Insomnia -- sleep restriction troubleshooting/support
March 20, 2019 6:34 AM Subscribe
I suffer from insomnia and I'm three weeks into self-directed CBT-I and sleep restriction. I'm feeling awful and unsuccessful, and I could use some help from those who tried them.
Hi all, you've all been incredibly helpful to me in the past and I'm hoping you can help me solve this one pesky, persistent issue. I've been struggling with insomnia for about 3.5 years -- I never have trouble falling asleep, but I have significant problems with middle of the night awakenings, waking up too early, and not sleeping very deeply. This was due to a combination of factors, like being at the mercy of other people's schedules (roommates with inconsistent sleep schedules, living in a living room and being exposed to ALL my housemates' schedules which varied across the board, and living with my partner, a resident physician, in a studio apartment who has downright unpredictable hours... think waking up at 4am somedays, 6am on other days, 11am on days where they have call, and etc.). I coped with my sleep deprivation in maladaptive ways that I now know made my insomnia worse and more entrenched, like allocating more time in bed for sleep, laying in bed during the daytime to browse the internet because I was so tired, and having caffeinated drinks at all hours of the day.
Otherwise, my life is going incredibly well. I am mentally and physically healthy, have a good job with great benefits, and am surrounded by healthy social circles that bolster me up. I also have my own quiet bedroom that I do not share with anybody, so it's an ideal time to fix my insomnia. I read Say Goodnight to Insomnia and decided to follow their self-directed CBT-I program. I downloaded the CBT-i Coach app to help me track my sleep.
I learned about sleep hygiene, stopped my maladaptive behaviors, and aside from sticking to the same wake and sleep time, my sleep hygiene is impeccable (think no screens an hr before bed, no caffeine after 12, having wind down activities before bed, journaling my sleep anxieties, using the bed only for sleep and sex, and etc.) I also avoid all sleep medications because they haven't been helpful.
It's been about 2 weeks and 3 days and I'm feeling frustrated at a lack of progress. My average time in bed is 6.2 hours and average time asleep is 4.8. My average sleep efficiency is 77.1%. I feel like dying is an understatement.
Here is a brief overview of what happened:
Week 1 -- I dedicated this week as an observation period. I set my bedtime to 10:50pm and wake time to 6am because I don't need that much sleep on a good night -- maybe 7 or 7.5 is ideal. I cycled from sleeping approximately 6.5 hours, to 3.5 the next night, then 5, to 6 again, 3, and 7. Lots of middle of the night awakenings and waking up too early feeling wired and ready to start the day, yet having significant daytime fatigue later on.
With middle of the night awakenings, there is a 50/50 chance I'll fall back asleep after being awake for 1.5-2 hrs. Otherwise, I'll get up and start my day early.
Week 2 -- This was a mess. Daylight savings really screwed me up. I tried to "keep" the same schedule by setting my bedtime to 11:50pm and wake time to 7am, and for three days I strung together 6-7 hours of sleep. It was amazing. However, I really wanted to wake up at 6am so I could have extra time for myself before going to work so I adjusted my sleep back to 10:50pm - 6am again. I had 4 hours of sleep, then 6 hours the next night. I was so desperate and exhausted, I decided to restrict my sleep on the sixth night to 11:50pm-6am (my average hours asleep up until this point + 1 hr). I strung together two nights with 4 hours of sleep.
I noticed my dog was waking me up two nights out of the week, so I trained her to sleep in the living room. She's doing well there. The other early awakenings was due to my usual middle of the night awakenings.
My room was also too warm so I turned on a fan.
I also experimented with napping on one of those days. To no one's surprise, I had trouble falling asleep so napping is out.
Although my sleep was deeper this week, I wasn't wired anymore. I wanted to drop dead from exhaustion, especially when I first wake up in the morning and on the run-up to bedtime.
Week 3 -- I'm only three nights in and I'm doing poorly. I'm sticking to my 11:50pm-6am sleep schedule, although sometimes I sleep at 11:40pm because I cannot stand the exhaustion. I'm really good at waking up at 6am though. I slept 5 hrs and 41 mins on the first night, then 5 hrs and 30 mins on the second nights. On both nights I woke up in the middle of the night but was able to fall back asleep in 20 mins because I exercised during the day. Last night I only had 3 hrs and 50 mins of sleep because I didn't exercise and wasn't feeling sleepy enough to fall back asleep. I'm TIRED though, but for the life of me I CANNOT SLEEP.
