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Welcome to the forum. Can you tell us a bit more about your sleep? How do you want it to improve? What are your sleep goals?
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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.
To tell you about my goals, I first need give a history of my sleep. My first reply will be my sleep history.
About 12 years ago, I came down with a case of chronic primary insomnia (no other health related issues). Well, honestly, I have sleep apnea also to some degree but my problem was that not being able to fall asleep and it was in my head. I was fortunate to find a sleep clinic in my area and they helped me with CBT for insomnia. It took a while but after several months, I was sleeping pretty well. Not as long as I would have liked but deeper than before. I kept at it month after month and after about 3-4 years, I was pretty much a normal sleeper again. I even travelled internationally and was able to manage 12 hour time zone differences using the principles learned in CBTi.
Life was good all around but in particular, sleep wise.
Then about a year ago, I came down with severely intrusive tinnitus. One of the most common complaints for people with tinnitus is sleep disturbance. I think you could appreciate that having a cricket in your ear making noise 24 hours a day would cause sleep disturbance. And after a few nights struggling for sleep, well, its no longer just the cricket but the tired, anxiety, and no relief in sight. Life was hell.
Tinnitus has no cure. For many, there are no therapies that give even the slightest of symptom relief. Sound therapies are helpful for some, for others, not so much. The only hope for those with severe/intrusive tinnitus is what they call habituation. Basically, it is a subconscious process wherein your brain learns that the sounds in your head are not threatening/dangerous. Then eventually, you react less and less. Less fear, less anxiety and then eventually, return to normal life. That is the hope anyway. The vast majority of people with tinnitus habituate in 6-18 months.
For me, I didn’t think I would last 6 months. That’s a long time to be in hell. After all, who could go 6 months of 2 hours of sleep every night and waking up in panic attacks because you know no relief is in sight?
However, I was armed with a pretty powerful weapon – I am veteran when it comes to insomnia and in my bag, I had sleep restriction. I set up a sleep window. I also found a night time routine where I could escape the worries of tinnitus. The tinnitus would still be there but I set up time every night where I could sit on the couch waiting for my bed time. I found about 2 hours a day of relief from worry.
As the days went on, I was finding that I would have 2 or 3 nights of ok sleep and then a bad night. And 2 or 3 more nights of ok sleep and then another bad night. On days after a good sleep, I would feel so much better. And of course, after a bad night, the fear and anxiety would return. But I kept at it.
So, its almost a year now. And in general, I have been sleeping a ton better. For example, I recently had a run of 2 weeks of good sleep and then a bad night then followed by 16 days of good sleep. By “good” I mean asleep in less than 10 minutes and woken up by my alarm clock (6 hour sleep window).
I glanced at a few of the posts here and I think one thing some members ask – does CBTi work? I am not a professional but I will say emphatically, absolutely. It worked like a charm for me when I had primary insomnia. And my experience in the past almost 1 year of having intrusive tinnitus is that, it helps you sleep better even with tinnitus. So much so that when I am on one of those 2 week runs of good sleep, I could even envision a day when I would be a normal sleeper again, despite the tinnitus.
And though tinnitus is still there and “intrusive”, after a good night’s sleep, I feel a lot better equipped to deal with it. I don’t really know what habituation is like. But as long as I can get decent sleep, tinnitus is less and less of a nuisance.
As to my goals – in no particular order:
- Although I have had considerable success with CBTi in dealing with insomnia that was triggered by tinnitus, I still have the occasional “relapse”. I guess when one goes on a long streak of success, one gets greedy. And then when one stumbles, the resulting disappointment can tend to be disproportionate. I’ve been looking for a place to participate in positive discussions related to CBTi. As a source of affirmation that while there is the occasional stumble, that things have been and continue to get better. I know it sounds strange that I seek affirmation but the first time around when I had “simple” primary insomnia, the process was a lot easier. Once I got through the first 4 months or so, it was pretty much smooth sailing. This time around, insomnia has been a little stickier.
- Occasionally, the limits of my knowledge (sample subject of only one (me)) are tested. For example, while I implement stimulus control, I am trying to learn how to balance getting out of bed on a bad night vs. giving myself ample time to fall asleep. Also, looking for tips on what to while waiting for sleep to happen. So far, the only technique that has given me consistent results is imagery. I’ve tried deep breathing with not very good results. I haven’t really done PMR but I wonder how effective that would be as a sleep initiation tool.
- Although not necessarily a benefit for my sleep, I am hoping that the successes I have experienced can give encouragement to others. I know that when I went through insomnia the first time around, I was very skeptical of the supposed efficacy of CBTi. Maybe someone will read about my experiences and find some benefit. Even if it is only to read that someone indeed became a normal sleeper again using CBTi.
Thank you so much for sharing your experiences with others in the forum. I have no doubt that they will take a lot of comfort in what you have shared and be reassured that CBT-I is a powerful ally when it comes to improving sleep.
You mentioned that you have the occasional relapse — this is completely normal! Even the best sleepers in the world have a bad night every now and again, so it’s only to be expected that you will have a bad night every now and again, too.
If this ‘relapse’ comes from not implementing techniques you know to be helpful and effective, I would suggest that this is more of a ‘lapse’ than a relapse since you know that reimplementing the right techniques should, once again, lead to improved sleep. So, as I suspect you are aware, you shouldn’t be unduly hard on yourself when bad nights happen — because they are normal and to be expected.
Instead of focussing on the fact a bad night happened, try to focus your efforts on the cause of the bad night and see if you can address that cause (for example, not implementing a certain CBT-I technique, too much stress at work, etc). Since we can’t control sleep, tackling an identifiable source of disturbed sleep is usually a better strategy.
When it comes to implementing stimulus control, I suggest giving yourself roughly half an hour in bed before getting up. Don’t clock watch this period of time — just use your best estimate. So, if you go to bed and don’t fall asleep within about half an hour (or if you wake during the night and don’t fall back to sleep within about half an hour), get out of bed. Then, when out of bed, give yourself roughly half an hour (or wait until you feel sleepy) before getting back into bed and repeating the process.
As for activities to try when out of bed, I simply suggest anything that is relaxing and enjoyable. A book or relaxing music can be good options.
I’m happy to hear that you’ve been finding imagery helpful. You might find progressive muscle relaxation beneficial, too — but I would encourage you to practice this during the day for a couple of weeks before trying it when in bed. Relaxation is a skill and takes time to learn, so getting a couple of weeks of daytime practice in before trying it at night is often a good idea.
Dartmouth College offers a number of free relaxation downloads, including a progressive muscle relaxation download.
Finally, remember that the ultimate goal of relaxation is relaxation — not sleep! So, don’t practice relaxation with the expectation that it will immediately lead to sleep.
I hope this helps, and thanks again for your contribution. I hope to read more of your posts in the future!
—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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