How Bill’s health scare led to insomnia and how tackling sleep-related thoughts and behaviors helped him improve his sleep (#14)

Transcript

Martin Reed: Welcome to the Insomnia Coach Podcast. My name is Martin Reed. I believe that nobody needs to live with chronic insomnia and that evidence-based cognitive and behavioral techniques can help you enjoy better sleep for the rest of your life.

Martin Reed: The content of this podcast is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. The statements and opinions expressed by guests are their own and are not necessarily endorsed by Insomnia Coach LLC. All content is provided “as is” and without warranties, either express or implied.

Martin Reed: Okay. So thank you so much for taking the time to be on with us today, Bill.

Bill Hunter: My pleasure.

Martin Reed: So let’s start at the beginning. When did your sleep problems begin, and do you remember what initially triggered that sleep disruption?

Bill Hunter: Yes. So sleep problems really started in about February of this year, and it’s been a part of… Well, to be honest, I think in August last year I was admitted to hospital with what was a suspected heart attack. Didn’t turn out to be that, but it was an anxiety-related issue. So I guess in using a term that used to be used, it was probably what you might describe as a nervous breakdown in August last year. So it’s been a very difficult last 12 or 14 months or so for me.

Bill Hunter: It was one of those ones where, I guess in terms of mental health, they call it the holy trinity, I think. Anxiety, depression, insomnia, they all go together. So the insomnia part of it started as I said in February while I was away from home for a few days, in a night where I got zero sleep, which I don’t think had ever happened to me that I can ever remember before. So after that, those nights of no sleep seemed to be happening just more and more frequently, and it just became very, very distressing really.

Bill Hunter: You end up just in this, I think, this sort of vicious circle where the insomnia feeds the anxiety, and the depression becomes a bit worse and you sort of just spiral down, so that’s when it started.

Martin Reed: Yeah, absolutely. I think everyone listening to this will really identify with you talking about this vicious cycle, you know where you start to worry about sleep, sleep becomes more difficult, and then it kind of leads to even more worry about sleep, which then makes sleep more difficult. It can just seem like this cycle is just going to be endless, and it seems as though there’s kind of like no way out. Is that kind of how you felt at the time?

Bill Hunter: Yeah, I think it’s fair to say that you just become quite desperate really, especially if it’s something that you haven’t perhaps suffered with your whole life. You begin, or in my case anyway, start clutching around for solutions anywhere you can find them, sort of reading a lot of books and trying different medications and visits to the doctor and all sorts of pre-sleep rituals that people swear by as of course you try harder and harder and sleep becomes more and more elusive. That game doesn’t really help you very much.

Martin Reed: Yeah, absolutely. Did you ever have any problems with sleep before this health issue that you experienced in August of last year?

Bill Hunter: I wouldn’t say for my whole life I’ve been a great sleeper. I’ve been reasonably okay. I obviously went through some patches of bad sleep when my children were young as everybody does, but I think probably in my case, to be honest, I had a traumatic event in childhood. My mother died when I was three, and I think ever since then I’ve really probably slept not as well as I could have. So it’s probably on and off been a bit of a lifelong issue.

Martin Reed: Yeah. And how was your sleep… You mentioned that everything kind of came to a head in February, that you kind of had this health issue back in August. How was your sleep between that period, between August and February? Was there minimal impact and it just all came to a head when you had that night of no sleep, or was it kind of disrupted in between as well?

Bill Hunter: I think you could say between August and that period it was disrupted, but I certainly hadn’t had prior to February any nights where I couldn’t sleep at all, so I might have had sleep that wasn’t as good as it could be. I wasn’t at a level where I felt I couldn’t really cope with it. It was after February when I started getting sometimes not just one night of no sleep, but I remember one weekend where I had two nights of no sleep, and that to me was just the absolute pits, you know, I found it very, very hard after that second night of no sleep.

Martin Reed: Yeah. I mean, again, I think everyone’s going to really identify with what you’re saying because for a lot of people, there is this quite identifiable event or issue that either disrupts sleep or makes sleep worse than it normally is because for a lot of people with insomnia they’ve tended to always have maybe more disrupted sleep, but never been that big of a problem, they just recognize that maybe they’re not one of these great natural sleepers. But then once you have that one night of no sleep like you described, and that kind of raises your worry, and then if it turns into two, that can really feel like the wheels are coming off.

