A Sleep Solution Without Sleep Hygiene

Yesterday’s blog post about sleep hygiene may have been a little over the top, but the emphasis was on target. All these methods designed to improve the chances of going to sleep are good. They do help… a little. But only a little. They also trivialize the problems encountered on the way to sleep. Sleep hygiene doesn’t even address the real issues. Here is a graphic that illustrates what happens, and what can go wrong during a night’s sleep (Figure 2-1 in In Pursuit of Sleep):

The Stages and Cycles of Sleep

The Stages and Cycles of Sleep

If we sleep normally, we go through five sleep cycles of varying depth. The very first stage, the period of time where we try to get to sleep, is called hypnagogia. Hypnagogia is also called “sleep onset.” At the end of each cycle, we ascend and enter a state called REM (for rapid eye movement) where we dream. After REM, we may not go back to sleep and instead actually wake up. If we do wake, we have to try to get back to sleep again, and this involves going through hypnagogia once more. So, we have five chances to mess up a good night’s sleep by not successfully negotiating hypnagogia.

What happens during hypnagogia that it can waylay our descent into sleep? Hypnagogia has a lot of distracting influences that can be irresistible to a mind that has a lot going on during the day, as shown in the following figure, which is also from In Pursuit of Sleep (Figure 3-1):

Hypnagogia Distractions

Hypnagogia Distractions

Each of these types of distractions can pull you off the beaten path to sleep. They are described in detail in In Pursuit of Sleep, pages 22-26. The way to avoid them and find your way to sleep is to use the Transition Trek, also shown in Figure 3-1, which is described in detail in Chapter 4. The Transition Trek is a detailed thought control technique, one that directs your mind toward sleep.

So, now hopefully, you can see why I don’t have a lot of faith in sleep hygiene. It doesn’t address what actually happens when you close your eyes. Well, that may not actually be entirely true. If you have a lot of things going through your mind, they attribute them to stress and recommend you see a psychotherapist. They don’t recognize the fact that many of these thoughts are due to creative impulses, fantasies, and perfectly reasonable worries, among other things, that should not have to be address by a therapist. All you really need is a reliable thought control technique that directs you away from these disrupting thoughts and toward sleep. You should not need medication either.

All that is presented in In Pursuit of Sleep. It should be all you ever need.

The Truth About Sleep Hygiene, or the Goldilocks Syndrome

Ever notice how sleep professionals like to talk about sleep hygiene? For those of you who aren’t well read on the literature and science of trying to get to sleep — and I do mean trying — sleep hygiene is the art of making your bedroom the perfect place to sleep. You make it as dark as you possibly can, preferably dark enough to develop your 35 mm film in (for those of you who are old enough to remember that cameras have not always been digital and didn’t come as an afterthought on an iPhone). They also want you to remove all evidence of time. No clocks, even soundless, lightless digital ones. And, oh horrors! Absolutely no real-world ticking clocks. No sound whatsoever, and as much like a recording studio with padded acoustic walls etc., etc. And it must be the perfect sleep temperature, not too hot or too cold. The Goldilocks temperature, one might say. And the firmness of your mattress… Well, you get the idea. Haven’t these people ever heard of deafferentation?

Actually, I wasn’t telling you the truth, not all of it at least, when I said that sleep hygiene was “the art of making your bedroom the perfect place to sleep.” They also want to make you the perfect sleep generator. You must not eat anything too close to bedtime, it might upset your stomach, or too far from bedtime, you might get hungry.  (Makes me wonder how many times they were read Goldilocks and the Three Bears as a child.) Caffeine and alcohol are strictly forbidden, and oh yes, you can’t so much as catch a glimpse of a computer screen, or you are condemned to a lifetime of insomnia. Oh, get plenty of sunlight. And workout like a fiend.

It doesn’t stop there. You cannot ever think a bad thought about your bedroom. It must be your perfect haven but only for sleep. Well, you are allowed to have sex there, but not when you should be sleeping, because you must go to sleep at the same time each night and wake at the same time each morning. The worse thing of all is to have a bad attitude toward the amount and quality of sleep you got the previous night, or for that matter, the way you have been sleeping for the last couple of years, or, possibly, decades. No bad thoughts about sleep.

