Sleepless in America

Healthy rest, problem sleep, and the dreams and nightmares therein

Mindful Sleep

Mindfulness meditation can help people reduce stress and fall asleep.

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In order to be able to sleep, we have to be able to relax and let go of the day’s stress and tension. We can’t make ourselves sleep; we can only allow sleep to occur. Trying to sleep only results in greater difficulty falling asleep and when this becomes a nightly pattern, contributes to insomnia. Insomnia consists of difficulty falling and staying asleep and results in daytime symptoms such as low mood, irritability and poor memory. The harder we try to sleep, the more distant sleep seems to become. Throughout human history people have struggled with poor sleep and its daytime consequences.

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It is no different today. Not only is insomnia the most common sleep disorder, but during the Great Recession and in the era of economic difficulties that have continued after the official end of the recent recession, rates of insomnia significantly increased. This most likely is the result of increased stress levels in society.

Insomnia is often treated with medication, either over the counter or prescribed. Despite the popularity of medication for treating insomnia, many people have poor results, unacceptable side effects, or prefer non-medication based approaches. Training in relaxation techniques and other cognitive behavioral strategies have proven effective in helping people fall asleep. Some common relaxation techniques include diaphragmatic breathing, progressive muscle relaxation and guided imagery. In addition to being a method of meditation, mindfulness is also used by many to relax and reduce stress. Mindfulness is being aware of our experience moment-by-moment, in the present moment. Practice of mindfulness can make us more aware of the functioning of our minds and decrease our reactivity to our negative thought processes.

Mindfulness meditation is based on meditation techniques that are used in Buddhism to help increase mental focus and improve moment-to-moment awareness of thoughts and experience. Thich Nhat Hanh, the Vietnamese Buddhist leader who was nominated for the Nobel Peace Prize by Martin Luther King during the Vietnam War, originally introduced it to the West.

I recently had the opportunity to attend the Harvard Medical School continuing education program, “Meditation and Visualization” taught by Daniel Brown, Ph.D. Dr. Brown is deeply knowledgeable about mediation, especially in the Tibetan Buddhist tradition. This workshop emphasized the use of mediation to sharpen concentration, to reduce negative states, and to cultivate positive states. Dr. Brown noted that the form of mindfulness meditation that is most often taught in the West today is based on ancient Buddhist meditation methods but was formulated in its modern form in Burma about a hundred years ago.

According to Brown, Burmese mindfulness meditation is a hybrid and combines both awareness and concentration training. In this approach concentration is increased and stabilized by focusing on the rising and the falling of the breath or some other focus of concentration such as a mental image. This decreases thought activity and provides a focus for the mind. Moment to moment awareness is then facilitated by labeling mental processes with descriptors such as “thinking”, “sensing”, “feeling”, and “hearing” – as they occur. I have found the lecture series by Dr. Mark Muesse (2011) on Mindfulness to be a very good introduction to this approach. There are also apps to help people meditate.

Mindfulness has been an increasingly important tool in mind/body medicine and clinical psychology for over 20 years. Jon Kabat-Zinn at the University of Massachusetts introduced mindfulness into clinical practice in the 1970’s. Marsha Linehan used it in dialectical behavior therapy, the first empirically supported treatment for borderline personality disorder. Stephen Hayes used mindfulness as a core component of acceptance and commitment therapy (ACT). Mindfulness is increasingly being incorporated into cognitive-behavioral approaches to therapy and behavioral medicine. Mindfulness has been applied to coping with illnesses such as chronic pain and other chronic medical conditions as well as with psychiatric disorders such as depression, anxiety and addiction. For an example, see Orsillo & Roemer (2011) for an approach to treating anxiety that uses mindfulness.

One way in which mindfulness techniques differ from classical cognitive therapies is in their approach to coping with symptoms. In cognitive therapy patients are taught to increase their awareness of their internal self-talk so that negative cognitions and ineffective patterns of thought can be identified and challenged. In mindfulness practice patients are taught to not avoid negative thoughts and states but to be aware of them in the present moment in a curious and compassionate way. Patients become more aware of their negative thought patterns and how they are mentally focused on negative experiences. By doing so it is possible to have greater awareness of habitual thought processes and to respond more effectively to the stresses and challenges of day-to-day life. By not avoiding challenging or frightening situations people can be open to a wider range of more fulfilling experiences.

