The To-Do List: A Sleep-Friendly Bedtime Activity?

If you’ve got insomnia, you’ve probably heard of “worry lists.” Sleep doctors for years have been urging insomniacs to write our worries down before going to bed, claiming this will alleviate anxiety and sleep will come more easily.

Really? Write about looming deadlines and all the upcoming functions I have to prepare for before I go to bed? That’s sure to send my anxiety through the roof! (not to mention keeping me up for hours).

But the idea may not be as counterproductive as it sounds.

Insomnia because you're worried about tomorrow? Make a to-do-list in the eveningIf you’ve got insomnia, you’ve probably heard of “worry lists.” Sleep doctors for years have been urging insomniacs to write our worries down before going to bed, claiming this will relieve anxiety and sleep will come more easily.

Really? Write about looming deadlines and all the upcoming functions I have to prepare for before I go to bed? That’s sure to send my anxiety through the roof! (not to mention keeping me up for hours).

But the idea may not be as counterproductive as it sounds, a new study suggests.

Nighttime Challenges for Insomniacs

No one likes arguments or bad days at work, but experiences like these can be doubly disruptive for people with insomnia. At night these upsetting events cycle over and over in your head, making it hard—sometimes impossible—to sleep.

Likewise, it can be hard to sleep when you’re looking at challenges ahead. Tests to study for, deadlines to meet, presentations to deliver, events to organize, flights to catch—any unfinished business, especially lots of it, can keep you wakeful long into the night.

Could making a to-do list before going to bed relieve anxiety about tasks ahead and enable sleep to come more quickly? The jury is still out concerning insomnia sufferers per se. But a new study of healthy, normal sleepers conducted at Baylor University and Emory University Medical School suggests it might be helpful.

Polysomnography and a Pencil-and-Paper Task

This study—the first part of a larger study—was simple in design. Participants were recruited on campus and screened for various disorders, including sleep disorders. Sixty participants aged 18–30 were chosen (three were later disqualified). They were randomly divided into two groups.

The evening of the study, participants in both groups went to a sleep lab, where technicians prepared them to undergo an overnight sleep study, wiring them up for polysomnography.

After that, participants in one group were given a sheet of paper and told to spend the next five minutes writing down everything they had to do the next day and in the next few days. Participants in the other group were given a sheet of paper and told to spend five minutes writing down everything they’d accomplished that day and in the past few days.

The sheets were then collected. Lights went out at 10:30 p.m., and participants’ cerebral activity was monitored through the night.

To-Do List More Helpful Than List of Accomplishments

The results were all significant:

  • Participants who made a to-do list at bedtime fell asleep faster than those who wrote about completed tasks. (On average, the to-do list makers fell asleep in about 16 minutes while the others who listed accomplishments fell asleep in about 25 minutes.)
  • Among participants who made the to-do list, the greater the number of items on their list, the faster they fell asleep.

So making a detailed to-do list might actually be a good activity to add to your wind-down routine at night.

Results in Perspective

Other studies suggest these findings aren’t as unusual as they may seem. Researchers studying adults in highly stressful situations, such as having a son or daughter diagnosed with cancer, found that the more specifically parents could map out concrete steps they were going to take to contend with the child’s problem, the less stressed out they felt. Another study showed that first-time pregnant women who could simulate in detail how their labor would go were less worried than women that were less successful in simulating labor.

But back to doctors’ advice about worry lists: It seems to me there’s a difference between a worry list and a to-do list. The one sounds problem focused while the other is focused on solutions—which may make a difference in their effects.

At any rate, if you have insomnia and at night your mind is constantly drifting toward tomorrow and all the things you have to do, try writing down the steps you’re going to take to make things happen before you get in bed. It might relieve your anxiety and slow your busy brain just enough to hasten sleep.

9 Ways to Keep Worry From Sabotaging Sleep

These days people are worried about jobs, health care, the environment, the possibility of worldwide war. Uncertainty about the future, and fear of negative outcomes, may rob even reliable sleepers of sleep from time to time.

But for many insomnia sufferers, worry and anxiety about sleep itself—“It’s two o’clock and I haven’t slept a wink!”; “If I don’t get to sleep now I’ll get sick!”—is an equally powerful enemy of sleep.