And last of all — and this is when they actually come close to the real problem — they want you to only have pleasant thoughts running through your head while you are trying to go to sleep. No thoughts about that colleague you plan to shove down the elevator shaft the first thing when you get to work in the morning, or perhaps the fact that you are considering getting a cage to lock up your 15 year old. And if the neighbor’s dog doesn’t quit barking you are going to go after both him and the dog with a baseball bat, right now. You can’t think that. Be calm, be nice, be gentle and go to sleep.

Okay. Possibly you can’t get to this sleep state by reading the rules of sleep hygiene off a website, but they have a course you can take, costs only a few hundred dollars, but the really effective way to take it is in residence, which only costs a few thousand. Did I mention that they also have medication? Not quite the same as sleep, but will certainly make you unconscious.

All this is what sleep professionals like to tell insomniacs because they know nothing about getting to sleep. Did you notice that? When you close your eyes, you are on your own. They know nothing about actually getting to sleep. You have thoughts coursing through you brain instead of sleeping? Try meditation. The purpose of meditation is to purge your mind of thoughts and put you in a perfect spiritual state. Perhaps you’ll even talk to God. Well, count sheep then. Count backwards from a thousand. Imagine shooting a hundred free-throws.

But the barking dog. The fifteen year old. And the elevator shaft.

Truth be known, sleep professionals know nothing about actually getting to sleep. Well, maybe that isn’t quite true. Researchers have studied sleep onset, the period of time from when you close your eyes until you are actually asleep. This transition state is also called hypnagogia. We have literature on it going all the way back to Aristotle. A woman, R. E. Leaning, wrote an excellent article on hypnagogia in 1925 titled, “An Introductory Study on Hypnagogic Phenomena.” Daniel L. Schacter wrote an excellent article in 1976 titled, “The Hypnagogic State: A Critical Review of the Literature.” And to top it all off, Andreas Mavromatis has written an excellent book titled, Hypnagogia, The Unique State of Consciousness Between Wakefulness and Sleep. Researchers have also written a book that documents some of their more recent work on sleep onset titled interestingly enough, Sleep Onset: Normal and Abnormal Processes, edited by Robert D. Ogilvie and John R. Harsh, 1994. Ever see any of this literature referenced by any of these so-called sleep professionals? No one. Ever. Mentions. Any of it. Ever.

A cynical person might think that these sleep professionals are making a lot of money off insomniacs and really aren’t interested in solving the problem. A cynical person might think that sleep professionals, therapists, pharmaceutical companies, and charlatans in general have a vested interest in keeping this information from insomniacs because someone might come to understand the true nature of the problem and solve it themselves, without spending a lot of money on online courses, webinars, seminars, retreats, and yes, yes, yes, office visits and medication, medication, medication. Companies could go bankrupt. That someone might write a book. It would destroy the economy, global economy. But let’s not think those cynical thoughts because we could lie awake at night planning to do harm to these people. It could cause insomnia.

Instead, we could read that insomniac’s little book — and it is a little book — because it tells the truth about why we can’t get to sleep and provides a method, called the Transition Trek, for getting us all the way to Slumberland. Not only that, it tells us how to fix our sleep propensity curve so that we radically improve our inclination to go to sleep and possibly even cure our insomnia. Without redecorating the bedroom. I do like clocks.

The book is called, In Pursuit of Sleep: The Origins of Insomnia and What to Do About It. It is free on this website’s homepage and on iBooks and B&N. Costs 0.99 for the digital on Amazon and $7.99 for the paperback. Click here to buy it online.

Insomnia and the Sleep Propensity Curve

Sleep propensity, i.e. the force behind the urge to sleep, is also the force behind the problem of not being able to get to sleep. I discuss sleep propensity at length in Chapter 1 The Sleep Problem (pages 3-7) of In Pursuit of Sleep. The higher your sleep propensity, the more difficult it is to resist going to sleep. Here is the sleep propensity curve for a normal person:

Normal Sleep Propensity Curve

Normal Sleep Propensity Curve

I did not make up this curve. The research that determined it is documented in Sleep Onset: Normal and Abnormal Process, edited by Ogilvie and Harsh, page 25. As you can see, our propensity to sleep starts to increase in early evening and only reaches a maximum in the early hours of morning. That bump in the afternoon is what some of us call siesta time. Many cultures recognize the need for a nap and close shops to afford the time for an afternoon siesta.

If this propensity curve works in our favor, why don’t we all get a good night’s sleep?

