The science of insomnia self-talk: why trying harder to sleep backfires

TEST_YOURSELF · How well do you know this science?

1. 01 According to Espie's attention–intention–effort model, why does deliberately trying to fall asleep tend to backfire?

   Sleep requires total silence to startSleep is an automatic process, and attention, intention and effort interfere with itTrying to sleep burns too many caloriesEffort only works for morning people

   The 2006 theoretical review argues good sleepers fall asleep automatically; selectively attending to sleep, explicitly intending it, and putting effort into it inhibit that sleep-wake automaticity. source ↗

2. 02 In Tang, Schmidt and Harvey's 2007 experiment, what happened to people with insomnia told to monitor the clock while falling asleep?

   They fell asleep fasterNothing measurable changedThey worried more about sleep and took longer to fall asleepThey slept longer overall

   Clock monitoring was randomly assigned, so the study shows a causal effect: monitoring the clock fed pre-sleep worry and lengthened sleep onset compared with monitoring a neutral display. source ↗

3. 03 What does 'paradoxical intention' ask a person who can't sleep to do?

   Count backwards from 1,000Get up and do intense exerciseVisualize a calm beach in detailGently try to stay awake instead of trying to sleep

   The technique, originating in Viktor Frankl's logotherapy, removes sleep effort by reversing the goal. The 2022 systematic review and meta-analysis found large improvements in central insomnia symptoms relative to passive comparators. source ↗

4. 04 In Harvey's 2002 cognitive model, what keeps insomnia going night after night?

   Worry about sleep and monitoring for sleep-related threatPurely genetic factorsToo much melatoninWeak willpower

   The model describes a maintaining cascade: excessive negatively toned cognitive activity triggers arousal and selective attention, which distort the perception of sleep and daytime deficit — and the distorted perception feeds more worry. source ↗

5. 05 What did the American College of Physicians recommend in 2016 as the initial treatment for chronic insomnia in adults?

   Long-term sleeping medicationCognitive behavioural therapy for insomnia (CBT-I)A strict eight-hours-in-bed scheduleDaily daytime naps

   The ACP clinical practice guideline recommends that all adult patients receive CBT-I as the initial treatment for chronic insomnia disorder — a therapy targeting sleep-related beliefs and behaviours rather than adding effort or medication first. source ↗