How to Get Sleep in Anxious Times | Dr. Donn Posner
Donn Posner, Founder/President of Sleepwell Consultants and Adjunct Clinical Associate Professor at Stanford, normalizes sleep problems during stress and offers tips for acute insomnia. He emphasizes structured sleep habits, especially consistent wake times, and debunks common sleep myths to prevent chronic insomnia.
Deep Dive Analysis
13 Topic Outline
Defining Acute vs. Chronic Insomnia
Causes of Increased Acute Insomnia During Stressful Times
The Importance of Sleep Structure and Consistent Wake Time
Guidelines for Napping Effectively
Determining Your Individual Sleep Needs
The Dangers of Fixating on Sleep and Trying Too Hard
Strategies for Dealing with Middle-of-the-Night Awakenings
Telehealth Options for Insomnia Treatment
Why Some People Are Sleeping Better During the Pandemic
The Role of Light Exposure in Circadian Rhythm
Addressing Listener Questions on Middle-of-the-Night Waking
Analysis of Over-the-Counter Sleep Aids and Marijuana for Sleep
Advice for Overcoming Late Bedtimes and 'Doom Scrolling'
7 Key Concepts
Insomnia Disorder (Chronic Insomnia)
Defined as trouble initiating sleep, maintaining sleep, or waking too early (taking longer than 30 minutes to fall asleep, being awake for 30+ minutes in the middle of the night, or waking 30+ minutes earlier than desired time), occurring three or more nights a week for longer than three months, with associated daytime symptoms like fatigue or concentration problems.
Acute Insomnia
Involves insomnia symptoms lasting anywhere between three days and three months, typically due to a stressor. It is considered a normal and adaptive reaction to stress, where sleep is deferred when the body perceives danger or significant change.
Social Jet Lag
A feeling similar to jet lag that occurs when an individual significantly varies their wake times, such as getting up at different hours on weekdays versus weekends. This inconsistency disrupts the body's internal biological clock.
Sleep Drive
An internal biological mechanism that builds up the longer a person is awake, increasing the body's need for sleep. It works in conjunction with the circadian rhythm to regulate sleep.
Circadian Rhythm
An internal biological 24-hour clock that regulates various bodily functions, including sleep-wake cycles, hormone secretions, and body temperature. This rhythm is primarily 'entrained' or set by light exposure, especially upon waking.
Sleep Effort
The counterproductive act of trying to force oneself to sleep, which involves expending energy and tensing up. This effort makes sleep more difficult, as sleep is an autonomic process that cannot be consciously willed.
Benzodiazepine Receptor Agonists
A class of newer prescription sleep medications, such as Zolpidem (Ambien), Sonata, and Lunesta, which are specifically targeted to promote sleep rather than general sedation. They are not true benzodiazepines but act on similar receptors.
8 Questions Answered
Acute insomnia involves sleep problems lasting less than three months, often due to stress, and is considered a normal, adaptive response. Chronic insomnia (insomnia disorder) involves symptoms (trouble falling or staying asleep, or waking too early for 30+ minutes) occurring three or more nights a week for over three months, with associated daytime impairment.
Increased stress from the pandemic (health worries, job loss, economic concerns) and changes in daily structure (working from home, loss of routine) are major contributors. These factors can lead to acute insomnia, which can escalate to chronic if not managed.
The amount of sleep needed varies individually, typically ranging from about six to nine hours per night. The best way to know is if you feel fine, active, concentrated, and not excessively tired or sleepy during most of the day when consistently getting that amount of sleep.
Napping is not inherently bad, but there's a right and wrong way. If you plan to return to a work schedule that doesn't allow naps, it's best to avoid them. If you do nap, aim for a short 'power nap' (around 20 minutes) during the post-lunch circadian dip (7-9 hours after waking) to avoid sleep inertia and disrupting nighttime sleep.
Do not stay in bed ruminating or trying to force sleep. Get out of bed, go to another room, do something enjoyable and relaxing, and return to bed only when you feel sleepy again. This prevents associating your bed with wakefulness and worry.
No, most over-the-counter sleep aids (often antihistamines) are not well-studied for sleep and are not very effective. Marijuana, like some prescription sleep aids, can help with initial sleep but may lead to tolerance and dependency over time, and neither addresses the underlying perpetuating factors of chronic insomnia. They are generally not recommended for long-term use.
Yes, insomnia diagnosis typically does not require a sleep study unless other occult sleep disorders are suspected. Behavioral sleep medicine specialists can diagnose and treat insomnia (e.g., with Cognitive Behavioral Therapy for Insomnia, CBTI) exclusively online through telehealth.
This often relates to an individual's preferred sleep phase (being a 'night owl') or a tendency to engage in stimulating activities (like 'doom scrolling' or watching TV) late into the night. While some people naturally have a later preferred phase, consistently pushing bedtime back can disrupt sleep patterns.
22 Actionable Insights
1. Don’t Panic About Poor Sleep
If you are currently sleeping poorly, don’t freak out, as it’s a natural and normal reaction to stress and often resolves on its own.
2. Consistent Wake Time is Key
Maintain a consistent wake time, getting up at the same time at least five days a week, as it’s the single most important structural input for entraining your internal biological circadian rhythm.
3. Don’t Compensate for Bad Sleep
Do not compensate for a bad night’s sleep by sleeping in later, going to bed earlier, or napping, as this disrupts your internal sleep regulation and makes future sleep problems more likely.
4. Leave Bed When Awake
If you wake up in the middle of the night and can’t get back to sleep within a reasonable time, get out of bed, go to another room, do something relaxing, and return to bed only when sleepy to avoid associating your bed with worry.
