Beyond Hot Flashes — The Real Reason Menopausal Women Can't Sleep

From mindbodygreen.com

By Zhané Slambee

Sleep problems are one of the most common complaints during the menopause transition, affects up to 60% of perimenopausal and postmenopausal women. Night sweats or hot flashes often get the blame for disrupting sleep, but the real issue may be what happens after a woman wakes up (aka the stress, the racing thoughts, the desperate effort to fall back asleep). Over time, these patterns can amount to insomnia. 

A new pilot trial tested whether a form of cognitive behavioural therapy designed specifically for menopause could break this cycle and help midlife women sleep better without medication.

Researchers tested a therapy that targets both insomnia and hot flashes

Cognitive behavioural therapy for insomnia (CBT-I) is already considered a go-to treatment for chronic sleep problems by the American College of Physicians. But standard CBT-I wasn't built with menopause in mind. This trial adapted the approach specifically for midlife women dealing with both insomnia and nightly hot flashes.

Researchers enrolled 43 perimenopausal and postmenopausal women who had been diagnosed with insomnia and reported at least one hot flash per night. Participants were randomly assigned to receive either the menopause-adapted therapy (four 50-minute sessions over eight weeks) or a single menopause education session.

The therapy combined standard CBT-I techniques (like limiting time in bed, only using the bed for sleep, and reframing unhelpful thoughts about sleep) with strategies designed specifically for hot flashes, including slow breathing exercises and techniques for changing how women react to night-time symptoms.

                                                                                             Image by Addictive Creatives / Stocksy

CBT-MI improved sleep

Women who received CBT-MI showed significantly greater improvements in sleep than those who received menopause education alone.

Insomnia severity scores dropped more in the CBT-MI group immediately after treatment (about a 10-point reduction vs. 6 points in the control group), and improvements were maintained at the 1-month follow-up.

The CBT group also reported less disruption from night sweats and higher sleep self-efficacy, meaning greater confidence in their ability to sleep despite symptoms.

Some sleep benefits, particularly night-time symptoms, were still present at 3 months, suggesting the skills learned may have lasting effects beyond the intervention period.

How you respond to waking up may matter as much as the hot flash itself

The study's findings line up with a well-known model of how insomnia becomes a long-term problem. According to this model, insomnia often starts with a combination of a natural tendency toward sleep trouble (like being a light sleeper or having high stress reactivity) paired with a triggering event (like menopause or night-time hot flashes). But what keeps insomnia going are the habits and thought patterns that develop afterward: spending more time in bed trying to force sleep, worrying about not sleeping, and starting to associate the bed with stress rather than rest.

This is where the therapy steps in. By teaching women to change how they respond to night-time awakenings and hot flashes, it breaks the cycle of stress and hypervigilance. Research suggests that women who feel more in control of their reactions to hot flashes tend to report fewer and less bothersome menopause symptoms overall.

CBT-I techniques you can try tonight

If you're struggling with menopause-related sleep problems, the techniques used in this study offer a helpful starting point:

Sleep restriction: Limit your time in bed to match the amount of sleep you're actually getting, then gradually expand it as your sleep improves

Stimulus control: Use the bed only for sleep (and sex); if you can't fall asleep within 15 to 20 minutes, get up and do something quiet in another room until you feel drowsy

Avoid clock-watching: Checking the time only adds to the anxiety about not sleeping; turn your clock away from view

Slow breathing: Deep, slow breaths from your belly can help calm your nervous system during a hot flash or when you wake at night

Reframe unhelpful thoughts: Notice when you're thinking things like "I'll never function tomorrow" and practice replacing them with more balanced thoughts

Keep the bedroom cool: A cooler room may help reduce the intensity of night-time hot flashes

Limit alcohol and caffeine: Both can disrupt sleep and worsen hot flashes, especially when consumed later in the day

If these strategies aren't enough on their own, working with a trained CBT-I therapist may be a worthwhile next step. Many now offer virtual sessions, and CBT-I is considered a first-line treatment for chronic insomnia before sleep medications.

