Many people who contact me want to know if relapses – experiencing worse insomnia after a period of improvement – are normal. They also want to know what they can do to make sure they don’t have them anymore.
I have to tell them that relapses are very normal, and in fact are an unavoidable part of the process of getting over insomnia. I also tell them that trying to avoid relapses and getting upset and discouraged when they happen can often make insomnia worse, simply because of its paradoxical nature, which I have written about so often. I have to reassure them that they are on the right track even if it feels very much like nothing is happening and things are even getting worse.
It is just a reality that getting over insomnia is not the smooth ride we all wish it could be.
So I find it necessary to reassure people that a) relapses are normal and should be expected and b) you can’t make them not happen by doing anything special and c) getting upset is pointless, but of course you will anyway, and that’s also to be expected and nothing to worry about. You just have to keep going using whatever methods have been helpful so far in improving your overall sleep.
How It Works
The major pitfall of a chronic insomnia cure that is going along nicely is that you start to think you have been a smashing success. When the setback inevitable comes around, your disappointment will be in direct proportion to how happy you have become in thinking you have beat insomnia for good!
Here is the most common scenario drawn from my own experiences and what others have described to me (which are strikingly similar): You begin your program of insomnia and things begin to look up after a week or two or maybe three. You are beginning to sleep better, your anxiety about sleep is starting to fade, you are feeling better, more optimistic, more energetic, healthier, happier…
…And then you get a night that is worse than anything you ever had before. A night where the tossing and turning is driven by a mental anguish you have never felt before.
You possibly don’t even get one minute of sleep. You get out of bed exhausted, depressed, frustrated, disappointed, disoriented and just plain mad. You can’t help but ask the hard questions: Where did I go wrong? Why did this happen? Why isn’t the program working anymore? Why did I have this terrible night when I was doing so well?
It’s hard to answer all these “whys”… but sometimes it is because a new anxiety has crept into your brain, sneaking in very quietly, unnoticed. This anxiety, if it were expressed, would start out innocently enough as something like this:
“Wow, I’m really starting to sleep better. This insomnia program is really working. Isn’t that great? I hope it continues.”
Of course it doesn’t end there… the next stage goes something along the lines of:
“Yes, I really hope it continues. I would hate to go back to not sleeping again. Wasn’t that terrible, all those sleepless nights? This is much better. I’m so much better. Wouldn’t it be awful if the program stopped working and I started sleeping bad again? I really, really, really hope that doesn’t happen…”
Hmmm. Do you sense a little paradox in the works?
Then the dialogue continues further, something like this:
“Maybe I should work harder at this just to make sure. Maybe I should do the exercises three times a day instead of twice a day. I SURE WOULD HATE TO HAVE MY INSOMNIA GET WORSE AGAIN!”
It’s important to understand that this is all done on a semi-unconscious level, where we are unaware of what we’re doing, possibly unaware that these thoughts are even circling around in our brains. Yet it is enough to start the vicious cycle of paradoxical misery.
Why are relapses so disappointing?
We are used to thinking of relapses as failure. In a mechanical sense, suppose we think we have fixed something and the machine runs smoothly for a while, but then the same problems crops up again. What do we think? Our first response is something like “I guess it wasn’t fixed after all.” And the only way to move forward is to continue to troubleshoot the problem and keep trying to find a different solution.
But when we talk about the human brain, we are in an entirely different reality. Relapses are not like mechanical failures. They may have any number of causes. Sometimes they indicate another solution should be considered, but most of the time relapses simply tell us to patiently pick ourselves up and continue on the same path we are on.
In the case of addiction, relapses can be quite devastating to one’s sense of self confidence and inner strength. Counselors of rehab programs have to constantly reassure their clients that relapses are not the end of the world, that they can still get themselves up and moving on, that they can keep making progress no matter how badly they have messed up. There is no failure as long as they don’t give up.
Insomnia, of course, is not an addiction, and relapses should not carry the same kind of significance. But because insomniacs tend to beat themselves up a lot, they ask a lot questions like “Why can’t I have better control over my own mind?” But often it is this very effort to do the right thing to get over insomnia that causes the relapse to begin with!
Why are relapses such a problem to insomniacs?
Most of us are used to making slow but sure progress in many things, whether recovering from an illness or injury, learning a new subject or skill, or starting and completing a project. What’s the great rush?
Well, people are understandably desperate for relief. But besides that, recovering from chronic insomnia is not like those above-mentioned things, not only because of the paradoxes, but also because so much improvement can be followed by so much misery. A night of seven straight, blissful hours of slumber is followed by a night of no sleep at all. The orderly progress we are accustomed to when we start a self-improvement program just isn’t there.
Actually, it IS there, but remains unpredictable and elusive in the beginning stages. Much of the improvement is taking place at a below-conscious level and has not had a chance to prove itself. Sleep is a complex and mysterious thing, and so is the human brain. And speaking of the human brain, have I mentioned that it tends to change very slowly? I believe I have.
Of course none of this helps when you are knocking your head against the headboard out of frustration and disappointment.
So what are some ways to deal with relapses?
There are three ways to deal with relapses.
- Treat your thoughts about the relapses using CBT techniques.
- Think of other ways you can help your insomnia and take proactive steps toward that.
- Stop working on your insomnia for a brief period of time.
Let’s look at each one of these.
People who are most upset about these setbacks are afraid they mean nothing is working and insomnia is incurable and will never go away. These are classic sleep anxiety worries and excellent statements for CBT exercises.
If you have been treating your insomnia using cognitive behavioral self-therapy techniques, you can simply start a new sheet of paper or a new document and write down all your thoughts about having relapses and not getting anywhere. Then you can challenge these thoughts using rational, calming, reassuring, practical, helpful, thoughtful answers. See here for some examples.
But relapses can also happen by putting too much effort into CBT techniques as a way to cure insomnia, and making too much of an emotional investment in the outcome, causing deep disappointment when your sleep gets worse even after three hours of CBT exercises per day!
This is when you need to step back and think of other methods you can use to help yourself, including relaxation techniques, sleep hygiene, mindfulness, physical exercise, dietary changes and so on. Treating insomnia is a multiple approach and no one thing is meant to do the whole job.
Then you can just throw up your hands and quit doing anything for a while.
Well, make that quit doing anything except the obvious common sense activities such as keeping a consistent sleep schedule and avoiding caffeine before bed time. It is fine to take periodic breaks from “working” on insomnia, often just to let the lessons you’ve learned sink in and to counteract any extra pressure you’ve been putting on yourself and the techniques you have been relying on. I will discuss this further in upcoming articles.
Is There Really No Way to Avoid Relapses?
I do not know of any way to avoid them. They are a normal part of the recovery process and should be expected. The more you try to avoid relapses and the more you stress out about having them, the more misery you will feel when they occur. Keep trudging along patiently, keeping your expectations low and your spirits up, and they too will pass.