Have you ever experienced a miserable night’s sleep? I’m sure you have. Most if not all people have endured at least a few nights that have yielded little to no rest. For some, however, the troubles extend beyond the occasional tossing and turning. When sleeplessness becomes a regular occurrence, a person may be diagnosed with insomnia.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), insomnia is a “disorder.” It is defined as a “predominant complaint of dissatisfaction with sleep quantity or quality (362).” The person suffering from insomnia may have difficulty “initiating sleep” or difficulty “maintaining sleep,” the latter characterized by “frequent awakenings or problems returning to sleep after awakenings” (362). In order to classify as a genuine disorder, however, one’s trouble with sleep must cause “clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.” In other words, one’s exhaustion from lack of sleep must be so severe that it affects their relationships, work productivity, academic performance, and other important areas of life. Difficulty with sleep must occur at least three times a week for a period of three months and cannot be attributed to an underlying medical condition or medication.
By listing insomnia in the DSM, the American Psychiatric Association is suggesting that insomnia is a significant disorder that requires the intervention of medical and psychological professionals. But is it really a “disorder?” How should Christians assess the category of “insomnia?”
Is there a Medical or Medicinal Cause?
First, if a person is experiencing constant disruptions in their sleep, it is important to discern if there is an underlying medical condition that is frustrating their nightly rest. Sleep apnea, for example, is a medical condition where a person’s body may be jolted awake because they have stopped breathing while asleep. If these episodes occur several times a night, the person with sleep apnea will likely report a generally poor night’s rest. Also, some medications may cause disruptions on one’s sleep. These potential causes must first be ruled out.
Are There Physical or Environmental Causes?
What’s the next step in a biblical counseling methodology for getting to the bottom of one’s insomnia? One might conclude that once we’ve dismissed an underlying medical condition we need to immediately consider the principal spiritual problems that are causing one’s sleeplessness. We will get there, but not just yet. A sound biblical approach to this problem will also consider physical and environmental factors that may be hindering a person from getting the sleep they need.
For example, one should consider if their caffeine consumption during the day is affecting their sleep. While it may be difficult for some people to stop drinking caffeine due to their dependence on it, it should be obvious that eliminating a stimulant from one’s diet is the first step in determining the cause of their sleep troubles.
A person should also consider if there are environmental factors that are making sleep difficult. Are there cars idling outside every time you try to go to bed? Are there dogs barking in the yard next door? Is there loud music coming from the house across the street? Do you live near a ballpark, airport, or train tracks? While it may not be possible to eliminate every environmental factor, it is possible to procure resources that greatly mitigate the noise problem. Earplugs and sound machines can be useful in such cases.
Exercise is another factor to consider. For many of us, work is mainly sedentary, and because we don’t physically exert ourselves much throughout the day, our bodies do not expend the energy they were meant to. Exercise, therefore, becomes not only a matter of health, but a matter of energy dissipation in preparation for bedtime. Those whose jobs involve manual labor and much physical exertion often sleep better (Solomon noted this difference between the physical laborer and the sedentary rich man in his own day, see Eccl 5:12). You may not be sleeping well simply because you are not getting enough exercise throughout the week.
It is also important to consider our bedtime routines. If you are reading books before bed that provoke in-depth thinking about complex or interesting topics, you may find it difficult to go to sleep as your mind is abuzz with captivating ideas or concerns. Also, if you are looking at a smart phone or computer screen one to two hours before bed, you may find it challenging to fall asleep because these screens cause our brains to suppress the production of melatonin, which is necessary for sleep. Eating an hour before bed can also cause inconsistency in one’s sleep cycle, while constantly shifting our bedtimes can make it difficult for the body to prepare for sleep each night.
Observations and Common Grace
Both steps noted above (addressing medical and then environmental factors) are nearly identical to the steps a medical professional would take in diagnosing and treating insomnia. Why is this so? Because both the biblical counselor and the medical professional (regardless of his religious commitments) are working within the realm of common grace. These observations about possible medical or environmental factors that may be causing one’s sleeplessness are not the exclusive jurisdiction of the psychiatrist or psychologist: they are observations that a well-informed biblical counselor or secular psychiatrist can make.