I'm not feeling wired and optimistic anymore. I'm beyond frustrated and hopeless. At least now I've isolated external factors that were keeping me up and I'm now dealing with the insomnia directly, but I'm feeling too tired to stick this through. I just want to lay in bed all day, nap, or turn off my alarm to sleep in after a poor night's sleep. I want to have a mental breakdown and reduce to a sobbing mess. But I can't, I'm not ready to give up yet.
I guess the purpose of this post was to vent a little, but most importantly I want to hear from those who tried CBT-I and sleep restriction. Was it successful? Did you have a terrible time at the start? How long did it take to work? I'm also wondering if I am doing this right, but I want to give it two more weeks before consulting a CBT-I provider. Thanks for your help in advance.
Hi all, you've all been incredibly helpful to me in the past and I'm hoping you can help me solve this one pesky, persistent issue. I've been struggling with insomnia for about 3.5 years -- I never have trouble falling asleep, but I have significant problems with middle of the night awakenings, waking up too early, and not sleeping very deeply. This was due to a combination of factors, like being at the mercy of other people's schedules (roommates with inconsistent sleep schedules, living in a living room and being exposed to ALL my housemates' schedules which varied across the board, and living with my partner, a resident physician, in a studio apartment who has downright unpredictable hours... think waking up at 4am somedays, 6am on other days, 11am on days where they have call, and etc.). I coped with my sleep deprivation in maladaptive ways that I now know made my insomnia worse and more entrenched, like allocating more time in bed for sleep, laying in bed during the daytime to browse the internet because I was so tired, and having caffeinated drinks at all hours of the day.
Otherwise, my life is going incredibly well. I am mentally and physically healthy, have a good job with great benefits, and am surrounded by healthy social circles that bolster me up. I also have my own quiet bedroom that I do not share with anybody, so it's an ideal time to fix my insomnia. I read Say Goodnight to Insomnia and decided to follow their self-directed CBT-I program. I downloaded the CBT-i Coach app to help me track my sleep.
I learned about sleep hygiene, stopped my maladaptive behaviors, and aside from sticking to the same wake and sleep time, my sleep hygiene is impeccable (think no screens an hr before bed, no caffeine after 12, having wind down activities before bed, journaling my sleep anxieties, using the bed only for sleep and sex, and etc.) I also avoid all sleep medications because they haven't been helpful.
It's been about 2 weeks and 3 days and I'm feeling frustrated at a lack of progress. My average time in bed is 6.2 hours and average time asleep is 4.8. My average sleep efficiency is 77.1%. I feel like dying is an understatement.
Here is a brief overview of what happened:
Week 1 -- I dedicated this week as an observation period. I set my bedtime to 10:50pm and wake time to 6am because I don't need that much sleep on a good night -- maybe 7 or 7.5 is ideal. I cycled from sleeping approximately 6.5 hours, to 3.5 the next night, then 5, to 6 again, 3, and 7. Lots of middle of the night awakenings and waking up too early feeling wired and ready to start the day, yet having significant daytime fatigue later on.
With middle of the night awakenings, there is a 50/50 chance I'll fall back asleep after being awake for 1.5-2 hrs. Otherwise, I'll get up and start my day early.
Week 2 -- This was a mess. Daylight savings really screwed me up. I tried to "keep" the same schedule by setting my bedtime to 11:50pm and wake time to 7am, and for three days I strung together 6-7 hours of sleep. It was amazing. However, I really wanted to wake up at 6am so I could have extra time for myself before going to work so I adjusted my sleep back to 10:50pm - 6am again. I had 4 hours of sleep, then 6 hours the next night. I was so desperate and exhausted, I decided to restrict my sleep on the sixth night to 11:50pm-6am (my average hours asleep up until this point + 1 hr). I strung together two nights with 4 hours of sleep.
I noticed my dog was waking me up two nights out of the week, so I trained her to sleep in the living room. She's doing well there. The other early awakenings was due to my usual middle of the night awakenings.
My room was also too warm so I turned on a fan.
I also experimented with napping on one of those days. To no one's surprise, I had trouble falling asleep so napping is out.
Although my sleep was deeper this week, I wasn't wired anymore. I wanted to drop dead from exhaustion, especially when I first wake up in the morning and on the run-up to bedtime.
