Where I Sleep: Exploring Bedroom Alternatives

Many people experience difficulty sleeping in their own beds, despite being able to sleep in other places. This phenomenon is often attributed to conditioned arousal, where the brain has associated the bed or bedroom with wakefulness and frustration due to past experiences of tossing and turning. This can lead to a cycle of insomnia and further reinforce the negative association with the bed or bedroom. However, it is possible to recondition this relationship by following techniques such as stimulus control, which involves removing all activities except sleep from the bedroom and only going to bed when feeling sleepy. Additionally, underlying pressure and performance anxiety can contribute to sleep difficulties, as the absence of designated sleeping times can reduce the feeling of a threat to sleep.

Insomnia and the brain's survival system

Insomnia is a sleep disorder characterised by chronic dissatisfaction with sleep quantity or quality. It is associated with difficulty falling asleep, frequent nighttime awakenings, and/or early morning awakenings. Insomnia can be differentiated from sleep deprivation by the fact that insomnia involves difficulty sleeping despite having adequate opportunity to do so.

Insomnia is often considered a disorder of hyperarousal, or increased somatic, cognitive, and cortical activation. This hyperarousal can be physiologic, affective, or cognitive, and it interferes with the natural "disengagement from [...] the environment" and decreases the likelihood of sleep.

The hyperarousal model of insomnia suggests that insomnia may be caused by excessive activation of the arousal systems of the brain. This involves the bottom-up reticular activating system, limbic networks, and the top-down cognitive systems. The major wake-promoting systems of the brain include the reticular activating system, the limbic networks, and the cognitive systems. These systems project to the cortex via the thalamus and basal forebrain and include cholinergic, noradrenergic, serotoninergic, histaminergic, and basal forebrain cholinergic nuclei.

The orexin/hypocretin neurons of the lateral hypothalamus play a particularly important role in insomnia. They project to all of the arousal-promoting centres in the brainstem and hypothalamus and reinforce their activity. The ventrolateral preoptic area (VLPO) and median preoptic area (MnPO) are critical sleep-promoting regions that inhibit the arousal systems. During normal sleep initiation, the VLPO and MnPO inhibit the arousal centres, while activation of these arousal centres is sufficient to terminate sleep.

Insomnia may be caused by chronic coactivation of sleep and wake circuits during the desired sleep period, resulting in simultaneous activation of brain structures responsible for sleep and wakefulness. This model is supported by animal studies showing that the reciprocal inhibitory innervation between the VLPO and the arousal system can decouple under stressful conditions, resulting in a unique state with simultaneous sleep and wake features.

In addition to hyperarousal, insomnia can also be caused by conditioned arousal, which is the repeated association of sleep-related cues with wakefulness and/or arousal. This results in an arousal response when a sleep-related stimulus is presented. Conditioned arousal is particularly relevant in the context of the bedroom, as insomniacs spend more hours awake in bed than asleep, and the bedroom becomes associated with wakefulness more than sleep. This is known as "conditioned arousal" or "stimulus control."

To treat insomnia, it is important to recondition the relationship with the bed and bedroom. This involves associating the bed with sleep and removing all other behaviours and activities from the bed and preferably from the bedroom. Techniques such as stimulus control and cognitive behavioural therapy can be effective in treating insomnia by enhancing sleep processes and reducing cognitive and emotional arousal.

Conditioned arousal

The bed and bedroom environment become conditioned to feelings of anxiety and frustration, rather than relaxation and sleep. This is because people with insomnia spend many hours tossing and turning in bed, worrying about getting enough sleep and how they will function the next day. As a result, the bedroom becomes associated with wakefulness more than sleep.

Stimulus control as a solution

Stimulus control is a set of techniques that can be used to undo conditioned arousal. It aims to break the link between anxious feelings and the bed, and instead reinforce the association between the bed and sleepiness. Stimulus control was developed by Richard Bootzin and is often used as part of Cognitive Behavioural Therapy for Insomnia (CBTi), a highly effective treatment for insomnia.

The key instructions for stimulus control are:

• Establish a regular morning rise time to strengthen the circadian clock regulating sleep and wakefulness.
• Only go to bed when you feel sleepy, as this will increase the likelihood of falling asleep quickly. It is important to distinguish between fatigue and sleepiness.
• If you are unable to fall asleep, either at the beginning of the night or during the night, get out of bed and only return when you feel sleepy again.
• Avoid excessive napping during the day. A brief nap of 15-30 minutes is unlikely to disturb nocturnal sleep.

Underlying pressure and performance anxiety

The pressure to sleep at the "right" time can create performance anxiety, which can be a significant contributor to insomnia. This anxiety transforms sleep from a natural process into a forced performance, leading to a vicious cycle where the pressure to sleep keeps you awake. The fear of not sleeping can become so powerful that it affects your daily life, causing you to chase sleep at unusual times and places.

The paradox of sleep is that the more accepting we are of the possibility of not sleeping, the better our sleep quality becomes. When we sleep in places outside our bedrooms, such as airport floors or couches, we often feel less pressure to fall asleep because we don't view those locations as "designated" sleeping areas. This lack of pressure allows us to relax and fall asleep more easily.

