[Steve]

One other quick question for you Deb. What do they mean by “Acceptance” for ACT? Is it not thinking about the effects of the insomnia the next day? If you aren’t thinking about how bad you feel, have you accepted it? Or is Acceptance something else? I feel real crappy today but I am not thinking about it as much as I did yesterday. I mean it’s hard not to think about it but I still have less thoughts about it today. I am trying to use mindfulness to keep my mind on other things. I agree with gsdmon in that I feel worse than when I started ACT 5 nights ago. My sleep has gone downhill in that the last few nights I have only slept about three hours a night and I was fluctuating from 3 to 5 on SR.  I know you were having 5 out of 7 good nights on SR and then you started going downhill when you started ACT. And like gsdmom, I know this procedure can take a couple months. I’m just not sure what ACT means by Acceptance. I know when I wake up at 2 or 3 in the morning and can’t get back to sleep, my mind is pretty much blank and I have no thoughts or urges to welcome. Those usually come in the day although yesterday and today, there have been less. I’m hoping that means I have started not worrying about them. So, I just lie there and do breathing exercises or just let my mind wander.

 

On another note, because my sleep has gone down to 3 hours or less, I was wondering if I should shorten my SW by a half hour. But then I thought it wouldn’t help much as the sleep I am getting is still consolidated in a three hour or so block. It’s not fragmented so I would still have that long awake period at the end of the shortened SW. Also, if I was really doing ACT with both feet in, I wouldn’t really have any SW at all. And the SW that ACT does have, I am near. ACT wants you to cut 30 minutes off the beginning and the end period that you stay in bed. I need about 8 hours of sleep as that is what I was getting before I had insomnia. So the two 30 minute cuts totaling an hour would bring it down to 7 hours of sleep and I am doing a 6.5 hour SW now. So I am near that figure anyway.

[Steve]

gsdmom – I guess we both need more patience with this method.

[Deb]

Gdsmom – what have your 5 days been like? If you’re having light sleep or just a few hours of sleep, that’s normal and just part of the process. Try not to get disappointed because it will take some time. The more you can relax and accept, the quicker the process. I was shocked how quickly it worked for me once I could consistently get my mind into that state. I always thought about the story in the book of Carlos, who saw no improvement in his sleep for the first two weeks, but just learned to relax more and more in bed during that time. Then he started to see improvement after that.

[Deb]

Steve – When I think about acceptance, I’m thinking mostly about acceptance at night – that I will relax and accept whatever sleep I get or don’t get during the night and not worry about it or try to do anything about it. This also includes not worrying at night about the effects of the insomnia the next day. It sounds like you’re doing a pretty good job at this both during the night and during the day.

I think in the beginning of doing ACT just like the beginning with SR/SC, there’s a lot of fear that it won’t work and that it’s going to be hard. Those were definitely my thoughts and that’s why I stopped and started so many times. It seemed so hard, but I really wasn’t giving myself a chance by giving up after just a few days. I thought about Carlos, whose sleep didn’t change for the first two weeks and then started getting better after that. Finally I made the commitment to do it at least two weeks and then re-evalute after that.

If I were you, Steve, I wouldn’t worry about trying to change my sleep window. In March when I did ACT the first time, because my sleep was so shallow I thought that maybe I needed to combine ACT with SR so that my sleep would deepen. But that’s when things started getting worse for me. I was all over the place adjusting this and that because of worry and it just made my sleep worse.

[Steve]

Deb – Yeah, that’s what I figured which is why I am going to leave the SW as is. Thanks for all of your input.

[burn]

Steve,

I am also trying to get into this state of acceptance. In my understanding it is most important not be emotionally involved into thoughts about sleep. The goal of the therapy is to calm down worrying center of the brain. We understand the situation with rational part of our brain, so I guess it is ok to have thoughts, but we just need to be able to gently (!) shift from them or be with them without emotional involvement (easier said than done) day and night. After all it is that emotional, worrying part of our minds that keeps us awake at night. Just my two cents.

Nik.

[Deb]

Just some comments about getting professional help. I found out why the counseling is so limited at the Sleep School. They don’t get enough business! I asked the sleep doctor about this and she answered my question in an indirect way. I think that just as most people have never heard of CBT-I, even less people have heard of ACT.

