“Don’t tell me to try meditating” my patient said to me as we discussed his struggle to fall asleep most nights. You could feel the resistance penetrating his words. “I’ve tried and it never works,” he said, convicted but also tired.
In many ways your sleep routine starts the minute you wake up. Logically though what we do right before bed gets the bulk of attention. Most books, blogs and catchy instagram reels will tell you: good sleep hygiene includes having a bedtime routine.
Many have good sleep hygiene but still struggle
In my experience most folks already have these routines, especially people who struggle with sleep. They know the do’s and don’ts. Unfortunately knowledge, even if acted on, doesn’t always lead to desired results. Problem solving with a few patients in the past year made me think perhaps what they needed is to rethink their routine into a ritual.
What’s the difference between a routine and ritual?
A routine is an act done consistently whereas a ritual can be described as a routine with meaning. In his book “The Power of Ritual” Casper Ter Kuile cites 3 things that are needed for a ritual:
intention, attention and repetition
Certain components of a bedtime routine have greater ritual potential than others. Take journaling as an example. This is certainly an act that involves both intention and attention. Sometimes the intention is embedded in the type of journal you use: reflective, goal-oriented, and gratitude journaling are some that come to mind.
Fancy pens = greater intention for some
I am a big fan of journaling but one thing it doesn’t necessarily do that mindfulness meditation does is focus on the present. This is a skill that is invaluable and a big component of being able to self-regulate our stress response.
In many cases what we are seeking to do with mindfulness meditation, as part of a bedtime routine, is to let go of the past day. We prepare to down-regulate by shifting our awareness from the things we may journal about, the past and the future, to the now.
Meditation for all its benefits comes with baggage for certain people due to expectations and beliefs. Folks have expectations on how it is supposed to feel and beliefs that they aren't "good at it." Sometimes these ideas can serve as a mind block.
The mind block then becomes a body block.
If someone exhibits resistance to a suggestion it most often will not serve you to push it, even if you’re pushing in the form of education. To help my patient I needed to get creative and figure out another route to enhance sleep readiness.
There is always more than one way
Rumination is a frequently reported barrier to sleep. While some forms of meditation intend to "clear the mind", many individuals can’t let go of these thoughts. And the idea that they need to can add fuel for more ruminating. The meaning then behind the bedtime routine becomes a struggle.
Can we get similar physiological effects by changing one’s intention and attention of the bedtime routine? Can we calm the “whole person” by focusing on the body?
When my patient informed me he wasn’t going to meditate I pivoted away from his idea of how meditation was supposed to feel and gave him 4 exercises to do right before bed. To transition this from a routine to a ritual I called it his ritual. I infused meaning by setting the intention for “sleep readiness for his body” instead of “PT exercises.”
We can make many of our daily routines into rituals by focusing on a deeper connection. Deeper connections don't always have to be with an outside source, you can connect more deeply to yourself.
The cues for his exercises included focus on paying attention somatically to what it felt like. I’ve found that people sometimes get anxious about performance so I asked him to pay attention to what he felt vs. what he should feel.
To listen to themselves
My directions were:
“Here is your bedtime ritual. I want you to do these before bed because they will help your body shift into a sleep ready state. There isn’t a right or wrong way to feel during them. I just want you to take the time to be intentional with each one. Pay attention to how your body feels. Go slow.”
For all of these exercises pick a position of comfort:
Long exhales with straw Place the straw in your mouth. Breathe in through your nose and the a slow exhale through the straw. The effort is on progressive relaxation as you get more comfortable with each exhale.
Eye palming- Close your eyes and then place your palms over your eyes in a cupping manner where your are touching the face around the eyes but not pressing on the eyelids themselves. Relax your face/head into this pressure and support while you take slow, relaxed breaths.
Gargling- Take a sip of water then tip your head back to gargle the water towards the back of your throat. Start for a short amount of time (eg 5-10 sec) to get comfortable with this and then try and extend the time. Gargle-swallow-repeat.
Hummingbird breath- Inhale through your nose then hum as you exhale trying to achieve a vibration in your mouth, throat and even your chest. Make the humming exhale long and SLOW. Inhale again through your nose and repeat.
The bedtime ritual demonstrated in the video can create a deeper connection with one’s internal environment; less cognitive and more somatic. I learned these vagal nerve stimulation techniques at Seth Oberst’s course Stress, Movement and Pain. Check out his content to learnabout the science of stress and the practical application of self-regulation.
Sleep interventions fall under my general philosophy: One size does NOT fit all. Likewise not all bedtime rituals will look the same.
Sleep readiness is the goal for this ritual. The intention is to calm your body. With each exercise the focus of attention may differ but is self-directed to what the individual resonates to. Repetition engrains this somatically and serves to magnify the meaning that accompanies the ritual for sleep readiness
A plethora of information, advice, gadgets and diagnoses exist out there. Akin to rehab, some of the solutions can be surprisingly simple and only require a change of context.
While my patient and many of you may not prefer meditation as a solution to your sleep or other stress-related problems, a bedtime ritual can serve as the beginning of a graded exposure approach to learning the skills of awareness and self regulation.
Take the time to reframe the bedtime routine as more than a TO DO list. Setting intentions and focusing on your internal environment can help create a ritual with deeper meaning. My hope is that it results in better outcomes for your sleep. It did for my patient.
Aaron Burden and Hayes Potter from Unsplash
Burst and Gratisography from Pexels