Sleep Restriction or ACT for Insomnia

This topic contains 154 replies, has 10 voices, and was last updated by Steve 1 hour, 19 minutes ago.

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  • #27425

    dragon
    ✘ Not a client

    Is the SRT sufficient though for the anxiety?  I recall Deb looking for alternatives and she had been doing quite well with it.

    #27426

    Deb
    ✓ Client

    Yes, Dragon, I looked into Guy Meadows’ method of dealing directly with the anxiety. You can read about it in his book, The Sleep Book. So last Saturday night I faced directly those fears and as a result was awake all night. He said that this is common, because for the first time you’re facing your original fear directly. Since then I’ve slept through the night for the last 5 nights.

    I actually took a radical approach and went back to my normal sleeping pattern of going to bed with my husband between 10:30 and 11:00 and then getting up at 7:00. I just decided to relax all the constraints like SR and just deal with the fear directly. So far so good. I had a couple nights where the fears crept in, but it didn’t keep me awake more than 15-30 minutes.

    I’m thinking that probably the SR that I did for 7 weeks actually reduced a big portion of my anxiety, so that now I’m just dealing with the little bit that is left over, and that’s why it’s going pretty easily. Also, all that reconditioning of associated the bed with sleep is paying off, making it easier to fall asleep. Let’s hope this keeps up. Will keep you posted.

    #27427

    delv-x
    ✘ Not a client

    SRT can help with associating bed with sleep. For some people it works well. For others, a too strict SRT may make things worse because the act of overthinking, overdoing, overwinding for bed can make things worse.

    Deb and I are incorporating a more ACT approach. Not to say you throw everything out the window but rather ease up so your mind is more at ease. For example go to bed and wake up at the same time. With CBT-I it is strict with that. With ACT, you go to bed and wake up at the same time but allows wiggle room of 30 minutes if need be. CBT-I, bed is for sleep and sex only, ACT is sleep, sex and light reading if you wish.

    The big difference is with when you are in bed for 20 minutes and can’t sleep. With CBT-I you get out of bed and find something to do in another room until you get sleepy. With ACT, you stay in bed, rest and welcome the discomfort.

    Allow normal bedroom activities
    CBT-I: NO – Use the bed for sleep and sex only
    ACT-I: YES – Allow calm non sleep activities such as reading in bed

    Go to bed when either tired or sleepy 
    CBT-I: NO – Only when sleepy
    ACT-I: YES – Both states allowed

    Stay in bed, if awake at night 
    CBT-I: NO – If not asleep within 15mins, go to a spare room/read
    ACT-I: YES – Focus on resting and welcoming discomfort

    Allow daytime naps 
    CBT-I: NO – Avoid all daytime napping
    ACT-I: YES – Allow a short (<20mins) daytime naps

    Keep in mind CBT-I has been more thoroughly studied. ACT-I is a different approach that may work better for others but has less backing study wise for the moment.

    #27428

    delv-x
    ✘ Not a client

    Hi Deb

    Glad to hear! Last week was good for me. The past few nights, I’ve been slipping. Last night I woke up around 4am and my mind was chatting and my body was tense and alive. I stayed in bed and just relaxed. Trying to accept the sensation and accept if I don’t sleep. 7Am, got up and feel tired, a little zombie like and lazy. I am only on chapter/week 2 that just starts to talk about the techniques.

    I watched a show on Netflix called “A user’s guide to to cheating death” and there was an episode on sleep. A lot was covered in the hour. If anyone is curious, it’s worth a watch.

    #27429

    Deb
    ✓ Client

    Thanks, Delv. I like how you mention “For others, a too strict SRT may make things worse because the act of overthinking, overdoing, overwinding for bed can make things worse.” I was tired of being afraid of and worrying about having a bad night if I didn’t do everything perfectly (going to bed 15 minutes early, eating a cookie, winding down only 1/2 hour, etc). As Guy says, when you’re doing that you’re trying to “control” sleep instead of just letting it happen naturally. So that’s why I decided to throw out all the constraints for now. Of course I will still practice good sleep hygiene such as getting up and going to bed at the same time, not sleeping till noon on the weekends, etc.

    #27432

    delv-x
    ✘ Not a client

    Hi Deb,

    I have been keeping a sleep diary for 5 months now and it’s been a yo yo. Overall when looking at it, it’s not terrible. I have had stretches of 90% SE and 6+ hours of sleep per night and felt pretty good. I can’t pinpoint a reason but I do know that when I am just too tired, exhausted and care less and accept (easier said than done) I sleep better. One of the things Guy mentions is to avoid any pill or prop. I do take a pill for now but I was propping with tea, supplements, blue light blocking glasses, watching the time etc basically doing everything I never used to do before. The night I didn’t do any of that and do what I would have before all this, I had a better night. I stayed up and played video games and then brushed my teeth, changed and went to bed. Eventually after a few days things slipped over and over. I still believe this approach is better for me because it makes me worry less overall. I just need to be able to relax and deal with the punches of relapse when they occur.

