[Daf]

Actually, within the approach of Dr Guy Meadows, based on Acceptance Commitment Therapy / (linked to mindfulness), he has a chapter about Sleep Restriction – keeping same wake up time, keeping sleep to a minimum (then building up), only going to bed when sleepy-tired.

But the key difference is that he suggest staying in bed and just er, “accepting” being awake, rather than getting up after 15 mins or so.

I have to say, I like SRT approaches but will decide (based on how relaxed I am) whether to get out of bed or stay there, if still awake on any night.

If I do get out of bed, I generally spend the time trying to calm my mind and talking sensible thoughts about sleep to it. This might be anything from “Hey Daf, it’s all in your head” to “Remember how you recently went 7 weeks without a nil sleep night”, to listening to Youtuve vids by meditators like Eckhart Tolle or Mooji…

I think I read a piece somewhere where Meadows thinks that getting up and doing something else is still making “the sleep a problem” by giving it more power. Hence his emphasis on making peace with being awake and also accepting any anxious thoughts that come along. Not easy to do though!

This article summarises his approach:

https://www.irishexaminer.com/lifestyle/features/how-to-put-insomnia-to-bed-276711.html

Interesting to hear what people think of this approach.

Daf

[delv-x]

Although traditional CBT-I contradicts ACT when it comes to stimulus control, when it comes to getting out of bed, I believe ACT can work better for some. There have been times when I woke up in the middle of the night and  I would think about getting out of bed for a bit but chose to stay in bed and then fall back asleep quite quickly.

One particular area with ACT that I find useful is the less of a deal one makes going to bed or caring, the better and easier they fall asleep and stay asleep. The days I would wind down looking at the clock, drinking my tea, reading a book, taking a bath, dimming the lights etc I would have more trouble that night than nights where I just watch TV and feel like it’s about bedtime and go to bed.

Stimulus control is about the association with bed and sleep. If one stays in bed tossing and turning every night for hours may associate bed with being awake. If this is the case then SC is warranted and a part of CBT-I anyway

I think the best approach for most is to do both and go with your gut. They say if you are in bed more than 15-20 then get out especially if sleep doesn’t seem like it will happen. If you are tired and drowsy and don’t like the idea of getting out of bed to color then by all means stay in bed longer and see if sleep will happen.

[Daf]

I totally agree with what you are saying there – you echo  my approach exactly.

It’s starting to work for me, though I have had to change the way I am a bit over the last two years to become a more laid back, less obsessional type of person. This has been no bad thing for me.

As I have realised how obsessional and driven I am deep down, and how this has hurt me in the past (a glorious revelation I had whilst out running one day), I have changed, become a bit more mindful and my sleep has got better.

I do wish other folks on here could also “soften” in their view of sleep, instead of being so focussed on whether they get 4 hours or 8 a night, (I’d be happy with 4 or 5 every night for the rest of my days, but I accept we all have different needs), I think it would help them. But part of doing that involves becoming a lot more mindful – and that takes time. But it’s a nice journey. I’ll never be an old hippy, but being more accepting of life, less driven, more calm has been a great journey.

[delv-x]

For sure. Just recently for example, nights where I would get a cushy 7.5 hours or sleep I was more tired and groggy than nights where I got about 5.5 hours. I am sticking with CBT-I but as my therapist is saying is not to be perfect, relax and not worry.

If I could just not worry and just go to bed because I am tired I am sure I would sleep rather well. Good sleepers don’t think about sleep, they just go to bed.

 

[Daf]

Here is a link to a view of the Acceptance Commitment Approach (AST) to sleep.

OK it is by Guy Meadows, who it must be said, is a big proponent of its use to fight insomnia in the UK, and he has a business around it, a book, day-workshops etc. So, it may be a bit biased. But ACT is, of course, a recognised psychological approach I think originally formulated by a man called Stephen Hayes. So it is routed in theory.

In the article, he does compare some differences between standard CBT-I (CBT for insomnia) approaches with ACT, which is useful to read.

I think both approaches can compliment each other, which he kind of says too.

How much you take from each is up to you – and your personality. But look at yourself – trust your mind and body and go with what works for you. (As Martin says, “Your body will sleep in the end, no matter how anxious about sleep you are”, but that’s another matter, though routed in mindfulness (and common sense, for that matter)).

Personally, I generally  don’t like the idea of getting up if not asleep after 15 mins – too stressful for me, and I don’t think it would calm my anxiety, but I will get up sometimes, if I feel I need to do some positive self talk/ do some mindful thinking.  Others may be OK with that.

I’m OK with keeping the same wake up time and restricting sleep. No stresses there for me. But I note that Meadows thinks that some folk may find this too anxiety-making. He may be right, he may be wrong. I can’t see how SRT and SCT can be harmful, but from reading some folk’s testimonies, I wonder if it is too stressful, for them.