Week 3 -- I'm only three nights in and I'm doing poorly. I'm sticking to my 11:50pm-6am sleep schedule, although sometimes I sleep at 11:40pm because I cannot stand the exhaustion. I'm really good at waking up at 6am though. I slept 5 hrs and 41 mins on the first night, then 5 hrs and 30 mins on the second nights. On both nights I woke up in the middle of the night but was able to fall back asleep in 20 mins because I exercised during the day. Last night I only had 3 hrs and 50 mins of sleep because I didn't exercise and wasn't feeling sleepy enough to fall back asleep. I'm TIRED though, but for the life of me I CANNOT SLEEP.
I'm not feeling wired and optimistic anymore. I'm beyond frustrated and hopeless. At least now I've isolated external factors that were keeping me up and I'm now dealing with the insomnia directly, but I'm feeling too tired to stick this through. I just want to lay in bed all day, nap, or turn off my alarm to sleep in after a poor night's sleep. I want to have a mental breakdown and reduce to a sobbing mess. But I can't, I'm not ready to give up yet.
I guess the purpose of this post was to vent a little, but most importantly I want to hear from those who tried CBT-I and sleep restriction. Was it successful? Did you have a terrible time at the start? How long did it take to work? I'm also wondering if I am doing this right, but I want to give it two more weeks before consulting a CBT-I provider. Thanks for your help in advance.
Response by poster: Yes -- if I don't fall asleep within 20 mins, I get up to read. I also know about the importance of getting 5.5 hours of core sleep. I certainly give myself enough time for it. I just can't stay asleep long enough for it sometimes.
posted by squirtle at 6:56 AM on March 20, 2019
posted by squirtle at 6:56 AM on March 20, 2019
I hope this doesn't feel too off-topic, but have you looked at any meds you're taking and whether they can affect sleep? I'm similar to you in the kind of insomnia I have (I fall asleep easily but wake up/don't sleep deeply/sleep meds don't help and sleep hygiene hasn't helped much) and I recently realized that a (psych) med that I was taking can negatively impactsleep. I mention it particularly because it really wasn't a medicine I would have expected to interfere with sleep or sleep quality--it's supposed to help with anxiety (buspirone)--but I noticed that I slept better on a few nights where I forgot to take it, and after doing some digging/experimenting I realized this wasn't a fluke.
posted by needs more cowbell at 6:58 AM on March 20, 2019
posted by needs more cowbell at 6:58 AM on March 20, 2019
Response by poster: I'm really sorry for a lack of details in my original post. There is just a lot of information to add that I'm forgetting. I just want to clarify -- I am not on any meds whatsoever and haven't been on them in years. I believe my prior mental health struggles were a direct result of social issues that were resolved by being in a healthier environment and receiving EDMR treatment for CPTSD. I'm thriving now in all dimensions of life -- no meds or therapy needed.
posted by squirtle at 7:03 AM on March 20, 2019
posted by squirtle at 7:03 AM on March 20, 2019
Best answer: I did sleep restriction as part of a guided sleep therapy, and it took several weeks for it to work. Several weeks - like 4 or 5. It was miserable; I remember feeling actually thirsty for sleep.
But once it worked, man, did it work. It's been years and I have not had another bout of longstanding insomnia. Sometimes I have a rough night, or a night where my kids wake me up a lot, but I'm able to quickly fall back asleep whereas before I would be up for the rest of the night. So I encourage you to stick with it.
One question - are you trying to go to sleep at 10:50 or 11:50? You've got both times in your list up above. At three weeks in, I had started lengthening my sleep time in 15 minute increments every few days. I started with five hours in bed (and obviously less sleep than that), but within 3 weeks I was at close to 7 hours. My sleep therapist especially had me focus on lengthening to an earlier bedtime. If you're falling asleep at 11:40 and your bedtime is 11:50, for one thing you are not being consistent enough to see results, but since you've been at it for a while, it might be time to extend your bedtime back a little earlier.
You might also have to cut all caffeine. Sorry.
posted by peanut_mcgillicuty at 7:36 AM on March 20, 2019 [3 favorites]
But once it worked, man, did it work. It's been years and I have not had another bout of longstanding insomnia. Sometimes I have a rough night, or a night where my kids wake me up a lot, but I'm able to quickly fall back asleep whereas before I would be up for the rest of the night. So I encourage you to stick with it.
