[Steve]

JT – You have a ways to go before you start to feel true acceptance. Keep using the tools and working at it. You won’t be cured in a month or two so remember that. It takes awhile and that’s another fact you have to be accepting of. Feel free to post here anytime even if it’s just to vent. We will support you. Consider us “family”. (What time is Thanksgiving dinner at your place? lol.)

[Deb]

Mac – I’m sure that you remember that my primary frustration with CBT-I was that it wasn’t getting to the root of my anxiety. 5 nights out of 7 I managed to keep the anxiety at bay and fall asleep, but on the other two nights the anxiety won out. ACT gets to the root of anxiety and helps you learn how to let go of it so it’s not there underneath the surface ready to spring up just when you think you’re cured. I agree with Steve, too, that hanging out in bed was a good thing. It’s creating an association of relaxation with your bed. Of course there is always going to be the honeymoon period for a few days because you get your hopes up. But then reality hits. The thing is to keep doing what you’re doing so that eventually the fears of hanging out in bed will go away. The goal is letting go of all anxiety which is the cause of insomnia in the first place.

Delv – It sounds like you’re doing well overall in comparison to months ago. You’re relaxing more and more about sleep, not worrying about your sleep window or doing a sleep diary and other things. I’m sure as you continue to learn to relax, you’ll continue to get better.

Jamie – I’m so sorry that you’re depressed. All of us have been there, believe me. Maybe especially within the first few months because we go from sleeping normally to this horrible condition and wonder if we’ll ever recover. But you will. I was so bad that I had to go to the emergency room for help with my despair. I finally got on an antidepressant which took off some of the edge. But I kept going, trying different things – first CBT-I for 2 months with Martin, then 1 month of ACT but without any help, then back to CBT-I for another 2 months and then back to ACT, but this time with help from Dr. Kat from Guy Meadow’s clinic. When I finally implemented ACT the second time and understood how to practice acceptance, I recovered in two weeks. So never give up. Continue CBT-I for a few weeks to see if it helps. If not then switch to ACT. We can help you here with ACT because it’s more tricky. You don’t “do” things differently like practicing SR or SC in CBT-I but you learn to “think” differently, which is more subtle and needs some coaching to understand and get the hang of it.

[JTthemillenial]

Thanks, all. I appreciate the support. ACT philosophy is hard. I work to get myself to a place of acceptance, but it still feels like I am lying to myself. Perhaps I just need more practice.

SRT seems to be stabilizing things a bit, but it is only day 5. I guess I’ll see how it goes.

[Mac0908]

Jamie – 5 days is nothing. You have a traumatized nervous system. It will take time. If after 5 weeks of serious SRT you have no real improvement then we can talk.

Deb – Thanks, I know full well about how there is underlying anxiety that needs to be dealt with. I promise you I have been implementing more and more ACT lately. Positive thoughts during the day, welcoming the negative thoughts when they may arrive in the evening, focusing on my breath in early awakenings, etc.

Steve – Glad you are doing a lot better these days even if you are still not close to fully cured. Stay the course and keep it going though. Something tells me you will be fine in due time. We all will be.

• This reply was modified 5 years ago by Mac0908.

[Deb]

Mac – that’s great that you’re implementing ACT. You may also want to add acceptance of your sleeplessness when you wake up. Then eventually you’ll fall back asleep and maybe stop waking up early as well.

[delv-x]

Hi JTthemillenial,

Stick with CBT-i SR. What will happen is your sleep will bounce around but bounce less because the window only has so much room. What you are looking for is the bigger picture. I know one bad night feels awful and defeating and one good night feels like Christmas came early but what you are looking for is consistency over the weeks. Once you get 2-3 weeks of >85% sleep efficiency then you can add 15-30 minutes to your sleep window and continue on.

SR and SC are two powerful things that help most. If sleep anxiety/sleep performance is an issue then you may want to either A. Increase your window to make you feel like you have more opportunity to sleep or B. Implement a bit of ACT and give up the struggle and “act” how you did before all this started.