So, in a nutshell, it’s what works for you. Listen to your body and go for what works.

https://actsig.files.wordpress.com/2013/04/act-for-insomnia-act-i-by-dr-guy-meadows-the-sleep-school.pdf

Kind regards

Daf

[Martin Reed]

This is a great discussion!

ACT is definitely worth trying — however, it is a skill that requires practice. When it comes to comparing ACT with stimulus control, if you wake during the night and feel relaxed and confident that you’ll fall back to sleep, there is no need to get out of bed and begin practicing stimulus control.

If, however, you wake and immediately feel worried, anxious, or stressed, practicing ACT may be less effective unless you are a highly skilled practitioner of ACT. In this case, I would suggest getting out of bed and implementing stimulus control.

ACT shouldn’t be seen as competing with any component of CBT-I. All these techniques are helpful and complement one another. It’s just a case of finding what’s right for you — a reminder that an individualized approach is usually the best approach.

—

If you are ready to stop struggling with insomnia you can enroll in the online insomnia coaching course right now! If you would prefer ongoing phone or video coaching calls as part of a powerful three month program that will help you reclaim your life from insomnia, consider applying for the Insomnia Mastery program.

The content of this post 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. All content is provided “as is” and without warranties, either express or implied.

[Daf]

Totally agree, Martin. Good flexible approach.

Shame that here in the UK, our NHS (health service) does not seem to take the same line  – they are a bit dogmatic and most practitioners,  and even consultants in sleep medicine here don’t seem to have heard about ACT – and in Colin Epsie’s book, which is their bible I don’t recall it mentioned either.

Part of success in overcoming sleep phobia issues, it to learn to listen to your body and do the approach that works for you.

[Mac0908]

we have a lot in common. I too have always been a bit of an ‘obsessive’ type. Whether with sleep or my health in general. Definitely a touch of OCD here. For as long as I can remember I was a time counter with sleep. “Ok I can still get 7 hours if I crash right now”, “Ok I only got 6 hours so tonight I’ll catch up a bit”. This was in play way before my Insomnia started. Would worry about sleep from time to time. It was almost as if I was destined to end up where I am.

I guess if there’s any one single blessing through this nightmare it’s that I’m learning how to relax myself more and more with regards to sleep worry and understand what’s really worth ‘worrying’ about after all and what’s not, like good sleep hygiene

[Daf]

Glad you liked it.

That’s why I thought you and Deb would enjoy the read and benefit from this way of looking at things differently. It’s helped this slightly obsessive person – me! – with my sleep … getting it a bit better, slowly!

[Deb]

This all sounds good. Its funny because I just read in Sasha’s other book (The Effortless Sleep Companion), where she also talked about SC and said that instead of getting up after 20 minutes,  if you think you’ll eventually fall asleep, then why get up? This made sense to me because for years it’s always taken me 20-30 minutes to fall asleep and sometimes even an hour. But it was never a big deal. I would just lay there in bed doing and thinking nothing in particular, and eventually would fall asleep.

Going back to her objections to SR and it being used as a crutch. She heard from people who increased their sleep window and then couldn’t sleep anymore. I can see how this could happen with people who are obsessive and worry a lot. They come to depend on SR and think that if they deviate just a little, then they’re screwed. But because they think this way and worry, then they ARE screwed!

Regarding myself, this triggered something in me and I wondered if I was using SR as a crutch. I thought about how on the good nights when I fall asleep right away out of total exhaustion, I’m basically keeping the fear at bay. But the monster is always there, lurking in the background. The monster is the fear of not falling asleep right away and then staying up all night (or just sleeping a few hours). I realized that I need to learn how to deal with the times when I don’t fall asleep right away and thus deal with this monster. So last night was a good start. It took at least 30 minutes or more for me to go asleep, but I reminded myself that this was always how it has been in the past. So chill out. If I can do this regularly, then my insomnia will basically be cured.

I hope this is making sense to you. I’m a little tired.

[Mac0908]

This is what I mentioned in a post weeks ago. How ultimately the thing we are trying to defeat is the anxiety. The sleep fear. Whatever you want to call it. You can sleep well all you want on and off for weeks or months, but if you still are letting those negative thoughts bother you come some bedtimes or while you’re trying to nod off or if you ever wake up in the middle of the night, you are simply not fully cured. Can SRT help cut down the anxiety? Absolutely it can. Can it completely get rid of it? Maybe, maybe not. Everyone is different. But for some, including myself, a sufferer of 2+ years, I think it will take a lot more psychological discipline to get rid of any underlying fear once and for all. But before I can even worry about that, I need to start putting together more than just 2-3 good nights in a row.

