Insomnia demystified - A Sleep Psychologist's Guide (Part 1)
This is the first in a series of four articles explaining how chronic insomnia develops and what you can do to get relief from it.
Chronic insomnia can be a baffling experience for those who are in its grip. Sufferers lie in bed, hoping for and expecting sleep to come while it remains stubbornly elusive. “Why is this happening?” they think. “What did I do in the past to put myself to sleep? I’m trying as hard as I can now!” And yet for all the trying, the sleeplessness remains.
To understand why this is not a helpful approach to one’s sleep difficulties, we first need to take a step back and think about the nature of sleep itself. Specifically: which aspects of sleep are within our control, and which are not?
You can’t will yourself to sleep
Our body has many natural processes that run entirely on their own without us having to control them. Some obvious ones are that we don’t have to consider when to breathe, or how fast our hearts should beat, or what we would like our body temperature to be. Our brains and bodies are very good at regulating those functions without our input, and a good thing too, or we would have a lot to think about every day.
On the other hand, there are some vital bodily processes that do need our conscious attention. For example, we get signals that we are hungry and thirsty, but we still must put in the volitional effort to walk to the refrigerator and get something to eat or drink. We also have the choice to ignore feelings of hunger or thirst for quite some time if the need arises, even though nutrient intake is ultimately essential to survival.
Which of those categories does sleep fall into? Interestingly, it lies somewhere in the middle. Our bodies send us signals to tell us when we’re sleepy, but we have some say about whether to obey them. If we lie down in a dark environment and close our eyes when we feel sleepy, sleep will come. However, people routinely extend their bedtimes beyond the point where they are sleepy (often to watch just one more episode on Netflix). Sleep signals can also get overridden if we’re anxious, stressed, or not able to wind down at night.
Under more extreme conditions of sleep loss, we observe the reverse situation; staying awake becomes more and more difficult, and we nod off even when we may not want to. This has probably happened to many of us at some time during a meeting or lecture, but a more dramatic (and dangerous) statistic is how many drivers fall asleep at the wheel, sometimes with fatal consequences.
On the flip side, when we are not sleepy, there isn’t much we can do to force ourselves to go to sleep. As an experiment, try lying down in bed after a full restful night and see if you can compel yourself into unconsciousness. Probably not happening.
In short, even though we have a fair amount of control over our sleeping habits, sleep is still a natural process that generally happens on its own. As we’ll see, one of the misconceptions often held by people with insomnia is that they have more control over this process than they actually do.
A little bit of biology
Here's what’s happening underneath the hood (science-phobes, don’t be scared). Our brains have chemicals and systems that support alertness when it’s time to stay awake. There are other chemicals that signal when it is time for the alertness systems to be turned off, systems that are responsible for putting us to sleep.
One of these systems is known by scientists as the “sleep homeostat”. Just like a thermostat that keeps a room at a fixed temperature, the homeostatic system acts to keep our sleep pressure from building up to an excessive level. The longer we are awake, the higher our level of sleep pressure, and the sleepier we feel. Once we fall asleep, the valve on this system opens, sleep pressure is released, and we wake up with lower levels of sleep pressure again. Having 7-8 hours of sleep on a regular basis is generally enough to completely dissipate sleep pressure by the morning.
The second system that regulates sleep and wake cycles is a “circadian” process (circa means “about” and “-dian” is a suffix meaning “day”, so circadian is“approximately one day”). This process is governed by an internal light-sensitive clock, a timekeeper that tells our bodies when it is time to sleep and rise.
The homeostatic and circadian systems interact to keep us stably alert during the day and asleep at night. When we let them do their thing according to our natural body rhythms, falling asleep at night and waking up in the morning is effortless. All we need to do is pay attention to the signals of sleepiness and alertness, and our biology will do the rest.
Paradoxically, it’s when we try to take charge of those systems and put effort into getting to sleep that problems start to arise. By worrying about what we must do to make sleep come, we start engaging alerting systems, making it harder for our sleep systems to perform their natural functions. When it comes to sleep, the act of trying can make sleep that much harder to attain, and that’s when insomnia can start to rear its ugly head.
To summarize:
1) When you are extremely sleepy, trying to stay awake can be futile.
2) When you aren’t sleepy, it’s almost impossible to force yourself to sleep.
3) Most importantly for insomnia: Even when you are sleepy, trying to sleep can make it (much) harder to fall asleep.
In the next article, I’ll build on these principles to explain how chronic insomnia develops over time.
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