It may not come as a surprise that, while lying weary but sleepless in his bed, Shakespeare was thinking of a woman. Love isn’t the only thing that keeps us up at night though.
I've struggled with insomnia for years.
Sometimes I can’t seem to stop thinking, and I obsessively worry about the future, or relive some past event.
Other times I’m so stressed about needing to get 8-hours of good sleep in order to function tomorrow, that I can’t seem to get sleepy.
Or, I can’t relax my body, I notice that my hands are clasped tight, my breathing is short and shallow, and my heart is beating quickly.
I wanted to find out why this happened, and being a psychology researcher, I turned to the scientific literature, to try to answer the question of why I couldn’t sleep, and how maybe I could get some rest.
So what keeps us up at night? Why, when we are heavy with exhaustion, do we toss and turn, or stare at the ceiling or the inside of our eyelids?
When the sun has set and stillness, silence, and darkness are all around us, why do our hearts race?
Why do we see vivid images in the darkness?
Why does the very thought of sleep keep us from it?
Turns out, modern psychology has an answer.
Put simply, we have forgotten how to relax, and we cannot still our minds.
This may seem self-explanatory, but by truly understanding and measuring the problem of insomnia, we can hypothesize about solutions, and put them to the test.
Cognitive Scientists call the overactivity of the mind, and restlessness of the body ‘Cognitive and Physiological Hyperarousal’.
To understand how and why this happens, we need to understand a little about the Autonomic Nervous System, which has its name because it normally functions without conscious control, or ‘automatically’.
Now some people know all about the Fight or Flight response (a.k.a the Sympathetic branch of the Autonomic Nervous System), which prepares you for danger by redistributing blood flow away from your stomach and reproductive organs, altering hormone levels, and changing basic physiological patterns like breathing and heart rate.
If you’ve ever felt butterflies, this is the Sympathetic nervous system deciding that your stomach does not need blood at the moment.
However, most people don’t know the counterpart to our Fight or Flight response: it’s called the ‘Rest and Digest Response’ (a.k.a. Relaxation Response, a.k.a the Parasympathetic branch of the Autonomic nervous system or more Relaxation Response).
This system regulates bodily function when you are not in danger, lowering heart rate, blood pressure, elongating the breath, and making the use of oxygen more efficient.
In essence this is the opposite of the Fight or Flight pattern. Now you may think, if you are not in Fight or Flight, then you are relaxed, ready to rest and digest. But this is actually not true.
These two branches of the Autonomic System are doing a constant balancing act, and often this means they are unbalanced. If the Sympathetic or fight or flight system is even slightly dominant, it can impair the regular functioning of the Parasympathetic Nervous System.
Now daily stress and anxiety activate the Sympathetic system, which would be helpful if we needed to run fast, or fight hard, but is not so helpful when dealing with modern challenges.
In a sense, we are lying in bed, stressing about work or school or our relationship, and our bodies are responding as if there is a tiger waiting for us in the night.
You may have heard of the ‘monkey mind,’ which refers to our conscious thought processes being over active, never still.
But we also have a ‘monkey’ nervous system, evolved to deal with predators in the wild, and not with the social pressures of modern life. Thus, we often respond to daily stressors using the same branch of the nervous system that evolved to deal with life-threatening events.
So we have our hypothesis: an overactive Sympathetic branch of the Autonomic nervous system may lead to insomnia by creating hyperarousal in the mind and body.
Five years ago, scientists tested this theory and published their results in the Journal of Sleep Behavior. They found that people with chronic insomnia had elevated Sympathetic nervous system activity.
How did they test this? They used Heart Rate Variability (HRV).
This is a measure of the amount of change in time elapsed between heart beats. When you are in fight or flight, your heart beat is very steady and rhythmic.
Think back to the last time you were very frightened or were exercising very intensely, chances are your heart was beating very rapidly and steadily.
This rhythmic heart rate is not the the most efficient in the long term because you will tire and deplete resources more quickly, but it is useful when you want rapid access to oxygen and energy.