• This reply was modified 5 years, 9 months ago by Mac0908.
• This reply was modified 5 years, 9 months ago by Mac0908.
• This reply was modified 5 years, 9 months ago by Mac0908.

[Daf]

Deb and Mac,

You have echoed my thinking exactly. And for me it tends to be All or Nothing….. go to sleep right away or not, and then be awake all of the night (or most of it).

And you are right, beating this stupid illogical fear is the hard bit.

That is why I may, if the silly anxiety gets too much at night, actually get up for a bit and read my own positive thoughts about this from my own journal. This EITHER can be orientated towards Acceptance – to realise I can just lie and rest in awareness without TRYING to sleep AND/OR challenging negative thoughts about sleep (CBT).

But I am getting better at just lying there and accepting it.

I’m lucky and grateful that once I have slept for an hour or so (and wake up, as I always do at least four times a night), I can then almost always get back to sleep again. And also lucky if when I have a night on no sleep at all, I can always sleep easily the next night.

Plus, I am fine on around 5 hours. If I were to have 7 hours occasionally, I love it, but it always leads to me not being sleepy the next night.

So I am lucky.

Often, I will take Valerian tablets (herbal, pretty harmless). And also, v. occasionally, will take Mirtazapine (7.5mg) if I should need to try to break an episodic run of sleepless nights. See my other post about this – and when I take it.

[Deb]

Two nights ago I had another bad night – just 3. 5 hours of sleep. So yesterday I was discouraged again. And really depressed. I didn’t even feel like writing/venting about it here. Same ole, same ole. Nothing new. I looked over my sleep logs for the last 4 weeks and felt discouraged. Basically since week one, the pattern has been the same – 5 nights of sleep and 2 bad nights every week. I seemed to have reached a plateau.

I decided to check out Guy Meadows. I purchased his book and then went online to his website. I had an hour and a half to kill before my 12:00 bedtime so I went ahead and signed up for his online course and started to go through it. Btw, it’s surprisingly inexpensive. I didn’t care at this point that I was on the computer this late, I just needed some hope.

I like his approach, which is to stop obsessing about sleep and to learn to relax our way into sleeping naturally. Interesting, I just re-read some of the posts here and I noticed some of your language: Mac – “defeat the anxiety” and “psychological discipline“, Daf -” beating this stupid illogical fear.” It’s like a battle that we have to fight to defeat the enemy. Not a very relaxed approach.

His approach involves practicing mindfulness at bedtime and also in our daily lives (in Sasha’s 2nd book, there is a whole chapter devoted to this as well.) Part of mindfulness is the practice of accepting our thoughts and emotions, observing them and then letting them drift away. Coincidentally, just this week I started an 8 week course on mindfulness. So when I went to bed I decided to try this approach. Sure enough, I could feel that black, dark heaviness start to creep in and the anxiety ramping up. But this time I just allowed it to come and observed it. I didn’t keep the monster at bay. I had no idea whether this would work or not, but it made a lot of sense and was certainly worth a try. Also, I decided to relax my sleep window because worrying about not getting enough sleep when that 6:30 alarm goes off also gets in the way. I fell asleep and slept the whole night, waking up refreshed at 7:30. I don’t know whether I fell asleep because I was so totally exhausted last night, because of the mindfulness or a combination of the two. Anyway, I intend to start practicing this regularly and just see how it goes.

[Mac0908]

Yes I understand that me stating things like “defeat the anxiety” might SOUND like it’s a fight, please understand that’s not my real approach. After over 2 years of this, I know full well that the last thing a person a sleep problem should be doing is battling the bad thoughts in their mind every night. I just phrased it like that to make everyone understand that at the end of the day, it is in fact anxiety/fear that we must get rid of. Ultimately, trying to relax and trying to accept our worries is the smarter move of course.

Guy Meadows was one of the first people I found over 2 years ago when this all began for me. He has some good stuff. But Deb I will say that from reading your posts and seeing you seemingly look for and sign up for every program there is, it is concerning. Perhaps you are way more wound up than you need to be. If your log is really accurate and you are only having 2 bad nights out of 7 a week, is that really horrible? Can’t you just think back at that log every night and say to yourself “Well, I’m doing ok. I’m sure eventually I’m going to get even better” and just ride this out?

[Deb]

Yes, I probably am wound up. But on the other hand, I don’t like wasting time and effort either, doing something that maybe has reached its limit of effectiveness. I felt like something was missing and that maybe SR and SC was not enough for me although it may be enough for some. I don’t want to live with 2 bad nights every week. The reason that I have those nights are because the exhaustion doesn’t override the anxiety on those nights. So I wanted to find a way to deal with the anxiety.

I don’t intend to throw away SR and SC, but instead to add mindfulness. This may be the missing piece for me.

[Author]

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