How do I stop my mind from ruminating in the middle of the night?
January 10, 2014 6:21 AM   Subscribe

I keep waking up in the middle of night, thinking about things I have no control over. One area I gravitate to more than most is decisions my parents in their lifetimes that have been harmful to me. Sometimes I think about work related issues. How can I resolve this?

I wake up feeling overwhelmed with anger, self-doubt, and sadness. I am either replaying events from my past in my head, or thinking about different ways of handling a past situation that did not end well.

This of course makes it very difficult to fall back asleep. I then end up tossing and turning for twenty minutes in a futile attempt to fall asleep. Eventually I give up and grab my phone to read inane things on the web until I may or may not fall back asleep. I then end up going through my day feeling zapped and dull. This is pretty much a routine at this point.

I have discussed this issue with my therapist, and unfortunately his only resolution to this matter is sleep medication, which is an option I want to avoid.

As a note, what I find interesting about this is I have little trouble falling asleep at a set time at night. Come 4 to 6am though, I wake up and the cycle starts.

Does the hive mind have any suggestions on how to deal with this issue?
posted by helios410 to Health & Fitness (16 answers total) 24 users marked this as a favorite
B vitamins can get the "brain swirlies" to stop. So up your consumption of foods that are high in Bs.

Rather than something like Ambien, give Trazadone a try. I've been taking a half a dose every so often and it really, really helps. It's pretty innocuous and doesn't have unpleasant side-effects. It's also really cheap.

If I'm under severe stress, I will wake up in the middle of the night. It usually starts with some dumb song I can't get out of my head. Then I have a panic attack, and then it's downhill from there.

If you're under other types of stress, it can inturrupt your normal sleep patterns. So getting that stress under control will help with your sleep problems.
posted by Ruthless Bunny at 6:28 AM on January 10, 2014

1) Practice good sleep hygiene. Wake up at the same time every day. The bed is only for sleeping. Go to bed earlier.

2) Don't read inane things. Read an old favorite novel. It is both familiar and pleasurable. You will get your mind off other things without feeling the need to know what's next or "just one more."

3) Or if this works better for you, there are approximately more guided relaxation videos on youtube than there are people in the world.
posted by yeolcoatl at 6:30 AM on January 10, 2014

Are you opposed to all medication that will help you sleep, or just sleeping pills and their ilk? I used amitriptyline for about a year, off-label, to be able to go to sleep and stay asleep without the "brain swirlies" (excellent term, by the way). It helped me sleep all the way through the night, from the very first night I took it. It changed my life.
posted by juniperesque at 6:33 AM on January 10, 2014 [2 favorites]

Magnesium might help, it's cheap at any drugstore and worth a try.

How is your sleep hygiene? If your room isn't dark (completely dark), fix that. Remove any non-red light sources and face any clocks with red LEDs away from the bed. If you must browse the internet on your phone, consider using something like these to block the blue wavelengths, as recently discussed on Metafilter.

And yes, stress management. Do you exercise? If not, start that -- it will take time to pay off but long-term, it will help.
posted by pie ninja at 6:35 AM on January 10, 2014 [1 favorite]

I listen to talk radio, through a single earpiece, just loud enough for me to hear, lying in bed (on the other ear) in the dark. I usually fall asleep within 30 mins. I dare say podcasts or audiobooks would do equally well.
posted by Segundus at 6:35 AM on January 10, 2014 [8 favorites]

Try writing your thoughts down if you wake up like that. What I found is that somehow, the act of writing forced me to think more concretely about those things, which short-circuited them - one of the reasons you may be coming back to those thoughts again and again is because you haven't really given them a full think. And for me, the act of writing forced me to think about them - because if you're trying to find the words to describe something, you can't help but think about it. Not that you will be passing your floor looking for the right word, that sort of happens subconsciously.

Also - once it's down on the paper, it is out of your head. It's kind of like the act of writing is a transfer system - you are downloading those thoughts into storage, and that frees your brain up. Mind you, they may come up again, but writing them down gets your brain to let go of them quicker each time.
posted by EmpressCallipygos at 6:36 AM on January 10, 2014 [3 favorites]

I've linked to this comment a few times, but the description of obsessive thinking and how to recognize it and interrupt the cycle was really helpful for me.
posted by gladly at 6:43 AM on January 10, 2014 [2 favorites]

I would advise to treat the source of your pain.

One area I gravitate to more than most is decisions my parents in their lifetimes that have been harmful to me.

I have been here. This kind of ruminative thinking can simply be a bad habit. It's a learned behavior and keeps you in a state of feeling sorry for yourself. Keep working with your therapist on healing childhood wounds and learning to let that stuff go.

Replace negative thinking about your parents with more positive activities and thoughts. It's your life and you get to choose what you think about. One thing that helps me, is to think about the positive things my parents have done or said. When you find yourself going down that road of victimhood and self-pitying, and how badly you've been wronged, think about a positive moment from your life. Think of that positive moment, be grateful for it, and promise yourself you will go on to thinking about something else. If you cannot think of a positive thing, you can simply say to yourself, "I know my parents are flawed but I know that they love me." You have to heal from your past pain and train yourself not to go down that rumination, soul-destroying road. Ignore the negative, nurture the positive.
posted by Fairchild at 6:51 AM on January 10, 2014

I used to wake up at 4 am all the time with anxiety very, very similar to what you described. I bought a pair of SleepPhones and now when I can't sleep, I listen to my favourite audiobooks read by my favourite English actors. Instant lullaby.
posted by girlpublisher at 6:52 AM on January 10, 2014 [2 favorites]

1. Meditate on something positive (love or compassion for others) for 5 min right before bed. This sets up your mind for a peaceful dream/sleep state and will reduce the chances that you'll wake up with your subconscious coughing up bad feelings. Do it immediately before sleep.

