Too Sad To Sleep: How To Cope With Insomnia While Grieving a Loss

As a Traditional Chinese Medicine (TCM) doctor and former medical researcher, I knew everything to do—and not do—when experiencing insomnia. I did not use screens or work in bed. I meditated before bed. I set aside at least eight hours of dedicated time for sleep each day. Unfortunately, none of it was working. I even tried sleep medications prescribed by my doctor to no avail. At work and with my family, I have always been a sleep proselytizer. I believe quality sleep is the foundation of health, but despite my passion and my efforts, I could not lay myself down to sleep after my daughter died in her sleep.

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It turns out I was far from alone in my grief insomnia. Although few studies examine insomnia in bereaved parents¹, specifically, a 2008 study exploring the effects of lingering grief in a nationally representative sample of more than 400 bereaved parents in Sweden found that nearly 40 percent of fathers and 33 percent of mothers who lost a child to cancer reported regularly experiencing difficulties falling asleep² even several years later. I have met hundreds, if not thousands, of bereaved parents in the 10 years since Alice died, and the vast majority have experienced insomnia at some point after the death of their child.

Besides the frustration of tossing and turning, chronic insomnia can lead to serious health problems³ such as diabetes, hypertension and cardiovascular disease, anxiety, depression, and more. Coincidentally, grieving can cause many of those same problems⁴; therefore, I knew I needed to address the quantity and quality of my sleep to protect my health while grieving.

How grief can negatively impact sleep

“I think people are surprised by the physicality that comes with grief and how much our bodies are affected,” says grief therapist Claire Bidwell Smith, LCPC, author of Anxiety: The Missing Stage of Grief. “We see sleep frequently altered in grief because of the stress hormones that build up during such a huge emotional experience. Our cortisol levels increase, which [negatively] affects sleep.”

“We see sleep frequently altered in grief because of the stress hormones that build up during such a huge emotional experience.” —Claire Bidwell Smith, LCPC, grief therapist

A 2020 systematic review of studies exploring the neuroendocrine mechanisms of grief⁵ and bereavement found that cortisol levels are indeed elevated in times of grief, with higher levels of self-reported grief and lower levels of social support associated with especially high cortisol levels, which have been implicated as both a cause and consequence of insomnia⁶.

But grief’s impact on sleep is not solely hormonal. “Our brains are learning to be in the world in a new way [when grieving],” says Smith. “Our entire view of the world often changes when we go through a big loss. Sometimes, we have never gone through such a huge loss before. On some level, we never really believed something so terrible could happen...our brain is mapping a new landscape, which can lead to many changes...and sleep is definitely one of them.”

Beyond dealing with neuroendocrine and worldview changes, the bereaved are often not granted enough time and space to grieve; in the United States, the average company allows only three days for bereavement leave, which is often insufficient time to make logistical arrangements, much less grieve. Many bereaved people do not have the resources to take extended leave or get grief counseling, and not everyone has adequate social support—all of which can force the difficult process of grieving to take over what little time is set aside for sleep.

“We often feel unable to fully grieve for many different reasons, whether we’re not feeling supported by our family or culture, or we’re afraid of all of the big emotions that come up, and so we go about our day doing our best to get through, often shoving the grief away, trying to tamp down the emotions that come up,” says Smith. “Then suddenly, it all bubbles up at 3 a.m.”

Often entangled with grief are deep feelings of anxiety: “A terrible loss can make anything seem possible,” says Smith. The result is a kind of hypervigilance that can be a significant contributor to grief insomnia. “You’re hyper-attuned to your environment as a protective mechanism, and you’re trying to [prevent] any other horrific outcome, so the brain won’t rest,” says Smith.

The resulting sleep loss can also harm your mental state, worsening the grieving process. Indeed, a 2021 study found that people who experienced chronic sleep issues before a loss were also more likely to develop complicated grief following a loss⁷ (which is defined as intense grief that subsists a year or more after the loss and which impairs daily functioning).

“Grief can cause sleep disturbances due to the heightened...stress, and poor sleep can exacerbate grief by reducing emotional resilience and cognitive processing.” —Chester Wu, MD, psychiatrist and sleep specialist

This bidirectional relationship between grief and insomnia can lead to a vicious cycle. “Grief can cause sleep disturbances due to the heightened emotional and physiological stress, and conversely, poor sleep can exacerbate grief by reducing emotional resilience and cognitive processing,” says board-certified psychiatrist and sleep medicine specialist Chester Wu, MD.

