Mission: Cognition

Sleep restriction and stimulus control were the main behavioral interventions for tackling my insomnia, but they don't call the treatment cognitive behavioral therapy for nothing! A large portion of it involved addressing the thoughts and fears that were contributing to my lack of sleep.

It's easy to follow a bunch of rules: Get out of bed at the same time every morning! Don't go to bed if you're not sleepy! Don't stay in bed if you can't sleep! It's a lot harder to change your unconscious responses and entrenched beliefs, but these were probably the biggest factors that were keeping my insomnia alive.

"I can't sleep." "Why am I still awake?" "I have forgotten how to sleep." "OMG, the sun is rising in 2 hours and I still haven't slept!" "What if I have fatal insomnia?" Thoughts like these are not restful thoughts! They are the kind of thoughts that get your your mind racing and your heart to follow suit, until your entire body is on high alert.

Learning to recognize these thought patterns and how they were sabotaging my sleep was vital in my recovery. And the first step was gaining a basic comprehension of how sleep works. I don't want to pass myself off as any kind of expert, but here's the gist of what I learned, told maybe just slightly more dramatically than how I learned it.

 

Sleep is basically controlled by a constant, epic battle between two forces: sleep drive and arousal. Sleep drive is, in essence, a measure of how badly your body needs to sleep. When you first wake up in the morning, your sleep drive is low because you're well rested, and it builds up over the course of the day until you're (normally) ready to fall asleep again at night. Sleep drive is controlled by one factor and one factor only: how long you've been awake. Longer wakefulness = more sleep drive, and enough sleep drive always leads to sleep eventually.

However, sleep drive doesn't operate in isolation. It can be suppressed by the other major player in the sleep arena: arousal. No, I'm not talking about sexual arousal—come on guys! It's just a word that means... well... the opposite of sleepiness. Lots of factors can contribute to arousal—being uncomfortable or in pain, chemical stimulants, excitement, emotional distress, and fear. When you have enough mental arousal, it overrides your sleep drive, and you will not be able to sleep.

Arousal typically has an edge over sleep drive, because you need to be awake in order to respond to potentially dangerous situations. However, in the mind of an insomniac, sleep itself gets conflated with a dangerous situation (because of all the conditioning that has linked bedtime with worry and wakefulness). Consequently, the insomniac develops more fear and worry about sleep, experiences more nighttime arousal, and sleeps even less!

It seems so obvious when I see it explained like that, but it was a breathtaking revelation to me when I was still in the thrall of insomnia. My sleep wasn't some magical entity that had decided to abandon me; I had driven it away with my own thoughts! In order to sleep well again, all I had to do was replace my negative and erroneous beliefs with reassuring facts, and gain control of my feelings about sleep.

Here are the facts that helped me turn the corner on insomnia.

1. You can sleep.

This is the tagline on all of Martin Reed's Insomnia Coach videos, and with good reason. When I was struggling with insomnia, I worried extensively about my ability to sleep. At times, I thought I really had lost it entirely. This was of course completely silly, because I did sleep, every night. Maybe for only one or two hours, and maybe only with the aid of some substance or other, but I always did fall asleep. This should have clued me in to the fact that I hadn't lost my ability to sleep, but I needed to hear it in words. And I did. At the height of my insomnia, I would watch a Sleep Snippet video every evening, just for the reminder.

2. You can't force sleep.

Learning how sleep drive is the one and only thing that can make a body sleep was an immense weight off my back. I was immediately liberated from all the time-consuming practices I'd adopted to help me sleep. All that nighttime yoga, the binaural beats, the experiments with meals and their timing, the neverending guided meditations and breathing exercises—I could throw them all away, because none of them were going to make me sleep! They might help me relax a little, and they certainly weren't harmful, but they weren't going to make any significant difference. All I really needed to do was wait to sleep until my body was ready for it.

3. Sleep always wins.

This is another direct quote from Martin Reed, but I found it incredibly reassuring. In the epic battle between sleep drive and arousal, arousal may take the upper hand for a while, but even chronically sleep-deprived folks experience micro-sleeps, and even hardcore insomniacs crash after several days awake. It's impossible to go without sleep forever, and once I internalized that fact, I was able to go to bed with confidence that eventually I would fall asleep again. In the past, I had felt like I was at the mercy of my insomnia, but now I realized, my insomnia was only just barely holding its own against my indomitable sleep drive.

4. You're probably sleeping more than you think you are.

One fact (backed up by research) I keep hearing is that "normal" sleepers generally overestimate how much sleep they get, whereas insomniacs tend to underestimate it. I found a video explaining that if you are woken up during stage 2 non-REM sleep, you only have a 50% chance of believing that you were asleep at all! Knowing this, I could recall plenty of nights when I thought I hadn't slept, but time had seemed to pass much too quickly for me to have been awake. Another sleep expert said that if you can't tell whether you were asleep or awake, you were probably asleep. Deciding to believe that I'd actually been asleep during those ambiguous times made me feel a lot better! Even if I wasn't sleeping great, I was still probably getting some amount of much-needed rest.

5. Going without sleep is not a catastrophe.

This one walks the line between fact and belief, but it's rooted in logical analysis and an evidence-based conclusion. One of the things I was encouraged to do in my sleep training is interrogate my beliefs about sleep. For example, when I was lying in bed at night and starting to panic over the fact that I was still awake, I was supposed to ask myself things like, "What is the worst thing that could happen? What is the most likely outcome?" When I put my thoughts to the test, I realized the worst-case scenario was that I would not sleep at all and start a run of several nights of no sleep, resulting in a mental breakdown and administration of benzodiazepines in the ER (it's a story oft told in my insomnia support group). Honestly, I think that would be a catastrophe—but it had never happened to me. It was much more likely that I'd at least sleep a couple of hours once I calmed down, and the sleep deprivation from this night might even make it easier for me to sleep the next night.

Arming myself with these facts had an almost immediate positive impact. I no longer stressed about sleep all day long. Once I stopped thinking about sleep all the time, I also stopped feeling tired all the time. So even though I was sleeping much less than I ever had before, I still felt pretty energetic during the day. It was a great shift, and it helped give me the emotional strength to tackle the greatest challenge yet—adjusting my attitude.

But I'll save that topic for another post.