Can writing a simple to do list right before bed let you fall asleep faster? Recent research says yes. Which points out that if people do simple cognitive behavioral therapy for insomnia, or CBT-I, they can make their sleep and waking lives a whole lot easier.
The Study
Young people 18-30 who weren’t having a lot of sleep issues were randomly sorted into two groups at Baylor Medical School. For five minutes before 10:30 they were given two different tasks: either write a to-do list for the next few days, or write about the tasks they completed in the last few days.
Those who did their to do lists fell asleep a lot faster. The more specific the list and requirements they set themselves, the quicker the slumber.
The folks who went over what they had accomplished the previous few days fell asleep a lot less quickly. The more specific their descriptions, the slower they went to sleep.
Planning helps. Knowing what you want and need to do helps you sleep. Cognition set matters, particularly when you can do simple cognitive-behavioral therapy for insomnia.
Expectations Versus Reality
The American “Lie Down and Die Model” of sleep is not physiologically sound. Most studies of multiple cultures, particularly pre-electronic ones, demonstrate triphasic sleep: a first sleep with a waking in the middle of the night; a second sleep generally ending around dawn (many languages include phrases for “first” and “second” sleep); and a nap in the early to mid afternoon. Today’s preference is to spend less and less time in bed, and in one swell swoop go from the nightly news to perfect slumber to waking up jumping out of bed fully refreshed.
This rarely happens.
The truth is many Americans sleep less than seven hours a night and feel chronically tired. When they don’t get enough sleep, they worry about sleep. Think about it. Eventually obsess about it. And find they can’t sleep.
Moreover, very few people have “perfect” nights. Most times we awaken 15-20 times a night though we usually can’t remember these discontinuities, for sleep produces amnesia. Even “perfect” sleepers have bad nights. Many come to believe they “need to get that sleep back” by sleeping in the next morning.
Correcting the differences between expectation and reality is a basic premise of CBT I (Insomnia.) Some of its methods are:
1. Sleep Ritual – making sure you have a cool, calm, dark, safe place to sleep, an ability to take an “electronic diet” before slumber, and a series of small behaviors like teeth flossing and brushing and short bouts of reading that tell the body it’s time to sleep.
2. Respecting biological clocks. A large part of what gets humans to sleep is our biological clocks setting the times of our waking and slumbering. The more regular we are, the better we function overall.
3. Stimulus Control – when you’re not asleep, you should not be in bed. Stimulus control includes a series of small behaviors that create the mental pattern that beds are for sleep and sex. Libraries are filled with books and talking books that can help people sleep when they wake in the middle of the night.
4. Sleep Restriction. Americans greatly admire efficiency. Sleep efficiency is a real number, defined as time asleep divided by time in bed. Mostly you want that ratio above 85%. Sleep restriction means staying in bed only the number of hours one expects to sleep, and when sleep is poor to build a base that can be expanded, much as one learns to play instrument first with notes, then scales, then melodies.
5. Not clockwatching. Through our cell phones we watch clocks all day. Not a good idea during the night. Watching the clock makes us wake when we see the clock, setting up a conditioned insomnia and early wake time that goes on and on.
6. Relapse Prevention. Bad nights are normal. Bad nights should be expected. Often they are not. Expecting bad nights and preparing for them, by using techniques like stimulus control and sleep restriction, takes the sting out of a bed hotel night or the strange noises of a relative’s home.
Simple Steps
Sleep should be as simple as breathing. Making it into work makes it not work.
CBT I is about returning sleep to its more natural state, where the body and brain are relaxed enough for biological clocks to take over and gently bring us into sleep, night after night. The individual techniques are simple, though putting them together may be best with the aid of a sleep clinician interested in behavioral treatments of insomnia (sadly, the commercial insurance emphasis on sleep apnea means many sleep clinicians are not.)
If something as simple as a to do list can help you sleep, the conceptually easy homework of CBT I can do a lot more. Sleep is like food. We need it to survive.
Lots of us imbibe lots of dietary advice. Why can’t we do the same for sleep?
