need? If you feel alert and good except for the witching hours when it is totally normal to feel sleepy: (a) right when you wake up, (b) right before it is bedtime and (c) in the mid afternoon. If those are the only times you get sleepy, you are probably getting enough sleep. If you try to sleep for more hours each day than you need, after a while you are likely to have a wakeful period in the middle of the night.

  • The previous bullet was about a sign you are getting enough sleep—even if you sleep less than 8 hours. On the other side, a way to tell that you are sleep-deprived, getting too little sleep, is if you fall asleep instantly when you lie down or are quite relaxed.

  • Keeping the lights as low as possible for several hours before bedtime can be helpful. I find the common advice of avoiding screens much too painful to follow. But I keep the room lights off for at least 4 hours before bed and only have light from screens. Blue light interferes with sleep most. Many devices now have modes that dim the screens and reduce the blue-light content of the remaining brightness. Adjustable nightlights allow me to brush my teeth without the help of the room light.

  • In addition to light interfering with getting to sleep, it can wake you up too early. It isn’t easy to make light-blocking curtains work in my bedroom, so I wear an eye mask except in winter, when it stays dark late enough in the morning that I don’t need to. (Some people are sensitive enough to light they’ll need lot-blocking curtains or an eye mask year round.)

  • I have come around to the view that getting up at close to the same time every day is helpful for sound sleep. The experts say it is even more important to standardize your wake-up time than it is to standardize the time when you go to bed.

  • Something I don’t have to think much about because I have a short eating window each day is that it will help you to sleep soundly to stop eating many hours before you go to bed. The reason is simple: heavy-duty digestion can disrupt sleep.

  • Finally, to help calm my mind I use a meditation app at night (in my case “10% Happier”) and throughout the day use the Positive Intelligence tools I talk about in these posts:

For annotated links to other posts on diet and health, see:

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