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I get this particular image in my head when I think about insomnia.
I see somebody in a bathrobe lying on the couch, lights off TV on, staring like a zombie at a stream of late-night infomercials.
I wonder what core memory I'm flashing back to here.
It's definitely got a late 90s, early 2000s vibe.
The scene might be a little different at your house.
Maybe it involves a bottomless pit of scrolling on your smartphone.
But the feeling is the same.
Desperation.
You either can't sleep at all or you can't stay asleep.
And you keep looking at the time like, OK, only three hours until I have to get up.
But I still haven't gotten down.
Recent estimates say 25 to 30 million American adults are dealing with insomnia at any given time.
So bad sleep affects a lot of us.
But when you're up in the middle of the night and you know everyone else is sleeping, it's a really scary feeling and it's a lonely feeling.
I feel like I'm the only one dealing with this, or mine is worse than everyone else's.
Steve Orma is a clinical psychologist who specializes in treating insomnia.
This is a career path he found through personal experience when he faced a bout of sleeplessness for the first time in his early 40s.
It plagued him for months.
Before that point, Steve had had a bad night's sleep every now and then, but never a fully sleepless night.
So when suddenly that just kept happening...
I started getting into the frame of mind that most people get sucked into.
You start to worry, oh, what's going on?
Is there something wrong with me?
The longer it went on, the more he fixated on the issue.
And this is the cycle that ultimately, if it continues, leads into insomnia, where it becomes more of a steady, consistent problem.
Now, whether you've dealt with this once or a hundred times, that anxiety, that sleep stress.
That's pretty universal.
Oh, my God, what if I don't sleep tonight or sleep at all or, you know, get X number of hours?
But that's not really the fear.
The fear is the consequences of that.
For me, it was I'm not going to be able to perform well in my work.
That was my biggest fear.
Maybe you're afraid you won't be able to show up for your kid or that not sleeping is going to hurt your health.
Without ever having to read the mountain of scientific evidence on the topic.
We all feel how critical a good night's rest is to our bodies, our judgment, our emotions, our relationships, just every facet of our lives.
But sleep, unfortunately, isn't something you can achieve or can even try to do.
It's something that happens to you.
That can be hard to swallow in this era of constant self-optimization.
But when it comes to sleep, doing less is often doing more.
And in fact, there are a lot of ways you might be unknowingly messing with your sleep by trying to perfect it.
So how can you do both things at once, both care deeply about your rest and not try to sleep?
Put the focus on things that will result in sleep, but you don't focus on trying to sleep directly.
It's just like if you're trying to lose weight, you don't focus on the weight.
You focus on changing behaviors that will result in the weight going down.
It might take time and patience, but it is possible.
On this episode of Life Kit, reporter Andy Tegel talks to experts about the science of sleep, walks you through some of today's most common sleep stressors and gives you tools for how to deal with them.
That's after the break.
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Okay, it's time for a quick wake-up call, Worry Warts.
Steve says he hears a common misconception at the office.
My sleep is broken.
I've lost the ability to sleep.
That kind of thing, which is not true.
That's takeaway one.
Your sleep isn't broken, but it might need a professional reset.
If the experience of sleeplessness is new to you, it might be helpful to know there are a few different flavors of insomnia.
Like sleep onset insomnia.
Difficulty falling asleep.
Sleep maintenance insomnia.
It takes you a while, but you do fall back asleep.
And then what's called early morning awakening, where you wake up significantly before your wake-up time and you don't fall back asleep at all.
You might have one, a combo, or hit the jackpot.
And severity can range a lot, too.
Most adults will suffer the occasional off night.
Around.
A third will deal with acute insomnia, roughly understood as short term bouts of sleeplessness ranging anywhere from a few days to a few months.
And about one in 10 adults at any given time are dealing with chronic insomnia.
Clinically that's defined as trouble sleeping at least three days per week for at least three months.
Understanding your particular brand can help you decide the best way forward.
