When we ask patients about the content of their racing thoughts, the common answers revolve around past or future events and the related worries about what has happened or what will happen. The circumstances are almost always about work problems, relationship issues, or concerns about health or finances. Other topics emerge, but they often lead back to these major categories of stressors in one’s life. A closer inspection of this content invariably reveals a deeper or more primal emotional basis for the worry in which the concern equates to some type of threat.
You are worried about a conversation you had with your boss and wonder if you overstepped your role or boundaries in your efforts to offer constructive criticism. Depending upon how well you communicated, you may be confident in having provided sound feedback. But if you are prone to worry you will soon develop racing thoughts about the interaction; and, underneath these ruminations lays the fear triggered by a threat (real or imagined) to your job security. Common sense would hope to prove there is nothing to worry about, but if the element of threat surfaces from the conversation, then the fear is a very real phenomenon even if you do not recognize or experience the feeling of fear. Instead, you experience the fear as racing thoughts, the signature calling card for most insomniacs presenting for treatment. However, over time as this pattern repeats itself, you often lose any awareness of the emotional underpinnings and instead confirm in your own mind that “I just can’t shut off my mind and now I’m going to have insomnia once again.”
In any of these major stressful circumstances, whether relationships, health or finances, something from the past and future seems amiss. You cannot control the past, because it has passed, and you cannot control the future, because it has not happened. But, you can certainly worry about the past and the future when you imagine no other ways to work through the emotional duress you are feeling about past events or future possibilities. Interestingly, worrying about the present or current issues may be healthy and appropriate, because an issue may require immediate attention and action. Still, in most circumstances, it is more likely that a present worry is actually related to something previously encountered or an expectation about the future. Again, a threat is usually at the heart of the matter.
However, threats do not indicate that fear is the only emotion to manage. Instead, any adverse emotion such as sadness, frustration, shame, embarrassment or guilt may be the underlying feeling driving your racing thoughts. In not uncommon circumstances, one can be overjoyed with anticipation for a future event in which the enthusiasm or excitement is too strong and triggers the racing thoughts. Too much emotion of any type that is ineffectively processed throughout the day will linger in the evening and bedtime and lead to racing thoughts.
The key to solve this source of racing thoughts is learning how to deal directly, immediately and spontaneously with troublesome emotions. Yet, if you have waited until bedtime to deal with these intense feelings, you are usually too late; and, the insomnia will be your bedpartner for a while. For these reasons, I describe in my book, Sound Sleep, Sound Mind, that insomnia starts first thing in the morning as soon as you wake up should you ignore your emotions and feelings for most of the day. By ignoring what you are feeling, you are building up a reservoir of emotional tension, sure to influence many of your thoughts and behaviors throughout the day. With healthier emotional processing skill, the individual pays close attention to feelings during the day and willfully chooses to “listen to the heart” to determine the relevant information embedded in these emotions. Although a broad term for this skill is “emotional intelligence,” the more accurate way to understand this capacity is to realize that any human can experience and identify a feeling, after which the goal is to feel the feeling and process it.
The two latter steps (feeling and processing it) are the most difficult for insomniacs, because they became insomniacs by not learning how to feel feelings or how to process them in effective and healthy ways. Instead, they learned to ignore and stuff emotion, after which they began to suffer from racing thoughts; and, in most cases, few made the connection that unprocessed emotional experiences is the root cause of their ruminations.
Many insomniacs are capable of identifying a host of emotional experiences, but their problem occurs when they can only think about their feelings instead of feeling them. As the very best example of this constrained approached to human emotion, insomnia patients are confused when asked, “where do you feel your anxiety or your stress or your anger or frustration?” It does not occur to them that feelings are experienced in any other place except the mind, so their most common response is to point to the head when asked these questions. Nonetheless, when explained to insomniacs that most feelings can and usually should be experienced somewhere in the body, notably in the chest (the anatomy that surrounds your heart), most individuals recognize they do not function in this manner. Instead, they recognize they are thinking about feelings instead of feeling them and when they comprehend this disconnect, they sense there is a difficult task ahead.
