Can’t Sleep? Here Are Some Surprising Strategies That Work
The pandemic has given us a year of lousy sleep and insomnia. Here’s what to do.
The pandemic has given us a year of lousy sleep and insomnia. Here’s what to do.
How are you sleeping?
After one year of a pandemic—and a lot of disturbed slumber—it’s clear that our usual sleep strategies aren’t working. Scientists say many of the things we do to chase sleep are actually hurting us, and recommend a counterintuitive approach instead: Stay in bed for less time, not more.
I’ve been battling insomnia lately. I know I’m not alone. Approximately 40% of the population has had sleep problems during the pandemic, according to a meta-analysis of 44 studies from 13 countries published online in February in the Journal of Clinical Sleep Medicine.
The pandemic has been a significant source of stress and worry. Our daily routines have been disrupted, affecting our circadian rhythms. And social isolation has led to mental-health problems such as depression and anxiety.
“Our brains have to feel like the world is safe and secure to be able to fall asleep,” says Wendy Troxel, a clinical psychologist, certified behavioural sleep medicine specialist and senior behavioral and social scientist at Rand Corp. “Sleep is a vulnerable state.”
We all know we’re supposed to have good sleep hygiene—keep a consistent schedule; use the bed for sleep and sex only; avoid alcohol, caffeine and bright lights before bed and practice other healthy sleep habits. This is important. But the American Academy of Sleep Medicine recently declared it’s not enough to solve chronic insomnia. In an article published online in February in the Journal of Clinical Sleep Medicine, it recommended a series of treatments collectively known as cognitive behavioural therapy for insomnia, or CBT-I.
Unlike run-of-the-mill sleeping problems, insomnia is a clinical disorder. We have insomnia when we have difficulty falling or staying in sleep three or more times a week, and this lasts a month or longer, leading to daytime consequences, such as fatigue, mood changes or difficulty concentrating. Sleep experts believe insomnia is triggered in part by the fear and anxiety we have about not sleeping.
The brains of people with insomnia act differently than the brains of people who are sleeping well, according to Daniel J. Buysse, a professor of psychiatry and sleep medicine specialist at the University of Pittsburgh School of Medicine. Dr Buysse has conducted PET scans of people who sleep normally and people with insomnia. In people with insomnia, parts of the brain involved with self-reflection and monitoring the environment show higher levels of activity during sleep compared with normal sleepers.
Ironically, insomnia is also driven by the things we do to try to solve it, experts say. We start to chase sleep—waking up later, taking naps, going to bed too early. This diminishes our sleep drive, which is our body’s need for sleep. It makes it harder to sleep when we’re supposed to. And it creates a vicious cycle: More time in bed means more opportunity for frustration and failure. Before long, we’ve taught our brain to associate our bed with the negative emotions we feel lying there.
“It’s Pavlovian,” says Philip Cheng, a clinical psychologist and sleep researcher at the Henry Ford Sleep Disorders and Research Center. “If you spend a lot of time in bed worried and frustrated and miserable, in time your brain learns that your bed is a place to do all of these things but sleep.”
CBT-I focuses on breaking this loop by helping us change the thoughts and behaviours that are counterproductive. Research shows it may have lasting effects—not just fixing our sleep problems in the present but helping us form a sort of sleep resilience. A study conducted by Dr Cheng and colleagues and published online in November in the journal Sleep found that people who received CBT-I years ago have been sleeping better and have better mental health during the pandemic than those who did not.
The treatment is typically six to eight sessions with a therapist, but there is an abbreviated version, as well as online programs to try at home. The primary component is “sleep restriction,” also called sleep retraining, which is limiting the amount of time we spend in bed awake. To track this, we calculate our “sleep efficiency number,” which is the percentage of time we’re in bed that we’re asleep. The goal is at least 85%.