And depending where you are on the spectrum, that might require some course correction.
See, Steve says often the go-to advice for sleeplessness is practicing better sleep hygiene.
And we are not knocking that.
Sleep hygiene is all about establishing healthy routines like not eating large meals too late at night, limiting naps and creating a conducive environment for good sleep.
Make your room dark, make your room quiet, make it cool.
And all those things are great until you have insomnia, which is a set pattern.
Sleep hygiene doesn't do anything.
He says, think of it like dental hygiene.
So like if you already have healthy teeth.
Then it's good to brush your teeth, to floss, to see the dentist once or twice a year.
But if you have a cavity, if you have like a broken tooth.
That's not going to do anything, you know, and it'll keep getting worse.
So insomnia is like a cavity for your sleep processes.
And so you have to get to the root of the problem.
To be clear, we still all need to practice good sleep hygiene.
In the same way, we should all be brushing our teeth twice a day.
But if you think you might be in that acute to chronic insomnia camp, you shouldn't expect sleep hygiene alone to be able to fix the issue.
Because...
It not only doesn't work, it makes it worse because the person gets even more frustrated and anxious because they're doing everything their doctor is telling them, or the internet, or chat, GPT or whatever it is.
And, you know, and then they're thinking, oh my God, there must be really something wrong with me.
When you've reached acute or chronic levels of insomnia.
Steve says it's like your sleep system has been trained to wake you when you want to sleep.
In order to break that backwards behavior loop, Steve works with patients using a treatment called CBTI, or Cognitive Behavioral Therapy, for Insomnia.
So CBTI is like the gold standard for evidence-based non-pharmacological treatment for chronic insomnia.
And it's also been shown to be effective for acute insomnia.
Unlike more general talk therapy, CBTI is tailored to sleep anxiety specifically.
And that's an important distinction.
See, when you treat symptoms of more general anxiety, Usually you're worrying about stuff that actually isn't happening.
With sleep anxiety, if you're not sleeping well, it's not in your imagination.
You're actually not sleeping well, and so you have to actually improve the sleep to get rid of the sleep anxiety.
Typically, a CBTI program lasts about six to eight weeks.
And each week you and a provider work on a skill or a strategy that can help reset sleep behaviors and restructure your thinking around rest.
And while this kind of treatment does require commitment, it's not always a walk in the park.
It can also be super effective.
I've seen people that have had insomnia for 30 years and overcome it.
So it's not like certain people are doomed with this.
Like, you can always overcome it.
And no matter where you are on the insomnia spectrum.
CBTI practices can boost sleep, which is why we'll be breaking down a few to help you start stressing less and sleeping more.
Takeaway two, wake-up call number two.
Have a set one every day.
Yes, you heard that correctly.
Set the same morning alarm seven days a week.
Yes, that includes days off and holidays.
And this is hard.
You know, it's hard to kind of convince people of this.
Like, they want to sleep in on the weekends, and I get that.
Eric Prather is a professor and sleep scientist at the University of California, San Francisco.
And the author of the book, The Sleep Prescription, Seven Days to Unlocking Your Best Rest.
And he doesn't just study this stuff.
You can tell he's a sleep enthusiast.
Sleep has this, it's just this kind of deliciousness for our body, right?
It does so much for our heart, for our immune system, for our emotions.
When people get the sleep they need, they really are kind of the best version of themselves.
One of the best and easiest ways to be that best you?
Set that alarm to fill up your internal sleep balloon in a timely manner.
What's a sleep balloon?
Is that not just a thing everybody says?
Okay, so there are two primary processes that control sleep in our body.
The first I'm sure you're familiar with is your circadian rhythm, also called process C, that internal clock that gets a jumpstart from sunlight in the morning and ebbs and flows throughout the day.
The other is process S, or our sleep drive.
I do think of it as kind of like a balloon.
Like you wake up in the morning and your balloon is flat.
And then as you kind of go throughout your day and use energy, it fills up.
It kind of gets bigger and bigger with sleepiness.