Bill Hunter: Yeah.

Martin Reed: Did you kind of feel like get concern that maybe you’ve kind of lost the ability to sleep or that there was something else that was really wrong or anything like that?

Bill Hunter: Well I knew physically I had everything checked out with my heart, so I knew that there was nothing obvious that I could see that was physically wrong, but I was seriously having worries about my mental health really around that time. It just send you on a half crazy I guess in a way. I think primarily the worry is that you just won’t be able to cope anymore with life almost, because when you’re in the middle of a period like that you just feel like you kind of can’t cope with doing things anymore, so me being a bit of a catastrophizing type thing, which is something I’m trying to deal with in other ways, but it leads you to start worrying that, well if I can’t get any sleep I won’t be able to work anymore, and the wheels will fall off as far as just basically providing for the family.

Bill Hunter: You start thinking one thing after another, and it all becomes just a huge snowball of worry that’s very difficult to get on top of. I think that’s the point where many people, including me, sort of say, “Well, surely there must be some drug that can at least help me get out of this, this hump, this short term, whether it’s a hump or… You know, just to basically get things back in some kind of order to be able to make sense of it all.

Bill Hunter: I did the same thing. I took some Valium at that time, which I hate, but that’s why you go down that path I guess.

Martin Reed: Yeah, I was actually just about to move on to that, so what kind of things did you do when you noticed these nights of no sleep at all started to crop up? Was it the case that you just went to the doctor and they suggested medication, or did you just feel the medication would be the thing that would help you get back on track? Was there anything else that you tried before going that route?

Bill Hunter: Well, I felt I tried many of the… Many books, obviously, suggest a lot of pre-bedtime rituals and relaxation techniques and warm baths and herbal teas, and things before bed. There’s a long list of things that people swear by. Insomnia’s one of those things where everyone has a different suggestion. They’re only trying to help of course, but if you wrote them all down and tried them all, you’d be busy for about three or four hours before you actually went to bed.

Martin Reed: Oh yeah.

Bill Hunter: But yeah, look, when I was having that period of successive nights of no sleep I was aware of the fact that many of these things that you can try take a fair while to actually work, and you’re really looking for something quite short term. I’d known from previous experience from taking a temazepam in hospital, which is another one of those benzodiazepines that those things work for me in terms of at least being able to get a night of sleep, so when I went to the doctor the next day after that, he obviously explained to me all the risk of benzodiazepines, which I already knew, but he prescribed me some anyway just for some short term relief.

Bill Hunter: So I did take those, and they did at least allow me to get some sleep and start getting my head back in order enough to function and take some more shall we say longer term decisions. Anyway, from that point, I started to look in some other directions because I knew that benzodiazepines worked good so I knew all about how addictive they were. I was very keen not to go down that path.

Martin Reed: Mm-hmm (affirmative). So I think you mentioned when we were talking before this call, you mentioned that at one point you had a sleep study done. Was that before you started to look to taking the medication or was this after? Where did the sleep study fit in with regards to your sleep history?

Bill Hunter: Yeah, so I think after February, things were certainly not getting better on the insomnia front. I had a trip to New Zealand with my wife, which I’d had a few nights there which were pretty poor. We’d had a weekend away at a nice relaxing spa down in Victoria, and the night we had a hotel I couldn’t feel well, I was about to have my second night of no sleep, so we disrupted that particular night with a midnight trip back home so I could sleep in my own bed. That disrupted that nice weekend away.

Bill Hunter: It was really after that that I started thinking well, what else can I do. There was a place nearby at a local hospital, which was fairly well regarded sleep clinic, so I was fortunate to be able to get to see one of their sleep doctors quite quickly, and he sort of had a look at me and he said, “Well, you might have sleep apnea based on your physiology.” I said, “I don’t think I have sleep apnea because my wife would know whether I had that.” But anyway, he said, “You need to do a sleep study,” and anyone who is contemplating one of those things, I found that to be a very expensive waste of time.

Bill Hunter: If you’re going to have one of those things done, you basically go into hospital and they wire you up like Frankenstein with electrodes and things all over your head. I don’t see how anybody could possibly sleep at all with those wires and things coming off them, but in any event I did that, and the diagnosis of that was no sleep apnea. But the sleep doctor recommended two things: medication and CBT.

