Sommeil et médecine générale
Recherche dans le site

Insomnia - wanting to sleep

"Never believe straightaway in peoples’ misfortune. Just ask them if they are still able to sleep? If the answer is yes, then everything’s allright. It’s enough."
(Louis Ferdinand Destouches called Céline "Journey to the end of the night")

Insomnia is the illness of someone who suffers from being awake when he/she wishes to sleep.
That suffering is amplified by the conjunction of two factors :

    Vicious circle of acquired insomnia.

  • on one hand, the subject loses a lot of time in bed for nothing because he/she thinks (right or wrong) that he/she has to wait for the sleep to come;
  • on the other hand, he/she strongly overestimates the length of that wait, because he/she develops the skills of a watcher which he/she uses to watch out for his/her arousals, like would (for example) do a doctor on ward all over the night.

All in all, the truly sleepless nights are rare but they are experienced in such a painful manner that the sick person is ready for anything to protect him/herself from them.
In fact, for the insomniac, the total amount of sleep doesn’t go down below a level considered as normal for very short sleepers (3 to 5 hours a day).
But, in him/her, the conditions are gathered (see below) to enter the vicious circle of insomnia and sleeping pills.

Map of the page :

"It is only when one doesn’t find sleep that he/she knows the night is long. The good sleeper has nothing to say about his/her sleep".

What is insomnia ?

It is a complaint : The person observes during the night that he/she doesn’t sleep properly and complains about it.
Nevertheless, to sleep poorly or little doesn’t alaways mean to be insomniac : there exist short sleepers and people who shorten their nights whithout any troubles. In both cases, there is no complaint, they are not insomniacs.

Is the difference only psychological ?
No, there is no specific type of personality for individuals who suffer from insomnia.
According to certain studies, some psychological characteristics or traits might though predispose to the illness :

  • Neuromuscular hyperexcitability. The term describes a state of mental and physical agitation which can persist night and day. The physiological state that goes with it appears in a muscular tension, fast hearbeats, and a high body temperature.
  • The strength of character is another one, it appears to be inversely proportional to the quality of sleep.
  • The rigidity of the certitudes concerning the ins and outs of insomnia is also implicated in its negative influence on the next day.
    • a tendency towards moral and physical exhaustion,
    • a psychomotor slowing down,
    • attention and memory disorders,

The different forms of insomnia ...

Initial insomnia, maintaining sleep insomnia or terminal insomnia?

    JPEG - 3.6 kb
    Evening insomnia

  • The initial insomnia : difficulties to fall asleep when going to bed.

    Already 1 AM, yet Mathéo went to bed early
    He has been trying to sleep for three hours.
    Usually, he takes a long time to fall asleep, but he stays in bed because he thinks that will, at least, provide him a little rest.
    He has drunk a herbal tea meant to help him go to sleep, with a couple of tablets of plant medications, tried to empty his mind, count sheeps, concentrate on his breathing, ... in vain.
    He has heard all the noises from the neighborhood, the neighbor’s clock, the noise of the fridge, the ticking of the alarm clock.
    No technique seems to be able to help him get rid of the ideas that spin endlessly in his head. In the opposite, he becomes more and more awake and anxious, turning over and over again in his bed, in search of a comfortable position, propitious to sleep.
    Two hours ... three hours ... he calculates how much time is left until he has to get up to go to work. When the alarm clock rings in the early morning, he feels totally exhausted and gets up with the feeling that he hasn’t shut his eyes.
    The days off work, he takes advantage of that morning sleep that allows him to recover but... of late...he doesn’t always manage to fall asleep!
    Sometimes Mathéo wonders if he is going to become crazy.

    JPEG - 3.2 kb
    Sleepless night

  • Maintaining sleep insomnia : multiple arousals during the night.

    All night long, Ferdinand looses all his time. In the evening, he goes to bed exhausted as soon as he can and falls asleep in five minutes but, with no apparent reason, wakes up almost every hour.

    - Sometimes, he can fall asleep again, he is very careful not to move in order not to wake up completely.

    - Sometimes, too, he experiences a lot of trouble going back to sleep but he prefers to stay in bed. He casts an eye on his alarm clock, once, twice, ten times...

    - Rarely, he gets up, spends a part of the night up, but it makes him nervous to think about how tired he will be during the day. He gets angry with himself and wonders what he is doing up while everybody else is asleep. He ends up going back to bed around 5 or 6 a.m. and, when the alarm clock rings, he has to make a prodigious effort to get out of bed.
    He has made up his mind : tomorrow, he will talk about it with his doctor.