When that balloon gets big enough, your eyelids get heavy.
You begin to yawn.
You go to sleep and then you kind of drain out that sleep.
And it's kind of like you let the air out of a balloon.
And when your process S and process C are well aligned, then it often predicts kind of a restorative sleep.
It's common sense, right?
If you wake up at 7 most days, but then you sleep until 10 on Saturday morning, not only is your circadian rhythm thrown off, essentially inducing some minor jet lag, but also Your balloon's not going to start building up until that time.
And then, you know no surprise you may not feel those same sleepy cues at night.
Now, why focus primarily on wake-up time?
It goes back to the idea of controlling the controllable from the top of the episode.
We can't control when we get sleepy, right?
But we can control when we wake up.
So setting that morning alarm and doing your best to stick to it, painful though it may be on some days, can be a first step in unburdening a bit of that sleep stress by offering you some agency and giving your body some predictable cues to work with.
In CBT I speak.
This is a stimulus control practice, aka making deliberate choices about when you're getting in and out of bed.
That can help to address conditioned arousal, which is just the fancy scientific phrase for when someone's relationship with their mattress gets turned upside down from too many nights of sleeplessness.
So, instead of the bed being a cozy, comforting cue for the brain and body to drift off to dreamland, Eric says often people will tell him.
You know, I feel sleepy before I go to bed and then I get in bed and my brain wakes up.
Or they wake up in the middle of the night and they look at the clock and their brain is like, just like activated.
The bedroom tells your body to be awake.
Completely breaking that association between your bed and anxiety will likely require some retraining and rearranging both inside and out of the bedroom.
But I promise it's not all a chore.
For example, the next task on our conditioned arousal checklist.
Takeaway three, go on, stay up late.
Get out of bed when you feel like it.
Just give yourself enough time to power down before bedtime.
It sounds a bit counterintuitive, working on your sleep by spending less time in bed, right?
But do you remember fighting against your bedtime as a kid?
Or do you maybe have a kid who fights against theirs now?
You know, like, mom, I'm not sleepy yet.
People may hope to get in bed and be asleep by 930.
And instead, they're spending more time in bed getting frustrated that they're not getting sleep.
And that really aggravates the issues.
Dr Ravi Isola is a physician, a clinical professor of medicine and the director of the Sleep Disorder Center at UCLA.
He and Eric are going to walk us through a few other CBTI practices.
Namely, only go to bed when you're sleepy and get out of bed when you're not.
You don't have to cease all activity to better support your sleep.
Just don't actually get into bed until you're sleepy.
Like, can barely keep your eyes open type sleepy, ideally.
That'll help reinforce that positive association between the bed and sleep.
Now to be able to get to that level, Robbie says, instead of focusing on a bedtime, focusing on kind of an off time, when I've decided that OK, at 9 pm doesn't mean I'm going to, you know, be on my computer and do work until 9 pm, shut it off and then jump into bed and expect that it's going to happen.
I'm going to flip a switch.
As Eric says, our brains are predicting machines, constantly trying to take in context clues and figure out how to use our metabolic resources to keep us alive and thriving.
And that's why you need to give yourself a long off-ramp from all the excitement of the day.
So you know, when people go to bed, they often have these rituals, whether they know it or not, that they do each night as they begin to go to bed.
And the more consistent things you make that, the more your body understands.
It's like oh, now we're going to transition to sleep.
To start to downshift your brain and body into rest mode.
Dial down your environment as best you can too.
For example, at home, Robbie dims all the lights when the sun goes down, in keeping with a natural rhythm of the body.
And I find that that makes a difference.
But I think a bigger part of it, or as important, is the attention we give to the things that we're looking at.
And obviously you don't want to put on the most thrilling movie in your catalog or plan to hate scroll preposterous Reddit threads.
But your nighttime ritual doesn't have to be completely screen free.
Some people watch TV before they go to bed with their loved ones, or maybe they have a conversation, or maybe they're reading or they listen to a podcast.