The takeaway

This pilot trial suggests that cognitive behavioural therapy tailored for menopause can meaningfully improve sleep and reduce the impact of hot flashes without medication. The key insight: how you respond to night-time awakenings may matter as much as the awakenings themselves.

https://www.mindbodygreen.com/articles/beyond-hot-flashes-real-reason-menopausal-women-cant-sleep

Why you can't sleep: a doctor explains what's really keeping you up at night

From creators.yahoo.com

By Robin Raven 

What chronic insomnia actually is, why it's linked to heart disease and dementia, and the treatment many patients never hear about

Are you sabotaging yourself? When you have insomnia, sometimes the harder you try to sleep, the more awake you feel. According to one leading sleep physician, that desperate effort to force sleep may be the very thing making your insomnia worse.

Dr. Ashkan Lee Naraghi, MD, FCCP, is a board-certified pulmonologist and sleep specialist who has spent years helping patients untangle the complicated, often misunderstood condition of chronic insomnia. In this in-depth conversation, he breaks down everything from the real definition of insomnia to the promising new treatments most patients never hear about. He also explains why the advice you've been following may be backfiring.

What insomnia actually is (and what it isn't)

Most people assume a few rough nights qualifies as insomnia. Dr. Naraghi draws a clear line. He says insomnia is defined as difficulty falling asleep, maintaining sleep, or waking up too early — despite having adequate opportunity to sleep — along with daytime consequences such as fatigue, poor concentration, mood changes, or impaired function. "Everybody experiences a few bad nights," he explains, "but to be diagnosed with chronic insomnia, symptoms are generally at least three nights per week for three months or longer."

That distinction matters, because chronic insomnia is a condition with measurable consequences for your body and brain.

                                                                                                 (antoniodiaz)

The scary link between poor sleep, heart disease, and dementia

Research connecting chronic insomnia to cardiovascular disease and cognitive decline has been making headlines, and for good reason. Dr. Naraghi confirms there is "a clear association between chronic insomnia and cardiovascular disease and cognitive decline" — though he's careful to note this reflects association, not necessarily direct causation. Still, the risks are serious enough that he wants patients paying attention.

He outlines the warning signs that turn poor sleep into a medical urgency: chest pain, severe shortness of breath, confusion, suicidal thoughts, dangerous sleepiness while driving, or symptoms that suggest sleep apnoea — "such as choking, gasping, or witnessed pauses in breathing." On the question of dementia, he offers cautious reassurance: "Chronic insomnia has been linked with higher dementia or cognitive impairment risk, but this can be ameliorated with early diagnosis and treatment."

The habits that can make insomnia worse

Here's where many well-meaning people quietly sabotage themselves. Dr. Naraghi says the biggest mistake is self-medicating with sleep aids and alcohol. Also, the list of counterproductive behaviors goes further: taking caffeine late in the day, lying awake in bed for hours, sleeping in to compensate, "catch-up" napping, and watching the clock. "A lot of these behaviours," he explains, "program the brain to think the bed is a place of frustration."

That psychological imprint of the brain learning to associate the bedroom with anxiety rather than rest is at the heart of why chronic insomnia becomes so self-perpetuating.

“Trying harder to sleep usually makes insomnia worse. Sleep has to be allowed, not forced." The real goal of insomnia management, he says, is "to rebuild confidence in sleep and stop the vicious cycle of fear, frustration, and compensating behaviours."

What melatonin actually does (and doesn't do)

Melatonin has become a cultural reflex for anyone with sleep trouble, but Dr. Naraghi wants to set the record straight. "Melatonin is not a sleeping pill per se but a circadian rhythm signal," he notes. "It's basically a hormone that your body naturally produces to help control your sleep-wake cycle." It has legitimate uses such as jet lag, delayed sleep phase, and shift-related timing problems. However, "results are not consistent with chronic insomnia."