    JPEG - 4.1 kb
    Morning insomnia

  • Terminal insomnia : too early morning rise.

    Every morning, Mireille wakes up, without being able to fall asleep again.
    She generally falls asleep quite easily in the evening (sometimes, she takes a little pill ("it can help") but never sleeps more than five or six hours.
    In the early morning, she hears the noises from the street, goes to the toilet, goes back to bed, hoping to fall asleep again before the alarm clock rings for her to go to work.
    Mireille panics, her thoughts are pessimistic, keep up like that much longer, but how is she supposed to do, what with the house, the children, shopping...
    She dreams, her thoughts wander aimlessly, she doesn’t know anymore about anything, her mind is worried all that time.
    When the alarm clock goes off, she thinks that she was not sleeping, she feels drained, heavy and stiff, and more tired for the day ahead than she was the day before...
    Her neighbour told her that she was depressive, that she should talk to her doctor.

All in all, are you like Mathéo, Ferdinand or Mireille, or a bit of each ?

In fact, there is no unique definition of insomnia. There exist many individual differences when it comes to the needs of sleep of every person.
Some very short sleepers consult because they don’t stand to sleep less than their partner... though they have no disorder at all (neither sleepiness nor functional disorders). (The real problems start in case of untimely use of sleeping pills !).

Insomnia results from the shift between the way sleep is experienced (sleep onset latency, continuity and duration) and the expectations in terms of satisfaction and efficiency (sensation of rest, performance and vigilance during the day).
The experience of everyone is that a «bad night» often results in a gloomy day with troubles with memory and concentration.
The insomniac patient lives with the terror to renew the experience.
That is the starting point of a true vicious circle where the fear to sleep badly finds its justification in the certainty that the next day will be ruined.

Insomnia is a subjective experience and that subjective perception of sleep does not always correspond to the real physiological sleep, as measured with the electroencephalographic recording.
We observe, for example, that the insomniacs have a tendency to overestimate the time they have to wait to fall asleep and underestimate their total sleep time. When they are woken up in stage I or II (i.e. during light sleep), they often claim they were awake while good sleepers are more likely to say they were asleep.

Two types of insomnia ?

The habit has been taken to distinguish two types of insomnia. In fact, it is rare that insomnia depends on a unique factor. It is the resultant of several components (event related, behavioral, cognitive, psychological) which have repercussions on the person’s physiology through activation, excitement phenomenons, incompatible with a good sleep.

  • Occasional insomnia : passing, short term.
  • Chronic insomnia : its duration can go from several months to several years, and its origin can be linked to the organism of the person itself, or to exterior factors (environment...). Often, it results from a bad care (sleeping pills +++) of an occasional insomnia of which the natural tendency is towards aggravation (inherent to the fact that cognitive changes happen from the first herbal tea used to help one’s sleep ...)

NB. Many insomnias of the adult originate in childhood, when the little one gets used to have to wait and hope for sleep while he/she has been put "to sleep" at a wrong time.
That distrust and the incompetence to find sleep will unveil, years later, at the occasion of a situation where the subject will think that it is very important for him to manage to sleep. The sleeping pill thus appears like a true lifeline.

How does an insomnia become chronic ?

Who suffers from insomnia ?

The surveys show that :

  • more than one adult out of three suffers from insomnia,
  • 27% of the general population complains of an occasional insomnia,
  • 10% of the population suffers from chronic insomnia.

NB : These numbers are much higher than those resulting from consultation surveys. Many insomniacs choose not to mention the subject with their doctor... (fear of the sleeping pill or of an irrelevant answer ?)

There exist several causes of sleep dirturbance : psychiatric, medical, pharmacological, environmental... Some people are more vulnerable than others, but almost everybody can develop sleep disorders in the presence of stressing events of life for example.
It is called occasional or reactional insomnia. Such an insomnia is generally limited in time but the moral pain associated with it leaves the subject who ,in the opposite hopes to sleep in order to forget his/her troubles, the painful memory of a true "sleepless night".
The awakening is tainted with dark thoughts but the daytime performances of the subject are not objectively affected.

