Another Night, Another Battle
“I hate it. I dread it. I’ve tried everything. As it gets later and later, I get more and more worked up looking at my clock. I have to face the inevitable and feel frustrated and tired the next day.”
“I enjoy it. I don’t think much about it actually. It just seems to happen naturally. Sure, sometimes I would have a bad night or two, but that’s how it goes with life.”
Sleep, it turns out, can be a divisive issue. On the one hand, individuals with chronic insomnia view bedtime as another battle for trying harder to fall asleep, with all its dread and anxieties (e.g., “How am I going to be ready for this important meeting tomorrow morning?”). On the other hand, healthy sleepers seem to revisit their land of dreams without any apparent effort at all, which often drives those with sleep difficulties all the more envious and resentful (e.g., “What am I doing wrong?”; “There must be something wrong with me.”).
In a recent survey by the American Academy of Sleep Medicine (AASM, 2024B), 12% of U.S. adults reported to have been diagnosed with chronic insomnia. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM5; APA 2022), chronic insomnia is characterized by difficulties falling asleep, staying asleep, or waking up too early, happening at least three nights a week for three months or longer, while ruling out other disorders such as sleep apnea. Chronic insomnia disrupts our daily lives, leading to significant distress. Moreover, insomnia has been found to be a significant predictor of mental disorders such as depression, anxiety, alcohol abuse, and psychosis (Hertenstein et al., 2019).
Orthosomnia and the Perils of TikTok Wellness
Social media and popular culture in the U.S. contribute to the pressure to maximize our sleeping hours: if we are not sleeping enough, it is up to us to fix it. Indeed, 81% of Americans reported losing sleep due to their anxieties about sleep problems in pursuit of achieving that “perfect” sleep (AASM, 2025). There has been no shortage of advice (e.g., TikTok sleep hacks), apps (e.g., celebrities gently telling soothing stories), and gadgets (e.g., smart ear pods that cancel noise and track sleep). The global sleep wellness economy has been estimated to be $585 billion in 2024 (Statista, 2023).
Sleep becomes another kind of “work.” Noteworthy trends include “sleepmaxxing” and “bed rotting” from TikTok, which have garnered coverage in the press (Lindsay, 2024) and cautions from sleep experts (AASM, 2024A). Sleepmaxxing, for instance, involves using multiple strategies (e.g., consistent sleep schedule, sleep hygiene, etc.) with conscientious tracking with wearable devices in order to find that maximum solution for sleep problems. Bed rotting recommends staying in bed for an entire day or more, without performing daily chores as a form of “self-care” to restore energy (Hollingwood, 2024; Marples, 2023). A survey (AASM, 2024A) found that nearly a quarter (24%) of Gen Z respondents endorsed having tried bed rotting, including live streaming their time in bed.
Sleep researchers (Baron et al., 2018) observed a similar phenomenon of fixation on quantifying and tracking sleep several years ago. They termed it “orthosomnia,” which paradoxically fuels sleep-related anxiety. They described patients appearing at their sleep clinic because they had been tracking sleep with wearable devices. They became convinced that they were not getting enough sleep and spent more time in bed than was necessary, which increased their wakefulness in bed, worsening their insomnia.
Tired but Wired Quest for Ideal Sleep
Orthosomnia and the quest for that ideal sleep can be appealing especially for perfectionists: if we have a problem, we can fix it. If the problem persists, we must work harder to get rid of imperfections. Letting go of that struggle of control over imperfections and accepting their sleep as natural and effortless are especially difficult.
Sleep scientists have examined the connection between perfectionism and poor sleep health. A recent meta-analysis (Stricker et al., 2023) of 15 studies and a systematic review (Stricker et al., 2022) of 24 studies both found that excessive concerns over imperfections are substantially linked to poor sleep. One study (Schmidt et al., 2018) noted that worries over mistakes and self-doubts are associated with insomnia. Moreover, they found that perfectionism increases unhelpful thinking of “could have, should have” scenarios with feelings of regret, shame, and guilt, which further aggravates insomnia.
Our attention on trying to sleep heightens our arousal (e.g., anxiety, frustration, anger) as we try harder to fall asleep in bed – a phenomenon known as sleep effort (Manber & Carney 2015; Wu, 2023). Often tips for sleep improvement fall into the broad category of “sleep hygiene.” While it includes some common sensical advice such as avoiding caffeine late (e.g., it interferes with adenosine build up – a neurotransmitter that promotes sleep; Reichert, Deboer, & Landolt, 2022), believing sleep hygiene alone can treat insomnia could do more harm than good by reinforcing the rigid belief that “I am doing sleep wrong,” which can lead to redoubling of sleep effort.
Worse, the repeated unsuccessful attempts to sleep end up training (“conditioning”) our brain to pair up these negative feelings (e.g., anxiety, frustration, anger) and overworking in problem solving mode with our bed as a place to become aroused, or in other words, to be wide awake (Manber and Carney, 2015; Wu, 2023). Sufferers with insomnia often find themselves in this conditioned state of hyperarousal – they are “tired and wired.”
Checking Our Beliefs about Sleep
It does beg this question: what if sleep itself is altogether a different kind of problem and our sleep effort, while well intentioned, interferes with what our body naturally needs?
Before diving into the basics of sleep, let’s check our beliefs about sleep. See if we can answer the following:
- True or False. Practicing good sleep hygiene is key to overcome insomnia.
- True or False. Sleep is a skill I need to practice and try harder to maximize.
- True or False. I need to have at least 8 hours of sleep every night.
- True or False. Insomnia is the same as sleep deprivation.
Each of the above statements is false, and especially unhelpful for individuals with sleep difficulties.
