Why You Go To Bed Sleepy But End Up Wide Awake

It’s 11:47pm. You’re lying on the couch and re-watching an episode of Friends while munching on a bag of Sour Cream & Dill Lays chips. Your eyes are getting heavy, and you know it’s time for bed, because Joey’s explanation on why ‘moo point’ is the accurate terminology for certain facts that do not matter (because it’s like a cow’s opinion), is oddly starting to make sense.

You carry your heavy body to bed, however, just as your head hits the pillow – it’s a like a ‘light switch’ and a torrent of thoughts begin to make their way into your head.  

“What am I going to do tomorrow?”

“How come I can’t sleep again?”

“Why do I go to bed so sleepy but then now I’m wide awake?”

“I should have yelled back to the rude customer today”

“Why would Cinderella’s shoe fall off if it fits her perfectly?”

It’s frustrating when you feel so ready for sleep but somehow you always feel more awake once your bed hits the pillow. But why does this happen?

Conditioned Arousal

The answer is anxiety! Unsurprisingly, anxiety is incompatible with sleep. And that makes perfect sense, because we wouldn’t want to be asleep if there was a threat around – like a bear. But anxiety can be very troublesome for sleep, especially when the anxiety is about sleep itself! Oftentimes, people with chronic insomnia spend a lot of time in bed awake and in distress about the fact that they are not sleeping. This creates an unintentional association between the bed and being awake (conditioned arousal), rather than for sleep. This is also the reason for the ‘light-switch’ phenomenon, and why you go to bed sleepy but feel wide awake once your head hits the pillow.

Conditioned arousal is very similar to the principles of classical conditioning. If you recall Ivan Pavlov and his dogs, what happened was Pavlov rang a bell as a cue to let the dogs know that he had put food out. Over time, the dog began to associate the ringing of the bell with the food. Because of this, Pavlov found that the dogs began to salivate at the bell ringing even when no food is around.

In insomnia, the bell ringing is the bed, and the salivating is anxiety/distress. People with insomnia have created an association with the bed and being awake. Interestingly, this is also one of the reasons why some people sleep so much better when they sleep in different environments, like a hotel room or in a tent. Their conditioned arousal is specific to their bedroom environment.

How to I break the conditioned arousal?

The idea is to break the association between bed and wake; and re-establish a relationship between the bed and sleep. Of course, this is easier said than done. In behavioural sleep medicine, there is something called stimulus control. Stimulus control is essentially a fancy term that contains a set of instructions to restore the association between bed and sleep and is often used as part of cognitive behavioural therapy for insomnia. Stimulus control is an evidence-based treatment and has been shown to be effective in treating insomnia symptoms. Its instructions include:

1. Only go to bed when you are sleepy

2. If sleep is not coming, get out of bed and do something quiet and enjoyable (e.g., reading a book, responding to light emails, watching a pleasant show)

3. Go back to bed when you are sleepy (i.e., getting close to dozing off; not just tired)

4. If you feel awake again, repeat the process

5. Wake up at the same time every day

6. Try to avoid daytime napping (but please do so if you feel like there could be a safety concern)

This doesn’t make sense. I’ll just be in and out of the bed and never get sleep.

I’ll be the first to admit – stimulus control can suck. And it’s doubly annoying to feel like you are putting yourself in a situation that seems super counterintuitive and uncomfortable (i.e., being awake in the middle of the night). But stimulus control when done properly is very effective. Some people trip themselves up because of feeling anxious in the middle of the night. Because of this anxiety, they may go back to bed too early when they are not truly sleepy; they may sleep-in to catch up on sleep; they may try to take naps in the day. All of these things trip up the excellent work you are doing when you are engaging in stimulus control.

Stimulus control is going to be uncomfortable. It’s going to suck. But if you can stick with it and be okay with not getting much sleep for a couple days, it’s going to be effective. During those tough nights where you are awake at 3:00am in the morning, find something enjoyable to do. Watch a movie, read some books, and importantly – be okay with being awake. It’s the paradox of insomnia that the people who are the most anxious about not getting enough sleep, are the ones that struggle with sleeping the most.

It sounds crazy, but many of my patients have found the greatest movement towards improving their insomnia when they radically changed their perspective to enjoying being awake in the night.

They decided that being awake in the middle of the night wasn’t so bad after all. They had quiet time for themselves to watch a show that their partner didn’t enjoy; they had time to do some work; or they just had some peaceful time to themselves.

And recognize that you can do a lot more than you think even with poor sleep. You are more resilient than you think, and I’m sure you can come up with many situations where you had crappy sleep but were able to do the things you needed to do (albeit with more effort). Many of my patients have struggled with insomnia for years, but they are great parents, succeeded in school, and perform well in their work. Leverage that knowledge when fears of not getting enough sleep try to trap you in the vicious cycle of insomnia!

Does this mean I can’t watch my shows in bed?

Absolutely you can! I always say that good sleepers don’t worry about their sleep. For people with insomnia, stimulus control can be a great way to get them closer to their goals. But once you feel confident about your sleep, you can be free to be flexible and experiment with your sleep. You are welcome to take naps, watch shows in bed, or sleep in on weekends. From a pure sleep perspective, these behaviours might not be optimal for sleep. But that’s okay! Because sometimes other values (like being able to snuggle with your partner in the morning) take priority.

At the end of the day, we sleep to live; we don’t live to sleep.

I hope this was helpful in helping understand a bit more about sleep! If you’re interested in learning more about the causes of insomnia, see this post here!

Best wishes,

P

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