He also flags risks most people overlook: next-day grogginess, vivid dreams, drug interactions, inconsistent supplement dosing, and "false reassurance that a deeper sleep problem is being treated." And on the instinct to take more when the standard dose isn't working? "Higher doses are generally not more effective than lower doses," he cautions.

The gold-standard insomnia treatment most people have never tried

If you've never heard of CBT-I, you're in good company, and that's a problem. Cognitive behavioural therapy for insomnia is, according to Dr. Naraghi, a helpful treatment for many people with chronic insomnia. "It is a structured program that retrains the sleep system," he shares. The program typically includes sleep restriction, stimulus control, work around sleep anxiety, relaxation techniques, and targeted sleep scheduling.

Why is it better than medication? Because "it treats the underlying learned insomnia pattern and has durable benefits." So why aren't more people using it? "The problem is access: there are not enough trained CBT-I clinicians, and many patients are offered medications first." The good news, he adds, is that "there are newer virtual programs that are very promising."

Why standard sleep advice doesn't work for everyone

Sleep hygiene tips like consistent bedtimes, dark rooms, and no screens get repeated so often they've almost become background noise. Dr. Naraghi insists they’re not a catch-all solution, and certain groups need a fundamentally different approach. Menopause, pregnancy, having a newborn, shift work, anxiety, depression, chronic pain, and sleep apnoea all "warrant a different approach," he states.

The specifics matter enormously. "A shift worker may need circadian scheduling and light management, whereas someone going through menopause may need treatment of hot flashes or hormonal contributors." One-size-fits-all advice, he suggests, can do more harm than good when the underlying cause is being ignored.

When it's time to stop self-treating and see a specialist

Dr. Naraghi is specific about the red flags that mean it's time to seek professional help. Insomnia lasting more than a few weeks, affecting daytime functioning, or requiring regular medication or alcohol is a clear signal. So is insomnia occurring alongside snoring, gasping, restless legs, abnormal behaviours during sleep, depression, anxiety, or excessive daytime sleepiness. If poor sleep is affecting your driving, work, relationships, or existing medical conditions, he's unequivocal: get help.

What the future of insomnia treatment looks like

For patients who feel like they've tried everything, Dr. Naraghi offers genuine optimism. He thinks the future is moving toward more personalized care: better access to virtual cognitive behavioural therapy programs and behavioural sleep medicine. Also there should be better access to newer medications — specifically "dual orexin receptor antagonists, which target wakefulness rather than simply sedating the brain." He's measured but hopeful: "These are not magic fixes, but they give us more nuanced tools for patients who have not responded to older approaches."

The science of sleep is evolving, the tools are improving, and the conversation is finally catching up to the complexity of the problem. If you've been suffering in silence, Dr. Naraghi's message is clear: help exists, it works, and you don't have to white-knuckle your way through another sleepless night alone.

https://creators.yahoo.com/lifestyle/story/why-you-cant-sleep-a-doctor-explains-whats-really-keeping-you-up-at-night-171213779.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAACQN0AvexO0rvmHoXPTTrWuV8IayqYs5FtkAuqIfi3Gp3OaKZLf1h3MOzQTHK3KvGRbYq5iqn-srwawGqIYCi0qAKlTST33DeFD8YHW8qN3NprbIlyrPe0eDli4C55q99dRmUgXZ5QnJMuDCKCxA9azPNHpk8pvuNUyUE9oOvXJU

Know­ing if you’re a lark or a night owl will help you sleep bet­ter

From pressreader.com/ireland

If you’re not among the 1pc who can get by on five hours’ shuteye, here is how to get a bet­ter night’s rest

We all need sleep. It’s essen­tial for our health and well-being. But it turns out we are all dif­fer­ent when it comes to how much shuteye we need. Some get away with six hours a night, oth­ers need nine or 10. Sci­ence has recently turned atten­tion to those who need a lot less sleep than aver­age, mean­ing five hours or less. They are called short sleep­ers.