Bill Hunter: In my case, the medication that he recommended was some drug called Gabapentin, process synthetic sort of melatonin. So I started to take that and he recommended a local therapist in Melbourne that could do the CBT stuff, but she had a three or four month waiting list to see her, so that was no use to me. But there was an online CBT course that can be done in Australia, so I started… This is before I came across you and your site, so I started that for four or five weeks before I had a look at your forum and started chatting to you.

Bill Hunter: So I was familiar with CBT from some other work that I’d done related to anxiety, and I’d found that very helpful, so I was already pretty confident that the CBT, and particularly the sleep restriction was going to, based on everything I’d read about was going to be effective and yeah, I found that it sure was.

Martin Reed: Yeah. It’s really interesting. First of all, I was really happy when you told me that you had the sleep study done just to rule out sleep apnea, but whoever you were working with that the sleep study suggested cognitive behavioral therapy for insomnia, CBT-I. I just found that really encouraging because it needs to be recommended to everyone with chronic insomnia, but that’s so very rarely the case, so people are just focusing all their attention on these techniques that are more related to sleep hygiene that aren’t very helpful.

Martin Reed: You described them as all these pre-sleep rituals, like taking a hot bath, doing this, doing that, maybe having the blackout curtains, doing the sound machines, trying to limit your exposure to light, all these things that aren’t actually that helpful when you’ve got chronic insomnia, but you were kind of prompted to look into CBT-I and I just found that part of your story just so encouraging because you were kind of given that opportunity. You were directed down the route that ultimately helped you get your sleep back on track.

Bill Hunter: Yeah, I found this very interesting, because this chap that I saw, I won’t give you his name, but he’s really a very eminent sleep physician in Australia. I found it interesting really that he has a practice where he’s booked up with patients for three or four months of sleep people going there pretty desperate like me to get some answers for sleep. But really if you don’t have sleep apnea the only things that they can recommend or a doctor can recommend is medication, and we know medication is really just a bandaid measure to try to sort of get you back on track like I was.

Bill Hunter: The only real tool he could offer was CBT, which was not actually something he could directly do anything about. He’s left it then entirely up to me to go and find what the best CBT resource was. So effectively it was a doctor that had no tools in his arsenal to help me with if you follow what I’m saying.

Martin Reed: Yeah, I do absolutely, because I do hear it a lot. A lot of people, they’ll seek medical advice and maybe even CBT wouldn’t even get discussed. The default option would be some kind of prescription medication. But at the time when CBT-I is discussed, a lot of the doctors, it sounds like it’s a similar situation in Australia, but here in the States, there’s a really limited kind of referral network. Doctors that do know about CBT-I, they don’t really have the time to engage in it in their own practice, but at the same time they don’t really have this referral network. Like you just experienced, they can say, “Yeah, try CBT-I. Good luck,” and kind of send you on your way and you don’t really have anyone that you can directly work with. It is a big problem.

Bill Hunter: Yup. It is. I think it’s a huge problem. I think the more enlightened doctors would know a bit about it. I’ve spent my life as a design engineer, designing medical devices, so I work with the medical profession quite closely. The words to describe CBT in insomnia and in anxiety as well is gold standard.

Bill Hunter: Now gold standard means, what those two are significant. It means there is no better treatment modality than this. And the other thing that maybe people with insomnia aren’t perhaps quite aware of is CBT isn’t some thing that sounds a big heepish and someone just thought it was a good idea. It’s got an extensive amount of clinical evidence around it.

Bill Hunter: If you actually researched it and have a look at the technical papers about it online and the number of people that have been studied that have been through it, I’m a real numbers guy, the numbers don’t lie. That was why I was so confident really that when I started it I had a very good feeling that it was going to work, and it did.

Martin Reed: Yeah. I think actually the reason why it’s so effective is because it just gets to the bottom of all these factors that perpetuate the problem. So we have this model of insomnia where we describe how insomnia develops from just this one night of poor sleep. We have this precipitating event, but it’s all the things we kind of do in response that perpetuate the problem.

Martin Reed: For example, all this worry about sleep or maybe all this research, trying to go to bed earlier in the night, spending longer in bed, maybe napping during the day, trying to conserve energy, catastrophizing about the effects of sleep, all these things that just perpetuate the problem and make it really hard for our sleep to get back on track. CBT-I just addresses all of these perpetuating factors, and that’s why I think it’s so effective for everyone with chronic insomnia.

