 | An LA detective battles sleep deprivation while investigating a murder in a small town in Alaska where the sun never sets. Veteran detective Will Dormer flies to Nightmute, Alaska to assist the local police force in an ongoing murder investigation. While trying to find the killer, detective Dormer battles sun filled nights that rob him of sleep. As Dormer’s mind becomes increasingly fatigued he must come to terms with a second crime as he struggles to differentiate between his waning consciousness and reality. |
Neuropsychological Review
Just Let me Sleep
Steven M. Smith
As Insomnia begins we join detective Will Dormer, played by Al Pacino, early in his battle with insomnia and, possibly more importantly, anxiety. Throughout the opening credits, director Christopher Nolan uses fading and pulsating imagery to simulate the struggle of keeping one’s eyes open, effectively placing the viewer in the shoes of someone who is experiencing the side effects of extreme fatigue.
Just Let me Sleep
Steven M. Smith
As Insomnia begins we join detective Will Dormer, played by Al Pacino, early in his battle with insomnia and, possibly more importantly, anxiety. Throughout the opening credits, director Christopher Nolan uses fading and pulsating imagery to simulate the struggle of keeping one’s eyes open, effectively placing the viewer in the shoes of someone who is experiencing the side effects of extreme fatigue.
In the United States one-quarter of the population report occasionally not getting enough sleep and about ten percent experience chronic insomnia (Center for Disease Control and Prevention [CDC], 2013), a disorder that is characterized by difficulty initiating sleep, maintaining sleep, and early morning awakening with the inability to return to sleep; and is often due to increased anxiety and an overabundance of light. (American Psychiatric Association, 2013).
Throughout Insomnia detective Dormer shows many signs of sleep deprivation. He appears drowsy, inattentive, confused, and he encounters numerous scenarios that appear to be visual hallucinations, a possible symptom of extreme sleep deprivation (West, Janszen, Lester, & Cornelisoon, 1962). But just as Dormer begins his murder investigation, a second murder occurs and the anxiety surrounding this crime begins to take an extreme toll on his sleep and overall wellbeing.
In addition to the midnight sun of Alaska, in true Christopher Nolan fashion, the director has added another element to Dormer’s decay: extreme anxiety. By creating this traumatic event in Dormer’s life, Nolan creates a scenario in which the audience sees both anxiety and lack of sleep contributing to Dormer’s decay.
Throughout Dormer’s time in Alaska, he endures one night in which he struggles to sleep before he witnesses a second crime. It should also be noted that despite having no apparent sleep this one night, the following day he does not suffer many adverse effects despite being tired. It is only after he is exposed to the trauma of second crime that the majority of his symptoms begin to manifest.
Due to this timing, from a psychological point of view, we can begin to examine differential diagnoses. One diagnosis that captures Dormer’s experience alarmingly well is Acute Stress Disorder. The symptoms of Acute Stress Disorder typically occur with 3 days to 1 month after a trauma but can manifest immediately (American Psychiatric Association, 2013). These symptoms include recurrent, intrusive and distressing memories, distressing dreams, flashbacks, an altered sense of self or surroundings, effort to avoid the memory, negative mood, and sleep disturbance (American Psychiatric Association, 2013). Keeping these symptoms in mind, it becomes increasingly clear that while Dormer does seem to be bothered by the never setting sun and his inability to sleep, his experience is better explained by Acute Stress Disorder. This would likely be his primary diagnosis because of how well his experience is captured by this disorder. It is not likely he would receive a primary diagnosis of insomnia from this snapshot of his behavior because sleep difficulty must persist for 3 months before meeting diagnostic criteria (American Psychiatric Association, 2013).
Since sleep disturbance is a significant part of the Acute Stress Disorder diagnosis, how would his disturbed sleep be accounting for many of the symptoms we see during the movie? Detective Dormer is very sleep deprived and it appears that he has not slept once during the entire movie. Due to this extreme sleep deprivation, we would suspect that Dormer would begin to have hallucinations (Sheldon, Kryger, Ferber, & Gozal, 2014). In Insomnia though, Dormer begins to have hallucinations early on which is atypical for short durations of sleep deprivation.
