Sleep problems are prevalent, and can take a significant toll on well being. Thus, this month’s article focuses on mind-body approaches to address occasional and chronic insomnia. Last month, I wrote about the most common herbal and nutritional supplements for insomnia. Mind-body approaches are especially important tools for treating sleep problems because they are considered safe, have demonstrated evidence of benefit, and do not interfere with other treatments such as medications.
The Many Faces of Insomnia
Although we tend to use the term ‘insomnia’ to describe any problems associated with sleeping, some are thought to be biological in origin (such as sleep apnea and circadian rhythm disorders). Other problems are thought to have more of a psychological and/or behavioral origin, such as difficulty falling asleep, waking several times in the middle of the night, or waking too early. Frequent barriers to sleep include ruminating over past mistakes or worrying about the future. Pain or muscle tension may also vie for one’s attention as soon as the distractions of the day are gone. Poor sleep hygiene can also cause or exacerbate insomnia (see last month’s article for Do’s and Don’ts for getting a good night’s sleep).
Although biologically-based sleep problems need to be addressed medically, for those whose problems appear to arise from mood issues and bad pre-sleep habits, mind-body therapies can provide significant and lasting benefits.
Which Mind-Therapies Can Help with Sleep?
Cognitive behavioral therapy (CBT), hypnosis, and mindfulness have some scientific evidence of benefit and can be used alone, combined with each other, or with other remedies one may be taking. In some studies, approximately 70-80% of patients whose insomnia was treated with mind-body therapies reported benefit, even without the use of drugs.
Working with a therapist, CBT can help one to identify the thoughts, feelings, and behaviors interfering with sleep, and provide tools for changing them. Common thoughts include, “I only have X more hours left to sleep, and if I don’t sleep, I’ll never be able to function tomorrow. I MUST go to sleep!” These tend to increase, rather than decrease, feelings of anxiety and muscle tension, making sleep seem impossible. Common problematic behaviors include consuming larger and larger amounts of caffeine during the day to combat fatigue. The caffeine further throws off the sleep cycle, however. Having a few alcoholic beverages before bedtime can make people feel sleepy initially, but the alcohol also disrupts the sleep cycle and typically leads to waking in the middle of the night. The longer sleep problems continue, the more likely someone is to nap during the day to alleviate fatigue; yet, this in turn will further disrupt the sleep cycle. CBT can help identify these types of patterns and give patients tools for decreasing anxiety and bodily tension and creating feelings of relaxation. CBT can help improve sleep quality over the course of several weeks.
Hypnosis remains one of my favorite tools for working with a variety of issues because it helps people deliberately foster states they access anyway, many times per day, without even realizing it. What I mean by this is that we all go in and out of trance states without any effort whatsoever. Next time you read a good book, notice that after a short while, the words on the page seem to be less prominent and you may begin to “see,” “hear,” “feel,” and even “smell or taste” something the main character does, if the book is really engaging. You can see that the child character is playing with a brightly colored, shiny plastic beach ball, or that the old women has blue-gray hair pulled into a tight bun and that she’s carrying a tray of warm, buttery, chocolate chip cookies. Maybe you also hear the neighbor’s lawn mower, and smell the fresh-cut grass. That’s a trance state.
Formal hypnosis with a trained therapist can help foster a state of deeper relaxation and inner focus (aka, trance) that can be very beneficial for reducing stress and muscular tension and calming the mind before sleep. Patients can be taught self-hypnotic techniques that are individually tailored to them and that they can use during at-home practice. For example, one may find it relaxing to breathe in a specific, calming color. Another might prefer to imagine returning to a favorite nature spot from childhood. Many people pair hypnotic imagery with a pleasant aroma of their choosing (known as aromatherapy). For those who prefer more guidance during at-home practice, CDs or downloads featuring guided imagery for restful sleep can induce a similar state with no effort whatsoever on the part of the individual listening (if you lose focus or drift off while listening to the imagery, that’s a good thing).
Mindfulness is a practice that has been used successfully to address a variety of issues, from depression and anxiety to chronic pain and eating disorders. Mindfulness is a meditative technique that fosters present moment, non-judgmental awareness by focusing on the breath or whatever one is doing or experiencing currently, without trying to change it. Training is often used in combination with CBT, good sleep hygiene practices, and other strategies associated with improving insomnia. Mindfulness can be especially helpful in addressing the stressful thoughts that keep many people awake at night. When faced with a train of worrisome thoughts, most of us will either try to “block them out”, make mental lists, go from one stressful thought to the next, or try to solve problems. An alternative is to cultivate the ability to “let,” or to simply observe the thoughts, like clouds blowing by in the sky, rather than trying to change them, stop them, or hop a ride on one. Remember, you can wish to do all of these if you spot an intriguing cloud in the sky, but the effort would be futile…same thing with all of those thoughts – including the thoughts like, “I only have X more hours left to sleep before the alarm goes off.”
Try avoiding last month’s “Don’ts” and practicing the “Do’s,” and adding one or more of the mind-body therapies above to your healthy sleep program, and don’t be surprised if you see a positive change. Be patient. The above will take longer to work than taking medication, but the results are likely to be more lasting. For sleep problems that do not improve sufficiently with the above, it may be worth contacting a sleep specialist for medical evaluation.
For more information:
National Sleep Foundation
- Graci, G. M. (2007). Evidence-based hypnotherapy for the management of sleep disorders. International Journal of Clinical and Experimental Hypnosis, 55(3), 288-302.
- Ong, J., & Sholtes, D. (2010). A mindfulness-based approach to the treatment of insomnia. Journal of Clinical Psychology: In Session, 66(11), 1175-1184.
- Guided Imagery for Sleep
© Copyright 2011 by Traci Stein. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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