Introduction
People with insomnia try everything under the sun to get sleep when they are in bed at night. Counting sheep, meditations, prayers, deep breathing, muscle relaxation exercises, relaxation tapes, suppressing thoughts, among hundreds – if not thousands – of other old wives’ tales.
This is not to say that relaxation exercises are not effective for chronic insomnia. It is. There is some research evidence to suggest that relaxation strategies are helpful in insomnia, especially in falling asleep (e.g., Straten et al., 2018). Relaxation strategies are also regularly used in cognitive behavioural therapy, which is the gold-standard insomnia treatment.
So if relaxation is seen as effective in the research, what’s the problem? The problem lies in how and where people are using relaxation exercises.
The problem with relaxation exercises in bed
When we talk about causes of insomnia, one of the major contributors of insomnia is anxiety. The bed becomes a place of worry for people with insomnia and they often are afraid of not getting sleep. Over time, the bed becomes associated with distress and being awake – leading to something called conditioned arousal.
Because of this, people with insomnia look for sleep crutches to rely on in order to get some sleep. Some people take melatonin; others drink their chamomile tea; and some engage in breathing/relaxation exercises in bed.
The thing is that these strategies may work pretty well in the short-term. The reason why it works in the beginning is because it acts as a coping technique for our anxious thoughts. Instead of “I’m going to bed in the bed awake the whole night again”, they may think “aha, I am doing my relaxation exercises so I will be able to sleep”. This comforting thought actually leads to breaking the self-fulfilling prophecy and getting better sleep.
The problem is on nights where the strategies don’t work. Because the strategy has become a saving grace for some people, it causes significant anxiety when poor sleep inevitably comes on certain occasions. The thought insidiously starts to move towards “I cannot sleep even with my relaxation exercises”. Over time, the relaxation strategy may even become part of the conditioned arousal.
A common story I hear from my patients is that they will be using relaxation strategies (or other sleep tips), which works well in the beginning. However, it slowly begins to lose its effects and they might typically say “it doesn’t really work very well anymore” or “it’s 50/50 – sometimes it works, other times it doesn’t”.
Photo by Sam Carter on Unsplash
When should I engage in relaxation exercises?
Relaxation strategies should be used outside of bed – preferably at a time that you can stay consistent with your practice. Ultimately, relaxation strategies are a great way to reduce arousal levels and can facilitate sleep. However, when it is used in a direct attempt to fall asleep at night and in bed – this becomes sleep effort. Sleep effort is tricky because it makes us feel that sleep is something that cannot come without some sort of intention. In reality, sleep is a natural process that our body performs without our intervention. The more we get in the way, the more sleep becomes harder to obtain.
Should I never do anything in bed to help me sleep?
Not necessarily! These behaviours are only problematic in the context of people with chronic insomnia problems. If you notice that these strategies only augment your life, then please continue. However, if you begin to notice that you are fearful of not getting sleep and have thoughts such as “I cannot sleep without X”, then it may be helpful to consider whether psychological treatment for your insomnia is appropriate. You can also discuss this with your medical provider.
In order to restore your confidence in sleeping, cognitive behavioural therapy for insomnia can be a great treatment method to support this goal.
If you’re interested in learning more about causes of insomnia, see this post here. Also check out this post on a few evidence-based relaxation strategies!
Best wishes,
P
Featured photo credit: <a href=’https://www.freepik.com/photos/sleepless’>Sleepless photo created by Drazen Zigic – http://www.freepik.com</a>
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