The inability to turn off one’s mind is the most frequently reported complaint of individuals who cannot fall sleep or return to sleep in the middle of the night. This factor is so prevalent, anywhere from 80 to 90% of insomniacs will report racing thoughts and ruminations as the chief cause of their insomnia. “I just can’t turn off my mind,” or “my engine just won’t shut down,” are common refrains among these folks, ranging from children to adolescents to adults to the elderly.
Racing thoughts and ruminations are the primary target of the pharmaceutical industry when developing prescription or over-the-counter (OTC) sleep aids. While the pharmacology is designed with a goal to create the feeling and sensation of sleepiness, the effectiveness of the drug can be measured by how effectively it overcomes the frenetic mental state. To be sure, there is no drug to eradicate racing thoughts (although some drugs advertise they can quiet the mind of an anxious or bipolar patients); rather, the drug’s ability to induce drowsiness must prove sufficient to overcome the racing thoughts and ruminations.
As is well known, many insomniacs shy away from the medication approach, prescription or OTC, for numerous reasons, two of which include drug side-effects and developing a dependency on the medication. Insomnia patients therefore are always looking for other means to eliminate racing thoughts and ruminations, which brings us to a recent article published at cnbc.com on their MAKE IT section under the heading tab “Careers.” No surprise, a lot of people suffer from insomnia when they are searching for new pathways in their professional lives.
The piece, entitled “5 tricks to fall asleep when your mind is racing about work,” describes five specific tips or techniques for overcoming racing thoughts:
- Stimulus control: get out of bed
- Read a book or color
- Schedule 10 minutes of worry time earlier in the day
- Exercise for 20 minutes every day
- Set up a sleep routine
I will briefly describe the pros and cons of each “trick,” followed by a deeper explanation of the fundamental causes of racing thoughts and how to manage them most effectively over the long-term without sleeping pills and without tricks.
Stimulus Control: this mainstay of cognitive-behavioral therapy for insomnia (CBT-I) is one of the most powerful tools for combating sleeplessness. It works on the premise that when you remain in bed while not sleeping, you are teaching yourself the bed is place to not sleep. To reverse the conditioning or habit, you leave the bed and bedroom and engage in some other activity until you feel sleepy, at which point you return to the bed to go to sleep. This technique works wonders in many insomniacs, but a sizeable proportion will return to the bedroom with persistent racing thoughts and ruminations. Thus, stimulus control is similar to drug treatment in that the goal is to get you sleepy enough to overcome the racing thoughts as opposed to directly targeting the racing thoughts. No doubt, whatever you choose to do outside the bedroom may have a direct impact on the racing thoughts. More later.
Reading or Coloring: Both techniques work well for many individuals with insomnia and what is especially interesting is each method could be used in bed before lights out for only a few minutes to bring on the requisite sleepiness. However, if prolonged reading or coloring occurs, these approaches are self-defeating, because they not only interfere with sleep hygiene but also may entrench a new learned behavior or conditioning effect in which the insomniac arrives in bed to read or color and not to sleep. Nonetheless, when reading or color is effective, it can be argued its effects are not simply inducing sleepy feelings; instead, by directly activating the mind in non-verbal ways (e.g. coloring is a visual experience; reading activates images from the book’s content), racing thoughts are directly targeted; reading and coloring then are potentially more powerful tools if their application yields rapid changes in the mental landscape.
Worry Period: This concept is legendary in sleep medicine history as well as in the treatment of insomnia and is considered another variation of stimulus control; it dates back several decades and shows validity when applied by mild insomniacs. However it may not function as an enduring system for moderate or severe insomniacs. The idea is simple: if you face your worries honestly for a few minutes earlier in the day or evening, then perhaps these same worries will no longer haunt you when you climb into bed. To turn the worry period into a routine behavior, you must repeat the process each day at the same time and in the same location. In the original anxiety research, 30 minutes duration was recommended. To repeat the above criticisms in a different way, if your worries are of a mild nature, then 10 minutes of worrying might do the trick, but when someone perceives her life stressors as more painful, complex, and unrelenting, then a great deal more mental and emotional work is needed to overcome these worry triggers as bedtime approaches.
Daily Exercise: Many people report daily exercise deepens their sleep and may enhance sleepiness around bedtime, which naturally would promote faster sleep onset, but I am unaware of any study that indicates exercise will decrease racing thoughts and ruminations directly, specific to the problem of attempting to fall asleep or return to sleep when awakened. That said, long and brisk walks sometimes enable individuals to “burn off” anxiety and worries and thus may actually decrease racing thoughts and ruminations. Whether or not this effect is maintained at bedtime or during the night if awakened is unknown. Thus, exercise is a great tool for general health and to promote sleep, but its impact on racing thoughts are more likely to be inconsistent and more of an indirect effect.
Sleep Routine: Here, the idea is to simply pick a time about one hour before bedtime to unwind in various ways to promote relaxation, which in turn allegedly decreases racing thoughts and ruminations. For example, stretching exercises, yoga, meditation, coloring and so on may encourage the mind to do less thinking and worrying and more accepting and relaxing. Eating and drinking during this window prior to lights out may prove counterproductive if indigestion occurs. Bathroom rituals such as flossing, dental hygiene, brushing hair as well as showering or bathing can all promote the mindset it is time to prepare for sleep. Again, while a sleep routine seems like common sense and indeed works very well for many normal sleepers, it may or may not yield consistent results among more severe insomniacs.
Overall, these ideas are worth considering, because they have helped many insomniacs, but for the most part these approaches do not directly address the nature and causes of racing thoughts. In many conversations with sleep experts over the years, I have often asked the question “why do insomniacs have racing thoughts at bedtime?” Surprisingly, the only consistent answer is that insomniacs suffer anxiety and tension surrounding sleep issues, and racing thoughts and ruminations are a component manifestation of the sleep disorder. Nonetheless, few have reported specific techniques that directly target the racing thoughts, which is the topic of the next post along with the etiology of the problem.