Most people who don’t get enough sleep, for example because of insom­nia or shift work, can suf­fer all kinds of ill effects. The day after a bad night’s sleep can be a struggle. Your immune sys­tem doesn’t work as well and so you might catch a bug. You may find your­self unable to think straight. Those with chronic insom­nia have a higher incid­ence of depres­sion and heart dis­ease. But sci­ent­ists have noticed that some people, about 1pc of us, get away with five hours or less sleep at night with no ill effects. How can this be?

One fam­ily, the Osmonds from Pennsylvania, have been stud­ied in detail. Joanne Osmond stays up late read­ing. Her sis­ters often spend hours in bed solv­ing cross­word puzzles. Her engin­eer father fixed tele­vi­sion sets late into the night and early in the morn­ing. Only her mother got a reg­u­lar night’s sleep.

Joanne said: “Grow­ing up, we didn’t real­ise that there was any­thing dif­fer­ent about us.”

Then in 2011, she dis­covered she had a vari­ant of a gene linked to short sleep that con­trols a brain chem­ical called glutam­ate. Her sis­ters were tested in 2019 and had the same vari­ant. Joanne is now 27 and only needs four hours’ sleep a night. She has cal­cu­lated that she has spent 13 years longer awake than the aver­age per­son given that she is awake three to five hours longer a day than most.

She feels she has made great use of all that extra time. She got a degree in engin­eer­ing, had five chil­dren, worked in jobs in tech­no­logy and, hav­ing stud­ied edu­ca­tion policy into the wee small hours of many nights, became pres­id­ent of the Illinois Asso­ci­ation of School Boards. “The world seems to need eight hours, and I don’t,” she said.

Ying-Hui Fu is a sci­ent­ist who has stud­ied about 100 short sleep­ers. Many of them have hob­bies they take ser­i­ously, and work in demand­ing jobs. They are also inclined to have a higher tol­er­ance for pain and don’t suf­fer so much from jet lag.

To under­stand how they get away with it, we need to know how sleep works and what it is for.

Most anim­als need sleep, but it’s dif­fi­cult to say exactly why. One reason is when we sleep we slosh out from our brains the waste products that build up dur­ing the day because of all the brain activ­ity going on. Another is that memor­ies get fully laid down.

There are big dif­fer­ences between spe­cies, however. Bats need 20 hours a day, while ele­phants need only two.

We humans are clearly obsessed with it. Books about sleep often top best­seller lists. Many of us wear sleep track­ers, giv­ing rise to a new psy­cho­lo­gical con­di­tion called “ortho­som­nia’’, defined as the obsess­ive pur­suit of optimal sleep met­rics. Guess what all this obses­sion with sleep can lead to? Insom­nia.

It’s import­ant not to drink too much alco­hol. Drink might help you sleep, but the sleep you get is ‘non-pro­duct­ive’

We all have a daily bio­lo­gical clock, called cir­ca­dian rhythm, that dic­tates when we fall asleep and wake up. As even­ing comes on, we make our own nat­ural sleep­ing pill called melatonin. And then we make something to wake us up, which is called cortisol.

Some people (who are called larks) get up early and oth­ers (who are called night owls) stay up late. Both still get an aver­age of eight hours a night, however.

In the 1990s, sci­ent­ists began study­ing people who only needed four or five hours’ sleep, but func­tioned nor­mally dur­ing the day. They real­ised this trait ran in fam­il­ies and figured that it was prob­ably genetic. And then in 2009 a par­tic­u­lar gene called DEC2 was dis­covered in short sleep­ers. It pro­duces a pro­tein called orexin, which was already known to pro­mote wake­ful­ness. One of the causes of nar­co­lepsy (a con­di­tion where people fall asleep spon­tan­eously at any time of day) is a defi­ciency in orexin. To make sure it was involved, mice were engin­eered to have the DEC2 vari­ant. Guess what? They slept a lot less than other mice.

Since 2009, six more genes have been found that are linked to wake­ful­ness. The Osmonds have a gene vari­ant that affects how a brain chem­ical called glutam­ate works.