Here’s more about worry and insomnia and how to keep them from spoiling the night.

Insomnia sufferers should incorporate a bath into their bedtime routineThese days people are worried about jobs, health care, the environment, the possibility of worldwide war. Uncertainty about the future, and fear of negative outcomes, may rob even reliable sleepers of sleep from time to time.

But for many insomnia sufferers, worry and anxiety about sleep itself—“It’s two o’clock and I haven’t slept a wink!”; “If I don’t get to sleep now I’ll get sick!”—is an equally powerful enemy of sleep.

Here’s more about worry and insomnia and how to keep them from spoiling the night.

Worrying Around the Clock

Worry and sleep don’t mix. Like anxiety, which is more intense, worry—or repetitive thinking about issues of concern—triggers the release of neurochemicals that prepare the body for action rather than for rest.

Some people are by nature inclined to worry day and night. Allison Harvey, in her cognitive model of insomnia (2002), hypothesized that round-the-clock worry about sleep led to arousal, resulting in the sleep problems experienced by insomniacs at night.

Worrying at Night

More recently, research has suggested that it’s worry in bed—rather than worry day and night, or trait-level worry—that is connected to trouble sleeping, and a new study published in Behavioral Sleep Medicine supports this conclusion. Researchers administered a series of questionnaires to 139 insomnia sufferers and had them complete sleep diaries every day for 10 days. Neither trait-level worry nor trait-level rumination (repetitive thinking about negative emotions) was shown to have a relationship with any aspect of sleep.

The researchers then conducted a similar study with another group of insomniacs. Sixty-four participants were asked to fill out two diaries: one at 6 a.m., to record the sleep-related worries experienced during the night, and the other at 7 p.m., to record sleep-related worry and stress experienced during the day.

The results? Nighttime sleep-related worry had a significant and negative effect on every aspect of sleep, including trouble falling asleep, being awake longer during the night, and sleeping less efficiently. In contrast, daytime sleep-related worry had a negative impact on sleep quality only.

“Cognitive activity during the day is relatively benign,” the study authors concluded, “but cognitive activity in bed plays an important role in development and persistence of sleep problems in insomnia.”

The Take-Away

Do your worrying during the daytime rather than at night!

Because that’s easier said than done, here are nine ways to check your worries—sleep-related or not—at the bedroom door.

  1. Write your worries down early in the evening. Preempt nighttime worrying by taking 10 or 15 minutes to write down the issues you’re worried about, whether or not they’re related to sleep. Beside each concern, write what action you’ve taken/you’re taking/you will take to deal with the problem. Some problems may be clearly outside your control (or feel that way), yet resolving to take some small action to manage the problem can afford relief.
  2. Share your worries with an empathic listener at dinner. Sharing your concerns with an empathic partner or friend over the evening meal can also help to preempt worry at night. And when it comes to figuring out how to deal with a problem, two heads are often better than one. Further, research suggests that regardless of who’s talking and who’s listening, interactions with friends and supportive family members help tone down stress.
  3. Create a pre-sleep routine. It’s important to end the day with a wind-down period (ideally, at least an hour) in the run-up to bedtime. Think of it as a time to indulge in self-care, incorporating activities that make you feel good—such as listening to slow jazz and bathing by candlelight. The aim is to create an end-of-day ritual that’s worry free. Doing the activities in the same sequence every night will establish a clear association between your wind-down routine and sleep.
  4. Train your attention on something outside yourself. Watch a movie or a sit-com. Read or listen to a novel with complex, interesting characters. Do a crossword puzzle or play a word game such as Scattergories (Pick a category: Food. Pick a letter of the alphabet: L. Think of all the foods that begin with the letter L.) If you can do so without disturbing others at home, play a musical instrument. Engaging your mind will free it from repetitive thinking and enable you to go to bed feeling more relaxed.
  5. Adjust your perspective with cognitive restructuring. Confront your worries head on by asking a series of questions to find out how realistic your repetitive thoughts about a worrisome situation really are. In the process you’ll often find your anxiety level going down. Click on cognitive restructuring to find out more.
  6. Do a low-key physical activity. Underlying worry and anxiety are neurochemicals that trigger the urge to fight or flee. Low-key physical activity, such as walking outside or around the house, enables you to work the stress out.
  7. Do a deep breathing exercise. Deep diaphragmatic breathing triggers the relaxation response, enabling the body to move out of fight-or-flight mode and into a relaxed and restful state. Sitting in a chair, slowly inhale to a count of 4, pause briefly, and exhale to a count of 4. Focus on your breathing. If you find your mind wandering, gently guide your attention back to your breathing. Repeat this cycle as many times as needed.
  8. Do progressive relaxation. Sitting or lying down, one by one, tense and release every group of muscles in your body. Start with the muscles in your toes and move upward through your trunk to your head. Then move downward through the arms to the fingers.
  9. Do a guided meditation. Allow someone else to lead you through meditations designed to quiet your mind and relax your body. Jon Kabat-Zinn, whose guided meditations are available on the internet, is a master at this.