Basically insomniacs have lower heart rate variability, which implies the branches of their autonomic nervous system are not balanced or in harmony. Less HRV implies more Sympathetic activity, more fight or flight.
Other tests have shown physiological hyperarousal in insomnia. You can find a review of the evidence that hyperarousal is related to insomnia right here.
But bodily stress and arousal are not the only kinds.
As mentioned above, there is cognitive hyperarousal, which involves the wandering thoughts that Shakespeare explored.
Unlike Shakespeare, for the modern insomniac, these thoughts often pertain to sleep itself. Ironically, you can keep yourself up by worrying about sleep. Anxiety can lead to expectations that a poor night’s sleep will ruin our performance the next day.
For more evidence, here’s a review of the theory published in the scientific journal Behavioral Research and Therapy.
So we know there is evidence that a hyperaroused body and mind can lead to insomnia. So how do we improve sleep using our new understanding?
Although Heart Rate Variability (HRV) is a measure of autonomic balance, it’s not quite automatic. You can actually change your HRV, and thus improve the balance of your fight or flight vs. rest and digest responses.
This can be done with simple breathing techniques. At a certain rhythm, with specific timing, breathing can change large swaths of your physiology.
Specifically, one of the elements that conscious breathing can improve is your HRV. This can lead you away from the stress response toward a relaxed state.
How is this done?
The vagus nerve which runs from the brain stem, down the neck, and through entire length of the abdomen, is involved in parasympathetic and sympathetic activity, and interfaces the heart, lungs, and gastrointestinal tract. So there is a direct neural connection between breathing, the stress response, and the heart.
The brain stem is one of the oldest parts of the brain, and is located right at the base of the scull, just above where the spinal cord connects to the brain. Breathing responses are regulated, most of the time, automatically in this primitive part of the brain. When taking conscious control of your breath, you are regulating breathing with much more recently developed brain regions. And through the vagus nerve connection, you are even able to consciously alter elements of your heart rate.
This kind of conscious control over autonomic balance was studied by the Harvard doctor and and clinical researcher, Herbert Benson. He found that people with chronic high blood pressure (hypertension), could lower their blood pressure with the aid of a simple biofeedback machine.
Basically, every time one of his participants lowered their blood pressure, they would hear a sound, which they knew meant that they were getting a small amount of money. With this minimal reward system, most of them were able to improve a major vital sign.
Benson, as he tells it, was then approached by longtime meditation practitioners, who told him that they too could lower their blood pressure, without the use of biofeedback. This led Benson down a long road of study, and eventually he developed a simple procedure for inducing the relaxation response. The basic unifying element of the system Benson developed, is slow rhythmic breathing.
Over and over again, deep, slow, rhythmic breathing has been shown to have powerful positive effects. Only recently has a particular rhythmic timing of breathing been discovered to improve Heart Rate Variability, and thus is return autonomic balance.
This is very useful for those who have an autonomic imbalance in the direction of too much stress, like the insomniacs we talked about earlier.
Not surprisingly, those who studied yoga have been doing this kind of breathing for a long long time. What is new, is that we now know the specific physiological effects, and so we can encourage people with specific physical imbalances to try this kind of breathing.
Besides specific kinds of breathing, what else could help?
Well, Benson’s method also included mindfulness.
Mindfulness is often hyped up to be some complicated and spiritually elite activity, but it really just means paying attention to the present moment, intentionally, and without judgment.
With our busy overstimulated lives, this can be harder than it sounds, so having a skilled guide can be really helpful. By developing mindfulness, your body and mind learn to relax. This is in part because an effect of mindfulness training is Meta-awareness — or the ability to observe the activity of the mind.
Presence, combined with this new level of awareness, helps to not be distracted by intrusive thoughts, which might otherwise keep us awake.
Let’s say that you are guided through clinically tested breathing exercises, and you’re taught the basics of mindfulness, so you’re more relaxed, and you have developed a sense of calm presence and self-awareness, and yet you are still having specific thoughts that are keeping you awake. What should you do?
That’s where Cognitive-Behavioral Therapy for Insomnia (CBT-I) can help.