JPEG - 16.9 kb
Not sleepy

It is even probable that that form of insomnia, described as physiological, is a reaction of defense, beneficial in a stress situation.
It can be pictured that that reaction of arousal in a situation of danger has contributed to protect mankind in the past.
This excitement, with such harmful consequences as far as sleep is concerned, could, in the beginning, take part in increasing daytime performances and, during the night, provide a time for thinking that a sleepy state would not allow.

Yet, for a large amount of persons, the disorder persists. It is here that the "psychological" factors play a major role in the development of insomnia which becomes gradually chronic.
The term of psychological factors describes, in that context, behaviours, attitudes, beliefs regarding sleep.
Some of these learned reactions are incompatible with a good sleep and maintain the disorder. That type of insomnia is referred to as "learned insomnia".

According to our experience, these situations of physiological insomnia reveal a preexisting loss of confidence towards sleep, often acquired in early childhood.
Childhood is a period of great vulnerability (unrestrained imagination) where the parents’ errors quickly lead to the fear of sleeping. The short sleeping children are particularly exposed to insomnia because they get used very young to wait for the sleep to come. See the child’s sleep.

Thus, there exist :

  • genetic factors that predispose to insomnia (short/long sleeper, morning/evening person). See the questionnaires of sleep typology
  • environmental or social factors that hasten insomnia : a stress, a death, an illness, familial or professional problems... See "life events"
  • maintaining factors like attitudes or beliefs regarding sleep.
    • an excessive time spent in bed waiting;
    • irregular waking up hours during the week-ends;
    • naps during the day etc...
    • thinking that one needs more than eight hours of sleep to work well the next day;
    • the most frequent belief being to consider insomnia the cause of all evil.

Apart from these bad habits and irrational thoughts, another factor is implicated in the constitution of a chronic insomnia; it is the excitement (the physiological activation) of the arousal systems :

  • cognitive excitement : linked to thoughts and/or worries,
  • physiological disturbances : linked to muscular tension, warming of the body, changes in cardiac rythm, hyperactivity of the brain.
  • reinforcement of the beliefs.
  • counterproductive behaviors ...

It is the vicious circle of insomnia :

The chain reaction; the cascade that maintains and aggravates an occasional insomnia that occurs on a predisposed ground :

  • Supply for the beliefs :
    • worries concerning the loss of sleep ("I will never sleep again")
    • brooding over connsequences ("I am going to fail everything tomorrow, or become crazy")
    • unrealistic expectations ("It will be ok if I sleep 9 hours")
    • false attributions /amplification : ("If I had no worries, I would sleep"/ "I haven’t closed my eyes all night")

  • Behavioral consequences :
    • excessive time spent in bed ("I wait without a move")
    • irregular sleep schedules ("On Sunday mornings I make up for the week bad nights by sleeping until 10 o’clock.")
    • naps during the day ("I rest but I don’t sleep")
    • activities that are incompatible with sleep ("I choose the most boring TV program because it puts me to sleep")

  • Activation/hyper-excitement :
    • arousal reaction, proportional to the efforts to control the phenomenon.
    • cognitive excitement : racing of negative thoughts that "spin in a circle"
    • physiological excitement : increase of the body heat linked to muscular tension, to the changes in blood pressure and cardiac rythm, to the hyperactivity of the brain.

  • Disturbances :
    • emotional : the mood is upset (anxiety, anger, despair), a social embarrassment can settle;
    • cognitive : intellectual tiredness, performances decrease;
    • physiological : tiredness settles with its functional components (See the hypo-sleep syndrome).
JPEG - 34.1 kb
Cognitive and behavioral vicious circle

and ...

  • insomnia out of performance anxiety generated by the failure of the attempts to control sleep and which will maintain insomnia in the future.
    (Anxiety is an extremely awakening feeling): To try to sleep when not inclined to is an ordeal.

    How to manage the problem ?

    Read, here, the rest of the article about "Wanting to sleep : Insomnia"

    Smg offers you an interactive sleep disorder screening test : "select the items for which you feel concerned" ... ... "your answers are compatible with the following problem(s)" ... "you should discuss these questions with your doctor".

  • P.S. 

    This text is freely adapted from the principles of Cognitive Behavioral Therapy applied to insomnia, used by Professor Charles M. MORIN (sleep specialist at the Laval University in Québec).
    We advise you to refer to his book designed for the general public : "Defeat the enemies of sleep" (Marabout santé 3599).

    Auteur | Contact | Copyleft | Traductions | derniere modif 8 January 2008.