Intelligence Levels in Insomnia Patients

At the CPAPTALK.com forum, a question was raised about my frequent comments in my book, Sound Sleep, Sound Mind, about higher intelligence levels among insomnia patients. The following is the post I wrote on that issue:

Human Intelligence

Human intelligence, as everyone knows, is a complex dimension to measure, and I am no expert in measuring it. However, as a sleep doc, I’ve formed some fairly clear perceptions about patients with insomnia, who I believe often “suffer” from a higher than average level of “intellectual” intelligence, for lack of a better term.

TFI System

This insight emerged in my own thinking once I realized that most human behavior is coupled to a fairly prominent system of consciousness called the TFI System. (T = Thoughts; F = Feelings; and I = Images.) I write extensively about this system in my book, Sound Sleep, Sound Mind, because the balance within any individual’s TFI system predicts who is most likely to suffer insomnia, who is most likely to have difficulty adjusting to PAP therapy, and who has the capacity to engage in sufficient, self-generated cognitive restructuring (“changing your mind”) to overcome or adapt to either of these difficulties (insomnia or PAP issues).

To simplify, before you eat, you THINK about the need or desire for food, FEEL hungry for food, or PICTURE (IMAGE) in your mind’s eye the sumptuous Caesar salad you crave. Each of these three activities represents the unique and overlapping components of the TFI System. If you spend time “observing yourself” throughout the day, you will notice you spend at least some time with each component preceding, during or after various behaviors.

In unusually well-adjusted individuals, great awareness of all 3 components is the norm, leading to a balanced system in which the individual freely moves through all components at any given time as needed to adapt to and interact with their environment and the people in it. Having said that, you can no doubt imagine a hundred interpretations of what a “balanced system” entails or feels like. Without wishing to be cryptic, however, let me just say that tasting the experience of a balanced TFI System is a much easier way to know it than someone trying to explain it to you.

Lacking Balance in the TFI System

It’s much easier to explain the opposite—a lack of balance, in which one component of the system tends to predominate or one component tends to be relatively absent. Most of us learn to keep our TFI systems out of balance, and we usually adopt this jaded system some time in childhood or adolescence. As the most classic and relevant example to our discussion, many insomniacs show a high intellect that arguably developed out of a desire (usually unplanned) to adopt an imbalanced system dominated by thoughts and lacking in emotion, which turns out to be a perfect setup for insomnia.

Let’s assume you are a smart person, and your intelligence is obvious to those around you as early as childhood. More importantly, let’s suppose you begin to notice in school or elsewhere that your mind is sharper or quicker than many others at certain intellectual tasks: solving math problems, remembering grammar rules, knowing more words, how to spell them and what they mean and so on. In a short time, you would receive a great deal of reinforcement (grades, praise, requests for advice/answers, etc.) buttressing the belief that your “thinking capacity” is more advanced than others. Very soon, you will turn repeatedly to your powers of intellect to solve the problems you face. So far so good; this example describes a fair number of people who end up with graduate degrees in engineering, physics, medicine, other sciences and so on. In these individuals, “Thoughts” are the predominant component of the TFI system and up to a point have served them well in society.

The question or problem arises at some point as to what happens to the other two components of the system: Feelings and Images. The answer for a lot of individuals is the person grows far too comfortable solving life’s problems with thoughts and conversely grows more uncomfortable attempting to manage emotions or mental imagery. Why so? Because the latter two components of the TFI system seem or feel chaotic; whereas, thoughts seem more controllable.

Over time, some individuals who go down the intellectual path will see a decay in their innate capacity to work effectively with feelings and mental imagery. In the single most classic example of this phenomenon, individuals no longer readily access their own emotions in direct fashion. Instead of “feeling their feelings,” they “think about their feelings.” If you describe this distinction to someone with a healthy and balanced TFI system, they immediately and fully understand the difference. If you make this point to an insomniac, they often need much more explanation (still more intellectual discussion) just to come close to understanding the distinction between “thinking about vs. feeling an emotion.”

Insomnia and the TFI System

And, therein lies the basis of my observations and theories. In my clinical and personal experience, people with balanced TFI systems rarely have trouble closing out the day at bedtime. Because they’ve spent much of the day processing a wide array of thoughts, feelings, and images, they fall asleep faster than you can say “lights out.” But, for the individual with too much reliance on intellect, the lack of balance throughout the day means that emotional or imaginative residue probably lingers at bedtime and prevents the necessary closure that leads to the Land of Nod. In fact, among the majority of insomniacs, the single most common complaint is “I cannot turn off my mind,” which means racing thoughts or other ruminations actively fuel the mind with too much alertness to permit sleep.

Returning now to the balance concept, the intellectually inclined individual has spent far too much time in life developing their “thinking smarts” but now they pay for it with insomnia. Why would too much thinking lead to insomnia? Because thinking represents a very active component of consciousness within the TFI System, whereas feelings and imagery represent more receptive components.

When you fall asleep, can you guess which components are closer to the final point of wakefulness where sleep onset begins? The answer appears to be feelings as in feelings of comfort and sleepiness, followed by mental imagery as in little dreamlets that flash across your mental landscape just as you fall asleep.

In other words, active thinking is antithetical to sleep; but if you spend more of your day in the world of thought, there is no easy way to turn off the spigot of thoughts at bedtime. In my book, I describe at length how excess thinking in most insomniacs has actually become a “defense” mechanism, which individuals use to avoid feelings and imagery. But, as I’ve just pointed out above, sleep does not follow from an active and ruminating mind; it follows from a receptive mind based on comfortable feelings and dreamy images.

Summing Up

Most insomniacs I’ve treated have a marked imbalance of the TFI System. The thinking system is so powerful it blocks most feelings and some images throughout the day. Eventually, it prevents the individual from fully processing the day’s experiences, because the system directs the person to think and self-talk about the day without processing deeper emotions or clearer images about the actual experiences during the day.

Finally, SDB patients with similar or other imbalances of the TFI System tend to have greater difficulty adjusting to PAP therapy, because the imbalance makes their personality somewhat more rigid. Their ability to “change their minds” and adapt to the foreign nature of PAP therapy is less than it could be if their minds were more balanced.

In sum, in a large proportion of insomnia patients and some proportion of poorly adapting PAP therapy patients, I routinely see this highly intellectualized intellect, which in fact frequently correlates with a higher IQ. In my opinion, these patients “suffer” a great deal from this lack of balance as they try to solve their sleep problems.