In this post I present the research on writing as an effective way to deal with insomnia, some thoughts about why it works, and offer some practices to try. It’s a long post, but if you, or someone you care about, is suffering from sleeplessness I think you’ll find it helpful.
Several years ago, before I became a psychotherapist, when I was still “just” a writing facilitator, I had a client – I’ll call her Kathy. We published her memoir about her husband’s battle with cancer and her journey as first his caregiver, and then his widow.
One time when we both at a bookstore for her to do a signing, she confessed to me that she was exhausted.
“I’m not sleeping,” she said. “I get to sleep alright, but then I wake up at around 3:00 in the morning and my head is whirling. I can’t get back to sleep for hours.”
My focus in my Masters was the healing power of expressive writing. If you’ve ever been a client of mine, you’ll know that I usually recommend that you integrate writing into your therapeutic process.
And I knew a thing or two about insomnia from personal experience. A few years before, at the end of my marriage and, at the same time, in the throes of the failure of my business, I’d lain awake so many nights that I thought that if I ever wrote an autobiography it should be titled “Staring Wide-Eyed Into The Dark”.
For months I’d simply lain in bed “trying” (ie. striving, efforting) to go back to sleep, but instead getting more and more anxious that I was going to be exhausted the next day. Eventually, through trial and error, I learned to get up, go to my office, get out my journal and put those spinning thoughts down on paper. And when I finally did lie down again, I’d fall asleep immediately.
I shared that experience with Kathy. “You could try that,” I offered.
The next time I saw her, I asked how things were going with her sleeplessness.
“So you tried that getting up and writing, and it worked?”
“Even better!” she crowed. “I didn’t wait till I woke up. I started a practice of writing before I went to bed. I’d start by saying, This is what I need to set down before I go to sleep, and I’d write about all the things that were bothering me or that I needed to deal with. Since I started doing that, I don’t wake up in the middle of the night anymore. I’ve been sleeping straight through.”
I was delighted to know how well the technique had worked for her. And since then, when I recommend journaling to deal with insomnia, most clients who try it report it helps a lot.
Now that I am a psychotherapist, I’m aware of how many people struggle with sleeplessness either before they fall asleep, or Kathy’s variety – waking up and not being able to get back to dreamland. Almost 30% of Canadians and Americans report that insomnia has a negative impact on their daily lives, and many more suffer from the occasional bout of sleeplessness.
I’m a big fan of writing as a therapeutic tool, not just for sleeplessness but in all areas of life. And my faith in it has been buoyed up by so much of the research, starting with James Pennebaker’s groundbreaking work in the 1980s (*1) that showed that a certain kind of writing (what Pennebaker termed “expressive writing”) literally strengthened the immune system and predicted better health. Then came a wealth of follow up studies, all showing positive results. Here are some of them:
EXPRESSIVE WRITING HAS BEEN SHOWN TO RESULT IN:
- Fewer stress-related visits to the doctor
- Improved immune system functioning
- a lessening of anxiety and depression symptoms
- Improved mood/affect
- Feeling of greater psychological well-being
- Fewer post-traumatic intrusion and avoidance symptoms
- Altered social and linguistic behavior
- Reduced blood pressure
- Improved lung function
- Improved liver function
- Fewer days in hospital
- Improved working memory
- Improved sports performance
- Higher students’ grade point average
The how of expressive writing is that it works by:
- Gives an outlet for emotional expression
- Organizes thoughts
- Helps distance yourself from the situation
- Helps gain control over the situation
- Regulates emotion
- Clears your mind and provides relief
- Creates greater self-awareness and understanding about the situation
It also helps with:
By happenstance, I led that workshop in the evening. One of the participants emailed me the next day to tell me how impressed she was with how deep participants had gone, and how fast they’d gotten there. She also mentioned that she’d had the best sleep that night after the workshop that she’d had for months.
In that workshop we used Pennebaker’s protocol, which is the set of instructions used in his original research into the effects of disclosure. Those instructions have been used in a great deal of research since then.