Please share any strategies you’ve found to cut down on worry at night.

Prebiotics Improve Stress Resilience and Sleep

Is stress the driver of your insomnia? Eating more high-fiber foods—sometimes called prebiotics (different from probiotics)—may help both your stomach and your sleep.

In a new study on rats conducted at the University of Colorado, a high-fiber diet promoted the growth of healthy gut bacteria, increased resilience to stress, and made sleep more robust following a stressful event. Here are the take-aways and what the study suggests about human sleep.

Insomnia sufferers should eat high-fiber foods for stress protection and better sleepIs stress the driver of your insomnia? Eating more high fiber foods—sometimes called prebiotics (different from probiotics)—may help both your stomach and your sleep.

In a new study on rats conducted at the University of Colorado, a high fiber diet promoted the growth of healthy gut bacteria, increased resilience to stress, and made sleep more robust following a stressful event. Here are the take-aways and what the study suggests about human sleep.

Stress, Sleep, the Gut, and Probiotics

Most of us sleep better when life is moving along on an even keel. It’s when we have to cope with stressors—a divorce, a bullying boss, sustained combat—that insomnia tends to occur. Chronic stress may eventually lead to chronic insomnia.

Likewise, stress has a harmful impact on the gut. A healthy gut has diverse beneficial bacteria spread evenly throughout the gastrointestinal tract. Stress makes the bacterial community less diverse and less evenly distributed.

One approach to reestablishing a healthy community of gut bacteria is to use a probiotic such as yogurt containing live bacteria, soft cheeses, or a probiotic supplement. Probiotics help repopulate the gut with beneficial bacteria. They’ve also been shown in rodents and humans to reduce the effects of stress on both the body and the brain.

A Prebiotic Diet Has Beneficial Effects

Prebiotics are non-digestible fibers found in certain foods that promote the growth of beneficial gut bacteria such as those found in yogurt and probiotic supplements. The researchers at University of Colorado wondered if feeding young rats a diet rich in prebiotics would increase beneficial gut bacteria and reduce the effects of stress, including its effects on sleep.

So they conducted a controlled experiment using 52 rats. One group was fed a control diet and the other was fed a prebiotic diet. After several weeks, half of the rats in each group were administered a series of tail shocks. The lead author of the study has described these shocks as “the equivalent of a single intense acute stressful episode for humans, such as a car accident of the death of a loved one.”

From analyses of the rats’ fecal material, body functions, and sleep before and after the tail shocks, the authors concluded that the prebiotic diet:

  • Increased stress-protective bacteria in the rats’ gastrointestinal tracts
  • Reduced measurable symptoms of stress
  • Cut down on stress-related wake-ups during recovery sleep
  • Increased beneficial REM sleep during recovery sleep

Overall, the prebiotic diet made the rats more resilient to stress and their sleep more robust.

A High Fiber Diet for Humans?

Would a diet high in prebiotics be similarly protective of the human gastrointestinal tract and human sleep? That, say the researchers, is what they’re going to study next.

For now, given prior clinical research and the fact that there are no known downsides to consuming prebiotic foods, it’s probably a good idea to incorporate more high fiber foods into your diet—especially if you’re prone to stress related insomnia.