One question - are you trying to go to sleep at 10:50 or 11:50? You've got both times in your list up above. At three weeks in, I had started lengthening my sleep time in 15 minute increments every few days. I started with five hours in bed (and obviously less sleep than that), but within 3 weeks I was at close to 7 hours. My sleep therapist especially had me focus on lengthening to an earlier bedtime. If you're falling asleep at 11:40 and your bedtime is 11:50, for one thing you are not being consistent enough to see results, but since you've been at it for a while, it might be time to extend your bedtime back a little earlier.
You might also have to cut all caffeine. Sorry.
posted by peanut_mcgillicuty at 7:36 AM on March 20, 2019 [3 favorites]
Response by poster: On the first week, I slept at 10:50. Then on the second week, I restricted to 11:50. Daylight savings happened sometime between there as well, so you're right -- I am not consistent.
I know I'm not supposed to thread sit, so I'll step away now!
posted by squirtle at 7:43 AM on March 20, 2019
I know I'm not supposed to thread sit, so I'll step away now!
posted by squirtle at 7:43 AM on March 20, 2019
Best answer: I'm reading this and I'm not sure what you're doing actually matches the program super well. There is a point where you extend the time, obviously, but it doesn't seem like you've actually started strictly at your average, with no cushion. If you start adding in padding time to allow for your waking periods, I don't think it's actually sleep restriction anymore, and I don't think it's apt to work as well. I understand not being able to be this consistent--that's part of why I wound up skipping this and finding something else that worked for me, for the moment--but some of these kinds of programs really don't work well unless you're following it to the letter.
(I wound up accidentally finding a regular biphasic schedule works better for whatever the heck it is my brain's doing right now that disagrees with staying asleep for more than five hours solidly, but obviously mileage on this very much varies.)
posted by Sequence at 7:54 AM on March 20, 2019 [2 favorites]
(I wound up accidentally finding a regular biphasic schedule works better for whatever the heck it is my brain's doing right now that disagrees with staying asleep for more than five hours solidly, but obviously mileage on this very much varies.)
posted by Sequence at 7:54 AM on March 20, 2019 [2 favorites]
I've tried it multiple times and it was hell and didn't work. BUT my sleep issues are a lot worse than yours so that doesn't mean it won't work for you, especially since you've addressed some issues and are going to start maintaining consistency.
The most helpful way of getting through it for me was to have a list of things on hand to do when I was exhausted but not allowed to be in bed. Yours will be different from mine, but mine included yoga videos, walking my dog, miscellaneous household chores, etc.
posted by metasarah at 8:03 AM on March 20, 2019
The most helpful way of getting through it for me was to have a list of things on hand to do when I was exhausted but not allowed to be in bed. Yours will be different from mine, but mine included yoga videos, walking my dog, miscellaneous household chores, etc.
posted by metasarah at 8:03 AM on March 20, 2019
Keep going with some tweaks: cool percale cotton sheets; sleep naked or with very little clothing; after 20 minutes of wakefulness get out of bed (if it doesn't disturb your partners) and read or listen to a soothing podcast until you feel cold and crave warmth. You'll get there!
posted by Elsie at 8:10 AM on March 20, 2019
posted by Elsie at 8:10 AM on March 20, 2019
Just a data point: the "get up if you can't sleep" advice is a coin toss, not a sticking point (I mean, it may be on this particular methodology you're using, but it is otherwise a thing people throw around like "everybody knows" it's the correct thing, but it is not necessarily - especially if you're turning on lights), and will depend a LOT on the narrative you apply to your waking periods.
I used to snap into a rage when I woke up, like instantly. I'd trained myself into it. And then one day I read that (possibly apocryphal) thing that makes the rounds every so often that it used to be totally normal to sleep in two shifts and people got up and did chores and Ben Franklin would upset his household staff by taking "air baths" naked around the house before going back to bed. Whatever, it's just that my brain took that in and went OH THIS IS ACTUALLY FINE. Since then, if I wake up it's cool, everything's going to be fine, I'll just take care of any biological needs and straighten my covers and get back into bed and rest until I sleep again. I do a kind of loose visualization exercise that is sleep oriented - I try to think up the most amazing bed/sleep scenarios I can and how incredibly comfortable and perfectly accommodating to my preferences and I have no budget and frankly I can ignore any science that gets in my way (in my universe, it's totally safe to sleep in a pool, it's the non-drowning type of water).
