- April 14, 2019 at 2:22 pm #28471
Hello all —
I have been experiencing sleep maintenance insomnia for several months now. After trazodone and some sleep hygiene adjustments, the pattern has become: set a “cool down period” of at least 30 minutes with no internet or bright lights, go to bed (and usually fall asleep instantly), and then wake up after six hours or so without feeling fully rested. Only very rarely would I ever get seven hours of sleep.
Anyway, I just finished six weeks on the road. It was a hectic schedule: to Oregon, then to Japan, then to Hawaii, back to Japan, to China, back to Japan, back to home. Severe jet lag, and lots of running around. Anyway, I slept better on the road! I got seven hours of sleep most nights, and some nights I got closer to eight.
I just got back home a few days ago. The jet lag hasn’t worn off yet, but so far it’s been back to the previous routine. For example, this morning I woke up after about 6:15 of sleep, which didn’t feel at all adequate.
I am wondering what to make of this?? It could be psychological — I had gotten into something of a rut (mostly because of the insomnia), and I mentally associate my home with that. But I also wonder if there are any potential environmental factors at play, if there is anything in the physical environment at my home which I could look to correct.
Any experience with this?
Thank you!April 14, 2019 at 5:23 pm #28472
jazzcat22✘ Not a client
I’ve read in sleep books that this often happens. It is because we associate our beds at home with sleeplessness, whereas a strange bed somewhere else doesn’t have that association.
I find it interesting that 45 or 60 more minutes of sleep is the difference between you feeling refreshed or not. It’s like I never understand when people in the US have difficulty with losing an hour of sleep a night once a year for Daylight Savings. Never bothered me, either before or with the insomnia.
Were you taking the Trazadone while traveling? What dosage and how much before bed? Didn’t do much for me at 50 mg an hour or so before bed.
I had three hours of sleep as usual last night, so I envy your six.April 14, 2019 at 10:22 pm #28477
75 mg of trazodone, about 30 minutes to an hour before bed.
I wouldn’t say there’s a hard barrier between 6 hours and 7, but I definitely feel better after 7!
Three hours, oooooof, good luck to you!!April 14, 2019 at 11:07 pm #28478
jazzcat22✘ Not a client
Thanks. Yeah, I’d say 7 hours is optimal for me (don’t need to be greedy and wish for 8—supposedly 7 hours is the sweet spot anyway!).
So with the Trazadone do you actually get drowsy with it, like nodding off, or do you just go to bed and sleep happens? I know someone who takes a lot of Trazadone every night—like 300+ milligrams! He’s a big guy, but still…April 15, 2019 at 1:36 am #28480
I often get somewhat sleepy with it, although I’m not sure if it’s entirely the trazodone. With the smaller amount of sleep I’ve been getting, and my newly incorporated sleep hygiene habits, I think I’d get drowsy anyway.April 15, 2019 at 11:34 pm #28520
Martin Reed★ Admin
Thanks for sharing your experience, impendia — as suggested by @jazzcat22 this is a classic sign of conditioned arousal. In other words, you have learned to associate your own bed with wakefulness rather than sleep. So, as soon as you removed yourself from that environment, you were able to sleep.
Have you tried implementing CBT-I techniques such as stimulus control? Stimulus control will help you relearn to associate your own bed with sleep and, therefore, improve your sleep over the long-term.April 16, 2019 at 3:16 pm #28537
Yeah, I was on the stimulus control and CBT-I bandwagon already. Indeed, on the road was the first time in months that I wasn’t following the rules (for example by browsing the web from my hotel room bed).
I think the reason has to be one of the following two things: (1) psychological — I tend to deal with change better than routine; I had gotten stuck in a rut, largely as a result of the insomnia itself, and perhaps I mentally associated home with that; (2) environmental factors — for example, I think the air in my apartment is dryer than I’m used to.
Do either of these sound plausible?
Thanks.April 16, 2019 at 7:19 pm #28541
Martin Reed★ Admin
I am 99.99% certain that the reason you were able to sleep away from your own bedroom was due to conditioned arousal — and this is best tackled using CBT-I techniques.
Browsing the web when in bed is more to do with sleep hygiene than a CBT-I technique — and sleep hygiene doesn’t fix chronic insomnia. So, I just want to double-check — have you tried CBT-I techniques such as following an appropriate sleep window and getting out of bed when unable to sleep?
If so, how long did you implement these techniques before determining that they weren’t helpful?
I think it would be constructive to focus on this because I have yet to come across someone with chronic insomnia who implemented CBT-I techniques correctly and consistently for at least eight weeks and didn’t get their sleep back on track.April 17, 2019 at 1:49 am #28554
I called them “sleep hygiene adjustments”, but I also meant that I was basically doing CBT-I (at least the behavioral end). Certainly I wasn’t lingering in bed for long when unable to sleep, and all my time in bed was confined to a fairly short window. For example a (very) typical night would be: go to bed at 10:20 (same time every night over long durations), fall asleep very soon afterwards, sleep through the night, awaken around 4:30 or so, out of bed by 5:00.
It was helpful as far as I could tell — at any rate, things were slowly improving, and I interrupted it only because of my travel. But then I hit the road, and all of a sudden I was getting 7+ hours of sleep most nights.