Prebiotic Foods

Here are several foods high in prebiotics. You get more mileage from plant fibers when fruits and vegetables are eaten raw, but a light steaming may not do much to diminish their effectiveness.

  • asparagus
  • leeks
  • garlic
  • onions
  • dandelion greens
  • apples
  • bananas
  • jicama
  • Jerusalem artichoke
  • wheat bran
  • bread made of wheat flour
  • barley
  • oats
  • seaweed
  • flaxseeds
  • legumes

Stress-Related Insomnia? Don’t Give Up

Why does stress cause insomnia in some people while other people can park their stress outside the bedroom door? No one has a comprehensive answer to this question.

But researchers say that sleep reactivity, situational factors, and responses to stress determine who’s likely to develop insomnia and who isn’t. Here’s more about the research and how to keep stress from ruining the night.

Stress affects some people's sleep more than others, but everyone can become more resilientWhy does stress cause insomnia in some people while other people can park their stress outside the bedroom door? No one has a comprehensive answer to this question; too many things are involved.

But researchers at Henry Ford Hospital say that—in addition to sleep reactivity, a trait-level quality that predisposes some of us to insomnia—situational factors and responses to stress determine who’s likely to develop insomnia and who isn’t. Here’s more about their research on stress and sleep and thoughts about how to keep stress from ruining the night.

How Investigators Got Their Information

The study they conducted was aimed at identifying factors that cause sleep to go from good to bad. They used data collected from good sleepers participating in the Evolution of Pathways to Insomnia Cohort study.

First, the researchers determined that none of the 2,892 participants qualified for an insomnia diagnosis at the beginning of the study. Next, participants took several pencil-and-paper tests designed to assess relationships between stress and sleep. A year later, the group took the same battery of tests a second time to ascertain how their lives and their sleep had changed.

Impact of Stress on Sleep

By the end of the year, 262 study participants, or 9.1%, had developed insomnia disorder.* The number, severity, and duration of stressors had a significant impact on participants’ sleep. The odds of developing insomnia increased

  • by 19% for every additional stressor participants reported
  • by 4% for every one-point increase participants gave to stressors on a severity scale
  • by 2% for every 1-month increase in the duration of stress.

None of this is surprising, but it’s interesting to see quantitative data coming out of a prospective study.

Response to Stress

Many insomniacs say that what keeps them awake is a mind that keeps going and going at night. In this study, participants had to report how much they thought about the stress they were experiencing by assigning a numerical value to statements like this: “I thought about it when I didn’t mean to.”

The tendency to engage in intrusive thinking following stress exposure was a significant predictor of who would and wouldn’t develop insomnia, accounting for 69% of the total effect of stress exposure on insomnia. The inclination to ruminate has long been known to perpetuate insomnia. The results of this study suggest that rumination may also precipitate insomnia.

Coping Strategies Matter, Too

But vulnerability to insomnia isn’t just a matter of genes and traits and happenstance. How we cope with stress can also amplify or mitigate its effects on sleep. The authors note that thought suppression, a strategy insomniacs often use to hold intrusive thoughts at bay, usually backfires. It tends not to empty the mind but rather to heighten cognitive arousal.

They also report that under conditions of stress, the following coping strategies are predictors of insomnia:

  • substance use
  • giving up based on a belief that nothing can be done to ease the situation
  • self-distraction

But regarding self-distraction (which I believe actually helps me when I’m feeling too aroused for sleep), the authors acknowledge that the literature on this coping style is mixed. Some studies suggest it’s effective in times of stress and others suggest it’s of little or no benefit.

So What to Do?

What not to do is pretty clear from the above. Better strategies for managing stress (and its negative effects on your sleep) are these:

  1. Make sure you have a physical outlet for your stress: daily exercise, or a mind-body practice such as yoga, qi gong, and tai chi.
  2. Try mindful stress reduction. Early studies suggest that it helps reduce stress.
  3. Resist the urge to go it alone. Research has shown that spending time with friends and supportive family members reduces stress.
  4. Increase predictability where you can. If sporadic late night phone calls from your mother stress you out, ask her to refrain from calling after 7 p.m.
  5. Do what you can to increase your sense of control (except in extreme situations where you really have no control). Shorten your to-do list by getting rid of nonessential commitments; negotiate for someone else to cook the turkey this year; and when a stressor feels overwhelming, sit down with a paper and pencil and break the problem into smaller parts. This way, you can actively work to ease or resolve the situation in a step-by-step fashion, which will likely help your sleep.