It's much easier to get back to sleep when you're not in an anxious desperate fury. My turnaround time is rarely longer than 20 minutes. I do wake most nights, and I operate under the assumption that this is normal and a thing a lot of people do even if they don't remember it. I don't use sleep activity trackers because it gives me something to perseverate on, and I use my phone - turned face down on the nightstand - as a clock that I only check once on waking (because it may actually be nearly time to get up, and I find I'm in better shape if I just do that instead of drifting back off just to be alarmed awake 15 minutes later) but don't watch.
(One other thing I discovered that made a real difference: white noise, good white noise that fills the room acoustically. It tells my brain there's no point in being vigilant for every little noise, because we aren't going to be able to hear anything short of some kind of real emergency anyway.)
posted by Lyn Never at 8:33 AM on March 20, 2019 [4 favorites]
I used to snap into a rage when I woke up, like instantly. I'd trained myself into it. And then one day I read that (possibly apocryphal) thing that makes the rounds every so often that it used to be totally normal to sleep in two shifts and people got up and did chores and Ben Franklin would upset his household staff by taking "air baths" naked around the house before going back to bed. Whatever, it's just that my brain took that in and went OH THIS IS ACTUALLY FINE. Since then, if I wake up it's cool, everything's going to be fine, I'll just take care of any biological needs and straighten my covers and get back into bed and rest until I sleep again. I do a kind of loose visualization exercise that is sleep oriented - I try to think up the most amazing bed/sleep scenarios I can and how incredibly comfortable and perfectly accommodating to my preferences and I have no budget and frankly I can ignore any science that gets in my way (in my universe, it's totally safe to sleep in a pool, it's the non-drowning type of water).
It's much easier to get back to sleep when you're not in an anxious desperate fury. My turnaround time is rarely longer than 20 minutes. I do wake most nights, and I operate under the assumption that this is normal and a thing a lot of people do even if they don't remember it. I don't use sleep activity trackers because it gives me something to perseverate on, and I use my phone - turned face down on the nightstand - as a clock that I only check once on waking (because it may actually be nearly time to get up, and I find I'm in better shape if I just do that instead of drifting back off just to be alarmed awake 15 minutes later) but don't watch.
(One other thing I discovered that made a real difference: white noise, good white noise that fills the room acoustically. It tells my brain there's no point in being vigilant for every little noise, because we aren't going to be able to hear anything short of some kind of real emergency anyway.)
posted by Lyn Never at 8:33 AM on March 20, 2019 [4 favorites]
I know nothing about this training you're doing but I went through a hard-core phase of waking and not being able to fall asleep again. For a time, the Deep Sleep Hypnosis track dedicated to returning to sleep was helpful if I woke in the middle of the night. I can't remember if it was free or paid.
posted by DarlingBri at 8:40 AM on March 20, 2019
posted by DarlingBri at 8:40 AM on March 20, 2019
I have one other suggestion. I also wake up in the middle of the night, though I haven't tried sleep restriction yet (for me personally, it feels like it could cause more problems than it solves...also, to clarify what I was saying above, I was just concerned that you weren't spending the minimum amount of time in bed if you're staying out of bed the whole time you're awake. I don't know how this works if your average sleep is so short). It does help me to do very gentle yoga both before bed and if I wake up. I recommend getting a used copy of ZYoga for Sleep. The routine for middle of the night waking is particularly useful.
posted by pinochiette at 9:26 AM on March 20, 2019
posted by pinochiette at 9:26 AM on March 20, 2019
Oh, another important thing a CBT provider would encourage you to work on is to avoid stressing out about not sleeping. Reframe things, so instead of waking up and thinking "oh crap now I'm never going to get back to sleep and I'm going to feel terrible tomorrow and for the rest of my life etc. etc." It sounds like you might be doing some of that, and moving instead to accepting it and recognizing that you WILL still make it through the next day is important.
posted by metasarah at 9:43 AM on March 20, 2019
posted by metasarah at 9:43 AM on March 20, 2019
Best answer: Dear squirtle,
As a CBT-I therapist who's been in the sleep field since 2008, hope I can offer some educational insights.
