Modern life isn’t easy, with concerns about money, housing, work, relationships and living a “successful” life being frequently reported as sources of worry for many people in modern society. Quite often, we won’t be able to stop thinking about these things even when we want to, such as when you need to focus on something else, or if it’s time to go to sleep. Often, those affected by stress, anxiety, depression and insomnia have an especially difficult time with controlling their own thoughts.
Frequently, people living with insomnia will report that racing, intrusive (unwanted) thoughts make it more difficult for them to get to sleep compared to any physical sensation, like feeling overly energetic at bedtime or being in pain. In trying to get to sleep, those with insomnia will commonly try to shut out thoughts that are stopping them from sleeping; seemingly a sensible solution. Unfortunately, untreated insomnia sufferers commonly use thought control strategies that cause more problems than they solve, meaning that getting to sleep can be even more difficult for them.
By implementing better ways to deal with intrusive thoughts, the time between getting into bed and falling asleep needn’t be so difficult; nor does falling back asleep if you wake up too early. There have been a number of thought blocking strategies that have been studied for dealing with intrusive thoughts in insomnia and many of them will likely be covered in a course of CBT for insomnia (CBTi). These strategies aim to enable the person using them to substitute thoughts that might keep them awake (called arousing thoughts) with thoughts that are less likely to keep them awake (non-arousing thoughts) and in doing so, reduce the time it takes to fall asleep (the sleep onset time) and/or increase sleep quality. We’ll go over a few of these strategies here, in the hope that they’re useful to you or someone you know.
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Repeat a word or do a mental puzzle: One of the early, but effective solutions to racing and intrusive thoughts in bed is called “articulatory suppression,” in which a person mouths a word at a rate that makes formulating any other thought difficult- usually 3 to 4 times a second. The underlying psychology is complex, but the theory is that mouthing a word requires a lot more mental power than just thinking it, leading to a blocking of the original intrusive thought. In this method the word “the” is often used, but can be a nonsense syllable or a proper name, the only requirement being that it has no emotional significance to the person trying to control their thoughts (i.e. is non-arousing). Since everyone is different, it might take a few goes to find a word that works for you. Moreover, if you find that a lot of your intrusive thoughts are visual, you can accompany the word you use with imagination of a shape, such as a triangle or square. There are even more alternatives , such as counting back from 1000 in certain “jumps” e.g. 1000, 993, 986, if you were to use “jumps” of 7. This is mentally engaging enough to divert your attention, but is also non-arousing enough that it won’t get in the way of falling asleep.
Distract yourself: “Imagery distraction” is a technique in which a person trying to block intrusive thoughts imagines themselves in an engaging and interesting scenario, such as a relaxing holiday, a recipe for a meal, a nice afternoon 1 or something equally pleasant for them. Once chosen, the aim is to experience the scenario as deeply as possible by imagining all the sights, sounds, smells and ultimately relaxation that comes with it, so that it’s impossible to think of anything else. It is important to choose something that isn’t too arousing, such as a sporting event or sexual encounter because these scenarios are unlikely to be relaxing and therefore less conducive to helping you get to, and stay asleep. Although there is less evidence that an imagination-based approach to thought blocking reduces sleep onset time, using mental imagery been reported to increase sleep quality once a person is asleep. If you experience early waking, then the technique can be used as it would be at your usual bedtime.
Be grateful: Since negative thoughts are often cognitively arousing, fixating on them can make insomnia worse. In one study, subjects who were asked to focus on their regrets at bedtime were observed to have a longer sleep onset time than those that did not. In another, the converse result was noted; when instructed to focus on positive thoughts and things they were grateful for at bedtime, a population with insomnia experienced sleep benefits. This may be difficult for some people more than others, such as those with co-morbid depression or anxiety. Specialised treatment should be sought for these conditions.
Accept your thoughts: As strange as it sounds, not doing anything about your intrusive thoughts can be a surprisingly effective strategy to deal with intrusive thoughts. Here, the key is simply to accept that you aren’t able to sleep without worrying about the implications, or trying to fight your own thoughts. By doing this, the impact of your own intrusive thoughts is dulled, meaning that they are less liable to be arousing and to keep you awake.
These strategies, while effective on their own are more effective as part of a structured CBTi programme. There are a variety of techniques that can be used such as:
If you’ve tried multiple techniques and nothing works, you may need support from an expert sleep team. Sleepstation is a drug-free and clinically validated sleep improvement programme that can help you optimise your sleep for better health. Get started today.
Researched and produced by Dr Raminder Mulla
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