This treatment has many components, like helping develop healthy habits around sleep. The aspect of a CBT-I program that is most ameliorative to intrusive thoughts and worries, while you’re trying to fall asleep, is something called Cognitive Restructuring.
Again, this sounds more complicated than it is: basically, as humans we have certain biases, in memory and judgment that can make it really easy to get into a negative feedback-loop of anxiety.
One of the ways this happens is through something psychologists call State-Dependent Memory. When you are in a particular mental state, you tend to recall memories that are associated with that state.
In this way, moods are reinforced because you recall things that support that mood, not knowing that the recollections are because of the mood. This is what is meant by a feedback-loop.
So laying in bed, you might be a little anxious about your presentation tomorrow, and you start to remember more things that make you anxious, like how you couldn’t fall asleep the night before. Now you’re not worried about the presentation, you’re worried about being so tired you can’t wake up in time to get to work.
HRV breathing can take you out of the mood that induces these thoughts, and so can stop the cycle before it starts. Mindfulness can help you to stay present, and be more aware of these thought patterns.
What CBT-I adds is a way to directly address these thoughts. As the name Cognitive-Behavioral Therapy implies, it approaches thoughts like behaviors that can be changed.
First, we analyze the specific expectations and beliefs that influence the maladaptive behavior (in this case, compulsive or intrusive thoughts).
From there, we identify the kind of irrational thought processes (biases) that are influencing this cognitive behavior. Finally, we replace these thoughts with more adaptive cognitive processes.
Here is a collection of studies, that when analyzed together, demonstrates that CBT-I works to improve sleep for people with insomnia. And here is a clinical test of Cognitive Restructuring and its effects on intrusive thoughts before sleep (and here’s another one for good measure).
A very exciting discovery is that CBT-I can be used in combination with Mindfulness Training to improve sleep, as shown in this study.
We especially like these kinds of studies at Pzizz, because they show that there is no need to dogmatically follow one method. Instead, scientific evidence indicates that it can be very helpful to combine proven methods for even better results.
Another technique for addressing the variations of mental hyperarousal that often interferes with insomniac’s sleep is Guided Imagery (GI).
Guided Imagery uses some of that mental energy for good. A skilled practitioner will guide you through the steps of imagining yourself in a beautiful and idyllic space. This accomplishes two things in two different ways.
Firstly, you use the part of your mind that otherwise would be imagining disaster scenarios of sleeplessness, and you redirect it to think of something peaceful.
Secondly, you actively relax by mentally putting yourself in very calming space.
Again, this relaxation technique works well in conjunction with other methods, like music. Scientists have combined Guided Imagery with music to reduce stress hormones and improve mood.
We’ve written about it extensively, but it’s worthwhile to note that certain kinds of music can have powerful relaxation effects, and can improve sleep. You can check out the science of how music improves sleep here.
You can read our other blog posts for a synthesis of the research on music’s ability to improve sleep.
So we have covered a fair amount of research on how to relax the mind, but besides Heart Rate Variability breathing techniques, how do we relax our bodies?
One way is through Progressive Muscle Relaxation (PMR). This involves tensing and relaxing every major muscle group. This has a similar effect to exercise, after the temporary increase of tension the muscles are actually more relaxed than before.
Finally, there is something called Autogenic Training (AT). This takes elements form Progressive Muscle Relaxation and Clinical Hypnosis, and teaches you to produces certain sensations in your body that are associated with relaxation, like warmth, heaviness, and looseness.
All of these techniques are great, but how would you actually go about using them to improve your sleep?
We’re always exploring new ways to increase the effectiveness of Pzizz, especially in utilizing the latest research in evidence based treatments.
There are so many great results that come out of clinical and academic research that never get a chance to make an impact in “the real world.”
So we set out to design a new narration for Pzizz that would be influenced by a lot of the modern, credible research on insomnia.
As we’ve gone over earlier in this article, combining methods of different disciplines can be even more effective than just using one. So we integrated the leading methods into one comprehensive script that would help you relax both your body and mind.
It took a year of research, design, and testing to bring these new narrations to life.