Glad you asked. The above sleep propensity curve is normal only for people who have no problem getting to sleep and staying asleep throughout the night. If they do wake — to go to the bathroom or check on the kids — they get back to sleep quickly and with little trouble. For the rest of us, we either can’t get to sleep to begin with or have difficulty getting back to sleep once we wake up because our sleep propensity curve has holes in it.

What happened to our sleep propensity curve? Were we born wrong?

No. Turns out, sleep propensity is malleable. If we lie awake initially, or get woken up at the same time night after night, our sleep propensity adjusts to that new normal. This is where the holes come from.

So how do we go about repairing it? Is that even possible?

Repairing the sleep propensity curve is definitely possible. All you have to do is get to sleep quickly and stay there, night after night. If you do wake in the middle of the night, you must get back to sleep quickly.

Sounds like the chicken and the egg. I can’t get to sleep because I haven’t been able to get to sleep.

You are right. That is the crux of the matter. You must have a way of getting to sleep reliably every night, and one that will get you back to sleep as soon as possible after waking. To accomplish this you have to go get sleep. Sleep is not coming to you. If you have insomnia, you have proven sleep’s elusiveness night after night.

Where would I find such a method?

You would find it in In Pursuit of Sleep, The Origins of Insomnia and What to Do About It. The method is called the Transition Trek. It teaches you how to push aside those thoughts that are raging in your mind and focus on images and sounds of a Transition Trek that leads you to sleep. You can learn the method by reading only the first four chapters of In Pursuit of Sleep, which shouldn’t take anymore than an hour. Then you can start the method that very night.

You don’t have to spend weeks training yourself to think of your bedroom as only a place to sleep. No, your bedroom doesn’t have to be absolutely dark. No, you don’t have to get rid of all extraneous sounds. You don’t have to cover your clocks and put your iPhone in the next room. You don’t have to get rid of your restless sleeping partner. You just have to concentrate on going to sleep using the Transition Trek method. Every time you wake, for whatever reason, the Trek is there inside your head waiting to put you to sleep.

Insomnia and Deafferentation

Ever notice that when you first lie down to go to sleep, you are inundated with all sorts of body irritants (itches, feet too hot or too cold, etc.) that seem to want to keep you awake? Strangely enough this hassle is good news. This is the first stage of falling asleep, and is the first indication that you have entered hypnagogia, also called sleep onset. It also raises the question of how we ever go to sleep with all this sudden increase in physical sensitivity. Well, we have an answer to that question: deafferentation.

I suspect that you have never heard of deafferentation. But electrochemical deafferentation is in large part what allows you to go to sleep with all this extracurricular physical awareness raging. (See In Pursuit of Sleep pages 32 and 88.) Hypnagogia, the period of time between being fully awake and being fully asleep, starts by making us less aware of our surroundings and more aware of our physical state. But hypnagogia also starts another process that transfers our awareness from our physical state to our psychic state. To do this, the mind starts to electrochemically shutoff our awareness of the physical state in favor of activating the psychic state, which of course is our mental processes. This process of shutting off the physical senses is called deafferentation.

Deafferentation of the physical senses is not total; however, it is enough to enable us to go to sleep despite our physical uncomfortableness. We are not totally oblivious to the external world either. The cry of a child will still wake us, as will the blast of a car horn next door. Still, deafferentation is our friend, and we should pay homage to it.

How do we go about that?

Once we know about deafferentation, we can pay homage to it by not panicking when we first get in bed and encounter all these physical and environmental impediments to sleep. This is that first level of emotional control we need to exhibit to keep us from sabotaging our own descent into sleep. It is much easier to not become demoralized right off the bat if we know that this little hero of ours called deafferentation is taking over.

Other sleep disciplines want you to exercise complete control over your sleep environment. CBT wants you to make your room as dark as possible, get rid of all extraneous sound, and ensure the room temperature is perfect. CBT also wants you to make your bedroom a place only for sex and sleep. I think this may be helpful for some but is mostly hogwash. Most people use their bedrooms as a refuge, and I see no reason to stop this. Also many elderly people live in constrained housing situations where their beds are frequently in their living quarters, making this recommendation impossible to fulfill. When you employ the Transition Trek (In Pursuit of Sleep, Chapter 4 Charging the Gates of Slumberland), it shoves all this into the background and directs your attention toward sleep. Controlling your thought process through providing psychic images and sounds puts you fully in the psychic world and directs you toward Slumberland. This is all accomplished by following the Transition Trek.

