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Rubin Naiman, Ph.D. Headshot

Insomniacs Anonymous: Do We Need a 12-Step Program for Sleep?

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INSOMNIA TREATMENT
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Ask insomniacs why they can't sleep and they'll likely tell you its because they're just not sleepy enough. But, how could this be? Given their chronic sleep loss and typical diligence about doing all the right things, surely they must be sleepy. But, they're not. In fact, they are even less sleepy than normal sleepers are during the day.

The reason insomniacs feel insufficiently sleepy is that they are relentlessly wakeful or, technically, hyperaroused. Hyperarousal is caused by an acute stress reaction that has become chronic, sustained and unremitting. It's as if one's personal threat advisory system is stuck on high alert, leaving them anxious and hypervigilant.

Hyperarousal is characterized by over activation of the endocrine, immune and nervous systems as well as elevated body temperature, rapid metabolic rates and increased waking EEG. Psychologically, hyperarousal is associated with obsessive-compulsive tendencies-- a kind of hurry sickness that overrides life's natural rhythms of activity and rest.

Although the relentless wakefulness of hyperarousal becomes obscured against the bustling backdrop of waking life, it is palpable and unsettling in the dark and quiet of night, where it easily trumps sleep. Despite its presentation, insomnia is largely a disorder of wakefulness.

Wakefulness is not a uniform, homogenous experience. As reflected in brainwave measures, it's complex and remarkably nuanced. Just as we recognize various stages of healthy sleep and types of dysfunctional sleep, we would benefit from a new taxonomy of waking consciousness. In the meantime, it's helpful to recognize that there are normal, healthy ways of being awake, and less functional, unhealthy ways of doing so.

Not surprisingly, relentless waking is seductive and, arguably, addictive. It's highly valued, strongly encouraged and considered normal, if not exemplary, in our world. Of course, the up side of relentless waking is the putative benefit of heightened activity, efficiency and productivity. Much like process addictions to gambling, sex, the internet or food, relentless waking promises short-term pleasure or relief at the cost of long-term distress. Those caught in the grip of relentless waking are likely in denial, feeling powerless over their inability to manage their lives and willfully self-reliant. Relentless waking puts a monkey (a hyperactive one at that) on one's back. Ironically, the come down from this addiction is precisely the inability to come down.

We need to break through our denial about the widespread addiction to relentless wakefulness. Einstein advised that we could never solve a problem at the level of its occurrence. If we recognize relentless waking as a causal factor of insomnia, we will become less likely to keep re-engaging it in an effort to heal our sleep. In the end, healing our sleepless nights requires that we complement established treatments with a more sober approach to our excessively wakeful days. I believe a number of key elements of the 12-step recovery process can be most helpful in doing so and will review just a few of these.

I often find myself talking with insomnia patients about the serenity prayer. A staple of the recovery process, this brief invocation affirms the need to serenely accept what we cannot change, courageously change what we can and cultivate the wisdom to distinguish between these two conditions. Relentless waking encourages incessant action and largely circumvents acceptance. Understanding the role of acceptance is crucial in recovering from insomnia.

The recovery process generally begins with a humble admission of powerlessness over an addiction and an acknowledgement that it has become unmanageable. While mired in the depths of a sleepless night, insomniacs may privately struggle with such powerlessness and manageability. Come morning, however, they typically muster the will to try once again to manage the unmanageable. Admission of powerlessness and manageability can be easily confused with a loss of faith in oneself and supplication to insomnia. In fact, it's about extending faith to something greater than ourselves and not supplicating but gladly surrendering to that.

Some people bristle at the religious tone of the 12-step notion of a higher power, specifically that " a power greater than ourselves could restore us to sanity." This is not about a religious conversion, however, but an essential spiritual shift in consciousness that recognizes positive and friendly forces outside of one's self. For example, one's higher power can be the principles of natural world, the collective goodness of humanity or, a more traditional notion of God. It is virtually impossible to deal with powerlessness and unmanageability without leaning on something greater than ourselves.

Fellowship, based on the belief that healing addiction depends on community support obtained through regular group meetings, is a core feature of recovery. Short of clinical therapy groups that teach sleep strategies, the conventional treatment of insomnia emphasizes individual responsibility. As a complement to this, insomnia anonymous meetings could provide much needed social and community support as well as structures to guide insomniacs through a recovery program.

Relentless waking is associated with relentless thinking and relentless effort. In fact, insomniacs commonly exert excessive "sleep effort," that is, they try much too hard to get to sleep. The theme of surrender that permeates recovery can offer powerful spiritual medicine for the treatment of insomnia. Falling asleep, whether at the beginning or the middle of the night, is not an act of will (or pill), but one of willingness. The simplest yet the most challenging aspect of getting to sleep is the surrender of one's relentless wakefulness. Once again, doing so requires that we extend trust or faith in something greater than ourselves. All the complexities aside, a sleep recovery process could help us remember that, beyond all the biomedical complexities, falling asleep is an act of faith.

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