Bill Hunter: Yeah, I agree. I think the biggest thing about it really that works is the hardest thing about it, which is the sleep restriction, which I’m sure we’ll talk about. My issue was with all the pre-sleep rituals, I could get myself into a state where I was before bed, I was as calm as a Buddhist monk. I’d be sitting down in a chair reading a book and fighting sleep almost to stay awake till the sleep window thing started. Then at the start, well before CBT I suppose, I could be really tired, but put my head on the pillow and then suddenly, I’m sure lots of people have this sleep onset anxiety, suddenly bang, you’re wide awake.

Bill Hunter: You’re wide awake because you’re anxious about getting a bad sleep, and think, oh no, not this again. But sure enough that’s what happens with this sleep onset anxiety. With the sleep restriction, I think what happens is you just get so, the difficulty where it is, this gets so overwhelmingly tired that you get to a point where your head hits the pillow and somehow you do just go to sleep. Suddenly once you get into this pattern of that happening a few times, the sleep onset anxiety seems to just wither away. I found that, as I said, that sleep restriction part of this program very difficult but necessary. That’s the thing that works the best.

Martin Reed: Yeah. It is so helpful, especially when arousal is a problem, when you’ve got this high level of sleep-related anxiety, just because it helps to build that sleep drive. Once your sleep drive gets to a point, like you said, you recognize that you are going to sleep. You can’t stay awake indefinitely, so you kind of train yourself to recognize that once you get this intense level of sleep you are going to sleep. But in combination, when you’ve got this higher level of sleep drive, kind of just takes the edge off of that high level of anxiety. It’s like these two competing factors, and you can kind of use sleep drive to your advantage and help overpower that anxiety that you’re feeling that’s making it hard to fall asleep.

Bill Hunter: For sure. Yup, I agree.

Martin Reed: So for people that aren’t familiar with sleep restriction, basically what it’s about is just reducing the amount of time that you allot for sleep to just more closely match the amount of sleep you’re currently getting on an average night. It’s not about forcing yourself to sleep less, it’s just giving yourself a more appropriate length of opportunity for sleep.

Martin Reed: When you are implementing this, what kind of sleep window were you looking at? How much time were you spending in bed before sleep restriction, and once you implemented the technique, roughly if you remember, how much time were you allotting for sleep then?

Bill Hunter: Yeah, so before the CBT-I, I think my problem was I was getting so tired that I would being think, “I think I’ll go to bed early tonight, and try to get a big catch up sleep,” so I might go to bed at say, 9:00 p.m. and say after a couple of rough nights might actually have a big sleep. I may be even to make it eight or nine hours of sleep, but the problem is when that pattern starts to happen you’re sort of setting yourself up for a cycle of big sleeps, no sleeps, big sleeps, no sleeps, it’s very peaky. You’re not sort of really getting anywhere.

Bill Hunter: With the sleep restriction, you tend to obviously not have those great big sleeps, but you’re trying to sort of balance it out more to get… Maybe in the first week as I did, you’ll only average five and a half hours of sleep a night, but at least each night you’re getting some sleep, so you’re not having those debilitating nights of no sleep.

Bill Hunter: But getting back to your question, as far as the word sleep efficiency goes, in other words how much time you’re actually spending asleep divided by how much time you’re in bed. I think before I started the CBT, my sleep efficiency would have been maybe 70%, something like that. Six or seven weeks after doing the CBT, it was up around like 95. I was falling asleep in five or 10 minutes. Once in the middle of the night, I’d go back to sleep in five minutes, and that’s pretty much where I am now.

Martin Reed: That’s fantastic. You made a really good point about when we allot this huge chunk of time for sleep because we want to get that much sleep, the problem that we have is we do experience this roller coaster where one night we might be in bed for eight, nine hours and get very little sleep, and then after a few days because our sleep drive just becomes so intense, we get a big chunk of eight or nine hours of sleep, right, only to then, once that sleep drive has been reduced, to go back to struggling again. So you’re just dealing with these ups and downs, ups and downs, which is just so frustrating.

Martin Reed: The sleep window just really helps you kind of even out those highs and lows and just consolidate sleep. Was that how you experienced it too?

