The Insomnia Trap: Trying Harder Makes It Worse

A conversation between an insomniac and a therapist.

Therapist: Tell me about your sleep.

Patient: I can’t fall asleep.

Therapist: How long has this been going on?

Patient: Since my junior year of college. I’m 52 now.

Therapist: So over 30 years?

Patient: Yes.

Therapist: Do you practice good sleep hygiene?

Patient: Better than most sleep experts.

Therapist: What does that mean?

Patient: I watch the sunrise every morning to anchor my circadian rhythm, and to start the biological process that governs nighttime melatonin release. I stop drinking coffee before 9 a.m. I wear blue-light blocking glasses after sunset. A bed is for sex and sleep only — no screens, no books, no TV. I follow a consistent sleep and wake time seven days a week to avoid social jet lag.

Therapist: That’s an enormous amount of cognitive bandwidth devoted to preventing sleep disruption.

Patient: Wait ‘till I get going! I’ve set my phone to switch to night mode as the sun sets and my computer screens do the same. My bedroom is cold and dark, as it would have been for our ancestors. I avoid eating or drinking at least a few hours before bedtime.

Therapist: Do you exercise?

Patient: Intense exercise six days a week. I also do cold plunges four or five times a week.

Therapist: Cold plunges late in the day?

Patient: Don’t be ridiculous. I finish by noon because I know the body’s efforts to rewarm after a plunge can interfere with the normal evening drop in core body temperature that helps trigger sleep.

Therapist: So you’re tired at night?

Patient: Exhausted.

Therapist: But you can’t sleep?

Patient: I climb into bed tired, drowsy, ready to sleep. Then nothing happens.

______________________________

Therapist: Have you tried medication?

Patient: I’ve taken a low dose of lorazepam for about twenty years.

Therapist: Does it work?

Patient: Every time, but I understand the impact of a sedative on sleep architecture compared to a true sleep aid.

Therapist: Have you developed a tolerance to it?

Patient: Oddly enough, I’ve become more sensitive to it over the years.

Therapist: Have you tried replacing it because of the studies that show a correlation between long term use of benzodiazepines and dementia in the elderly?

Patient: Yes. Trazodone worked for me for a few months and then fizzled. Doxepin did nothing. Mirtazapine just made me hungry. I know that the remarkable drug GHB works great for sleep onset insomnia and keeps your natural sleep architecture intact. Unfortunately, the FDA killed GHB in the early 1990s because it threatened drug company profits.

_____________________________

Therapist: Let’s talk about your family.

Patient: My mother has the same problem.

Therapist: Anyone else?

Patient: My sister.

Therapist: Anyone else?

Patient: My uncle — my mother’s brother.

Therapist: Interesting.

Patient: Why?

Therapist: Because we’re no longer talking about someone who simply has bad habits. Genetically, some people are born with extraordinarily resilient sleep systems. Others are born with fragile sleep systems.

Patient: It’s funny you say that. My father can sleep soundly on his side of the bed while my mother packs a suitcase after midnight on hers. I was married to a woman who watched screens in bed, didn’t care about her sleep schedule, engaged in late night socializing, was oblivious to blue light exposure at night, ate late meals … yet slept instantly under any conditions — on planes, in cars, and around every kind of noise. Pretty impressive actually.

Therapist: They slumber because their nervous system fundamentally trusts the transition into sleep. You believe sleep is a high stakes event that every day must be carefully engineered and defended.

______________________

Therapist: What happens if you only sleep four hours on a particular night?

Patient: I’ll feel terrible.

Therapist: Anything else?

Patient: I’ll be less productive. Less healthy. I might have to miss my workout. I’m damaging my brain.

Therapist: So we’re not just talking about sleep anymore. We’re talking about catastrophe.

Patient: But sleep is health. Metabolic health. Insulin sensitivity. Cognition. Emotional regulation. Cardiovascular risk. Immune function. Longevity. Recovery. Memory consolidation. Everything else in the health ecosystem is just improvement on the margins if your sleep foundation is intact.

Therapist: That’s true. But there’s a difference between respecting sleep and having sleep become the organizing principle of your existence. After enough years, the cost of that lifestyle, including social withdrawal, can exceed the direct physiological cost of imperfect sleep itself. There’s actually a name for this phenomenon: orthosomnia. Honestly, has the sacrifice been worth it?

Patient: I can’t say.

Therapist: Sleep is unique because it is one of the few biological processes that worsens under effort. You cannot make yourself sleep in the way you can make yourself diet or exercise. Sleep requires a kind of neurological surrender.

Patient: So what’s the lesson?

Therapist: The pursuit of perfect sleep often creates the very hypervigilance that prevents sleep. Some people improve by gaining confidence they can survive imperfect nights, recognizing their body is not terrifyingly fragile, and accepting that sleep does not require constant supervision.

Patient: Ok, but where do I start?

Therapist: I think you should consider that your goal is to build a meaningful life. Sleep is important, but it isn’t the purpose of your life. Somewhere along the way you’ve reversed that relationship, with the current purpose of your life designed to facilitate sleep.

Patient: So I should stop caring about sleep?

Therapist: You should stop measuring your life by last night’s sleep.

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As an athlete, model, personal trainer, and all-around fitness fanatic, Keva Silversmith has logged thousands of gym hours, and accumulated the nagging injuries that seem unavoidable. Committed to strength, fitness, physique, vigor, and confidence at an age when most men have let it all go, Keva has studied and experimented with how best to preserve his health and stay forever 35.

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• ​Why Sweating Isn't Detox​

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