Life Kit - Anxious Thoughts? 5 Tips To Help You Sleep

Episode Date: March 26, 2020

Difficulty sleeping can cause anxiety, which often leads to more trouble sleeping. Life Kit host Allison Aubrey talks to sleep experts about how cognitive behavioral therapy for insomnia can bring relief for people with chronic sleep issues.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

What's in store for the music, TV, and film industries for 2025? We don't know, but we're making some fun, bold predictions for the new year. Listen now to the Pop Culture Happy Hour podcast from NPR. Hi there. This is Megan Cain, LifeKits Managing Producer. Before we start this episode, I wanted to bring you a quick tip about coping in these coronavirus times. It's from LifeKit listener Sharon Comer-Blau from DePlaines, Illinois. My older kids, they join me on a run in the morning. They have a lot of energy to burn between 10 and 13 years old.

So we just run stop sign to stop sign. We're not at a complete mile yet, but it gives them something to look forward to. It gives them a way to burn off some energy. More importantly, it gives them small goals. My goal is for them to run an entire mile without stopping. Maybe ambitious, but hey, I have a t-shirt for them if they complete it before they go back to school. We are still taking more of these, so please, if you have a good tip about how you're managing right now during coronavirus, we want to hear it. Leave us a voicemail at 202-216-9823.

Just say your full name, where you're from, and your tip, and also a number where we can reach you. Or just send us an email at lifekit at npr.org. We are looking forward to hearing more of your tips, and thanks. Lots of us have been there. It's 3 a.m., you're tossing and you're turning, you can't fall asleep, and you're starting to freak out. You're thinking of all the bad things that could happen if you don't fall asleep. This happened to me a few years ago on a work trip, and I had a full-fledged panic attack. After five days of not sleeping very much at all, I actually thought I was dying.

I went to a colleague and I was like, oh my God, how long does it take to die from not sleeping? And I was completely serious. And it turns out, I'm not alone. Those are comments that I've heard probably a thousand times or more. That's Stephen Amira. He's a psychologist at the Brigham and Women's Hospital in Boston, and he sees a lot of patients who struggle with insomnia. Most people would like to be able to get into bed,

and in a very natural and self-regulating way, they would just like to be able to close their eyes and go to sleep. But when that doesn't happen, and you really can't fall asleep, your thoughts can start to run rampant. I mean they can start galloping. Why is my brain being so stupid? If I don't get to sleep now then I'm only gonna have gotten four hours of sleep tomorrow. Okay it's been a minute you're not asleep. Now it's been an hour. Now it's been six hours. Shaking my fist at the world or shaking my fist at God or whatever is kind of, you know, why me sort of thing. I'll never be able to hold a job. I'm going to be by myself. I'm not going to be able to care for my baby well.

All of a sudden, my baby is in danger. Everything is horrible. I feel like I'll never sleep again. Those are the people who look out the window in the middle of the night, and what they see is a darkened world where they assume that everybody else is asleep and they're the only ones who are going through this. And maybe this is you right now, but one of the most effective things you can do to improve your sleep is to acknowledge just how powerful your catastrophizing thoughts can be. It turns out your thoughts are really a big part of why you're not sleeping. With practice, you certainly can change your thoughts, and that can help you sleep better over time. This is NPR's Life Kit. I'm Alison Aubrey. I cover health and wellness here at NPR.

And in this episode, we have five strategies to help tackle insomnia. We talk to people who deliver what's considered to be the most effective treatment out there, cognitive behavioral therapy for insomnia, or CBTI for short. Think about it this way. Sleeping pills can help mask the problem, but CBTI gets to the root cause of poor sleep. So whether you have chronic sleep issues or just a bad night here or there, what you're about to hear will hopefully help you get to sleep and stay asleep. The Indicator is a podcast where daily economic news is about what

matters to you. Workers have been feeling the sting of inflation. So as a new administration promises action on the cost of living, taxes, and home prices. The S&P 500 biggest post-election day spike ever. Follow all the big changes and what they mean for you. Make America affordable again. Listen to The Indicator, the daily economics podcast from NPR. Support for NPR and the following message come from the Lemelson Foundation, dedicated to improving lives through invention, innovation, and climate action. Do you make resolutions in January? We do. Specifically, we make pop culture resolutions. We also check in on what we resolved to do this last year.