Bill Hunter: Yeah, absolutely. I mean, I think that’s absolutely right. To me it was really those nights of no sleep, which were the debilitating thing and once the sleep restriction put that into place, things started to improve. With the CBT, I think first couple of week I was around five and a half hours average sleep, probably 80% sleep efficiency.

Bill Hunter: By week seven, I’d gotten up to around about seven hours average sleep, sometimes as much as seven and a half with 95% sleep efficiency. That continued for about three weeks. I then sort of went backwards for a couple of weeks, week 11 and 12, and there were some issues that happened there, which caused me to go back to about six hours of sleep a night, and my sleep efficiency dropped away again to mid-70s.

Bill Hunter: Then after that for the last four weeks, I’m back to about seven hours of sleep a night, and 85, 90% sleep efficiency. Really over the last four weeks, I think probably only had one bad night of sleep, which was probably a couple of hours. I still expect to have a bad night of sleep here and there. That’s just par for the course for me, so I don’t get too worried about anymore.

Martin Reed: Yeah, absolutely. I think that’s something that’s important to emphasize too because when you’re going through this process of getting your sleep back on track, it’s so easy to dwell on any bad nights that you have along the way or to expect that your progress should just be completely incremental, you know, every night should be an improvement on the last night. But it’s completely normal for sleep to be disrupted, because even the best sleepers in the world will always have a bad night every now and then.

Bill Hunter: Yeah.

Martin Reed: It’s so important to just recognize that a bad night is normal, and that ultimately it’s kind of our response to that bad night that determines how quickly our sleep is just going to recover from that bad night.

Bill Hunter: Yeah, that’s very true. I think with the bad nights, I think it’s sort of baked into the program of CBT more or less that you are still going to have a bad night, or maybe a few of them in the week. The difficulty, I think, people will tend to face is they’ll look at those bad nights and not be thinking clearly enough and saying, “Oh, this program isn’t work, so I’ll abandon it.” I think that’s where it’s really important, I think anyone who’s doing this CBT-I to be a bit rigorous about the sleep diaries.

Bill Hunter: As I said, I’m a real numbers guy, so I was pretty rigid about the sleep diaries, and also I still use a spreadsheet to actually track not just my sleep, but this like how my mood is going during the day and some other things, which help me with… They basically just help me to look at things from more of a macro perspective to say, “Look on balance, this trend is getting better, and ignore the outliers in the data, the one or two bad nights of sleep here and there.” Generally the trend is improving. So for me those numbers were really helpful. So I would say anyone doing CBT, don’t get disillusioned by the few nights you’ll have a bad sleep. Have a look at the overnight and the patterns there.

Bill Hunter: Be very, very patient with yourself. In my case it sort of took six or seven weeks for things to start being noticeably better, and that’s quite a long time. Yeah, so those are the main things I think.

Martin Reed: I think that’s really good advice. We have to make a conscious effort to look at the better nights, because otherwise our brain will just default all of its focus on those bad nights, right? They’re the problem areas so our brain wants to solve the problem areas, so it completely ignores any good nights and just focuses on all the bad nights, or all the nights that you weren’t satisfied with.

Bill Hunter: Yeah, that’s true. I mean, people with insomnia like me are more likely than not to be people that tend to be a bit anxious anyway. People who are a bit anxious tend to, maybe a bit like me, catastrophize more about the bad times than they do to so celebrate what’s happening with the good ones if you know what I’m saying.

Martin Reed: Oh, I completely understand. It’s also really important to recognize that you’re implementing changes that are a long time approach. So you’re implementing things today that are going to reap benefits for months and years and decades down the line, so it really is important to take that long-term view. So how you slept last night or how you’re going to sleep tomorrow night, in the grand scheme of things doesn’t really matter. It’s all about just implementing these techniques and staying committed to them in order to get those long-term improvements that you’re looking for.

Bill Hunter: For sure. Absolutely. Yup. And when you do get those improvements, I spoke before about that vicious cycle, but you can start creating a virtuous cycle when things start to improve that you’ll find when insomnia starts to improve, anxiety sometimes doesn’t seem quite so bad and depression starts to lift, and everything starts looking a lot better in life.

