Howdy all! This will be the first of many posts pertaining to insomnia, a spectrum of sleep disorders from which many millions suffer in this country. Insomnia truly can be a challenge to manage, in part because so many things can cause it and perpetuate it, and because fixing the problem properly often requires modifications in lifestyles, thought processes, and expectations on the part of the patient. Tonight’s post will not be in any way exhaustive in its scope; it’s the end of my workday and I’m tired. I will concentrate on an important consideration, however: how one’s own thoughts can worsen the insomnia problem.
Insomnia simply refers to one’s perception of poor and/or insufficient sleep during the habitual sleep period, such that it is bothersome and has the potential for daytime dysfunction, like fatigue and sleepiness. By nature the problem is subjective; what makes the sleep poor or insufficient may depend on a whole host of variables, including the absolute amount of time slept, the perceived amount of time slept, how much time was spent tossing and turning, and how much the problem is driving the insomniac crazy. One can have difficulties falling asleep at the beginning of the night, difficulties staying asleep throughout the night, or both; one may be bothered by spending a half-hour awake at 3 a.m., or one may feel like he or she didn’t sleep all night long.
One can imagine that there are hundreds of things that can cause insomnia. I will not list them here; that would be a topic of another post. Virtually everybody has experienced situational insomnia, which occurs as the result of something exciting, stimulating, or traumatic in one’s life. I’m pretty confident that over the past several months, David Petraeus, Lance Armstrong, Michael Christian, and Ronaiah Tuiasosopo have all had some sleepless nights. Though most people don’t typically have experiences as, uh, intense as these folks, the general concept is the same: life events or circumstances in general that are of substantial emotional value can cause temporary difficulties falling and staying asleep. In many ways this is simply part of the human condition; we all are subject to such physical responses to the ebbs and flows of life. Often the insomnia is self-limited, improving and resolving as the dust settles from whatever it was that sparked the problem.
However, in some cases, the insomnia can persist even though the triggering event goes away. There are many reasons as to why this may occur, but eventually one may get in a “rut,” experiencing night after night of difficulties sleeping, to the point in which an expectation of poor sleep develops. That’s when things really start getting nasty. The bed then feels like the enemy; the insomniac comes to look at the bed at night with a vague combination of hope and fear, on one hand hoping that tonight will be different, but on the other fearful that tonight’s gonna suck just like last night did.
One basic tenet of insomnia management is the recognition that the more time you spent awake in bed, the harder it often gets to fall asleep. Why is that? Simple, really: because it’s frustrating. I mean, no one wants to be in bed awake when they’re trying to sleep, right? It’s always a frustrating experience. Frustration is a stimulating emotion. It makes you feel more awake and alert. So the more time you spend awake in bed, the more frustrated you get, the more awake you feel, and the worse the insomnia gets. This is the reason why what you read in all those self-help books on sleep–that you should limit the amount of time spent awake in bed each night–is an important component in chronic insomnia management. I promise we will delve more into that at a future date.
OK. There is an additional, very natural tendency hardcore insomniacs have, which is the proclivity to try to fall asleep. I want you to think about this. Under normal circumstances you become sleepy prior to falling asleep. How, then, are you going to try to become sleepy successfully? Becoming sleepy is a natural biological function, and trying to become sleepy is no easier to make yourself achieve than trying to become hungry, for example, or becoming thirsty. It just doesn’t work that way, so of course you’re going to be frustrated by trying. However, all of this mental action can happen in such a buried, subconscious way that it may not occur to the insomniac how problematic it is, and how little it actually helps.
In fact, trying to sleep works against you. Why? Because now you’re adding an element of performance anxiety to your problem. Imagine engaging in that classic routine, counting sheep, in your attempt to fall asleep. You now count to 100 . . . 200 . . . 300 . . . and sure enough, you haven’t achieved sleep by the time you’ve reached whatever mark you’ve set for yourself, and you aren’t sleepy yet. That just compounds the anxiety and frustration, doesn’t it? Now you’re more upset, even angry at yourself, for not achieving what you’re trying so desperately to achieve.
Let me give you another scenario. Have you ever had a tough night in bed, tossing and turning, trying to sleep, and finally you “gave up” and left the bedroom, went the couch in the living room, turned on the TV, and then fell asleep immediately? Why do you think that happened after having suffered so much in bed, where you’re supposed to be sleeping? It’s because you stopped trying.
So . . . take-away point of tonight’s entry: stop trying to sleep. It doesn’t work, and it often works against you and makes things worse. The idea is to allow your body’s natural tendencies to become drowsy to fall into place so that you can fall asleep without your help. That’s the way we were built to be. Just let it happen. It doesn’t need your help.
Hey man, this blogging thing is fun. Will write another entry soon. Sleep well!
“Never go to bed mad. Stay up and fight.” — Phyllis Diller
I’d like to know your thoughts on the following strategy. I was suffering from a sort of chronic insomnia where I would wake up and could not go back to sleep. It didn’t happen every night, but it happened often, and it went on for years. I started taking Ambien, of which, I was not particularly fond. I was supposed to take it “on occasion” but instead, I did an experiment. I thought that maybe insomnia was sort of a rut – a habit we get into. So, I took Ambien every night at exactly the same time for two months. My thinking was, I’ll reprogram my sleep pattern. I’ll effectively reboot my system. Well, it seems to have worked. In fact, I now find it hard to stay awake around the time that I was taking the Ambien. If I want to stay up late, I actually have to power through that period. Note that I no longer take Ambien. Have you ever heard of this sort of approach to taking such medications?
Hey Neil (!). Thanx for the message. Your experiment is intriguing. Well, your approach was probably not so much a matter of “reprogramming,” but probably instead a gradual regulation of your sleep scheduling. One problem with insomnia is that the problem can become compounded by irregularities in sleep scheduling, such that one awakens at various times in the morning and/or goes to bed at various times at night (if you’re a musician like I am, night-time gigs can do that, for example). Your body clock in your brain wants you to be regular, i.e., awaken around the same time every day. Little tricks to force your body clock’s regularity to coincide better with your actual schedule often makes insomnia better. This is the reason why the largest patient population I have with insomnia is the group of patients that don’t work; retirees etc. Sounds like things improved; good on ya!
love this blog morris! i think sleep is something we all know very little about. and it’s so important to our well being! thanks for sharing your expertise!
Thanx Kris! Missing our old gang in the Upper Valley! I appreciate your reading my blogs. There should be more stuff out there than there is on sleep!