On Thursday, Dr. Elliot Kyung Lee, medical director of the Sleep Disorder Clinic at the Royal Ottawa Mental Health Centre, and I were interviewed by Matt Galloway on The Current (CBC National radio) regarding the pandemic, insomnia and mental perturbance. You can listen to the episode on this CBC page which also includes an article about the interview.

In this blog post, I’d like to elaborate on the concepts of mental perturbance and insomnolence that were discussed. I’d also like to put the sleep tips in context.

Preamble: Replacing worry with curiosity

The subtext of my contribution to this interview, and to all of my work on sleep onset and insomnolence is this. Literature on insomnia often emphasizes the fact that many people are not getting enough of sleep and the adverse effects of sleep deprivation. While sleep is definitely important it’s important not to get all worked up about insomnia. Worrying about insomnia is itself on the pathway to insomnia.

Instead, I recommend becoming curious about the mechanisms that control sleep onset and insomnolence. In my view, to understand human sleep onset and insomnolence requires understanding oneself more generally (emotions, executive functions, etc.). That’s intrinsically interesting and can be helpful in all aspects of human life.

Causes of insomnia and insomnolence

As Dr. Lee noted, insomnia can be caused by many factors. Dr. Lee also pointed out that insomnia is both a symptom and a cause of many disorders. (Compare this free article: Insomnia as a transdiagnostic process in psychiatric disorders). To treat insomnia, it helps to know the cause.

Insomnia involves difficulty in falling asleep, maintaining sleep, or sleep being refreshing. However, not all difficulty obtaining sleep qualify as insomnia per se, as insomnia is a specific psychiatric condition.

My co-authors and I use the term insomnolence to refer specifically to difficulty transitioning to sleep, whether or not this difficult is a psychiatric condition. This also includes difficulty falling back to sleep after early awakening. The concept is narrower than insomnia in that it focuses on transition to sleep rather than sleep quality or sleep maintenance. It is also more general than insomnia, in that it can apply regardless of whether one has insomnia per se. It is also not a clinical diagnosis. This can normalize one’s condition, and perhaps help one catastrophize less about sleep. The concept is also meant to draw attention to the mechanisms that control sleep onset. We hope this will be helpful for practitioners and the public.

My colleagues and I have proposed a 5-factor model of the causes of somnolence (propensity to fall asleep). (Hereafter “we” refers to the co-authors of this and related publications.) A factor that is particularly relevant to pandemic-related insomnia, which I mentioned in the interview, is mental perturbance.

Mental perturbance

Mental perturbance is a disruption of executive functions, typically involving a very insistent motivator or cluster of motivators. Mental perturbance is akin to an intense preoccupation or active obsession. Mental perturbance tends to involve repetitive thought about a motivator. You can think of a motivator as a concern (the object of a fear, urge, impulse, wish, desire, aversion or the like). A motivator is insistent if it tends to draw your attention. So mental perturbance tends to involve an insistent motivator.

In a previous blog post, I gave examples of pandemic-related motivators. An example would be a concern that your children’s school has been closed due to the pandemic. If the motivator is sufficiently insistent, you tend to think about it.

When you are in bed, trying to fall asleep, your brain needs to compute whether it is safe and appropriate to do so. The algorithms used by your brain are unconscious and evolutionarily old (sleep is ancient!). One of the tricks human brains seem to use is gauging whether one is engaged in problem solving that is driven by an insistent motivator. If there’s an insistent motivator driving your thinking (however confused your thinking might be), the brain’s sleep onset control system assumes it’s probably better to stay awake, other things being equal. (The brain also considers other factors.)

Alarm-based perturbance

Two forms of mental perturbance are worth distinguishing. The main form is semantically rich, i.e., involves a motivator vying for attention, as alluded to in the previous section.

The other form is more diffuse and global. It is alarm-based perturbance. A mental alarm is a general signal that something important and urgent is happening. The alarm does not convey the specifics about the danger (who, what, where). Suppose that returning home from a walk one evening, you enter your dark home implicitly assuming it is empty. As you enter the living room, you open the lights and a dozen of your friends shout “Surprise!” Your brain then rapidly triggers an internal global alarm, which will have repercussions throughout your central and peripheral nervous system and the rest of your body. (In parallel, insistent new motivators to deal with the external situation will be generated and influence your cognition and behavior. Habitual responses will also be primed [stimulus-driven cognition].)

Hans Selye, the Hungarian-Canadian originator of the psychological concept of stress, referred to the first phase of stress as an “alarm reaction”. But he wasn’t involved in AI and didn’t outline the information processing mechanisms involved in the alarm reaction.

Surprisingly, vanishingly few psychologists and cognitive scientists elaborated on the concept of alarm, let alone with computer models. British Canadian emotion psychologist, Keith Oatley, briefly used the concept of alarms in his book Best Laid Schemes: The Psychology of the Emotions, but didn’t pursue it in any detail. Aaron Sloman proposed that alarms are a major type of emotion. In his theory, which we pursue, alarms can trigger global behavioral responses, and also cause many subtle internal physiological and cognitive responses. Bernard Baars and colleagues incorporated Sloman’s concepts in updates to their theory of consciousness.

My colleagues and I have posited that perturbant alarms are insomnolent, meaning they tend to keep people awake. An alarm is perturbant if it disrupts executive functioning, particularly attention. I believe alarms are a more specific source of insomnolence than physiological arousal, not all of which is related to an alarm reaction. Other effects of the alarm reaction might also be insomnolent, a topic that requires more theoretical and empirical investigation. I believe the concept of alarms merits more attention in understanding human agency in general, and emotions and insomnolence in particular. It may help resolve some questions regarding the polysemic concept of arousal in insomnia literature).