Martin Reed: Completely agree. This is something that I talk a lot about with clients is because they recognize this vicious cycle, the way more that more anxiety leads to more sleep disruption and that leads to more sleep anxiety. But the great thing with these CBT-I techniques is as soon as you kind of get that first night, you know when you first recognize for example sleep restriction is working, you’ve got that really intense sleep drive, really struggling to stay awake and you fall asleep and you’ve got that night, and it’s kind of like this discovery the, “Oh, I can sleep. Things can improve.” That kind of just chips away at the worry a little bit.

Martin Reed: As that worry goes down, you find sleep a little bit easier. Then as a result the worry goes down even more, and as a result sleep becomes easier. It’s kind of a positive cycle. It turns that vicious cycle completely on its head and just really helps you improve.

Bill Hunter: Yup, yup, that’s right. I know you mentioned in your email to me before this talk that there’s a lot of doom and gloom in bad insomnia, and there sure is because it’s a rotten problem. Yeah, if you can get on top of it, I can remember that feeling when I first put together two or three nights in a row of seven-ish hours of sleep with very little interruption in the middle of the night, and oh, my goodness it was such a blissful feeling in the morning to wake up and think, “Oh, that’s what life is,” waking up feeling refreshed rather than waking up, or not even waking up but getting up in the morning, “Oh, I feel terrible. I haven’t had any sleep last night.”

Martin Reed: Yeah. And that was your reward for getting through that short-term struggle and just being committed to that sleep window because it does take time for you to see those results, and in the short-term like you described, it can be really challenging and it can be so tempting to just give up and say, “This isn’t working,” and then kind of be back to square one.

Martin Reed: I find in my experience the people that just stick with it, they’ll get results and they’ll notice improvements in their sleep. It definitely can be a challenge.

Bill Hunter: Yup, for sure. It’s hard.

Martin Reed: Did you find any other CBT-I techniques helpful or was it just primarily just this sleep restriction and just observing this more appropriate sleep window?

Bill Hunter: Well I think that the two major things were the sleep restriction and probably this idea of going to bed at a fairly late hour for me, 11:00, 11:30. I found that really challenging to stay up to that time, especially when you’ve had a lot of nights of restricted sleep. But I felt that was really helpful as well, and I’m still doing that now, going to the bed much later than I used to. I find that very helpful.

Bill Hunter: But those were the two main things that I remember anyway. That plus keeping the sleep diaries, I think those were all of the things that really helped me.

Martin Reed: Mm-hmm (affirmative). What kinds of things would you do in the evening, in the early days of sleep restriction? A lot of people struggle with staying awake until the start of the sleep window, so they’re always looking for ideas on things to do to prevent them from prematurely falling asleep. Did you have any specific strategies for that?

Bill Hunter: Yeah, so I found that period when you’re feeling very tired and trying to stay awake to 11:00, 11:30 really hard. I would find myself, if I was reading a book or listening to some music or watching TV kind of doing this microsleep thing where you just sort of keep nodding off and nodding off. I don’t think that was very helpful in terms of then when you finally do want to get to sleep.

Bill Hunter: It’s sort of like if you get into that pattern, the way I think of it is that for a couple of hours before you’re actually going to sleep, your brain is saying, “Don’t go to sleep. Don’t go to sleep.” Then all of the sudden you’re going to go to bed and and you want your brain to say, “Now go to sleep.” Well, it’s sort of like all these mixed messages. I found that when my head hit the pillow I would be almost about to fall asleep, and my brain would suddenly say, “Don’t go to sleep. Don’t go to sleep,” like it was fighting microsleep still. Those microsleeps I found weren’t helpful.

Bill Hunter: So activity which isn’t overly exertive, I think in finding some activity you can do in those few hours before bed is really helpful. In my case I could do some music practice, because I play trombone, so that was good, but the biggest thing for me I found was going for a really long walk. This is a bit weird, but going for a really long walk at say, even 10:00 or 9:30, maybe an hour walk or more, I found that really helpful, because it would make me tired enough that that would help me to go sleep, but obviously you can’t microsleep while you’re going for a walk. It’s sort of also not a form of activity which is too demanding so that you’re all pumped up like going to the gym or something, then you’re actually too alert to go to sleep. So yeah, lots of moonlight walking for me was really helpful.

Martin Reed: Yeah, that is a good tip. I like to say anything that gets you moving, because it’s very hard to fall asleep when you’re moving, so even if the idea of going outdoors and going for a walk in the evening isn’t appealing, then even if it just involves standing up and moving jut around your own home, you know? Just some light chores even, just anything that keeps you moving can really help if you’re finding yourself struggling to stay awake in the short term for the start of that sleep window.