An 1899 Cure for Insomnia

As usual, I found this cute little cure for insomnia in the New York Times archives for July 23, 1899.

Cure for Insomnia in the New York Times July 23, 1899.

Cure for Insomnia in the New York Times July 23, 1899.

The reason that this article caught my attention is that I have used some of these techniques. Many years ago, I had used pushups as a method of tiring myself so I could get back to sleep. I also have used warm milk. My wife used to complain that I thought sex and a glass of milk could cure anything.

I found a lot of “cures” through the decades, but the Transition Trek of In Pursuit of Sleep is all I ever need now.

CBT or Transition Trek?

How does the method of getting to sleep presented in In Pursuit of Sleep differ from Cognitive Behavior Therapy (CBT)? In Pursuit of Sleep‘s emphasis is the Transition Trek, an imaginary path we travel down after we close our eyes to reach Slumberland. CBT for insomnia (CBT-I), http://www.cbtforinsomnia.com, focuses on reducing daytime stress, providing a favorable bedroom environment, and having a good attitude toward sleep. They accomplish this with 5 sessions of instruction over 5 weeks. The CBT-I method also does not think much of sleep medication. I believe the CBT-I method is excellent, and this article by Austin Frakt in the New York Times would seem to prove that point. It is proven to be more effective than medication and the results of the sessions generally stay with you and improve you life. This research study published in the Journal of the American Medical Association also demonstrated considerable benefit to CBT-I. However, 9 of the 63 subjects simply walked away from the study before completion of the treatment phase because of lack of interest, which demonstrates that it isn’t for everyone. In addition, the Transition Trek method should start working the very first night.

So what does the Transition Trek method have that CBT-I doesn’t? CBT-I has nothing that actually directs the mind toward sleep. It offers nothing in the way of a psychic action to pursue sleep. Even though it provides both an external and internal environment conducive to sleep, it still expects you to “fall” asleep. The same mental processes that have prevented you from going to sleep in the past are still active although the negative influence will definitely be diminished. It does not address all the distracting elements of hypnagogia (sleep onset).

The Transition Trek method provides activities that occupy your mind and direct it toward sleep. It provides both imaginative images and a narrative to occupy your psychic voice that will lead you into Slumberland. But In Pursuit of Sleep offers much more than that. It provides a detailed description of sleep onset and the psychic environment that leads the mind astray in the first place. It is not just a corrosive external environment and internal stress that has lead you astray. These in all probability are not even the most important impediments to sleep. If you don’t understand all the elements of hypnagogia, you cannot possibly understand how to control the mental processes encountered on your way to sleep.

Perhaps the most beneficial aspect of the Transition Trek is the focus on images and the other psychic senses that position you in the psychic world where sleep occurs. In Pursuit of Sleep also makes you aware of the effects of “deafferentation” that diminish the physical irritants (like itches, cold feet, restlessness, etc) that can keep you from believing you are going to sleep. In doing so, In Pursuit of Sleep focuses on the way the mind functions while transitioning from being awake to being asleep.

The other beneficial concept presented in In Pursuit of Sleep is the “sleep propensity curve.” The identification of this curve helps you understand what has gone wrong with it and how to repair it over time, so that you have a high probability of getting to sleep and staying asleep every night.

The bottom line is that CBT is extraordinarily helpful and has been proven so, but it still has some deficiencies because it is not focused on the mental elements of actually getting to sleep. In Pursuit of Sleep fills in that deficiency.

Insomnia or Sleeplessness?

I have been pondering the article I ran across recently concerning sleeplessness. In this blog post, I referred the reader to a 2011 article in the American Journal of Public Health concerning the medicalization of sleeplessness as insomnia. The problem is that I can find no official publication that draws a distinct between the two. This confusion, if it indeed exists, goes back at least as far as 1888 as demonstrated by this article from that time period, which uses the words “sleeplessness” and “insomnia” interchangeably. A quick search of the Internet reveals no consistency in the definition of insomnia, and rarely do they discuss sleeplessness. I believe the distinction drawn by the article in the AJoPH is valid. I do not believe stress induced sleeplessness should be considered insomnia. However, I have used the terms interchangeably in IPoS because they are treated that way even within the medical community.

