Sleep Anxiety

I used to have insomnia. For two decades. Then sometime after turning forty, my sleeping problems diminished. I’m not sure why. Probably a combination of factors, foremost of which might simply have been the slow shift of my circadian rhythms over time. I was a late night-owl as a teenager, but made an abrupt shift to an earlier schedule when I arrived in the U.S. as a college student in my early twenties. In my tropical home country, we ate dinner later and there was a tradition of a late-night supper when the weather was cooler.

 

Because of my insomnia, I have read many books and articles on sleep over the years. I continue to do so as a matter of habit, and simply because sleep still remains mysterious even though scientists have amassed a lot of interesting data and we now know much more than we used to. I didn’t experience significant sleep anxiety during my two decades of insomnia; I just got used to it and it didn’t significantly impair my work performance. Napping helped. And I have significant chunks of time to myself, which is a great boon as an introvert.

 

The Sleep Prescription is a mini-book by Aric Prather, a sleep scientist at UCSF. Published last year, its tagline is “7 Days to Unlocking Your Best Rest”. The author provides a good mix of the scientific underpinnings of sleep along with engaging anecdotal stories of anxious insomniacs trying everything they can to improve their sleep. I was familiar with much of the science, but I still appreciated Prather’s approach in this book – very practical with easy-to-remember tips. Here’s my summary of his seven points for seven days.

 

#1. Set your wake-up time and stick to it! Yes, even on the weekends. I used to sleep in on weekends to catch up on my deficit. I stopped doing so a long time ago. It helped. I no longer confuse my circadian rhythm. At least until I travel internationally and my body clock gets messed up. But that’s okay because I give myself time to readjust.

 

#2. Sleep problems are often tied to waking life problems. Particularly stress. Prather discusses the role of cortisol in the sympathetic nervous system and its role in waking you up from sleep. I am blessed to have led a relatively stress-free life. I didn’t feel the pressure to “get all A’s” as a college student. Early on in my career as an academic, I decided I didn’t need to be a star, and I instituted strong work-life boundaries. I’d say work stress wasn’t much a factor in my insomnia. Although sometimes I would lie awake thinking about work-related ideas in my teaching and research. (These were positive thoughts but still kept me awake.) Prather’s advice is to “ease off the gas” and schedule micro-breaks from work stress. I already take regular breaks mostly so I’m not sitting for too long.

 

#3. Energize when you need to during the day. Prather mentions sticking your head in the freezer for cold shock. I’d heard this before, but I don’t do it. He also discusses managing your caffeine. I avoid caffeine so that’s not an issue. Is it okay to nap? Yes, but not for too long. Prather explains the sleep cycle and how to relieve sleep pressure without getting into the phase where you wake up groggy. Turns out forty winks is a good measure. I lie down for forty minutes. I might not fall asleep but if I do so, it might be for twenty or thirty minutes. It works. But you must set an alarm and not hit the snooze button.

 

#4. Set aside time blocks to worry and not too late in the day. The strategy behind this is to reduce anxiety because you can tell yourself that you have time to worry. It sounds weird, but Prather assures the readers that it works. He provides several “levels” of doing this. I’m thankful I don’t feel the need to do this, but I can see its usefulness for folks who are in much more stressful situations.

 

#5. You are not a computer, you can’t just shut down. That’s the title of chapter five. When I had insomnia, I learned the importance of having a wind-down routine. I do many of the things you’ve likely heard about. I have relaxing activities. I take a warm shower. I have a tiny cup of cereal with milk. And I’m adamant about not doing any work in the evenings, which also means I hardly use my computer then. When I was younger and my insomnia was worse, having the routine helped. I also kept a sleep diary (as Prather recommends) to help me discover what worked and what did not. I stopped doing so in my early forties; I no longer needed the diary. But the routines have stayed.

 

#6. You can retrain your brain. Prather has a number of good tips, including “do not get into your bed until you’re sleepy.” This is a tough one for me because I like lazing in bed. It’s physically soothing and I feel happy when I’m in bed with my pillows. It doesn’t help my sleep though. Prather also says that if you don’t fall asleep after 20-30 minutes, get up and do something else that’s still relaxing. And don’t bring your book or laptop into bed. If you have to, do it differently – in a different position, at a different corner of the bed, etc. I like to read in bed and it is part of my wind-down routine. Prather understands these things and discusses compromises. While I don’t necessarily follow his advice here, I’m reminded of his suggestions and I found myself readjusting to them.

 

#7. Stay up late to build up sleep pressure if needed. Prather has a scheme for doing so and provides appropriate guidelines. While I would use this strategy when shifting time zones, I wasn’t always consistent. I like Prather’s approach and I will try it the next time I need to get over jet lag. I was also reminded, not just in this chapter but throughout the book, that the goal is not perfect sleep, but good-enough sleep. What is good enough? Prather has a straightforward scheme for you to calculate this from a 7-day log of your sleep. I like his guidelines and his approach of keeping all these strategies low-stress.

 

If you are anxious about your sleep issues, I highly recommend Prather’s book. I find it practical and research-informed. Sleep anxiety should not rule your life. Your body is built for sleep and wakefulness. Prather recognizes that individuals have different sleep needs and his book might help you find a happy medium.