Watching the clock can worsen insomnia

A patient of mine was having difficulty sleeping and was waking several times during the night. As I was taking her history, she noted that she was waking at 2 am and 4 am every morning. When I asked her how she knew the exact time, she responded, “Well, I look at the clock!”

I expected my patient's answer, but I was hoping she might realize for herself what was happening. Watching the clock is a huge detriment to sleep. It happens more often with patients who have insomnia and those who are overly concerned that they are not getting enough sleep. If these patients do not fall asleep quickly, they roll over to see how long they have been in bed. Or, if they wake during the night, they may check to see what time it is and calculate how much longer they have to sleep before the alarm goes off.

Tell your patients that these behaviors only create anxiety. Those that watch the time while trying to facilitate sleep only increase their inability to fall asleep. If a patient feels as though they have been lying in bed for a long time, advise them to get up and go to another room until they feel tired again, but emphasize that checking the time is not important.

Patients who wake during the night, look at the clock and start calculating, might develop a routine and start doing this every night. For many of us, the brain wakes us every morning right before the alarm goes off, because it knows that it is our regular time to awaken. We've noted that time every morning when we turn off the alarm. Similarly, noting the time during the night can have the same effect. This is why my patient wakes at 2 am and 4 am each day.

This type of insomnia is an easy to remedy the situation. Recommend that your patient remove the clock from his or her bedroom. If they need to awake to an alarm, tell them to cover the clock or turn it around so that they cannot see the time. It works! Patients find that they go to sleep easier and wake less during the night when they stop looking at the clock.

Sharon M. O'Brien, MPAS, PA-C, works with Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.

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