At a brain level, that’s because any kind of emotional distress (like that from grief) “can activate the amygdala, which is the brain region involved in emotional processing,” says Dr. Wu, “and an overactive amygdala can lead to increased arousal and sleep disruption.” The less restorative sleep you get, the more sensitized the amygdala can become, “which just amplifies emotional reactions, perpetuating the cycle of distress and sleep disturbance,” he says.

Fortunately, in much the same way that sleep loss can play into the cycle that is grief insomnia, improving your sleep can also help with the experience of grief. Below, find expert-backed ways to actually get some shut-eye when dealing with insomnia in the wake of a loss.

6 tips for dealing with grief insomnia

1. Actively prioritize sleep

After a significant loss, one of the most important things you can do for your health is set aside intentional time and space for sleep. “Prioritizing sleep during the grieving process is a keystone to overall well-being and emotional resilience,” says Dr. Wu. “By addressing and improving sleep, individuals can better navigate and process their feelings of loss.”

This is often easier said than done, as in my case. One thing that worked for me was setting a regular bedtime and wake-up time, allowing for at least nine or 10 hours of sleep time in between, so I could hopefully clock eight hours total even if I awakened in the middle of the night. I also made sure to walk outside every day to get exposure to sunlight, which can help reset your circadian rhythm. I also stopped all work—household or otherwise—an hour before bed and used that time to decompress as best as I could with a bath, journaling, or meditation.

“It’s important to prioritize sleep because how are you supposed to attend to the huge transitions [of grief] when you’re exhausted?” says Smith. “You’re taking on new roles and responsibilities...it’s imperative to be well-slept [enough to] show up for those things.”

2. Practice good sleep hygiene

Once you are committed to prioritizing sleep, Dr. Wu recommends taking a few steps to brush up on your sleep hygiene. In addition to maintaining a regular bedtime and wake-up time, as noted above, he suggests minimizing naps (particularly avoiding long naps later in the day) and only going to bed when you’re truly sleepy. “If you wake up in the middle of the night and can’t fall back asleep within about 20 minutes, I recommend leaving the bedroom, engaging in a calming and distracting activity, and only returning to bed once you feel genuinely sleepy in order to reinforce the association between the bed and restful sleep,” says Dr. Wu.

3. Meditate before bed

Smith recommends all her clients embrace meditation before bed as a way to prepare the mind and body for sleep. “Meditation is useful for learning to step away from your thoughts,” she says. “It’s not necessarily about achieving this peaceful nirvana; it’s about learning to notice a thought and not going with it, which can be helpful if you wake up in the middle of the night, and these big thoughts and emotions arise.”

In this instance, flipping on a guided meditation from a meditation app can help you mentally distance yourself from those emotions. “When we’re grieving, we’re spending a lot of time in the past reflecting on our person and a lot of time in the future, often feeling anxious about what life will be like without them,” says Smith. Where meditation can come into play is by helping us learn to orient back to the present, she adds, where we can heal.

4. Journal

Because you may not have the time or space to fully grieve during the day, you could find that those feelings bubble up at night, disrupting your sleep. “Journaling is one of the best ways to release some of the stuff running through your mind that makes it difficult to sleep,” says Smith.

In my personal experience, writing about my experience and the memories of Alice made an enormous difference to my mental health. It provided a safe space for processing big feelings during the day, thus reducing my sleep disruption at night.

5. Seek out social support

Not only did journaling and blogging provide a sanctuary and structure for my evolving emotional landscape, but because I shared my writing with loved ones, it brought me immense social support, which also allowed me to rest easier.

As noted above, the more you are supported and allowed to express your grief during the day, the less of a chance there is that it will wake you up at night. Friends and family do not always know what to say or do, and it may be tough for you to find the words, too, but anything you do share can help eradicate the invisible divide between you and your supporters. “Because a lack of social support can prolong grief⁸ [and potentially worsen grief insomnia], it’s important for your health to continue to seek social support and connection,” says Dr. Wu.

6. Get professional help from a therapist who practices CBT-I

Grief therapy can provide a safe outlet for big emotions and social support, thus improving sleep quality. But if your insomnia persists, you may want to seek out therapy geared specifically toward sleep issues, like cognitive behavioral therapy for insomnia (CBT-I), suggests Dr. Wu. “This approach addresses the cognitive components contributing to insomnia and the behavioral factors that can perpetuate it,” he says, and it typically includes support for implementing some of the best practices for sleep hygiene noted above. Perelman School of Medicine at the University of Pennsylvania maintains an online directory of CBT-I therapists here.