Can’t Sleep? Here Are Some Surprising Strategies That Work
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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.

By Elizabeth Bernstein
Wed, Mar 24, 2021 3:14pmGrey Clock 6 min

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.

 

Tips to Help You Sleep

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.



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Italy, Land of Uncollected Garbage, Combines Running With Trash Pickup

At the World Plogging Championship, contestants have lugged in tires, TVs and at least one Neapolitan coffee maker

By ERIC SYLVERS
Wed, Oct 4, 2023 4 min

GENOA, Italy—Renato Zanelli crossed the finish line with a rusty iron hanging from his neck while pulling 140 pounds of trash on an improvised sled fashioned from a slab of plastic waste.

Zanelli, a retired IT specialist, flashed a tired smile, but he suspected his garbage haul wouldn’t be enough to defend his title as world champion of plogging—a sport that combines running with trash collecting.

A rival had just finished the race with a chair around his neck and dragging three tires, a television and four sacks of trash. Another crossed the line with muscles bulging, towing a large refrigerator. But the strongest challenger was Manuel Jesus Ortega Garcia, a Spanish plumber who arrived at the finish pulling a fridge, a dishwasher, a propane gas tank, a fire extinguisher and a host of other odds and ends.

“The competition is intense this year,” said Zanelli. Now 71, he used his fitness and knack for finding trash to compete against athletes half his age. “I’m here to help the environment, but I also want to win.”

Italy, a land of beauty, is also a land of uncollected trash. The country struggles with chronic littering, inefficient garbage collection in many cities, and illegal dumping in the countryside of everything from washing machines to construction waste. Rome has become an emblem of Italy’s inability to fix its trash problem.

So it was fitting that at the recent World Plogging Championship more than 70 athletes from 16 countries tested their talents in this northern Italian city. During the six hours of the race, contestants collect points by racking up miles and vertical distance, and by carrying as much trash across the finish line as they can. Trash gets scored based on its weight and environmental impact. Batteries and electronic equipment earn the most points.

A mobile app ensures runners stay within the race’s permitted area, approximately 12 square miles. Athletes have to pass through checkpoints in the rugged, hilly park. They are issued gloves and four plastic bags to fill with garbage, and are also allowed to carry up to three bulky finds, such as tires or TVs.

Genoa, a gritty industrial port city in the country’s mountainous northwest, has a trash problem that gets worse the further one gets away from its relatively clean historic core. The park that hosted the plogging championship has long been plagued by garbage big and small.

“It’s ironic to have the World Plogging Championship in a country that’s not always as clean as it could be. But maybe it will help bring awareness and things will improve,” said Francesco Carcioffo, chief executive of Acea Pinerolese Industriale, an energy and recycling company that’s been involved in sponsoring and organizing the race since its first edition in 2021. All three world championships so far have been held in Italy.

Events that combine running and trash-collecting go back to at least 2010. The sport gained traction about seven years ago when a Swede, Erik Ahlström, coined the name plogging, a mashup of plocka upp, Swedish for “pick up,” and jogging.

“If you don’t have a catchy name you might as well not exist,” said Roberto Cavallo, an Italian environmental consultant and longtime plogger, who is on the world championship organizing committee together with Ahlström.

Saturday’s event brought together a mix of wiry trail runners and environmental activists, some of whom looked less like elite athletes.

“We like plogging because it makes us feel a little less guilty about the way things are going with the environment,” said Elena Canuto, 29, as she warmed up before the start. She came in first in the women’s ranking two years ago. “This year I’m taking it a bit easier because I’m three months pregnant.”

Around two-thirds of the contestants were Italians. The rest came from other European countries, as well as Japan, Argentina, Uruguay, Mexico, Algeria, Ghana and Senegal.

“I hope to win so people in Senegal get enthusiastic about plogging,” said Issa Ba, a 30-year-old Senegalese-born factory worker who has lived in Italy for eight years.

“Three, two, one, go,” Cavallo shouted over a loudspeaker, and the athletes sprinted off in different directions. Some stopped 20 yards from the starting line to collect their first trash. Others took off to be the first to exploit richer pickings on wooded hilltops, where batteries and home appliances lay waiting.

As the hours went by, the athletes crisscrossed trails and roads, their bags became heavier. They tagged their bulky items and left them at roadsides for later collection. Contestants gathered at refreshment points, discussing what they had found as they fueled up on cookies and juice. Some contestants had brought their own reusable cups.

With 30 minutes left in the race, athletes were gathering so much trash that the organisers decided to tweak the rules: in addition to their four plastic bags, contestants could carry six bulky objects over the finish line rather than three.

“I know it’s like changing the rules halfway through a game of Monopoly, but I know I can rely on your comprehension,” Cavallo announced over the PA as the athletes braced for their final push to the finish line.

The rule change meant some contestants could almost double the weight of their trash, but others smelled a rat.

“That’s fantastic that people found so much stuff, but it’s not really fair to change the rules at the last minute,” said Paul Waye, a Dutch plogging evangelist who had passed up on some bulky trash because of the three-item rule.

Senegal will have to wait at least a year to have a plogging champion. Two hours after the end of Saturday’s race, Ba still hadn’t arrived at the finish line.

“My phone ran out of battery and I got lost,” Ba said later at the awards ceremony. “I’ll be back next year, but with a better phone.”

The race went better for Canuto. She used an abandoned shopping cart to wheel in her loot. It included a baby stroller, which the mother-to-be took as a good omen. Her total haul weighed a relatively modest 100 pounds, but was heavy on electronic equipment, which was enough for her to score her second triumph.

“I don’t know if I’ll be back next year to defend my title. The baby will be six or seven months old,” she said.

In the men’s ranking, Ortega, the Spanish plumber, brought in 310 pounds of waste, racked up more than 16 miles and climbed 7,300 feet to run away with the title.

Zanelli, the defending champion, didn’t make it onto the podium. He said he would take solace from the nearly new Neapolitan coffee maker he found during the first championship two years ago. “I’ll always have my victory and the coffee maker, which I polished and now display in my home,” he said.

Contestants collected more than 6,600 pounds of trash. The haul included fridges, bikes, dozens of tires, baby seats, mattresses, lead pipes, stoves, chairs, TVs, 1980s-era boomboxes with cassettes still inside, motorcycle helmets, electric fans, traffic cones, air rifles, a toilet and a soccer goal.

“This park hasn’t been this clean since the 15 century,” said Genoa’s ambassador for sport, Roberto Giordano.

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