When you feel awake…but you’re really asleep

You’re lying in bed, unable to sleep, getting increasingly frustrated. You turned out the lights at midnight and now look at the clock and see that it is 1am. Your brain wanders, thinking about everything you need to do the next day at work. You look at the clock again, which now reads 2am. You are certain you have been awake in bed now for 2 hours and start to worry about how you will feel the next day. You nudge your bed partner awake, stating “I can’t sleep again”. “What are you talking about?” your bed partner says, “you have been snoring for hours!”

Most of us have been in the situation of being unable to fall asleep, or get back to sleep, at some point in our lives. Did you know, however, that when it feels like you have been lying awake in bed for hours, it is actually possible, and likely, that in reality you were asleep for much of that time?

The phenomenon of feeling you were awake when, in fact, you were actually asleep is called sleep state misperception. It is a common experience for adults both with and without sleep problems such as insomnia. (Insomnia is a medical condition where a person feels they have insufficient sleep due to difficulty falling or staying asleep. A person with insomnia feels that they function suboptimally during the day due to their sleep difficulties.) Sleep researchers can tell if a person is awake or asleep by looking at the pattern of brainwaves collected from electrodes on the person’s scalp during an overnight sleep study (“polysomnography”). With sleep state misperception the person being monitored reports being awake but the brainwave recording shows they were asleep.

Why and how does sleep state misperception occur? No one really knows for sure, but scientists suspect that it is related to the brain attempting to keep itself more alert, trying to attend to the surrounding environment even while asleep. Most people think of sleep as a state where we lose all awareness of our surrounding environment, but more and more research is suggesting that it is actually possible for a small part of the brain to be awake with some awareness of its thoughts and surroundings while the rest of the brain is asleep. Additionally, when our sleep is repeatedly disrupted by environmental sounds or other causes, our brain only remembers the times when it woke up and erroneously jumps to the conclusion that we were continuously awake.

Sleep state misperception most often occurs as part of the general hyperarousal response to stress. This is a state in which the body increases its “fight or flight” hormone levels in an attempt to stay more alert and be able to respond quickly to any impending threats. Hyperarousal often occurs during the day and night. When we are under stress and hyperaroused, we may feel anxious or “on edge” during the day, or simply very alert with an improved ability to focus on the task at hand. During the night, our sleep can be lighter, shorter and a bit more fragmented, allowing us to preserve some awareness of our environment and thoughts, protecting us from potential nocturnal threats and helping us prepare to respond to these threats.

In the short term, hyperarousal is not harmful and can actually be helpful in allowing us to prepare for upcoming stressful events. When it continues for prolonged periods of time, however, hyperarousal can be detrimental to our overall health. Fortunately, there are well established techniques that we can use to reduce hyperarousal during the day and night, including deep, slow breathing, exercise, mindfulness and/or meditation, cognitive behavioral therapy for anxiety and depression, among others.

To help determine whether you are experiencing sleep state misperception, try these experiments:

1. Imagine sitting upright and awake. If you feel like you’ve been awake for a significant period of time in bed, think about how you would feel spending that same amount of time fully awake, sitting upright, in a boring room without a smartphone, magazine, TV or other way to occupy the time. If the time awake in bed feels shorter than how you would perceive the same amount of time sitting upright and awake, reassure yourself that you likely did get some sleep during that time.
2. Stop checking the clock. Studies show that checking the clock during the night actually causes increased sleep disruption and distress. If you have to wake up at a specific time, set an alarm (or two) for that time and place it across the room so you know you will be forced to get up and turn it off. If you feel the urge to check the time, ask yourself “why?” “how will the information I obtain from checking the clock be useful?” Chances are that knowing the exact time will not actually be useful in any way and will only lead to increased anxiety and hyperarousal. (For instance: “Oh no, I’ve been awake for THREE HOURS!”, or “Oh no, I only have 1 hour left before my alarm goes off, now I will never get back to sleep!”) If you are unaware of how long you have been awake or how much time is left in the night it is far easier to relax and get back to sleep. NOTE: Checking the time on a smartphone is doubly bad because your brain automatically thinks about all the other content on the phone and becomes more stimulated than if you simply lay there resting. Additionally, most smartphones emit blue light which stimulates alertness pathways in the brain. Keep your phone out of the bedroom or across the room where you cannot access it.)
3. Stop worrying about not sleeping. It is actually normal to spend some time awake during the night. The brain sleeps in 90-minute cycles and we are supposed to wake up briefly between each cycle to check our surroundings (see https://medium.com/@michelle.jonelis/understanding-normal-sleep-and-alertness-329093cc3869). Sleep is also naturally deeper in the first half of the night and we wake up increasingly frequently as we approach the morning to help our brain prepare for the day. Sleep state misperception is very common during this last portion of the night where it is completely normal to have dreams intermixed with thoughts intermixed with moments of awareness of our surroundings. It is considered normal to take up to 30 minutes to fall asleep at night and to awaken up 3 times during the night for 20 minutes per awakening (and more/longer awakenings may still be normal for some individuals ). Taking a little bit of time to fall asleep and having a few awakenings during the night may actually be a sign that you are sufficiently well rested. When you are aware of being awake at night, remind yourself that some time spent awake in bed is normal. Take some slow, deep breaths. Enjoy the quiet rest time. Let your mind wander through pleasant thoughts. Often once you stop trying to sleep, hyperarousal lessens and sleep just happens.
4. Change the situation. If you find that you really are fully awake and getting anxious or stressed in bed, this is a sign that you need to get out of the bed and do something else for a short period of time. Distract your mind with something like reading a good book (a physical book, rather than reading on a device is optimal) for 30–60 minutes. Then return back to bed and let yourself rest and drift off to sleep.

After trying these experiments, if you still believe you’re spending long periods of time in bed awake and your daytime performance or energy level is being negatively affected, talk to a sleep medicine specialist to see if there are additional steps you can take to get a good night’s sleep. You may also need to be checked for obstructive sleep apnea or another sleep disorder.