Tips for better sleep

Matt Galloway asked for some tips for dealing with mental perturbance as a source of insomnolence. Here, I’ll recap and extend my answer.

My first general tip for “dealing with”, or more precisely relating to, insomnolence that is triggered by mental perturbance is to learn and apply mindfulness concepts. Fortunately, these concepts are becoming more popular. In particular, it helps to come to terms with the fact that many things, even extremely important things, in life are out of our control. Yes, sleep is essential, and it can be influenced, but even sleep is not completely under one’s deliberate control. And of course motivators that are sufficiently insistent to be called perturbant are difficult not to think about — that is partly how we define them! A good resource on mindfulness is The Happiness Trap by Russ Harris. My first Cognitive Productivity book gives suggestions on how to think scientifically about mindfulness.

In the interview, I also mentioned “constructive worry”. Here, several hours before bedtime one journals about one’s major concerns (motivators). (Compare this worksheet, in PDF). Then at bedtime one tries to postpone other problem solving to the next day, knowing that time is set aside for constructively thinking about it then.

However, anyone who has tried to meditate knows that one can’t simply will (or command) oneself to stop thinking about one’s motivators. Again, this difficulty is a key aspect of mental perturbance! There are opaque, involuntary, evolutionarily old mechanisms that determine the insistence of a motivator, which is their propensity to “consume” one’s attention — to divert thinking, maintain consciousness. One experiences motivators as “popping into” one’s consciousness. You can think of the “bottom-up” mechanisms that determine whether one thinks about something as being in a separate, even external, modular machine.

However, it is possible to indirectly influence one’s thinking.

Articulatory suppression and the cognitive shuffle

In the interview I referred to a technique called “articulatory suppression”. One form of articulatory suppression is to repeat a phoneme or syllable such as “the” with some variation such as a change of pace. Another is to select a category, such as dog, and list examples in alphabetical order. Spelling would be another example. See Articulatory suppression and the treatment of insomnia – PubMed for more details. What little attention this strategy has had has been promising.

I developed a technique called the cognitive shuffle which shares a theoretical and practical basis with “articulatory suppression”. The most popular variant of this is known as serial diverse imagining. From the somnolent information processing theory, I’ve also derived new variants of the cognitive shuffle that have yet to be tested.

In a paper published in Sleep Medicine Reviews recently, My colleagues and I reviewed literature on sleep onset cognition and strategies to facilitate sleep onset. Hopefully, the the pandemic will motivate funding for more research on sleep onset and cognitive (non pharmaceutical) strategies to deal with insomnolence.

The sledge-hammer approach, including abstaining from caffeine

When it comes to self-help on insomnia, I personally prefer a “sledge hammer” approach. The idea is follow most of the best recommendations—best meaning inscribed in research. So, one would follow the best practices of “sleep hygiene” (an awful term but important concept).

Several years ago, I published tips on the mySleepButton website, which I edit once in a while.

You will notice that, in particular, I recommend abstaining from all caffeine and other stimulants (while following doctor’s orders of course). From a psychology perspective, it’s very interesting that many people with insomnia will continue to consume caffeine despite being told they shouldn’t. Well …

you make your bed and you lie in it… awake much of the night.

Many people claim that caffeine doesn’t affect their sleep. They are deluding themselves. Some (even researchers) tell people with insomnia to avoid having caffeine paste noon. That is not enough. Even small amounts of caffeine taken in the morning can disrupt nocturnal sleep. If you can’t sleep many hours, and yet continue to consume caffeine (or other stimulants), you will just be compounding your problem. The sleep you do manage to obtain will be less restorative.

Services

If you have think you have insomnia, consider talking to a medical doctor about it. As Dr. Lee mentioned, insomnia is transdiagnostic. You might be referred to a sleep clinic.

Somnolence+ Inc., with which I am affiliated, provides sleep training services to individuals and organizations.

Readings

• Beaudoin, L. P., Pudlo, M. & Hyniewska, S. (2020). Mental perturbance: An integrative design-oriented concept for understanding repetitive thought, emotions and related phenomena involving a loss of control of executive functions, Simon Fraser University Education Reviews, 13 (1), 29-58.
• Beaudoin, L.P. Infographic for “Pre-sleep Cognitive Activity in Adults: A Systematic Review”
• Beaudoin, L.P.Can Your Bedtime Thinking Keep You Awake? Or Help You Fall Asleep? – CogZest
• Kay, D. & Buyse, D. (2017). Hyperarousal and Beyond: New Insights to the Pathophysiology of Insomnia Disorder through Functional Neuroimaging Studies.
• Lemyre, A., Belzile, F., Landry, M., Bastien, C., & Beaudoin, L. P. (2020). Pre-sleep cognitive activity in adults: A systematic review. Sleep Medicine Reviews, 50, 1-13.
• Levey et al (1991). Articulatory suppression and the treatment of insomnia.
• Molar, F., Frank, C., Chun, S. & E. K Lee (2020). Insomnia in older adults: Approaching a clinical challenge systematically.
• Sloman (2003) How many separately evolved emotional beasties live within us-Aaron1999.pdf
• Walker, M. Why We Sleep: Unlocking the Power of Sleep and Dreams by .