[Deb]

Hi Everyone – I’ve done 8 days of ACT now and this time I’m seeing results. This is the longest time I’ve been consistent since last March when I did it for over two weeks before getting confused and then giving up. Although I tried to start ACT again over a month ago, there have been lots of starts and stops with my vacation and other things (like getting frustrated and taking a sleeping pill).

It was hard getting started again. The first night I was awake all night and then the next day a zombie. The next night again I was awake most of the night, but somehow in the early morning got 1 or 2 hours of sleep. When I woke up I felt half way decent and was able to function fine during the day. Then the next few nights I fell asleep with no problem and had the light sleep all night. Woke up tired, but ok. Could function fine the next day. The night before last, I was awake again most of the night but got a few hours of sleep in the early morning. Miraculously, I felt fine all day yesterday. Last night I fell asleep quickly and don’t remember being in light sleep. I woke up feeling good. So I’m thinking that my sleep is beginning to deepen.

Overall, I’m feeling more and more relaxed about sleeping. I just go to bed with my husband and then do nothing. I may fall asleep right away or I may not, but I don’t worry about it. This is turning out to be a lot easier than I thought it would be.

[Steve]

Glad to hear it Deb. So let me ask you a couple questions. Do you think you did better on ACT because of your sessions with Dr. Kat and that if you didn’t have those sessions you would still be having problems with ACT? Do you have any more sessions planned with her? Does this mean you are not doing SC and that if you are awake longer than 30 minutes, you don’t get up? Do you think it’s just the overall stress levels being reduced that you are sleeping better? Are you generally feeling better than when you were doing CBT-i after you finished Martin’s course? Do you use a sleep window? Are you still taking anti-depressants to combat your anxiety at bedtime? Sorry for all of the questions but I am curious. I really don’t have the anxiety that I used to have when I go to bed. I do admit I have some anxiety about how I am going to sleep that night but I am getting to sleep, usually, within 15 minutes after I go to bed, if not too much longer after that. So something is causing me to be aroused about 4 hours after I go to sleep. I figure I will slowly conquer that as long as I start getting more and more sleep and my sleep window expands. My confidence in my ability to sleep should increase at that point.

I am still all over the board with my sleep. At the beginning of last week I had a couple of really good days then towards the end of the week I had a couple of bad days and then I got two good days, but last night I got a bad night again. However, that could be because of the high heat and humidity we have been having. Last night, I couldn’t get the house any cooler than 79 degrees. That was too hot to sleep in and while I did manage to fall asleep and stay asleep for awhile, I couldn’t get back to sleep after I woke up at 3:10 in the morning. I can live with the bad sleep if it wasn’t for the headaches I get the next day after I have a bad night. And of course, the dry eye syndrome that the insomnia is causing which is affecting my vision. In fact, I really don’t have a problem with being tired anymore as a night or two of good sleep takes care of that. The vision problems do cause dizzyness and I never really had a problem with my eyes until I started SR and SC. Overall, I think I am improving but very, very slowly but I would like to ditch SC if I could. I signed up for Martin’s extended course and I am asking him if as long as I am not tossing and turning, can I stay in bed rather than do SC. I know there are times I should use it, like when I can’t stop tossing and turning, but when I have to get up early in the morning for it, I end up just sitting in a darkened room because I can’t focus my eyes to read.

Glad to hear you are doing better.

[Deb]

Steve – I don’t mind the questions at all! I actually made lists of questions during the week before I talked to Dr. Kat (I wanted to get my full $200 worth!) Sometimes I would ask the same question but just from another angle. When I felt completely satisfied with the answer, then I could finally relax. Most of them had to do with “what is normal” just like we’ve asked Martin and others here on the forum when practicing CBT-I. For me the biggest question was whether or not it was normal to have the light sleep. I asked it from different angles and then finally felt reassured that this was completely normal. This is what threw me off the first time doing ACT in March.

For myself, just having this one question answered has made all the difference and made it worth it to hire Dr. Kat. Also, just knowing that there was someone I could go to with all my questions, helped me relax and trust the process. I have one more session lined up with her this week, but so far, I have no questions! It may be my last session.

