[Hampshirian]

I have had very severe insomnia for 15 year which is very effectively treated with 20 mg Ambien nightly. I have had many sleep studies, and I get all 4 stages of sleep. It is getting harder to get the 20 mg and less does not work. I tried all of the techniques offered in CBT in the past and they do not work. In my experience whenever there is something new that produces favorable data it becomes the new thing.Right now that is CBT.  I just don’t believe the results are as good, especially long term, as the data appears.  I am not sure why but maybe it has something to do with subjects wanting to please the person doing the testing.

[Martin Reed]

I’m sorry to hear about the sleep issues you are facing.

Since you’ve undergone numerous sleep studies, it looks as though we can rule out a medical cause of your insomnia. Therefore, it’s likely that your sleep issues may be related to the way you think about sleep and/or your sleep-related behaviors.

Typically, short-term sleep issues develop into longer-term issues as a result of the anxiety, worry, and compensatory behaviors we adopt in response to the initial sleep problem.

For example, we may experience a stressful event and our sleep suffers. This is completely normal! However, after the event has passed we then begin to worry about our sleep and think about it more than we ever did before. We might go to bed worrying that because our sleep has been so bad the past few nights, it will probably be bad again. This worry alone is enough to disrupt sleep.

After a period of poor sleep, we may then decide to try to adjust our routine to improve our sleep and make life a bit more bearable. For example, we may go to bed earlier than normal, stay in bed later than normal in the mornings, nap during the day, call in sick to work or cancel plans with friends. Unfortunately, all of these behaviors can make our sleep issues worse.

The end result is, our sleep becomes progressively worse, and this makes us worry about sleep even more, which makes our sleep even worse. It’s a classic vicious cycle.

The reason why CBT-I is so effective is that it helps to change the way we think (and behave) when it comes to sleep. You mentioned that you have tried all of the techniques offered, but they didn’t work. Can you tell me a bit more?

Did you try sleep restriction? If so, how long did you try this technique and did you try it every single night (without fail) before determining that it didn’t work for you?

Did you try stimulus control? If so, how long did you try this technique and did you try it every single night (without fail) before determining that it didn’t work for you?

CBT-I techniques don’t work overnight and they are challenging to implement. They require consistent implementation over the course of a number of weeks before consistent improvements in sleep may be noticed.

Although I completely understand your opinion that the results of CBT-I studies may not be as good as the data appears, it’s worth bearing in mind that studies have been finding CBT-I techniques to be an effective option for insomnia sufferers since at least the 1980s.

In addition, I know that CBT-I is effective for the vast majority of individuals with insomnia because I see the way sleep improves in my clients as they progress through my course.

I truly doubt that subjects wanting to please the person doing the testing is skewing overall results since this would imply consistent response bias in hundreds of studies that are all peer-reviewed in order to ensure valid research.

Some studies may be weak, but I would argue that the vast majority are not — and this is why organizations such as the National Institutes of Health, the American College of Physicians, the American Academy of Sleep Medicine, and the British Association for Psychopharmacology all recommend CBT-I as the first-line treatment for insomnia.

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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.

[Hampshirian]

You may have s point that I didn’t give them enough time. It’s hard to remember much about how long I did them since it has been years since I tried them.

How do sleep studies rule out a medical cause for my insomnia? I’ve always read that sleep studies don’t tell much about insomnia. Did I mention that in my first study I had no stage 3 or 4 sleep and failed a sleep latency test? I was initially diagnosed with Narcolepsy and tried on Xyrem. That was in 2004. I should also have said that the reason I keep having the studies is because I also have sleep apnea and am tested periodically to be sure the pressure is good on my CPAP.

I also have Fibromyalgia and Psoriatic Arthritis. I understand there is some thought that Fibro and sleep problems may be related and also that chronic pain and sleep problems may be related – both suspected to be due to something other than people being kept awake or being awakened by pain. I understand though that research is limited at this time. The insomnia and the pain both started/accelerated around the same time.  Between the two of them they took down my life and I had to stop grad school and stop working and go on disability.

First-line treatment makes sense. My concern is that it is being considered a cure all in a time when doctors are afraid of prescribing controlled substances and any failure is being blamed on the patient because doctor’s (understandably) are hesitant to take on the liability of long term prescribing of any controlled substance.

It could be that I need to start over again with the techniques. It is complicated for me, however, because spinal pain (arthritis through out) requires that I switch back and forth between sitting and lying down so I do pretty much hang out on my bed. My living room is not comfortable and one of my dogs claims the couch as his. But maybe I will have to move the TV out there and teach him to share. The other dog claims my bed. They are big dogs.

I did read the very positive post by one of your clients mentioning blue blocker glasses, I never knew they existed. That is a definite must for me because I could not imagine not being able to be online or watch TV for 2 hours before bed. I live by myself in the woods…there is nothing else going on anywhere near me. In years past I did abide by that, however, and it made no difference.

[Martin Reed]

My apologies — when you wrote that you’d undergone sleep studies I didn’t know that they were to investigate your insomnia. In that case, you’re right — sleep studies don’t really tell us much about insomnia. However, they can tell us if we are living with another sleep disorder that could be contributing to insomnia.

Pain and sleep are definitely related. Studies are finding that sleep deprivation can increase pain sensitivity and reduce pain tolerance, while pain (perhaps unsurprisingly) can disrupt sleep.

There are ways to modify CBT-I techniques to accommodate your situation. For example, instead of getting out of bed when unable to sleep you could try sitting up in bed and reading. Although not ideal, you could continue to watch TV in bed for a short period of time before bed — again, I’d suggest sitting up while watching TV and limiting the amount of TV you watch before bed (a timer is a good idea).

Falling asleep with the TV on can be disruptive to overall sleep since the changes in volume throughout the night can disturb sleep (even if you don’t notice yourself waking in response).

I hope this helps.

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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.

[Hampshirian]

I use a Kindle to read because my eyes just don’t focus well on the smaller print in books any more. Do those blue blocker glasses really make a difference? How does one know how to choose them? Are some better than others?  I’ve been checking them out online and they really do vary in price.  I don’t care how they look but I do want to be sure to get some that are effective.

I never leave the TV on while I sleep.  I have never understood people who do that.

[Martin Reed]

Sorry for the delay in getting back to you. I think the blue-blocker glasses can help. Although I don’t think they can be thought of as a cure, they do have the potential to remove one link in the ‘sleep-disruption chain’ — so they could be beneficial.

The Gamma Ray Optics glasses get good reviews on Amazon. If you decide to give them a try, let us know how you get on!

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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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