Addressing mental or spiritual causes for insomnia, however, requires one to access their worldview to develop an interpretation of what may be troubling the person. If we can dismiss the possibility of an underlying medical condition and eliminate the environmental and physical factors, the counselor must now address the inner, spiritual realm. Once we venture into this territory, we are now under the expertise of Scripture.
Spiritual Causes for Insomnia
Scripture speaks often about sleep and rest and has much to say about what causes a lack of it. For the person who can find no relief for their insomnia after dealing with the medical and environmental factors, it is time to address potential spiritual problems.
The first question one needs to settle is whether they are in a saving relationship with Jesus Christ. Only those who come to Christ can experience true rest (Matt 11:28-30). It’s hard to think of a spiritual state more conducive to sleep than knowing that you are at peace with God through the death and resurrection of Jesus (Rom 5:1), or a condition more antithetical to rest than standing under God’s just wrath (John 3:36; Rom 1:18) and living in the fear of death (Heb 2:15). The gospel is the greatest antidote to insomnia.
But it is possible for Christians to lose their restful posture. For example, unconfessed sin will keep one from sleeping well. Nothing enables good sleep like a clean conscience, and nothing disturbs our sleep like a sense of guilt. David was deeply troubled during the day and night while he lived with his unconfessed adultery and murder:
For when I kept silent, my bones wasted away, through my groaning all day long. For day and night your hand was heavy upon me; my strength was dried up as by the heat of summer.Psalm 32:3-4
While David harbored his sin and refused to repent, he felt the weight of God’s holy hand upon him, throughout the day and into the evening. It wasn’t until he confessed his sin to God that he found relief (Ps 32:5).
Keeping an appropriate view of work and wealth is an essential ingredient for a good night’s sleep. We must engage in our daily labors in trustful obedience to God, knowing that he provides for all our needs and that, apart from God’s blessing, all our toil will come to nothing (Ps 127:1-2; see also Matt 6:25-33). The one who commits his work to the Lord can sleep well knowing that his plans will be established (Prov 16:3).
Sleep also evades those who fail to trust God amid danger. David, however, took refuge in God’s protection and, after crying for God’s help, learned to rest with the confidence that God protected him from evil (Ps 4:8).
Generally speaking, the one who is actively trusting the Lord and his word (Prov 3:5-6), walking in humility and turning away from evil (Prov 3:7-8), honoring God with their wealth (Prov 3:9-10), gladly accepting God’s good discipline (Prov 3:11-12), and treasuring wisdom (Prov 3:13-22), will experience rich amounts of genuine, deep rest: “Then you will walk on your way securely, and your foot will not stumble. If you lie down, your sleep will be sweet” (Prov 3:23-24).
But Christians must also recognize that sleeplessness may be their temporary portion during certain seasons of life. David experienced sleep-robbing trials: “I am weary with my moaning, every night I flood my bed with tears; I drench my couch with weeping. My eye wastes away because of grief; it grows weak because of all my foes” (Ps 6:6). The same David who trusted God in the midst of danger and thereby enjoyed restful sleep (Ps 4:8) also experienced times when his enemies were so overwhelming that he wept all night rather than sleeping.
Paul experienced sleepless nights due to ministry hardships. His lack of rest didn’t originate from a lack of trust in God, but as the normal course for a man who was devoted to serving God and loving others with the gospel (2 Cor 6:5; 11:27). Solomon also notes that as you grow older sleeping well becomes a challenge (Eccl 12:4).
Believers, therefore, can’t expect that they will enjoy an unbroken series of rejuvenating nights of sleep for the rest of their lives. Living in a fallen world will create seasons when our sleep is hindered, and living for the glory of God and the good of others will sometimes keep us up at night. That’s the normal Christian life.
Nevertheless, the Christian who is trusting God and obeying his commands will be one who is able to find many nights of restful sleep, for God has promised to give rest to his beloved (Ps 127:2). This isn’t to suggest that getting to the place where we are trusting God’s providence in our lives and walking consistently in wisdom is easy. But it is to say that God will bless those who take this path to a good night’s sleep.