I started using an antidepressant back in April when I was at a really bad place. As a safeguard, I decided to remain on it until I’m completely over the insomnia. I don’t use a sleep window. I go to bed at the time I always did before the insomnia. I used to go to bed between 10:30 and 11:00 and would wake up between 7 and 7:30. Since I have the luxury of sleeping in if I need to because I have my own business, I just wake up naturally. My wake up time has tended to be a little later like 8 or 8:30 because with the light sleep I seem to need more time to sleep. I’m sure as my sleep gets back to normal, I’ll start waking up earlier.

I don’t use SC either. With this program the goal is to become comfortable with being in bed. When I don’t fall asleep I just lay there and relax, without worrying or struggling. The time actually seems to go fast. I think that’s because I’m probably in light sleep part of the time without even realizing it. One thing that has helped me is to just tell myself I’m going to bed to “rest” instead of “sleep” so that I can just accept whatever happens more easily.

[Steve]

Thanks for answering my questions Deb. I have to say that I really can’t use ACT yet as it didn’t help me at all the first time I tried it. And while CBT-i has only increased my sleep by an hour since I started using it, it has condensed by sleep. It used to be very fragmented but now it has consolidated a lot, which is better for me. I’m afraid if I started using ACT again, and going to bed and getting up when I did previous to my insomnia, which was about 9:30 to 5:15, my sleep would become fragmented again and I would be very tired again. And if I couldn’t handle that, I would have to start from scratch with SR again and it’s dreaded SC. Of course you were doing good on SR with about 5 out of 7 good nights. And you were sleeping what on those 5 nights? Around 7 hours a night? So you were way ahead of me. Maybe when I sleep that well, I can try ACT again.

[Deb]

I think I averaged 6 to 6.5 hours per night. Regarding levels of anxiety that you asked about earlier, just like the second time I did CBT-I it was easier to jump back into it and start getting results, it’s been easier this time getting back into ACT. The first time I had a lot more anxiety so I had to use the “mindfulness” and “welcoming” tools more often to calm myself down and get to a place of “acceptance.” This time I’ve hardly needed to use the tools at all because I’m able to get myself into the acceptance state of mind more quickly.

[Steve]

Hi Deb. If you are monitoring this, I have a question for you. I know with ACT, you are supposed to stay in bed if you can’t sleep. Or at least sit on the side of the bed for awhile. What do you do if you can’t sleep and you start tossing and turning? Thanks.

[Deb]

Hi Steve – the thing is to learn to relax and accept whatever happens. But sometimes it’s hard to get to that place, especially in the beginning. That’s what the “mindfulness” and “welcoming” tools are there for. You need to learn first of all how to recognize what you’re thinking and feeling, and whether or not you’re struggling with trying to go to sleep. Because if you are struggling, you won’t fall asleep. Once you stop “trying” to sleep or worrying about sleep and get to the point of accepting whatever happens, then the conditions will be there to fall asleep naturally. I know that this is true, because it’s worked for me. These tools help create some space between the thoughts and feelings and you, instead of you being wrapped up in the thoughts. Then it’s easier to let them go.

If I just can’t relax my mind no matter how much I try using the tools, then I get up and write in my journal for awhile. This also creates some space between thoughts and feelings and myself. When my mind is finally relaxed, then I go back to bed and accept whatever happens. I tell myself that I’m going to bed to “rest” instead of to “sleep” so that there are no expectations.

If you want to try this method, I strongly encourage you to read The Sleep Book, especially the second and third chapters on Accepting and Welcoming. It clearly explains the concepts and the tools. Also I suggest practicing mindfulness during the daytime when it’s easier. Once you get the hang of it, it will be easier to put into practice in the night. The book gives several mindfulness practices, which only take minutes.