I’m going to reproduce them here. (For the purposes of his research, his participants only did the protocol for four days in a row but of course you’re welcome to do them as often and for as long as is useful to you. And if you’re having trouble sleeping, do them regularly.)
INSTRUCTIONS FROM PENNEBAKER’S EXPERIMENT PROTOCOL:
Write for at least 20 minutes per day on your very deepest thoughts and feelings about things that have happened that have distressed and dismayed you, and particularly things that have happened and that you have never talked about.
Really let go in your writing; let yourself explore your deepest emotions and thoughts. You might tie your topic to your relationships with others, including parents, lovers, friends or relatives; to your past, your present or your future; or to who you have been, who you would like to be or who you are now. You may write about the same general issues or experiences on all four days of writing or about different topics each day.
Don’t worry about spelling, grammar or sentence structure. The only rule is that once you begin writing, you continue until the time is up.
If you’re going to try this as an intervention for insomnia, do it earlier in the evening. Pennebaker’s research shows that participants may feel emotionally worse for a short time after writing expressively, although over time they feel more buoyant and happier than they did before.
For years I followed the ongoing research into expressive writing to deal with a whole host of challenging circumstances, but I hadn’t looked into what’s been done lately. And as I began to think about this post, I wondered what research, if any, had been done specifically to look at sleeplessness and writing to cope with it.
So, (with that nerdy thrill I always feel when I log into Google Scholar) I started researching. And, although not much peer reviewed research has been done (or at least, not much has been published) I did find a few interesting pieces.
In sleep literature, bedtime worry about work-related tasks has been investigated (*4, *5, *6, ) and it has been shown that this kind of worry can trigger cognitive arousal, and extend the amount of time needed to fall asleep (known in the sleep biz as sleep onset latency (SOL) (*7, *8 ). In fact, one study has shown that difficulty falling asleep is most common at the beginning of the work week (*9 ).
Also, much of the research results into insomnia have been done using anecdotal reporting. Having worked in a sleep lab, I know firsthand that people are not necessarily the most reliable judges of their own sleep patterns. Often they report that they didn’t sleep at all, when the recording equipment shows that they absolutely did. So I was really interested to find this study from Scullin et al., Baylor University, (*10 )which actually used polysomnography recording in a controlled sleep lab situation to capture the outcomes.
In this study, fifty-seven healthy young adults completed a writing assignment for a mere five minutes before going to bed. They were randomly assigned to write about tasks that they needed to remember to complete the next few days (the To-Do List Condition) or about tasks they had completed the previous few days (Completed List). Participants who wrote their to-do list fell asleep significantly faster than those in the completed-list condition. Furthermore, the more specific and detailed their to do list was, the faster they fell asleep.
This seems counter-intuitive, right? Wouldn’t writing a to-do list activate all the anxieties about how much needs to be done? The researchers thought so too. Before the experiment they hypothesized that writing about the future would lead to increased worry over unfinished tasks, and thus extend the amount of time it would take participants to fall asleep. And there is lots of evidence that unfinished tasks are a significant source of cognitive activation and worry (*11, *12, *4, *13, *5, *6, *7, *14. )
But their other hypothesis was that writing a to-do list might “off-load” those thoughts from consciousness (i.e., as in expressive writing), and thereby shorten the time needed to fall asleep. Previous to this experiment, there was anecdotal evidence that writing a bedtime to-do list helped one to fall asleep, (but the theory had not been tested.) There’s a sidebar/possibly related effect here: in a different study with healthy adults, researchers found that having participants imagine worrisome future events in a specific/detailed manner decreased anxiety about those events. (*15, *16. )
In the Scullin study, researchers also discovered that the more specifically participants in the completed tasks group journaled about those past tasks, the longer it took for them to fall asleep.
The study results suggested, therefore, that individuals who are having difficulty getting to sleep could benefit from writing a very specific and detailed list of their “to-dos” right before bed. With regards to anxiety activation because of unfinished tasks, the key factor in this research seems to be that participants wrote down their to-do list instead of just mentally ruminating about them.
