Sleep Maintenance

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This topic contains 8 replies, has 4 voices, and was last updated by Deb 4 days, 13 hours ago.

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  • #30913

    TiredTwinDad
    ✘ Not a client

    Hello,

    First post.  Found Martin on YouTube.

    Though I don’t want to spend a ton of time thinking and reading about insomnia, I thought I’d check this forum out.

    Sleep Maintenance is my issue.  I am currently working with a sleep psychologist and cbt-i.  I’ve always been an early riser, even though I always wanted an extra 30-60 min, and felt I could use it.  For some reason, my sleep window shrunk even more at the beginning of the year.  Instead of getting up close to 5a, it became close to 4a and even earlier.  I’m curious if anyone else has overcome early morning or sleep maintenance insomnia.

    #31285

    Martin Reed
    ★ Admin

    Welcome to the forum — always good to hear that the Insomnia Coach YouTube channel is proving to be helpful.

    When you wake during the night, what do you think is making it hard for you to fall back to sleep? Any change or improvement over the past few weeks?

    #31353

    TiredTwinDad
    ✘ Not a client

    Well I know I don’t have sleep confidence, though I do fall asleep just fine at 10p. When I wake in the early morning hours (2:30-3:30, I think), I just do not feel as drowsy like I do at 10 and my mind feels like it’s ready to go, even though my body is tired. And then doing CBT-i, I know to not wait in bed, but then I’m constantly monitoring myself waiting for that same sleepiness I feel at 10p. Once that monitor kicks on, it’s very hard to turn off. I might notice I’m not paying attention to whatever show and decide to go back to bed, but then within 5 min of being in bed, the awareness kicks back on. And of course with CBT-i, now that I have an alarm, when I wake I’m just hoping for that alarm to go off.

    Insomnia is interesting. When I first started seeing the sleep doc, my issue was my already short sleep pattern had become even shorter. I start CBT-i and suddenly I’m waking in the night. Eventually I built up enough sleep drive where I was falling back asleep pretty quickly.

    The last few weeks have been interesting. As I took a vacation, my sleep doc said to take a vacation from all of this work as well. And suddenly, the last day of vacation, I was no longer being woken in the middle, I was getting a more solid 5.5-6. And that stuck around for a few days, and even extended. I was getting really excited. And I had also added in light therapy around this same time (and it seemed like it was helping). Though I was nervous with the light therapy affecting my bedtime (which it did at first), so I continued my CBT-i break, as my sleep seemed like it was starting to regulate on said break.

    But unfortunately, those early awakenings have returned. And though I’ve continued with the light therapy (in the eve to help correct circadian rhythm), I’ve still been sleepy at a good time at night, so I started back logging/sleep restriction last night. What’s also been unfortunate is my sleep doc was on vacation for 2 weeks after my 1 week vacation.

    But I also think it’s time I stop feeding the cookie monster. Thanks for the reply.

    #31365

    Nao
    ✓ Client

    Hi, thank you for your post. My problem has also almost always been sleep maintenance, i.e. I almost always fall asleep quickly no matter the time, then wake during the night and often have a hard time falling back asleep or staying asleep. I completed a course of CBT-I with Martin, going from a start of a 5.5 hour window to now an 8 hour window over a series of several months. My sleep improved most nights but I still have had many relapses, lasting from one day to now at least 5 days. It is very frustrating that I’m not fully “recovered,” and the bad nights and following days are very hard for me to tolerate. I am told that it is likely my anxiety that is the problem. I am still using CBT-I techniques to the best of my ability, although I do not implement them perfectly every night and day.

    I know that CBT-I is considered the best treatment for insomnia and has overwhelming evidence of working for most people for decades, but I am discouraged and feel defeated by my own brain/anxiety/fears that still maintain my problematic sleep and make me afraid the relapses will just continue or get worse.

    Any support/encouragement/suggestions is most welcome. Thanks.

    #31366

    Martin Reed
    ★ Admin

    Thanks for the additional insight, TiredTwinDad!

    It’s to be expected that you’re not going to feel as sleepy when you wake after four-and-a-half to five-and-a-half hours of sleep compared to when you first got into bed since the sleep drive you accumulated during the previous day has been significantly reduced.

    You mentioned that you have always been an early riser — have you typically been someone who gets by on what might be considered a shorter amount of sleep, too?

    Some people do notice that they sleep a lot better when on vacation (but some end up sleeping worse — we’re all different)! I think, for those who experience better sleep when away from home, it’s due to a combination of not sleeping somewhere that we have learned to associate with wakefulness (ie, our own bed!) and a realigned focus on daytime activity and all the joys associated with being on vacation. In other words, we spend less time thinking and worrying about sleep and more time being active and enjoying life.

    When it comes to being fully “recovered” this is a harder nut to crack — because we all have a different definition of what “recovered” might mean!

    Sleep disruption is normal — everyone experiences it from time to time. When we are stressed or anxious, sleep disruption is normal and to be expected. I would argue that it would be abnormal for sleep not to be disrupted when we are anxious or stressed!

