Don’t think, sleep!

Sometimes it isn’t how much sleep you got that’s important, but how much sleep you think you got.

Our own perception of how much we slept during a night can be startlingly inaccurate. Dr Allison Harvey (now of UC Berkley) took insomniacs and measured how much they actually slept during the night. Despite the insomniacs reporting that they had only slept for two or three hours, they had in fact been asleep for an average of 7 hours – only 35 minutes less than a control group who didn’t have any problems sleeping.

This shows that insomniacs (and probably the rest of us) are very bad at judging the time it takes us to get to sleep, and the time we actually are asleep. It also suggests that worrying about sleep, and our beliefs about how we’ve slept, have a big role in the negative affects of what (we believe) is a sleepless night.

To test this Dr Harvey attached monitoring sensors to insomniacs which gave them a read-out in the morning of how much they had slept the night before. Except that the read-out was a lie and always told the participants in the experiments that they had slept ‘okay’ regardless of how badly they had slept. (In the seminar where I heard Dr Harvey discuss this research she told us that originally they tried giving false-feedback saying that the insomniacs had slept ‘excellently’ each night, but they just didn’t believe it so the researchers settled for just ‘okay’).

And what happened? When asked about how they felt, about their mood and alertness, those people who were lied to and told (by a scientific measurement, no less) that they had got a normal night’s sleep felt better for it!

So, it seems, one of the surprising disadvantages of trying to get enough sleep is that you can be hypersensitive to those times you don’t get enough – and that the hypersensitivity alone can depress and distract you.

Another entirely separate study shows neatly the role of anxiety in insomnia. A placebo effect is where something works because we believe it will work, not because of any intrinsic quality the thing itself has (there’s lots more on placebos in the book). Placebos are known to be potentially very strong – for example in one study of placebo painkillers a significant proportion of people found the placebo to have as strong an effect on their pain as morphine.

Anyway, what would we expect if we gave someone a pill and told them that it was a strong stimulant – something like eight cups of espresso – just before they went to bed? Well if they were normal we’d expect them to take longer to get to sleep, and that’s what happens. But if they’re an insomniac then they get to sleep quicker than they do normally. Why? Because, the theory goes, the insomniac is preventing from getting to sleep by their anxiety about getting to sleep (there’s lots of other work on this, including research by Dr Harvey). When they are given the fake eight-shots-of-espresso pill they are still anxious, but now they can put it down to the pill – “I’m awake, but hey – of course I’m awake, I had that pill” – now, because they’re not worrying about it, they fall off to sleep. Genius!

All this says, to me, that the best thing to do about not being able to sleep – or about not having had enough sleep – is to not worry about it, especially if the hours you have available to spend unconscious are out of your control. Often self-awareness is a good thing, but when it comes to sleep, both before and after, a little less self-awareness can do a lot of good.

(I should apologies for the lack of references in this post. I heard the material about inaccuracy of sleep perception in a seminar Dr Harvey gave at the University of Sheffield in 2003, and haven’t been able to find my notes, or any published details of the study. My apologies for any errors that have crept in. People wishing to follow this up could start with this paper [1] which shows that students with insomnia improved after they were shown the discrepancy between their perception and a more objective measure of how much they sleep. The placebo study I read in a textbook and unfortunately can’t remember where. You can buy one of the gadgets researchers use to measure sleep here and you can read The Onion‘s advice on fighting insomnia here).

refs

1. Tang, N.K.Y. & Harvey, A.G. (2004). Correcting distorted perception of sleep in insomnia: a novel behavioural experiment? Behaviour Research and Therapy, 42, 27-39.

6 Comments

  1. christian
    Posted December 7, 2004 at 10:57 am | Permalink

    Hi
    interesting stuff. the trouble is how do you stop the cycle of worry once it’s started
    ? maybe the only cure would be to stop caring how much sleep you got, but then if that were really true you wouldn’t mind having insomnia anyway…Here’s an earlier study by Harvey I wrote about in the BPS Research Digest (http://www.bps.org.uk/publications/rd.cfm) -
    cheers, christian
    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
    7. SWEET DREAMS
    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
    Is insomnia related to the way people think when they’re trying to sleep?
    Julian Nelson and Allison Harvey (Oxford University) asked 34
    undergraduates with primary insomnia and 38 sound sleepers to take an
    afternoon nap. Overall, the students with insomnia rated their pre-sleep
    mental images and verbal thoughts as more distressing than the sound
    sleepers did. They felt they had less control over their mental images, and
    subjective and objective measures showed they were more aroused by their
    thoughts. Finally, although objective measures showed that all the
    participants fell asleep at some point, fewer of the insomniac students
    than sound sleepers reported that they had managed to get to sleep.
    Nelson, J., & Harvey, A.G. (2003). An exploration of pre-sleep cognitive
    activity in insomnia: imagery and verbal thought. British Journal of
    Clinical Psychology, 42, 271-288.

  2. JussiR
    Posted December 8, 2004 at 4:30 pm | Permalink

    “All this says, to me, that the best thing to do about not being able to sleep – or about not having had enough sleep – is to not worry about it”
    I think most insomniacs are somewhat aware of this, but its not very easy to *not* think or worry about something that is very important to you. A bit like trying *not* to think about an elephant but multiplied by ten, because its much more important for us to be able to sleep, than to prove ourselfs that we can be without thinking about an elephant.

  3. JussiR
    Posted December 8, 2004 at 4:34 pm | Permalink

    Oh, it seems Christian already covered somewhat same point than i did…

  4. Posted December 10, 2004 at 5:33 pm | Permalink

    Just a thought…but maybe knowing that it is possible to get to sleep merely by not worrying about it can have a liberating effect?

  5. Posted December 10, 2004 at 7:47 pm | Permalink

    Hmm, I hadn’t really made the connection before now, but I’ve noticed a lot less staring-awake insomnia since I stopped using a glowing-red “look, *look*, it’s two o’clock in the morning and you’re *still awake*!” LED alarm clock.
    That dark is just dark.

  6. Posted December 11, 2004 at 10:52 am | Permalink

    I used to have loads of trouble sleeping, and it was after I noticed the feedback between the stress caused by not sleeping (gritted teeth at 2am: “must… sleep… important… day… tomorrow”) and not getting to sleep because of stress. I decided to enjoy it: It’s the middle of the night, there’s nothing I can actually usefully achieve, all I can do is lie in the warm and think. Those chances are so rare, I thought, I should just luxuriate in them. And of course, they didn’t happen so much after that. A pyrrhic victory.


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