How many times have you heard a patient say, “I just can’t get my mind to shut off, so I can sleep?” It may very well be a daily occurrence, as getting to sleep has become a real problem for many patients.

We often think of difficulty sleeping as a physical problem, but research shows psychological difficulties outrank physical problems 10-fold. One issue is that the brains of insomniac are hyperactive in areas that should not be. We call this “cognitive hyperarousal.”

Patients with cognitive hyperarousal typically go to bed either thinking about what they have to do tomorrow or are overcome with negative thoughts, such as worry and frustration. Some try to solve problems or dream up inventions as they fall asleep.


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Treating cognitive hyperarousal can be difficult, but it is possible. Passing along meditation techniques is one approach that can help patients with this difficulty. Meditating 20 to 30 minutes before bedtime on a regular basis can be beneficial. There are hundreds of guided meditations you can find on the Internet for free, and many more are available for purchase on CD and DVD. If you have personal experience meditating, consider creating one yourself to distribute to patients.

Another technique to combat cognitive hyperarousal is to advise the patient to get up and leave the bedroom if they are unable to fall asleep. This does not mean turning on the television or checking email, but instead finding a quiet spot to sit.

Reading a physical book (not electronic) or thumbing through a magazine is okay. Tell them to use low light and to try not to look directly into the light source, as this may stimulate the patient and keep him or her from getting sleepy. The patient should only return to bed when feeling sleepy.

Writing is another approach that helps some patients wind down before bed. Advise the patient to sit with a pen and paper and jot down what comes to mind for half an hour each night. This may help put overactive thoughts on hold until the next day.

Too many of us are running home, fixing dinner, taking care of the kids and doing household chores, and then think we can just go to bed and crash. But it doesn’t work that way for most people. There needs to be a time to relax and remove your mind from the stress of the day.

Most importantly, turn off the electronics! We are wired to answer that “ping” when we hear it – it is part of our neurobiology. Encourage your patients to turn off their computer, phone and other electronic devices one to two hours before bed. I also suggest they establish boundaries with their friends not to call them after a certain time of day.