[daleuk]

Hi Guys

So I have middle of the night insomnia, onset is fine, currently i sleep an average of 3-3.5 hours a night. I have no sleep apnea, sleep lab told me this. I do not smoke/drink. I used to run half marathons, now i do my best to keep active. Im of a health weight. Currently I feel nervous and twitchy in the daytime with my feet moving, constant frontal headache, and now tinnitus too (recent addition since sleep restriction), all these things have worsened in the past 6 weeks restrictions. I’ve had sleep problems for 3 years now.  Most probably started due to an emotional stress, which is no longer around. I have been seeking help for insomnia on and off for 2 years. I know all about CBTi, I’m trying sleep restriction and behaviour conditioning for the second time. So I go to bed and get up at strict times, and I’m out of bed for any awakenings. 2 years ago, when I first tried to tackle this, I got 78% sleep efficiency, and an average of 5.5 hours sleep, over a TTIB of 7 hours. It took me about 3 weeks of effort to achieve this, and I don’t remember it being too difficult. 3 months back I moved from sunny Cyprus to the UK, in the hope to seek better medical attention, to find that elusive root cause of all my problems.. but blood tests all appear normal.. im healthy, I do not think this. Since moving back it appears to have come and hit me hard. I’ve now even gone down to 5.5 hr restriction, and it appears to have had no effect. I’d kill for that now!

Over the years my gut has become lactose intolerant, also can no longer have coffee. I don’t have sugar, caffeine, soy, gluten, dairy. I could eat all these things before.

Right now, I’m 6 weeks into being super strict with myself, tinnitus has also set in too now, my lymph nodes in my throat are all swollen.. and im feeling quite terrible. I try to practice yoga and meditation, I am still going to work, but I am very near the edge of quitting the job.

Here’s my results summary so far:

Week 1 – TTIB 7.5 hrs Sleep Efficiency 49%  3.71 average hours sleep

Week 2 – TTIB 6.1 hrs (7 to 5.5 hrs mid way) Sleep Efficiency 55%  3.36 average hours sleep

Week 3 – TTIB 5.5 hrs Sleep Efficiency 67.4% 3.75 average hours sleep

Week 4 – TTIB 5.5 hrs Sleep Efficiency 63.2% 3.58 average hours sleep

Week 5 – TTIB 6 hrs Sleep Efficiency 59.4% 3.36 average hours sleep

Week 6 – TTIB 6 hrs Sleep Efficiency 66.1% 3.9 average hours sleep

2017 – I got TTIB 7 hrs Sleep Efficiency 78.6% 5.5 average hours sleep – enough for me to feel good! and im sure I just worked onward from here.

If you would like my sleep diary you can view it here: https://docs.google.com/spreadsheets/d/1WB3x-o1AYVVjwuAydBYHl7-x6ycaHdIDUF_5QKeXcB4/edit?usp=sharing

As you can see you might agree that my progress is negligible.. I am exhausted! I think I felt better when I was not restricting, I am thinking maybe I need to be less strict with limiting time, and more focus on the behaviour conditioning, so say have 7 hours TTIB, but every time I wake get up and return only when sleeping, this was what I had done 2 yrs back and it worked then, now this time iv taken the advice word for word and restricted down to the lowest level in the hope I would sleep it all, but it does not seem to have worked out this way… this is only my theory, I may be in correct.

On and off I have tried:

Melatonin time release just twice, once 3mg, and most recently 1mg, both times I really don’t like how they effected me, most probably  gave a longer sleep duration but I felt really not good the next day.

Valerian – I found 200mg gave some assistance to sleep, but not great still the sleep I got didn’t feel restorative.

Doctors seem a waste of time, the most recent doctor prescribed me 15mg mirtrazapne, I understand this to be an antidepressant with sleepiness qualities, but how would it make me feel? Is the sleep restorative? Is 7.5mg a better option, break in half the tablet? I haven’t started taking it, and was holding some faith in the CBTi, but it’s taking very slow progress… or should I try this med out? I probably am depressed, although a strong individual, I just do not want more issues! I really could do with some urgent help and advice, stick out the CBTi  (if so how long to go on for?) or try a prescription med?

How can I get some good help and advice? what to try next? im determined to not let this beat me, but I am lost with what to do.

Thank you for all your comments,
Dale

[Martin Reed]

Looking at your sleep diary, I don’t think your progress has been negligible — perhaps not as dramatic as you’d like, but I see progress.

