Meditation. I can’t do it. I just can’t switch off.

Sound familiar? This is something people often tell me.  But, with persistence and patience, most people can successfully add mindfulness meditation to their tools for managing sleep. I also have a lot of people tell me ‘I’ve tried everything’ and I still can’t sleep. But when working through the list of things they have tried there are usually a couple of treatments they haven’t come across that have good research behind them. Mindfulness is one of those, that we are increasingly using in a range of sleep disorders.

In this interview Dr David Cunnington (sleep physician) and Dr Giselle Withers (clinical psychologist) discuss when David would refer people with sleep problems for mindfulness training, how he explains it to people, and responds to those who don’t feel meditation will work for them.

Video Timeline:

  • 00:00 – 03:08 When is mindfulness recommended?
  • 03:08 – 06:53 A sleep physician’s explanation of mindfulness
  • 06:53 – 09:46 What about people who’ve ‘tried it all’ or are skeptical about mindfulness?

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Giselle Withers: David, you’re very supportive of mindfulness and often recommend it to your clients or patients. When would you recommend it and how would you explain mindfulness to the clients when you do recommend it?

David Cunnington: That’s a good question. So in terms of when I recommend mindfulness, it’s generally in conditions of sleep disorders where I think part of the core problems is the brain is too active during sleep. People have been getting to that situation for a whole range of different reasons. Sometimes it’s through being overly busy. Sometimes we’re exposed to external stressors and get a bit over-anxious and sometimes it’s thinking styles, so a tendency to worry can increase our risk of getting into that sort of situation.

So there are a few different sleep disorders where that can happen. The one most commonly where that happens is insomnia. So insomnia is often characterised by over-thinking sleep. So now it starts but that’s how it finishes. Often people really get a lot of emotion about sleep and trying very hard to control sleep and really analysing and monitoring and what can I do to make this better.

So the brain is not switched off during sleep at all. It’s all about, “Have I gone to sleep yet? Have I slept enough? What’s happening? My sleep is too light,” all that style of thinking. So training and techniques to disconnect from some of that thinking or to be able to – training techniques to be able to switch off is really helpful in insomnia.

One of the other conditions where I will use mindfulness is in managing parasomnia. So parasomnia is sleepwalking, sleep talking. So one of the triggers for them can be stress. But it can also be just with the brains in those higher adrenaline levels during sleep because essentially their muscles are more active during the sleep. So it makes people more likely to do things like move while they’re asleep.

One of the techniques for reducing that is actually to reduce brain adrenaline levels during sleep. So mindfulness is a great technique for that, so training people in mindfulness so that they are able to through the day reduce that sort of adrenaline levels and adrenaline sort of drive. Then at night-time, your brain works in a more switched off kind of state so they don’t get the same muscle activity.

The third group where I will use mindfulness is in people who are feeling more tired during the day. It seems a bit strange. We use it if you can’t sleep. We use it if you’re too sleep. But often we have people that – they’ve gotten an absolutely genuine biological reason why they’re tired. They may have a physical condition or a mental health condition or a sleep disorder. But over the years or months of feeling tired, the tiredness itself just gets it own story and emotion. That can add another layer to symptoms. So it’s not just, “I’m tired.” It’s, “I’m tired and I’m sick of being tired. What does this mean for me? Why do I feel like this? What can I do to make it better?”

That style of thinking actually just gets the brain more active during sleep and makes sleep of poor quality and leads to the tiredness being worse. So if we can address that layer with mindfulness, we can actually make quite a difference to people who are already feeling fatigued.

Giselle Withers: Great. How would you explain mindfulness to someone that had it before and as a doctor, how would you put it in his words?

David Cunnington: Sure. So in simple terms, I try to talk about it as being present, focused observation. So one way of thinking about it as adults, we’re often thinking about the future or the past and thinking more about judgments about our experiences, which in turn lead to emotions about our experiences. Both those judgments and emotions fit right into the adrenaline system, that sympathetic nervous system. So if we’re constantly in that thinking space that’s all about judgment and emotion, what does this mean? How do I need to respond to this? Did I do that OK? What am I going to do tomorrow?

We’re just constantly engaging that sympathetic nervous system and just higher adrenaline levels in the brain not switching off. Whereas if we can think in a more present and observation sort of mode, then we disconnect in that fight-flight response and not pushing up the adrenaline levels. But it’s a style of thinking that doesn’t come naturally to us, particularly as adults and particularly in modern Western societies.

One analogy I will sometimes use with patients is if you think of preschool children, they have that more observation thinking style. An example being there are two boys in the sand pit and one bops the other in the nose and yeah, one is sore, cries while the nose is sore. But the thing is his nose isn’t sore anymore.

