Adventures In Therapy: Part 3 – Insomnia
What I’ve learned about dealing with Insomnia & Anxiety.
A terrible twosome, these two conditions can go hand in hand, often with Depression rounding out the trifecta. It could be finding it hard to go to sleep because of racing thoughts and elevated heartbeat or just lying awake in the middle the night worrying about everything that has happened, might happen or should have happened. And of course there’s the anxiety of “I should be asleep, I’m not asleep and NOW I AM ANXIOUS.”
I got asked by a pal a couple of months ago for some tips on dealing with insomnia, and it turned into a full length post, so I figured I’d share it. It might help someone, it might not, and I don’t think there’s anything harmful in here. If you’re a sleep professional and something I’ve shared is wrong or dangerous, please let me know!
These are some things I try to do that work for me, and some things I’ve tried that didn’t work for me but may well work for you. I’ll start with the absolute basics that any website or doctor will tell you. You’re probably already doing some or all of them, but they do help, and sometimes it’s good to see everything all laid out.
Please remember that even though I’ve gotten some of this advice from doctors or therapists, I am not in any way a medical professional, so if you’re concerned about anything I’ve said here, let me know and contact your own doctor for clarification! I’m also aware that if you’re in the depths of it, some of this stuff can be just Too Much. Try something small, see how you go, and then try the next thing.
This is one I’ve read a lot on. It doesn’t mean making sure you wash your teeth before bed (but, you know, do!), it’s just common sense steps to make sure you’re putting yourself in the best situation to get to sleep. What good sleep hygiene can do is help prepare your body and mind for the fact that it’s time to go to sleep, and it helps you avoid some stuff that would hinder good, healthy sleep.
Having the same bedtime and getting up time, even at the weekends, is a good way to get your body clock working right. I know it is hard, and it’s totally tempting to sleep in at the weekend to catch up, but routine will help your body to start feeling sleepy at bedtime, which is half the battle! Shift workers, I’m sorry, I have absolutely no experience of this, but I know there are some strategies about bedtime etc that reduce the awfulness somewhat.
Speaking of bedtime, how much sleep do you actually need? Count back from when you need to wake up and give yourself time to get enough sleep. Some people do fine with 6 hours, some people need 9. Remember that it takes most people up to 20 minutes to fall asleep, so factor that into your calculations. (It takes me over an hour to get to sleep on a good night and I still haven’t learned to factor that in!)
Pre Bedtime Routine
Work out a routine of the same stuff to do every night at bedtime so you’re getting your brain and body trained that it’s bedtime. Getting your stuff laid out for the next day, putting on the dishwasher, meditating, having a glass of milk, brushing your teeth, whatever – make a lil routine of simple stuff to do every night, start it in the lead up to bedtime. Set an alarm for up to an hour before your actual bedtime so that you can start getting ready.
My routine *should* look like this. The vital steps for me are putting screens away, taking a look at what I need to do for the following day and laying out clothes (and brushing my teeth), but if I have the headspace for the full list, it definitely helps me prepare for sleep. Yours could look completely different, but it’s what works to help you get ready for sleep that’s what’s important.
- Put Screens Away
- Prep breakfast for next day (if I’m doing overnight oats)
- 20 Minutes max tidying – clear off kitchen counter, run the dishwasher, put away laundry.
- Work on my Bullet Journal – what I did today, what I need to do tomorrow.
- Lay out Clothes for the next day and any stuff I’ll need (choir music, stuff for work etc)
- Change into my PJs
- Wash and Brush my teeth.
- Read in Living Room if I have a few minutes left.
The Best Bedroom
- Try to keep your bedroom for just sleeping and sex if possible.
- Working, watching TV etc is good to keep outside of bed and your bedroom.
- Keep the temperature relatively cool in the room too, and don’t have lights too bright.
- Well ventilated is good, stuffy is bad, cosy is awesome.
- Lavender oil can be relaxing.
- Wash your bedding at least semi-regularly.
- If you can afford it, get new pillows that you are comfy with. New pillows are the bomb.