First, I'd like to say that I am so sorry to hear that you have been stuck suffering with chronic insomnia for three and a half years. From your description of how it started, it sounds like there were a lot of precipitating and perpetuating factors that conspired to get you where you are. Living in a heavily trafficed living room would make good sleeping patterns almost impossible and although its my understanding that the American College of Physicians has set some guidelines to prevent the most egregious sleep deprivation issues when training new doctors, it never cease to amaze me at all the collateral damage caused medical training institutions insistence that new physicians work erratic work schedules. Its not good for the new physicians, its not good for their patients and as your story well illustrates, its even awful for their partners.
One of the things I find encouraging about your story is that despite a miazma of less than helpful curatives that are out there, you have successful managed to find what is empirically by far the most effective treatment for chronic insomnia and you have had the initiative to undertake self-directed CBT-I to rid yourself of your insomnia permanently. You sound like your doing a good job.
My main concern about self-directed treatment, is that it often doesn't sufficiently prepare patients for what is involved in CBT-I. One of the things I do to prepare my patients, is I let them know ahead of time that it can be hard and will feel uncomfortable. That unpleasantness is both normal and necessary. You will get worse before you get better. You are training your body to unlearn three and a half years of bad habits and it usually takes three to four weeks to start reaping the full benefits of the therapy. Its important to keep your goals in focus. You will get better.
While you feel unpleasant, my experience has been that its about the same as having the flu without the fever. Think about before you started treatment, back then would you have been willing to trade feeling like you have the flu for never having chronic insomnia again?
I also want to note that, if I prescribe a 6 hour Sleep Restriction window for a patient, I do so with the knowledge that they will likely not actually get that full 6 hours of sleep every night, especially early on. In those first few weeks some get less than 5 on average. It sounds like you're smack dab in the middle of that phase.
It's not uncommon for patients to call me during this period and tell me they had a day when they had no sleep at all. I always try and calmly reassure them that sleep is a biological imperative and that despite all the maladaptive learned behaviors they carry they will sleep again and when they do it will be more consistant. If they don't sleep well tonight, then they will tomorrow, or the next night and when they do all that sleep pressure will be the thing that consistently helps them fall asleep, stay asleep and re-learn good sleeping patterns that they need to do so consistantly. It may feel bad right now, but but that sleep pressure is actually your best ally in recovery.
When my patients are at the stage your at, I also often remind them of the efforts they have already put into this treatment and point out that they suffered with insomnia for a while (3 and a half years in your case) and gotten nothing out of it but more misery. Why not go a little longer for for the purpose of not suffering at all? Its better than having insomnia for another 3 and a half years.
I want to note that, as a therapist, one of my chief concerns is safety and a primary goal in CBT-I is to minimize potential drowsy related hazards. Please safety plan around your drowsiness accordingly. If your guide doesn't cover that, please find a resource that does and take that into consideration. But as you consider that, also take into account that long term chronic insomnia also has safety hazards associated with it.
Lastly, if self directed CBT-I is proving to be too much, I strongly encourage you to find a behavioral sleep medicine trained therapist in your area and consider working with them. I am happy to personally assist you in finding someone if you need it. If your interested and you can't find a good resource here feel free to message me and I'll ask around the community. If you think you want to stick with the self-directed approach, but continue to run into some hiccups, you are welcome to message me and use me a resource. I am always happy to help a fellow green reader.
posted by Jernau at 10:45 AM on March 20, 2019 [7 favorites]
As a CBT-I therapist who's been in the sleep field since 2008, hope I can offer some educational insights.
First, I'd like to say that I am so sorry to hear that you have been stuck suffering with chronic insomnia for three and a half years. From your description of how it started, it sounds like there were a lot of precipitating and perpetuating factors that conspired to get you where you are. Living in a heavily trafficed living room would make good sleeping patterns almost impossible and although its my understanding that the American College of Physicians has set some guidelines to prevent the most egregious sleep deprivation issues when training new doctors, it never cease to amaze me at all the collateral damage caused medical training institutions insistence that new physicians work erratic work schedules. Its not good for the new physicians, its not good for their patients and as your story well illustrates, its even awful for their partners.
One of the things I find encouraging about your story is that despite a miazma of less than helpful curatives that are out there, you have successful managed to find what is empirically by far the most effective treatment for chronic insomnia and you have had the initiative to undertake self-directed CBT-I to rid yourself of your insomnia permanently. You sound like your doing a good job.
