Frustrated You Can't Sleep? Try Staying Awake Instead
Paradoxical Intention has strong support in treating insomnia.
Posted Apr 30, 2018
If you've struggled with insomnia, you know the frustration of not being able to fall asleep. We often end up trying really hard to make ourselves sleep, as if the right amount of effort can make it happen.
But falling asleep isn't under our voluntary control, and trying to control involuntary responses often backfires; sleep specialist Colin Espie gives the examples of blushing, sexual responses, and stammering.
Insomnia also leads to worrying about sleep and performance anxiety about "will I be able to sleep tonight?" You might be falling asleep on the couch in front of the TV, but when you lie down in bed, sleeping suddenly becomes your job. Sleep and work are incompatible, so you're liable to end up frustrated and wide awake the harder you try.
Turn the Tables
One of the most effective treatments for insomnia is called Paradoxical Intention (PI), and it's recommended by the American Academy of Sleep Medicine. According to the AASM treatment guidelines, PI "involves remaining passively awake and avoiding any efforts to fall asleep." They go on to note that "the goal is to eliminate performance anxiety, as it may inhibit sleep onset."
PI is good news for sleepless souls! It means you can "clock out" at bedtime, rather than making sleep your third shift job. By turning the tables and trying to stay awake instead, you get to let go of worrying about sleep.
Principles of Paradoxical Intention
Colin Espie describes five key concepts that are part of PI:
- Consider other areas of life where effort is counterproductive. Imagine an Olympic figure skater who nails her hardest jumps in rehearsal, and then messes up in competition. While her body was perfectly capable of executing the moves, excessive mental energy can interfere with good performance. Any kind of performance can be impaired if we try too hard.
- Release preoccupation with finding a sleep solution. As I noted in an earlier post, techniques for falling asleep are often counterproductive. Dr. Espie notes that good sleepers tend to think very little about sleep because it's second nature to them. They might even break the "rules" for good sleep and not pay for it, and if they have a bad night's sleep they're able to get right back on track. So when starting PI we need to recognize the benefit in loosening our grip on fixing sleep problems.
- Consider the ideal sleep effort. Psychologists like to measure things, so naturally there are scales for sleep effort. You can access one of them here. Take a look at the scale and complete it based on how good sleepers are likely to answer. Total the responses, with Very much = 2, To some extent = 1, and Not at all = 0.
- Assess your own sleep effort. You probably gave all or mostly "Not at all" responses for good sleepers, right? Now complete the scale for yourself and add up your responses. How does your score compare to that for good sleepers? Take note of your particularly problematic areas, like using a lot of effort or worrying about not sleeping.
- Try to stay awake. Once you lie down in bed with the lights off, keep your eyes open and let go of any effort to fall asleep. If you feel wide awake, celebrate how easy it's going to be to stay awake. If your eyelids start to feel heavy, say to yourself, "Just stay awake for another couple of minutes" (as Espie suggests). Allow sleep to come when it will, rather than chasing it.
Now of course the goal is not really to stay awake, but rather to prevent anxiety and effort from keeping you awake. So while you could pinch yourself awake or drink massive amounts of caffeine before bedtime, clearly those behaviors would defeat the purpose
I raise these somewhat ridiculous examples of ways to stay awake to highlight the balance we're aiming for with PI. It's still a good idea to follow good guidelines for sleep, like keeping a consistent sleep schedule and making your bedroom cool, comfortable, and dark. Indeed, as I describe in my book Cognitive Behavioral Therapy Made Simple, attending to these factors is part of a broader approach of being kind to ourselves. We can provide the best conditions for sleep, and allow our bodies and minds to handle the rest.
As always, consult with your doctor if you're having chronic trouble sleeping.
Espie, C. A. (2011). Paradoxical intention therapy. In M. Perlis, M. Aloia, & B. Kuhn, Behavioral treatments for sleep disorders (pp. 61-70), Burlington, MA: Academic Press.
Morgenthaler, T., Kramer, M., Alessi, C. et al. (2006). Practice parameters for the psychological and behavioral treatment of insomnia: An update. An American Academy of Sleep Medicine report. SLEEP, 29, 1415-1419.