How use­ful might this research be? Drugs to block orexin are in devel­op­ment, as a treat­ment for nar­co­lepsy, which can be very debil­it­at­ing. Tar­get­ing DEC2 could turn you into a short sleeper, should you want that. It could, however, be dan­ger­ous because not get­ting enough sleep increases the risk of devel­op­ing Alzheimer’s dis­ease.

To get a good night’s sleep you should prac­tise what’s called good sleep hygiene. This entails main­tain­ing a good rhythm: going to bed and get­ting up at roughly the same time every day. Our bod­ies love routine. Hav­ing a com­fort­able bed with low light­ing is import­ant to help you relax. It’s import­ant not to drink too much alco­hol, though. Drink might help you sleep, but the sleep you get is called “non-pro­duct­ive”. Eat­ing before bed­time can also dis­rupt sleep as your digest­ing juices flow and your tummy rumbles.

One way to find out how much sleep you need is to fol­low your sleep pat­tern when you’re on hol­i­day. Sleep when you’re tired and get up when you wake. Do this over a few days and you’ll fig­ure out the optimum num­ber of hours sleep you need.

One bene­fit from this research is it can bring com­fort. One short sleeper used to worry that there was something wrong with him. Once he found out his short sleep­ing was in his genes he calmed down. He has eight chil­dren. A lot of short sleep­ers seem to have lots of chil­dren. I sup­pose they have to fill those night time hours some­how. He runs a 200-mem­ber choir, volun­teers in his church and reads vora­ciously.

If you are blessed with short sleep, use your time effect­ively. The Osmonds weren’t crazy horses after all. As for the rest of us, fig­ure out if you’re a lark or an owl, and act accord­ingly.

https://www.pressreader.com/ireland/sunday-independent-ireland/20260503/281659671651245

 

How to Stop Taking Pills Without Relapsing into Insomnia

From todoalicante.es

By Doménico Chiappe, Madrid

Patients arrive medicated from primary care when the condition is chronic. Three specialists discuss how they help patients stop taking medication

More than six million people in Spain regularly consume hypnotic sedatives, such as sleeping pills or benzodiazepines. This is especially prevalent among women, increasingly younger, according to data from the Ministry of Health's Survey on Alcohol and Other Drugs. "We live in a country where more sleeping pills are consumed than anywhere else. The problem is that higher doses are needed over time due to tolerance, leading to abuse. In this case, the patient faces two issues: insomnia and abuse," says Carlos Egea, president of the Spanish Federation of Sleep Medicine Societies (Fesmes). "Each year, the proportion of people taking them increases," confirms Ainhoa Álvarez, president of the Spanish Sleep Society. "Most drugs used for insomnia, though not all, are benzodiazepines, which cause dependence and tolerance."

When they reach the specialist, patients with sleep problems are already medicated. "An insomnia patient sleeps poorly or little, struggles to fall asleep, or wakes up and cannot return to sleep, and then feels unwell during the day. A diagnosis must rule out other sleep disorders and confirm insomnia," Álvarez continues. "The issue is that by the time they reach the Sleep Unit, they have often already been through primary care and have been prescribed medication, which is the quickest way to sleep."

The use of these drugs begins before the age of 15 in Spain, with an average age of 46. The groups with the highest consumption have low educational levels and work in unskilled manual jobs, administrative roles, rural areas, social services, or are unemployed, according to the 'Conclusions of the Gender Working Group of the Spanish Council on Drug Addiction and Other Addictions'. "If after an evaluation we diagnose chronic insomnia, the first-line treatment is cognitive-behavioural therapy. If there is no response, it is combined with pharmacological treatment to address the underlying mechanisms and correct the disorder with medication," recommends Adolfo Alcoba, a member of the Sleep Alliance. "The question is what to do if there is already dependence and the patient has been taking medication for a long time and developed tolerance."

"There are two public health issues: general sleep problems and the high consumption of hypnotic sedatives."