For example at the start of your sleep diary, your average weekly sleep efficiency was 49%. Just one month later, your average weekly sleep efficiency was 66%.

Can you clarify what all the 0s, 1s, and 2s represent on your sleep diary? I also have another couple of questions:

• How do you decide when to go to bed?
• How do you decide when to get out of bed in the morning?
• When you wake during the night and can’t fall back to sleep, what do you do?

Don’t give up! You are capable of sleep! I suspect you are putting a bit too much pressure on yourself to make dramatic improvements in a very short period of time.

—

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.

[daleuk]

Hey Martin, thank you kindly for your reply, I am very very grateful. 0 = get in bed, though it’s to the right of the 0 I get in bed, it’s a marker so my spreddy can calculate itself. 1= asleep 2=awake.  I have moved my sleep time around abit but it’s not a fixed get up at 5am no matter what, and bed at 11pm or if not tired stay awake a bit longer, although I can every time get to sleep. When I wake, I will try to sleep for ten or so minutes if not I get up go to another room and read a book in dim lighting or I’m experimenting with listening to a relaxation meditation.

Yes I see some improvement in % sleep efficiency, but isn’t most of this just due to reduced TTIB?

A planned addition is that as it is dark here at 5am, I have also purchased a SAD light so I can give my body a morning wake up signal nice and early on… Atleast that’s the idea.

I am currently at 6hr sleep window, given I achieved a good sleep before with a 7hr window, should I go 7hrs? Or stick at 6hrs? What I felt like is with when I tried the 5.5hr window I didn’t really gice myself any chance to get up out of bed, chill and go return to sleep there wasn’t enough time for that, but then maybe that’s the point 🙂

[daleuk]

Something else to note I’m taking no naps, even if I wanted I think the daytime is not easy for me to do so. I am trying mediation everyday, and from today I’m banning myself searching the internet for answers, your forum is my only resource! I think you are correct, as is my wife 🙂 I need to reduce my worry. If I just know what is the best plan to stick at… In terms of sleep window time.

[Daf]

For my thoughts on Mirtazapine (Remeron) go to:

Remeron / Mirtazapine

Kind regards

Daf (In that there London!)

 

[Martin Reed]

Thanks for the clarification on how your diary works, Dale. I have to say, that diary is quite overwhelming with all the data points you are collecting and I suspect that this may be leading you to pay more attention to your sleep than is ideal. I would suggest collecting more basic data and only calculating averages each week.

Here’s an abbreviated sleep diary that I think you will find helpful:

https://s3-us-west-2.amazonaws.com/insomnia-coach/Short+Sleep+Diary.pdf

Anyway, my suggestions would be:

Give yourself a sleep window based on the amount of time you allot for sleep. So, if you are trying to allot six hours for sleep, create a sleep window such as:

• Sleep window begins at 11:00 PM and ends at 5:00 AM
• Sleep window begins at 11:30 PM and ends at 5:30 AM
• Sleep window begins at midnight and ends at 6:00 AM

When you have your sleep window, the start of the sleep window is the absolute earliest time you should go to bed. So, if your sleep window starts but you don’t feel sleepy, don’t go to bed until you do feel sleepy.

However, regardless of when you go to bed and regardless of how well or how poorly you sleep, you should always get out of bed by the end of your sleep window every day.

I wouldn’t suggest lengthening your sleep window until your weekly sleep efficiency is at least 85%. When it is, lengthen the sleep window by 15 minutes and reassess after a week.

I hope this is helpful, Dale!

—

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.

[daleuk]

Hey Martin, I hope that you are well. So I thought I’d post an update, I have stuck with the same 6 hour window 11pm-5am, strict up at 5 (since 26/01), In the past I had helf more severe (5.5hrs) restriction since 01/01.

Speaking only about the past 2 weeks, everynight by 11pm I can hardly keep myself awake, having to walk around a little to stop myself nodding off. It feels beru unnatural to do this, but I force myself. Now, I get around 80-85% efficency, so on average 5hrs of the 6 are asleep.

However there are some blips twice waking at 2:30am removing myself from bed and later returning unable to return to sleep, on the other nights mostly I wake now around 4am, once I woke to the alarm. With 5 hours I wake without headache, and can function (not 100% but not feeling dead like I was with 3.5hrs) ok for most of the day until 4pm ish, then onwards I start getting increasingly tired and achy. So 5 hours isn’t enough for me, a little more would be good. Tinnitus continues, it’s milder on days with better sleep.