Mindfulness meditation was developed as a training method for increasing concentration and awareness. It can help focus the mind and decrease stress and so can be a useful technique for improving sleep. Jon Kabat-Zinn (1990) described the use of mindfulness in helping cope with sleeping problems in his book, “Full Catastrophe Living”. Kabat-Zinn details how the foundations of mindfulness practice lie in proper attitude and commitment to regular practice. He noted that the basic attitudes underlying successful practice are: non-judging, patience, beginner’s mind, trust, non-striving, acceptance and letting go. These attitudes can be very helpful when you consider that falling asleep requires relaxing, “letting go” and allowing sleep to occur.

A standard description of mindfulness meditation recommends getting into a comfortable position, perhaps sitting erect in a chair and beginning by clearly focusing on the intention to practice mindfulness. A mental focal point is needed and the breath is often used. The breath is very useful because as long as you are alive, it is always available as a focus. Just focus on the rising and falling of the breath. This begins to calm the mind and the body. This focus can be on the sensations associated with the breath, such as the coolness of the air as you breathe in and the warmth of the air leaving you as you exhale. You can also pay attention to the sensations in the chest and how they change as you breathe in and out. Notice the sensations of breathing as the breath rises and falls. As you do this it won’t take long for your mind to wander and when it does and you become aware of it simply and non-judgmentally return to the focus on the breath. This helps to develop concentration. It is important to be non-judgmental and thus non-critical as you are learning to be more mindful and focused. As thoughts come to mind just note them and label them, “thinking” and return to the focus on the breath. Daily practice of mindfulness will help improve mental awareness and focus.

There are many ways mindfulness meditation can be practiced including mindful eating. Some examples of guided meditations can be found at the UCLA Mindful Awareness Research Center site. A classic mindfulness meditation exercise is to mindfully eat a single raisin. You begin by noting the texture and color of every part of the raisin. This can take some time and you begin to become aware of how little you are usually aware of as you mindlessly toss a handful of raisins in your mouth and barely notice the flavor or texture of this dried fruit. After fully examining the raisin, place it in your mouth and note the taste, texture and mouth feel as you slowly and deliberately chew the raisin. Note how the flavor changes and persists even after swallowing. While doing this and remaining focused on the experience of the raisin, if thoughts about something else arise simply refocus on the experience of the raisin as soon as you are aware that you are drifting away from the immediate experience in the present moment. If you begin to judge the experience such as “this is a good raisin”, simply label this thought as “judging” and return to the direct experience of the raisin. This exercise is designed to help develop more focused awareness of direct experience in the present moment and may be relaxing, but obviously does not directly cause relaxation or encourage sleep. For that other mindfulness exercises are more helpful.

A simple meditation for sleep that was recommended by Kabat-Zinn is to focus on the breath while lying in bed as you are preparing to go to sleep. Follow the breath moving into and out of the body. As you are being aware of the breath just allow yourself to sink into the bed with each breath. He further suggests imagining breathing out to the ends of the universe and breathing from there back into your body.

By taking this mindful attitude, sleep is facilitated by simply being aware of the moment-to-moment experience of relaxing into the bed, without judging or being critical of that experience, so that the mind can gently slip into sleep. Practice of mindfulness meditation during the day can help focus the mind and decrease stress by reducing negative thoughts about the past and needless worries about the future. And that, combined with bedtime relaxation, can help you get the Zzzzs you’ve been looking for.

Hochman, D. (2013). Mindfulness: Getting its share of attention. The New York Times, November 1, 2013.

Kabat-Zinn, Jon. (1990). Full catastrophe living. New York: Delacorte Press.

Muesse, M. W. (2011). Practicing mindfulness: An introduction to meditation course guidebook. Chantilly, Va: The Teaching Company.

Orsillo, S. M. & Roemer, L. (2011). The mindful way through anxiety. New York: The Guilford Press.

 

 

John Cline, Ph.D., is a clinical psychologist, Diplomate of the the American Board of Sleep Medicine, a fellow of the American Academy of Sleep Medicine and a clinical professor at Yale University.

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