Bill Hunter: Yup, I would totally agree with that.

Martin Reed: Yup. So all right, let’s talk about how long it took for you to notice these improvements in your sleep. I think you kind of touched upon this. Really I think you mentioned seven to eight weeks was when you got to that point where you felt that you made real progress. But how long was it until things clicked and you actually recognized that the techniques you were implementing were actually making a difference and were helping you?

Bill Hunter: So around about week five I think I could definitely see that I was making some progress. I’d certainly increased… My sleep window was getting wider and I could see my sleep efficiency was getting better. I’d certainly started to see some progress by week five. It was a sudden switch from week four to week five. Up to week four everything felt like it was taking a long time to fall into place, but by week five, things were noticeably improving and then as I said by week seven I was sleeping pretty well.

Martin Reed: That’s great. I think it’s really important for people to hear that just because if you had given up halfway through week three for example then you wouldn’t be where you are now, but it was your perseverance that you carried on with these techniques and you got to that point where you did get the results. That’s really important for people to hear I think.

Bill Hunter: Yeah, I think as I said for me that’s where the numbers become really important, not only your own numbers as far as the sleep diary and trends, but if you were that way inclined and jump online and google the myriads of clinical data that’s actually out there and read some papers on CBT and insomnia, then you’ll begin to realize why it’s called the gold standard. The people who have insomnia, there really isn’t much else. I hate to tell you, but try the CBT or medication. If you hate medication, then you don’t attempt too many other choices I’m afraid.

Martin Reed: Yeah. You know, and it’s a real shame that we don’t see more information about CBT-I out there. You kind of do have to dig deep into this scientific realm of journals. It’s not like in the mass media, like all the scary headlines about insomnia and all the sleep hygiene advices often the first thing you’ll see. Can you imagine what kind of world we’d live in if all the newspapers were reporting stories on CBT-I success rates and looking up people that implemented CBT-I techniques got their sleep back on track. We would just live in such a better world, and I think insomnia would be far less of a problem.

Bill Hunter: Yeah, well we do live in a world where everybody, including me, would ideally like a quick fix. We would love to be able to take a pill which solved the problem tomorrow which didn’t give us any nasty side effects. That’s why the market for medication for insomnia is massive as it is, because everybody wants that, but the reality is that unfortunately the side effects with so many of these medications are so awful that you might be partially solving one problem, but you’re creating another massive problem, which the doctors don’t tell you with a lot of these medications what is actually involved if you actually want to withdrawal from them at a later stage. Anybody that’s been on any of these medications and has tried to withdrawal from them will know how difficult that can be.

Bill Hunter: So yeah, I don’t see medication as the answer. As I said, I think this is the only solution.

Martin Reed: Yeah, I think that is part of the problem, right, is because we can take a medication and feel as though we’re sleeping together, but because it doesn’t get to the root cause of the problem that’s perpetuating the insomnia like CBT-I does, as soon as you start to decide to stop taking the medication or try and taper off it, often your sleep issues can return. Then you’re trapped into this, “What do I do now? Does this mean I have to take medication forever?”

Bill Hunter: Yeah, well that’s right. I think they have a place when you’re at a crisis point and you just need some relief, but that’s certainly the way that Valium can help me I guess from that perspective, but I think you’d be wise to only use them as a very temporary kind of band-aid, like putting a band-aid on a cart or trying to staunch a wound. Unfortunately the solution, which is CBT isn’t a quick fix, but as I said, I just think it’s the only solution really.

Martin Reed: Yup, I completely agree with you. I do think that these sleeping medications definitely have their place in the short term, but they are never a long-term solution for people with chronic insomnia.

Bill Hunter: Yup, agreed.

Martin Reed: All right, Bill. I now have taken a lot of your time today, and I just have one last question for you.

Bill Hunter: Sure.

Martin Reed: If someone with chronic insomnia is listening and they feel as though they’ve tried everything, they’re beyond help, and they can’t do anything to improve their sleep, what would you tell them?

