Maybe you've heard this one: A woman goes to see a psychologist and tells him her husband thinks he's a chicken.
"Well," says the psychologist, "we have effective treatments for that. Why don't you bring him in?"
"I don't know," responds the woman. "We really need the eggs."
Like many sleep specialists, I wondered why our effective treatments for insomnia didn't seem to be significantly impacting the epidemic of sleeplessness. I wondered why so many of my patients struggled with following through on recommended treatments. And I wondered why so many people with insomnia didn't even seek treatment and instead opted for drugs, substances, or just muscling through.
The answer to these questions is secondary gain -- the indirect, potential benefits of not treating a health concern. Secondary gain is not a conscious or manipulative attempt to leverage illness. It is, rather, a kind of behavioral trap that snares and keeps us stuck against our will. Secondary gain does not mean we are in any way enjoying our sleep struggles. Like the golden handcuffs of an unsatisfying job or the emotional security of a dysfunctional relationship, the challenges of secondary gains around sleeplessness are both common and tricky to navigate.
The first step in addressing secondary gain is to identify the specific ways in which it affects us. Here are seven of the most common patterns of insomnia-related secondary gain I have observed:
1. Most obvious, spending less time asleep means more time awake. Being awake can allow us to feel more productive, can provide more time for ourselves, or can help us feel less pressured, less rushed. Independent of insomnia, restricting sleep has long been seen as a badge of honor.
2. Chronic sleep loss fogs our mind and blunts our emotions. As uncomfortable as the resulting daytime sleepiness might be, it can take the edge off waking life by rendering us desensitized or numb. In some ways, being chronically sleepy is similar to being somewhat inebriated.
3. Excessive daytime sleepiness provides legitimate excuses for avoiding personal, social, and professional obligations. Our unmanageable sleepiness can get us out of attending social events, can explain poor performance at work or school, can justify inattentiveness to family and friends, and can explain our failure to follow through on an exercise or weight management program.
4. Untreated insomnia can have a powerful impact on our primary relationships. For some, it may offer protection from intimacy by reinforcing the need to sleep apart or by otherwise limiting their availability to their partner. For others, it may encourage support, concern, kindness, or even pity from a partner. Research suggests that untreated insomnia eventually has a deleterious effect on relationships.
5. Chronic sleep difficulties can become a rationale for dependence on alcohol, marijuana, or food to make it through the night -- or day. In fact, many adult alcoholics began their heavy drinking patterns in adolescence in an attempt to manage their sleeplessness. Although alcohol, substances, and food may appear to help in the short-term, they ultimately exacerbate sleep struggles.
6. Chronic insomnia provides justification for remaining dependent on sleep medications, both prescription and over-the-counter varieties. Despite common knowledge that sleeping pills are of limited effectiveness and questionable safety, their use has continued to rise in recent years.
7. Probably the most subtle and least acknowledged form of secondary gain around insomnia is the avoidance of dreams. Because most sleeplessness occurs in the latter part of the night, when we are in our most protracted periods of REM sleep, it deprives us of our dreams. Shakespeare eloquently called our attention to this issue in Hamlet's famous soliloquy: "To sleep perchance to dream..." Many of us would rather evade the challenging emotions dreams can elicit and so we avoid, often unconsciously, dreaming.
Addressing insomnia-related secondary gain begins with the willingness to carefully consider how our symptoms might be serving us, even if indirectly. Give this some serious thought and obtain input from people who are close to you. Identify the specific benefits you might be deriving from staying sleepless, and then find alternative ways to obtain those benefits. In other words, plan to get your eggs elsewhere.
More often than not, treating insomnia calls for examining and changing lifestyle patterns. You'll find that what you need for better sleep is exactly what you need for a happier and healthier waking life. Consider getting help from a knowledgeable sleep therapist or coach, if needed.