The most common drugs for insomnia cause cognitive decline in the elderly, affect memory, create dependence, and require increasingly higher doses until they become ineffective, Alcoba states: "Here are two major public health issues. First, general sleep problems, affecting 40% of the population; and second, the high consumption of benzodiazepines and hypnotic sedatives. We need to reduce this percentage to a minimum. But if someone goes to their GP and says they can't sleep or wake up very tired, they are often given a pill by default. Can they stop taking it later?"

                                                                   A person sitting on their bed at night. (R. C.)

This week, the Sleep Alliance presented the 'Practical Guide to Cognitive Behavioural Therapy for Chronic Insomnia', on psychological intervention in these cases, as the first level of care and to help stop these drugs. This guide outlines several steps: the patient must learn what induces sleep and how to manage these factors, develop a "sleep hygiene routine", control alert stimuli, and apply various measures during insomnia, restrict time in bed, and feel the "pressure of sleep, because if a person doesn't go to sleep and watches TV or uses their phone, they won't sleep and become more alert," says Alcoba, co-author of the study.

"Thoughts about their insomnia problem, which can be intrusive, are changed."

"It has two parts. In the behavioural part, the patient is taught to adopt more suitable behaviours to overcome insomnia, as sometimes we make it worse. For example, staying in bed for too long, hoping to fall asleep. So, we work to change these patient behaviours. In the cognitive part, thoughts about their insomnia problem, which can be intrusive or myths about sleep, are changed," Álvarez explains about a treatment that "is often not offered in the National Health Service. Ideally, this therapy would be provided in primary care."

Years Go By

Something that is not a myth is that insomnia increases with age. "Yes, because we have more problems as we age. Mr. Prostate, Mrs. Hot Flushes, Mr. Pain. Older people have fragmented sleep and not the continuous sleep we all desire. It's more complicated," Egea states. "The age range for sleeping seven to nine hours starts at twenty and goes up to 65, pressured by our working lives. Then comes retirement, which allows more time for sleep, but there are also doctors, anxiety... Each stage has its general problems."

With age, night-time awakenings become more frequent and especially "longer," says Álvarez. "When you're young or a child, you wake up several times at night; it's normal to wake up three or four times. But we turn over, go back to sleep, and don't remember because it lasted thirty seconds or a minute. But when awakenings are longer, we are more aware and have less deep and shorter sleep. Sleep also changes with age. An elderly person may sleep less than two hours at night but take one or two naps, mid-morning and mid-afternoon."

One or Two Naps

Is it beneficial and advisable to take a nap? The experts' answer is 'yes'. "Napping is good, but always short. Less than 30 minutes," Álvarez maintains. "Our brain is programmed to nap, but if it's too long, it will take away from night-time sleep. We tell insomnia patients not to nap for more than 30 minutes, although it depends on each case. Some people work nights, sleep little, and then take a long nap. So, everyone has to adapt their lifestyle."

Egea agrees: "It's only good for about half an hour. The nap complements a little but doesn't replace night-time sleep. It doesn't take away from night-time sleep afterwards, but if you're an insomniac, we don't recommend it."

https://www.todoalicante.es/english/stop-taking-pills-without-20260430100423-nt.html

Want to Fall Asleep Faster? Try Gaslighting Your Brain

From oprahdaily.com

Psychologists explain why telling yourself to stay awake can have the opposite effect  

If you’ve ever lain in bed desperately willing yourself to sleep (me on most nights!), you’re familiar with a cruel irony: The harder you try to force sleep, the more awake you feel.

When you can’t drift off, panic sets in, and your insomnia feels like a high-stakes problem that needs solving ASAP. After all, sleep supports our metabolism, immunity, and mental well-being, while offering our bodies much-needed time to repair and reset. But the more you try to make it happen, the harder it is to achieve. That’s because sleep is a biological process that “collapses under pressure,” says Shelby Harris, PsyD, a clinical psychologist, sleep specialist, and the author of The Women’s Guide to Overcoming Insomnia.