Anyway, it turned out that getting an appointment was not that hard and Dr. Kat was willing to work with me and divide the hour into two 30 minutes sessions once a week instead of one whole hour every other week. I couldn’t afford to pay $200 every week and besides, I didn’t need a whole hour anyway. I felt more comfortable paying all this money knowing that it would just be temporary and that I wouldn’t need this therapy forever. It seemed like most people were a lot better by two months, according to the book, so I figured I’d probably be on my way towards recovery after a month and then wouldn’t need the therapy anymore. That turned out to be true. I only had 3 sessions starting in June. The last session I had nothing to talk about because I was already well on my way to recovery. We stopped at 15 minutes and whenever I want to use the other 45 minutes I can contact her.

I’m saying this to encourage you all to get expert help if this is not working well for you. I’m an expert only on my own recovery and that’s all. Dr. Kat could answer more thoroughly all your questions pertaining to your particular situation.

[Steve]

How are you talking to her Deb? Over the phone or e-mails? I would have to do e-mails.

[Deb]

We use FaceTime with our iPhones. I’m sure she uses other formats as well such as Zoom or Skype. Or just talking on the phone. One warning – their office is not very organized, or is understaffed. I would send emails to the office with questions and it took forever to get an answer if I got one at all. Once I talked to Dr. Kat I got her email address and things went smoother when she could get on the office administrator’s case to get back to me.

[Steve]

Thanks Deb. I don’t mean to keep asking you questions and I know you don’t want to keep being the source of info on ACT. It can get tiresome and I understand that. I will give it some time to see how this works out for me before I go to her.

[Deb]

I don’t mind answering questions. It’s just that I’m only the expert on me!

[gsdmom]

Deb – this is my sleep the last 5 nights:

1. estimate 6 hours, not watching clock, 2. no sleep, 3. no sleep by 11pm so decided to take Ambien, 4. fragmented and light sleep – actually fell asleep on my daughter’s little love seat within 5 minutes of doing a body scan with the lights on. That was light sleep for 45 minutes. Went into my own bed, then couldn’t sleep until 3am, got woke up at 5am and then maybe had 30 minutes light sleep 5:45-6:15am. 5. Slept maybe 2.5-3hours maybe 1am-4am? trying not to watch clock.

 

[RonA]

Deb, correct me if I am wrong but there really is nothing incompatible between ACT and CBT-I.  Practicing acceptance techniques to reduce sleep anxiety can be used in conjunction with SC.    The beauty of combining both therapies is that as you get better and better at accepting your situation, you are going to be less frustrated and thus have less need to implement SC.   I also see SR as compatible and actually while you can be successful without it, you are much more likely to shorten insomnia’s duration by spending less time awake in bed.

My concern with going back and forth between both therapies is the possibility the insomniac is not ready to fully accept the bad nights.  In that case, they are better off remaining consistent with CBT-I and incorporating ACT, than going back and forth.

[Steve]

Ron – I can answer a couple things where they differ. CBT-i uses SC where ACT does not. ACT wants you to stay in bed to conserve energy. CBT-i says only go to bed when you are sleepy. ACT allows you to go to bed if sleepy or just tired. You can do calm activities in bed, such as reading, besides sleep and sex with ACT.

gsdmom – It’s okay to watch the clock with ACT. You don’t have to be afraid of it. It’s your reaction to the time on the clock that is important with ACT.

[Deb]

Gdsmom – Sounds like you’ve had a rough 5 days. For myself, whenever I took an Ambien, it set me back and I had to start all over. Just curious why you took it so early at 11:00? Frustrated after no sleep the previous night? What time do you usually go to bed? Also, is your insomnia sleep onset, sleep maintenance or both? How long have you had it?

Ron – I don’t see any problem with combining the two either unless the SR causes anxiety because you worry about not getting enough sleep. I may ask the sleep doctor sometime what she thinks about this. In March when I started going back and forth between the two programs it was out of confusion and anxiety. Finally on went back on SR/SC alone and stuck with it for 2 months.

[Author]

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