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Stress & Sleep Part II: Coping Skills for Thought-Racing When It’s Time to Sleep


In Part I, we talked about how thought-racing can trigger physiological changes called The Stress Response, and that chronic activation of this response can not only fuel insomnia, but can also lead to potentially harmful biological changes in the body and brain that can lead to other medical conditions. So, how can we convince the brain (and of course, ourselves), that we’re under no immediate danger, and that now is the time to sleep? Shutting down thought-racing and worry can be as simple as practicing a few tricks that are used in Cognitive Behavioral Therapy (CBT), which research has shown to help address distressing thoughts as they occur.

Try this coping skill exercise for thought-racing in the next week. See if you notice less thought-racing, and as a result less stress, when you are trying to go to sleep:

  1. Get up briefly (turn on only a small light) and get a piece of paper and pen.
  2. Make three columns on the paper, labeled: 1) Situation, 2) Negative Thoughts, 2) and Positive Thoughts.
  3. Briefly describe the situation(s) you are thinking about, in the first column. An example might be, “I’m worried about my sister’s health…she is going through medical tests to determine a diagnosis for her chest pain”. Though of course you are concerned about your sister, staying up all night worrying is probably not going to help her (or you).
  4. For each situation, write down the negative thoughts associated with that situation in the second (“Negative Thoughts”) column. Going with our previous example, this might be, “I don’t know how she is doing.”, “I wish I could help her”, and, “Who is going to take care of her family?”. When thought-racing occurs, many people get stuck in the negative thoughts and never move on to more healthy and productive coping. That’s when the third column becomes useful.
  5. Find a more positive thought to counteract each negative thought, and write it in the third (“Positive Thoughts”) column. For each of the negative thoughts above in #4, a few positive alternatives may be, “I’ll be able to get more information about her health in time”, “I can ask her about what ways she needs my help over the next week”, and, “I can see what other resources I have and can offer to her if/when she needs them”.
  6. After you have identified some positive alternative thoughts, notice how you feel. Most people feel less anxious, worried, agitated, sad, etc. after going through this exercise. Using this and other techniques can help you feel more relaxed, making it easier to get to sleep.Dr. Carolyn Karr

Many studies have tied CBT coping skills like this one to reduced anxiety, depression, and other negative emotional states that interfere with sleep. One study in the Journal of the American Medical Association (JAMA) found that using CBT coping strategies increased both sleep time and sleep efficiency for those with chronic insomnia (Edinger, et al., 2001). Other CBT exercises can be found in a variety of books on the market today (e.g. Edinger & Carney, 2008).

For additional help in using CBT techniques to aid in sleep, Dr. Carolyn Karr at MidAmerica Neuroscience Institute offers sessions for those who would like help in applying these coping aids to their nightly sleep efforts.

Dr. Carolyn Karr is a neuropsychologist that practices at MidAmerica Neuroscience Institute in Lenexa, KS.


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