The Sleep Solution: Why Your Sleep is Broken and How to Fix It

by W. Chris Winter

Instead of setting an arbitrary time like this, just try to pay attention to your body. If you’ve been in bed for a while and you don’t feel like sleep is going to happen anytime soon, you can get up. But you don’t have to get out of bed if you don’t want to. If you are still “trying” to fall asleep even though I told you not to, and this is stressing you out, it’s okay to get out of bed. If you are not too bothered by the situation, I recommend simply lying there and resting. Plan out your dream vacation. Plan a surprise date with your partner or a thoughtful gift for

a coworker. It’s important to remember that resting even without sleeping is good for you too. You’re not wasting your time if you are lying in bed and not sleeping. If the twenty-minute thing is happening frequently, listen to your body. You are going to bed too early. It’s time to go to bed a little later.

Make your room dark. Crazy dark. Spend so much money on your new bedding and room furnishings that you can’t afford your nicotine and caffeine habits anymore. Buy your spouse a special gift, then kick him out of your bed until his own sleep problems are fixed. Develop a sleep routine. Feel free to incorporate Goodnight Moon. It works on adults too.

So if insomnia is not “not sleeping,” what is it? It’s simple. It’s not liking your sleep. You are allowed to not like your sleep yet still be sleeping. You can dislike your job, yet still show up for work every day. I think it is okay for a doctor to help a patient understand that his insomnia is not stemming from an absence of sleep. The doctor is simply reframing and redefining the problem. This redefinition should never lead to dismissing the patient or the problem. This is so important, I’m going to say it again in a slightly different way:

Knowing that a patient who says he can’t sleep does in fact sleep is not the same thing as the patient not having a problem or not needing treatment.

“It’s that thing when someone can’t sleep.” Wrong! We’ve already established that everyone sleeps, sometimes. A better definition involves two key elements: An individual who is dissatisfied with the quality of his sleep on a regular basis, say two to three times a week or more for three months. These lines in the sand are arbitrary.

I would remind you that a difficult night of sleep from time to time is okay. It’s part of the human condition, so to speak. We have really bad breakups with girlfriends. Our pet rabbits die unexpectedly. Fantasy football quarterbacks underperform on Monday Night Football. To put it bluntly: Shit happens. If that difficulty is happening more than what you like or can tolerate, you are halfway to having insomnia. An individual who cares, and cares a lot. Having difficulty with your sleep from time to time is not insomnia. To truly have insomnia, that difficulty sleeping has to bother you, annoy you, really get under your skin. It was shown in an interesting 2012 study that insomnia patients remember their bad nights of sleep more than their good nights. This selective memory is often on display when I ask a patient how her sleep has been since her last visit two months earlier. “Terrible” is the reply, but after looking at her sleep diaries, I see there are often more good nights than bad. For some insomnia patients, it is almost as if the good nights had never happened. For healthy sleepers, the opposite is true. They pay little to no attention to the night or two of bad sleep they have.

Insomnia is not when an individual can’t sleep. The true definition of insomnia consists of two components: A person is not sleeping when she wants to sleep. The person cares, and usually cares a lot, about not sleeping, whether or not she wants to admit it.

Most people consider a thirty-minute struggle or longer to meet the insomnia criteria. I think any amount of time, if it is frustrating, fits the bill.

Classically, the sleep-onset insomnia patients were thought to be anxious, whereas the individuals who struggled to maintain their sleep or who awoke too early were thought to be depressed. Most sleep experts do not subscribe to this way of thinking anymore. In reality, a good way to think about this is as follows: Anyone whose sleep is inefficient— meaning the time he sleeps divided by the time he is in bed is a low number, say less than 75 or 80 percent—has insomnia.

In 2005, neuroscientist Gilberte Hofer-Tinguely showed resting without sleeping improved cognitive performance. Resting is not wasted time; in fact, a 2009 study revealed that for some cognitive tasks, the benefits of resting are indistinguishable from those of sleep. So don’t worry too much about getting into bed and not sleeping immediately or having a prolonged awakening during the night.

Time and time again anxiety usually emerges as the number one cause of insomnia. Don’t believe me? Go find an insomnia blog. Now go find a blog for people struggling with some rare and deadly tropical disease. Which group seems more anxious about their condition?

Sleep is a skill to some degree. We all eat, but some among us can eat forty-three hot dogs in ten minutes. These individuals have taken an act that we all engage in and, through training, have made it into a superior, nauseating skill. Like anything else we do, we can approach our sleep in a similar way. We can learn to be good at it.

Once an individual has suffered with a sleep problem for more than three to six months, changes in the psyche of that individual start to happen. Going to bed, a relatively benign activity, starts to become a very negative task. Hours before one goes to bed, dread of sleep starts to set in.

the old plan of “get into bed and feel miserable as I try to sleep” is replaced with “get in bed to rest and do my relaxation drills.” Remember: Never try to sleep.