[Steve]

Is this the book by Guy Meadows? I have it and I read it but it never really worked for me. Maybe because we have different types of insomnias. You have problems falling asleep. I usually fall asleep within 15 minutes of laying my head on the pillow. It’s staying asleep that’s my problem. And like last night, I wasn’t “trying” to go back to sleep. I usually do breathing exercises to relax me and put me in the mood for sleep. And I think I have accepted the fact that I have insomnia. I just can’t get back to sleep. And after awhile, just lying there starts to get uncomfortable and boring and I start tossing and turning. So I end up having to do SC but there’s a good chance I end up staying awake the whole night until the alarm goes off. That’s why I was curious what you do when you start to toss and turn.

[Deb]

Yes, that’s the book. It should work for your type of insomnia as well. With either type of insomnia, the problem is that even if consciously we think we are relaxed, the brain is still on high alert when we’re asleep. So that’s why we wake up and then can’t fall back asleep. In my case, that’s why I would have light sleep all night. Now my sleep is beginning to deepen and I’m waking up more refreshed.

So for you, the thing is to learn to relax and accept whatever happens when you wake up in the night. If you can do this then over time your brain will finally begin to settle down and know that the bed is safe. Then you should start falling back asleep more quickly and eventually not be waking up in the middle of the night either. But you’ll have to be very patient because it may take awhile. I had to make the commitment to myself to accept whatever sleepless nights and tired days I may have in the beginning, even if it was a couple weeks. But it actually turned out to be only a few nights and then I began to see improvement.

[gsdmom]

Deb – thanks for sharing all that you’ve learned, its very helpful. Reading your posts I’ve realized I have not been good about practicing Mindfulness as much as I should, and realize it is not the same as meditation. As you wrote, I feel that intellectually I can am calm and there is no reason to be anxious, but the inner workings of my brain are not accepting this. Hopefully the brain will heal and relax over time. Your progress is encouraging for me.

[Deb]

Meditation and mindfulness are related. When meditating, you realize how our thoughts have a mind of their own. As you try to stay in the present moment by focusing on something like your breath, you see how your thoughts keep going off in different directions. Then you gently try to pull them back and focus again on your breath and the present moment. With mindfulness, you become aware of your thoughts and feelings that also can be all over the place and are making it hard for you to relax. So then you center yourself by focusing on something in the present moment, like the softness of your sheets. I focus on the sounds of crickets or the fan.  This soothes me and then I can relax again and be at peace in the present moment.

[Steve]

Hi Deb. After reading all of your comments over the last couple of days, I decided to try ACT again but on a modified basis. Martin and I already discussed that if I am not stressed, I can lay in bed past the 30/30 rule. I asked him because I noticed some time ago that SC no longer worked for me and I was getting up but never getting back to sleep when I went back to bed. SC only helped mu probably up to the 3rd week of SR. Once my sleep was consolidated, it mo longer worked for me. So, last night, I decided that I was going to stay in bed unless I really started to toss and turn. Once I made that decision, it seemed like a lot of stress left me because I no longer had to decide was I awake long enough that I had to start SC and then deciding what to do during SC and when I could go back to bed. It’s hard during SC for me since I can’t focus my eyes early in the morning. I am tired of playing solitaire and there just isn’t anything to watch on TV.

Last night was tough for me because I was extremely tired from two poor nights of sleep. Unfortunately, I fell asleep for 30 minutes before my SW began so that reduced my sleep drive. And it was a noticeable decrease as I no longer had to fight to stay awake while watching TV. But, I decided to increase my SW by 15 minutes anyway so that if I did wake up, I would hopefully have some time to sleep if I did fall back asleep. For some reason, I have been wakening earlier and earlier and last night was no exception as I woke at 2:00 AM. Before I would have been stressed because I would have to decide if I wanted to try SC or not. After realizing I wasn’t going to get back to sleep, I just got into a comfortable position in bed and faced the insomnia. I told you that last time I tried ACT, I wasn’t trying to force myself to sleep but I might take that back. After now realizing that I was actively trying to clear my mind so I could get to sleep, maybe I was trying to force myself to go to sleep. So this time, after getting into a comfortable position, I lied awake and faced my insomnia and pretty much just laid there and accepted my situation and just tried to counter any bad ideas or thoughts that would come to mind. The last I checked the clock it was about 3:30 and I must have drifted off to sleep because the next time I looked at the clock, it was 5:15. So, I figured I got about 4 hours of sleep last night total. Not great but I firmly believe if I did SC, I wouldn’t have gotten back to sleep so I would have gotten another bad night of sleep. So I consider it a good experiment that turned out positive and will try it again tonight.

