[impendia]

Dear forum,

First time poster here. I’d been coping with mild insomnia for a couple of years, which got much worse a few months ago. Since then I saw a doctor, a nutritionist, and a psychiatrist, started trazodone, and did a home sleep study (inconclusive). I’m waiting on a more intensive sleep study, but it seems that I’ll have to wait a long time before I can get an appointment. In the meantime I’ve been following all the usual sleep hygiene suggestions, and last week I started a practice of 10 minutes sitting meditation a day.

My symptoms settled into the following pattern: I went to bed around 9:00 nightly; occasionally I’d have mild difficulties falling asleep, but I’d get to sleep within half an hour. After falling asleep, I’d sleep straight through until sometime between 3:00 and 3:45 — at which time I’d wake up, feeling “buzzed” (although very tired!) and unable to get back to sleep. My Fitbit reported frequent and very short awakenings in the middle of the night (none of which I remember), and that I got too little deep sleep — as little as 20 minutes on some nights.

On the advice of my psychiatrist I recently shifted my bedtime back to 10:30 — a more normal time for me, that I’ll keep up if my insomnia lifts. I’ve been waiting out the clock, feeling very sleepy, and then usually falling asleep instantly once 10:30 hits and I do go to bed. I’ve still been waking up quite early, but I understand that I should keep to the 10:30 bedtime and never go to bed earlier.

After giving myself a week or two to adjust to the bedtime shift, I am trying to figure out if any more aggressive form of sleep restriction or CBT would be useful to try. Sleep restriction seems best suited to people having difficulty falling asleep, or waking up for extended periods in the middle of night — neither of which I am experiencing now. I could set an alarm at the same time every day, very early in the morning — but this feels like an absurd thing to do. Is it? Anything else worth trying?

Thank you very much.

[Edgar]

A great question! I’d like to know the answer to this myself, since we seem to be in the same boat.

It is my impression that SR is a great tool for people who can’t fall asleep initially, but what about us who wake up too early in the morning? I go to sleep around the same time as you (10-ish), but wake up too early to feel well through the day (4:30,5:30). Then the next night it’s the same story, like clockwork.

And yet the majority of advice online is about sleep onset insonia, not much for sleep maintenance issues.
Anyway, hope somebody else answers, someone who knows how to deal with this.

[Martin Reed]

Welcome to the forum, impendia and thank you for the great questions!

First of all, it’s important to bear in mind that sleep restriction is just one component of CBT for insomnia and so, for the best results, it should be combined with other components (such as stimulus control).

Short awakenings during the night are actually quite normal and tend to occur when we emerge from one sleep cycle in order to begin another one. I wouldn’t pay much heed to your Fitbit claiming insufficient deep sleep because the only way to determine if you are in deep sleep is by measuring brainwaves (to my knowledge, a Fitbit is unable to do this!).

Consumer sleep trackers aren’t always accurate, and relying on the data they produce can increase sleep-related anxiety and further harm sleep for those with long-term sleep issues. For this reason, I urge people with chronic insomnia not to use such devices.

If you are sleeping for a number of hours before waking, it’s far more likely than not that you are getting adequate deep sleep because the body gets the vast majority of deep sleep early in the night. So, early morning awakenings are unlikely to be having a dramatic effect on the amount of deep sleep you are getting.

Do you snore (or have you ever been told that you snore) loudly during the night? Do you ever wake, gasping for breath, or with a headache or dry mouth? If so, these may be symptoms of sleep apnea and you should ask your doctor about getting a sleep study to confirm or rule this out.

How do you feel during the day? Do you feel you struggle to get through each day? Do you randomly fall asleep or feel as though you might fall asleep during the day? Do you take daytime naps?

Finally, you mentioned that your set bedtime is 10:30 PM and that you never go to bed earlier than this. That’s a good strategy, but here are a couple of extra details. First, when 10:30 PM comes around, if you don’t feel sleepy and ready for sleep then you shouldn’t go to bed until you do feel sleepy. See 10:30 PM as your earliest possible bedtime and not necessarily your regular evening bedtime.

Second, you should also have a regular out of bed time in the morning, based on your average nightly sleep duration. So, let’s say your average nightly sleep duration is six hours. Add half an hour onto this time (to provide some time for falling asleep and short nighttime awakenings), and you have a sleep window of six-and-a-half hours. With this example, your sleep window would end at 5:00 AM each day and so you should be getting out of bed by 5:00 AM every day, including weekends.

Edgar — You mentioned that you fall asleep around 10:00 PM and wake between 4:30 AM and 5:30 AM. This suggests that you normally get between six-and-a-half hours and seven-and-a-half hours of sleep each night. Since this is within the normal range, I wonder if something else could be at play that could explain why you find it hard to feel well through the day. Perhaps you might benefit from a bit more sleep, but perhaps sleep isn’t the only influence on how you feel during the day — maybe your work or other daytime stressors are a bigger influence? Have you tried shifting your bedtime to start slightly earlier?

—

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 Clarity 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.

[impendia]

Hi Martin, thank you very much for your detailed reply.

To answer some of your questions — I don’t know if I snore or not (I sleep alone), but I had a home sleep study done and am making plans to have an overnight in-lab study done.

The days are sometimes a struggle, depending on how much I’ve slept the previous evening. I don’t ever feel like I’m going to fall asleep though. Only very rarely do I take naps.

Since I started the 10:30 bedtime last week, I have always felt sleepy at that time, and it has never taken me more than ten minutes to fall asleep. So that’s good. 🙂 (I’d previously been trying to compensate for lost sleep by going to bed very early, and I think this was causing more problems.)

