Every year, according to a 2018 study conducted by the University of Pennsylvania, one in four Americans develops insomnia. Fortunately, for three quarters of those sufferers, the bout is temporary.
For the remaining twenty-five percent, however, sleeplessness becomes a withering, intractable problem that eventually dominates their waking hours. From August of 2016 until January of this year, I was one of those people. For much of that time, I suspected that my sleeplessness had eroded my natural anatomical mechanism to fall asleep. In other words, I believed I’d physically forgotten how, which, as it turns out, is a common complaint among insomniacs and a key component in the mirage of insomnia itself.
The syndrome, called paradoxical insomnia, is when the sufferer swears not to be sleeping at all, yet sleep is actually going on, or commonly, as in my case, a shallow version of it known as micro-sleep: brief descents into stage 1 sleep punctuated by rearousal, the episode too fleeting to register cognitively. The brain only recognizes being awake, which, in turn, provides a distorted and negative interior commentary about how much sleep we believe we’re getting, proving, once again, how our minds can be the terrible problem we all carry around on our shoulders.
Unsurprisingly, the combination of worry and tiredness are poor bedfellows, causing us to vastly underestimate our own sleeping patterns. Ellen Wermter, a nurse practitioner who works with world renowned sleep expert Dr. Chris Winter at his Charlottesville Neurology and Sleep Medicine practice, deals with paradoxical insomnia on a regular basis. “This completely normal tendency to catastrophize about poor sleep is why cognitive restructuring is essential in insomnia management,” Wermter states. “Otherwise, the person with insomnia continues to have a stress response that causes hyperarousal and sets the stage for more difficulties falling and staying asleep.”
What it took for me to finally grasp the concept of paradoxical insomnia was an overnight in-lab sleep test, which recorded that I was falling asleep and waking myself back up, on average, every forty seconds. Not news you wish to hear, certainly, but it was sufficient to persuade me that I might not be a reliable narrator in my tale of sleeplessness. Simply put, I began to suspect I might be too close to the problem.
This insight actually turned out to be good news because in the wake of my sleep test, I understood for the first time that the insomniac body naturally wants to fall asleep. The subsequent challenge was allowing myself to do so, which required the kind of mental restructuring that Wermter to refers to: cognitive behavior therapy for insomnia.
CBT-I requires more work than swallowing a pill, but it’s much more effective because over time it stems the tide of negative perceptions about sleep washing through your sleep-deprived mind. Gradually, through supervised CBT-I, I unplugged myself from the notion that I needed medication or gadgets to drop off. I retooled my expectations and grew to accept that I might not be the best witness of what happens when I closed my eyes.
“I can tell a breakthrough happens,” Wermter reports, “when a patient stops searching for a solution. Those with insomnia tend to look to external sources to ‘make’ them sleep.”
That breakthrough isn’t the overnight cure we all dream of. I had to work at not operating with faulty perceptions where sleep was concerned. Mostly that amounted to learning how to get out of my own way because, as Wermter neatly describes the scourge of paradoxical insomnia, “the more attention we give insomnia, the more power over our life we are allowing it to have.”
Sleep, instead, is much more like love or art in that it can’t be forced. But unlike those other two, I discovered that anybody could achieve regular sleep with a little work. If your medical umbrella doesn’t cover Cognitive Behavior Therapy for insomnia or a visit with a sleep professional such as Ellen Wermter, here are some free, indispensable pointers about getting to sleep from her. Stop trying to control everything. Remove your expectations from the equation. Relax and allow your body do what comes naturally. To me, that’s pretty sound advice for when your eyes are wide open, too.