We don’t fully understand the mechanism of insomnia (defined as difficulty initiating or maintaining sleep). But some theorists believe untimely central nervous system arousal plays a large part. Our brains are always on, however when we think hard about something, our brain is more activated or aroused than when we are not consciously thinking about something (acting on autopilot). Caffeine to too close to bedtime can increase brain arousal as can bringing work home and doing stressful work before bed. We don’t know how long it takes for the mind to wind down after doing stressful work, but I compare it to lighting coals on the grill, getting them red hot then white, cooking your food, then having warm coals smolder long after you eaten your meal.
Unfortunately people can reinforce the nervous system arousal by getting into bed, watching the clock and worrying about how they are not falling asleep. This anxiety about the insomnia can produce more of a stimulating affect on the brain than the original stressful activity.
I usually talk with patients about their bedtime routine, emphasizing the need to have a wind down period before bed and a preparation period. So for example, think about what time you to be asleep. If this is 11pm, then you need to start preparing for bed around 10pm. Preparation can’t be finishing up those last stock trades or worse yet, getting off the treadmill. Preparation would be things like brushing your teeth, bathing (warm bath with dim lighting or relaxing shower), thinking about what clothes you will wear, etc. Because these activities are routine, your mind can rest and wind down. By 10:30 you could plan to be lying in bed with the expectation to be asleep within the next 30 minutes. Some people meditate or read a passage to help them fall asleep.
Leaving an hour in your evening to prepare for bed usually doesn’t happen. Usually what I see is a person will consider their bedtime to be 11pm, they calculate that if they go to bed by this time, they can get 7 hours of sleep. Then 10:50pm they are peeling away from the television and quickly jumping in the shower (or waiting until the morning), they slide into bed by 11:10 and watch the clock while they think about that intense Sopranos episode, which then leads to thinking about their boss and how their coworker is undermining them, etc. They may drift off to sleep by 11:45 – 12. There goes the 7 hours as the alarm is set for 6am.
Does this sound familiar? How do you prepare for bed? I welcome your input on what makes you fall asleep.
Let me know what you think