Text: Marjolein de Jong | February 8, 2022

How often do discouraged people call you asking how they can sleep better?
“All too often. That puts me in a difficult position as a researcher, because I’m not a clinician. Since it feels cowardly not to offer any advice, I end up telling them what they can do on their own and where they can seek help. It does highlight that the seriousness of long-term sleep problems is underestimated. I believe these people should receive professional help.

It’s important to realize that most people have trouble sleeping from time to time, but having a few restless nights here and there isn’t the same as chronic insomnia. Because this distinction is usually not made in practice, insomnia is often not taken seriously, even though it is a serious problem. Recent studies show that insomnia appears to be a significant factor in suicidal tendencies.’

In recent years, you’ve conducted research on the link between depression and sleep. What insights did you gain?
'Thanks to Danielle Posthuma’s genetics team, we’ve been able to identify genes that increase the risk of insomnia. What we observed is that these genes are primarily active in brain cells and circuits involved in emotion regulation. Strange, I thought at first. Is insomnia then an emotional disorder rather than a sleep disorder?

We then looked at emotional processing and how it relates to poor sleep. When good sleepers are upset in the evening but still get plenty of high-quality REM sleep, sleep helps them relieve stress. For people who do have REM sleep but keep slipping out of it, the opposite happens. We call that restless REM sleep. In that case, sleep doesn’t help you process emotions; it can even make you wake up feeling even worse.’

"You can limit the amount of restless REM sleep by spending less time in bed."

Stress, poor sleep, and then even more stress as a result. Doesn’t that become a chicken-and-egg problem?
"You do indeed end up in a vicious cycle. It can then escalate into depression or an anxiety disorder. With insomnia, you might think of it as a nighttime problem, but it’s a 24-hour disorder, where you can measure stress levels just as much during the day as at night."

For some people who have trouble sleeping, there seems to be light at the end of the tunnel. You can limit the amount of restless REM sleep by spending less time in bed. This is the most important component of Cognitive Behavioral Therapy for Insomnia (CBT-I). Your sleep will then become less restless. This helps you break out of the vicious cycle. Help from a psychologist is advisable here. Because, especially if you’re already sleeping so poorly, spending less time in bed isn’t fun—you don’t exactly feel more refreshed right away. Still, it seems to be the best approach to prevent other mental health issues. We’ve seen incredibly good results in curbing depression.”

Why is insomnia actually so often treated separately from conditions like depression or anxiety disorders?
“Traditionally, sleep has received very little attention in the diagnosis and treatment of mental health problems. Fortunately, practitioners are now increasingly recognizing the importance of sleep. We’re now seeking help from psychotherapists and people who have trouble sleeping to investigate whether better sleep aids in recovery from anxiety, post-traumatic stress, or emotion regulation disorders. They can contact me directly or check for themselves—with no obligation—whether they qualify for this study at www.slaapregister.nl/beter.'

'We need to conduct much more brain research on insomnia; only then can we expect better solutions than the current sleep aids.'

What are your thoughts on sleep aids?
“I don’t want to be holier than the Pope and say, ‘Sleep aids are completely useless.’ I don’t think that’s fair. Then we’d be pretending that we can help everyone with cognitive behavioral therapy, and that’s not the case. Even though sleep medication doesn’t restore natural sleep, it does seem to mimic it and provides relief for some people.

There’s a lot of opposition to sleep aids. I sometimes joke: “No, let’s definitely not prescribe sleep aids, because then we’ll end up handing out antidepressants.” Actually, you don’t want people to end up there and become depressed. We need to do a lot more brain research on insomnia; only then can we expect better solutions than the current sleep aids.”

Insomnia is partly genetically determined. What triggers it?
'In general, you see that as people age, the risk of insomnia increases. As a child, you might have been able to doze off sitting upright in the back seat of a car, but as you get older, it becomes increasingly difficult. Before you know it, you need earplugs and a sleep mask. It’s also linked to a person’s experiences in childhood. For example, for people with insomnia, sleep in childhood was often associated with punishment: being sent to your bedroom as a punishment, or being sent to bed without dinner. In addition, factors such as physical abuse or sexual abuse contribute to whether you’re a poor sleeper. The brain develops during childhood in such a way that a person can stay alert at night, exhibiting an extra level of vigilance.”

What kind of sleeper are you, actually?
“A light sleeper. My earliest memory of sleep is that I’ve always woken up at the slightest sound or light. When I went camping with my friends during my teenage years and drank my first beers late into the night, I was still awake as soon as it got light out. My friends, on the other hand, could sleep right through until noon. Later in life, I’ve also experienced periods of insomnia. I would have preferred to be a sound sleeper, but it’s also quite handy that I know exactly what people mean when they say they’ve “been up all night staring at the ceiling.”'