Paradoxical Intention for Sleep Anxiety

The Insomnia Paradox

It’s said that the dark is for dreaming,
But for me, it’s a waking nightmare.
And it goes on, and on, and on…
Into eternity.

It is the paradox of insomnia,
The more I cry, the more it grows.
The more I try, the further sleep goes.
So it goes…

To this eternal damnation, I have come to accept;
To this fear, I’m wholly numb.
And with true acceptance
…Sleep finally comes.

– My frightful attempt at a poem as a clinical psychology student.

Life (and sleep) is a paradox

Life is full of paradoxes. When we are least expecting or yearning something, that is when that something is most likely to occur. We hear this phenomenon in anecdotes and sayings all the time: “a watched pot never boils”, “you will find love when you least expect it”, among many more.

This idea is also true for sleep. The harder that we try to make sleep come, the farther away sleep tends to get. This is particularly problematic in people with insomnia because they are the ones that are looking for sleep the most! Those with insomnia often engage in sleep effort – behaviours that directly or indirectly ways to obtain more sleep. Examples can include going to sleep earlier, having a bedtime ritual, meditating in bed, counting sheep, among hundreds of creative strategies. The paradox, however, is that sleep is less likely to come in this case. It’s like the Chinese finger trap – the more you struggle, the tighter the cloth wraps around your fingers. Only through acceptance of the situation and relaxing your fingers is when the trap finally lets you go. Aligned with this analogy, better sleep comes from the true acceptance that sleep might not come and being perfectly fine with that idea. And for many people with insomnia, this is a tough pill to swallow.

Paradoxical Intention

Paradoxical Intention is an evidence-based technique for insomnia that is somewhat based on the concept of change through acceptance. The idea is that the person tries to STAY AWAKE for as long as possible instead of trying to go to sleep. This is therefore similar to an exposure technique in which the person with insomnia faces their fears (i.e., “not being able to fall asleep”). The scientific principle is that paradoxical intention reduces performance anxiety (the anxiety that they will not be able to “perform” and fall asleep) and stop direct efforts to sleep. Consequently, when anxiety is reduced and the person is not forcing themselves to sleep, this creates an environment that is paradoxically more conducive to sleep. Research has shown that paradoxical intention reduces subjective sleep onset (how long it takes to fall asleep) and anxiety about sleep (e.g., Broomfeld & Espie, 2003).

How do I engage in paradoxical intention for my insomnia?

Here are the steps for paradoxical intention:

1. Go to bed when you are sleepy

2. Instead of attempting to sleep, however, try to stay awake for as long as possible

3. Tell yourself “I’m going to try to stay awake for a few more minutes”

4. Avoid engaging in stimulating activities. Simply lie in bed with your eyes closed, with the thought that you are trying to stay awake.

5. Reflect on what happened the night before in the morning.  

Tips for success

Throughout this experiment, negative thoughts may creep up: “This is not going to work” or “I need to sleep otherwise something bad will happen”. In this case, try to notice the thoughts and disengage from them. In this case, it’s even possible to say to yourself “this is working exactly as intended because being awake is the goal”. If you notice the thoughts are too strong, you can check out another post on changing negative thoughts!

Taking a curious scientist approach will help create emotional distance from the situation too. Think of yourself as an experimenter – you are setting up an experiment to see what will happen if you actively try to stay awake as long as possible. In this case, you are not married to any specific outcome; rather, you are simply observing.  

And that’s it! If you find that sleep anxiety is something you want to try to reduce, then paradoxical intention may be a good solution to tackle the paradox that is sleep. To learn more about what other factors maintain insomnia, see this post on causes of insomnia!

Best wishes,

P