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  • The Reflective Doc

Sleep Within Reach

I love talking about sleep (cue my husband’s pretend snoring). As rates of insomnia have understandably climbed during the pandemic, many more people are experiencing the frustration of lying in bed, staring at the ceiling, and envying the deep slumber of their children, bedmate, or former selves.

We are often told to remove electronics from the bedroom, create a cool, dark sleep environment, and limit our caffeine consumption in the late afternoon or evening. But I want to share some of the tools that you may not have learned. In my psychiatry practice, I love working with people trying to improve their sleep, because when they apply these concepts and find relief, their transformation can be remarkable.

For example, I find it helpful to explain insomnia as “distress about not sleeping” rather than inability to sleep. In fact, we all sleep. If we restrict our available sleep time, our brains will simply steal moments throughout our day, often in brief periods called “microsleeps.” In fact, sleep is such a powerful human drive that we are simply unable to stay awake when we are truly sleep deprived. Contrast this with another drive—hunger. As has been demonstrated in certain situations and illnesses, humans can restrict their food intake long enough to produce devastating results. This is simply not possible with sleep.

Here is a crucial point (feel free to make it your evening mantra): My body will take the sleep it needs. Stated another way: It is not possible to stop myself from sleeping.

One of the movies my husband and I watch whenever it’s on TV is Forgetting Sarah Marshall. I highly recommend it for relaxing viewing. (I would like to say I also watch serious and important films, but that would be ingenuine.) Kunu, played by Paul Rudd, is the surf instructor at the Hawaiian resort where the main character, Peter, played by Jason Segel, has gone to escape his famous ex-girlfriend, Sarah Marshall, played by Kristen Bell (spoiler alert: she is there too.) One of our favorite scenes finds Peter on dry land, learning how to stand up on his surfboard. Kunu’s repeated instruction to Peter after each attempt is, “Do less.” Eventually, Peter is just lying flat on the surfboard, appearing extremely confused. My husband and I often laughingly encourage each other to “Do less” when we find ourselves trying too hard and yet still feeling powerless in a ridiculous situation (For example, insisting that our 7-year-old wear socks in his snow boots.)

So, this is what I recommend when you are preparing for sleep. “Do less.” Use less technology in bed, drink less alcohol*, eat less late-night food—especially protein, which can be stimulating. Most importantly, work less on being the perfect sleeper. It is not something you can improve through force or effort. However, you CAN learn neutral thoughts about what happens if you don’t fall asleep right away, or wake during the night. In a book I often recommend to my patients, The Sleep Solution, Dr. W. Chris Winter, M.D. describes his approach to a sleepless moment in bed, writing “On the nights when I get into bed, turn out the light, and don’t sleep immediately, I genuinely don’t care. I don’t fear the situation. I don’t anticipate it having any real consequence in my life. I’m doubtful of it happening two nights in a row. I sometimes challenge myself to see if I can be quietly in bed all night without falling asleep.”

If this seems like an impossible goal for your thoughts at night, you are not alone. One way I like to explain how differently we may think about sleep is to compare it to our appetites. We’ve all had the experience of sitting down for a meal and realizing we aren’t hungry. When this occurs, do you think, “This is terrible. Why am I not hungry? What if I never want to eat again? There must be a pill to help me feel hungry right away.” If you are like me, you know your appetite will return eventually (especially if peanut butter is involved). You probably had a late snack, or maybe your previous meal was rich in protein and sustained you longer than expected. Or maybe your appetite was decreased because you were worrying about an upcoming job interview or class presentation.

Having an understandable and nonthreatening reason for our lack of appetite reassures us that we will eventually eat again, and all will be well. This is very similar to the way I want you to think about sleep. Everyone experiences occasional difficulty sleeping with the schedule or for the duration they prefer. However, when this occurs, we can remind ourselves that the ability to sleep is not something we can truly lose, and that many (Most? All?) of the catastrophic events we imagined happening the day after a poor night’s sleep, never actually occurred.

*A note on alcohol. Yes, it is sedating, and you may even fall asleep faster and catch a couple good hours after consuming it. The problem is that alcohol interferes with your sleep architecture, meaning the natural pattern of sleep your brain produces to refresh you for the next day. Alcohol decreases your ability to achieve Stage 3, or deep, restorative sleep. If you’ve ever slept 12 hours after a big night out and still felt exhausted, this is why. Additionally, those metabolites created as alcohol breaks down in your body can awaken you in the middle of the night, and cause the tremulousness or headache you may experience. To summarize, alcohol is not your friend if you are struggling with insomnia. If your sleep is great, then a glass of wine before bed is certainly your prerogative. Enjoy responsibly.

To summarize this brief sleep introduction, sleep hygiene, such as creating a quiet, dark, cool room and avoiding evening caffeine and alcohol, can be helpful. But your thoughts are the most powerful tool for improving your sleep. So, when faced with worry about the night ahead, rather than trying even harder to sleep, be Peter on his surfboard, and “Do less.”

(Photo: Media from Wix)

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