The limits of a system designed to fix, not understand
If you are not sleeping well, you have probably been advised to seek medical help. Perhaps a doctor can provide medication to get you over the hump, something that targets anxiety or depression, or something to just help you relax.
Western medical professionals can address issues that affect sleep. However, the medications and therapies that are often suggested are usually most beneficial for people who are experiencing temporary sleep disruptions rather than long-term chronic insomnia. A sleep disruption is an event, a life stressor, an incident or episode resulting in acute insomnia. Acute insomnia is short-term and typically returns to normal once the stressor resolves. While the chronic insomniac might have had an acute origin to their insomnia, the ongoing inability to sleep points to a potentially different etiology. I argue that chronic insomnia is more deeply rooted in our psyches and nervous systems, hence short-term fixes that don’t address root causes will not bring lasting relief.
For chronic insomniacs, Western medical professionals will rule out physical causes to sleep disruption like sleep apnea. If you do not have sleep apnea, you will likely be advised to learn about Cognitive Behavioral Therapy for Insomnia (CBT-i). CBT-i is touted as the first line, “gold standard”, treatment. While research supports the effectiveness of CBT-i (Boness, et al., 2006) *, many people, including myself consider sleep restriction, which is the basic tenant of CBT-i, torturous. CBT-i’s demand for strict behavioral changes can be counterintuitive, challenging, harsh, and can backfire causing increased distress and fear around sleep. You can read here about my personal experience with CBT-i.
The Western medical model also includes several other tools in their arsenal against insomnia including sleep hygiene, relaxation techniques, melatonin receptor agonists, medications that target wakefulness rather than sedation, off-label medications that overlap with mood and anxiety treatments, hormone replacement therapy, and light therapy.
No doubt that some people have had success with these therapies. I personally have not. I have been pointed in so many directions by well-meaning medical professionals. I have gone down countless rabbit holes within the healthcare space. I have spent thousand of dollars on devices, medications, and subscriptions. But none of them gave me any lasting relief. While I honestly believe these doctors and medical professionals have good intentions, sometimes I wonder if treating chronic insomnia is outside of their purview of the Western-trained medical professional’s expertise. The Western medical model is not, in my opinion, built to address how issues of the mind can manifest in physical symptoms.
You see, this is the part that most people don’t get from standard Western medical care: these treatments aren’t designed to target the root cause of long-term, fear-based, chronic insomnia. The Western model is built on a behavioral framework that assumes that changing behaviors and thoughts about sleep will normalize sleep. But once insomnia lasts long enough, it often evolves into a mind-body pattern, where fear and hyperarousal become the central loop. The Western approach treats insomnia as something to fix and vastly underestimates the role that fear, hyperarousal, and repressed emotions play in the chronic, persistent long-term inability to sleep. This feedback loop keeps the nervous system revved up, and this is the primary driver of chronic insomnia.
The paradox Western medicine struggles with is that sleep is one of the few systems where the more you try to control it, the more you disrupt it. Western medicine is great at controlling variables and optimizing systems, but sleep requires letting go of control, reducing urgency, and allowing unpredictability. That’s a philosophical mismatch.
In my experience, the key to treating chronic insomnia lies in one’s ability to tap into embedded fears and emotions and to release them from the nervous system. This will, over time, rewire your neural circuitry and retrain your brain to stop interpreting emotions as physical danger. As your nervous system calms and resets, sleep will no longer be interpreted by your psyche as a dangerous thing. Peaceful, restful, rejuvenating sleep can be fully restored.
Curious about how you might do this? Please try the Rest ReSET. It is a specific journaling practice that will help your nervous system purge negative thoughts, emotions, and fears that may be at the root of your chronic insomnia.
Also, please consider signing up for my newsletter where I give insights and opinions surrounding the topic of chronic insomnia. The newsletter sign-up is below.
* Boness CL, Hershenberg R, Kaye J, Mackintosh MA, Grasso DJ, Noser A, Raffa SD. An Evaluation of Cognitive Behavioral Therapy for Insomnia: A Systematic Review and Application of Tolin’s Criteria for Empirically Supported Treatments. Clin Psychol (New York). 2020 Dec;27(4):e12348. doi: 10.1111/cpsp.12348. Epub 2020 Jun 4. PMID: 33692609; PMCID: PMC7939024.
