Improving Sleep = Improving Mental Health: What To Do When You Can't Sleep

The problem: You can’t fall asleep

You try to go to bed at a reasonable hour.  Midnight is reasonable, right?  I mean, it’s earlier than you’ve been going to bed. You thought about going to bed at 9 but knew you couldn’t possible get to sleep that early.

Ok, you’ve been in bed for an hour now.  Why aren’t you falling asleep?  Time to try counting sheep.  1….2…..3….Why am I doing this again?  Surely it won’t work.  You get a snack.  You listen to some music.

An hour later you’re still awake.  Why?  Now you’re feeling anxious.  You’re supposed to be asleep but your not.  How will you possibly function tomorrow?  You toss.  You turn.  Sleep is elusive.  What can you do differently?

The solution: Better sleep hygiene

What do I mean by sleep hygiene?  Basically it’s just habits to help you get to sleep.  Here’s my disclaimer…most of what I’m about to say comes from Marsha Linehan’s DBT Skills Training Handouts and Worksheets but I’m going to provide my own take on the material.  If you’re in DBT or have the book, I encourage you to turn to page 259 to look at Linehan’s handout as well.  I provide comprehensive DBT, but I also treat a variety of other clients.  I’ve found that these same things apply to all of the client’s I see whether the issue that brings them to therapy is trauma, nightmares, general anxiety or extreme emotions.

Increasing the likelihood of restfulness/sleep: Good habits to help you sleep

Follow a consistent schedule.  

This is often hard for my clients, because they don’t live in a world that is the same from day to day.  Maybe you work late some nights and are home early other nights.  Or outings with friends keep you up late.  Maybe you are a college student and find yourself up late on nights before tests cramming.  I get it…this is difficult.  Yet, it’s important to train your body to understand that a specific time of day is time for resting.

Do not use your bed in the daytime.  

When you talk on the phone, do homework, read, etc. in bed your body is less likely to consistently associate your bed with sleep.  You’ll be more likely to easily fall asleep if your brain and body understand that this space is for sleeping and sleeping only therefore when I lay down in this space it must be time to rest and fall asleep.

Avoid things that make you more likely to stay awake. 

For many people this means avoiding caffeine, nicotine, alcohol, heavy meals, television and/or exercise in the evening.  Know your own body and avoid anything that’s going to make it more difficult for you to go to sleep.

Set the stage for sleep.

Create an environment that promotes sleep. This may include turning off the light, keeping the room quiet and the temperature just slightly cool. You may want to consider turning down the temperature and instead using a warm, cozy blanket. Perhaps you need an eye mask, a white noise machine or some quiet calming music.  Create an environment that promotes sleep.

Give yourself half an hour to fall asleep. 

In the example above the individual stayed in bed too long and it only increased your anxious thoughts.  If you haven’t fallen asleep after half an hour, consider the suggestions below.

Do not catastrophize. 

Remember when you were already thinking about how you’d be a mess tomorrow?  Convincing yourself that still being awake is the end of the world will only make you more anxious therefore making it even more difficult to fall asleep.  Sure, you notice you’re still awake but try to focus on relaxing rather than catastrophizing.

If you are calm but wide awake

Get out of bed

Go to another room and do something calming. I’ve had clients read a book, color an adult coloring page or even paint.  I don’t generally recommend watching TV as the light and such can make it even more difficult to get to sleep, but a calming activity that doesn’t involve a screen can be helpful in getting the brain into “rest” mode.  When you are feeling more relaxed or sleepy, try returning to bed.

Try a light snack.  

Something light here-not a full meal-can be comforting but even just the change of scenery from walking across your house can help distract your mind.  I’ve noticed myself that a few times lately I’ve been a little hungry and just having a small snack can help me then get to sleep pretty quickly.

If you are laying awake due to anxious thoughts

Use paced breathing or another breathing related guided meditation.  

I often recommend clients search Youtube for “breathing meditation” or “paced breathing.”  Here is an introduction to Paced Breathing as it relates specifically to DBT (but again, anyone can use!).  There are many, many, many more breathing meditations you can find on Youtube so feel free to do your own search-these are just a couple of links to get you started.

Try a Progressive Muscle Relaxation.  

Again, that is simply a link to one option but you can search YouTube for progressive muscle relaxations of all lengths, voices, etc.

Use Another Form of Meditation. 

I’ve recently started using the MUSE headband in my practice, and have specifically found that teens like to meditate with the MUSE.  Basically, you meditate listening to soothing background sounds (desert, beach, ambient music, city park with kids playing or the rainforest).  Then if you become distracted you hear a storm brewing and if you stay calm and focused for at least 5 seconds you hear birds.

Focus on the bodily sensation of the rumination…

Where are you noticing the rumination? What does it feel like to be in your body right now?

Reassure yourself 

Remind yourself that worries in the middle of the night are normal.  Often these are the result of a sleep deprived brain and you feel better after a good night’s rest. Essentially, validate your own experience.

Read an emotionally engrossing novel. 

Read for a short period of time, then return to bed and try to sleep again.

Imagine the worst.

If rumination doesn’t stop, try imagining the absolute worst case scenario happening in whatever situation you are anxious about.  What would the catastrophe be?  Now imagine how you would handle that situation.  What would you do to get through?  Now, try to return to bed knowing that even if the very worst case scenario happened you have a plan. I think of this as “leaning into the anxiety.” Often we spend much time avoiding thinking about what exactly it is we fear. But it’s there building up under the surface. Sometimes, it helps to turn around, shine a light on that fear and reassure ourselves that we could handle even that.

And if all else fails….

I love Marsha Linehan’s final suggestion: “If nothing else works, with eyes closed, listen to public radio (BBC, NPR, etc.) at a low volume (use headphones if necessary). Public radio is a good choice for this, because there is little fluctuation in voice tone or volume.”

Counseling & Sleep

If you are having difficulty sleeping because of anxiety, tenseness, nightmares or fear consider talking about it in counseling.  More than half of my clients (I don’t have exact numbers, but seriously, it’s probably well over half) struggled with sleep at least when we began working together.  This is something we can help with.  Also, let us know if you’re having nightmares because we have specific nightmare protocols as well that are amazingly effective and can help you get rid of your nightmares in only a couple of counseling sessions!

If you live in Mid Missouri, please consider contacting Aspire Counseling today either using the form on this site or by calling 573-328-2288.  We are a counseling center in Columbia, MO that specializes in helping clients move forward from trauma, grief, anxiety and/or overwhelming stress and we would love to help you begin to bring more peace into your life!  Please, read a little about each of our current therapists and then follow a link to anyone you’d like to learn more about. Because we know the importance of finding the right therapist that you “click” with, each of us have recorded a video so you get a feel for our individual personality.

About the Author:

Jessica Tappana, LCSW is the founder, director and a therapist at Aspire Counseling in Columbia, MO.  She opened Aspire Counseling in May 2017 to provide quality, evidence based mental health services to individuals in the Mid Missouri area looking for healing from trauma, grief, anxiety and overwhelming stress.  The practice serves teens, college students & adults. Aspire Counseling is LGBTQ friendly and welcoming to people from all walks of life. We serve people from around Mid Missouri in person and offer online counseling services for anyone in the state of Missouri. Jessica is proud of the care that is taken at Aspire to match each client with a therapist who is uniquely suited to meet that client’s needs based on personality, training, specialty and experience. If you’re interested in starting counseling, you will find a safe space at Aspire Counseling. Healing Starts Here.