Is In Pursuit of Sleep directed toward sleeplessness or insomnia or both? If the distinction drawn in the AJoPH is used, IPoS primarily addresses sleeplessness. However, since the distinction is rarely drawn even in the medical community, IPoS reasonably uses the most common term for sleeplessness, which is insomnia. Hopefully, someday the distinction between these two separate conditions will be properly defined. I also believe that IPoS can be beneficially used, under certain circumstances, for the medical condition. Even the thoughts of those with a medical condition can go astray when trying to go to sleep. That is the reason I do not recommend anyone considering using the method developed in IPoS stop taking medication provided by a healthcare worker.

Does the distinction really matter? My contention is that it matters very much. The reason is that sleeplessness, using the strict definition, should be treated with thought control techniques such as that provided in In Pursuit of Sleep. My non-professional opinion is that medication for this condition should only be prescribed on a temporary basis. Insomnia, using the strict definition, is then a medical condition and should be treated with medication as long as deemed necessary by a healthcare provider, possibly augmented with thought control techniques.

Of course, pharmaceutical companies would resist this distinction because they want to treat both conditions with medication from now to the end of time. It increases the demand for their products and produces higher profits.

Oh If It Were Only True!

In my continuing saga exploring the historical pages of the New York Times, here is one article that proposes that eye defects are the cause of insomnia. Too bad it didn’t turn out. Anyway, here are the first four paragraphs of a very long article from Sunday, April 25, 1915. The headline is: “EYE DEFECTS CAUSE OF INSOMNIA, Practically All Cases of Insomnia Traced to Some Ophthalmic Trouble by a London Specialist.”

First 4 Paragraphs of 1915 New York Times Article on Insomnia

First 4 Paragraphs of 1915 New York Times Article on Insomnia

You can read the entire article here. Too bad Dr. Pronger’s theory didn’t meet the test of time.

What I find most interesting is the seriousness of the impact of insomnia even back 101 years ago, the reference to “the actual wastage of human lives by suicide, wrecked brains, and shattered nerves.” I realize that insomnia has been a part of the human experience going back as far as written records allow us to probe, but to have this degree of suffering caused by it, I just had no idea.

Of course, Dr. Pronger was a consulting ophthalmic surgeon to Harrogate Infirmary and would have seen the worst of it. I cannot say with any sort of certainty that the method I present in In Pursuit of Sleep would have helped any of them, although I do believe it could have helped many. However, there were people in the world then and there are today who have sleep problems that can only be addressed effectively with medication.

A Cure for Sleeplessness from 1876

Here is another article I ran onto today in the New York Times historical records. It was published on Saturday, December 30, 1876:

Short Article in the New York Times on Saturday December 30, 1876

Short Article in the New York Times on Saturday December 30, 1876

What intrigues me about this article is the suggestion by the American physician, Dr. Cooke, that, “…in numerous cases of sleeplessness it is only necessary to breathe very slowly and quietly for a few minutes to secure a refreshing sleep.” In In Pursuit of Sleep, I call this method “sleep breathing.” See pages 31/2. Of course, this is only one of several components of the Transition Trek method. But I suggest initiating sleep breathing at the very beginning of the Transition Trek, which then triggers the start of several physical processes that lead toward sleep.

A Cure for Sleeplessness from 1888

I ran onto this today by accident. From the New York Times, Saturday, August 11, 1888:

Short Article in the New York Times on Saturday August 11, 1888

Short Article in the New York Times on Saturday August 11, 1888

This brief little article suggests that someone having difficulty sleeping might think of a previous dream and go “over and over the scene it presented” to induce sleep. This is the subject of Chapter 6 Chasing Hypnos, pages 67-80. In that chapter, I recommend documenting five dreams and reading over them before bed. Then if you have difficulty getting to sleep initially or back to sleep after waking during the night, that you can use those five dreams to assist you getting to sleep. Of course, I also appropriate Hypnos, Greek God of Sleep, and Hermes, Guide of Souls in the Underworld, as aids with this.

The article also confirms my experience that, “counting numbers or repeating easy-flowing verses” frequently fails. Of course, In Pursuit of Sleep does suggest (Chapter 5 Controlling Your Psychic Voice) that poems can be used to augment the Transition Trek, but that is completely different from requiring the poem go it alone.

Anyway, interesting voice from the past with a couple of interesting thoughts on insomnia.

(Note that the article originally appeared in the London Figaro, a periodical founded by James Mortimer in 1870. It ended publication in 1897 due to a significant decrease in readership.)