When you’re stressed out, do you find that distraction helps or hurts your sleep?

* Insomnia disorder was defined in this study as (a) trouble falling or staying asleep, or nonrefreshing sleep, at least 3 times a week for at least 1 month, and (b) daytime distress or impairment.

Psychophysiologic Insomnia: What It Is & How to Cope

Psychophysiologic insomnia: This was my diagnosis when I finally decided to see a doctor about my sleep. I didn’t like the sound of it. “Psycho” came before “physiologic,” and to me the implication was that my trouble sleeping was mostly in my head.

My insomnia felt physical, accompanied as it was by bodily warmth, muscle tension, and a jittery feeling inside. I was anxious about sleep, too, and my thoughts weren’t exactly upbeat. But surely putting the psycho before the physiologic was putting the cart before the horse?

Psychophysiologic insomnia is a sleep problem involving physical and mental factorsPsychophysiologic insomnia: This was my diagnosis when I finally decided to see a doctor about my sleep. I didn’t like the sound of it. “Psycho” came before “physiologic,” and to me the implication was that my trouble sleeping was mostly in my head.

My insomnia felt physical, accompanied by bodily warmth, muscle tension, and a jittery feeling inside. I was anxious about sleep, too, and my thoughts weren’t exactly upbeat. But surely putting the psycho before the physiologic was putting the cart before the horse?

Don’t let the terminology put you off the way I did. Psychophysiologic insomnia (I’ll call it PPI) is a problem in which constitutional vulnerabilities, situational factors, habits, and dysfunctional thinking are so intertwined that it’s hard to sort them out. Here’s a brief description and recommendations on how to manage it.

A Diagnosis Based on Symptoms

No objective test can reliably distinguish between normal sleepers and people with PPI. So the diagnosis is made based on symptoms alone. In PPI as in other types of insomnia, the wakefulness may occur at the beginning, in the middle, or at the end of the night. But people with PPI also:

  • have a lot of anxiety about sleep
  • are prone to intrusive thoughts and involuntary rumination
  • feel physically wound up
  • fall asleep at unusual times and places
  • experience daytime impairments such as fatigue, moodiness, and trouble thinking

Polysomnography (PSG)—the test administered overnight in a sleep lab—is not usually recommended because it doesn’t discriminate well between people with PPI and normal sleepers. But PSG results show that overall, people with PPI sleep less, and spend more time in lighter stages of sleep, than people who sleep well. (In contrast, the PSG results of people with paradoxical insomnia look normal, even though sufferers may feel like they’re getting 1 or 2 hours of sleep at best.)

How PPI Develops

Often it begins in adolescence or early adulthood, showing up as light sleep or periodic episodes of poor sleep.* Some people are naturally more susceptible than others. This may be true, sleep expert Peter Hauri has written, because of “an inherent, mild defect in the sleep-wake system, i.e., either excessive strength of the reticular activating system [the arousal system] or a weakness in the inhibitory, sleep-inducing circuits. Because the sleep-wake balance in such patients might lean toward wakefulness, such people would be suffering from an occasional, neurologically based poor night of sleep long before developing serious insomnia.”

Stressful situations lead to more extended bouts of poor sleep. Sooner or later, concern about sleep sets in. This is when insomnia starts to get “serious,” to use Hauri’s word. Looking for ways to reestablish better sleep, people change their habits—trying harder to sleep, going to bed early, taking naps—in ways that actually make sleep worse. The bed and the bedroom come to be associated with not sleep but rather with wakefulness and worry about sleep.

Thus begins the vicious cycle where long stretches of wakefulness in bed, accompanied by feelings of tension, begin to condition arousal of the brain, in turn fueling more bodily arousal. What began as light sleep or an occasional stress-related bout of insomnia has become a chronic affair.