To help boost our sleep efficiency, we should avoid going to bed unless we’re sleepy. (I’ve learned the hard way that being bone-weary exhausted is not the same thing as sleepy.) And we shouldn’t stay in bed unless we’re asleep. If we’re having trouble falling asleep, we should go to another room, keep the lights low and do something pleasant but not too absorbing. Read a book. (No screens!) Do a crossword. Listen to some soothing music.
We need to wake up at the same time every day. (Yes, weekends too.) This helps regulate our circadian rhythm and keeps us from sleeping late, which would harm our ability to sleep the following night. To figure out when to go to bed, calculate the amount of time you are actually asleep during the night. Then subtract that from the time you need to wake up. That’s your bedtime, for now. (Don’t give yourself less than 6 hours in bed.) As your sleep gets back on track, start lengthening your time in bed slowly, by 15 minute intervals, to try to increase your sleep duration.
Finally, we need to challenge our thinking about our sleep. When we tell ourselves we “can’t sleep” or “won’t be able to function” the next day, we’re causing ourselves a lot of anxiety, which further interferes with our sleep.
After weeks of having trouble sleeping, I signed up for an online version of CBT-I and started tracking my sleep. I’ve set (and kept!) a consistent wake-up time and have become more careful about sticking to a steady daytime routine. I started going to bed later—I’m a natural night owl but had been trying to force myself to go to bed earlier, thinking I could catch up on sleep. And once I’m in bed, if I can’t sleep, I get back up and read until I feel my eyes starting to shut.
I’ve also tried to stop stressing myself out with thoughts such as: “I’ll never sleep tonight.”
It’s all helped a lot. But I still need practice. So when I got into bed one recent night, I opened my sleep app and clicked on a link that said “Help me get to sleep now.” A recording of a man’s voice told me to find a mark on the ceiling to focus on. “Your goal is to stay awake. Don’t let your eyes close,” he said. He was deploying a technique therapists call paradoxical intention—in an attempt to distract me from focusing on trying to fall asleep. “Stay focused on that spot,” he continued.
Then he told me to notice how my eyelids were getting heavier. He acknowledged that it would probably feel like a relief to close them.
“Resist! Resist! Resist the temptation to close your eyes, even as they feel heavier and heavier!” he said. “Remember your goal here is to remain awake.”
I don’t know what he said next. I was asleep.
Practice good sleep hygiene. Aim for seven to nine hours of sleep. Keep consistent wake-up and bedtimes. Keep the bedroom cool, quiet and dark. Use the bed for sleep and sex only. Avoid alcohol, caffeine and exercise before bed. Turn off your screens 30 to 60 minutes before trying to go to sleep.
Don’t chase sleep. Don’t go to bed early. Don’t sleep late. Don’t nap. You’ll diminish your sleep drive, making it even harder to go to sleep the next night.
Don’t go to bed until you’re sleepy. Learn the difference between tiredness and sleepiness. (Sleepiness is when your eyes are drooping.) And limit your time in bed to the amount of time you are asleep, plus half an hour.
Don’t stay in bed unless you’re asleep. Tossing and turning in bed reinforces your brain’s association between wakefulness (and negative emotions) and the bed.
Re-establish daily routines. Have a morning routine. Eat meals at the same time. Exercise at the same time (not too late). Log off work at the end of the day and take a walk.
Stick to your natural circadian rhythm. You’re not going to be able to easily change whether you’re a night owl or an early bird. Recognize when you sleep best and stick with it.
Have a bedtime routine. Just like a child. Establish a daily wind-down time. Then take a bath. Read a book. Relax.
Stop catastrophizing. Quit telling yourself you won’t be able to sleep, or to function the next day. Ask yourself if these thoughts are really true. Replace them with positive thoughts. (“A bad night of sleep is not the end of the world.”) Then try to focus on something else. “People who sleep well don’t think about sleep all the time,” says Wendy Troxel, a certified behavioural sleep medicine specialist.
Keep a worry journal. “Sometimes we worry because our brain is telling us to not forget something,” says Philip Cheng, a sleep researcher at the Henry Ford Sleep Disorders and Research Center. If you write your worries down during the day, “when worry comes at night you can tell yourself you’ve already documented it.”
