Sleep physiology for insomniacs

By November 4, 2019 No Comments

As a sleep physician one of the most common problems I see people having is trouble sleeping. Trouble falling asleep, staying asleep or both. Feeling tired and fatigued. What often surprises me is how many feel that their situation is unusual and how isolating insomnia can be. In fact, some 20% of the population in western countries have occasional difficulties sleeping and some 10% chronic insomnia. If you have trouble sleeping – you’re far from alone.

You’ve probably come across a ton of information about what you should be doing. Keeping the room dark, avoiding screens, try to relax etc. Sadly, almost 100% of what we always hear about is not helpful at all. A good place to start is at the beginning. Sleep physiology. Learning what regulates sleep and what is “normal”. Consider this article an overview to set the stage for really getting into how to sleep better.

Sleep is often mystified but it’s really not complicated: If you have a strong sleep drive an no factors that are blocking it then you will sleep.

A really good place to start exploring this is another from of drive, the drive to eat aka appetite.

Ask yourself what you need to do to become hungry? You may say that exercising makes you hungry or looking at something delicious does. But if you explore this a bit more, you’ll see that you don’t actually have to do anything. If you run a few miles you will burn calories and become more hungry. True. Seeing something that looks amazing stimulates your appetite. Also true, but if you didn’t do anything at all you would still become hungry. In fact the one thing that is guaranteed and needed to produce appetite is fasting. The absence of eating alone is enough to make you hungry.

Now what if you’re hungry and then hear that your dog was hurt in an accident. Chances are that you immediately lose your appetite and now no longer feel hungry. Your drive to eat is blocked by negative emotion.

This is exactly how sleep works. The one thing that can produce a sleep drive, a need to sleep, is wakefulness. Staying awake is the only thing that can make us stay asleep. This said, negative emotions like stress or preoccupation can block this sleep drive from making you sleep.

Knowing this it’s easy to see how so many with trouble sleeping will say that “nothing works”. Well how could it? The only thing that can produce a strong sleep drive is wakefulness and you can’t put that in a pill. It is true that your mood can be altered by distractions like soothing sounds or sedating medications and allow your sleep drive to produce sleep, but they never “work” in a sense that they produce sleep.

We will continue exploring how the above sets the stage for learning how to get past insomnia. But something practical even at this point – one of the most effective ways of getting better sleep is to build a strong sleep drive. As the one thing that can do this is wakefulness, spending less time in bed becomes key.

Spending less time in bed is part of every effective method for insomnia including cognitive behavioral therapy, The effortless sleep method and even ACT/mindfulness based therapies. We will explore all this much more as we go along. For now, consider spending no more than 7 hours in bed if you have trouble sleeping.

Building that sleep drive is a great start towards sleeping amazing!