Management Options

Once the PPI train pulls away from the station, it’s hard to get off. For decades I tried every trick in the book—sleeping on the couch, watching nature programs, listening to white noise, scenting my pillows, rhythmic breathing, drinking tea made from Chinese herbs. Nothing worked for long or without cost.

The good news is that PPI, unlike some other types of insomnia, responds well to treatment with cognitive behavioral therapy for insomnia (CBT-I). (While the name might suggest that it’s similar to conventional talk therapy, CBT-I is mainly focused on helping people modify habits.) For me, sleep restriction therapy, a treatment offered as part of CBT-I, was especially useful. Sleep restriction led to an awareness that my sleep could be reliable if I timed it right.

Equally important, though, for people whose insomnia feels physical (like mine) is finding a way to tamp the physiological arousal down. What works best for me is daily aerobic exercise. Research also suggests that mind-body therapies such as yoga, tai chi, and mindfulness meditation are helpful in this regard.

If this sounds like the type of insomnia you’ve got, check into CBT-I and physical training. There’s nothing to lose and much to gain.

How do you manage your insomnia? Has your strategy worked?

* Lee-Chiong T. Sleep Medicine: Essentials and Review. New York: Oxford University Press; 2008: 84.

Easing Worry and Anxiety about Sleep

Insomnia sufferers write to me often with complaints about sleep-related worry and anxiety.

“The more important the next day is to me, the harder it is for me to sleep,” Jessica says. “So I worry about not sleeping and then it turns into a self-fulfilling prophecy.”

Finding a solution to this problem can be tricky. It may require experimentation before you home in on a strategy that works.

Insomnia characterized by worry and anxiety about sleep can be alleviated using psychological and physiological strategiesInsomnia sufferers write to me often with complaints about sleep-related worry and anxiety.

“The more important the next day is to me, the harder it is for me to sleep,” Jessica says. “So I worry about not sleeping and then it turns into a self-fulfilling prophecy.”

“I finally had about 4 good nights after starting sleep restriction (about 11 days ago) but had a horrible night of anxiety last night,” Stacy says. “I was anxious about not being able to continue my good nights of sleeping. I find it hard to practice relaxation exercises when I’m that anxious.”

Achieving a relaxed state conducive to sleep can seem impossible with a mind that’s racing from one fraught thought to another. Likewise, the physiological changes that accompany worry and anxiety—the release of stress hormones, a faster heart rate, bodily warming, tensing muscles—are a better preparation for fight and flight than for relaxation and disengagement.

How to stop obsessing about sleep and sleeplessness is the main concern of many insomniacs, yet finding a solution can be tricky. It may require experimentation before you home in on a strategy that works.

Different Schools of Thought

Research backs a handful of approaches to managing the problem, but even among sleep experts there is no consensus as to which works best. It may depend on the nature of your insomnia and which approach you find more appealing.

Some experts promote a type of talk therapy–called “cognitive restructuring–as effective in reducing worry and anxiety related to sleep. The idea behind it is that sleep-related anxieties develop in part due to the misconceptions people have about sleep and catastrophic thinking about insomnia. Replacing these ways of thinking with attitudes that are more realistic and sleep-supportive should help.

Cognitive restructuring is normally presented as part of cognitive-behavioral therapy for insomnia (CBT-I). It usually involves work with a therapist, who helps you learn to talk yourself out of worries and anxieties about sleep and sleeplessness.

Mind/Body Approaches to Curbing Arousal

Other experts suggest that psychological treatments for sleep-related anxieties may not be as effective as treatments that simply help insomniacs learn to relax. Physiological hyperarousal is the main cause of poor sleep, they say, with sleep-related anxiety and worry developing as a result. Treatment should focus on tamping down arousal that gives rise to these sleep-related worries, enabling a stronger and more dependable relaxation response.

  • Relaxation training is recommended as helpful to sleep by the American Academy of Sleep Medicine. It may involve progressive muscle relaxation and/or autogenic training (guided visualization).
  • Mindfulness-based therapies enable people to become more accepting of unpleasant feelings and sensations and, in so doing, alleviate them. Mindfulness meditation has been shown in a handful of studies to help insomnia sufferers by cutting down on pre-sleep arousal, reducing wake time at night, and enhancing sleep quality.
  • Yoga has now been shown in several studies to help insomnia sufferers learn to manage stress and get more sleep. Not only does yoga practice effectively deactivate the stress system. Yoga postures, breathing, and meditation exercises also help people develop more resilience to stress.