[Dazzio]

This is a rollercoaster!!!! So i had my first real success with SR when i slept for nights in a row then i had a zero hour night. Then i slept for 5hrs again for the next 3 nights which was amazing. However last night as my sleep window approached i didnt feel sleepy, i stayed up a while longer but could feel anxiety build. Went to bed and didnt fall asleep quickly- then a moment of weakness kicked in and i rolled over and took half a xanax. I did fall asleep but made sure to get up at the end of my sleep window. This morning i am so dissapointed in myself that i did that- feel like have undone all my hardwork! I know i should probably get rid of the xanax as always a temptation- but at the same time it eases my anxiety knowing they are there if things get really rough!

[Daf]

Yes, it sure is a rollercoaster. You make small steps, some progress, fall down again, but hopefully the nil-sleeper nights get less over time.

I think people who are prone to insomnia have to accept that SRT can be used to mechanistically keep sleep drive up – that’s the purpose of that approach.

And ACT is about letting go and accepting when you don’t sleep. If you get the SRT amounts right (for you), you should always be tired enough next night to sleep OK, at least most of the time. So, in theory you would not need ACT.

Of course a “normal person” would not worry about all this SRT – they just sleep and naturally accept it when they cant sleep right away.

For someone who has had insomnia in the past, one has to accept that it will lurk in the background, ready to bite back from time to time. For me and many on here these times of “bite back” are utterly unpredictable and often not linked to stress events at all.

One thing I noticed for me is that I tend to get more insomnia in the winter. Other than that, there is no pattern at all.

[Daf]

Further from my previous comment, if you know how much sleep you need on average each night (SRT) but then for whatever reason go over it one night, by sleeping say an extra hour or two above your optimum sleep amount; then you may struggle the next night, because your sleep drive will be reduced, so you won’t go to sleep as easily, at least not at the usual time.

So, it is then, in such situations that you need to be in acceptance of the fact you are not sleeping (ACT). If you are good at this, you will chill out and sleep will come eventually, as it would for a “normal” person. If you are not good at this (and I think insomniacs tend not to be because many are by nature quite controlling), then the anxiety / frustration may rise and you may end up with another nil sleep night.

This is the nub of the rollercoaster, I feel. The only solutions would seem to be to stick close to your target sleep and get up, even if it feels tempting to “get another hour”… and / or get very good at ACT and acceptance/ mindfulness.

[Dazzio]

Yeah Daf, i think its time i start looking into ACT. I need some kind of alternative approach on the nights where, even though i have stuck rigidly to SRT and sleep window, i dont feel sleepy at my sleep window due to sudden anxiety kick.
On the occasions when you have stuck rigidly to your sleep plan but just dont feel sleepy at begining of your sleep window- do you stay up an hour or two longer to see if you get sleepy or do you just go up to bed, lay down and practice ACT?
There is a little devil on my shoulder at the moment- thinking that i could continue to use SRT(which has worked most nights) and then on nights where i cant sleep use 1/4 xanax- until i build up confidence in my sleep and in the long term phase the xanax out. I really think 1/4 xanax acts more like a placebo for me, as the moment i take it i feel instantly relaxed, however i doubt the dosage really has that big an impact.

Anyway thats just a nagging thought/approach that kicks in when im feeling a bit disheartened or not strong. On good days though i really want to achieve my goals without using any meds/supports etc. Just want to sleep the way i used to with absolutely no effort!
Listened to your interview David, it was excellent really insightful. The obsesssive observation really hit home with me. I am really like that and thats what makes Insomnia so hard. My brains experience is that if you want to achieve something- focus and work relentlessly on it and you’ll succeed. However i feel with insomnia it really is the opposite- the more you focus on it and work at it- the worse it gets!!!!! I know this now but so hard to train my brain to stop!

[Daf]

Dazzio, back of the net!

You have hit the nail on the head in so many ways.

I agree completely with all of what you say – and thanks for the compliment on by podcast with Martin.