Did we catch up on all those classic movies or finally write that novel? Find out on the Pop Culture Happy Hour podcast from NPR. Everybody has an occasional poor night's sleep. But millions of people have chronic sleep issues. And it can really take over their lives. I felt like I was always on edge, so I was super anxious. That's Drew Gaddy. She's in her late 20s, and she has struggled with insomnia since she was a teenager. It came on suddenly when she was 15. It's like something just shifted, and I woke up

and I felt different. It went on for years. She remembers lying awake all night, watching the sunrise, having not slept. She felt paralyzed. And you know, there was this one event that made her realize she had to do something. It was the day she had to bail out on a big family trip to visit her sister. And so I literally, I couldn't fly, and I couldn't go visit her, and it was like I was frozen. That's when Drew went to see Stephen Amira at his private practice, and that's why we reached out to him. Yes, I'm the guy. His specialty is CBTI, and he has been in this field for decades. He was part of a group committed to finding something other than sleeping pills to help people. Many of the medications had some serious drawbacks when they were used

extensively and excessively, and so there was a real effort to help people find some alternative. Fast forward a few decades and CBTI is now probably the first thing a doctor will recommend if you go in saying you have insomnia. Now keep in mind, if you do have bad sleep problems, you probably do want to go see your doctor. What we're going to do here is give you a cheat sheet of the main concepts behind CBTI. So the first thing that Stephen teaches his patients is to do what's really a big reality check. And this is step number one. You know, a lot of people with sleep issues say things like, oh my god, last night I didn't sleep

at all, when the reality is something very different. So he has people gather some data. Step number one is let's take an actual look at what your sleep is. Log your sleep over a number of days. This basically means writing down what time you went to bed, what time you think you fell asleep, how many times you thought you woke up during the night, and then when you got up to start the day. When Drew started this, she was convinced that she never slept, which of course is impossible. I, you know, I'd wake up and I'd say, oh god, I almost, I definitely only slept one hour. But when she actually started to log her sleep, a different picture emerged. Oftentimes it would be anywhere from two to three and maybe the occasional five

hours of sleep. So it wasn't a ton of sleep, but it was more than she thought. Now this is the first step to help you realize that there's often this big gap between your worst case scenario fears and what's really happening. So logging your sleep, it may seem simple, even obvious, but Stephen says it's powerful. When you observe a behavior, you can actually start to change it just by observing it. And usually folks have not observed their own behavior in any kind of systematic way. So step number one, log your sleep. Now on to step number two. And this you can think of as kind of a different kind of data collection. This time, you want to examine all of those catastrophizing worst-case scenario thoughts and replace them with something more neutral.

Now, I know this is easier said than done, but we're going to walk you through it. So when this happened to Drew, say she would have this thought. I'll become, you know, a burden upon everyone. She'd pull out her Drew, say she would have this thought. I'll become, you know, a burden upon everyone. She'd pull out her journal, she'd write that fear down, and then she'd look at it and think. That's not realistic. I think about if I heard someone else say that, you know, I'd say, are you serious? So she would strike out that thought and replace it with a more logical one. Something like, you know, of course I won't become a burden to my family. Again, this may seem simple, but it's pretty powerful. So when you have those thoughts, when they pop into your head, go ahead, write down that fear. It was like rerouting this like brainwave, 12 years of just

consistently saying, if you don't sleep tonight, you will not be okay. So it sounds like you really had to learn to reframe your thoughts, to really kind of push away all of the catastrophizing thoughts and replace them with, I guess, what was closer to reality. Yeah, totally. Writing down the fact made a difference to me. It made it feel very real. It turns out that a lot of what we tell ourselves is false, and those false thoughts really can keep you awake at night. What Drew was doing then was she was becoming aware of the thoughts that precede the anxiety about her sleep and understanding how that actually starts a big cycle.

It's kind of like a snowball rolling down a hill. It builds momentum. And when you learn to replace those fictional thoughts with the factual ones, it can stop that runaway snowball. So we want to become mindful of those thoughts, and then we're going to tackle those thoughts logically and rationally. Now go back to that moment when you're alone in the middle of the night. You feel like you're the only one who could possibly be up at this ungodly hour.

And you say say this is just who I am I'm an insomniac these the cards I've been dealt well labeling yourself that's another kind of harmful fiction I always tell my patients you are not an insomniac you are a person experiencing insomnia now there is another helpful step to break this pattern, and it builds on what you've learned in your sleep log. The next step is something called sleep restriction. And the basic idea is that you use your bed only for sleep. You don't want to lie in bed and worry about sleep. You really want to be asleep. And oftentimes this means you spend less time in bed. And so it seems paradoxical, but what we do is we tell people to not spend excessive amounts of time in bed.

