Fight Club ends with a cadre of radical anarchists blowing up the towering headquarters of credit card companies, but it all starts because the narrator couldn’t get a good night’s sleep. Maybe the whole mad affair could have been avoided if he’d taken Dr. Luis Buenaver’s advice instead of getting in drunken scraps all night long.“It’s important to be consistent, intentional, and mindful about sleep,” Buenaver, the head of Johns Hopkins’ Behavioral Sleep Medicine Program, tells Inverse. “People get frustrated by insomnia, and then it’s easy to slip into bad habits, and then you’re exhausted and chasing sleep.”From Taxi Driver and The Machinist to, well, Insomnia, a chronic inability to sleep is cinematic shorthand for a character who’s stressed out or alienated. But you don’t have to drop 60 pounds and become an emaciated paranoiac like Christian Bale’s Trevor Reznik to encounter it; Buenaver says that about a third of the American population struggles to fall or stay asleep at any given time, with 10 percent to 20 percent “meeting the criteria for chronic insomnia disorder.”Between his own guilt and the endless daylight of an Alaskan summer, Insomnia’s protagonist barely gets a wink. | Warner Bros. PicturesSleepless On The Silver ScreenInsomnia can broadly be defined by three factors: trouble falling asleep, trouble staying asleep, or not feeling rested after sleep.“Everyone wakes up at night, but say you wake up three or four times,” Buenaver says. “If we add up your time awake, and it’s more than half an hour, that would meet the definition of trouble staying asleep.”Anyone can have a few bad nights. Maybe you’re stressed out by a big deadline, financial difficulties, or relationship woes. Maybe, like Al Pacino in Insomnia, you accidentally shot your partner before he could spill your secrets to internal affairs, and now you’re frantically trying to cover it up while also solving a murder. Regardless, “insomnia is more if bad sleep persists beyond the stressor,” Buenaver says. “If bad sleep is happening at least three nights a week for at least three months, then you would meet the diagnostic criteria for insomnia disorder.”“I remember thinking [Pacino] did a really good job. I could feel it in his eyes.”Twenty percent of the population, as far as we know, is not in a fight club, and Buenaver notes that Hollywood tends to portray the extreme end of the spectrum. “In pop culture it’s often overly emphasized; in reality it might be more subtle,” Buenaver says. “Although, I remember thinking [Pacino] did a really good job. I could feel it in his eyes.”Fight Club’s narrator claims to have gone without sleep for six months; Reznik, in The Machinist, for a year. Realistically, they’re probably snatching at least a few hours off-screen.“When people say they haven’t slept for six months, my interpretation, through my clinical filter, is that they’ve had really, really severe insomnia for six months,” Buenaver says. “It feels like they haven’t slept, but maybe they’re getting two to four fragmented hours a night.”The Machinist’s title character was probably snatching at least a few hours here and there. | Paramount ClassicsTo illustrate this point, Buenaver says that would-be Navy SEALs who go sleepless during their training’s so-called “Hell Week” report hallucinations after just five days. Buenaver himself once had a sleep-deprivation hallucination of a “huge, neon-colored centipede in the middle of the road” at the end of a college-age ski trip (don’t worry, he’d pulled over).“You can’t really go without sleep,” Buenaver says. “Everyone’s threshold is different, but if you literally go without sleep, you’ll get to a point where your brain will override your free will and just power you down. There have been some really rare cases where people just couldn’t sleep, but that’s the exception.”While a giant neon centipede might have given Insomnia quite the twist, Buenaver notes that the reality of insomnia is often a subtle parade of little mistakes and lapses.“I would show the restless character trying to sleep, and then move the camera to the clock to show the passage of time,” Buenaver says, were Christopher Nolan to call him up for tips. “Show them waking up throughout the night, and then in the morning, they’re dragging. Their eyelids are closing throughout the day, they’re having trouble concentrating, stuff like that. Show it across several nights. And show the person making mistakes, like forgetting stuff at work or not turning the stove off.”Regardless of how insomnia is portrayed on-screen, there’s more going on under the hood than just existential ennui.Then, of course, the character accidentally shoots their partner. But regardless of how insomnia is portrayed on-screen, there’s more going on under the hood than just existential ennui or the pressure of a high-stakes murder investigation.