I have completely stopped logging any sort of a diary and I have not been thinking about sleep, as to remove any possible worry my brain may have been holding on to. Meditation every day. I’m active everyday. Food is simple and nutritious, no stimulents.

This is where maybe I feel I’ve got a point where I’m not improving furthe.

I didn’t take any antidepressants or any pills at all, I felt them to be completely unnecessary and my GP freely prescribes!

This is where maybe I feel I’ve got a point where I’m not improving further, so I am here to ask for advice on the best course of action, do I wait out further at 6 hours to see more solid consistency? Or should I expect blips and now I’ve achieved a good sleep efficiency statt extending outward. I think the first is the best option. I don’t believe further restricting would help, my body is already exhausted.
Thank you for any advice and tips.

Best regards from over the pond, Dale.

[Martin Reed]

Hello again, Dale! First of all, give yourself credit for the commitment and effort you have been putting into making long-term improvements in your sleep. The short-term pain is real — but it is often necessary to reap the long-term rewards.

It sounds as though you are falling asleep without any problems, but you sometimes wake during the night and find it hard to fall back to sleep. Quick question — why do you think it is hard to fall back to sleep when you wake during the night?

I think you would benefit from continuing to keep a sleep diary because this often provides a far more accurate representation of sleep. The human mind isn’t very good at estimating sleep over a period of time such as a week — but it’s quite good at estimating sleep and wakefulness that occurred in the past 12 hours or so.

I encourage you not to start taking medication in a bid to improve your sleep since this will not give you the long-term solution you are looking for.

—

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.

[daleuk]

Hey Martin / All – I hope you are well.

So an update, unfortunately I stopped the 6hr SR, it got to the point where I was getting some chest ache and my heart was pounding so hard, I had to relax the restriction and now the relaxed current situation is, 7hrs TTIB, and I wake at 4.5hrs then just rest and generally do not manage to return to sleep. Back in 2017 with 7hrsTTIB, getting up, and returning to bed did allow me to get an extra hour sleep 5.5/6hrs total sleep.

What I have learned from my most recent SR is as I sleep restrict more, down to 6hrs, then my awakening became stronger/more angry, and then keeps me up awake and unable to return to sleep.

Thus I am unsure what to try next?

Remember this has been occurring for 3 years now, AND the pattern is basically unchanged and exactly the same I wake after around 4.5hrs. By bedtime I am very tired, huge sleep drive and drop off very quickly. So when I wake, what it is that generally happens, is that I feel my heart to be beating harder, at the moment since easing up on the SR (from 6hrs to 7hrs), this has eased up allot. I wake and generally now my heart I am not feeling as much.

I have tried a few supplements to ease any possible ‘anxiety’, I say like this as I still do not feel sure about what it is thats the cause, L-Theanine did offer some relaxed calm feeling, but the awakening was exactly the same. 1mg time release melatonin, did offer calming properties, it calmed my heart upon wakening, extended my sleep time to 5.5-6hrs ish but it did not make for a good feeling the next day, I still felt fatigued and groggy, so I stopped this. I have tried elimination diets and this proved not helpful.

is stress the only cause? stress and a brain habit of waking up in fear I have to defend myself at this time? or I should stop thinking about sleep completely, I am everyday, and im possibly creating some fear of it? Although i feel very relieved when I do get to climb into bed.

My diary: https://docs.zoho.com/sheet/published.do?rid=ccp4r8ef9c2fe3d2c4da08dda257bf35d55e3

You can see tabs for: TODAY – last few days showing relaxed 7hrs and 4.5hrs sleep pattern, JANFEB2019 when I tried sleep restriction for 6/7 wks got sleep to 5/5.5hrs in the last few days of weeks of effort, and 2017 – with the same pattern of waking after about 4.5hrs but back then I was able to rise and return to sleep a bit an hour later.

By daytime, I am generally not anxious, or mildly anxious about sleep, I guess mildly depressed due to sleep. I tried Celexa for one day! and felt terrible, any ideas if I took this drug more seriously for some months would it help sleep?

I know >5.5hrs or more and I can feel very good!!!!

I am committed to attempt another bought of SR, but only if it is going to be effective… I mean when I wake after 4.5hrs and return to bed say in an hour after I get sleepy again at 5.5hrs… that leaves half an hour of possible sleep time, it doesnt really work does it?  Im looking for the best strategy here.. and majorly struggling, in life!!

ECG shows my heart is ok. All other blood tests showed no organ function problems.

[daleuk]

Update, my heart kept me up all last night, zero sleep. 🙁

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