Maybe they're like super NPR Life Kit fans, and that's awesome.
Eric says, if you are going to consume content, shoot for things that are calming and slightly positive.
So chef's choice here put on that favorite lighthearted TV show, read your favorite comic book, or there are a ton of resources specific to sleep out there, like the Calm or Headspace apps.
You could go for a favorite chill playlist and a cup of soothing, non-caffeinated tea.
Just aim to provide something for yourself that is supportive and puts you on the path to sleepy town.
And these are the same tools you can turn to if you find yourself up in the middle of the night, unable to go back down.
Because trying to force sleep is only going to up your stress levels.
When people are awake in bed, we don't want them to kind of stew there.
We often have like a cutoff of like 20 minutes.
You hit that threshold where you have that internal feeling, that kind of ugh, that internal side that tells you it's not happening.
Or I'm getting to that frustration point.
Get out of bed and I say, a dull book and dim light.
And the reason I mention a book is because books have endings, as opposed to say the endless black hole that is doom-scrolling.
A warm shower has been proven to encourage sleep, too.
But don't be too rigid about it.
Whatever best soothes you, distracts you from your worry, is the right thing.
One final pro tip here.
Eric says, if fully getting out of bed feels hard or scary for you, sometimes just switching up your positioning can be enough to jolt your brain circuitry like give you the change you need to miss your specific corner of sleep space.
If you go and lay at the foot of the bed, you'll be shocked at how different an experience it is.
And that really just reinforces like how powerful like the bed and your usual routines are for supporting your sleep.
So now we have some solid nighttime strategies.
After the break, we'll move into daytime hours.
So now we have some nighttime strategies.
Let's move into the daytime hours.
Takeaway four.
Don't save your worry for your pillow.
De-stress in the daylight.
Quick thought exercise for you.
When you lay your head down at the end of the day and your mind starts to run back the highlight reel.
Is it the good stuff?
Small wins, things you're proud of or looking forward to?
I mean, it happens, but it's often around worries.
And that time is kind of misplaced.
It's true.
I mean, have you ever even once been like?
I am so glad I stayed up that extra half hour to relive that embarrassing moment from work.
Or all those mommy mishaps?
Or man.
I wish I spent just a little more time last night having that fantasy argument with that rude salesperson from earlier.
All your stressors will be there in the daylight too.
And in fact, will probably be better served by a well-rested brain.
Enter worry scheduling.
Take that 10 15, 20 minutes whatever you think you can realistically spare and Put it in your schedule where you sit down and you just do your worrying.
Eric says he thinks this practice works best if you write out what you're worried about.
It just gives that nebulous worry monster more of a distinct, tackleable form.
But speaking them aloud or, say, recording them on your phone could work too.
And it's been shown that when people make this a consistent schedule it does seem to lead to less of that same worrying at night.
So it's like giving your brain a space to do it, doing it in a consistent way.
Because, as we all well know at this point, Stress is the enemy of sleep.
So building in breaks, doing just a little something for your mental health throughout the day, can make you better equipped to face challenges as they come, which in turn can lighten your mental load come bedtime.
And like, I get it.
Like, you know, some people listening might be like, oh, that would be great.
But I, how am I going to do that?
Yeah, it must be not, yeah.
Good tip.
But I mean, I think we can't let perfection be the enemy of like good enough, right?
And I think any steps that people can make, even just beginning to make those like small changes, can you know, certainly kind of chip away at what might be getting in the way of their sleep.
One big stressor that might be unknowingly tripping up your rest?
Your sleep tracker.
We have a phrase now that is commonly mentioned at our sleep conferences called orthosomnia, where I think all sleep physicians have experienced this.
A patient comes in and, well, what's the reason you're coming in today?
Well, my tracker tells me I'm not getting enough XYZ sleep.
You know slow-wave sleep, or deep sleep or REM sleep.
Orthosomnia.
