[zac]

I posted a few day ago with a question about Sleep Anxiety and had a couple of responses. Now I’m going to put my struggle with Sleep Restriction Therapy(SRT) out there, and I would like to hear similar stories as to mine, if any, and how they have coped and hopefully succeeded in conquering their insomnia with SRT.

I am currently 56 and have had insomnia for 25 years…..which came on from the birth of hour first child who kept us awake with broken sleep every night for twelve months. I have known about SRT since early 2000s when I read ‘Say Good Night to Insomnia‘ by Gregg D Jacobs. Now days calling it CBT-i, and a more refined course, but still SRT appears to be the main crux of the course and the most challenging.

Over the years I have failed at SRT on three occasions, and now on my fourth occasion, which I’m struggling with and is not looking good to succeed – hence why I have landed here. The content of Martin’s Website is very comprehensive, does impress me, and I have read some quotes regarding SRT that make sense now…..especially the one that states ‘exhausted tired does not mean you’re sleepy’, and is not a queue for bed.

I know I have an underlying Anxiety Disorder which I have had all me life,which displays itself as over arousal, quick to trigger fight-flight system, and racing heart, sweats, if i have to make a public speech or certain phone calls, and always have negative thoughts pop up in general.

Then when insomnia hit around the age of 30, then some depression started to set in also. Four years ago, I went through a phase of experimenting with Antidepressants and combinations of, for a solution to my insomnia. My conclusion was, band-aid fixes which kept me going but never provided the deep restful sleep feeling I used to feel before insomnia came onboard. The only medication that makes me feel rested, puts a smile on my face and makes me feel about normal is Lorazepam. Ok, we know, highly addictive, will turn out worse in the long run, so I have only been using it recently and sparingly in times of desperate need……which brings be to my topic and question:

Does Sleep Restriction Therapy work with an underlying Anxiety/Depression Condition?

This is where I fail with SRT: I commence SRT and can last a few days with barely any sleep, then I start experiencing the frightening feeling (which I described in my other post), where I am totally exhausted, and my sleep system is trying hard to sleep but my arousal system is wining over my sleep system, resulting in no sleep and frightening how my arousal system thinks there is more energy to burn, but I am totally exhausted and my body can’t go on and resulting in more anxiety (think i feel an adrenaline rush), then the painful physical symptoms commence in the form of Stomach Gastritis with breathing difficulties. It is now after the commencement of the painful physical symptoms, that I cannot go on with a ‘short window’ in bed, and need to remain in bed awake and resting for longer hours due to the physical pain……and then you have my SRT attempt failing.

So my questions:
1. Does Sleep Restriction Therapy work when you have an underlying Anxiety or Depression Conditions?
2. Has anyone experienced what I have mentioned above, ie. Anxiety with pain? did you get through and succeed with SRT?
3. Could SRT be performed while on Anxiety or Depression medication and then weaned off Meds after sleep restored – anybody been successful in this?

My next thought is attempt SRT with some medication onboard, or i will resolve to Lorazepam and hopefully get a good 20 years out of it….and that might be it for me, as the past 25 years has not been great.

Appreciate your help and support,
Zac

[Martin Reed]

Thanks for raising this important and relevant topic, Zac. To answer your questions:

1. Does Sleep Restriction Therapy work when you have an underlying Anxiety or Depression Conditions?

I can only tell you that, in my experience, I have seen it work in clients with underlying anxiety or depression.

2. Has anyone experienced what I have mentioned above, ie. Anxiety with pain? did you get through and succeed with SRT?

I can’t speak for others, but a common trait I see in clients who have been successful in such circumstances is being able to take committed action — to commit to making a change, even though it might generate difficult thoughts, feelings, and emotions, and even though it might lead to some additional sleep disruption over the short term.

Being able to move away from intense sleep effort and ongoing detective work and replacing these actions with behaviors that help move a client toward the kind of life they want to live is also very influential when it comes to success, in my experience.

3. Could SRT be performed while on Anxiety or Depression medication and then weaned off Meds after sleep restored – anybody been successful in this?

Since no medication can generate sleep (sedation, sure — but sleep, no) I have seen clients do well when they taper-off meds (under medical supervision) while implementing techniques such as sleep restriction and when they taper-off only after they start to experience improvements in their sleep. Really, the when doesn’t seem to matter too much — although one can expect some initial “rebound insomnia” whenever such a change is made.

I most commonly see clients struggle when they take medication contingently, according to how they sleep from night to night, or when they continue to experiment with medication types/doses while implementing evidence-based behavioral changes such as sleep restriction.

I hope this helps!

—

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.