Exercise, Anxiety, and Sleep

Still other experts advocate exercise as the best way to relieve the anxious arousal that sabotages sleep. There’s now solid evidence that regular exercise promotes sounder sleep and preliminary evidence that exercise is effective in reducing anxiety. A meta-analysis published in April shows that even a single bout of exercise has a small but significant anxiety-alleviating effect.

Strenuous exercise is the way I calm myself down in times of stress, especially when my old fear of sleeplessness threatens to stage a comeback. The minute I feel that happening, I push myself to work out longer and harder and, most of the time, it helps.

But which kinds of exercise will give you the most bang for the buck? University of Pennsylvania researchers, analyzing data from a huge survey of behaviors affecting health, have found that while walking is associated with better sleep compared with getting no exercise at all, aerobics, calisthenics, biking, gardening, golf, running, weight-lifting, yoga and Pilates are associated with even better sleep.

Consider these strategies if worry and anxiety are feeding your insomnia. Continuing to obsess about sleep and sleeplessness is surely worse than making a good-faith effort to try some of these practices out.

The Insomnia/Perfectionism Connection

Do you hold yourself to high (sometimes impossibly high) standards? Do you tend to be self-critical and cringe at making mistakes? Is it even difficult sometimes to take pleasure in your own hard-won achievements?

These are signs of perfectionism, and perfectionists are more susceptible to insomnia than people who can shrug off their mistakes.

Perfectionism may or may not be a predisposing factor to insomniaDo you hold yourself to high (sometimes impossibly high) standards? Do you tend to be self-critical and cringe at making mistakes? Is it even difficult sometimes to take pleasure in your own hard-won achievements?

These are signs of perfectionism, and perfectionists are more susceptible to insomnia than people who can shrug off their mistakes.

The theory that perfectionism and other personality traits (such as neuroticism and internalization of negative feelings) are the main drivers of insomnia has not withstood the test of time. But the evidence for an association between perfectionism and insomnia remains fairly strong. Even so, a team of Swiss researchers has found that when they take stress, poor coping strategies, and poor emotion regulation into account, perfectionism’s role in explaining insomnia all but disappears. There’s a message here for those of us who want to improve our sleep.

Where Perfectionism Comes From

Like many personality traits, perfectionism appears to have both environmental and genetic components. “It is likely that a perfectionistic orientation develops over time, and family history may contribute to the development of perfectionism,” wrote Cal State University researchers David R. Hubbard and Gail E. Walton, who in 2012 reported interviewing 36 students about perfectionism and the motivation to achieve. Two aspects of experience differentiated the perfectionists from their nonperfectionist peers:

  1. The perfectionists felt pressure from their families to succeed.
  2. Their parents were overly critical of their mistakes when they were growing up.

But inherited genetic material may also make people more inclined to perfectionism. When researchers at Michigan State administered a series of tests to 292 young female adults in the Michigan State University Twin Registry, they found that both anxiety and maladaptive perfectionism (concern about mistakes and doubts about actions) were moderately heritable—on par with the heritability of general intelligence. A second twin study found that identical twins were more alike than fraternal twins in how much they idolized skinny celebrities—another sign of perfectionism.

A Relationship Between Perfectionism and Sleep

Chronic insomnia is attributable to a mix of factors: physiological and psychological, environmental and behavioral, inherited and learned. The dysfunctional processes underlying perfectionism (manifesting as doubts about abilities, concern about mistakes, and so forth) might be similar to those that underlie trouble sleeping, the Swiss researchers reasoned. So they gave a battery of pencil-and-paper tests to 346 college students to see what relationships would emerge.

Statistical analyses showed that perfectionistic traits were associated with trouble sleeping and the same daytime complaints of people with persistent insomnia: tiredness, reduced concentration, and low mood. But when perceived stress, poor coping strategies, low emotion regulation, and low mental toughness were factored into the equation, perfectionism’s contribution to sleep disturbance was nil. In other words, the researchers conclude, “It is not perfectionism per se, but rather the underlying psychological mechanisms that best explain the association between perfectionism and poor sleep.”