This is a recently developed form of insomnia that we absolutely needed to shed a little daylight on.
Robbie says sleep trackers can be helpful for logging sleep.
In fact, it's another aspect of CBTI therapy that can help identify patterns and tailor treatment.
But for the average unassisted consumer.
He says it's important to approach this data with a healthy level of skepticism.
So if you must track, he says do so with purpose and a specific goal in mind.
You know, measurement without guidance is where we run into problems.
How are you using that information?
Is that information helping you make changes in your behavior or your lifestyle that are helpful?
Or is it stressing you out and making the insomnia worse?
So understand the abilities and limits of your specific device.
Like if it's known to be internally consistent with sleep scores or duration, say.
Then check in with your body before you check your scores, rather than letting your tracker tell you how you feel.
Like this, told me that I had a bad night last night and I remember waking up X number of times and tossing and turning and I feel terrible today.
And then on a different night that...
For whatever reason, you slept better and feel better in the morning.
And the tracker kind of confirms that.
I think that is meaningful information, to at least tell you that this is matching up with how I feel.
Maybe that leads to some action, like a conversation with your doctor or a consultation with a specialist like Steve.
Or maybe it can just help reinforce your beliefs about sleep.
And that brings us to our final takeaway, takeaway five reframe your sleep story a little at a time.
All right, we've loaded up your pillowcase with lots of tools to help sweeten your dreams but, as any insomniac up all alone at 4 am knows, reshaping your sleep habits is only half the battle.
The rest of the work comes down to shifting your mindset. like one night at a time.
Expectations are a huge part because it's not like a linear process.
The sleep kind of just varies.
So the people that handle it the best just have the right frame of mind.
And it's this learning to change your relationship with the sleep.
And when you do that, your sleep starts to get better because you're not being reactive to it.
In CBTI, this is called Cognitive restructuring.
Recognizing and replacing your negative sleep thoughts with more accurate and positive thoughts.
For example, instead of fixating on how bad your last night of sleep was, you could look ahead and remember.
And we let them sleep.
The next night, they immediately drop into deep sleep, right?
That restorative sleep.
It's like your body's trying to eat it up as quickly as possible, because there's a lot of compensatory mechanisms to keep us healthy.
That doesn't mean you have to find an answer to every question in your mind.
Like, maybe your insomnia fear's been further out.
Maybe you're worried about how sleeplessness might affect your long-term health.
You know right now I can't necessarily tell you exactly exactly what the consequences are going to be.
You know 20 years from now.
But I can tell you that it's not helping that you're worrying about that right now.
And so reminding ourselves that insomnia occasionally is normal, that the world is not going to end.
I don't have to get eight hours of sleep every single night.
And when all else fails, Robbie says, return to your breath.
There's safety there.
People have to feel safe when they go to sleep.
You're okay.
You're breathing.
You're able to regulate your reaction to the world.
And that ability to start self-regulating brings some reassurance.
All right, sleepyheads, let's recap.
Takeaway one.
Your sleep isn't broken, but it might need a professional reset.
Takeaway two.
Have a set wake-up time every day.
Takeaway three don't go to bed until you're sleepy and do your best to set up your sleep environment for success beforehand, to get you there.
Takeaway four, be deliberate about de-stressing in the daylight.
Schedule your worry, build in breaks, and if you must track, track with purpose.
Finally, takeaway five, reframe your sleep story.
Everybody has bad sleep now and then, and I promise sleep will come.
When it does, we wish you sweet dreams.
That was LifeKit reporter Andy Tegel.
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This episode of LifeKit was produced by Lennon Sherburn.
Our visuals editor is Beck Harlan, and our digital editor is Malika Gharib.
Megan Cain is our senior supervising editor, and Beth Donovan is our executive producer.
Our production team also includes Claire Marie Schneider, Margaret Serino, and Sylvie Douglas.
Engineering support comes from Kwesi Lee.
Fact-checking by Tyler Jones.
I'm Mariel Segarra.
Thanks for listening.
