Insomnia Feeds on You Trying to Get Sleep

Insomnia sufferers often find themselves trying everything under the sun in a frustrating and seemingly futile attempt to get a good night's sleep.

However, these all-consuming efforts may be doing more harm than good. They fuel the very problem that they are intended to cure, an expert told Newsweek.

Dr. Jade Wu is a behavioral sleep medicine specialist and researcher at Duke University School of Medicine. She has helped hundreds of patients over the course of her career.

Figures from the American Sleep Association show that 10 percent of U.S. adults suffer from chronic insomnia, which can severely disrupt everyday life. Many more have short-term bouts.

In her new book, Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications, Wu gives an easy-to-follow guide for people with insomnia. It aims to shift the focus from trying to control sleep toward building a healthier and more sustainable relationship with it.

Wu says that, even if you have insomnia, you already know how to sleep—your rest is not broken. The route to recovery lies in stepping away from treating the issue as an engineering problem that must be fixed with formulas, "hacks" or products.

One of the main issues perpetuating chronic insomnia, according to Wu, is "sleep effort." This involves anything you intentionally do or think to induce sleep or become a better sleeper. This effort can involve a number of behaviors or thoughts—some common examples Wu includes in her book are:

• Trying really hard to clear your mind or turn off your brain at night.
• Trying to figure out the best sleep position or perfect bedtime routine.
• Making sure you go to bed early so you have plenty of time to get enough hours.
• Trying to drum up a positive attitude about sleep leading up to bedtime.
• Avoiding drinking liquids in the late evening to minimize nighttime urination.
• Using special sleep meditations, soundtracks, or binaural beats to try to induce sleep.
• Buying or consuming products that are purported to induce sleep.
• Going down an internet-research rabbit hole about sleep and insomnia.

While any of these individual examples of sleep effort may seem like a good idea, they counterintuitively may be setting you up to fail. Hard work is usually seen as something to strive for in today's society. However, when it comes to trying to sleep, putting in too much effort often backfires, according to Wu. This can lead to an unhealthy relationship with sleep that may prolong insomnia.

Constantly thinking about sleep and strategizing about how to get more of it can increase conditioned hyperarousal. People with insomnia experience this when trying to fall asleep, which exacerbates the problem even further. Sleep effort can make the individual more anxious. It can draw further attention to the issue, or increase frustration around it.

Wu compares the concept to quicksand: the more you struggle against the unwanted wakefulness—by trying hard to relax or thinking about how you should be sleeping, for example—the worse the problem gets.

The problem can be compounded by the "sleep hygiene" advice that is usually offered as a solution to people struggling with insomnia by well-meaning health-care professionals and organizations.

Sleep hygiene refers to a checklist of recommendations designed to promote good sleep. These range from avoiding screens late at night; winding down before bedtime and not eating too late; to getting light exposure and exercise in the daytime; and ensuring your room is not too warm.

Wu says that, while such guidelines may be helpful for preventing some sleep problems, they do not necessarily address the root causes of insomnia.

"They're generally not helpful if someone already has insomnia," Wu said. "In fact, putting too much emphasis on perfecting sleep hygiene can backfire, because sleep effort increases anxiety and makes insomnia even more likely."

It is also often unsustainable for people to follow all of the guidelines over long periods of time. There are a lot of recommendations, and everyday life has many commitments.

Wu said treating insomnia with sleep hygiene is like trying to treat a cavity with dental hygiene—by this point, it is too late, and the focus is misplaced.

"Sleep hygiene is not the answer, nor the blame, for your insomnia. Some of it might be helpful for you. Some of it might not be, but that's not the starting point," Wu said. "Start with building a good relationship with your sleep where you figure out what you need.

"Even the term 'sleep hygiene' really places a judgement on people implying, 'Oh, you're not hygienic enough, and your poor sleep habits are the reason why you don't sleep well,'" Wu added.

"What I want to do is give people a bigger and more sustainable framework. If you just give people a list of things to do, and tell them they're bad for not doing it, it's not very feasible."

Wu said she hopes people create a healthier relationship with their sleep, one that does not involve trying hard to manipulate and control it. This she believes is a futile endeavor.

The researcher also said a one-size-fits-all approach and rigid rules when it comes to sleep messaging may not necessarily be beneficial. Instead, Wu wants to empower people to trust themselves and their own individual sleep patterns.

"If we strike the right note of having a friendly relationship with sleep, it's a lot easier to trust your sleep to take care of you," Wu said.

"People fall on a spectrum of how much sleep they need. And so when we get the same message—you should sleep eight hours; you should set your room temperature to this number of degrees, etcetera—that may not be the right answer for people.

"Our sleep needs also change over time depending on our age, lifestyle, and other factors," Wu said. "So, instead of trying to achieve one very specific amount of sleep, it's much better for our health and our relationship with sleep to be flexible. As long as you protect your sleep environment and opportunity to sleep, you can listen to your body's sleepy cues to know whether you're getting enough."

It is important to note that perfection is neither necessary nor sufficient for sustainable sleep health, Wu added. Creating a good relationship with your sleep means taking good care of it while not being overbearing; it also means having some meaningful boundaries but not being governed by rigid nighttime rules.

Turning Away From Sleep Effort

Instead of working harder at trying to get to sleep, Wu said letting go of the struggle could be a "game-changer." She has a number of tips on how to go about this.

One recommendation is to "accept reality." Notice what is happening in the moment without analyzing and evaluating what is going on—or striving to try to sleep—when you are lying in bed awake.

"When you're wide awake at night, you can similarly acknowledge that, yes, you're awake right now, it's already happening, and your wakefulness won't magically become sleepiness just because you and your flailing brain really, really want this reality to change," Wu wrote in her book.

The second tip is to ask: "What would a good sleeper do in this situation?" and act appropriately. This sends a signal to your body that insomnia is not an ever-present threat and it is safe to relax. It can also help to address an individual's entrenched identity as someone who is a bad sleeper.

"If our actions indicate that sleep is fragile, our bodies will make us more vigilant about wakefulness at night, making us more prone to waking up and staying awake," Wu wrote. "If our actions indicate that changes to our sleep routine are dangerous, our bodies will react with anxiety whenever our sleep routine is disrupted.

"However, if our actions indicate that sleep is resilient and adaptable, and that our relationship with sleep is solid enough to withstand some turbulence, our bodies will tone down the arousal, resting assured that it doesn't need to be on guard for danger."

Finally, Wu recommends that, if you cannot sleep, avoid checking the time. Watching minutes and hours pass by, while not being able to sleep, can increase feelings of anxiousness or frustration. It is not helpful in any way. Cover up the clock, and put your phone away somewhere out of reach.