Surprised by Sleep

Professor Colin Espie at Glasgow University’s sleep research centre calls it “Attention-Intention-Effort” in the insomnia cycle.  The more attention and intentional effort you put into trying to get to sleep the more hypervigilant you become, resulting in yet more fragmented sleep.

That’s why some of the best problem solvers and highest achievers are stunned to find themselves stuck in conditioned insomnia, unable to predict or control sleep through the night despite avidly practising all the sleep hygiene measures.  Even backed by good science, (which is why sleep psychologists check on your sleep hygiene practices in the first CBTi session), if you cling to sleep hygiene practices without restricting awake time in bed you will likely associate your bed with frustrated wakefulness.  Or hopeful wakefulness.  Either way, the yearning for sleep means nonacceptance, and more control strategies (and even mindful meditation can constitute a control strategy if you try hard enough, ironically).

So the path out of insomnia may surprise you. Instinctively people see over time that attention and intentional effort means trying too hard and making sleep worse.  After putting in this much sleep effort they’ve expected to get a sleep result, not:

More sleep effort/aids= more sleep expectation = more hypervigilant attention = less sleep.

This is what we call an expectancy violation, where a predicted outcome didn’t occur, resulting in surprise.  

Surprises are everywhere in sleep, both dreadful and wonderful surprises.  And they all mean new learning.  Clinical Psychologist Michelle Craske uses expectancy violations in CBT inhibitory learning theory, to treat panic. Expectancy violations promote stronger learning which helps new “my bed is not a danger signal” associations win out over competing “my bed is a danger signal” associations that may be long-held.  

In insomnia an example behavioral experiment would be NOT doing a sleep-safety seeking action that was predicted to assist sleep – warm bath, relaxation or white noise app – with a commitment to worsened sleep that night.  Or worse, doing something (late exercise or 4pm chocolate) that would again increase your likelihood of worse sleep.  Already this must seem counter-intuitive to people with insomnia, but insomnia is paradoxical at core, after all.  The harder you try…

The next morning we will review just how bad your sleep was.  If your sleep is poor that night, no surprise – it’s what was predicted, after all.  But what if you sleep the night through? Specifically after not doing all the careful bedtime routine?  How does that work? – after all, you’re not setting up for sleep success like previously.  These are surprises, or expectancy violations.  And how big the surprise is, is how memorable the learning is.  And curiosity about paradoxical sleep is a pretty interesting emotional state compared to fear, don’t you think?  See our “Unlearning Insomnia & Sleep Medication Dependence” workbook if you’re interested in more behavioral experiments that overturn backfiring sleep control strategies.