Desperate To Fall Asleep? Three Things You Need to Know.
Huaihui ZHANG, Associate Medical Staff of Psychiatry
Tomorrow is a big day for Jack! He has a big presentation at the company’s annual convention and all the senior leaders will be there, so this is an excellent opportunity for him to show his talent. He has already spent the last few days fully preparing and all he needs to do is make sure he gets a good night’s sleep. He can then wake up fresh and rested tomorrow morning for this important event. He goes to bed earlier than usual thinking, “I have to do my best to fall asleep as soon as possible”.
Half an hour later, Jack is still awake. He starts to think of the night before his college entrance examination, when he didn’t fall asleep until 2am even though he went to bed at 9pm. He starts to worry: “if this happens again, I won’t perform well tomorrow”, he says to himself. He looks at his phone. It’s almost 11pm. “Why am I still not sleepy?” he wonders. He feels fidgety, lies in a bed of panic and sweat, with terrifying thoughts racing through his mind. “What happened? Please let me fall asleep!”. Jack tosses and turns restlessly on the bed for a long time and in the end, desperate, finally falls asleep.
Have you had a similar experience? Wanting to fall asleep faster but usually failing no matter how hard you try. Many people suffer from chronic insomnia. If you have similar difficulty sleeping, please remember the following 3 things that can help you fall asleep easier.
1.Insomnia is not as terrifying as imagined
Insomniacs commonly believe that sleep is very crucial, and say things such as “I must sleep for 8 hours to regain my energy”, or “poor sleep will jeopardize my immune system, so I’ll be more likely to get cardio-vascular disease or cancer”, or “I will feel terrible if I don’t get enough sleep”. Although these things are true, they tend to over think it, and start to worry about sleep even before going to bed. If they are still lying awake after some time, they will start to feel nervous and hope to fall asleep soon. But in fact, the more you push yourself to sleep, the less likely it is to achieve it, and this will simply make you feel even more anxious. So, insomnia is actually caused by your thoughts creating a cycle:
Belief of the harm of insomnia on health and work performance——————→
Lie awake, nervous
Dread of insomnia, and a wish to fall asleep successfully—————————-→ insomnia
To break this cycle, you need to restructure your cognition about sleep, i.e., remove the wrong opinions and replace them with positive knowledge of sleep in your mind. In this way, you will have less anxiety and frustration, and a more relaxed mood can help you sleep.
First of all, you need to know, the concept of 8 hours sleep being necessary has no basis. Secondly, researchers haven’t confirmed that insomnia can lead to severe health issues. No one has died only due to insomnia. Third, even though you sleep very well, can you guarantee that you will be very productive and do everything perfect next day? NO!
It is estimated that about 40% of the U.S. population sleeps for less than 6 hours. In fact, people who only get three hours sleep can still complete their work in next day. The example above of Jack is actually a friend of the author of this article who only slept two or three hours the night before the college entrance examination but yet was accepted to a top three university in China. Another friend of the author, who was awake for almost the whole night before exams, was a top ten student in medical school. Therefore, when you have difficulty sleeping, try not to be nervous. Remember that the human body is a sophisticated machine; it will secrete large amounts of epinephrine and cortisone to drive the brain and body. Your body is tougher than you imagine! Thinking back, I’m sure you can recall an experience when you had to finish a task under using strong will power, even though you were lacking sleep. Can’t sleep? Who cares! Once you believe that insufficient sleep isn’t a big deal, you can keep your spirits up by drinking a cup of coffee or another drink you like, and then you can feel more relaxed and find it easier to fall asleep.
2. The habit of sleeping is stronger than your power to prevent it.
Another feature of insomniacs is lack of confidence to sleep. If they have experienced insomnia a few times, they will start to doubt their sleeping ability. Especially if their bed-mate has the ability to fall asleep very fast, by comparison, insomniacs will start to believe their sleeping ability is very poor.
Of course there are individual differences when it comes to sleeping. But it’s important to remember the law of nature that compels humans to sleep at night has existed forever. This phenomenon has been stamped into human genes, and you as an individual are not capable to change this law. During the night, sleep is floating toward you; nothing can stop it, even nervousness. If by bad luck you can’t fall asleep tonight, you definitely will fall asleep tomorrow night or the night after. The habit of sleeping is human nature; sleep will come sooner or later. You should tell yourself “I could fall asleep the past 99% of night in my life, so tonight will be the same”; “I always fell asleep every night in the past, right?”.
3.Don’t hesitate to use sedatives, and remember that they must be prescribed and supervised by a doctor.
If you think the first 2 things can’t help you immediately, and you expect to fall asleep like a shut-down computer; suggestions from doctors would include taking sleeping pills. New medications such as Zolpidem Tartrate and Eszopiclone are effective and have fewer side-effects. Doctor’s supervision can prevent addiction, dependence, and tolerance.
The reason why doctors recommend sleep-aid pills is to prevent short-term insomnia from turning into chronic insomnia. One of the definitions of chronic insomnia from the World Health Organization (WHO) is having suffered for one month. Chronic insomniacs have less confidence to sleep, and are harder to treat. Therefore, small doses of sleep-aids plus psychotherapy is necessary for short-term insomnia. Research demonstrates that more than 80% of insomniacs benefit from medications plus psychotherapy.
Medication also has a psychological comforting effect. Several patients have told the author that the prescribed sleep-aid pills give them a feeling of security, which in turn helps them to fall asleep.
Difficulty sleeping is very common with almost everyone experiencing it at some stage during their lifetime. There are significant researches to support the efficacy of psychotherapy on insomnia. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the leading example and is widely recognized. The guidelines for insomnia in many countries designate CBT-I as the first line of treatment. The first two points above are from examples of CBT-I. If you are interested in CBT-I, you can find self-help books related to CBT-I. Shanghai United Family Pudong Hospital can provide comprehensive service for insomnia, including sleep monitoring, CBT-I, and medication.
 Gallup poll. In U.S., 40% Get Less Than Recommended Amount of Sleep. https://news.gallup.com/poll/166553/less-recommended-amount-sleep.aspx
The author: Dr. Huaihui Zhang is an Associate Senior Physician of Psychiatry, Professional Counselor, and Psychotherapist. She attended the CBT-I training taught by Dr. Gregg D. Jacobs, the Insomnia Specialist at the Sleep Disorders Center at the University of Massachusetts Medical School and the author of “Say Good Night to Insomnia: The Six-Week, Drug-Free Program Developed at Harvard Medical School”. Dr. Zhang has mastered the core competencies for CBT-I and is a certified CBT-I Clinician.