Many individuals struggle with some symptoms of insomnia, a condition that impairs functioning and exacerbates mental health difficulties. Although insomnia can be caused by a variety of medical conditions, including sleep apnea, chronic pain, and neurological disorders, primary insomnia is more common than these other conditions, whereby the sleep difficulties do not have a specific medical cause (Krystal et al., 2019). For individuals struggling with primary insomnia or other sleep difficulties, most individuals have heard of basic sleep hygiene techniques, such as sleeping in a dark environment and decreasing activity or screen time before bed. Nevertheless, there are additional evidence-based techniques for improving sleep that are a bit more complex, and perhaps may even appear to be counterintuitive at face value. Specifically, the techniques of sleep deprivation, controversy surrounding napping, and paradoxical intention will be explored in further depth. If you are struggling with chronic sleep deprivation or implementing these techniques, please consult with a medical provider first, and work with a mental health provider trained in sleep disorders.
Sleep Deprivation
Sleep deprivation is the primary technique used in the evidence-based treatment for primary insomnia: Cognitive Behavioral Therapy for Insomnia (CBT-I) (Trauer et al., 2015). CBT-I recommends sleep deprivation to improve sleep quality in the long run, by restricting the amount that you sleep during the day, improving the sleep-wake cycle. For example, if an individually currently goes to bed at 9PM, but does not fall asleep until 11PM to 12PM, then wakes up until 3AM, and then sleeps from 3AM to 7AM, the recommendation may be for the person to start sleep deprivation by trying to sleep only from 2AM to 7AM. Then, when the sleep deprivation technique works, the amount of sleep will be gradually expanded, whereby the individual may go to bed from 1AM to 7AM. Therapists trained in CBT-I can help calculate the recommended amount of sleep, and help individuals to track sleep over time. Thus, although it may seem counterintuitive to try to stay awake, this may ultimately be what is needed to get back on track.
Napping
One of the controversies that individuals face when trying to work on their insomnia involves deciding whether or not to take naps. Sleep experts are divided on this issue. Practitioners that endorse the idea of eliminating naps point to evidence about preventing disruption of the sleep-wake cycle and certain individuals’ experience of naps being disruptive, rather than energizing. To the contrary, practitioners that support power napping, point to evidence showing that some people are more focused and attentive after brief naps. Moreover, most sleep experts are primarily concerned about longer naps, which can lead to sleep inertia (i.e., feeling groggy and tired after waking up from deeper stages of sleep) and increased difficulties falling asleep at night.
Paradoxical Intention
Another counterintuitive technique that is weaved into sleep deprivation and other evidence-based approaches is called paradoxical intention (Jansson-Fröjmark et al., 2021). When discussing sleep techniques, paradoxical intention refers to the idea that trying to fall asleep actually makes it harder to fall asleep. Therefore, to apply paradoxical intention, when it is difficult to sleep, it is recommended that the person gets out of bed and participate in a different activity that does not involve pressuring oneself to fall asleep. Instead of fighting the wakefulness, a person practicing paradoxical intention should refrain from looking at the clock, and should provide oneself with counterintuitive messages like, “Everything will be ok, even if I am awake all night.” After a period of time engaging in a different activity, a person may find that she or he naturally begins to feel tired again, drifting off to sleep.
As noted earlier in this post, if you are struggling with insomnia, first consider consulting with a medical provider to make sure that an underlying medical condition is not causing your insomnia. If you are facing primary insomnia, you may benefit from working with a mental health practitioner to implement these (and other) techniques, as you work toward maintaining a routine that promotes quality sleep. Although these techniques are perhaps not as intuitive as staying in bed as long as possible, going to bed earlier, or taking long naps during the day, the techniques outlined in this blog have greater evidence for their efficacy than the habits one might automatically develop to try to cope with the difficulties of insomnia.
About the Author
Samuel Eshleman Latimer, Psy.D., (he/his) is a clinical psychologist that specializes in effective conflict management and dialectical behavior therapy. Samuel also works to help individuals, couples, and families decrease interpersonal difficulties and manage challenges associated with borderline personality disorder. Samuel believes that people do not need to choose between learning effective techniques that are based on science and developing warm, genuine relationships, as both of these styles complement each other. Click Here to learn more about Samuel’s experience and therapeutic style.
References:
Jansson-Fröjmark, M., Alfonsson, S., Bohman, B., Rozental, A., & Norell-Clarke, A. (2021). Paradoxical intention for insomnia: A systematic review and meta-analysis. Journal of Sleep Research, https://doi.org/10.1111/jsr.13464
Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an update. World Psychiatry, 18(3), 337–352. https://doi.org/10.1002/wps.20674
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine, 163(3), 191-204. doi:10.7326/M14-2841