WRITE A ROBUST AND SPECIFIC TO-DO LIST BEFORE BED:
Just before going to sleep write a to-do list of things you need to complete in the next few days. Make the list as detailed and specific as you can; include as many to-do tasks on there as possible.
The writing procedure resembles what has been labeled in behavioral sleep medicine as a “worry list.”
Many people who struggle with insomnia go for therapy to deal with it, and CBT-I (cognitive-behavioral therapy for insomnia) is the first-line treatment recommended by physicians—even before sleeping pills. Hundreds of studies have found 75-80% of participants have improved sleep after this treatment. Chronic insomnia is driven by two components:
- what a person thinks or believes about sleep and insomnia, and
- what they do in an effort to deal with their insomnia.
The therapy addresses both the anxiety often involved with insomnia and the behaviors which perpetuate the insomnia.
Writing a “worry journal” is a key component of this form of treatment (*17 ), worry lists involve having insomnia patients record their worries (while not in bed), with the goal of unburdening their anxieties and concerns and allowing them to later fall asleep more easily (*18) .
FILL OUT A “WORRY JOURNAL” – ABOUT 3 HOURS BEFORE BED:
The expressive writing procedure in some ways resembles what has been labeled in behavioral sleep medicine as a “worry list.” Often included in cognitive-behavioral therapy for insomnia (CBT-I), worry lists involve having insomnia patients record their worries (while not in bed), with the goal of unburdening their anxieties and concerns and allowing them to later fall asleep more easily.
There’s a very specific, four-part “worry journal” practice used in this method. Here are the steps:
- Write down your worries approximately three hours before bed. This gives you time to not only list your worries, but to analyze them. If you write your worries just before bed, it can trigger more anxiety without giving you time to process the worries.
Don’t go too in-depth – if you do, you risk becoming overwhelmed with it all. Stick to the main points:
- what it is that you’re actually worried about
- why you have the worry,
- how it makes you feel
- List your fears and concerns, then try to organize them into chronological order. Focus on the worries that are affecting you right now in the present. Then go over each fear and concern and explore what you think is going to occur next, then next after that.
- Look at each worry and ask yourself “Are there any facts that could support this bad thing happening?” Journal about this. This gives you an idea of where your fear stems from and whether your fear over what’s coming next is justifiable.
- Identify ways to view your worries differently. For each fear or worry you’ve written down, try and identify at least one other way you could view the situation. So, if you’re worried about getting some bad news, for instance, try and switch your thinking to “What if things turn out to be fine after all?” Think about the positive things that can happen. Humankind’s negativity bias means we need to exert a little effort to counteract our tendency to focus on the worst-case scenario—an outcome that often never happens.
- Avoid judgments. Don’t judge yourself for having these fears. Think of this process, this time of writing before bed, as a safe place to vent your worries and concerns. Allow yourself to express your fears and concerns fully.
(Note: Another important set of practices in CBT-I is Sleep Hygiene – the behavioural part of CBT. Here is a link to a list of seventeen tips from evidence-based research for improving your sleep.)
So there, you go – there are some hows, and some findings. But I was also curious as to why it works.
I had a dim memory about reading something about research into writing things down so you can let them go and how once you write something down, you’re less likely to be able to recollect it without referring to the written version.
I had been trying to find that research again for quite a while now without much luck. I found lots of research showing the opposite—that if you process learning through writing it by hand (and that part is important – not keyboarding, but writing by hand) that you’re more likely to remember it — something to know if you’re studying for exams.
But finally I found a piece from Maria Konnikova ( *19 ) in Scientific American. She begins her piece by referencing Zeigarnik, [who has already been referenced above (*14).]
So Bluma Zeigarnik was a Gestalt psychologist and is the originator into the research that would come to be known as the Zeigarnik Effect. In 1927 she noticed that waiters in a Vienna restaurant could only remember orders that were in progress. As soon as the order was sent out and complete, they forgot it completely.
She designed a study to investigate this. She gave a group of adults and children between 18 and 22 tasks to perform (both physical ones, like making clay figures, and mental ones, like solving puzzles). And then she interrupted half of them, so the tasks weren’t completed. She discovered that subjects were more than twice as likely to remember the tasks that had been interrupted, rather than the ones they’d completed.
