The Connection Between Sleep, Sunlight and Social Withdrawal

In the United States, people refer to 20-somethings who struggle to self-actualize, find a job, manage their emotions, and leave their parents’ house a failure to launch, implying that they haven’t left the nest. In England they term this NEET (not in education, employment or training), and in Japan it’s termed Hikikomori (pulling in). Psychologists term it extreme social withdrawal (ESW). However it’s identified, difficulties with sleep are a major symptom for these folks. This makes sense, especially when considering how the hermit-like lifestyle would impact a regular routine of getting sunlight, social connection, and exercise. Furthermore, insomnia is often a symptom of depression and anxiety, which these folks also experience.

But understanding insomnia isn’t as simple as seeing it as trouble sleeping. Insomnia is the condition of feeling tired but wired, and it’s associated with difficulty falling asleep, staying asleep, or waking up too early. What distinguishes the Hikikomori (ESW) experience is not about the quality or even quantity of sleep; it’s about when the sleep happens. Folks I tend to see report ten or more hours of shut-eye; however, it occurs from the wee hours until mid-day or even later. This is problematic because it places someone out of synch with social norms, where jobs and social lives are happening.

This isn’t insomnia. It’s a circadian rhythm disorder. CRD is within the DSM-TR-V classification for sleep disorders and seen as sleep onset insomnia; an individual may get enough sleep, but the quality and time of sleep are the issue. We see CRD in shift workers whose irregular schedules impact their circadian clock as well as in the jetlag experienced from international travel. Think here of medical professionals, airline workers, construction crews, and police officers. Their odd work hours would throw a loop in anyone’s clock.

The Hikikomori may also be falling asleep around 3-4 AM and waking up in the early afternoon. It’s a problem if they’re ever to rejoin the customary work hours, which may be a source of shame. It probably registers in thoughts like: I can’t wake up that early because I’m a piece of crap.

If a shift worker were diagnosed with a circadian rhythm disorder, a behavioral sleep specialist wouldn’t tell them to focus on their sleep hygiene because that’s not the issue. What’s at issue is the creation of melatonin. Thus, the sleep specialist would focus on shifting the individual’s production of melatonin through light exposure, a.k.a. bright light therapy.

Bright light therapy involves exposing a person to high lumen levels of light, preferably sunlight, immediately after they awaken. Here’s how it works:

• First, we’d use a sleep diary to track sleep patterns
• We’d determine how much sleep is needed, the bedtime, and the average wake time
• We’d then set the average wake time as the target daily wake time
• Once awake, go outside or seek a light box to experience the high lumens
• Sunlight is best (and even better if accompanied by outdoor exercise)
• Screen time is omitted an hour before bedtime and lights are dimmed in the evenings
• Good sleep hygiene is helpful (but secondary to wake time followed by lumens)
• Bedtime corresponds to the hours needed to meet your desired amount of sleep
• After two weeks of this, we’d dial the wake time back a half hour
• Rinse and repeat until your circadian clock has been reset

Although it is helpful for anyone to learn how to reduce screentime before bed and focus on relaxing activities—like stretching or reading a book—the real game for CRD is light therapy because it creates natural melatonin. Over time, this shifts your circadian clock. Obviously, other activities, like getting regular exercise and a Mediterranean diet (proven best for healthy sleep), are beneficial, too. But Rome wasn’t built in a day.

For Hikikomori, the hitch is developing the desire to want to do this and the motivation to follow through on it. So, maybe this isn’t the first thing you will want to work on. Maybe you want to focus on acceptance and commitment therapy. Here, the goal is to foster psychological flexibility by identifying goals and values and using perspective taking to defuse from unpleasant thoughts and feelings and problematic behaviors mindfully. But, when you’re ready to get out there, you may find bright light therapy as the most supportive for addressing CRD.

For the clinician working with Hikikomori, you may want to enlist the help of a behavioral sleep specialist (behavioral sleep medicine). After all, Rome was built by many hands, not just one or two.

To find a therapist near you, visit the Psychology Today Therapy Directory.