What I don’t know is when I should start increasing my SW. I don’t want to increase it too much to fast and risk starting to get fragmented sleep. But I want to start setting myself up for more than 5.5 to 6.0 hours of sleep. I really used to sleep around 7.5 to 8 hours before insomnia hit but I can’t start out at that right away or I know I will get fragmented sleep. I might stay at a 6.25 hour SW for a day or two and then bring it up to 6.5. As long as I can stay comfortable in bed and instead of rolling over and trying to fall back asleep but rather realizing I am awake and confronting my insomnia, I am hoping this works for me. And, another positive about ACT that I noticed before, while ACT may not have worked for me, I did have more energy the next day as I wasn’t expending it doing SC. I don’t feel fantastic today, after all, it was only 4 hours of sleep. But I do feel I have more energy  from staying in bed and not having to deal with SC.

[RonA]

Hi Steve, would you rather have 4 hours of consolidated sleep or 6 hours of fragmented sleep?   On week 2 of my SR, I got a few nights of 6 hours very light sleep.  I psychologically felt great because I thought I was going to quickly beat this thing.   The following week I returned to 2-4 hour pattern but my sleep was somewhat more consolidated.   I am now getting 4-5 hours of consolidated sleep but I have not to be able to sleep past the 5 hour mark again since my early SR success.

The funny thing is I feel pretty good with the 4-5 consolidated sleep, certainly as good as I did with 6 hours fragmented.   I feel good enough that if you told me I had gotten 6-7 hours sleep last night, I would think I did not have an insomnia problem.  It feels like my body has (at least for the time being) adjusted to 4-5 hours as all that I need.

So, psychologically, I would prefer to get 6-7 hours but I am not sure my body is agreeing, at least right now.    I am trying to tell myself, that this is just my sleep cycle right now and it is ok because it is consistent, consolidated, and I feel pretty good during the day.  I hope that over time it will elongate back to where it previously was but I am trying to celebrate the success I have right now and hopefully not stress about what it is not.

[Deb]

Hi Steve – if you try to go ACT all out, you won’t have to worry about your sleep window. With ACT, sleep is not brought on by increasing the sleep drive but by relaxation and relearning/remembering how to “let go.” Think of the times you sat through a boring lecture and fell asleep. You weren’t tired, but just got so relaxed that you fell asleep. I go to bed and get up at the same times I used to before the insomnia and my sleep is getting better and better.

Dr. Guy says he doesn’t even talk about when to sleep until later on in the book because most important is changing our attitude and relationship with sleep. Later, the sleep time can be adjusted if needed. Yes, you will have more energy the next day if you stay in bed and also when you stop struggling and worrying about sleeping and just accept whatever happens and “rest” in bed. When you wake up in the middle of the night, just accept and tell yourself “I’m resting.”  Over time your brain will settle down and it will be easier to fall back asleep. It takes patience, but it will work.

[Steve]

Hi RonA. The problem is, I am not even getting 4 hours of consolidated sleep anymore. I got about 3.5 hours three nights ago, 2.75 hours two nights ago, and if I did SC last night, I’m pretty sure I would only have gotten 2 to 2.5 hours last night. I felt horrible the next day after those first two nights. Today I feel okay. Not great but certainly not in zombie territory. As I said in my post above, once SC consolidated my sleep, which was after about the 2nd week of SR, it really stopped working for me. I no longer get back to sleep after I get up to do SC and then go back to bed. So, whatever sleep I get in the beginning of the night is pretty much it. I want to give ACT another chance. In essence, I am still keeping my SW, even if it’s just a little bigger than it was and with Martin’s approval, I am staying in bed as long as I don’t start really tossing and turning. The only thing I have really done is taking the stress away by knowing ahead of time that I probably won’t be getting up to do SC that night.

[Author]

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