Fear of not sleeping: is there a way out?
In this article I talk about psychophysiological insomnia, i.e. sleeplessness caused by the fear of not sleeping. This is one of the trickiest fears that keeps one in the loop of sleepless nights. And to get out of this loop myself I needed to understand how such loops are created and how our brain works.
I used to think that insomnia was some sort of an entity: it comes to you whenever it desires, messes up your life and decides when to leave. Like you don’t have any say in it. But thinking of insomnia as some sort of illness, like a viral disease, is not correct.
In fact, insomnia is simply the absence of sleep drive. It is neither bad nor good, it is a neutral event that almost all of us experience from time to time. It is our reaction and interpretation of such a fact that might give insomnia “life” of its own.
What happens is that we start fearing the state of not sleeping: our nervous system fires up when it is supposed to calm down and prevents us from falling asleep.
Soon after my insomnia peaked I figured out that to me fighting insomnia directly is a poor strategy. I might occasionally fall asleep, but the underlying problem — the fear of not sleeping — will still be there. So I focused my research on understanding fears in general.
The fear
First, fear is an emotion. And emotions are processed by our limbic system.
Then, there is the amygdala. It is a part of the limbic system and it plays a huge role in the fear formation, fear storage and fear expression.
For chronic insomniacs, there are four things about amygdala they should be aware of.
Amygdala is very reactive. It processes inputs way faster than our prefrontal cortex (the rational part of the brain) and immediately launches our stress response: muscle tension, higher heart rate, sweating, etc. You can’t consciously control this response.
For example, if your amygdala has a record of the insomnia fear, you might start being worried immediately when you see a bed (if the bed is one of the fear triggers). The reaction is so fast, you don’t have time to prevent it. You just start feeling anxious.
Amygdala is on the constant lookout for danger. Whenever there is a real danger, it makes us react immediately: dodge from a ball, move your hand quickly away from the hot stove, run from a tiger. This is why we need amygdala. But sometimes it can bring troubles. It can create fears of things that are not really dangerous to us — the irrational fears, or phobias. Yet, they are all real to your brain as they are stored in your amygdala.
The triggered amygdala can influence your behaviour to the worse. Active amygdala shuts down the communication with our pre-frontal cortex — our rational part of the brain. This is why in the moment of fear we might think and act irrationally.
The triggered brain of an insomniac makes them behave anxiously: force themselves to lie in bed, start taking supplements, google their symptoms. Such anxious behaviour might bring relief for a while but as a long-term strategy — worsen the situation.
Amygdala is flexible: it can create new fears and modify the existing ones.
How we learn to fear
Simply put, it comes down to this:
1. Something happened → 2. we reacted on it in a certain way
Next time, if you react to the situation in the same way, the fear will grow and your amygdala will react even stronger.
For example:
You didn’t sleep for one or two nights (neutral event)→ your mind interpreted it as a danger (reaction)→ you started either fighting or avoiding the fear (reaction)→ such behaviour made the fear stronger → your nervous system is overloaded → which is incompatible with good sleep. And the circle closes.
It is called fear conditioning, i.e. fear learning, and it gets hardwired in our brain — in the amygdala.
But as I wrote earlier, our amygdala is flexible. Not only can it record new fears, but it can also modify the existing ones. In other words, we can re-train our amygdala and unlearn our fear.
How we can unlearn the fear
The same way the fear was learned in the first place:
1. Something happened → 2. we reacted on it in a certain way
I stressed the ‘reaction’ because this is the part where changes happen.
But first, we need to understand what reaction is.
So let’s get back to the example with the fear of not sleeping. After the first sleepless night we might have reacted in any of these ways, thus creating a negative memory that was processed by amygdala:
1. We felt something: anger, anxiety, desperation;
2. We thought something: ‘I must sleep but I can’t’, ‘Something is terribly wrong with me’, ‘People should sleep 8 hours’;
3. We behaved in a certain way: made ourselves lie in bed, took a sleeping pill, started googling the symptoms.
Since these reactions caused the fear to form, changing them in the right way can do the opposite — make us stop being scared.
But this change is not that simple.
1.
You can’t control or change your feelings. Not directly. They just happen and it is the way your body is used to react. Whenever you try to intentionally control them, they will backfire and intensify.
2.
Same with thoughts. You can’t decide not to think bad and anxious thoughts because they are automatic. They can be the result of years of destructive beliefs, misinformation and thought patterns: ‘I need 8 hours of sleep otherwise I can’t function’; ‘normal people don’t have sleep problems’; ‘what if I will never fall asleep?’. For now just remember: it is normal to have these thoughts.
3.
The only thing that is 100% under our control is behaviour. You can feel crappy, your mind might be filled with scary thoughts, but you can always decide how you’ll behave. Choosing how to act despite your feelings and thoughts is the key to unlearning the fear.
Show your amygdala you are not scared
…and it will gradually stop getting triggered.
I deeply believe that, unless there is a medical condition, chronic insomnia is caused by the fear of insomnia. Remove the fear, calm your mind and your sleep will come back. So when I started solving my sleeping problems, I focused all my efforts on reducing anxiety, not insomnia itself.
An effective and well-studied method for curing fears, or phobias, is exposure therapy — it’s when you gradually face your fears without trying to suppress your thoughts and feelings.
You accept the fact that you cannot change the worrisome thoughts and feelings (no one can) and commit yourself to the daily acts of bravery.
You don’t avoid fear, you intentionally face it. It is the unanxious behaviour that signals to the amygdala “I know you are freaking out and it is perfectly normal. But look, I’m doing this right now and nothing horrible happens.”
The right unanxious behaviour can be different for each person, but here are some of the examples that worked for me:
By tackling things that scared me, I made my amygdala less and less sensitive to these things.
There is one simple mental exercise that can help define unanxious behaviour for you: “Do the opposite”.
Summary:
- Fear of sleep is the learned fear and you can unlearn it.
- You unlearn fear by changing your behaviour.
- Defining unanxious behaviour and sticking to it while accepting your current feelings and thoughts reduces anxiety and eliminates fear.
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Take care!
