Insomnia: Counting Sheep

InsomniaMaybe Grandma was right.

After all of the years of research and development trying to find medications to help with insomnia, we ran across a recently published paper which suggested that a single session devoted to teaching people with chronic insomnia to focus their attention on some idea, image, song, memory, that was not associated with strong emotions (especially negative emotions) was extremely effective at helping people to get to sleep. Like counting sheep. Or remembering a peaceful memory. Or thinking about a song or tune that you like.

We have known for a while that traditional sleeping medications (benzodiazepines), despite being very popular, are not all that good at helping people sleep more or improving their quality of sleep. A typical “successful” trial of such a medication finds that the medicines are very good at helping people feel that they went to sleep quickly, but they don’t have much effect on the overall amount of sleep that people have at night (an average of 15 to 25 minutes more in the short-term studies, often less in longer studies).

In long-term use even these modest benefits diminish and more of the problems with the medications emerge: such as the development of tolerance and, for some people, dependence.

There’s also evidence that long-term use of benzodiazepines may be associated with impairment in brain function, greater risk of accidents, etc..

The most effective treatment for insomnia, then, is not medication at all, but rather cognitive behavioral therapy.

The two approaches that seem to work are:

1. Sleep hygiene therapy. This focuses on trying to make sure that the room that you’re going to sleep in is cool, dark and quiet, and that you’re making an appropriate transition to sleep (not trying to go 1,000 miles an hour and then just hoping that your brain will shut off when you lie down).

2. Sleep restriction therapy. The focus of this treatment is trying to get people who may have developed anxiety about not sleeping (Oh my God I can’t get to sleep again, I am going to be a wreck tomorrow, I have to get asleep… etcetera)  to reassociate their bed with relaxation and sleeping rather than with worrying. People are allowed to be in bed for a limited amount of time (short enough so that it will quickly guarantee that the person is sleeping almost all of the time they are in bed). Gradually that amount of time is increased until the person has a stable daily routine of sleep.

This study looked at a different approach. People were asked to focus on one idea, or memory, or image, or song, and to stay focused on that, rather than worrying, or thinking about the upcoming day. The results were pretty impressive.

Maybe counting sheep might not be your ideal object of attention (although it certainly meets the criteria of not being associated with lots of strong emotions), but you might want to take this idea and develop a consistent focus for your attention when you’re in bed. Over time, this idea should become even more powerful, as the focus of attention becomes increasingly associated in your brain with successfully going to sleep.

We have some more resources on insomnia you might want to review.


Citation(s): Gellis LA et al. Cognitive refocusing treatment for insomnia: A randomized controlled trial in university students. Behav Ther  2012 Jul 27.