Typically, hallucinations, as experienced in Schizophrenia, are auditory in nature and are often described as hearing voices that are not present (American Psychiatric Association, 2013). However, Dormer’s hallucinations are strictly visual and he exhibits no other signs of Schizophrenia. One way to explain these apparent visual hallucinations that Dormer experiences is with a phenomenon known as micro-sleep. Micro-sleep is common in those with insomnia and is defined as a brief unintended episode of loss of attention; and often co-occurs with head snapping, a blank stare, and prolonged eye closure (Innes, Poudel, & Jones, 2013; BBC, 2014). Because Dormer is not sleeping at night, it is likely that his brain is attempting to rest whenever possible and slips into brief micro-sleep episodes during the day. With this in mind, when analyzing Dormer’s hallucinations, while it was not likely the intent of the director, it can be reasoned that he is in fact experiencing episodes of micro-sleep and therefore is experiencing hypnagogic hallucinations that can occur in the transition from wakefulness to sleep.
Since we have noted that Insomnia is a more accurate portrayal of Acute Stress Disorder, we should also note that some of the representations about insomnia as a disorder are indeed accurate and capture “what it feels like” to have insomnia. For example, late in the movie (time stamp: 1:44:27) detective Dormer is driving down a long stretch of straight Alaskan highway and begins to nod off while attempting to fight his body’s urge to sleep. This is not only an accurate portrayal of what insomnia's side effects could look like but it is also accurate because 37% of Americans have admitted to falling asleep behind the wheel in the past year (National Sleep Foundation, 2014). Overall, Insomnia captures the feeling of the insomnia diagnosis by utilizing a variety of imagery as demonstrated by a scene in which Dormer “spaces out” and experiences a distortion of his environment (time stamp: 1:11:38).
Insomnia is a movie I would recommend because it is not only an enjoyable film but it also does an excellent job of conveying “what it feels like” to have insomnia. Including the extreme cognitive and behavioral difficulties that may occur with insomnia. While this film can be used to demonstrate the idea of “what it feels like” to have insomnia, it should also be noted that this film is not strictly about insomnia alone. Insomnia is also about anxiety, trauma and more accurately Acute Stress Disorder. While the film does not clearly differentiate between what symptoms are due to Dormer’s anxiety versus insomnia, this effectively makes this movie very useful for teaching and discussing the topics of insomnia, anxiety, and trauma. Besides, leaving “gray areas” up to the interpretation of the viewer is a hallmark of Christopher Nolan and of good discussion.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
BBC. (2014, January 8). Who, what, why: What is a micro-sleep?. Retrieved from http://www.bbc.com/news/blogs-magazine-monitor-25593327
Center for Disease Control and Prevention. (2013, July 1). Sleep and Sleep Disorder. Retrieved from http://www.cdc.gov/sleep/
Innes, C. R., Poudel, G. R., & Jones, R. D. (2013). Efficient and regular patterns of nighttime sleep are related to increased vulnerability to microsleeps following a single night of sleep restriction. Chronobiology international, 30(9), 1187-1196.
National Sleep Foundation. (2014). Drowsy Driving. Retrieved from http://sleepfoundation.org/sleep-topics/drowsy-driving
Sheldon, S. H., Kryger, M. H., Ferber, R., & Gozal, D. (2014). Principles and practice of pediatric sleep medicine. Elsevier Health Sciences.
West, L. J., Janszen, H. H., Lester, B. K., & Cornelisoon, F. S. (1962). The psychosis of sleep deprivation. Annals of the New York Academy of Sciences, 96(1), 66-70.
Throughout Insomnia detective Dormer shows many signs of sleep deprivation. He appears drowsy, inattentive, confused, and he encounters numerous scenarios that appear to be visual hallucinations, a possible symptom of extreme sleep deprivation (West, Janszen, Lester, & Cornelisoon, 1962). But just as Dormer begins his murder investigation, a second murder occurs and the anxiety surrounding this crime begins to take an extreme toll on his sleep and overall wellbeing.
In addition to the midnight sun of Alaska, in true Christopher Nolan fashion, the director has added another element to Dormer’s decay: extreme anxiety. By creating this traumatic event in Dormer’s life, Nolan creates a scenario in which the audience sees both anxiety and lack of sleep contributing to Dormer’s decay.
Throughout Dormer’s time in Alaska, he endures one night in which he struggles to sleep before he witnesses a second crime. It should also be noted that despite having no apparent sleep this one night, the following day he does not suffer many adverse effects despite being tired. It is only after he is exposed to the trauma of second crime that the majority of his symptoms begin to manifest.