If they're not going to sleep, we want them out of bed and we want them to start experiencing successes with sleep. In Drew's case, Stephen told her to try to sleep for only six hours. This was the realistic amount of time Drew thought she could stay asleep based on what she learned from her sleep log. And so we said, OK, I'm going to go to bed at 1.30 every night and I'm going to wake up at 7.30. And by go to bed, that means that I do not go into my bedroom and get in bed until 1.30. And you do not get out of bed any later than 7.30, no matter how the night goes, no matter when I end up going to sleep or if I have to wake up early,

those are my times where I am getting in and getting out of bed. So even though she may have been a little tired restricting it to that narrow window of six hours, it was helping her consolidate her sleep and start associating her bed again with being asleep. Is that right? And that's exactly right.

We want you to associate your being in bed with sleeping, not with anxiety and worrying about your insomnia. So as you experiment with this sleep restriction, here's another takeaway to think about. Try some meditation techniques. I know it sounds kind of obvious, but they really can help. For some people, it may be simply listening to somebody with a soothing voice. For others, it may be somebody who takes you on a guided trip just through your own body and has you focus on each individual part, slowly letting any tensions go. Now I want you to move and focus on your right leg. Your right leg is feeling heavy and warm.

Your right leg is feeling more and more relaxed. This is Christina McRae. She's a psychologist and a CBTI expert at the University of Missouri. And what you just heard her do is called a body scan. Now, it's often taught as part of a stripped-down approach to meditation. One form of this is called mindfulness-based stress reduction. And believe it or not, this has been shown in multiple studies to really help relieve anxiety. And this is what you're really trying to do. You're trying to quiet your mind and tamp down that state of hyperarousal.

The first time somebody had me participate in it as a student, I was trained in it, and then I had to administer it the next day to a group of veterans. And I thought about being sick. I don't want to come do this because I thought it was so corny and so hokey. But what I found is even when I administered it myself, I started to feel this sense of just overall relaxation, both my body, my mind. And I became a believer at that point. Wow. Wow. That's a big, that's a big transition there from complete skeptic to saying this really works, huh?

Exactly. And over the years, whenever I've demonstrated this, whether it's with patients, in classes, with undergraduates, graduate students, and anywhere I've demonstrated it, I've had almost always somebody in the audience, in the classroom, who has fallen asleep. Now, there are lots of ways to get there, to this state of deep relaxation. Drew uses an app on her phone. It's called Headspace. It's narrated by this guy named Andy Puttycomb. Just feeling the weight of the body sinking down into the bed.

I love his voice. It's the most relaxing thing ever. And I like it. I like what he has to say because I sometimes think, wow, is he just talking to me? You know, everything he has to say is so it feels so relevant. I'm just allowing the mind to drift off in its own time. There are a whole bunch of apps. There's one called Calm,

one called 10% Happier, Insight Timer, and all of the experts we spoke to said there's not one technique that works better than the other. Find one that works for you and over time, you might just find that you can do

these deep breathing or these meditation techniques without your app. So your takeaway here is find a relaxation technique that works for you. Now we're going to go on to the next step. You've got to redefine your relationship with your bedroom. It needs to be a calm space. So we want them to use their bed only for sleep. With a few exceptions. Sexual intimacy is okay. All right, we thought we had to point that out. So one way to make sure that you're only using your bed to sleep is when you

lay your head on the pillow and you start to have those ruminating thoughts. Leave your bed. Get out. Don't try to stick it out. When you're spending a lot of time in your bed doing things other than sleep, you're building up this sort of learned connection between your bed, your bedroom, with things that are more arousing. And so the goal is to have you spend the time that you're spending in your bed, your bedroom, is connected with sleep. If you get into bed and you start having those automatic thoughts that are negative, after a certain period of time, say 10-15 minutes, you want to get up and go into another room, do something kind of low-key, and only return to your bed when you're starting to feel sleepy again. Now, this runs completely contrary to what most people's instincts are.

They figure, hey, it's bedtime, I want to be sleeping, I should stay in bed. But again, we're trying to reduce the amount of time that they spend in bed feeling stressed. So this is what Steve and Amira had Drew try. I wasn't supposed to get back into bed until I was falling asleep, you know, eyes not yawning, but eyes heavy. And then if I went back into my bedroom and I couldn't fall asleep in what felt like another 15 minutes, I had to leave my bed. So there would be times where I would do that for 10 times. But it was about not connecting, you know, my bed with these negative, I can't sleep, you know, I had, you know, kind of rerouting what the bed, my bed meant to me. So what was your more positive take about that moment of getting into bed? I guess when you

got into bed at 1.30, you were really tired, yeah? Yeah, I was really tired. So it kind of made this weird shift where I had always been, I hate getting into bed. It stresses me out to, oh my God, I'm so glad I can go get into bed right now because I've been up for two and three hours watching reruns of Friends, and I'm just so ready to go get in bed. So instead of fretting, Drew just learned to hang out and have a little relaxation time in her living room. Now, another part of this strategy is to get clocks out of your bedroom. What people with chronic insomnia tend to do is they look at that clock repeatedly.