The absence of accurate information about insomnia can lead to further confusion and frustration. Many people assume that their insomnia is due to a rare sleep disorder or a lack of discipline, which only adds to the anxiety and pressure they feel. However, understanding the underlying causes of insomnia, such as conditioned arousal and performance anxiety, can help reduce the fear and panic associated with it.

To improve sleep quality, it is essential to address the root causes of insomnia. This may involve seeking accurate information about insomnia, practicing stimulus control techniques, and making lifestyle changes to reduce overall stress and anxiety. By taking away the mystery of insomnia, individuals can respond to their sleep challenges from a place of knowledge rather than fear, gradually teaching their brains to let go of the alarm bells that keep them awake.

Creating associations with bedrooms

It is not uncommon to develop a negative association with your bedroom, especially if you have insomnia or other sleep disorders. The very thought of your bedroom might evoke feelings of frustration, anger, or anxiety. This is called "conditioned arousal", where the brain has identified being awake at night as a threat and thus, it enters a heightened state of alertness. This paradoxically wakes you up when you want to sleep.

However, you can recondition your relationship with your bedroom. Here are some tips to help you create positive associations with your bedroom:

Stimulus Control

This is a set of techniques that can help undo your conditioned arousal. The main principle is: the bed is for sleep, and sleep is for the bed.

• Do not engage in any activities in bed other than sleep. This includes planning for the next day, watching TV, looking at your phone, or reading. Find a comfortable place outside your bedroom to do these activities. The only exception is sex.
• Get into bed only when you feel sleepy. If you're unable to fall asleep within 10-15 minutes, get out of bed and engage in a relaxing activity elsewhere until you feel sleepy again.
• If you start dozing off outside your bed, such as on the couch, get up and get into your bed.
• If you take naps during the day, do so in your bed.

Revamp Your Bedroom

• Consider redecorating your bedroom. Try repainting, getting a new bed frame, or investing in new bedding and pillows with soft and comfortable fabrics.
• Ensure your bedroom is a soothing and relaxing space. This might include adjusting the lighting or sound to suit your preferences.
• Make your bedroom a tech-free zone. Avoid watching TV, using your phone, or playing video games in bed.
• Maintain a comfortable temperature in your bedroom.

Address Underlying Issues

• Reflect on any underlying emotions or lifestyle factors that might be affecting your sleep. Are you satisfied with your life? Are there any changes you want to make?
• Understand that it's okay to not feel "happy and cozy" every night. Accept that different nights will feel different, depending on various factors such as your activities during the day or the day of the week.
• Be mindful of any performance anxiety or pressure you may be feeling about sleep. Remember that the more you accept the possibility of not sleeping, the better your sleep will be.
• Practice mindfulness and stress-reducing activities, such as meditation or deep breathing, to help you wind down and improve your sleep quality.

By following these tips and being patient, you can create positive associations with your bedroom and improve your sleep quality.

The paradox of sleep

Sleep is essential for our health and happiness, but for some, a good night's rest is elusive. Insomnia is a common condition that affects many, and one of the ironies of this disorder is that those who suffer from it can find themselves able to sleep almost anywhere but in their own beds. This phenomenon, known as "conditioned arousal", is a result of the brain identifying being awake at night as a threat, triggering a heightened state of alertness.

The bedroom is meant to be a sanctuary, a place where one can retreat and unwind after a long day. However, for insomniacs, the bedroom can become a source of frustration and anxiety. The very place that should bring comfort and relaxation instead elicits feelings of restlessness and insomnia. This is the paradox of sleep: the inability to sleep in the one place designed for slumber.

The Science Behind It

Conditioned arousal is a form of hyperarousal that is learned over time. It occurs when the brain associates the bed and bedroom with wakefulness and frustration, rather than sleep. This can happen due to various factors, such as stress, underlying pressure, or performance anxiety. The person may start to dread bedtime, anticipating another night of tossing and turning. As a result, the brain starts to view sleep as a threat, triggering alarm bells that keep the individual awake.

The Impact

The impact of conditioned arousal can be significant. It can lead to a fear of not sleeping, causing individuals to chase sleep whenever and wherever they can. This can result in unusual sleep patterns and a shrinking world as individuals accommodate their fear of not sleeping. It can also affect one's mental and physical health, as sleep deprivation takes its toll.

Breaking the Cycle

So, how can one break free from the cycle of conditioned arousal? The first step is understanding what is happening. Recognizing that insomnia is often a result of the brain's automated fear program can help reduce the panic and confusion associated with it. This awareness can help dial down the fear and slowly teach the brain to let go of the alarm bells. Additionally, stimulus control techniques can be employed to recondition the relationship with the bed and bedroom. This involves removing all activities from the bed and bedroom except for sleep, creating a new, positive association with the sleep space.

A Common Solution

For some, the solution to this paradox may be found in sharing a bed with a partner. The presence of a partner can provide comfort and security, improving sleep quality. However, sharing a bed also comes with its own set of challenges, such as differing sleep habits and preferences. To navigate these challenges, communication and compromise are key. Partners may need to make adjustments to their sleeping environment, such as using earplugs or eye masks, or even sleeping in separate beds or rooms if needed.

Frequently asked questions