5. Wind Down Before Bedtime
Transition to lower light levels and quieter, more relaxing activities at least an hour or two before bedtime to prepare your body for sleep, avoiding work or stressful calls.
6. Maintain Dark Bedroom
Keep your bedroom as dark as possible, using sleep masks or room-darkening shades, to prevent early light exposure from disrupting your circadian rhythm and waking you prematurely.
7. Seek Morning Light
Open curtains and expose yourself to as much natural light as possible first thing in the morning to entrain your circadian rhythm; if possible, get outside or sit by an open window.
8. Avoid Sleep Obsession
Do not become overly fixated on your sleep, as trying too hard to sleep or worrying about it can undermine the natural process and perpetuate insomnia, since sleep is an automatic process you cannot force.
9. Chronic Insomnia Needs Pro Help
If insomnia persists beyond three months, seek assessment and targeted treatment from a behavioral sleep medicine specialist, as it often won’t resolve on its own, and Cognitive Behavioral Therapy for Insomnia (CBT-I) can be done via telehealth.
10. Don’t Use Alcohol for Sleep
Do not use alcohol as a sleep aid, as it may initially cause drowsiness but ultimately leads to fragmented sleep and middle-of-the-night awakenings.
11. Nap Short and Timed
If you nap, do so for about 20 minutes, setting an alarm, ideally seven to nine hours after waking, to avoid sleep inertia and preserve night sleep; avoid naps if you foresee returning to a non-napping work schedule.
12. Set Wake Alarm, Back-Time Bed
Determine your desired wake time, set an alarm to consistently wake up then, and back-time your bedtime based on your estimated sleep need, but don’t go to bed if you are not sleepy.
13. Structure Daily Life
Maintain regular mealtimes, exercise times, and other daily activities to support circadian entrainment and overall sleep health, and stay active during the day to avoid lethargy.
14. Assess Sleep Need by Day
Determine your individual sleep need by how you feel and function during the day (e.g., not tired, concentrating well), not by a fixed number like eight hours, as needs vary (typically between six and nine hours).
15. Limit Time in Bed
Avoid spending excessive time in bed beyond your actual sleep need, as this can lead to waking up in the middle of the night.
16. Filter Device Blue Light
Download and activate blue light filters on electronic devices, especially in the evening, to reduce blue light exposure that can disrupt circadian rhythm; if awake at night, use devices at a distance from your eyes.
17. Prescription Sleep Meds Short-Term
If considering sleep medication, opt for prescription medications designed for sleep, use them for short-term problems, and have a clear cutoff point under a physician’s guidance, as they are not intended for long-term use.
18. Skip OTC Sleep Aids
Avoid over-the-counter sleep aids (often antihistamines), as they are generally not very useful or helpful for sleep and are not recommended for chronic use.
19. Marijuana Not for Chronic Sleep
Do not use marijuana as a long-term solution for sleep, as it functions similarly to other sleeping pills and can lead to tolerance and withdrawal issues when used solely as a sleep aid.
20. Set Bedtime Reminder
If you struggle with delaying bedtime (e.g., doom scrolling), set an alarm on your phone for when you intend to start getting ready for bed to help transition into your wind-down routine.
21. Face Late Bedtime Consequences
Consistently wake up at your set time, even after a late night, as experiencing the daytime consequences (e.g., exhaustion) can strongly disincentivize future late bedtimes.
22. Insomnia Needs No Sleep Study
Insomnia can be diagnosed and treated behaviorally without a sleep study unless other underlying medical sleep disorders (like sleep apnea) are suspected.
8 Key Quotes
If you're sleeping poorly right now, he says, don't freak out; it is natural and normal.
Dan Harris
Sleep is deferred when the lion walks into the mouth of the cave.
Donn Posner
You cannot make yourself sleep.
Donn Posner
Good sleepers do nothing.
Donn Posner
If you get into bed and you start trying to make yourself sleep, you are done for.
Donn Posner
If you're getting overly fixated on your sleep because somebody's told you that sleep is important, you're going to undermine the whole machine.
Donn Posner
If you're awake, never be in bed when you're awake. Go somewhere else, do something fun, wait until you're sleepy again, and try again.
Donn Posner
What works for insomnia, sometimes? Everything. Including magic pajamas.
Donn Posner
2 Protocols
Preventing Acute Insomnia from Becoming Chronic
Donn Posner- Maintain structure in your life, especially a consistent wake time.
- Get up at the same time at least five days a week (or seven if trying to fix a 'broken clock').
- Back-time your bedtime based on your desired wake time and estimated sleep need, but do not go to bed before you feel sleepy.
- Do not compensate for a bad night's sleep by sleeping in, going to bed earlier, or napping during the day.
- Maintain other regularities in your life, such as consistent mealtimes, exercise times, and daily activities.
- Transition into lower light levels and quieter, more relaxing activities at least an hour or two before bedtime.
- If you wake up in the middle of the night and cannot get back to sleep, get out of bed, go to another room, do something enjoyable and relaxing, and return to bed only when you feel sleepy again.
- Avoid overthinking or worrying about sleep, as this can undermine the natural sleep process.
- Control light exposure: get morning light (by an open window or outside) and keep your bedroom as close to really dark as possible at night (e.g., using room darkening shades or a sleep mask).
- Avoid alcohol as a sleep aid, as it can initially cause drowsiness but often leads to fragmented sleep and middle-of-the-night awakenings.
Finding a Behavioral Sleep Medicine Specialist
Donn Posner- Visit the Society of Behavioral Sleep Medicine website (behavioralsleep.org).
- Navigate to the 'provider search' feature on the website.
- Click on your state on the provided map of the United States to view a listing of certified or diplomate-status providers in your area.