Generally speaking, they are correct. The good news is that intellectually they understand the deficiency or incompleteness in the way they are working (processing) with emotion. But, the bad news is that they are decidedly uncertain on how to learn to function in the healthier way. Unfortunately, for many of these individuals, months or years of new attention to emotional development is necessary. My book, Sound Sleep, Sound Mind, details many pathways to choose from and practical exercises to work on in developing emotional processing skill.
For the insomniac acutely interested in how to overcome this problem, while there are no simple answers for long-term success, occasionally a clearer recognition of the nature of the problem can start moving the individual toward fewer sleepless nights. The most basic way of attacking the racing thoughts is to literally say to yourself, “I know I am suffering racing thoughts right now, because something in my daily life is bothering me on a deeper level.” Then, add, “My guess is the thing that is bothering me is...[fill in the blank], and so I am going to reflect on that issue for a few minutes to see whether I can comfortably gain awareness of my feelings.” Even if the individual does not succeed in any insightful fashion, the simple acknowledgement that racing thoughts are a signal of a deeper problem accompanied by the willingness to minimize the importance of the racing thoughts may provide some relief, because people gain a great sense of security when they can define and understand an unpleasant experience.
Knowing that racing thoughts are not the real problem but the marker of a deeper issue means the insomniac no longer feels like something is seriously wrong for not being able to turn off the mind. Instead, there is comfort in knowing that racing thoughts are a predictable outcome when daily emotions go unaddressed. Just this small amount of knowledge can reduce the intensity of the ruminations and lead to faster sleep onset.
When the racing thoughts are not of the most severe type, unlike the problem in someone with serious mental illness who might be on the brink, imagery distraction techniques are another strategy to break the spell of ruminations. Although the human imagery system can be described in very complex fashion, one of the remarkable things about the mind is its ability to be influenced by non-verbal activity. If thinking or self-talk is what makes up most of your mental activity, day or night, it may only require a small push towards non-verbal experiences to quiet down the racing thoughts and ruminations. If for example you hop into bed and immediately set your mind to picture the round of golf you played earlier in the day or the walk in the park or the last time you were playing with your grandchildren and so on ad infinitum, you will often discover you are no longer overwhelmed by the experience of racing thoughts. Imagery proves powerful in taking over your mental landscape, after which the tendency to fall asleep comes to the forefront.
Imagery may also be potent for reasons related to the actual sleep onset process. As humans fall asleep, it is common to notice dreamlets or other bits of imagery just prior to dozing off. Thus, practicing imagery skills during the daytime and then bringing these skills with you into the bedroom and into bed may prove a convenient way to overcome racing thoughts and ruminations and induce rapid onset of sleep. We have prescribed this technique for thousands of patients who have visit our sleep center for more than a decade, and many of these individuals report remarkable benefits by adopting imagery practice to treat their insomnia.
To review what has been discussed so far, it is important to reiterate racing thoughts are a nearly universal problem among insomniacs, and a nearly universal cause of racing thoughts and ruminations is the inability to process emotion in one’s daily life. Thoughts manifest as the “safer” way to experience emotion when someone fears feelings or is simply untrained in the ability to work directly with emotions. For many insomniacs, many emotions appear very large and menacing, so it seems more natural to avoid such feelings. The good news, however, is that many feelings show potential for much easier management than anticipated, which is why the imagery technique provides so much relief. In contrast, when an individual is suffering a severe bout of racing thoughts and ruminations that do not respond to imagery exercises, we can predict the emotional basis is in fact at a very intense level of type that might only respond to psychotherapy or medications.
You can see from the above summary that the concept of threat is at the core of this process. A very high threat indicates very strong emotions; whereas a lesser threat suggests the emotions may be processed more easily upon brief reflection, or imagery might dissolve the issue (for the time being) so that sleep is just a few minutes or moments away.
This point about threat is essential to understanding the relationship between insomnia and sleep-disordered breathing and how the latter may provoke racing thoughts to cause or aggravate the former, all of which will be covered in the next post.