You mention stimulus control, and I’m already essentially doing this. I spend almost no time in bed (or indeed in my bedroom at all) other than when I am sleeping. The one problem is that I keep waking up (and getting out of bed) after only six hours of sleep (I used to get eight), not feeling well rested.

I read Ehrnstrom and Brosse’s book, and the central strategies they recommend (also found on your link above) are sleep restriction and stimulus control. They suggest that these strategies are particularly recommended if your sleep efficiency is low, which mine isn’t. The only thing I am not already doing is setting an alarm. If I did so, most nights it wouldn’t change anything at all — I’d only awaken to the alarm on nights where I was getting an unusually good night of sleep. I find it difficult to imagine that this would accomplish anything. But maybe I’m not thinking about this in the right way …… ?

Thank you very much.

[Martin Reed]

Glad to hear you are implementing effective techniques in a bid to improve your sleep — and that you are now naturally falling asleep around your allotted bedtime (this is a symptom of a healthy and strong sleep/wake cycle).

You mentioned that you tend to get six hours of sleep and that your sleep efficiency is good. So, this suggests that you are allotting somewhere in the region of six to six-and-a-half hours for sleep. Does this sound about right?

—

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 Clarity 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.

[impendia]

In effect, what I’m doing is equivalent to that. In practice, I’m allotting an unlimited amount of sleep — but if I wake up around 5:00, having gotten as much sleep or more than my recent average, then I’ve been getting out of bed promptly without trying to go back to sleep.

Thanks.

[Martin Reed]

Does this mean you get out of bed at a different time every day? Do you go to bed around the same time at night?

—

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 Clarity 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.

[impendia]

Yes — I’ve been going to bed at the same time every night. Often I feel sleepy earlier, but wait out the clock to keep things consistent.

I’ve been getting out of bed whenever I wake up — so not at the same time every night.

Thanks.

[Edgar]

Hi Martin,

You said this:

“Edgar — You mentioned that you fall asleep around 10:00 PM and wake between 4:30 AM and 5:30 AM. This suggests that you normally get between six-and-a-half hours and seven-and-a-half hours of sleep each night. Since this is within the normal range, I wonder if something else could be at play that could explain why you find it hard to feel well through the day. ”

You are right about this , I do have MS so maybe that plays a role in the whole exhaustion thing. However, on the rare days when I get 7.5 hrs and even 8 (those only happen with the help of pills) I am OK throughout the day, so I don’t know. My average of sleep for the past 2 years has been between 6 and 7 hrs, just under the 7.5-8 that I need to feel really well. I even wake up early on the weekends and holidays, no difference.

The thing is that it’s easy to hold on like that for a few days, but sleeping an hour less then your body needs EVERY DAY, without the possibility to make up for it anytime, makes a huge sleep debt I think. And since I never nap during the day (for some reason never could), the night is all I have.

All in all, apologies to impendia for barging in his/her thread. I just felt it’s polite to answer Martin’s reply.

Thank you for all the hard work around this site , Martin. As a long time insomniac (but only lately of this early-morning-awakening kind, which I think is the worst) I can say that the internet needs good websites dedicated to the problem of sleep. I hope this one makes it and stays active for a long time.

Thanks again,

Eddy

[impendia]

> All in all, apologies to impendia for barging in his/her thread.

No apologies necessary! It’s helpful to see what others are going through and how they’re dealing with it.

[Martin Reed]

Hello again, impendia. I would suggest making sure that you are out of bed by the same time every morning. If you wake before this time and feel you won’t be able to get more sleep, by all means, get started with your day. However, if you are keeping a regular bedtime, then on mornings when you sleep relatively late, sleep pressure may not have enough time to build during the day and this could lead to difficulties falling asleep and staying asleep that night.

Eddy: If you have averaged between six and seven hours of sleep for the past two years, that may be all that your body wants or is capable of. The thing is, we can’t actually control sleep duration — so trying to sleep for a certain amount of time is an endeavor that will only ever lead to failure. The best thing we can do is ensure we are setting the stage for sleep to give ourselves the best opportunity for sleep. Sleep quality is usually thought of as being more important than sleep quantity. Do you follow a regular sleep schedule?

—

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 Clarity 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.

[SIimon]

are you still sleeping straight through from 10:30 to 03:00 – 03:45 or do you now wake later in the morning?

[impendia]

The pattern I settled into was:

• Go to sleep at 11:00 pm each night, occasionally later when I was out with friends; never earlier.
• Fall asleep almost immediately, and sleep straight through the night with minimal waking up.
• Wake up around 5:00 or 5:30. I’d feel in my body that no more sleep was going to happen, and I’d get out of bed soon after and start my day.

Much better would be if I slept until 6:30 or 7:00 — but at least now, I get enough rest to have a productive day.

Simultaneously with starting this regime, I kicked a habit of eating a lot of food just before bed, or getting out of bed to eat when I was lying in bed unable to fall asleep. I was somewhat overweight when I first posted, and I’ve lost 10-15 lbs. or so.

I saw a CBT specialist, did an in-hospital sleep study, the whole works. (The sleep study confirmed that my “sleep efficiency” is quite high, although it reported very little deep sleep on the night I did the study.) I feel that by now I’ve incorporated nearly all of the advice I’ve gotten. The one thing I could do more of is various techniques for inducing relaxation, controlling worry and anxiety, etc.

In the meantime, I’m in the middle of a month of travelling — all over the place, across all kinds of time zones, and with crazy jet lag. I’ve actually been sleeping better. I’ve never been a person who enjoyed routine, and it seems not only my mood but also my sleep are better when I get out of it.

[Author]

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