Clarity on Insomnia: Why Can't I Sleep?
Updated: May 19
I hear "I can't sleep" almost daily in my life. Whether it is my clients, my friends, family members, or random people, the complaints are almost the same. "I can't fall asleep - I just lay there in bed miserable", or "I fall asleep and then wake up in the middle of the night every night!", or "I always wake up way too early, and then I cannot fall back asleep." While many people have only one of these issues, some have a combination of problems, such as difficulty falling asleep combined with early morning awakening. If you have experienced this, you understand how this negatively impacts your quality of life. Sleep disturbance causes a great amount of distress, often creating anxiety about even getting into the bed each night. Chronic insomnia can also lead to both physical and mental health issues, and by the same token, physical and mental health issues can lead to chronic insomnia. Sometimes it becomes a chicken or the egg question...which came first? Health issues like chronic pain, Gastroesophageal Reflux Disease (GERD), restless legs, and sleep apnea can cause insomnia and sleep disorders. Obviously, if we are physically uncomfortable it will be difficult to rest, yet the body needs this vital commodity to physically function at its best. Mental health issues also greatly contribute to disruptive sleep. Anxiety, for example, is often the culprit when it comes to challenges with ability to fall into a slumber. Clients with anxiety often describe the struggle with racing thoughts and worry, which prevents them from calming down once the head hits the pillow. Chronic insomnia can also lead to many other emotional issues, including mood swings, anxiety, depression, and in severe cases, can even trigger mania or suicidal thoughts.
Sleep is vital for our well being, but how much do we need? This is a more complex question than most of us realize. Despite what you may have been told, there is not necessarily a formula that takes into account age and spits out the appropriate number of hours of sleep needed. It's not that simple! While the Center for Disease Control and Prevention (https://www.cdc.gov) reports that one third of U.S. adults get less than the recommended amount of sleep, the question becomes.....what exactly is the recommended amount of sleep for ME? Behavioral sleep medicine, such as cognitive behavioral therapy for insomnia (CBT-I) involves taking a closer look at the individual needs of each person, rather than focusing on a one-size-fits-all prescription for the right amount of sleep to feel rested and function effectively during daytime hours. With the right professional guidance, behavioral modifications and changes in thoughts and beliefs about sleep can make a significant difference in improving your slumber. The reality is that sometimes the problem is more about lying in bed awake with the perception that you are sleep deprived, NOT that you actually are sleep deprived. For many people, this is initially a difficult concept to grasp as the long-term belief has been "I am not getting enough sleep." Now to answer the question, "Why can't I sleep?"....well, maybe you actually are sleeping, but need to change the way you view your nocturnal needs and bedtime behavior. If you are really not sleeping enough to function, a closer look into the issue can lead to a solution. Proper assessment for insomnia by a behavioral sleep practitioner will help determine what is actually going on so that the appropriate course of treatment can be designed and implemented.
For now, here are a few starter tips to help take the focus off the time you are NOT sleeping:
(1) Turn any visible clocks around - no staring at the clock to count the minutes you are awake!
(2) Use your bed for only sleeping and sex. These are the only things that should happen in your bed.
(3) Sleep in your bed, and nowhere else. Try to avoid falling asleep on the couch or in your favorite recliner, as this can make your bedtime routine more challenging.
(4) If you cannot sleep, get out of bed. You want to associate your bed as a place where you sleep. If too much time passes and you are awake in bed, you will start to associate your bed with wakefulness.
(5) Start paying attention to how you feel during the day rather than focusing on the belief "I didn't get enough sleep." Are you functioning well at work? Do you feel rested? Are you actually sleepy during the day or alert and awake? Maybe you did actually get the amount of sleep needed, but your sleep requirement is less than many people you know.
(6) If you are having short-term insomnia problems (2 weeks or less), try to "go with the flow." This is likely happening because of a stressor in your life - mental or physical - and will pass once you work through it. However, if the insomnia persists, get help before it becomes a chronic issue.
Because insomnia impacts both your physical and mental health, both physical and mental health issues should be assessed in order to have the most effective treatment plan. A complete medical exam is recommended to screen for physical issues that may be impacting your ability to get the rest you need. Additionally, working with a therapist allows the opportunity to explore mental health components that could be contributing to your insomnia. The longer insomnia persists, the more difficult it can be to treat as old thought patterns and behaviors need to be altered. For example, changing behavior of 1-2 years that contributes to insomnia is going to be easier than changing behavior of 10-11 years. Don't wait to get help for chronic insomnia, as this can cause many years of unnecessary suffering.
Consider alternative solutions, such as cognitive behavioral therapy for insomnia (CBT-I). This is often very brief treatment with a limited number of visits, and a successful track record of positive outcomes and long-term results. CBT-I is focused on eliminating negative habits, behaviors, and disruptions to improve sleep efficiency. Check here for more information on CBT-I and behavioral sleep medicine https://www.behavioralsleep.org/index.php/sbsm/about-bsm/what-is-behavioral-sleep-medicine
If you have more questions about assessment and treatment for insomnia, contact me for more information and an initial consultation. Let's talk and see if I can help!
Anissa Bell, LMFT, Clarity Therapy Associates, San Diego, CA