And you can see how looking at that clock and seeing it say 1.30 and now 2.30 and I'm not asleep and how that contributes to the thought pattern. So what we tell them to do is either turn the clock around or take it out of the bedroom altogether because it reinforces that catastrophic thinking process. And there's some other things that you probably want to get out of the bedroom too. And you've probably heard this. All of those devices, the iPad, the iPhone, your laptop. Stephen Amira says they tend to give off a lot of blue light,

and that's not good for sleep. So he says get them out of your bedroom at least one hour before bedtime. They're just too stimulating. We don't want you to be engaged and interactive. We want you to be letting go. So now that you've learned all of these tools, the next thing you need to realize is that this is going to take some time. You won't have perfect sleep instantly. It's not a magic bullet. But generally, CBTI starts to help people pretty quickly within a few weeks. But there will be some bad nights. When this happens to Drew,

here's what she tells herself. I look at myself in the mirror and it sounds super corny, but and I'll just talk to myself and say, like, you've always been OK and you will be OK. And I remind myself, you've done this before and it'll happen again. And you you've always gotten through it. Stephen says the definition of success is going to vary from person to person, but what is clear is that people learn effective tools that really can work. There are people who will say, I'm going to have some recurrence every once in a while, but I know exactly what to do so that I don't get into a prolonged bad patch. What I want people to feel is that they are confident that they have

an approach that they can use in the future so that whatever comes their way, they have confidence that they can handle it. I like jokingly say I've been in remission. To have control of this feels so liberating. It's totally changed my life. Do you remember the first full night of sleep, the first night where you got in bed, you were tired, you closed your eyes, and the next thing you knew, it was light outside? I remember this night, but I actually woke up in the middle of the night. I think I had to get a drink of water, go to the bathroom. I don't know what it was. And I woke up and I was like, I know I'm not supposed to look at the clock, but I really want to look at the clock. And it was like 4 a.m.

And I remember like almost dancing in my kitchen. You know, I was like, yes, hallelujah. Like, oh my gosh, I fell asleep. Like how this is the best thing ever. And I got back into bed and I fell back asleep again until 7.30. I think I woke up my fiance and I was like, I slept. Like, get up, you know, let's start the day. It really brings a smile to my face, obviously. It's always nice to hear a patient experiencing

a great success like that. It's very true. Drew worked very hard at this. And Christina McRae says she's seen so many success stories similar to Drew's. You're working with patients who often have suffered for, like Drew, 14 years, 20 years, 25 years, 30 years. So it is highly rewarding that in a relatively brief period of time, four weeks, eight weeks, you can get the level of improvement that she described. So let's recap what we've learned. Takeaway number one, to sleep better, you need to know how much you're really sleeping. Log your sleep over a number of days.

Including when you fall asleep, the times you wake up in the middle of the night, and when you get out of bed the next morning. So step number two, keep a journal of any thoughts and anxieties that are around sleep so that we can better understand them. Takeaway number three, rethink how much time you spend in bed. And number four, find a relaxation technique that works for you,

whether it's deep breathing or a body scan. And lastly, you need new rules for what to do and not to do in your bedroom. We want people to change their relationship with their bedroom and establish a whole new set of rules as to how to go about the whole sleeping and waking pattern. For more NPR Life Kit, check out our other episodes. I hosted one recently on how to take a break from drinking. And we've got lots of episodes on topics such as money, parenting, and health. You can find these at npr.org slash life kit. And if you love Life Kit and you want more, subscribe to our newsletter.

And here, as always, is a completely random tip. This time from NPR's Joshua Bote. If you're prone to getting stains on your white t-shirts, whitening toothpaste works really well. Just rub the toothpaste on the stain, put it in the wash, and voila! If you've got a good tip, let us know. Leave us a voicemail at 202-216-9823 or email us at lifekit at npr.org. This episode was produced by Sylvie Douglas. Megan Cain is the managing producer.

I'm Alison Aubrey. Thanks for listening. This message comes from Grammarly. 89% of business leaders say AI is a top priority. The right choice is crucial, which is why teams at one third of Fortune 500 companies use Grammarly. With top-tier security credentials and 15 years of experience in responsible AI, Grammarly isn't just another AI communication assistant.

It's how companies like yours increase productivity while keeping data protected and private. See why 70,000 teams trust Grammarly at grammarly.com slash enterprise.