I Can't Sleep Because I'm Worried About Not Sleeping

The breathing problem uncovered during my sleep assessment is only a piece of the puzzle. After conducting a probing interview concerning my sleep problems and habits, Dr. Clerk concluded that I also suffer from a rather respectable case of good old-fashioned chronic insomnia — the inability to fall or stay asleep — a distinction I share with 35 million others. (We're a regular bleary-eyed nation).

Anyway, the first thing to know about insomnia is that it's really just a symptom, with a myriad possible causes: physical disorders, psychological stresses, too much alcohol or caffeine, the list goes on and on.

The Cycle of Sleeplessness

Usually, several of these factors are acting in concert. In some especially contrary cases, the cause of insomnia seems to be insomnia itself. Guess what? Dr. Clerk says that's the way it works for me.

He began to suspect as much when I told him how my sleeplessness makes me feel.

"The most frustrating thing is, I can't sleep when I need to," I said. "Say I'm working overtime on a story, and the deadline's bearing down, and I need to get a good night's rest. That's exactly when I won't sleep at all. Then I'm wasted the following day and I don't get anything done, so the next night, there's more pressure and I really need to sleep, but even though I'm exhausted, I just lay there wide awake, waiting to nod off. I just don't have faith that sleep will ever come."

Dr. Clerk nodded, as if he had what he was after. "You worry that you are not able to sleep," he said, "and as a result you are not able to sleep."

I had to admit, it sounded so me.

"The harder you try to sleep, the more worried you become, and the harder it is to fall asleep," he continued. "This is psychophysiological insomnia, it means you have conditioned yourself to have difficulty falling asleep."

Wait a minute! I've taught myself how not to slumber?

"Exactly," said Clerk, "you have lost faith in your ability to sleep."

I shrugged, muttered that faith truly is a gift and asked him how I got this way. He told me it's a matter of simple conditioning. The more I fail at sleeping, the more I associate all the trappings of sleep with big-time slumbo- failure. For most folks, he said, the bedtime ritual — brushing the teeth, turning out the lights, pulling up the covers — is an effective cue triggering relaxation and drowsiness. For me, it's a warning buzzer signaling frustration ahead: a neurotic wake-up call that sends me to bed fully jazzed and ready for nothing.

Tips for a Better Night's Sleep

Sounds familiar. But how can I change my ways? Clerk responded with the following list of tips, intended to unravel all my negative bedtime associations:

Get up the same time every day, and go to bed only when sleepy.
Exercise regularly, (but never close to bedtime) and cut down on caffeine.
Establish a relaxing pre-sleep ritual — a warm bath, a light snack, 10 minutes of light reading. But skip the nightcap, since even a small dose of alcohol can make your sleep more fragile.
Use the bedroom only for sleep and sex — that way, you'll be conditioned to relax whenever you enter.
If you can't fall asleep in 20 minutes, don't toss and turn. That will only exacerbate the negative associations between bedtime and sleep. Instead, you should get up, do something boring and go back to bed only when you feel drowsy.

Well, see, I've had all that just about exactly backward: I tend to swill coffee, work late, fall into bed while my mind's still chugging and, when I can't nod off, I fixate on the work I didn't finish, or the puzzling silence of God, or why my beloved Steelers continue to blow games in the AFC finals.

But now I know better, and one more piece of the puzzle has been snapped into place. But I'm still a work in progress, and tomorrow I'll show you how Dr. Clerk untangled yet another of my baffling slumber woes.