During my recovery I used Mirtazapine occasionally to deal with really bad patches. It’s an odd drug indeed. For me it would never work to “put me to sleep” in the middle of the night, but it worked well if taken an hour before you’d like to be asleep. The other odd thing is that there is much research online, (from users mainly and only a little from professional researchers), who say that smaller doses than the standard 15mg work best for insomnia. (It’s main reason to exist was as a treatment for depression, but they found also works for insomnia too).
I actually tapered down to an eighth of a 15mg tablet. Very, hard to cut it down as the pills here in the UK are tiny to start with. But they still seemed to work at even that small amount. Placebo? Maybe, like you say? My doc thought so, but who knows, as there are lots of people on many review website who say it works a treat at 3.75mg and at an eighth of a tab (1.875mg if my maths is right).
I got dose down from 7.5mg to 3.75mg in a month, then to 3.75mg every second night, then to 1.875mg, then every second night and eventually stopped. If my insomnia rages back I WILL use it again, along with all the SRT and ACT approaches.

One final thing to say is after a nil sleep night, if you can learn to not think about insomnia / the next night (hard to do for us controlling types, I know), then the bad feelings that come the next day will be lessened and hence the fear of insomnia on later nights, when you cant get to sleep should be reduced. ..i.e. all you will have to face is lying / sitting awake at night, but not feeling awful the next day. (I used to get a very tense chest and nausea feeling from all the stress, but once I realised that a nil sleeper would be followed always by a good night, I relaxed a little and did not spend the whole of the next day fearing the next night).

Hope this helps. It’s a weird affliction indeed. But I think this discussion is providing pointers for many folks – not all the approaches will work for all, but a lot will.

[Daf]

Oh and to answer your point, yes if I’m not tired, I usually try to just stay up later. This is often what happens when I have had the joy of 6 or 7 hours sleep (which itself often follows a nil sleep night). … i.e,, what I’m saying is that after a night of 6 or 7 hours sleep I’m just not tired until say 2 or 3am. Going to bed too early would risk me not getting to sleep and possibly another nil sleeper… so one could end up like the rollercoaster some have talked about… Good night, bad night, good night, bad night etc….

[Steve]

Rough night for me and I think I am regressing some. This is now the third bad night of sleep in a row and I only got 2 and a half hours last night. I lay there for 5 hours calmly and comfortably and accepted it but really feeling crappy again today. The only real problem I had from laying there all night awake was temperature control. It would be too hot so I would throw a blanket off of me and then 10 minutes later I’d have to retrieve it because I was too cold. And on and on it went. If I was asleep, I know that wouldn’t have bothered me. Probably because my body temperature would have been lower due to sleeping and I would have needed the blanket all night. I think I am improving but I really hope I am not in a cycle of having a couple bad nights of sleep and then one or two good nights to make up for it. I did practice the tools all night and welcomed unwelcome thoughts but that was more for practice as I didn’t really have any unwelcome thoughts. I did have a little anxiety but that wasn’t really a factor after I used the tools. No matter how much I let my mind wander, I couldn’t get over that hump and get to sleep. I am accepting though of whatever sleep the weekend brings.

[delv-x]

Sorry to hear about your poor night Steve. I am on day 5 or poor sleep. Some onset issues but mostly maintenance. It’s been rough when I sleep 2 hours and then not able to fall back. It’s hard not to get frustrated but I am used to it now but get thoughts about how many more poor nights before things start swinging upwards.

I agree with Daf about no pattern at all. There often is no precipitating factor and it just happens. I also find it more frequent in the winter. Sure I had it in the spring/summer but it was less frequent and easier to manage. I guess I was out and about more. In the winter I am indoors more frequently and less in nature. The long dreary colder days I find makes it more common.

[JTthemillenial]

Sounds like a lot of us are having a rough go of it. I had another no-sleep night. Like Steve, I used the ACT tools and got past my anxiety, but couldn’t get over that hump and just felt broken-hearted and despondent knowing sleep wasn’t coming. I haven’t felt rested in a week and a half. This sucks. All I want to do is take a Remeron and sleep for two days straight.

[Author]

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