I’ve learned a lot from Dr. Lynelle Schneeberg. She is a clinical psychologist boarded in Sleep Medicine. She is the director of Behavioral Sleep Medicine at Gaylord Sleep Medicine, which is soon to become the Yale Sleep Medicine Program. I have sent her some of my most challenging cases and she has been incredibly helpful. I’m really glad she agreed to help with advice on how to get 30 more minutes of sleep at night. She writes here on what to do when you wake up at night and just can’t get back to sleep:
(“The acorn falls” by Liza. Click the photo to go to the original)
Should you ever read in bed in the middle of the night if you have a long awakening?
Actually, yes! Another method of getting 30 more minutes of sleep each night would be to keep nocturnal awakenings short. All of us, of course, hope to obtain the most possible sleep each night between the time our heads hit the pillow and the time our alarms ring in the morning. But many people struggle with nocturnal awakenings and sometimes these awakenings are fairly lengthy.
Most people think that the smartest approach is to lie in bed waiting for sleep to return. “At least I’m relaxing!” they’ll say, or “If I sit up or get up, I’ll never get back to sleep.” However, this is often not true. Lying in bed awake is often rather stressful and frustrating. We all tend to think about the things in our lives that have gone wrong, that might go wrong, that are currently going wrong…you get the picture! We also begin worrying about all of the sleep we are losing. These thoughts often result in longer and longer awakenings and the bed becomes a place where some people are awake more than they are asleep.
Moreover, “trying to sleep” is not often very successful. In fact, there was a very interesting study in which some subjects were told there would be a cash prize for the first person who fell asleep while other subjects were simply asked to fall asleep in their normal fashion. What happened? As you might guess, the subjects who were offered the cash took three times as long to fall asleep.
So, what should you do if you awaken at night and can’t fall back to sleep? The best option is simply to sit up in bed and read a book. Try using a soft reading light or, if you use an electronic reader such as an iPad, read your book on the night setting to keep screen light exposure to a minimum. Reading allows drowsiness to “sneak up” on you by engaging your busy mind on something else and by allowing you to relax. Reading in bed is also likely to be much less disruptive to your bed partner than tossing and turning. This technique is called “stimulus control” and it is used to make sure that your bed remains a “stimulus” only for sleep, not for long periods of wake. Try not to use your bed for anything else besides reading or sleeping, though. Keep those electronics out of the bedroom but keep that book on your bedside table and don’t be afraid to crack it open at 2am!
I find stimulus control to be one of the most important interventions for patients with insomnia, but all of us can benefit. When I was taught about this, I learned that you are supposed to actually get out of bed, so I asked Lynelle about this. Her reply was informative:
Classic stimulus control as developed by Bootzin does absolutely say to get out of bed include but Dr. Gregg Jacobs, a well-known expert on insomnia treatment and author of Say Good Night to Insomnia, has modified the practice of stimulus control to allow sitting UP in bed (which is a different behavioral “state” than lying down in bed) as long as the person doesn’t read for more than an hour. (And we are posting this in the winter which I know from long experience is a difficult time to ask people to leave their beds.)
I do find that my patients (kids and teens) may still benefit from more clear instruction. For this group, I recommend that they do a low light, low stimulation activity. For kids that don’t like to read, I recommend coloring books or jigsaw puzzles.
Do you struggle with middle of the night insomnia? If so, have you tried stimulus control?
We are at the end of January and a few snow days have put my a bit behind schedule. I have a few more entries which I will be running next week. Thanks for following!