2. If you wake up with bad feelings, force yourself to think about something boring. FORCE it. Your mind will get pulled to stuff that has "sticky" emotion attached to it, but keep forcing it to something boring that has no emotional connection for you. Think about your grocery list. Think about your garden. Name all the models of cars you've owned. Shit count sheep, and imagine the sheep in detail. If you feel any twinge of emotion (positive/negative), put it aside and go for the boring.
posted by St. Peepsburg at 6:56 AM on January 10, 2014 [4 favorites]

So there definitely sound like there might be some therapy issues going on here, but you might want to consider whether there could be an underlying sleep issue unrelated to your mental/emotional state. Depression can cause sleep problems, but sleep problems can also lead to depression-like symptoms. In any case, if you can avoid waking up in the first place, you won't have to deal with this as much, or at least not while you're trying to sleep.

Sleep apnea, for instance, is a real thing, and it tends to be significantly under-diagnosed. I've likely had it for two decades, but I only got diagnosed last year. Fortunately, it's very, very easy to treat. Or it could just be hypopnea, which is less severe than apnea, but the same kind of thing. It's not the only medical issue which might be in play either. Back issues,

Another possibility is that you've just got a viciously strong circadian rhythm. I know I do. I wake up at 4:30-5:00 AM every day, without the need for an alarm, unless I've been up past 1:30AM or so. If I go to bed before that, whether at 9:00 or midnight, I'm up by 5:00. So if you're waking up at 4:00-6:00AM, your body may simply be telling you that it's time to get up. So rather than trying to go back to sleep, you might just decide to start your day. 4:00 is perhaps a little early, but there are plenty of people who get up at 5:00 on a regular basis. That, at least, would give you something else to think about. Staring at the ceiling is probably going to make it harder to break out of those thought cycles than taking a shower and getting your day on.

It does sound like you've got some work to do in terms of improving your outlook and thought patterns, but I really would explore the idea that the issues with your sleep might be unrelated.
posted by valkyryn at 7:03 AM on January 10, 2014 [1 favorite]

Melatonin really helps me with this. Start with 1mg (it can be a little hard to find but it's out there) because higher doses can give you really vivid dreams which can make you have less restful sleep.
posted by dawkins_7 at 7:55 AM on January 10, 2014

You can practice labelling the thoughts ("Oh, my brain is doing that thing again..." or you can even come up with a word to describe the thoughts, and say it to yourself silently whenever the thoughts come up - "Ruminating" might work) and then observing them, while not actively engaging with them or feeding into them. Watch them come and go. If you don't engage, the thoughts and feelings will pass on their own.

Then you can distract yourself with something fun - I keep my Kindle (with a little dim light) near the bed for nights like this, and have it stuffed full of fun trashy books to read.

Sublingual melatonin also helps me on nights like this - also keep it near my bed. You can take it and dissolve it in your mouth without water.
posted by Ouisch at 8:02 AM on January 10, 2014 [1 favorite]

I've had good luck with relaxation/sleep-inducing guided visualizations. This is the one I use, but there are a lot of different options out there and it's important to find a combination of voice and sounds that you find soothing. I found that the more I used this tool, the faster my response to the relaxation sequence was--so if you want to try this out, you may want to try listening to your chosen audio as you go first go to sleep to train your brain to associate the audio with the successful falling-asleep process--hopefully your brain will then respond in the same way when you have middle-of-the-night wakings that are more difficult to resolve.
posted by drlith at 8:04 AM on January 10, 2014

The sleep medication is all I've had luck with—and I should note that for me at least anything other than the prescription stuff, such as melatonin or OTC sleep aids, do help me sleep but result in feeling like crap the next day—but another approach that seemed to me might have potential is learning and becoming proficient in a meditation discipline, like some kinds of yoga for example, so that you'll develop the skill to blank your mind and promote calmness at will. Didn't have the focus to keep up with it myself, though.
posted by XMLicious at 9:14 AM on January 10, 2014

Your description of your sleep troubles and thought processes screams Generalized Anxiety Disorder. What "sleep medication" does your therapist want to prescribe? There are lots of different "sleep medications." Several benzodiazepines are accepted treatments for anxiety (including GAD), and are helpful for sleep in anxious persons because of their anxiolytic effect, in addition to the sedative/hypnotic effects that anyone taking them would experience.

If your therapist has somehow missed the fact that you have clinically significant anxiety and just wants to throw an Ambien prescription at you to keep you asleep, it's time to find a new therapist.

If your therapist hasn't missed the fact that you have clinically significant anxiety, you might want to reconsider his suggested treatment. If he's suggesting something like a small dose of clonazepam before bed, that's quite reasonable, and might temporarily alleviate your sleep problems while you work on a longer-term solution like CBT. Ultimately, however, if you disagree with his therapeutic approach, you should look for another therapist.
posted by jingzuo at 10:41 AM on January 10, 2014

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