How to manage sleepiness

Some strategies for people with narcolepsy

The advice in this blog post is intended primarily for people with narcolepsy or other sleep disorders that involve chronic daytime sleepiness. It may still be helpful for people without such a sleep disorder, but in most cases the standard advice to get more rest and improve lifestyle factors like diet and exercise is probably the better way to go.

For people with narcolepsy, sleepiness is basically the body’s default mode, even with an optimal lifestyle. So you need to find other ways to deal with sleepiness.

We’ll take a divide-and-conquer approach. Sleepiness can be divided into three components:

• Body heaviness
• Fading awareness
• Aversion to effort

Body heaviness

When you feel sleepy, your body tends to feel heavy. You are more likely to slouch, and it’s harder to keep your eyelids open. The best way I know to counter this feeling of heaviness is to change your physical posture such that your weight is carried primarily by your bones, not your muscles. Ideally, when your body is stationary, your muscles are only used for maintaining balance, not for bearing weight. If your muscles are carrying weight, then that consumes a lot of energy that could otherwise be available for your brain to use to stay alert.

Also, the psychology of posture plays a role in determining your perception of your alertness level. That is, there is a perceptual feedback loop whereby feelings of sleepiness cause slouching, and slouching causes feelings of sleepiness. Correcting your posture can interrupt this feedback loop and possibly even reverse it, making you feel more alert than before.

For eyelid heaviness, as simple as this may seem, opening your eyes slightly wider than normal (without causing discomfort) can make your eyelids feel lighter. The keyword here is “slightly” because forcing your eyes open too far causes strain and can lead to headaches. It takes some experimenting to find the right balance.

Fading awareness

Fading awareness is the “falling” part of “falling asleep”. Falling is a useful metaphor in this context. If we consider the ways that we prevent our bodies from physically falling, those strategies can act as hints toward analogous strategies for staying alert.

Many of the ways that we prevent our bodies from falling down involve holding on to something with our hands. Handrails, walking sticks, ski poles, etc. And just as you can hold on to a handrail while walking down a flight of stairs, you can “hold on” to a sensory experience (sight, sound, or feeling) to steady your awareness. For example, one thing I like to do is rub my hands together and notice the resulting tactile sensations in my hands. The key is to pick something specific (preferably something salient and not boring) and attach your awareness to that specific thing. If your awareness is just open and diffuse, not attached to anything in particular, then you’re more likely to drift off.

Another strategy for preventing physical falling is to stay in motion. When riding a bicycle, for example, it’s much easier to stay upright when moving forward than when standing still. Likewise, keeping your body in motion helps with staying alert. For example, tapping your foot or nodding your head to the beat of a song (whether audible or imagined) can be enough to keep your awareness from sinking further into sleepiness. Fidgeting is another small way to keep the body moving, things like folding paper or drawing doodles in a notebook.

Aversion to effort

The impulse to rest makes it difficult to do things that require effort. Which makes sense. Effort is basically the opposite of rest. So, it can sometimes feel downright wrong to override that impulse, almost like you’re doing physical harm to your body. It can feel physically painful.

Trying to force yourself to do things that require effort despite the urge to rest is sort of like putting your foot on the gas pedal of a car while the parking brake is on. It might work for a while. But if you do it constantly, then it will eventually lead to burnout. Luckily, there is a better way, which is to practice equanimity. But before we get to equanimity, we first need to discuss pain and suffering.

Pain and suffering are two different things. There’s nothing inherently good or bad about pain. Pain is just information from your nervous system. Suffering occurs when we interpret that pain signal as negative and we resist it. Suffering is caused by resistance to pain. Therefore, it is possible to feel pain and not be bothered by it if you can learn to interpret it as either neutral or positive and stop resisting it. For example, going to the gym and lifting weights is physically painful, but people voluntarily subject themselves to this pain and may even learn to enjoy it because they interpret it as a signal that their body is getting stronger.

Just as the pain of lifting weights can hold positive meaning as part of the body strengthening process, the pain of exerting effort while sleepy can hold positive meaning as part of the equanimity cultivation process. Actually, any kind of pain can be used to practice equanimity. Exerting effort while sleepy is just a specific case.

This is not to say that you shouldn’t avoid pain. In most cases, you should. There’s a reason that pain feels unpleasant. Pain is a signal from the body that something might be wrong, so you should take care not to allow yourself to get hurt, whether physically or psychologically. But when you are confident that the pain you feel does not actually indicate true danger (or the pain is simply unavoidable), then you may as well make the most of it by practicing equanimity.

So, what exactly is equanimity? Equanimity is non-resistance to pain and non-clinging to pleasure. Equanimity is what enables the possibility of pain without suffering. To return to the parking brake metaphor, practicing equanimity is like disengaging the parking brake, allowing the car to accelerate freely.

The practice of equanimity has a long history, going back at least to the origins of Buddhism. Much has been written about equanimity, so I won’t get into it in depth here. One resource that I have found particularly helpful is meditation teacher Shinzen Young’s writings and audio recordings on the topic of mindfulness meditation for chronic pain.

Conclusion

Hopefully these strategies for managing sleepiness will be helpful to you. You may want to try out the strategies in the order presented. Using posture to reduce feelings of body heaviness is a good place to start. Using focused attention and physical movement to prevent fading awareness is a good next step. Cultivating equanimity takes significantly more time and practice, but it is very much worth the effort.