Happiness in this World

Reflections of a Buddhist physician

Insomnia

A unique technique for falling asleep

Photo: Carlos Martz
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Whatever its cause, few things interfere with our waking lives like the inability to sleep at night. Insomnia has multiple causes: anxiety, depression, and medications, just to name a few. I find myself unable to sleep when I'm excited about something (if I'm anxious, I drop off right away—unlike most of my patients). Some people have primary insomnia, meaning we can't identify any precipitating cause. These people tend to report a lifelong struggle with falling asleep.

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Studies show good sleep hygiene in most cases is just as effective as sleeping pills, which in general are only moderately helpful. But one study suggests a counterintuitive method that I've personally found quite helpful: making a list of everything for which I feel grateful.

Feeling gratitude seems to improve sleep by reducing negative thoughts at bedtime. Gratitude, in other words, is distracting—and distraction is especially helpful in combatting insomnia given the fact that once a person develops insomnia, anxiety over an inability to sleep itself promotes wakefulness. Any technique that distracts us from worry, in fact, is useful.

This was suggested in a study by Nancy Digdon and Amy Koble, who took forty-one undergraduates with poor sleep due to disruptive thoughts and taught them one of three interventions designed to distract them: constructive worry, imagery distraction, and gratitude. Constructive worry "involved setting aside 15 minutes earlier in the day (before 8:00 p.m.) to write out worries and concerns that were likely to interfere with sleep and steps toward their solution. If students started to worry at bedtime, they could remind themselves that they had already devoted time to these concerns, and that they could do so again tomorrow when they were less tired and better able to think of good solutions."

Imagery distraction involved having the subjects "close their eyes and imagine a situation that was interesting and engaging, but also pleasant and relaxing (such as a holiday, beautiful summer afternoon of leisure, or a special family occasion), but not too arousing (such as a sexual encounter or an exciting sporting event)."

Participants in the gratitude intervention arm were told that "people’s moods at bedtime can affect how easily they fall asleep. When people are under stress, it is common to be preoccupied with worries and concerns, and to ignore recent positive experiences. If people shift their attention so that they spend more time thinking about positive events, then people should be in a better mood at bedtime and be able to fall asleep more easily." They were then instructed to "schedule a daily 15-minute session in the early evening when they could write about a positive event that has occurred lately or that they anticipated would happen in the near future. They were to write about the event itself, and about how they felt at the time... their writing would be private, and for their benefit only. They were asked to write about events rather than just think about them because the intervention would be more effective when done in writing than just in their heads. Writing leads to a deeper level of processing that has a more prolonged effect on moods."

The study showed that all three interventions decreased the participants' level of pre-sleep arousal. Though this didn't lead to the participants falling asleep more quickly, it did lead to a better quality of sleep. In my case, thinking back over the things that happened during the day for which I feel grateful as I'm lying in bed (as opposed to writing them down before bed) has proven a remarkably effective technique. Imagery distraction works for me not quite as well, and constructive worry not at all (but this may be because, as I mentioned, anxiety isn't what keeps me awake). If you suffer from insomnia, I'd offer these techniques as things to try to see which, if any, work for you.

 

Dr. Lickerman's book, The Undefeated Mind: On the Science of Constructing an Indestructible Self, is available now. Please read the sample chapter and visit Amazon or Barnes & Noble to order your copy today.

Alex Lickerman, M.D., is a general internist and former Director of Primary Care at the University of Chicago and has been a practicing Buddhist since 1989.

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