🎯 What Is Insomnia?
Insomnia is a consistent struggle with sleep resulting in a significant decrease in your quality of life or daily functioning. It can be acute—lasting days to weeks—or chronic which means it occurs most days for more than a month.
👀 3 Types of Insomnia
- Initial Insomnia. Initial insomnia is when you have trouble falling asleep when you first get into bed. Laying in bed worrying about not falling asleep, for example.
- Middle Insomnia. Middle insomnia (sometimes called maintenance insomnia) is when you fall asleep initially but wake up in the middle of the night and struggle to fall back asleep.
- Terminal insomnia. Terminal insomnia involves waking up in the very early morning, before your normal rise time, and being unable to fall back asleep.
😬 Problems Associated with Insomnia
- Low mood and irritability. People with insomnia often struggle with excessive moodiness and irritability and have a harder time managing difficult emotions generally. Insomnia can also be a significant maintaining cause of depression.
- Low energy, motivation, and focus. Insomnia is an under-appreciated factor in procrastination as well as difficulties concentrating and following through on projects or goals.
- Sleep Anxiety. When you struggle to sleep, it’s natural to start to worry about not sleeping or the consequences of poor sleep. This leads to anxiety about sleep, which in turn makes insomnia even worse.
- Intimacy Issues. When it’s chronic and severe, insomnia can lead to significant relational issues with important people in your life, especially spouses, partners, and kids. It’s hard to be truly present and attentive when you’re constantly struggling with sleep and rest.
🌀 Origins and Causes of Insomnia
Common initiating causes of insomnia:
- Birth of a child. The birth of a child is frequently a joyful and beautiful experience. It’s also highly disruptive to sleep—and this is especially true if either the parents or child has significant health issues. While most people recover from the sleep disruptions that begin with a new baby, for many people it initiates the habits which lead to chronic insomnia (worry in bed is a common one).
- Divorce or separation. For many people, their insomnia can be traced back to a divorce or separation. Because it’s a highly stressful and emotionally-taxing process, it’s not uncommon for it to cause significant sleep disruptions and changes in sleep habits which eventually lead to insomnia.
- Death of a loved one. It’s normal for sleep to be affected during the grieving process and acute insomnia is often the result. But if it leads to significant changes in your overall habits around sleep, acute insomnia can turn into chronic, long-term insomnia.
- Traumatic event. Any sort of traumatic event from physical abuse to the loss of a job can trigger an episode of insomnia.
Common maintaining causes of insomnia:
- Sleep anxiety. This is the most common maintaining cause of chronic insomnia… The more you worry about poor sleep and its negative effects, the more anxious you become about sleep. And the more anxious you are about sleep, the more you will struggle with sleep.
- Sleep effort. Exerting effort of any kind promotes wakefulness and interferes with sleep. So, counterintuitive as it may sound, trying to sleep is one of the very worst things you can do if you have insomnia. A good metaphor for this effect is the Chinese finger trap—the harder you pull, the tighter it gets. This is the paradox of sleep effort.
- Alcohol and drug use. Many common drugs from alcohol and marijuana to common anti-anxiety medications like Xanax can help you fall asleep initially. But they also lower your overall sleep quality. So even if they knock you out, you’ll tend to have more fitful and restless sleep and feel worse the next day.
- Sleep perfectionism. Sleep perfectionism means maintaining unrealistically high expectations for your sleep. “I have to sleep 8 hours!” “If I don’t get good sleep tonight, tomorrow will be a disaster!” etc. Sleep perfectionism increases sleep anxiety and frustration which only exacerbates insomnia.
- Chronic stress. People who have chronically stressful lives and aren’t good about putting boundaries on their stressors tends struggle with sleep and be more vulnerable to insomnia. This is especially true for difficulties with overthinking and not being able to “turn off” their problem-solving brain during bedtime.
💡 Key Insights About Insomnia
- Insomnia is an anxiety problem, not a sleep problem. Insomnia has traditionally been classified as a sleep problem because, superficially, that’s the aspect of insomnia we most easily see and feel. But unlike other sleep disorders such as sleep apnea or narcolepsy, there’s nothing wrong with your body’s ability to sleep in insomnia. Insomnia is when your thoughts and behaviors interfere with your body’s natural desire for sleep. And those problematic thoughts and behaviors—like worry and avoidance, for example—are the same ones that govern anxiety. Of course, this may sound surprising or controversial, but it’s worth reflecting on—especially if you’ve struggled with insomnia for a long time without much success. Maybe you’re “treating” the wrong issues?
- Medication can be effective (and risky) for insomnia. Sleep medications like Ambien or Lunesta can definitely be helpful when used correctly. But they’re also risky… Not because they’re especially physically addicting, but because they’re psychologically addicting. In other words, it’s easy to start to emotionally rely on medications to fall (or stay) asleep. And as a result, you start to fear that you won’t be able to sleep without them. This growing fear and lack of confidence in your ability to sleep unaided by drugs can become a core driver of insomnia and is often very difficult to undo.
- Tired is different than sleepy. People with insomnia frequently confuse these two very distinct concepts: Sleepy means your body is literally ready to sleep. It’s that feeling when your eyelids are droopy and you start nodding off. Tired means all sorts of things ranging from physical exhaustion to stress and emotional strain. While they sometimes overlap, just because you’re tired doesn’t mean you’re sleepy. As you cross the finish line of a marathon, you’re very tired but nobody falls asleep then! This distinction matters because if you try to sleep because you’re tired but not actually ready to sleep, you will only get more frustrated and anxious about not sleeping, which in turn will further aggravate your insomnia.
