„I haven’t slept at all“. Said XYZ

Misperception of sleep is a thing. Join us in this episode as we explore how this condition can turn a rather normal thing like sleep to a dreadful moment.

#paradox #insomnia #CBTi #therapy #sleep # wearables 

Transcript

SPEAKER_00 0:09

What actually happens when we fall asleep? Um, can we rely on our brains to remember or to uh reproduce things that happen in the sleep when we are awake? And are we in actually a position to quantify or to actually um get an exact picture of the events that happen, how we when what when you're asleep, like how much have we slept, or how long did something happen when uh we were sleeping, like if something woke us up, how long did we stay awake, if we didn't look at the clock. And does the duration of our sleep actually say anything about the quality of our sleep and how we eventually feel during the day, or is it just a perception? This episode will probably answer some of these questions, and will probably also highlight some of the things that come up or that happen while we sleep. Hello everyone, and uh thanks for tuning in into today's episode. If you're new here, you will be happy at the end of this episode that you chose to spend this time with me, I assure you. And uh if you've been here before, um thank you for tuning in again, and I welcome you all to subscribe so you don't miss out on future episodes. And also, if you are related to any of these episodes, feel free to give feedback on what you would like us to tackle next or any ideas that uh could be of improvement to this. And um, I also want to congratulate you all for making this decision to be here because this is one thing we are growing one at a time. I uh I get a bit of feedback once in a while here and there, and I appreciate that so much. So, if you've done that, please keep on doing so because you are helping me in knowing what to how to keep on with this. So, join me in this journey and let's get to see what's in for us today as we handle the case of one brilliant lady who we are going to call Nia. Nia sincerely and honestly, with all her existence and call, that she had not had any sleep for a couple of days, if not for years, and at as at what her memory and body served her, she probably thought that this could have been going on for a while, as long as she could remember. Her brain, however, had a totally different outcome when put to test. This we will explore also towards the end of this episode, and I will give them a detail of what actually an outcome of the test the brain was. So, today we explore the fascinating mystery in sleep that is quite paradoxical, a sleep state misperception. Nia is a wife, mother, and a professional whose greatest fear has become the belief that sleep had abandoned her. If not for a while, but forever, because she could not, like I've mentioned, remember the last time that she actually did feel that she had slept through the night. She believed she had not slept for weeks, and she believed that she actually kept waking up as frequent and staying awake for long stretches at night, as much as she remembers and she reports. So Nia's problem began with what seemed like ordinary stress: a deadline at work, a few late nights, and one restless evening turn into several. She barely could keep up with thinking of doing any activities late in the night, especially because she always put herself much into pressure to go to get to bed early to catch up with the elusive thing that had become, or rather, the sleep that has now become quite elusive for her. Every morning she woke up convinced she had been awake all night. At first she shrugged it off, but as days became weak, worry replaced patience. She started watching their bedroom clock, counting every minute that passed, convinced she was collecting evidence that she never slept. She can't remember how long this could be going, but for as long as she can report, she reported, she felt like she was literally awake every hour, and uh even if she got to fall asleep, it could be very short. Her partner noticed something that Nia could not accept though. They would wake up in the middle of the night and hear her snore softly. Sometimes she rolled over, sometimes her breathing slowed into the steady rhythm of sleep. Like you can tell when someone is awake and when they get to sleep, there's a way the breathing pattern changes even from the sound. Yet at breakfast she insisted, I didn't sleep at all. Their conversations slowly became arguments. She believed her experience, and the partner believed their eyes, but neither was actually trying to deceive the other. It was just what both perceived, and what both perceived as facts. But none of this seemed to help. And even though she tried all that was available at her disposal to try, she still wasn't confident or felt like this is something she needs to address outside or with someone else. She just tried all this on her own and because uh after all she felt like probably she's crazy or probably something could be wrong with her, and due to fear of stigmatization, first she kept it to herself and of course the partner. The harder she chased sleep, the more anxious she became and the more elusive was sleep, you know, like a a cycle that was hard to break. Her world began revolving around one question. Will I sleep tonight? And after getting tired of trying all the self-sought remedies, she um near finally decided that maybe she needed to get some help from someone, from a specialist. But who exactly like she didn't really know where to begin. Some of the searches from the internet and from people she could probably be hinting about some of the problems she had, mentioned about them experiencing sleep issues and not sleeping because of her age or hormonal changes, and so she strongly associated it with probably getting into perimenopause. So she decided naturally to visit her OBGYN more or less from a disparate point of view and from a trial and error point of view, if whatever can be confirmed if her hormone uh function can be confirmed to be at uh normal levels. And um if any of what she was going through could be perimenopausal symptom or a hormonal shift, she was willing to accept that as her fate, although she felt that she was quite very young in her early thirties. The OBGYN assessed her case and referred her to a sleep specialist. Something she's never had before. She thought hesitantly about this and eventually accepted this um step as she was now at this point actually very desperate for health and was getting more and more fatigued about the thought of not being able to sleep again another night. The specialist reviewed her case, had her filled some documents, uh the questionnaires which she sent back, and while um during the initial visitation or consultation with the specialist, she got a kit to do a home sleep study that was supposed to be reviewed later on with the specialist. So this was actually the diagnostic step, which