Those experiences, even if they last only three minutes, often become exaggerated in our minds and overshadow the hours that we spent sleeping peacefully, simply because we remember them. The times that we do remember are those that we wish we couldn't: staring at the clock in the middle of the night, turning the pillow over desperately hoping that the other side is cooler, kicking the covers off or pulling them up close.
We can't easily judge the time that we are asleep because that time feels like an absence, a break from the demands of thought and awareness. It is a part of the paradox that sleep presents to a conscious mind. Some patients wake up in labs claiming that they didn't sleep at all during the night, despite hours of video and brain wave evidence to the contrary. Problems of self-reporting aren't limited to judging how long it took to get to sleep. Patients who have spent a night in a sleep lab, for instance, often complain that it took them more than an hour to fall asleep when a chart of their brain waves shows they were asleep within 10 minutes. Instead, doctors rely on self-reports from patients, which can be maddeningly vague, a result of the difficulty that we have with accurately noting how many hours we truly spent sleeping on any given night. Some patients go to sleep labs and undergo tests to rule out conditions such as sleep apnea, but knowing what they don't have offers little help in treating what they do. There is no medical test that proves whether someone is suffering from a temporary bout of sleepless nights or a more serious disorder. About one in 10 people in the US suffer from it during their lifetime. The classic form has no known cause, yet is widespread. The US National Institutes of Health (NIH) identifies the condition as "difficulty getting or staying asleep, or having non-refreshing sleep for at least one month". Instead, it is generally thought of as a string of otherwise peaceful nights during which a patient can't fall asleep when he or she wants to. One night of bad sleep because of a blaring car alarm or an upcoming stressful day at work doesn't classify as insomnia. Part of the reason is that science, as a whole, has a fuzzy definition of what constitutes the disorder. This problem compounds itself each night, leading to a state of chronic insomnia.
In the same way, sleep becomes more elusive as a person's sleep needs become more urgent. After he posed that challenge to research subjects, Wegner found that the average person becomes anxious as his or her mind constantly monitors its progress toward its goal, caught up in the second-by-second process of self-assessment. Your initial reaction most likely is to tighten up. To illustrate this concept, imagine someone telling you that you will be judged on how quickly you can relax. The cause is often the brain's refusal to give up its unequalled ability to think about itself, a metaphenomenon that Harvard professor Daniel M Wegner has called "the ironic process of mental control". Taking care of insomnia may therefore calm other aspects of a patient's life.Īnd yet insomnia is a unique and difficult condition to treat because it is self-inflicted. Mental health experts increasingly view depression or anxiety as an effect, rather than a cause, of insomnia. Is sleeplessness a result of another condition such as depression, or is the insomnia the root of the other problem? One report by the US National Institute of Mental Health found that depression rates were 40 times higher for patients with insomnia than those without sleep problems. "It is a precious good … but it is a good like none other, because to obtain it one must seemingly give up the imperative to have it."įor doctors, insomnia presents a chicken or egg problem. "The condition of sleep is profoundly contradictory," notes Emily Martin, a professor at New York University who has studied insomnia. As they lie in bed, many are caught in the classic paradox of insomnia: wanting sleep so badly that they can't get it. Every night, about a third of adults have problems falling or staying asleep that aren't related to a persistent sleep disorder.
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