- Rule out other sleep issues, especially sleep apnea. When you’re struggling with chronic insomnia, it’s important to rule out other sleep issues that could be related to insomnia. Sleep apnea, narcolepsy, restless leg syndrome, and sleep-phase disorders are the most. Typically you’ll need to see a sleep physician to diagnose or rule these out. If you do have another sleep issue, it’s often much easier to address the insomnia once the other sleep issue has been properly treated.
🛠️ Tips and Tools for Dealing with Insomnia
- Boost your sleep drive with sleep compression. Sleep drive is your body’s physical need for sleep. The longer you’re awake and active, the more of it builds up and greater your need for sleep. After sleeping, your sleep drive is depleted and begins building up again over the course of the day. You can increase your odds of falling asleep quickly and sleeping deeply throughout the night by ensuring that you have plenty of sleep drive built up. And one way to do that is by temporarily shortening the amount of time you spend in bed. If you typically spend 8 hours in bed and struggle to get 5-6 hours of sleep, compress your time in bed window to 6 hours. This means that you will be out of bed building more sleep drive throughout the day which will make it easier to sleep well at night. Once you’ve re-established consistently good sleep, you can gradually expand the amount of time you spend in bed back to your ideal amount (7-7.5 hours for most people).
- Don’t get into bed if you’re not sleepy. Most people assume that just because they’re tired, their body is ready for sleep. But as anyone who’s gotten in bed only to feel frustratingly awake and alert knows, just because you’re tired doesn’t mean you’re sleepy. If you struggle with insomnia, it’s essential that you don’t “try” to go to sleep if you’re not actually sleepy. Even if it means staying up later than usual and getting less sleep that night overall, it’s better than getting into bed before your body is ready, then getting anxious and frustrated about not sleeping, which only reinforces your insomnia and leads to a harder time getting to sleep.
- Maintain a consistent wake-up time. Contrary to popular opinion, it’s actually much more important to have a consistent wake-up time than a consistent fall asleep time. When you get out of bed at the same time every day, it ensures that you have adequate time to build up enough sleep drive so that by the end of the day you’re truly sleepy and ready for a good night’s sleep. Furthermore, unlike when you feel sleepy, you can always control when you get out of bed. That is, you can’t make yourself feel sleepy, but you can make yourself get out of bed. And as we’ve discussed, getting into bed when you’re not sleepy is a recipe for worse insomnia.
- Build a sleep runway. And stick to it. Most of us spend all day doing a lot of thinking and problem-solving. And your big problem-solving brain is like a jet airplane—it’s powerful and fast, so before it lands and comes to a complete stop at night (i.e. falling asleep), it needs plenty of “runway” to descend and slow down. A sleep runway is a consistent stretch of 90-120 minutes at the end of the day when you don’t do anything effortful or analytical (e.g.: checking work emails, difficult conversations with your partner, etc.), and instead, allow yourself to relax with calming and leisurely activities (e.g.: watching a movie, reading for pleasure, listening to music, etc.) And it’s critical that you protect your sleep runway time every single night.
- Don’t be afraid of naps and coffee. Good news… Just because you have insomnia doesn’t mean you can’t drink coffee or take naps! Obviously you don’t want to be drinking multiple cups of coffee in the evenings or napping for two hours in the late afternoon, but a cup of coffee or two in the morning or a short nap (30 minutes is ideal) early in the afternoon is unlikely to interfere with your sleep. The half-life of caffeine is about six hours, which means if you stop drinking coffee by noon, you have plenty of time for it to clear your system before bed. Similarly, a short nap in the early afternoon won’t deplete your sleep drive so much that it will significantly affect your sleepiness in the evenings. If you enjoy them and find them helpful, coffee and naps are perfectly compatible with being a healthy sleeper and overcoming insomnia.
💬 Quotes About Insomnia
- “I already want to take a nap tomorrow.” — Anonymous
- “Also, I could finally sleep. And this was the real gift, because when you cannot sleep, you cannot get yourself out of the ditch—there’s not a chance.” — Elizabeth Gilbert
- “Insomnia is a glamorous term for thoughts you forgot to have in the day.” — Alain de Botton
- “O sleep, O gentle sleep, Nature’s soft nurse, how have I frightened thee. That thou no more will weigh my eyelids down, And steep my senses in forgetfulness?” ― William Shakespeare
- “If you can’t sleep, then get up and do something instead of lying there worrying. It’s the worry that gets you, not the lack of sleep.” — Dale Carnegie
🔬 Selected Research and Statistics on Insomnia
- 2021 meta-analysis of the most effective treatments for insomnia. This is the most well-designed and comprehensive review of the research on insomnia I’ve found.
- Insomnia and mortality: A meta-analysis. Across 36,938,981 individuals studied, there was no association between insomnia and increased mortality.
- Meta-analysis of alternative treatments for insomnia. Note that none of the alternatives mentioned—from melatonin supplementation to meditative movement and exercise—had better results than CBT-I, the gold standard treatment for insomnia disorder.
📚 Recommended Reading and Resources for Insomnia
- Goodnight Mind by Manber and Carney (Book). Short, practical book with excellent tips for navigating insomnia the right way.
- Treatment Plans and Interventions for Insomnia by Manber and Carney (Book). The best book I know for clinicians who want to understand how to treat insomnia effectively via CBT-I.
- Theses on Sleep by Alex Guzey (Article). Many of these will sound controversial, but there’s a lot of insight in here that aligns with my own clinical experience and what the research shows.
- Hello Sleep by Jade Wu (Book). My favorite recent book about overcoming insomnia. I interviewed Jade about insomnia awhile back for my podcast, which you can listen to here.
- Acceptance and Commitment Therapy for Insomnia by Martin Reed (Article). Good introduction to the third-wave/ACT approach to insomnia.
- Sleep Coach School. Online insomnia coaching.