to be honest was quite upsetting to Nia as she had already tried quite a number of wearables at home, which all seemed to predict a perfect sleep pattern for her, less to her conviction, as she strongly believed something was wrong, and the devices could not be able to probably capture it, and maybe also faulty or maybe not up to date. So the results of the home sleep kit test also showed pretty much a consistent result with what she had been having before. A perfect sleep pattern, and yet again, to her disappointment, she had felt on this night that she had not slept at all, and she even associated with having this foreign device on her body and having the anxiety of needing to have a result of get uh an answer to her question or to her situation right now. So this ironical or result, paradoxical one, prompted the physician to have Nia admitted at the lab and just to have things ruled out and um to have a more closer and full recording with a video monitoring for the night. This happened quite pretty soon that Nia got to stay at the sleep lab and stayed for the night and had this all the full polysomenography, which is the test done for a recording done for different parameters of the body that affect sleep, and the next morning the physician revealed the results with Nia. She was taken through the whole recording, which involved the heart rate, um, the recording of her brain waves, the recording of her movements, and even the recording of her positions throughout the night. And again, the reside the results show more another consistency with the usual parameters used to judge normal or abnormal sleep showing being on the normal range. On this night, she actually had a good over six hours of sleep, and she stared in disbelief because how could that be? She felt she had not slept at all. She felt that the night ended as soon as it began, and of course she felt like she woke up pretty often and had to turn back and forth. The physician tried to break everything down, living in an evidence-based world, and explained that the results that they were viewing could not be from someone else, as she could see herself on the video monitoring system. And Nia, of course, was shocked, and the kind of paradoxical sleep that she was experiencing was something she has never even heard of, and was a phenomenon occurring when during the lighter stages of sleep, some people tend to um remain unusually aware of their surroundings. Brief awakenings become memorable, and the brain interprets these as long durations, and long periods of sleep disappear somehow from the brain's memory. So the brain then just reports whatever is left in the let me say memory center as if one had a sleepless night, and even though objective measurements show otherwise, a situation where perception and physiology no longer match, which is called um the medical term paradoxical insomnia, and rather than forcing sleep, treatment focused on reducing fear is what should be uh introduced to the patients because the more one the brain gives this wrong perception that one did not sleep, the more it gets fearful for most of those suffering with this condition. It gets to think about um the sleeping time. So Niob began um a cognitive behavioral therapy for insomnia and got some tips of also how to improve or to um optimize her perception and her feelings. She removed the bedroom clock, stopped calculating every hour of sleep, and especially during this brief awakenings, there she was advised not to look at the clock. She challenged also uh negative thoughts because these mostly came to her during these uh brief awakenings, and she was encouraged to introduce a countling night routine as well as reduce reducing the uh screen time before bed, and other than that, it was also uh advisable for Nia not to cancel her life or her social life while chasing sleep. And one thing the therapist emphasized is creating a welcoming and calming environment at the bedroom and avoiding to stay too long in bell in bed, you know, while doing sleep, it's like canceling all social events because she needs to get to bed early to catch up with the sleep, which she thought probably entered the room before she arrived, or something like that. So recovery was gradual, of course, and excuse me, a vital thing for Nia to practice as well was the perception that some mornings or rather that sometimes the brain can give us wrong messages. It apparently happens, especially with sleep. Some mornings still felt like she had barely slept, but instead of trusting fear and trusting completely her brain, she learned to embrace the short moments she would awake and also to trust um like the evidence, which was like the recordings she got even from her wearables, and uh she would awaken as yet another the moments she was awake, she would just look at them as yet another opportunity to get to sleep for a couple of more hours before eventually waking up for her daily routines, and instead of labeling these awakenings as another long restless night. So the clock also at the room that was bringing destruction and putting her more into pressure left the room, she only got a mini clock that was no longer staring at her when she was awake, that she could just put away to help her, like with an alarm system, and um she also learned to trust the evidence and her pretty normal daytime functioning because much as she felt that she had not slept, her daily functioning was pretty normal, she could go through the day, work, wake up normally without any challenges, other than the stress that she had not slept, and um despite the feelings before of not having slept that were also crippling her and accompanying her during the day, she just focused on the fact that she actually did sleep, even if for short her brain gave her the feeling that they were short durations. She still looked at it positively. Of course, it took time to get there, and um she still was able to show stable performance and was um like recovered her social life, was able to meet people both within friends and family cycles and also at work, and ironically, the less she fought sleep, the easier it became, and uh bedtime stopped feeling like an exam. Nia's story reminds us that our brains do not simply record reality, they interpret it, and most of the times these interpretations are accurate, but sometimes, especially with sleep, they are not. Like there are times things that we cannot explain. So, if you could have related to this episode, I would like to remind you that you're not alone and you're seen, and that there are effective treatments to this condition, and answers are possible. At times, our own brain can fool us and interpret things the wrong way, and that makes us to have to rely on external tools or help to realign this. So, thank you for listening and feel free to share this story with anyone who might need some hope tonight. Thanks again for choosing to spend this time with me, and until next time, sleep well.