Due to this timing, from a psychological point of view, we can begin to examine differential diagnoses. One diagnosis that captures Dormer’s experience alarmingly well is Acute Stress Disorder. The symptoms of Acute Stress Disorder typically occur with 3 days to 1 month after a trauma but can manifest immediately (American Psychiatric Association, 2013). These symptoms include recurrent, intrusive and distressing memories, distressing dreams, flashbacks, an altered sense of self or surroundings, effort to avoid the memory, negative mood, and sleep disturbance (American Psychiatric Association, 2013). Keeping these symptoms in mind, it becomes increasingly clear that while Dormer does seem to be bothered by the never setting sun and his inability to sleep, his experience is better explained by Acute Stress Disorder. This would likely be his primary diagnosis because of how well his experience is captured by this disorder. It is not likely he would receive a primary diagnosis of insomnia from this snapshot of his behavior because sleep difficulty must persist for 3 months before meeting diagnostic criteria (American Psychiatric Association, 2013).
Since sleep disturbance is a significant part of the Acute Stress Disorder diagnosis, how would his disturbed sleep be accounting for many of the symptoms we see during the movie? Detective Dormer is very sleep deprived and it appears that he has not slept once during the entire movie. Due to this extreme sleep deprivation, we would suspect that Dormer would begin to have hallucinations (Sheldon, Kryger, Ferber, & Gozal, 2014). In Insomnia though, Dormer begins to have hallucinations early on which is atypical for short durations of sleep deprivation.
Typically, hallucinations, as experienced in Schizophrenia, are auditory in nature and are often described as hearing voices that are not present (American Psychiatric Association, 2013). However, Dormer’s hallucinations are strictly visual and he exhibits no other signs of Schizophrenia. One way to explain these apparent visual hallucinations that Dormer experiences is with a phenomenon known as micro-sleep. Micro-sleep is common in those with insomnia and is defined as a brief unintended episode of loss of attention; and often co-occurs with head snapping, a blank stare, and prolonged eye closure (Innes, Poudel, & Jones, 2013; BBC, 2014). Because Dormer is not sleeping at night, it is likely that his brain is attempting to rest whenever possible and slips into brief micro-sleep episodes during the day. With this in mind, when analyzing Dormer’s hallucinations, while it was not likely the intent of the director, it can be reasoned that he is in fact experiencing episodes of micro-sleep and therefore is experiencing hypnagogic hallucinations that can occur in the transition from wakefulness to sleep.
Since we have noted that Insomnia is a more accurate portrayal of Acute Stress Disorder, we should also note that some of the representations about insomnia as a disorder are indeed accurate and capture “what it feels like” to have insomnia. For example, late in the movie (time stamp: 1:44:27) detective Dormer is driving down a long stretch of straight Alaskan highway and begins to nod off while attempting to fight his body’s urge to sleep. This is not only an accurate portrayal of what insomnia's side effects could look like but it is also accurate because 37% of Americans have admitted to falling asleep behind the wheel in the past year (National Sleep Foundation, 2014). Overall, Insomnia captures the feeling of the insomnia diagnosis by utilizing a variety of imagery as demonstrated by a scene in which Dormer “spaces out” and experiences a distortion of his environment (time stamp: 1:11:38).
Insomnia is a movie I would recommend because it is not only an enjoyable film but it also does an excellent job of conveying “what it feels like” to have insomnia. Including the extreme cognitive and behavioral difficulties that may occur with insomnia. While this film can be used to demonstrate the idea of “what it feels like” to have insomnia, it should also be noted that this film is not strictly about insomnia alone. Insomnia is also about anxiety, trauma and more accurately Acute Stress Disorder. While the film does not clearly differentiate between what symptoms are due to Dormer’s anxiety versus insomnia, this effectively makes this movie very useful for teaching and discussing the topics of insomnia, anxiety, and trauma. Besides, leaving “gray areas” up to the interpretation of the viewer is a hallmark of Christopher Nolan and of good discussion.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
BBC. (2014, January 8). Who, what, why: What is a micro-sleep?. Retrieved from http://www.bbc.com/news/blogs-magazine-monitor-25593327
Center for Disease Control and Prevention. (2013, July 1). Sleep and Sleep Disorder. Retrieved from http://www.cdc.gov/sleep/
Innes, C. R., Poudel, G. R., & Jones, R. D. (2013). Efficient and regular patterns of nighttime sleep are related to increased vulnerability to microsleeps following a single night of sleep restriction. Chronobiology international, 30(9), 1187-1196.
National Sleep Foundation. (2014). Drowsy Driving. Retrieved from http://sleepfoundation.org/sleep-topics/drowsy-driving
Sheldon, S. H., Kryger, M. H., Ferber, R., & Gozal, D. (2014). Principles and practice of pediatric sleep medicine. Elsevier Health Sciences.
West, L. J., Janszen, H. H., Lester, B. K., & Cornelisoon, F. S. (1962). The psychosis of sleep deprivation. Annals of the New York Academy of Sciences, 96(1), 66-70.
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