Takeaway
For patients with insomnia, coach them to visualize vivid, unrelated images to disrupt rumination and promote sleep onset. You can try it yourself, too!
Lifelong Learning in Clinical Excellence | November 13, 2025 | 2 min read
By Sara Benjamin, MD, Johns Hopkins Medicine
“G-A-R-D-E-N”
I say to myself, as I pop awake around midnight, reposition in bed, and feel rather alert. I picture a lush green landscape in the spring, with bright red and yellow tulips poking out from the soil, and a tranquil, blue sky.
Next—G—oh, I know, a fluffy white goose, right out of a fairy tale; then another G—a graham cracker framing a s’mores with gooey marshmallow and a melted chocolate square.
Moving on . . . A—an aardvark, with its pig-like snout, emerging from a burrow . . .
And then . . . I fall asleep. At least for an hour or so, when I may wake up again and restart this mental technique called “cognitive shuffling.”
I often discuss ask patients, “What do you think about when you’re awake in the middle of the night?” and “What techniques have you tried to quiet your mind?”
Many people use external stimuli to help them relax—like reading a book, listening to the audio of a familiar TV show or podcast, or using an app that features boring “sleep stories.” While these techniques may work for some, I think that there’s a benefit to relaxing the mind without external stimulus. However, if the mind is left to wander, unpleasant memories, stressors, and even “to do” lists may surface. To remedy this, I suggest a technique that’s gained popularity on social media in recent years—cognitive shuffling.
What is cognitive shuffling and how can we practice it?
In this technique, formally developed by Dr. Luc Beaudoin, a cognitive scientist, you think of a random word, comes up with other random words that start with the first letter of the word, and then briefly imagines a vivid image of each word, without building connections between the words. After you do a few words starting with one letter, move to the next letter in the original word, if needed. This technique is purported to work because it mimics what the mind does during the transition from sleep to wakefulness, which is called the “hypnagogic state,” with random, unstructured thoughts.
This technique is not a cure for insomnia, and may not work for everyone, but provides a suggestion for something to do when you can’t sleep. I also remind my patients of the framework for brief behavioral therapy for insomnia, including not going to bed until you’re sleepy, getting up at the same time daily, and reducing time spent in bed.
Taking a moment to talk through some specific ways to relax the mind might help a patient find a reliable strategy they can turn to when faced with a sleepless night.
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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.