[Alexf]

Hello, my name is Alex and this is my first post on the Forum.

I’ve been following CBTI techniques for some months but I still have some doubts that I haven’t been able to solve or find any precise answer to. I hope someone can give me some clarity regarding this issues. Thanks a lot in advance.

SUMMARY: I am a typical Sleep Maintenance Chronic Insomnia case. Tried everything prior to CBTI but failed. After implementing CBTI for some time, improved sleep quality and consistency and reduced sleep-related worries and anxiety, but despite being better, I’ve been stuck with no improvement for some months and I still feel I am far from getting the sufficient restorative rest I need for my life.

IN DEPTH CONTEXT:

My insomnia story is a rather typical one: It began 9 months ago when my reaction to a poor sleeping period triggered insomnia perpetuating factors which led to a neverending rollercoaster sleep scheme: I fell asleep quite fast for the first time every day just to wake up few hours later and go really fast into this hyper-aroused state which prevented me from returning back to sleep.

In reaction to that, gradually my whole life, energy, mental space and beahviours started focusing on getting sleep. Every action in my life had the aim to make me sleep better. I changed my habits, followed every single sleep hygene or typical sleep prescritption. I became an expert and devoted several hours a day learning about sleep and insomnia. Did it work? You already know it didn’t.

After all that failed, I went to the doctor and even I was reluctant, I said yes to trying a sleeping pill treatment (Benzodiazepines) for a short period of time because I was desperate and I wanted to sleep whatever the price was. Sleeping pills worked for the month I took them on a daily basis and I slept for 6.5-8h on average, which was my average sleep duration prior to insomnia. But as soon as I started tapering off the pills, guess what… Yes, not only I was sleeping poorly again, but my anxiety levels skyrocketed as even the pills weren’t improving my problem. I felt defeated and with no hope.

I felt at war with insomnia. I tried LITERALLY EVERYTHING… But CBTI. You know the story… And then I stumbled with Martin’s channel and CBTI. It was love at first sight. For the first time in months I heard an insomnia narrative I felt 100% represented in. I thought my case was rare, I thought I lost the ability to sleep, I thought some chemical imbalance was causing my awakenings, I didnt understand what was happening or why was it happening. It was such a shock to hear word by word how Martin described my story or things I had in my head with such accuracy it was even a bit scary. But it was such a relief cause I stopped feeling my insomnia was unique and I started to see some light at the end of the tunnel.

After 3 weeks I had watched every single video and podcast episode Martin has on the internet and l was determined to implement CBTI techniques. I stopped implementing any sleep hygene or sleep effort behaviour, cut off the pills and started following Sleep Restriction, Stimulus control and started a Sleep Diary. I’ve been following those techniques for 3-4 months now. I’ve been very compliant an disciplined and rarley deviated from CBTI’s prescriptions and I am motivated a feel really positive towards the future.

After a few weeks I found what was an adequate sleep window for me based on my preffered schedule and average sleep duration and I concluded this was 1:00am – 6:30am.

I’ve no problem at all implementing stiumulus control as I distinguish quite easy as I wake up when I am going to reamin awake or be able to go back to sleep, and I find easy to get out of bed as soon as I notice I am not being able to go back to sleep. This means almost 100% of the time i spend in bed is time sleeping.

But regarding sleep restriction I am in the following situation: Every time after one or two week period in which I try to increase my sleep window by 15 min based on reaching sleep effiency requisites for doing so (>90% ~) I find myself sleeping slightly less and worse for that next week. I’ve tried both adding time to my earliest possible bedtime or delaying my wake. In both cases the result has been I end waking up between 0.5 and 1.5 hours earlier than my wake up time, and having to return to the previous schedule or remain the same for 1 or 2 more weeks.

In general I’ve noticed a huge improvement, as my worry levels have plummeted and even I found myself in this counterintuitive situation: I was sleeping less but much better. Less awakenings, less “bad nights”, less fatigue during the day, more consistency and higher energy levels.

Despite that improvent I still feel I am not getting what I need from sleep to to live a happy fully-functional life. Of course this situation is a million time better than before implementing CBTI techniques, but right now I feel like i’m stuck in kind of a grey zone where I’m neither bad nor good. So here are my questions:

– What should I do? How should I approach the increasing of the sleep window? Every time I modify it, I end waking up earlier than my prescribed wake up time, But I’ve never set a sleep window shorter than 5-5.5 hours as reccomended. My average sleep duration is now quite stable around 4.5 – 5 hours, but I still feel the rest I get from that is not enough for my daily life.

– Should I count “awake-but-out-of-bed” time during my sleep window as wake time for sleep efficiency calculations? (I am currently counting as that, because if I dont, my sleep effciency is always 95%-100% as virtually all the time I spend in my bed is sleeping time).

I’ve been and will remain to be patient and focus on practicing rather than results and know it may be a long journey. I am really committed to CBTI and really aware and grateful for my improvements, but as it has worked so well in other aspects of my insomnia and I feel stuck for quite some time now with this specific issue I write this post with hope someone can give me their take on this.