Giselle Withers: Forget it and let it go.

David Cunnington: Let it go. Really they’re thinking, “My nose was sore. It’s no longer sore.” The observation is, “OK. I’m not sore anymore. Get back to …”

Giselle Withers: Time to move on.

David Cunnington: Yes. Whereas with adults, it’s not the same. Bloke hits the other bloke in the nose at the pub. It’s not about my nose isn’t sore anymore. It’s about what does that mean, what does that mean for our friendship. I’m angry about that. It has got that line of judgment and emotion. So as adults, we’re really in that thinking space.

Giselle Withers: Yes.

David Cunnington: So I say mindfulness is retraining us to be able to recognise when we’re in that judgment emotion style of thinking and just reframe, recalibrate, get back to that present, focused observation and do that periodically through the day to enable us to disengage that sympathetic nervous system and that adrenaline system and just lower adrenaline levels.

Another type of analogy that I sometimes use is to be – just become an observer of thoughts and things around us rather than a participant in things. So you’re on the train platform and think of your thoughts as trains that pass by. But you don’t catch them. You don’t go for the journey and you don’t sort of participate in everything that …

Giselle Withers: We basically have a choice about whether you’re catching them or what. You know if you are.

David Cunnington: That’s another analogy I will sometimes use when trying to explain mindfulness. When I think of it as a biological level and think of what I’m trying to achieve with mindfulness, it is all about disconnect in the sympathetic nervous system.

When we’re in that mode during the day of doing and in that head space of thinking in the judgment and emotional style of way, we’re engaging that sympathetic nervous system, the adrenaline system and the fight-flight response. If we engage that constantly in the day, there’s no way we’re going to be able to switch it off at night.

Whereas if we switch to that being mode, which we rarely do to stop and be, don’t have to be doing anything and focus our sort of thoughts and that present, focused observation, it disconnects that sympathetic nervous system. If we do that intermittently throughout the day and make a practice of doing that on a regular basis, it allows the brain to better switch off at night. It takes a while. It’s not the sort of thing you do to achieve results. You’ve got to be persistent.

Giselle Withers: Requires daily practice.

David Cunnington: It does require daily practice. But that’s really – when I think about the biology, that’s really how I think it works and the research would support that.

Giselle Withers: Yes. David, a number of people who sign up for a month in this course have often tried a number of different things to try to improve their sleep.

David Cunnington: Sure.

Giselle Withers: And perhaps not have much success. So they may be feeling somewhat sceptical about embarking on a mindfulness training course. Do you have any tips or advice for people in that situation?

David Cunnington: Yes, a really common thing that we see. So, when you and I are seeing clients in our normal day to day clinical practice, in our role as health professionals, we see that all the time. I’ve tried everything. You’ve got nothing for me. There’s nothing here you can teach me about this. I’m going to tell you there always is. So generally, I’m asking people about what they’ve done already. You and I know the research evidence and we know what has been proven to work.

Pretty much always we will find some things that someone hasn’t done, particularly if I’m looking at some of the components of non-drug therapy, so like cognitive behavioural therapy and so there are five core components. There will often be bits that haven’t been explored. So it’s very common for people to tell us exactly that. I’ve tried it all. We always find something.

Then the research about cognitive behavioural therapy which has been our standard therapy for many years, it is shown that it’s great therapy but about 40 percent of people don’t get as much of the response as they’re after. That’s why in the last 10 years we’ve been looking at, “What else can we do?” Then we add the CBT. That’s where mindfulness comes in.

Great research now supporting mindfulness as an additional therapy. If we added on to things we’ve done as part of cognitive behavioural therapy and that sort of standard treatment for insomnia, it adds a lot more effect. A couple of recent trials have been published and the work we’ve done together with Melbourne Sleep Disorders Centre. It really shows just a powerful addition to cognitive behavioural therapy.

The interesting thing for me is people also say, “Yeah, meditation, that’s not for me.” An interesting part of the research is a healthy scepticism is one of the predictors of getting a better response.

Giselle Withers: Yes, yeah. Keep an open mind.

David Cunnington: So the people who say, “Oh, meditation, yeah. I’m all over it. That’s really me,” or the ones who go, “No.” The one who goes, “No, maybe not meditation. I’m a bit sceptical,” in fact highest likelihood of getting a good response. So I find that really interesting. But that’s important because bringing an open mind to it and being persistent seems to be the keys in making it work and any mindfulness to what we have been doing seems to make a really big difference in terms of improving our outcomes.

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