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The How and Why of Chronic Insomnia
Here is the classic way chronic insomnia often starts and develops:
- A person suffers from a brief period of insomnia. This is often viewed by the person as very unpleasant and memorable.
- During this period, the person starts to relate his bed or sleep, not with rest and positive feelings, but with difficulty and stress. He engages in behaviors to try to cope with his growing anxiety, but they only reinforce his negative evaluation of sleep and make sleeping more difficult, resulting in more sleep failure.
- Especially when trying to sleep, the person is consumed with worry about the inability to sleep, the consequences of not sleeping, and the inability to control his or her negative thoughts and feelings. As a result of this worry, sleep becomes almost impossible to achieve.
- In time, irrational concern about sleep loss becomes constant and automatically causes angst and wakefulness at bedtime. Sleep-related thoughts and worries grow only worse.
- Insomnia then becomes a self-fulfilling prophecy that can continue indefinitely.
- Sleep may improve briefly at times, but something (usually stress) invariably triggers the negative thoughts, worries and behaviors to return resulting in further insomnia.
To further
explain and illustrate how and why chronic insomnia starts as
well as last indefinitely, I will share my story with you. If
you suffer from chronic insomnia yourself, this story will probably
sound more or less familiar to you.
My story: the sleepless
night
My insomnia began during a stressful time in my life. When I
was 23 years old, I was faced with a perfect storm. Problems
related to my school, work and family life had hit me hard --
and on the very same day. (In case you want to know the gory
details: I realized I probably was not going to pass a class
that I needed to graduate; I was laid off from my job; a friend
had become very ill.)
This caused me to feel a crushing amount of stress. I could
not help but take the stress to bed with me that night. My mind
and heart raced for several hours after I went to bed. On top
of this, I also knew that the next morning I was to give an
important presentation at school. So the longer I lay awake,
the more pressure I felt to fall asleep. This pressure, of course,
only increased my stress and made it even harder to relax. With
each passing hour, I grew more and more exhausted, panicked,
and frazzled.
That night I truly did not sleep, not one second. I had lain
in bed for at least seven hours, tried my best to sleep -- and
failed. This had never happened to me before, not even close.
I had experienced nights of poor sleep before, but nothing like
this.
Many people experience a situation similar to this at least
once their lives. But most don’t develop chronic insomnia
from it. In other words, once the cause(s) of stress that is
preventing sleep goes away, most people usually start sleeping
well again – as they did before the stress hit them.
However, I did develop chronic insomnia from my experience.
In other words, my stress or “perfect storm” eventually
went away, but my insomnia remained.
There are two main reasons why this happened. One has to do
with my thoughts related to sleep and the other has to do with
my behaviors related to sleep.
My thoughts
I allowed the night in which I did not sleep to set a precedent
in my mind. Prior to this experience, I did not know that I
could go an entire night without a wink. I had never given the
idea of not being able to sleep any thought at all because I
did not think it was possible. But the sleepless night changed
all of this in my mind, unfortunately.
After this bad experience, I now thought and worried about sleep. And with each subsequent night, it seems that I thought and worried more and more. I thought and worried that I would take too long to drift off; that I would wake up in the middle of the night and not fall back asleep quickly; that I would wake up too early and not get back to sleep; that I would never be able to sleep like I used to before the insomnia; that I would suffer through the following day if I did not sleep; that insomnia would have disastrous effects my personal, school and work life. Most of all, however, I thought and worried that I would not be able to sleep at all.
All of this thought and worry, of course, caused me great stress and anxiety which, entirely by itself, caused me not to not sleep or not sleep well. I would lay there in bed at night terrified and panicked that I would not sleep. My heart would pound, I would sweat and shake. I would almost feel as if I was losing my mind and that the walls were closing in on me.
I tried the best I could to not think and worry about sleep, but I could not stop.
It’s sometimes said that chronic insomnia is insomnia that’s taken on a life of its own. This is what is meant by that. The thinking and worrying about insomnia leads to stress and anxiety which causes and perpetuates the insomnia.
My behaviors
Thoughts and worries alone, however, do not cause and perpetuate chronic insomnia. Certain behaviors are also needed. These behaviors are often intended to be ways to cope with and overcome the insomnia. However, they only succeed in perpetuating it.
For example, in my case, here are the main behaviors I used to try to cope with my insomnia:
- I spent much more time in bed, sometimes up to 12 hours a day, even though I was sleeping very little. I figured that if I was in bed I might just get lucky and fall asleep.
- I actively tried to sleep. In other words, I would concentrate on falling asleep.
- I did as little physical and mental activity as I could for two reasons. First, I was tired and did not feel like doing anything. Second, I thought that if I exercised then I would be more tired the next day if I did not sleep that night.
- I started to plan my life around my insomnia. Almost every short- and even long-term decision I made took into consideration my lack of sleep. For example, I avoided things which would require a lot of activity or energy on my part, such as job interviews, promotions at work, vacations, and social events. I did this out of fear that I my sleeplessness would not allow me to meet these challenges properly.
These
behaviors were crucial in keeping my insomnia alive because
they were self-defeating and only reinforced my thoughts and
worries about insomnia. (For a detailed explanation on why
this is the case, see behavioral
techniques.)
The result
After a month or more of constant thoughts and worries about
sleep combined with the behaviors described above, I had officially
fallen into the dark abyss of chronic insomnia.
My persistent sleeplessness had caused me to evaluate sleep
negatively. In other words, I hated going to bed at night
because I knew it would be little more than several hours
of torture. If I just looked at my bed I would have feelings
of dread and nausea. More interesting still is that if I heard
someone just casually mentioned the word sleep or something
related to sleep (dreams, mattress shopping, napping), I would
feel anxiety rush over me. In short, I had learned to hate
and fear the idea of sleep and everything related to it.
The cycles
Fortunately, my insomnia after a few months largely went away.
I’m not totally sure why it did so, but at the time I
also was desperately experimenting with different ways to
deal with my insomnia. I must have stumbled upon somewhat
of a solution, but I do not remember what it was.
Even during this period when I was sleeping better, I always
had a sense of unease in that I knew the insomnia was just
dormant, not cured. In other words, I knew I had not beaten
it, but rather just somehow had kept it at bay. I also knew
that it could and almost certainly would come back given the
right circumstances.
And sure enough it came back. I don’t remember the specific
cause other than it was something that caused me stress, such
as having a “big day” planned for the next day.
And this triggered the insomnia again. All of my anxiety related
to sleep came rushing back as if someone turned on a faucet.
Just as with the first time, the insomnia would last much
longer than the thing that caused me stress. Eventually, however,
after many weeks or months of agony I would manage to start
sleeping at least somewhat better again – but only temporarily.
I went through this cycle of on-again off-again periods of
sleep many dozens, perhaps even hundreds, of times. I experienced
extended periods of maddening sleeplessness followed by usually
short periods of decent sleep, over and over again. At my
low point, I thought that this is how things would be for
the rest of my life.
Next:
My recovery begins