While sleep hygiene could be helpful, it is not enough to treat chronic insomnia. The latest clinical practice guidelines of the American Academy of Sleep Medicine (Edinger et al., 2021) recommend against using sleep hygiene as a stand-alone treatment for chronic insomnia. Instead, the guidelines strongly recommend cognitive behavioral therapy for insomnia (CBT-i; see more below) as the treatment of choice based on its empirical support.
Sleep itself is not a skill that we get better at with practice. Rather, it is an involuntary process that takes place naturally without our effort (Epsie, 2002). As such, we are better off by getting ourselves out of the way of this process, which we can learn as skills to let sleep happen.
Another myth is that we all need to sleep for at least 8 hours each night, as it is supported by public health communications (e.g., recommendations by the National Sleep Foundation; Hirshkowitz et al., 2015). While helpful for the general population, it overlooks variability of what we need at the individual level, which can range from 5 to 11 hours for adults (Hirschkowitz et al., 2015; Wu, 2023). For each of us, there could also be fluctuations from day to day (e.g., based on our daytime activities). Learning to perceive more accurately what our body truly needs is a crucial part of the treatment for chronic insomnia
Lastly, insomnia does not necessarily mean that we are chronically sleep deprived (Wu, 2023). A key distinction is that insomnia sufferers often do not experience sleepiness (e.g., dozing off) during the day. When we experience insufficient sleep, we feel sleepy. Instead, insomnia sufferers tend to overestimate how long it takes them to fall asleep and underestimate the amount of sleep they have experienced (Harvey & Tang, 2012).
Listening to Our Sleep Drive
If sleep unfolds so naturally without our effort and practicing sleep hygiene alone is not quite enough, then why do we have trouble with sleep? Typically, what can get in the way of a good night sleep are dysregulation of our sleep drive, conditioned arousal (e.g., the bed becomes a place for feeling “wired”), and disruptions of our circadian rhythm (Manber & Carney, 2015).
Normal sleep is regulated by the interaction between the pressure to sleep, or sleep drive, and our biological clock (the circadian process; Borbély, Daan, Wirz-Justice, & Deboer, 2016). The sleep drive starts as the weakest in the morning and then builds up during the day, which eventually leads to our experience of sleepiness and struggling to stay awake (e.g., dozing off). The sleep drive is also tied to our physical energy spent during the day. In other words, we accumulate “sleep debt” during the day, and we pay it off with sleep (Epsie, 2002).
If we nap during the day, for instance, we start to pay off some of that sleep debt earlier than our normal bedtime. Our sleep drive becomes weaker, and we likely would feel sleepy later than usual – this is how our body communicates with us. Similarly, unbeknownst to us, we end up weakening our sleep drive by spending too much time in bed (e.g., bed rotting), going to bed before we feel sleepy, trying harder to fall asleep (i.e., conditioned arousal), sleeping more than we need (e.g., sleeping in during the weekend), and being inactive during the day (Epsie, 2002; Manber & Carney, 2015; Wu, 2023).
Sleep psychologist and researcher Jade Wu (2023) has recommended shifting our mindset: instead of treating sleep as an engineering problem, we can do well to learn to rekindle our relationship with sleep as a friend. Cognitive behavioral therapy for insomnia (CBT-i) can help us re-learn to care for our sleep drive again, to let go of our sleep effort, to lower our arousal connected with sleep, and to gain a more accurate perspective of what our body needs.
Briefly, the first steps include collecting a couple of weeks of sleep data with the use of a sleep diary to understand our sleep pattern: how much total sleep we are getting compared with how much time we are spending in bed (Manber & Carney, 2015). Based on this gap between the time spent for sleeping and staying in bed, we work on limiting our time spent in bed to compress our sleep – yes, by sleeping less at the beginning, we end up strengthening our sleep drive. As we build up our sleep debt consistently with a new schedule tailored from the sleep diary, we also sync this up with our natural body clock to stabilize our sleep again. Lastly, CBT-i addresses the problem of conditioned arousal by helping us change our behavior (e.g., not staying in bed wide awake), relieving anxieties about mistakes made (e.g., letting go of our sleep effort), and shifting our rigid beliefs and mindset about sleep (e.g., it is not a skill). Typically, treatment takes 4 to 8 weekly sessions to complete.
Time for a Sleep Check-up?
Occasional nights of poor sleep can happen to all of us and may not warrant too much concern. Sometimes we might have to travel (e.g., jet lag) or fulfill obligations at night (e.g., parenting a newborn comes to mind) that can directly interfere with our natural sleep process. These tend to be short-term, acute problems that the resilience of our sleep drive can handle and help us re-balance. When we are sleep deprived, the sleep drive takes its natural course for us to feel sleepy.
When we start to feel “tired but wired” with sleep disturbances (e.g., trouble falling asleep) in more than half of the nights that would not go away for a few months, then it would be helpful to have a check-up with a provider with expertise with sleep assessment and CBT-i. Chronic insomnia is absolutely treatable, and more often than not, within a couple of months.
Self-Reflection
- What do you do when you have trouble falling asleep? How long do you stay in bed being wide awake? Remember the problem of training our brain to be wide awake in bed through conditioning (i.e., conditioned arousal).
- Do you view sleep as a self-improvement project to work and perfect? How often do you experience sleep-related anxiety because of your sleep effort (e.g., tracking sleep)?
- What can you do more to strengthen your sleep drive?
- What can you do less that can weaken your sleep drive?
- How often do you feel tired compared to sleepy? What do you do when you feel fatigued and need to rest? Some ideas include taking a break and going out for a walk, listening to music, eating a healthy and nourishing meal, and engaging in stimulating and playful activities.