- Sometimes, if you’re sharing a house, your bedroom is the only place in you have to relax in – in this case, maybe there’s a configuration of seating/desk that you can use for chilling and then move to bed only when it’s bedtime.
Screen free time
Keeping screens to a minimum before bed is a good idea, whether it’s your phone, tv, laptop, tablet or whatever.
The science is that the light is often blue which tricks the brain into staying awake, plus the common sense is that they can be over stimulating.
If you can keep screens out of the bedroom altogether. even better. My boyfriend has my phone set up to disconnect from the Internet at midnight. I hate it, but it helps me to set the phone aside and get ready to chill.
Don’t check your work stuff late if you can avoid it. If I check my work email before bed I’m guaranteed to get a stinker that will have me up half the night worrying about it. I also try not to check the news before bed for this reason – it’s hard to sleep when you’re vibrating with rage at the unfairness of the world.
Exercise is good for tiring the body out, but try not to work out too late. Trying to get from pumped to sleepy is not an easy job. Aim to have your workout finished at least a couple of hours before bed. Even if you’re not willing or able to exercise, 20 mins moving in the fresh air a couple of hours before bed could help your body work off some energy.
Try not to eat dinner too late, a full belly can lead to disturbed sleep. If you need to eat before bed, something light with slow release energy might be better. Like peanut butter on toast for example. While you don’t want to be over-full going to bed, being hungry isn’t going to do much good either.
Caffeine: I can’t drink caffeine after lunchtime or I won’t sleep. I also know that a second cup during the day will result in difficulty. Everyone’s intake and ability to process is different. You know yourself where your cutoff during the day is. Try to stick to it. The same goes for sugary drinks, even if there isn’t caffeine involved.
Alcohol is also not particularly good for sleep. Avoid overdoing it especially late at night. Sometimes a glass or two of wine will knock me right out but I’ll wake up with major sweats and find it nearly impossible to fall back asleep. Passing out drunk from alcohol is not falling asleep. You will know the difference in the morning. (Ughhhhhh)
I know new medication for anxiety/depression can take a good few weeks to bed in and start working. Are you taking your meds morning or evening? Might it be worth trying the opposite for a while to see if that has a positive effect? Chat to your doc if your medication is making your sleep worse. There might be an alternative that works better for your needs. I know, for me, personally, the few months I was taking Mirtazapine* for my depression, I slept like a VERY sleepy baby. Here are a few different things you can take that might help you sleep a little better.
A last resort, but your doctor might prescribe them if you’re having serious issues. If you’re going this road, work with your doctor on it. They can be useful for kicking your sleep cycle back into the right time zone, but they’re not good for longer term use, and this should be avoided if at all possible. You take them just before you hop into bed and they will work to knock you right out.
I’ve taken them on occasion, usually in the middle of the night when I know I’m not going to be falling asleep, and I always end up quite groggy the next day, which can be hard to shake. I also find I’m not quite as well rested as I would be from a night of natural sleep. If you’re genuinely at the end of your tether and going through a period of very bad/ no sleep, chat to your doctor about getting a short term course of sleeping tablets.
The Other Stuff
Herbal alternatives like valerian or hops tablets. This is stuff you can get in any pharmacy. They work for some people by helping to calm you down and work towards making you feel sleepy. They are nowhere near as strong as sleeping tablets and as far as I know, can be used longer term without issue.
Melatonin Tablets Again can be useful to get your sleep cycle into the right gear if you’re really out of whack it’s available on prescription in Ireland, but just get a pal to bring you some from the States. Cheap as chips!
Cannabis Anecdotally, I’ve heard of pals who have used cannabis to help them sleep. It can chill you out and make sleep come more easily. But after a while, your body can start depending on it to sleep and nobody wants to be that guy.
