From this title, it may sound like I am announcing a new recently discovered sleep disorder! Even though many rare and somewhat esoteric sleep disorders have been found, I don’t believe “Sleep Drooling Syndrome” has yet been described. Instead, I would like to describe one of the most common disorders of sleep, Conditioned Insomnia, in the context of a historical reference to drooling.
As the name implies, Conditioned Insomnia (CI) is something which develops over time. CI is insomnia which is in a sense “learned”. When getting to sleep or back to sleep becomes increasingly difficult due to any number of reasons (stress, worry, pain, irregular work schedule, medications, etc.), CI is developing.
This type of conditioning is called “classical” conditioning, first described about a century ago by a Russian physiologist named Ivan Pavlov (1849-1936). Dr. Pavlov was studying digestion and used dogs as subjects. Periodically, as the story goes, he would enter the lab, present the dogs with meat powder, and the dogs would of course salivate (drool). At some point, he noted that the dogs began to drool as soon as he entered the room, or as history has noted, when a bell on the lab door rang as he entered. The dogs became conditioned to drool, that is, they “learned” to drool for a psychological reason, not a physiological reason. In the same manner, a person with CI becomes conditioned to become alert in the evening or around bedtime for no physiological reason.
CI can often be uncovered with a few simple questions: “Do you become more alert at bedtime?” and “Do you tend to sleep better away from home?”. Answering “Yes” to one or both of these questions, combined with the complaint of frequent difficulty getting to sleep or back to sleep, confirms the presence of CI. CI is not an all-or-none condition. It is a gradual continuum, the extreme being downright dread of the bed or bedtime. Coping behaviors often develop as CI progresses: using TV for distraction at night, alcohol or sleeping pills before bed, or the oh so fun act of racing from the couch to bed so as not to miss the brief window of time in which sleep must occur or it’s “no sleep tonight!”. The run-on sentence is meant to give you a glimpse of the anxiety at bedtime that accompanies CI.
So, what can a classically-conditioned insomniac do? The answer is fairly simple, but effort is required. CI must be “un-learned”. This is done by the simple strategy of never being or staying in bed when alert. Even if someone with CI is falling asleep on the couch, gets the elbow from their spouse that it’s time for bed, and then proceeds to race into bed only to miss their sleep window, the best thing to do is to calmly leave the bed. Then what? In a previous blog post I suggested doing anything low tech, low light, and low noise. Best to start with some reading. For how long? Until sleepy again. Not bored, tired or exhausted, but sleepy, such as when you start dropping your book.
Over time, this strategy has been shown to really help, but it does take will-power. Not many people are usually there at 3am to encourage you to leave your warm cozy bed on a cold winter’s night when you become alert. Perhaps the best strategy is prevention: have a bit of low-tech wind-down time each evening without TV or computer screens in front of you. Adopt a calm, relaxed demeanor. Feel confident about sleep. And if you feel like sleep is difficult on a particular night, shrug, foot on the floor, do something quiet in another room until sleepiness returns.
Good sleepers know that an occasional rough night happens, but that sleep will be easier the next night. But if you struggle with persistent CI, and your doctor has indicated that nothing medically or psychologically is causing it, consider trying the SleepQ app, coming in spring 2014! A little late afternoon sleep training with SleepQ may be just the ticket to get your sleep back on track quickly!