I spend a good part of my hours as a clinical psychologist helping people repair their sleep. The approach I use is called Cognitive Behavioral Therapy for Insomnia (CBT-I), the first-line treatment for chronic trouble sleeping.
When we're struggling to fall asleep, our thoughts are good at going in unhelpful directions—mine as much as anyone's. Even though I recognize the mind's tricks when I'm lying in bed unable to sleep, I can still get caught up in them.
Thankfully the "C" in CBT-I focuses on lessening the power of these thoughts; the first step in any form of cognitive therapy is simply to identify what our minds are telling us.
So what are some of the common unhelpful thoughts that crop up with insomnia? Below are seven that I frequently encounter in my practice:
1. "I won't be able to function tomorrow."
Most of us worry that a bad night's sleep will hurt us the next day. We might worry that we'll fall asleep in meetings, will be miserable all day, or won't even be able to work. While it's true that insomnia is linked to lower performance on some tasks, the effects tend to be small, and there's no significant effect on other cognitive and physical tasks. Perhaps surprisingly, there is actually a very small correlation between insomnia severity and excessive daytime sleepiness. In fact, most people (myself included) report that after a really bad night's sleep, the next day may be a little rougher, but isn't the disaster they feared. There may be times when we feel quite sleepy, but other times when we feel alert, and we can get through the day just fine.
2. "I'll have to cancel my plans."
The fear of "paying" for bad sleep can lead to worrying that you won't be able to do the things you'd planned the next day. This worry about canceling can add to your distress about not being able to sleep. But we're usually fine keeping our plans—any effects on our enjoyment or performance are likely to be small. We can also relieve some of the pressure we feel about getting to sleep when we know we'll keep our plans either way.
3. "Insomnia is destroying my health."
It seems like every week another study comes out showing that insomnia is linked to bad health outcomes—fibromyalgia, GI problems, and chronic pain, to name just a few. And while there are significant links between insomnia and poor health, it's often not clear whether medical problems caused the insomnia or vice versa. (Often the effect runs in both directions.) Additionally, it's often hard to tell whether it's the insomnia per se that's causing health problems, or the conditions that tend to go along with it, such as depression. So while it's true that insomnia isn't good for us, in the middle of the night we tend to magnify just how bad it is.
4. "I have to get 8 hours of sleep every night."
If you've laid awake in bed before, you've probably checked the clock and done some calculations: If I fall asleep now, I can still get 7 hours of sleep... Now the most I can get is 6! I'm going to be a wreck if I get less than 5 hours' sleep, and will have to reschedule my plans. Eight has become the "magic number," and yet in reality there's a wide range in optimal sleep duration. The National Sleep Foundation recommends 7 to 9 hours per night for most adults (7 to 8 for older adults), with some individuals doing fine on just 6. Thus we may be giving ourselves more time in bed than we're actually able to sleep—which can fuel insomnia.
5. "I have to catch up on the sleep I've missed."
When we have a night of insomnia, we often try to make up for lost sleep by napping, sleeping in, or going to bed early the next night. However, it's generally counterproductive to try to recapture lost sleep. By giving ourselves even more time in bed, we're likely to spend more time awake and worrying about why we're not sleeping—making it even harder to break the cycle of insomnia. Sticking with our normal sleep schedule is a safer bet.
6. "There's no way I can sleep without medication."
This belief is understandably greatest if we've ever depended on sleep medication for a long time. In the short-term, discontinuing a drug for sleep tends to lead to rebound insomnia, which reinforces the belief that the drug is necessary. Obviously, medication can be helpful: Research has shown that people who received CBT-I did better in the short term if they also took zolpidem (Ambien). However, the best outcomes were among those who tapered off their medication after the acute treatment phase. Additional research found that CBT-I can help with discontinuing a benzodiazepine prescribed for sleep, like clonazepam (Klonopin). Thus, even those who benefited from medication initially may, with the right therapy, sleep better off the medication.
7. "I need to try harder to fall asleep."
We do better in most things when we try harder—sleep being a notable exception. When we're unable to sleep and worried about the consequences, we often start working to make ourselves sleep—in some way trying to fall asleep. We might try to find that one surefire trick that will knock us out, or force ourselves to relax enough that sleep takes over. However, sleep and effort are not friends, and trying to force sleep will only push it further away. The best we can do is to create the conditions that tend to bring on sleep and then let go of the outcome—which isn't really in our hands, anyway.
4 Ways to Challenge Exaggerated Sleep-Related Thoughts
Each of these thoughts is based on a partial truth that the mind exaggerates. It can be hard to push back on these thoughts, though, especially when we're panicked about falling asleep. If some of these beliefs resonate with you, here's a plan for addressing them:
1. Place a pen and paper on your bedside table.
When you can't fall asleep and your mind starts to churn, take a few moments to jot down what it's telling you. Don't worry for now about figuring out whether or not the thoughts are true. (For more on identifying thoughts, see this post.)
2. The next day, choose one of the thoughts and take a closer look at it.
What is the evidence that supports it? Is there any evidence that doesn't support it? Chances are you'll discover some inaccuracies in the thought.
3. Repeat the exercise with your other distressing thoughts about sleep.
4. After practicing in the clear light of day, begin to challenge your thoughts in "real time" as you lie in bed.
Based on your knowledge and experience, how accurate are the thoughts? Are there alternative ways of thinking that are more valid?
Here's what this process looks like:
Example for Challenging Thoughts
Thought: "Tomorrow's going to be a disaster if I don't fall asleep soon."
- On days I've slept really badly, I've tended to be somewhat irritable.
- I'm not always as sharp at work after a night like this.
- I can't think of any times I haven't been able to get through the day.
- I'm usually surprised that things are basically OK.
- I've been all right on less sleep than I could get tonight.
How accurate was the thought?
- There's a kernel of truth to it—I don't tend to thrive after a poor night's sleep—but it's never been as bad as I fear it will be.
More accurate thoughts:
- If I sleep really badly tonight, tomorrow may be a struggle at times.
- I've had hundreds of bad nights where I worried about the next day, and so far there haven't been any true disasters.
- Based on past experience, I'll still be able to function tomorrow, even if I'm not at my best.
For countless individuals, sleep often doesn't come easily, and the mind starts to spin tales. By recognizing and examining these stories, we can start to reshape the way we react to sleeplessness. Over time this practice can repair one of the major components of troubled sleep.
Do you have insomnia? Consider looking for a CBT-I provider today, starting with your doctor, insurance network, or the Psychology Today database.
The information presented here summarizes research findings and the author's clinical observations, and is not intended as medical advice. Every individual is somewhat different. Never ignore professional advice or delay seeking it because of something you have read on the Internet.
Morgenthaler, T., Kramer, M., Alessi, C., Friedman, L., Boehlecke, B., Brown, T., ... & Pancer, J. (2006). Practice parameters for the psychological and behavioral treatment of insomnia: An update. An American Academy of Sleep Medicine report. Sleep, 29, 1415-1419.
Morin, C. M., Blais, F., & Savard, J. (2002). Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia? Behaviour Research and Therapy, 40, 741-752. doi:10.1016/S0005-7967(01)00055-9