Practice gratitude. If you find yourself starting to ruminate in bed, think about the things you are grateful for, or savour your favourite moments from the day. This will train your brain to associate the bed with pleasant thoughts. “And it gets us back to feeling safe,” says Allison Harvey, a professor of clinical psychology at the University of California, Berkeley, and director of the Golden Bear Sleep and Mood Research Clinic.
Listen to someone else’s voice. A pleasant but unexciting audiobook is ideal. Turn it on low volume when you go to bed. This will distract you from your thoughts.
Try CBT-I. The website of the Society of Behavioral Sleep Medicine allows you to search for a therapist in your area. Some health programs, such as the Cleveland Clinic and the Department of Veterans Affairs, have programs. And app versions such as Sleepio and Somryst were developed by researchers.
Chris Dixon, a partner who led the charge, says he has a ‘very long-term horizon’
Booming demand for wellness tourism shows no slowing, with travel related to health and well-being projected to have reached $1 trillion last year and to hit $1.3 trillion by 2025, according to the Global Wellness Institute, a nonprofit based in Miami.
Curated wellness travel programs are especially sought-after, specifically holistic treatments focused on longevity. Affluent travellers not only are making time to hit the gym while gallivanting across the globe, they’re also seeking destinations that specifically cater to their wellness goals, including treatments aimed at living longer.
“I believe Covid did put a spotlight on self-care and well-being,” says Penny Kriel, corporate director of spa and wellness at Salamander Collection, a group of luxury properties in places like Washington, D.C., and Charleston, South Carolina. But Kriel says today’s spas are more holistic, encouraging folks to understand the wellness concept and incorporate it into their lifestyle more frequently.
“With the evolution of treatment products and technology, spas have been able to enhance their offerings and appeal to more travellers,” Kriel says.
While some growth is connected to the variety of treatments available, results and the digital world are also contributing to the wellness boom.
“The efficacy and benefits of these treatments continue to drive bookings and interest, especially with the support of social media, influencers, and celebrity endorsements,” Kriel says.
While genetics, environmental factors, and lifestyle choices such as regular exercise, a diet free of processed foods, sufficient sleep, and human connection play essential roles in living well and longer, experts believe in holistic therapies to help manage stress, boost immunity, and ultimately influence length and quality of life.
Anti Ageing and Beyond
“For years, people have been coming to spas, booking treatments, and gaining advice on how to turn the clock back with anti ageing and corrective skin treatments,” Kriel says. However, today’s treatments are far more innovative.
On Marinella Beach in Porto Rotondo, on the Italian island of Sardinia, guests at the five-star Abi d’Oru Hotel & Spa can experience the resort’s one-of-a-kind “longevity treatment,” a unique antiaging facial using one of the island’s native grapes: Cannonau. The world’s first declared “Blue Zone”—one of five designated areas where people live longer than average, some into their 100s—Sardinia produces this robust red wine varietal, the most widely planted on the island.
Known as Garnacha in Spain and Grenache in France, Cannonau supposedly contains two to three times more antioxidants than other red-wine grapes. By incorporating Cannonau, Abi Spa says its unique 50-minute longevity session increases collagen production for firmer, younger-looking skin.
Maintaining a youthful appearance is just one facet of longevity treatments, which range from stress-reduction sessions like massage to nutritional support and sleep programs, Kriel says. Some retreats also offer medical services such as IV infusions and joint injections.
Keeping with the trend, Kriel is expanding Salamander Collection’s existing spa services, such as detox wraps and lymphatic drainage, to include dedicated “Wellness Rooms,” new vegan and vegetarian menu items, and well-being workshops. “Sleep, nutrition, and mindfulness will be a big focus for integration in 2024,” she says.
Skyler Stillings, an exercise physiologist at Sensei Lanai, a Four Seasons Resort—an adults-only wellness centre in Lanai, Hawaii—says guests were drawn to the social aspect when the spa opened in November 2021.
