[Youngandtired]

Ive been struggling with sleep onset and sleep maintenance for 9 months.  Primarily sleep maintenance where I have 20-30 restless events per night.  Medication has not significantly improved quality or duration.  CBT through a sleep center has also not been effective however I don’t believe I was receiving true CBT.  My mood, work life and personal life have taken substantial hits as I am constantly tired, anxious and negative.  Occasionally I have a “good night” and become optimistic only to be disappointed again and again.  This is by far the most mentally challenging and draining experience in my entire life. 29 years old, stress induced start and suspect the cause to be behavioral conditioning or the emergence of an anxiety disorder.  Also struggle with my appearance due to the presence of dark circles and how I am being viewed by coworkers. I had situational anxiety prior to the emergence of chronic insomnia but it was manageable and not debilitating like it is currently.  With no stress cues I used to sleep fine.  My support system from my fiancé and family is weakening as the issue continues to persist.  Any advice is welcome.

[Martin Reed]

Welcome to the forum, Youngandtired. I am sorry to hear about your ongoing struggle with sleep.

You mentioned that you have 20-30 restless events per night. Can you tell me more about what you mean by a “restless event”?

You also mentioned that you tried CBT through a sleep center but did not find this helpful (and you suspect that it wasn’t even true CBT-I). Can you tell us a bit more about this? What kind of techniques were you implementing and why do you feel they didn’t work?

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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.

[Youngandtired]

I monitor my sleep using a Fitbit sleep tracker. I am aware that these trackers are not an accurate reflection of sleep quality or duration however given my issue is primarily sleep maintenance, I find it somewhat helpful in monitoring the relative number of restless events per night.  It is somewhat an indirect way of monitoring whether I seem to be improving  or not.  Regarding your second question, I was visiting a sleep center where I was being seen by both a sleep specialist and and clinical psychologist.  The sleep specialist was willing to prescribe whatever hypnotic I wanted but that’s where his help ended.  Insurance rejected my sleep study due to my age and a home study was inconclusive.  This isn’t surprising given I don’t have sleep apnea or restless leg syndrome however I was hoping to learn whether I am getting REM sleep or wether my excessive restlessness was keeping me in the lighter stages of sleep thus contributing to my overall fatigue and insomnia.  The sleep specialist referred me to the clinical psychologist who had me start to fill out a sleep diary, told me to get out of bed when I’m not able to sleep, talked about sleep hygiene, wind down routine, and relaxation techniques.  Over the 6 sessions there was very little information about how to change the way I think about sleep or the lack of it.  To me, this is clearly a mental affliction for the most part, so making physical routine changes will not solve the under lying issues.  Additionally, getting out of bed in generally is not effective for me because I do fall asleep but I wake up every 30 min – 45 minutes.  Reading has helped with winding down in the evening and I have pushed my bedtime to later start some light sleep conditioning rather than formal sleep restriction.

Other than the techniques I mentioned, is there anything else I should consider implementing?  Additionally the psychologist did not want me reading CBT-I books because she didn’t want me over-thinking things.

[Martin Reed]

Using an instrument that can’t consistently and accurately record awakenings is probably not going to be very helpful.

How long have you been using the Fitbit to track your sleep? Over the course of this period of use, has it led to you feeling happier or more confident in your sleep? If not, I would encourage you to avoid it and judge your sleep based on how you feel during the day (and a self-reported sleep diary).

By itself, waking during the night is quite normal. Here’s a short video I recorded about this: https://www.youtube.com/watch?v=329oFzXmwEM

From what you describe, it doesn’t sound as though you went through what I would consider to be a real course of CBT-I since this should include far more than just being told to get out of bed when you can’t sleep! In addition, sleep hygiene isn’t an effective treatment for chronic insomnia so is not something to be relied upon as a way of improving sleep when living with insomnia (in my online course I do talk about sleep hygiene but not until six weeks into the eight-week course, because it has such a small influence on sleep).

CBT-I should be collaborative in nature and cover a lot of sleep education to help explain the rationale of the techniques and help you identify the presence of any inappropriate sleep beliefs. It will also help you determine a regular and appropriate sleep window to help you build sufficient sleep drive for sleep and strengthen your body clock.

You will, of course, also learn more about getting out of bed when unable to sleep (especially the rationale and correct implementation, which is so important) and you will learn about relaxation techniques (and be reminded that the goal of relaxation is relaxation, not sleep).

To be honest, I still think you would find CBT-I very helpful and I question whether what you received in the past was truly CBT-I or was some basic psychoeducation about sleep combined with basically just being told to get out of bed when you can’t sleep!

How long ago did you work with your psychologist on sleep?

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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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