CHAPTER 123

2026-01-20

The greatest fear is fear itself.

People with depression often feel helpless, trapped, and anxious. Because of emotional, psychological, and psychiatric factors, the illness can reinforce itself. Starting from the initial cause, and together with the instability it triggers, these elements feed off one another, exacerbating the condition.

Anxiety can give rise to fear. Fear is a natural response to crisis—a signal, one of our survival instincts. Yet fear itself can take on a life of its own: even when the external environment does not objectively worsen, fear may continue to grow, until its force ultimately eclipses the original cause that gave rise to it. This is a bone-deep realization I gained through my own experience of acute depression.

The greatest fear is fear itself.

Recently, I came across a post discussing hypnic jerks (also known as sleep starts; see notes). While dreaming, one feels as if falling from a height and suddenly wakes up. One possible explanation is that the brain mistakenly interprets muscle relaxation as a loss of balance, or detects that bodily functions are slowing down, and therefore activates a mechanism to reawaken and re-energize the body.

This was exactly how my restless sleep began on the night of March 8, 2019. For nearly three months, regardless of morning, afternoon, or night, whenever I was utterly exhausted—whether sitting or lying down—at the moment when drowsiness overtook alertness and my eyelids drooped, a hypnic jerk would occur. I would wake instantly, my heart racing, yet unable to explain why. For three consecutive months, I was unable to sleep at all, leaving my mental and physical energy severely depleted.

What followed was impairment in everyday functioning. The first major obstacle was driving. Lethargic and unable to concentrate, I struggled to observe and respond to road conditions. I drove a manual-transmission car, which required smooth coordination of hands, eyes, and feet. From side roads to highways, many interchanges in this province require accelerating from a standstill to traffic speed within a very short time. On one occasion, difficulty shifting gears led to a near miss. Both the driver (myself) and the passenger (my wife) became increasingly tense. When the situation failed to improve, we switched to an automatic-transmission car two months later, which I have used ever since.

In low spirits and lacking motivation, I had little interest in cooking or eating. Meals were perfunctory and tasteless; weight dropped passively, and energy waned further.

Coincidentally, my liver function indicators had always been very stable. Before the onset of depression, my transplant team advised reducing the dosage of anti-rejection medication due to long-term side effects. Meanwhile, my family doctor prescribed psychiatric medication to treat depression, and the two treatments were administered concurrently.

Before long, several liver enzyme levels rose above normal. It was impossible to determine whether this was caused by the reduced anti-rejection dosage or the newly introduced psychiatric drugs. After much back-and-forth, the decision was made to restore the original anti-rejection dosage while continuing the psychiatric medication.

All of this added layers of complication, leaving the person involved increasingly confused—confusion upon confusion, chaos upon chaos.

After discharge from the hospital, my psychiatrist recommended that I join a rehabilitation group program, from which I benefited greatly and is worth sharing in the future. (End)

Notes:

The sudden sensation of “falling downward” at the moment of falling asleep is actually very common. This phenomenon is called a hypnic jerk (also known as a sleep start).

Why does it happen?

It usually occurs during the transition from wakefulness to light sleep (Stage 1 of sleep). Common explanations include:

1. Muscle relaxation misinterpreted by the brain

As you fall asleep, muscles relax rapidly. Sometimes the brain misjudges this as a loss of balance or falling, and sends an emergency signal causing a sudden muscle contraction.

2. An evolutionary explanation

One theory suggests this is a protective mechanism inherited from ancestors who slept in trees; the sudden jerk could help prevent an actual fall.

3. A “handover glitch” in the nervous system

The brain is switching from conscious control (wakefulness) to automatic control (sleep). During this handover, neural signals may briefly overlap, producing the sensation of falling.

4. Factors that make it more likely

• Stress or anxiety

• Extreme fatigue or sleep deprivation

• Caffeine or nicotine

• Vigorous exercise before bedtime

• An uncomfortable sleeping position

Is it dangerous?

No. Hypnic jerks are harmless physiological phenomena and are very common. Most people experience them occasionally, especially during periods of high stress.

When should you pay attention?

Consult a doctor if:

●     They occur very frequently and seriously disrupt sleep.

●     They are accompanied by confusion, injury, or brief loss of consciousness.

●     Involuntary muscle jerks also occur frequently while awake (to rule out rare neurological conditions)

How can the likelihood be reduced?

●     Maintain a regular daily routine

●     Reduce caffeine intake in the evening

●     Relax before bedtime (e.g., reading, deep breathing)

●     Avoid vigorous exercise before sleep