My main concern about self-directed treatment, is that it often doesn't sufficiently prepare patients for what is involved in CBT-I. One of the things I do to prepare my patients, is I let them know ahead of time that it can be hard and will feel uncomfortable. That unpleasantness is both normal and necessary. You will get worse before you get better. You are training your body to unlearn three and a half years of bad habits and it usually takes three to four weeks to start reaping the full benefits of the therapy. Its important to keep your goals in focus. You will get better.
While you feel unpleasant, my experience has been that its about the same as having the flu without the fever. Think about before you started treatment, back then would you have been willing to trade feeling like you have the flu for never having chronic insomnia again?
I also want to note that, if I prescribe a 6 hour Sleep Restriction window for a patient, I do so with the knowledge that they will likely not actually get that full 6 hours of sleep every night, especially early on. In those first few weeks some get less than 5 on average. It sounds like you're smack dab in the middle of that phase.
It's not uncommon for patients to call me during this period and tell me they had a day when they had no sleep at all. I always try and calmly reassure them that sleep is a biological imperative and that despite all the maladaptive learned behaviors they carry they will sleep again and when they do it will be more consistant. If they don't sleep well tonight, then they will tomorrow, or the next night and when they do all that sleep pressure will be the thing that consistently helps them fall asleep, stay asleep and re-learn good sleeping patterns that they need to do so consistantly. It may feel bad right now, but but that sleep pressure is actually your best ally in recovery.
When my patients are at the stage your at, I also often remind them of the efforts they have already put into this treatment and point out that they suffered with insomnia for a while (3 and a half years in your case) and gotten nothing out of it but more misery. Why not go a little longer for for the purpose of not suffering at all? Its better than having insomnia for another 3 and a half years.
I want to note that, as a therapist, one of my chief concerns is safety and a primary goal in CBT-I is to minimize potential drowsy related hazards. Please safety plan around your drowsiness accordingly. If your guide doesn't cover that, please find a resource that does and take that into consideration. But as you consider that, also take into account that long term chronic insomnia also has safety hazards associated with it.
Lastly, if self directed CBT-I is proving to be too much, I strongly encourage you to find a behavioral sleep medicine trained therapist in your area and consider working with them. I am happy to personally assist you in finding someone if you need it. If your interested and you can't find a good resource here feel free to message me and I'll ask around the community. If you think you want to stick with the self-directed approach, but continue to run into some hiccups, you are welcome to message me and use me a resource. I am always happy to help a fellow green reader.
posted by Jernau at 10:45 AM on March 20, 2019 [7 favorites]
I have to avoid sugar in the evenings or I wake up after a couple hours feeling really weird and I have to get up. Also, is it possible you are overheating. I like to fall asleep warm but not sleep warm so I start with a hot water bottle at my feet and kick it off before I drop off.
I think this Programme sounds really promising and I think it could work so don’t give up hope. I sleep trained my kids from a young age and a lot of what you describe sounds like how I worked with them- little changes and working towards a certain sleep routine. Newborns start off sleeping all the time and then with a quite erratic schedule, eventually moving to consolidated night sleep... but there’s definitely a lot of trial and error and tiredness (letting a nap go longer than it should and that having consequences for example) even when you are making progress and doing things right.
posted by catspajammies at 10:49 AM on March 20, 2019
I think this Programme sounds really promising and I think it could work so don’t give up hope. I sleep trained my kids from a young age and a lot of what you describe sounds like how I worked with them- little changes and working towards a certain sleep routine. Newborns start off sleeping all the time and then with a quite erratic schedule, eventually moving to consolidated night sleep... but there’s definitely a lot of trial and error and tiredness (letting a nap go longer than it should and that having consequences for example) even when you are making progress and doing things right.
posted by catspajammies at 10:49 AM on March 20, 2019
For what it’s worth, I’m another data point for sleep restriction being BRUTAL but, five years on, I’m not sorry I did it. I’ve been an insomniac pretty much my whole life and will probably always be, but overall I have seen some improvement over time. But only being able to be in bed (in my program) 3am-6:30am was rough as hell, especially since at the time I didn’t really own any other comfortable places to sit. You’re already being less dumb about this than me. But it’s just hard, and the mental/emotional exhaustion can make it MUCH harder.
posted by jameaterblues at 12:37 PM on March 20, 2019
posted by jameaterblues at 12:37 PM on March 20, 2019
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posted by pinochiette at 6:53 AM on March 20, 2019 [2 favorites]