[Elmtree57]

Hi Zac. My situation is a bit like yours with respect to meds. I have anxiety and of course insomnia. They go hand in hand! Doc put me on anti depressants and a day time anxiety pill along with a sleeping pill! So! I was on meds! Hated every minute of it. I discussed this with my doc and I told him I’m going off of them. I had only given them approx 21 days (I know that’s not long), but the fact that I hated it (bad attitude) made the side effects seems worse. It hasn’t been easy for sure. Been off the AD and daytime anxiety for approximately 3 weeks. Still on the sleeping pill. Have started weaning. I have also looked into Medical Cannibis to help instead of meds, feeling it’s a more natural way and definitely no side effects. I have some in the day time and then another prescription for at night while I am weaning off the sleeping pills. Eventually will stop the cannibis also. My sleep hasn’t been very good but am hoping my journey stabilizes soon. I think a lot of the healing is having a better attitude towards your condition and of course understanding what is happening to your body which Martin explains very well. I hope your journey sees a light!

• This reply was modified 3 years, 2 months ago by Elmtree57.

[zac]

Thanks Martin and Elmtree57 for your responses.
I was hoping someone may offer something on the pain I mentioned…….re ‘as I have attempted SR four times now and have failed’ re……’then the painful physical symptoms commence in the form of Stomach Gastritis with breathing difficulties. It is now after the commencement of the painful physical symptoms, that I cannot go on with a ‘short window’ in bed, and need to remain in bed awake and resting for longer hours due to the physical pain……and then you have my SRT attempt failing.’…….curious if others have experienced physical pain on SR and got through it or failed?

Martin, you mention SR re…..’generate difficult thoughts, feelings, and emotions, and even though it might lead to some additional sleep disruption over the short term.’…….these I can all handle, but it’s the physical pain I mentioned, that I can’t cope with, as it physically weakens you, and makes it impossible to go on with only a very short window of laying around.

As I have mentioned, I have known about Sleep Restriction for over 20 years (see my initial post), and attempted it four times. Here is my theory on why SR doesn’t work for all……it is all to do with the balance of your neurotransmitters, ie. Serotonin, GABA, Norepinephrine, Dopamine, etc.. My theory is people with neurotransmitters within normal ranges have more success at succeeding with SR, if their insomnia is a learnt behavior. In my case, I have had pathology testing and my Serotonin and GABA neurotransmitters are below normal range. Depression and Anxiety are normally associated with difficult thoughts, feelings, and emotions, but in some of us, there is also physical pain, which is in my case, and it is this pain that I am blaming for failing my SR attempts.

I welcome to hear from others, who have had their neurotransmitters tested pre commencing SR, were in the low range, and experience pain, and have succeeded with SR? I am happy to be proven wrong on my theory?

I am an advocate of SR, as I do believe my arousal in bed is a learnt behavior, but Depression and Anxiety with a pain component brought on by the stress of SR, is the barrier stopping SR succeeding. In the past when I have been on ADs my pain threshold is high and I don’t get Gastritis issues and my whole digestive system seem to work better.

So, my plan is to go back on ADs, give them a couple of months to restore my neurotransmitters to normal ranges, and then attempt SR again – what do you think?

I know Martin you mentioned to me above re…’no medication can generate sleep’…..yes I agree, but with the ADs, not using them for sleep, I am hoping to get my body chemistry right, and then when I attempt SR there will be no physical pain for the stress of SR, and sleep will come.

PS. I have used ADs in the past in an attempt to restore sleep, but never a really restorative sleep, but I used to lay in bed awake for long periods of time……now implementing SR, hoping it will be different this time around.

regards,
Zac.

[Mona352]

I’m so glad this topic was brought up. I’m having a terrible time doing sleep restriction too. I’ve had it’s increased a lot. anxiety most of my life but with the 7-year insomnia. Sometimes the meds I take for sleep don’t phase me due to the high amount of anxiety I get about sleep. I thought I’d lose my mind last night after getting little to no sleep for about five days. Last night I didn’t set the alarm to wake up and I finally got some more sleep. I don’t think my sleep therapist understands the extent of my snowballing anxiety at night. I was given a long list with about 100 things to do while awake at night. The anxiety stops me from being able to concentrate on most things. I was thinking of finding another therapist I can talk to more often. The sleep therapist only talks to me once a month. In between, I worry, sweat, and am almost nonfunctional. It’s been a real nightmare for me

[Grangers]

I suffer from ocd and my ocd therapist says i should be going to bed at a time that gives me 7 hours sleep at least and that staying up until i feel sleepy is an avoidance behaviour ie im avoiding going to bed because it makes me feel anxious???? I thought that was the whole premise of cbti lol going to bed only when you are sleepy. Thing is i average in a week enought for 5.5 hours sleep which on a wakeup time of 7:30 is 2am. I could stay up til 6am no problem at all and not feel sleepy and not feel.tired when im working the next day i have done so multiple times. So should we be keeping a regular bedtime based on a sleep window and average time in bed alseep or staying up until we are sleepy even if its just giving 1.5 hours sleep??? So confused.

[Martin Reed]

Hello @Grangers! Quite often, when we go to bed before we are sleepy enough for sleep we will spend a lot of time awake. It’s a bit like sitting at the dinner table before we are hungry!

I would recommend discussing your concerns with your OCD therapist. Nobody here is going to be qualified to give you specific advice or recommendations, unfortunately.

—

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.

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