Friends, family members and health professionals often have advise on how you can sleep better. Some advise may be helpful, like not watching Game of Thrones right before going to bed if that wires you up. Some advise are neutral, like drinking less coffe. Coffee in my experience is rarely a culprit. But cutting down certainly wont hurt.
On the other hand some very common advice makes insomnia sufferers sleep even worse:
1. Going to bed at the same time every night.
2. Creating a bedtime ritual.
For healthy sleepers going to bed at the same time every night and having a bedtime ritual may work just fine. But for those with active insomnia this can be detrimental.
Both advise come from a common underlying misconctepton: that sleep can be induced by habits and cues. In fact sleepiness is only created by wakefullness. Just as hunger is created by fasting.
Let’s look at the two pieces of advise in more detail.
When it comes to creating a ritual before you go to bed, we understand the intention. The thought is that by avoiding stress and creating a calm environment conducive to sleep starting about 1 hour before bed not only will you be able to sleep when you go to bed, but also start associating this ritual with sleep. The problem is that no ritual, no matter how calming it is can make you fall asleep if you don’t have enough sleep debt. And when the ritual does not work, your frustration with insomnia increases further. By the time I see patients in clinic, they have often tried their ritual for weeks without being able to fall asleep any faster. And then they feel as if they have even less control of their sleep.
“I’ve tried going to bed at the same time every night and it doesn’t work!” is something I hear on a weekly basis. As a general recommendation this makes absolutely no sense and whoever came up with it did not have an even basic understanding of sleep physiology. Sleep, as mentioned above, is homeostatically regulated just like hunger. In other words the longer you stay awake the more sleep debt you accrue until that sleep debt overcomes whatever alerting signals your body produces and you fall asleep. What time you decide to go to bed has no impact at all on your sleep debt. Imagine if someone told you to go to bed at 7 PM every night. Do you think you would start falling asleep at that time? Of course not! You would toss and turn for hours and fall asleep at whatever time your sleep debt was strong enough. Going to bed at the same time just makes people frustrated and feel as if they’ve tried yet another strategy that didn’t help them sleep.
What should you do?
1. Skip the ritual, sleep has to come naturally.
2. Go to bed only when you feel as if you can no longer stay awake. I can hear some of you thinking “but that will make me stay up all night!”.
And it may, for one or a few nights. But if you have restricted your bedtime (please see blog #2) and have a strict time to get out of bed you will start falling asleep at a predictable time after 1-2 weeks typically.
Thanks for reading and as always don’t hesitate to comment!