Special Strategies for Sleep:

If you are having a hard time getting to sleep, here are some special strategies that people have shared:

• Keep a journal next to your bed. Before you sleep, write down something about the day you are grateful for or three good things that happened during the day. Savor these things as you drift into sleep. You can also use the journal if you think of something you want to remember or do later, write it down, and let it go.

• If you have difficulty falling asleep and are bothered by complex thoughts, try not to get upset with yourself for thinking too much; this increases stress hormones and further interferes with sleep. Be aware that you are having difficulty, but tell yourself you are fine, you will get through the next day, and try to let the thoughts pass. Some people do fine on as few as four hours per night. Your body will tell you when you are getting enough sleep.

• If your thoughts bother you, some people try to think of something less stimulating or focus their attention on a specific topic to avoid distressing thoughts. Be kind to yourself and practice self-compassion when you have difficulty getting to sleep; tell yourself this is normal and everyone has a difficult time occasionally, and let these thoughts pass like clouds in the sky. A meditation practice can help you learn how to notice thoughts and let them go without getting caught up in them.

• Cognitive Shuffling:

  This is a neat strategy. Once you go to bed, pick a word that doesn’t carry much meaning to you and is five to 12 letters long. “The word should be emotionally neutral, so not something tied to stress or strong feelings,” says Patricia B. Pedreira, a health psychologist and postdoctoral associate at Duke University Medical Center who specializes in behavioral sleep medicine. “We want to avoid words like money or deadline or anything that might trigger worry chains.” Some of her favorites: blanket, garden, bedtime, and kitchen. With your word in mind, work through it letter by letter, generating as many unrelated words as you can for each letter. For example, if you choose bedtime, your shuffling might look like this: B: butterfly, basket, bagel. E: envelope, Egypt, emerald. (In practice, you’d keep going until you ran out of ideas.) “The key is keeping them unrelated,” Pedreira says. “If your brain starts making connections or building a story, it defeats the purpose.”

  Each time you name a new word, spend a few moments visualizing it. If you landed on the word goat for G, for example, “you’d briefly visualize the goat,” Pedreira says. Hold the image for a few seconds, and then move on to the next letter. Ideally, you won’t finish the whole word—you’ll have drifted off to dreamland. If you do make it to the end of your word still wide awake, just pick another one and start again.

  Why Cognitive Shuffling Works

  When your brain is busy reliving or processing what happened during the day, those thoughts can keep you stuck in an alert, problem-solving mode. “Your job is to change the channel and refocus on something that’s more likely to help you fall asleep,” says Nina Kaiser, a psychologist in San Francisco who teaches cognitive shuffling to the kids and adults she treats.

  The technique also gives you something to do besides tossing and turning. “It provides an alternative to lying in bed ruminating,” Pedreira says.

  There’s a neurological reason it works, too. Your waking brain is dominated by faster brain waves associated with focused, attentive thinking; as you fall asleep, those give way to slower, more meandering ones. “It’s a gentle shifting into a more loose, gentle, kind of random-flowing state,” says Sarah Gray, a psychologist and instructor at Harvard Medical School who specializes in cognitive behavioral therapy for insomnia. Cognitive shuffling helps your brain make that downshift.

  That’s also why the technique tends to work better than counting sheep, Gray says. Counting is so monotonous that the mind quickly loses interest, leaving room for the day’s stressors to come rushing back. Cognitive shuffling, by contrast, gives the brain just enough to do without revving it up.

  WHO WILL BENEFIT MOST

  Cognitive shuffling works best for people who have trouble falling asleep due to rumination and racing thoughts. “I see this a lot in people who are otherwise healthy sleepers, but they bring stress to bed with them,” Pedreira says.

  It’s not a fix for everything that disrupts sleep. Cognitive shuffling won’t address underlying sleep disorders, which need medical management. It also tends not to work as well for people who find visualization more alerting rather than relaxing, Pedreira says.

  If you don’t drift off in the first few minutes, don’t panic or start watching the clock. “It’s actually very normal to be awake and have a bit of an active brain for 10 to 15 minutes,” Gray says. The trouble starts when people fixate on not falling asleep instantly, because the worry itself keeps them up. That’s exactly the window cognitive shuffling is built for: something low-key to do while your brain settles, instead of one more thing to stress about.

• Focus your attention on comfortable feelings in your body or how good the bed feels. Try not to review the day's events. Concentrate on your intention to go to sleep and on how it feels to lie down and rest.

• Sleeplessness is often caused by internal self-talk, a kind of mental chatter, which can interfere with relaxing your body. The Headway website has an entire section on strategies for dealing with unhelpful thoughts. It is not advisable to tackle this when you are trying to sleep, but many tips and techniques might help if you look into these strategies at other times.

• Be patient with yourself. Sleep patterns are habitual, so you might need to work consistently on good sleep habits and savor any small signs of progress while ignoring setbacks. Watch for anxiety or feelings of anger or fear, which would make sleep unlikely or impossible. If you do struggle with anxiety/fear or resentment/anger, discuss these with a therapist who can help you work out a more stress-free view of life.

• One person shared a finger-tapping strategy. She tapped her index finger on the bed slowly and repetitively when she had difficulty sleeping. This helped her let go of disturbing thoughts. Other people have shared a strategy of naming things in the environment. If you are lying in bed and cannot sleep, you might name three things in the room. Focus on these three things for three breaths each, then start over, maintaining deep, focused attention on each item and relating them to your intention to fall asleep. Some people recommend counting your breaths from 1 to 4, then starting again with blocks of 4 breaths. Others try to visualize the numbers. Everyone is different; try to find a strategy that works for you.

  Sleep Positions and Their Effects

  There is ongoing debate about the most beneficial sleep position. Some proponents believe that sleeping on your left side aids digestion. This perspective is influenced by basic anatomy, as the stomach is located on the left side of the body, and its outlet, the pylorus, tilts slightly to the right to connect with the small intestine. Some evidence indicates that sleeping on the left side may help reduce acid reflux compared to sleeping on the right side, as this position can prevent stomach acid from rising into the esophagus. For individuals experiencing reflux or heartburn, trying the left-side position may be worthwhile.

  However, digestion occurs regardless of sleep position, so unless you have a specific digestive issue such as reflux, the way you sleep likely does not have a significant impact.

  Back Sleeping

  Sleeping on your back is sometimes recommended to relieve pressure on the neck and lower back. Nevertheless, this position can increase the risk of snoring or sleep apnea by allowing the tongue to partially block the airway.

  Side Sleeping

  Side sleeping is the most common position and can help reduce snoring and sleep apnea by keeping the airways more open. Pregnant women are often advised to sleep on their left side to improve blood flow to the baby and reduce pressure on the liver, though sleeping on the right side is generally acceptable as well.

  If you experience back or pelvic pain—especially during pregnancy—sleeping on your side with a pillow between your knees can help ease pressure on the lower back.

  Finding Your Best Sleep Position

  Ultimately, there is no universally optimal sleep position. While left-side sleeping may offer benefits for those with reflux or during pregnancy, most people should prioritize comfort, spinal support, and overall sleep quality, regardless of position. Realistically, no matter how intentional you are with your bedtime posture, you may find yourself waking up in an entirely different position. Please send us your suggestions.