Why Is This Important?

Let’s assume you have insomnia. A therapist you’re working with thinks the problem is personality-related and sets out to address it by helping you modify your perfectionistic tendencies.

Changing personality traits originating in childhood and/or predisposed at birth is a real challenge. It might not be impossible to free yourself from a harsh inner critic that developed under the watchful eyes of Mom and Dad, yet the effort it would take—several months (if not years) of psychotherapy—would be great and the results, uncertain. As for improving your sleep, well, good luck there. Psychotherapy has never been found to be an effective treatment for insomnia.

Targeting the psychological mechanisms underlying chronic insomnia directly would be a faster, more effective approach to improving sleep, the researchers conclude, particularly in insomnia sufferers with perfectionistic tendencies. Cognitive-behavioral therapy for insomnia (CBT-I) does this. Its cognitive restructuring component is aimed at dismantling the mental and emotional underpinnings of persistent insomnia. So CBT-I is a better treatment option than psychotherapy if your goal is better, sounder sleep.

Do Sleep Spindles Play a Role in Insomnia?

Looking for an objective test of insomnia?

New research suggests there’s a relationship between insomnia and sleep spindles—sudden bursts of fast electrical activity that occur in the brain mostly during stage 2 sleep. Investigators at Concordia University in Montreal found that students with lower spindle activity reported more stress-related sleep problems than students whose spindle activity was high.

objective insomnia marker | fewer sleep spindles in EEGLooking for an objective test of insomnia? Unfortunately, no such test exists.

But scientists hunting for biomarkers of the disorder have noted subtle differences between insomniacs and normal sleepers in the electrical activity occurring in the brain at night. Some studies show that insomniacs spend less time in deep sleep; others show that insomniacs who awaken frequently at night get less REM sleep. Still others show that insomniacs are more prone to high-frequency brain waves during sleep.

New research suggests there’s also a relationship between insomnia and sleep spindles—sudden bursts of fast electrical activity that occur in the brain mostly during stage 2 sleep. Investigators at Concordia University in Montreal found that students with lower spindle activity reported more stress-related sleep problems than students whose spindle activity was high.

Importance of Sleep Spindles

Here's what sleep spindles look like.
Here’s what sleep spindles look like.

Sleep spindles occur throughout the night during periods of non-REM sleep, and more spindles occur in some people than in others. Yet in any individual, spindle density is quite stable from night to night come rain or shine. So spindle density is regarded as an individual trait.

Previous research has shown that sleep spindles protect us from being awakened by noise in the environment. So these short bursts of electrical activity contribute to sleep stability. Spindles have also been found to assist in the overnight retention of memories and enhance learning. Sleep spindle density also correlates with higher scores on tests of intelligence. In short, sleep spindles are highly beneficial.

Concordia Study

Thien Thanh Dang-Vu and colleagues enrolled 12 healthy, normal-sleeping Concordia University students to test their hypothesis that students with fewer spindles would have more trouble sleeping during periods of academic stress. They gathered baseline data from each student at the beginning of a winter semester, when stress levels were low. Students underwent polysomnography (an overnight sleep study) and a battery of pencil-and-paper tests assessing their sleep, stress levels, and mood. Then, during a high-stress period—the week prior to final exams—the students underwent a second round of testing to find out how the stress of exam week was affecting their sleep.

As expected, the lower the sleep spindle activity, the more likely a student was to report sleep problems. In particular, lower spindle density at the beginning of the night—as students were falling asleep—correlated with more sleep complaints in response to academic stress.

Implications

What this implies, the researchers say, is that alongside other factors that predispose us to insomnia—a family history of insomnia, depression or anxiety, hyperarousal, poor health, and pain—people whose brains generate fewer sleep spindles at night are more prone to develop insomnia than those whose spindling activity is high.

Why some people are champion spindlers and others are not is a question that still needs sorting out. But insomnia treatments that promote sleep spindles could only be a good thing. Whether in the form of medication or herbs or pre-sleep activities, I say, bring ’em on!