“We saw a huge need for human connection,” she recalls. But over the past few years, what’s paramount has shifted. “Longevity is trending much more right now.”
Billionaire co-founder of tech company Oracle Larry Ellison and physician and scientist Dr. David Angus co-founded Sensei. After the death of a mutual close friend, the duo teamed up to create longevity-based wellness retreats to nurture preventative care and a healthy lifestyle. In addition to the Lanai location, the brand established Sensei Porcupine Creek in Greater Palm Springs, California, in November 2022.
Sensei has a data-driven approach. The team performs a series of assessments to obtain a clearer picture of a guest’s health, making wellness recommendations based on the findings. While Sensei analyses that data to curate a personalised plan, Stillings says it’s up to the guests which path they choose.
Sensei’s core three-day retreat is a “Guided Wellness Experience.” For spa treatments, each guest checks into their own “Spa Hale,” a private 1,000-square-foot bungalow furnished with an infrared sauna, a steam shower, a soaking tub, and plunge pools. The latest therapies include Sarga Bodywalking—a barefoot myofascial release massage, and “Four Hands in Harmony,” a massage with two therapists working in tandem. Sensei Guides provide take-home plans so guests can continue their wellness journeys after the spa.
Sanctuaries for Longevity
Headquartered in Switzerland with hotels and on-site spas across the globe, Aman Resorts features an integrative approach, combining traditional remedies with modern medicine’s advanced technologies. Tucked behind the doors of the storied Crown Building in Midtown Manhattan, Banya Spa House at Aman New York—the brand’s flagship spa in the Western Hemisphere—is a 25,000-square-foot, three-floor urban oasis.
Yuki Kiyono, global head of health and wellness development at Aman, says the centre provides access to holistic and cutting-edge treatments benefiting physical, mental, emotional, spiritual, and social well-being. Aman’s customisable “Immersion Programs” consist of a three- or five-day immersion. “The programs encompass treatments and experiences that touch every significant aspect to create a path for longevity, from meditation and mindfulness to nutrition and movement,” Kiyono explains.
The spa’s “Tei-An Wellness Solution” features 90- to 150-minute sessions using massage, cryotherapy, and Vitamin IV infusions. Acupuncture is also on offer.
“With its rich history of Chinese Medicine, modern research, and the introduction of sophisticated electro-acupuncture medicine, acupuncture has been proven to assist with problems and increase performance,” Kiyono says.
Resetting the Mind and Body
Beyond longevity, “healthspan”—the number of years a person can live in good health free of chronic disease—is the cornerstone of Mountain Trek Health Reset Retreat’s program in British Columbia, Canada.
Kirk Shave, president and program director, and his team employ a holistic approach, using lifestyles in long-living Blue Zones as a point of reference.
“We improve our daily lifestyle habits, so we live vitally as long as we’re meant to live,” Shave says of the retreat. He built the program from an anthropological stance, referencing humans as farmers, hunters, and gatherers based on their eating and sleeping patterns. Food includes vegetable-centric meals sans alcohol, sugar, bread, or dairy.
Guests wake at dawn each day and have access to sunrise yoga, several hours of “flow” or slow hiking, spa treatments, forest bathing, calming crystal singing-bowl and sound therapy sessions, and classes on stress reduction—one of Mountain Trek’s primary goals. The program motivates people to spend much of their time in nature because it’s been proven to reduce cortisol, the stress hormone that can lead to inflammation and disease when elevated for extended periods.
While most guests aren’t aware of how immersive Mountain Trek’s program is when they arrive, they leave the resort revitalized after the structured, one-week program. Set in the Kootenays overlooking its eponymous river, the resort and adventure promise what Shave calls a “visceral experience of transformation.”
“They’re interested in coming to be in nature,” Shave says of the guests. “They hit a wall in their life and slipped backwards, so they know they need a reset.”
This article first appeared in the Winter 2024 issue of Mansion Global Experience Luxury.
Chris Dixon, a partner who led the charge, says he has a ‘very long-term horizon’