Sleep inertia is unavailable to us on the couch if we haven’t been asleep.
Solution: Go to bed early in the process of becoming drowsy rather than when you are about to doze off. For example, you may feel your mind and breathing slow down, or find it a bit more effortful to keep your eyes focused. Don’t wait until you want to close your eyes or until you would find it taxing to stand up.
Let thorough sleepiness overtake you in bed so that you don’t have to start over. Having to restart is especially unkind if you suffer from insomnia.
Responsibilities before bed
Many of my patients make more than a pit stop in the bathroom on the way to the bedroom. Their preparation for bed is like a late-night job.
They brush their teeth (often under bright lights, which stimulate wakefulness), wash their faces, put in their eye drops and so on. Then they need to put on their pyjamas as a prelude to lying down. Sometimes conversations and planning for the next day ensue. Long gone is the readiness they felt on the couch.
Solution: Complete evening ablutions and put on pyjamas before winding down on the couch. There should be no work to do at bedtime. Make time to connect over conversation earlier in the evening.
Conditioned arousal
If we lie awake in our beds for extended periods night after night with insomnia and its attendant anxiety and frustration, lying there can become a conditioned trigger for those experiences. People with conditioned arousal may fall asleep readily elsewhere such as on the couch or at a relative’s home, but not in their own beds.
Solution: Break learned associations between the bed and anxious, frustrated wakefulness, and reassociate the bed with peace and sleepiness. This is chiefly accomplished by only being in bed when peaceful and nearly or thoroughly sleepy – or asleep.
Just waiting until you are close to sleepy to come to bed can go a long way. Having another inviting, restful environment available if you are awake for more than about 20 minutes (but without closely monitoring the time or being on a sleep vigil; remember the peace part of the prescription) also helps. For many people, the awake environment can be the other half of the bed. It is best to return to the sleep environment when almost sleepy again.
Breaking old associations and building new ones requires repetition. The technique usually takes at least two weeks.
Pressure to get to sleep
If we suffer from insomnia in bed, we may put pressure on ourselves to get to sleep.
The pressure is a response to “performance anxiety”. I find it helpful to think of performance anxiety as feeling personally responsible for one’s sleep while attaching great importance – and paying much attention – to both the goal and the stakes.
Anxiety, pressure, effort and frustration interfere with sleep even in the absence of conditioned arousal.
None of these problems afflicts us on the couch because we’re not expecting sleep on the couch. Sleepiness naturally overtakes us there because we don’t obstruct it through effort and desperation.
Solution: There are many ways to dial down performance anxiety. I wrote about some of them here. My favourite approaches are to understand that it’s not your job to sleep any more than it is your job to feel thirsty; to de-catastrophise sleep loss; and to comfort yourself when you feel anxious – all without invalidating your suffering.
Nothing to focus on
My patients are not usually just lying on the couch at night. They tend to watch TV or read there. It’s how they unwind after a long day.
Since we can only entertain one narrative (or image or song or bodily sensation) at a time, focusing on something soothing means we’re not focusing on all the thoughts that keep us awake, from worries (including worries about sleep) to regrets to stressors to exciting goings-on. The relaxing focus may also slow racing thoughts.
But when my patients go to bed, they are often without something calming to focus on.
Solution: Consider putting your mind on something soothing to bridge the interval between coming to bed and falling asleep. It might even be the same thing that was making you sleepy on the couch.
The focus can be on an external work (for example, an audio book; check out the offerings at the Sleepy Bookshelf) or in the privacy of your mind (for example, naming a flower, tree or plant beginning with every letter of the alphabet, skipping letters that are too hard).
Surfing the web, while righteous competition for your default thoughts, is probably not soothing.
I offered some other approaches to overthinking here.
A related issue is that some people fall asleep on the couch before bedtime. Night-time naps can interfere with both sleep onset and sleep quality, and can alter a person’s biological rhythm.
Lisa Strauss, PhD, is a clinical psychologist in the Boston area. She specialises in sleep disorders.