Bill Hunter: I think that’s actually a really good question. If somebody who had chronic insomnia for instance and tried CBT-I really properly and given it a good go, and that hadn’t worked for them, I think that’s possibly a position that many people on your forum that I’ve had a look at are in. Then my insomnia suggestion, because I’m not an expert like you, but I think that essentially underlying all insomnia probably has to be really anxiety, and I think therefore the answer lies in trying to get to the root of what is actually the cause of the anxiety. Where does this actually come from?

Bill Hunter: In my case it goes back a long way into childhood, but there’s basically… I think what people would need to do would be to go into that with perhaps a psychologist to try to understand where the anxiety is coming from, then try to deal with it. In my case I think over the last 14 months, there’s lots and lots of things that I’ve done with meditation, mindfulness, I’ve gone back to church which has helped a lot. I’ve had a psychologist that I’ve worked with for a year. I’ve gotten more in touch with my inner me and deeper self and started pursuits again like music that I really love. Deepen connections with family and friends, use massage, hugs. I’ve really cut down on my work which has been a super important part of all this to de-stress life, so that you’re not going to sleep and thinking, “Oh, my God, I’ve got six client meetings the next day.” I’m down to a couple days a week which I can still manage with.

Bill Hunter: Lots and lots of things, and they’re all little things, but when you add them all up they make a big effect on just reducing anxiety overall. Now, I know not everybody is in that position, but as I said, my biggest advice would be to say, “Well, why are you so anxious? Can you actually think of when you became anxious? Can you actually think back on a time when you used to sleep well? What was going on in you life back then? Were things a lot simpler and can you actually make some efforts or strides to get back to that point when life was a bit simpler and you weren’t so anxious?

Bill Hunter: Yeah, it’s not an easy answer to the question, and again it’s not a quick fix, but essentially I think that’s where probably for a lot of people, that’s probably where the root of the problem is.

Martin Reed: Yeah, I think a lot of people will identify with what you’ve said for sure, and I think it can be really helpful if following your advice you kind of look to uncover what those thoughts are that are generating this anxiety, and especially if you can work on that in combination with the behavioral side of CBT-I. You can really maximize your chance of this long-term success, because whilst you’re working on the more cognitive, the more analyzing your thoughts side of things, but at the same time implementing appropriate behaviors around sleep, like not going to bed until you’re sleep enough for sleep, and getting out of bed when you’re struggling, that kind of two-pronged approach can really be helpful for a lot of people.

Bill Hunter: Yup, totally agree.

Martin Reed: All right, Bill, well thank you again so much for coming on. I think it’s always great for people to hear these success stores, you know, these transformations. I think it can just provide reassurance, and it can also just give people that motivation, especially if maybe they’ve tried CBT-I in the past for a couple of weeks and didn’t find it helpful, maybe just to give it another try, just with the idea that it’s really just long-term approach and that you’ve really got to give it that time to notice the results.

Bill Hunter: Yeah, well I also just wanted to thank you. There’s not many, shall we say, beacons or lighthouses out there in the wilderness for people who are suffering from insomnia, and you’re certainly one of them. Your forums and your advice are a huge, huge help, quite life changing to many, many people. I just wanted to thank you for doing this and all your helpful advice as well.

Martin Reed: I really appreciate that. Thank you, and of course you’re very welcome. Thanks again, Bill.

Bill Hunter: Okay. Thanks, Martin. Bye.

Martin Reed: Thanks for listening to The Insomnia Coach Podcast. If you’re ready to implement evidence-based cognitive and behavioral techniques to improve your sleep but think you might need some additional support and guidance, I would love to help. There are two ways we can work together. First, you can get my online coaching course. This is the most popular option. My course combines sleep education with individualized coaching and is guaranteed to improve your sleep. You will learn new ways of thinking about sleep and implement better sleep habits over a period of eight weeks. This gives you time to build sleep confidence and notice results without feeling overwhelmed. You can get the course and start right now at insomniacoach.com/online.

Martin Reed: I also offer a phone coaching package where we start with a one hour call. This can be voice only or video, your choice, and we come up with an initial two-week plan that will have you implementing cognitive and behavioral techniques that will lead to long term improvements in your sleep. You get unlimited email-based support and guidance for two weeks after the call along with a half-hour follow-up call at the end of the two weeks. You can book the phone coaching package at insomniacoach.com/phone.

Martin Reed: I hope you enjoyed this episode of the Insomnia Coach Podcast. I’m Martin Reed, and as always, I’d like to leave you with this important reminder — you can sleep.