    As long as we avoid compensatory behaviors (such as spending more time in bed or spending more time thinking about or researching sleep) sleep will recover because sleep is a core biological mechanism that cannot be suspended indefinitely.

    In my opinion, someone is truly recovered from insomnia when they no longer worry or even think much about sleep — when someone becomes more accepting of whatever sleep they get, and trust their body to generate the sleep it needs instead of the sleep they think they should be getting. This process takes longer for some people than others.

    #31404

    TiredTwinDad
    ✘ Not a client

    As much as I was hoping to avoid insomnia topics, I’m at a low right now and I hope writing about it is therapeutic.

    Martin, to respond: Obviously I’ve survived on less sleep, but it’s never been by choice. Any time I got above average (close to 7) I felt better than on days I didn’t. I have no problem being a “lark” but my body just isn’t generating enough sleep. For a while it was a solid 6+, this year it’s been 5-6, and this past week I’m waking after 4, I think, and not falling back asleep.

    I always sleep way worse on vacation(and this was just visiting family, not a huge vacation). And this bed at my FIL’s is pretty uncomfortable too. My sleep doc recommended I take a vacation on vacation from all things CBT-I. She says I’m doing really good, but my strive to do good might be getting in the way. My usual sleep pattern continued, except the last night I finally lengthen my time significantly. And that continued at home for 2-3 days after, even getting close to 7 and feeling sleep inertia. And then my waking pattern has come back with vengeance, and more often than not, I’m not falling back asleep. Strange this pattern started with sleep restriction back in June. I think maybe I allowed my self to go too long after vacation with no sleep restriction, and though I was improving when I got back, I’ve hit a regression.

    Part of me wonders if part of the issue is having an alarm. I know having a consistent wake time is important, but when I wake at night, part of me is always waiting for that alarm to go off, which I think is getting in the way of falling back asleep. But I know I’m not supposed to look at the clock at night, so I don’t know how else to manage this. My sleep did get better after 3 days of no alarms, but then returned to bad pattern after that, with no alarm. Right now, the alarm is just there to tell me to stop worrying about sleeping and start your day.

    Also, days before that vacation, I started light therapy. Blue blockers in the morning, light box during dinner in the evening. Part of me wants to think my early awakenings is a circadian rhythm issue. I have a 2nd shift job 3-4 days a week, where I’m in a windowless somewhat dim walk-in closet in the afternoon/evening hours (4-5 hours), usually until 8:30 or 9p. The evening light box doesn’t seem to affect my bed time, and does help perk me up for my last half of appointments.

    I tried a timed release melatonin (5mg) last night, but I don’t think that did anything.

    I also started using nasal strips at night. I can certainly tell it improves my breathing, but I don’t know if it’s helped me or not. I’ve had good nights without it.

    I had my first appointment in 3 weeks yesterday with my sleep doc, and I got very conflicting advice. She told me to again, stop logging, but to keep a consistant 4a wake time. That instead of moving to a different bed when I wake to stay in the same bed (which helped on vacation, using pzizz). She really wants me working on sleeping in my bed, and not a couch or guest bed, though I’ve never fallen back asleep in my own bed in quite a while. There’s also conflict with having a beer or not (it was never a sleep aid), whether to alter that behavior or not let insomnia alter my behaviors.

    Part of me is wondering if I should just put it all on pause for now, the alarm, light therapy, melatonin, nasal strips. Like I’m putting a lot of effort into something that shouldn’t require none.

    Sorry for the wall of text. If you made it this far, thanks for reading.

    #31414

    Deb
    ✓ Client

    Nao – I did CBT-I for 2 months twice and during that time I averaged 2 bad nights and 5 good nights a week. I made good progress with CBT, but always felt that my underlying anxiety was still there. During that time I heard about another therapy called ACT and read The Sleep Book by Dr. Guy Meadows. This therapy goes to the root of insomnia by dealing with the anxiety directly. I switched to ACT and when I finally understood how to do and committed myself fully to it, I recovered amazing in less than two weeks. There are some other people trying it out now on the thread “Support Group for People doing SR.” This therapy might help to reduce your anxiety so that you won’t keep having these relapses.

    #31492

    TiredTwinDad
    ✘ Not a client

    Deb – Could you explain in broad strokes, what ACT is about?

    From what I gather, I think my sleep doc is about to have me go through that. Last week she told me to stop logging and that we would work on mindfulness this week.

    For anyone who read my word wall – I did put everything on pause and my sleep returned to a solid 5-6. I found out I had been waking around 1:30 and struggling for 5 nights straight. So I’m in a better place than I was a week ago.

    #31495

    Deb
    ✓ Client

    In broad strokes ACT works to reduce sleep anxiety so that you learn to relax in bed. You give up “struggling” to fall asleep and learn to accept and make peace with whatever happens using mindfulness and welcoming techniques. As your mind gets out of the way your body takes over and you naturally fall asleep. The best resource on this is The Sleep Book by Dr. Guy Meadows.

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