Zeigarnik attributed this finding to a state of tension: the mind wants to know what comes next. It wants to finish. It wants to keep working – and it will keep working even if you tell it to stop (to my insomniac readers – sound familiar?!)
All through those other tasks, your mind will subconsciously be remembering the ones it never got to complete. The Zeigarnik Effect has been demonstrated many times, in many contexts since that original experiment. Psychologist Arie Kruglanski ( *20 ) calls this a Need for Closure: the desire of our minds to end states of uncertainty and resolve unfinished business.
Maria Konnikova drew the parallel between Zeigarnik’s finding and Socrates admonition (in The Phaedrus) that writing things down is the enemy of memory. She quotes this passage where the god Theuth (or Ammon) has offered the gift of letters to the king Thamus. Here is Thamus’s answer:
“This discovery of yours will create forgetfulness in the learners’ souls, because they will not use their memories; they will trust to the external written characters and not remember of themselves. The specific which you have discovered is an aid not to memory, but to reminiscence, and you give your disciples not truth, but only the semblance of truth; they will be hearers of many things and will have learned nothing; they will appear to be omniscient and will generally know nothing; they will be tiresome company, having the show of wisdom without the reality.”
Konnikova poses this question: “Could this be the Zeigarnik effect in action, long before the psychological concept was discovered or explored in any great detail? When we no longer have the impetus to remember, when we are certain that what we know has been put into action—be it in the form of a completed order or a book that we know we’ll be able to reference at any future point— why take up precious mental real estate that can be put to use on other tasks that we can’t be so sure of completing or knowing how to complete, should that need arise?”
I know that many of you reading this have come here because you’re writers, so I’m going to include notes from the rest of her fascinating article as well – notes that pertain particularly to writers.
She quotes Hemingway’s interview with George Plimpton in the 1958 Paris Review, where Hemingway warns writers not to talk about their writing. “Though there is one part of writing that is solid and you do it no harm by talking about it, the other is fragile, and if you talk about it, the structure cracks and you have nothing.”
She goes on to say that “Hemingway’s words came from experience. When his wife lost a suitcase that contained all existing copies of his short stories, the work was, to his mind, gone for good. He had written himself out the first time around. He couldn’t recapture it–whatever it was–again. He even fictionalized the process in the short story, “The Strange Country”: the writer whose stories have been lost finds it impossible to remember. “It’s useless,” he tells his sympathetic landlady. “Writing [the stories] I had felt all the emotion I had to feel about those things and I had put it all in and all the knowledge of them that I could express and I had rewritten and rewritten until it was all in them and all gone out of me. Because I had worked on newspapers since I was very young, I could never remember anything once I had written it down; as each day you wiped your memory clear with writing as you might wipe a blackboard clear with a sponge or a wet rag.”
She also quotes the advice offered by author Justin Taylor: “Don’t take notes. This is counterintuitive, but bear with me. You only get one shot at a first draft, and if you write yourself a note to look at later then that’s what your first draft was—a shorthand, cryptic, half-baked fragment.”
In other words, if you WANT to be haunted by something, don’t finish it, don’t commit it to paper, don’t write it down. When you write it down, something tells the brain, “I’m done with that.”
So, the conclusion? If your sleep patterns aren’t all you’d like them to be – either you have difficulty getting to sleep, or you have trouble staying asleep for your individual ideal of six to eight hours – I invite you to experiment with these ways of engaging with writing to deal with insomnia.
Ideally do it before bed, but if you wake up and are unable to go back to sleep, by all means get up and do it then.
And I’ll end by giving you my client’s line again as a sentence stem:
FOR YOUR PRE-SLEEP JOUNALLING:
This is what I need to set down before I go to sleep…
Write until you feel “written out”, like you’ve set down everything that you don’t want to mentally carry into bed with you.
I love her phrasing, “need to put down” – like to “set down on the page”, but also as in “to lay down a burden she is carrying.”
Sweet dreams! Let me know how it goes.
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