Fortunately, there may be a simple solution to this type of sleeplessness. It’s called “paradoxical intention,” or pretending you want to stay awake—even when you definitely don’t.

We asked sleep experts about the surprising science behind paradoxical intention, and how you can try it at home.

                                                                                     Getty Images. Oprah Daily.

When Trying to Sleep Backfires

Under normal circumstances, your body builds sleep drive (your natural need for sleep) throughout the day simply by being awake and active, says Colleen Carney, PhD, a professor and director of the Sleep and Depression Laboratory at Toronto Metropolitan University. By the time you get into bed, you should have accumulated enough to drift off easily. But when you lie there willing yourself to conk out (because you’re worried about being well rested for tomorrow’s presentation, or you want to make up for a bad night earlier in the week), that mental effort creates arousal that overrides your sleep drive. Suddenly, you’re wide awake and exhausted.

Over time, this issue can create a cycle of sleeplessness. “The more you try to make sleep happen, the more anxious you get, and the harder it is to attain,” says Aric Prather, PhD, a sleep scientist at the University of California, San Francisco, and the author of The Sleep Prescription. And the more bad nights you have, the more stressed you get about sleeping, which only amplifies your issues.

Many people then try to double down on their sleep efforts: reaching for an eye mask, downloading a white noise app, or going to bed an hour earlier, says Carney. But each of those fixes reinforces the idea that there’s something wrong with you, which only worsens your stress about getting a good night’s rest. “Trying to sleep is like trying to fall in love—it’s not going to work,” she says. “Sleep has to unfold naturally.”

The Simple Magic of Paradoxical Intention

Essentially, paradoxical intention is treating your brain like a petulant child: Ask it to do something and it will do the opposite. In this case, instead of fixating on falling asleep, you lie quietly in bed with your eyes open and try to stay awake—without turning on lights, reaching for your phone, or otherwise engaging your brain. Shifting your mental effort away from sleep in this way can reduce arousal and allow your natural sleep drive to take over, says Carney.

“One of the fears in insomnia is that you’ll lie awake all night long, and paradoxical intention directly faces that fear,” adds Carney. When you’re actively trying to stay awake, you no longer brace for the thing you dread—insomnia—and this reduces the sense of threat around sleep. Threat averted, your brain can relax…and conk out.

This may sound like a TikTok hack, but paradoxical intention is a legitimate technique developed by renowned psychiatrist and neurologist Viktor Frankl to treat anxiety and phobias. It was later adapted for insomnia in the 1970s by psychologist L. Michael Ascher, says Carney, and there is some evidence to support its efficacy.

In professional settings, paradoxical intention isn’t widely used as a stand-alone treatment, Carney says. But it may be included as part of a more comprehensive cognitive-behavioural therapy for insomnia (CBT-I), a structured, evidence-based approach that addresses the thoughts and behaviours that interfere with sleep. “CBT-I is the treatment of choice for chronic insomnia,” Carney says.

Who Can Benefit from This Technique

Paradoxical intention tends to work best for people with sleep-onset insomnia (those who struggle to fall asleep at the start of the night) rather than people who wake in the middle of it, says Carney. It’s especially useful when anxiety about sleeping is part of the problem, adds Prather: not just difficulty sleeping, but stress and worry about that difficulty.

The technique may be less effective for other sleep struggles, says Prather. For example, if you fall into rumination—repetitive, intrusive thoughts that are hard to shut off—lying awake can sometimes give those thoughts more room to spiral. In those cases, strategies that gently redirect your attention, like listening to something calming or reading, may be more helpful. (We’ve got a whole list of ideas you can try.)

If you want to try paradoxical intention, remember that repetition matters. With practice, Carney says, you can potentially learn to trust your body to do what it already knows how to do. As Prather says, sleep is built into our biology—it doesn’t need your help. “If people can just get out of their own way, sleep will happen.”

https://www.oprahdaily.com/life/health/a71119068/paradoxical-intention-for-sleep/