Sincerely and deeply grateful,

Alex.

[Shradha123]

That’s great news. I look forward to a similar outcome. I’ve found the videos & case studies really helpful in getting a better frame of mind around sleep or lack of it.

[Chee2308]

Hi Alex!
How long have you been doing cbt-i? From my experience, i dont think you should do that for more than 2 months. After all, cbt-i is only supposed to help make your nights become more regular, increase sleep confidence and dissipate sleep anxiety, and it seems to have done its job for you. After that, hopefully the subject should improve their sleep further as their confidence increases and their anxiety abates. Do you still have a huge amount of sleep anxiety with dented sleep confidence? Because here’s the thing about cbt-i. It is not meant to be used as a tool to generate sleep forever for anyone, which is what you are trying to do here. After cbt-i, everyone should have a really relaxed bedtime schedule and nobody wants to follow a set of sleep rules forever, really. Have you ever explored what happens if you just continue to use your extended sleep window despite the initial setback and you feel you just had to go back and restrict your window? Just try it with no expectation of any outcome. Allow 6 hours in bed, you may or may not have as good as a sleep efficiency with a more restricted window but the key is really trying to “see” what the other side looks like once you’ve allowed yourself to potentially sleep this much. Imagine how the New World, the American Colonies and now the most powerful country in the world, the USA, would have lay undiscovered if people back then didn’t want to explore beyond their horizons and still thought the world was flat. Or if you still unsure stick with the 15 min increments for few weeks and try to resist rolling back because you want to “protect” your current sleep. Be brave and take that step forward, it might make all the difference to you because you may start discovering that you actually *can* sleep, even for 5, 10 mins and then that develops into 30,45 mins, 1-2 hours, it happened like that to me and I am sure almost everyone else here has a similar experience. Stop using cbt-i as a “tool” to sleep because it really isn’t! The best sleep remedy is actually sleep confidence and a very relaxed approach towards sleep, not a rigid, inflexible one.

[hiker]

Hi Alex, it sounds like you are willing to work hard toward improvement. The goal we all have is to sleep well enough to be rested to get on with our lives. Certainly a worthy goal, but I think this goal can be more elusive than average.

With most things, the more we practice or the harder we work, the better we get, e.g. learning a musical instrument or doing aerobic exercise. But in some situations, trying harder might not always be the best route to go.

Baseball hitters sometimes try harder and harder and go into a slump, when they start feeling desperate and wondering if they will ever hit well again. I think sleep falls in this category as well.

Maybe the key is we start obsessing about it. Our thoughts are all about sleep. This mental rut is what Martin addresses. I think he is presenting not just a temporary fix, but a long-term shift in attitude toward sleep, a shift which I think can help in facing all types of adversity, including insomnia. And with this shift, sleep becomes just a natural physical state. (Maybe the ultimate is the natural way a baby just goes to sleep, without thinking about it.)

I know, easier said than done, but I think if you view Martin’s program as a shift in perspective, it will be the best way to go.

Take care, you are not alone.

[Jacob]

same problem here. I can fall asleep easily. I have little no worry about my sleep, because every day i sleep 4 – 6 hours. It just i wake up to early… I tried to go bed earlier, but it end up only that i have more wake ups during night. I am in the grey zone to, that i constantly wake up in 4 am and cannot extend it to 6 am where i need to be.

I dunnno know what to do about it. Its not life tragedy. 4 hours are still better then nothing. But i fell i need 6 or 7 for optimal functioning in life.

The advaces like – dont worry. No guys, i dont worry i will wake up early, i just wake up early. Its just like that. Or advice – dont care about sleep rules anymore. No guys. When i dont care about rules i end up in going in bed in 10 pm because feel sleepy, but wake up in 2 am. No i am not obcese about my sleep a dont really think about my sleep during the day. I only dont have great sleep. Thats all.

Its natural wanting to solve that. Its like some broken item in your house, that you know you need to fix, but you are not obcese with that, because you know it snot that much important, but still important.

I totally feel Alex and i know why these kind of advice will not help, even if you mean it good. Its just we both have problem that we cannot extend our sleep.

[Martin Reed]

Hello Alex — it’s your mind-reading guru here! Only kidding — I can’t read minds (yet) but I can tell you that your story and experience is, once again, not unusual!

In and of itself, adding 15 minutes onto a sleep window of five-and-a-half hours is a tiny change to make (it’s just a 5% increase in time allotted for sleep). So, with this in mind, perhaps it’s not the extra 15 minutes that’s creating some additional wakefulness — but the increased monitoring for the effects of the extra 15 minutes.

Any time we make a change, our brain will want to be a bit more active to evaluate the effectiveness of the change. In the short term, this can create a bit more sleep disruption — but the mind soon adapts and gets used to the change, and becomes less inclined to monitor.

With this in mind, next time around you might find it helpful to add the 15 minutes and stick to it for longer — maybe a month or so, before deciding what to do next.

I hope this helps.

—

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