“There are three factors underlying and maintaining insomnia,” Buenaver says. “Brain arousal, circadian clock, and your sleep drive. People who have insomnia typically have a lot more brain activation; they’re overactive at night compared to normal sleepers. They also have a weaker sleep drive, and there might be a misalignment between when you need to sleep and when your body is ready to be asleep.”In other words, your will and your body aren’t in alignment, and your brain is either worrying about that fact or fixating on another problem, whether it’s a recent faux pas or a video game boss that’s giving you conniptions. Genetics and underlying health conditions can play a factor, too.“Everyone brings a certain degree of genetic predisposition to the table,” Buenaver says, “and whether it gets expressed depends on your environment.” Ultimately, however, insomnia can happen to anyone. Buenaver calls it bidirectional: Trouble sleeping can contribute to other problems, and other problems, like pain or depression, can contribute to poor sleep.Don’t throw off your sleep schedule with late nights in seedy theaters. | Columbia PicturesGetting Smarter About SleepInsomnia has been an infamous struggle throughout history, and figures ranging from Marcus Aurelius to Vladimir Nabokov have griped about it. Both probably could have benefited from better sleep hygiene. One of the biggest misunderstandings about sleep is that you can’t brute force it; knowing you need sleep but tossing and turning for hours in a frustrated attempt to get it is counterproductive.“One of the most common coping strategies is that people who have insomnia try to maximize their opportunity to get sleep,” Buenaver says. “They might go to bed earlier and stay in bed longer, but that doesn’t mean that they’re actually sleeping longer, just that they’re spending more time in bed. If you’re doing this regularly, you learn to associate the bed with a place where you lie there feeling anxious and irritated about your inability to sleep soundly. That contributes to being more mentally active at night.”“If you have trouble sleeping, what you do in bed does matter.”Our ability to sleep, Buenaver says, is no more limitless than our appetite. If you spend nine hours in bed but only snatch six hours of sleep, you’ll dampen your brain’s ability to produce adenosine, the neurochemical that controls your sleep drive.“Adenosine is cleared when you sleep,” Buenaver says. “The longer you’re awake, the more adenosine your brain produces, and the sleepier you’re going to feel when you go to bed. It’s like a balloon. It’s flat in the morning, you gradually inflate it throughout the day, and at bedtime, you have a certain amount of pressure that’s been built up. That pressure to sleep is your sleep drive. But if you’re in bed for a long time, then you’re not producing as much adenosine, and you’ll have less by the end of the day. And anytime you nap or lie down, it’s like releasing some air from that balloon.”Your attempt at an afternoon catnap might therefore come back to bite you when you’re trying to sleep at night, and other activities might be counterproductive, too.“For the average person who wants to improve their sleep, I would tell them to limit everything you do in bed to sleep and intimacy,” Buenaver says. “Many people watch TV, eat, and work in bed. If you do and sleep fine, good for you. But if you have trouble sleeping, what you do in bed does matter.”Fight Club’s exhausted narrator describes insomnia as making everything feel like a copy of a copy of a copy. | 20th Century FoxThe consequences of insomnia are numerous and unpleasant. You probably won’t form a rogue second personality, but Edward Norton’s haggard appearance and fogged brain were credible. Exhaustion, moodiness, and a lack of motivation are common, and ideally, you shouldn’t be operating any sort of machinery; Reznik should have found another job well before he sliced a co-worker’s arm off. “Driving with insomnia is dangerous. The Department of Transportation has done studies,” Buenaver says. “If you’re sleep-deprived and driving, your eyes can close for a second. That’s been defined as a microsleep, you’re literally asleep for a second. It can put you and others in danger.”But there are solutions, assuming you can find a more sympathetic doctor than the narrator of Fight Club did. Medication can offer short-term relief, but cognitive behavioral therapy for insomnia, which can include relaxation techniques and changes to your lifestyle and sleep routine, is ideal.“The effects of the treatment are durable,” Buenaver says. “A typical course is about six sessions. Once you finish, people tend to show improvement for years. Medications target symptoms, whereas therapy targets the underlying cause of the sleep disorder.”Like so many other troubled movie characters, our favorite fictional insomniacs really just need to go to therapy. But whatever course of action you choose, Buenaver encourages routine.“Look over the last week or two, estimate your average sleep time, and add 30 minutes,” he says. “That should be your overall time in bed, from when you get in to when you get up. Waking up at the same time every day is really helpful because it trains your biological clock, and your body likes consistency. And if bedtime rolls around and you’re not quite feeling sleepy, wait until you start feeling sleepy enough that you think there’s a reasonable chance you fall asleep. That will benefit you the following night and thereafter.”