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Ruminating on 'mental to-do list' interferes with sleep
Instead of counting sheep, count on this advice to get a good night sleep

Date published: 8/2/2009

IT'S LATE. I can't sleep. Sound famil- iar? Maybe you, like tens of millions of Americans, have trouble sleeping. Hopefully, you are not paying a doctor $150,000 a month to inject you with propofol, as Michael Jackson reportedly did. That didn't turn out so well.

Insomnia is remarkably common, and for the most part fairly straightforward. While there are many disorders that involve sleep--narcolepsy, obstructive sleep apnea, restless leg syndrome, parasomnias and night terrors, to name a few--insomnia is a more basic difficulty with sleep that happens to all of us at least sometimes.

When it persists, I hear about it in my exam room: "Doc, I just can't sleep!"

Neurologists and sleep specialists seem to have come to a consensus through research that human beings require about eight hours of sleep each night. Innumerable bodily functions occur while we sleep. Wound healing is at its peak during sleep, and most importantly, we synthesize our brain's neurotransmitters during sleep.

Sleep deprivation is torture. Prolonged sleep deprivation can cause seizures, hallucinations, psychosis and, in lab animals, death. Whoa.

Most people with poor sleep will have higher blood pressure and higher risks of heart disease, and they can be quite cranky. No wonder my patients sometimes greet me with some desperation when sleep is hard to come by.


The No. 1 cause of insomnia is what I affectionately call "the mental to-do list." It resonates with my patients when I say this.

It is common to carry a busy workday to bed, to be excited or nervous about upcoming deadlines or projects or to rehash a recent argument in our heads when we should be sleeping.

This need not be labeled "anxiety" or "stress." We anticipate the future and sometimes ruminate about the past. But leave the ruminating to someone else, or you will be counting sheep for hours!


Before we start your propofol, let's start with the basics. When you are having trouble sleeping, start with better sleep hygiene. Hygiene? Like brushing my teeth? Not quite.

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