Most cases of insomnia are caused by incorrect thoughts and behaviors towards sleep. Known as psychophysiologic insomnia, sufferers often focus far too much attention on their sleep (or lack of it). This makes sleep more difficult, creating a negative cycle of worry and sleep deprivation.
Healthy sleepers tend to take a passive approach towards sleep. It’s time for bed, so they get into bed. They switch off the lights, relax, and sleep comes.
Insomnia sufferers will often try to force sleep. They’ll go to bed earlier than they should (in an attempt to get more sleep), they’ll keep checking the clock and worry that they aren’t asleep yet. They’ll think about how tired they’ll be in the morning. The fact of the matter is that sleep is a largely automatic process that needs little intervention. The more we try to intervene, the more we risk harming our sleep.
Take breathing as an example; we don’t normally think about our breathing. Yet, during a panic attack we can easily place too much attention on our breathing. We may worry that we’re not getting enough oxygen, leading to hyperventilation. The symptoms of hyperventilation then make us worry even more, making the cycle even worse. If you want to improve your sleep, you need to stop thinking about your sleep. This is why cognitive behavioral therapy for insomnia is so effective; it addresses incorrect thoughts and behaviors towards sleep and teaches individuals to abandon attempts to control their sleep.The cause of psychophysiologic insomnia
To get all academic, C.A. Espie et al. suggest that the attention-intention-effort pathway is a critically important process when it comes to sleep disruption. Broken down, this pathway involves excessive:
Attention: Paying too much attention to sleep. Worrying and questioning sleep (and the consequences of sleep deprivation) in the pre-sleep period (also known as negative sleep thoughts).
Intention: Developing an explicit intention to sleep. Ironically, this actually makes sleep more difficult. Healthy sleepers do not have an explicit intention to sleep; instead, they just get into bed, turn off the lights and get comfortable.
Effort: Making too much of an effort to fall asleep and stay asleep. This leads to higher levels of arousal, making sleep more difficult. You may be putting too much effort into sleep if you find yourself tossing and turning at night, unwilling to get out of bed and ‘give in’ or ‘admit defeat’, or if you try exercising yourself to the point of exhaustion in an attempt to sleep.What is paradoxical intention therapy?
Since good sleepers don’t use any ‘strategies’ to fall asleep, one suggested treatment is paradoxical intention therapy.
Paradoxical intention therapy attempts to replace ‘trying to fall asleep’ with ‘trying to stay awake’. The aim of the technique is to get you to take a more passive role towards sleep by deliberately preventing your attempts to fall asleep.How to use paradoxical intention therapy to improve your sleep
In their book, ‘Insomnia: A Clinical Guide to Assessment and Treatment‘, Morin and Espie summarize the instructions for paradoxical intention therapy as:
- When you are in bed lie in a comfortable position and put the lights out.
- In the darkened room, keep your eyes open, and try to keep them open ‘just for a little while longer’. That’s your catch phrase.
- As time goes by, congratulate yourself on staying awake but relaxed.
- Remind yourself not to try to sleep but to let sleep overtake you, as you gently try to resist it.
- Keep this mind-set going as long as you can, and if you get worried at staying awake remind yourself that is the general idea, so you are succeeding.
- Don’t actively prevent sleep by trying to rouse yourself. Be like the good sleeper; let sleep come to you.
The key take-away is this: stop trying to sleep. Sleep is involuntary .