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HOW IMPORTANT IS INSOMNIA?
Ray Lightstone, PsyD

How concerned should we be about insomnia? Insomnia is often viewed as a symptom of depression: Treat the depression and the insomnia should resolve. Insomnia is also often viewed as a manifestation of worry. Solve the problem causing you to worry and you will sleep soundly.  None of this is true.  

Scientific research is showing that insomnia plays a central role in causing and perpetuating many psychological disorders. The first hint of this came from research on a phenomenon known as “residual insomnia.” When psychologists treat depression without directly treating the insomnia, the insomnia persists. In fact, residual insomnia significantly raises the risk of a depression relapse. Worse yet, this “rebound depression” is usually worse than the initial episode. Ongoing research is suggesting that this same dynamic may be playing out with anxiety and many other psychological disorders. Still, very few psychologists have been trained to treat this condition.

So how do we understand insomnia?  It’s best to start by trying to get inside the mind of a person with insomnia. Insomnia sufferers have trouble sleeping because they are afraid to have trouble sleeping. It’s similar to a phobia. Irrational fear and avoidance behavior lead to more anxiety and worry about sleep, exacerbating the insomnia. People with insomnia are right to worry about their sleep, but their only concern should be long-term sleep deprivation. Our bodies were made to handle short-term sleep loss, and we can function surprisingly well in the short run with inadequate sleep.

Still, insomnia sufferers are consumed with anxiety about tonight’s sleep. And tomorrow’s night’s sleep. So they develop a set of behavioral strategies to manage the fear: If they don’t get to sleep until late, they sleep late that morning. If their sleep is poor the whole night, they take a nap.  If they’re afraid to be tired, they drink lots of coffee. They also use a rather creative technique. They spend extra time in bed. Since so much time is spent awake during the night, they extend the time in bed to create a margin of error. 

All of these strategies seem like common sense. But they all make the problem worse. In fact, if you want to figure out how to treat insomnia, just take common sense and turn it upside down:  Napping is a no-no. Your wake time should stay the same each morning, even if you sleep badly.  You shouldn’t go to bed until you feel sleepy. If you wake up and can’t get back to sleep, you should get out of bed and do something relaxing. Don’t go back to bed until you feel sleepy.  And the total time you allow yourself in bed through the night should be decreased, not increased.

That last one sounds strange. If you want to get plenty of sleep, why would you decrease the number of hours you allow yourself in bed?
To understand the treatment of insomnia, you have to understand two fundamental forces that govern sleep. One is called the sleep drive. When you’ve had a long tiring day with very little sleep the prior night, your sleep drive will be high. If you had a four hour nap just a few hours ago, your sleep drive will be low. In insomnia treatment, we want a high sleep drive to be associated with your bed. If you spend a lot of time laying in bed with a low sleep drive, the bed will become a place you will dread. Looking at it will remind you of the tossing and turning and endless hours of worrying. If, on the other hand, you have a high sleep drive in your bed, looking at the bed will remind you of that peaceful, pleasant feeling of drifting off.  Restricting the total time in bed and staying away from the bed when you are wide awake are the best strategies for making the bed a place for sleep.

The second force governing sleep is called the sleep clock. Your brain has a clock that orders a host of biological processes to occur at specific times. Hormones, glandular secretions, thirst, hunger and the sleep/wake cycle are all governed by this clock. Your brain orders a hormone called melatonin to be elevated at a specific time, signaling you to become drowsy and to drift off. If this clock is off, you won’t be sleepy at bed time.

The most effective single strategy for regulating your sleep clock is keeping your wakeup time consistent. If you make up for lost sleep by sleeping late, you will throw your clock off.  Napping throws the clock off even more.

With a properly functioning sleep clock and sleep drive, you will become sleepy at the time you hope to go to bed and you will wake up when you need to without an alarm clock. You will also have a lot of deep sleep early in the night and dreaming late in the night. Your brain acts like an orchestra conductor, ordering up the right type of sleep at the right time for the best effects on your mental and physical health. 

If we view insomnia as a phobia or a fear of not getting adequate sleep, then the treatment makes sense. All irrational fears must be faced before they can be conquered. The insomnia sufferer must be willing to risk a poor night of sleep tonight to solve the long-term problem. Restricting the number of hours in bed, getting out of bed when wide awake and avoiding naps all trigger the fear. These strategies force you to risk a bad night’s sleep tonight. But if you keep these strategies in place and remain consistent with your wake time, sleep should ultimately come naturally. The more sleepy you are in bed, the less you will worry about your sleep. Even though these strategies can create some anxiety, they will produce far less anxiety than the old strategies that perpetuate the insomnia pattern. 

Many of these sleep management techniques are described in more detail on the “How To Get A Good Night’s Sleep” handout at www.anxietyandstressrelief.net

For additional information and reading materials, visit the National Sleep Foundation web site at:  www.sleepfoundation.org.

Dr. Lightstone's website is www.anxietyandstressrelief.net
To view Dr. Lightstone's referral listing, click here.

Statements contained  in the authored articles on the Westchester County Psychological Association (WCPA) website are the personal views of the authors and do not constitute WCPA policy unless so indicated. The information in the articles on the WCPA website is for educational purposes only. The information contained in the articles is not intended for diagnosis, psychological advice or medical advice.  It is not intended to be treatment and is not a replacement for psychotherapy. If you are in need of psychological treatment, you can utilize our clinician database which can be accessed by clicking on the link, "Find a Psychologist." WCPA and its directors and employees are not liable for any damages resulting from the utilization of information contained in articles posted on the WCPA website.

 


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