Hot Drinks Some people need a hot drink before bed, but your Barry’s or Lyon’s might not be the cup of tea you need. Decaf tea doesn’t taste as nice as the real stuff, but it can do the job. Herbal teas are a nice alternative if you are open to them. A caffeine free mix could be worth trying if something like chamomile isn’t something you find tasty. Celestial Seasonings do a range of Sleepytime teas which are cute and could be something that you include in your bedtime routine. FYI, green tea does contain a bit of caffeine, so might not be your go-to before bed. Hot chocolate is an option – milk is sometimes good for promoting snoozes – but be mindful of the sugar content. Maybe just flavour your milk with some cocoa or vanilla rather than doing full on chocolatey marshmallow madness.
Quieting Anxiety enough to go to sleep
Some ideas for getting the anxietybrain to shush so you can fall asleep:
Meditation, mindfulness, breathing exercises – these can be super helpful and if you haven’t tried them before it’s worth a shot. Work them into your bedtime routine help ol’ brainface chill the feck out.
Podcasts – I’m not talking My Dad Wrote a Porno here. No round table yelling, please! here are few that are designed as going to sleep meditation type things that some humans swear by but I love one called Sleep With Me podcast. It’s this guy who tells odd but boring stories in a quiet, boring voice. It’s very odd but it’s just enough to get your brain to half listen to while you’re in bed so it can’t start whirling. Again, you might hate it, but it’s worth a shot.
Worry time – this one sounds counter productive, but giving yourself a chunk of worry time early in the day where you’re allowed to worry can actually get it out of your system a little so you are less antsy come bedtime.
What to do if you still have trouble sleeping.
If you haven’t fallen asleep and are getting to the point where you’ve started obsessing about the clock and worrying about not being asleep yet, here are some things you can do.
Check in with your body/brain.
- Am I thirsty? (If yes, grab a drink of water)
- Am I hungry? (A small snack with slow release energy might help)
- Do I need to pee? (Go, pee)
- Am I experiencing pain or discomfort? (Can I find a way of lying that reduces this? Should I stretch out or try some painkillers?)
- Is there something distracting me? (Ear plugs/ Eye mask if you can stand them)
This one might sound counterintuitive, but if you’re really anxious and watching the clock, then get up for a little while. Go sit in the living room in low light or darkness and do something really boring like read some really dry technical manual or count your spoon collection. Don’t get tempted to be productive and check work email or have a quick game of FIFA or an episode of Kimmy Schmidt – do something BORING for a while until you start feeling sleepy again and then head back to bed and try again. Rinse and repeat as needed.
After Insomnia – What to do after a bad night
Its tempting – oh so tempting – to lie in. Try to get up at your regular time, you’ll be more likely to sleep the following night. If you need to nap, power nap. Make it a short snooze, not too late in the day. Long snoozes leave you groggy. Late naps mean more sleep problems.
Here is a list of resources/ courses that have helped me (or have been recommended to me) either deal with anxiety to the point that sleeping was easier, or else are directly insomnia and sleep related.
Insomnia Clinic – Clinic specialising in insomnia and sleep issues – held in Dublin (or Cavan on request)
Occupational Therapy – I was referred to an Occupational Therapist to help me work on ways to deal with my insomnia. She helped me learn about Sleep Hygiene and was generally lovely – she rang me out of the blue months after I left her care to see how I was getting on. You might not always get a Suzanne, but an understanding OT can be very helpful!
WRAP Program – I will never stop banging on about the WRAP (Wellness Recovery Action Plan) programme. Basically, it’s a way for you to identify the signs that show you’re starting to struggle and a way to provide a toolkit of ways to help you get yourself back to a healthier place. It’s definitely not a crisis intervention – it’s a longer term framework to help awareness of your own mental health. The website is very American, but I firmly believe this stuff should be taught in secondary school. I got access to this programme via my referral to HSE Mental Health Services in Darndale, so it’s worth talking to your doctor, psychiatrist or occupational therapist.
The other one was a CBT (cognitive behavioural therapy) based course I did (again HSE based). This one was awesome and helped me with how to deal with anxiety itself (what triggers it, what to do with the thoughts when they happen etc). It might be worth chatting with your doc to see if there’s anything local you can get referred to.