    As you posted:

    • Accept that sleep disturbances will still occur
    • See your relapses as due to identifiable causes such as stress and not as evidence of the return of insomnia
    • Follow the strategies that were helpful to you before
    • Don’t compensate for lost sleep – such as taking naps or going to bed earlier
    • Sleep conditioning – get out of bed when you can’t sleep (this has been changed to, stay in bed, relax and accept.)
    • Follow a regular sleep window

     

    #27434

    Deb
    ✓ Client

    Delv – just a thought. I wonder if when you relax and have a good week and then relapse, if you’re just keeping the fear at bay during the good times and then it catches up with you when you relapse. That’s what I felt about myself. During most of the weeks of SR I would either fall asleep right away and then sleep all night or stay awake half the night. On average, 5 days I would fall asleep right away and the other 2 I wouldn’t fall asleep right away and then would stay awake for hours. I always felt that on the 5 days I fell asleep right away I was keeping the fear at bay, just barely escaping it with the help of a night cap to knock me out. The other 2 days the fears managed to creep in despite my best efforts to keep them out. When I finally decided to stop having the night cap, the fears came back in full force. I had 4 bad nights in a row. That’s when I decided it was time to face the fears directly. Anyway, just a thought.

    #27463

    Martin Reed
    ★ Admin

    I’m fascinated to follow this discussion and to see how ACT helps each of you over the long-term. Since I am a huge proponent of CBT-I, some of the components being discussed do concern me (such as going to bed before you are sleepy and staying in bed when you aren’t sleeping), but I think that ACT has more in common with CBT-I techniques than differences since it’s primarily about abandoning sleep effort.

    Deb, you mentioned that when you were implementing CBT-I techniques you would typically have two bad nights of sleep each week. Since you started practicing ACT, has this changed?

    I also want to add that ‘trying’ to keep fear and worries out of your mind is NOT a CBT-I technique. Additionally, I strongly believe that getting out of bed when unable to sleep (rather than staying in bed awake) can actually help reduce fear and worry-related ruminations at night — because when we are in bed awake, resting, and not sleeping, we are far more likely to ‘try’ to sleep and we are far more likely to ruminate and worry compared to when we just get out of bed until we feel sleepy again.

    #27467

    delv-x
    ✘ Not a client

    Hi Deb, it could be that. It is so hard to know. I had a crap night last night and now in the mode of wondering why. My muscles and body felt achy so I decided to take some magnesium power with water in the evening (trying not to tie it as a pill or potion). I did some meditation in the evening at 9pm and after laid down for what I was hoping for 5-10 minutes but may have been 15-20 and may have fallen asleep for a few minutes. I felt more refreshed so most likely I did sleep but this may have ruined my sleep drive. I went to bed shortly after midnight and felt a little sleepy but not as sleepy as normal. It took a very long time to fall asleep, anxiety and mind was high and the sleep I managed to get was in short spurts. Felt like a lot of in and out sleeping, tossing and turning.

    I did stay in bed and tried to relax and welcome everything and welcoming it seems to help calm things down. So I am not sure. I did feel like at times to get out of bed for a time out because I was becoming frustrated.

     

    #27475

    Deb
    ✓ Client

    Hi Martin

    Since last Saturday night I’ve slept every night including last night and have had 6 good nights of sleep in a row. I’ve been going to bed with my husband between 10:30 and 11:00 and waking up around 7:00. This was my old pattern of sleep before the insomnia.

    Every evening I’ve felt some apprehension and heaviness about going to bed. I don’t expect this to disappear overnight though because I’ve had insomnia almost 5 months now and have been traumatized by it. But day by day the fear is decreasing. When I go to bed I’m not as exhausted as when I was going to bed at 12:00, but it hasn’t been a problem. Just the usual amount of tiredness I used to feel at bedtime before the insomnia struck. When I’m in bed, I’ll feel the fears come in, but somehow they haven’t been strong enough to keep me awake. I’ve been falling asleep after maybe 15 minutes or so.

    So, so far, so good.

    #27476

    Deb
    ✓ Client

    Delv – since CBT isn’t giving you the results you want I really want to encourage you to try ACT all out. You had a taste of it last night when you calmed down after welcoming everything. But then you got frustrated, thus were “struggling” with the insomnia. The goal is to stop struggling. I’ve reread the sections on ACCEPT over and over to really try to understand deeply what he’s getting at and it makes a lot of sense. On page 72 he says “stop the physical tossing and turning, emotional fretting, over-thinking or excessive energy expenditure, all of which keep your brain awake and prevent your entry into peaceful slumber.” On page 75 he says, “it is only when you can accept wakefulness that you can sleep.” And on page 85 he says, “the first step to accepting your insomnia is to be able to notice yourself struggling in the first place. What you don’t see, you can’t begin to let go of.” As in mindfulness, we become an observer of our thoughts. So when you catch yourself being frustrated again, just observe it and then let it go.

    If you really give this a good shot, Delv, you might have some sleepless nights like I did while facing your fears directly for the first time. But sleepless nights are nothing new to you, so you can handle that. The goal is to give up the fight and learn to be ok with not sleeping. Then paradoxically, you’ll start sleeping because your body will take over and do what it naturally does, instead of the mind trying to control things through struggling to fix the insomnia.

    #27478

    delv-x
    ✘ Not a client

    I will continue with it as I have. Last night was rougher than usual but know that trying and struggling won’t make things better. The techniques sound easy but easier said than done. Stop struggling and observing takes time and practice. I need to stop controlling sleep and let it naturally happen.

    #27479

    Deb
    ✓ Client

    Yes, easier said than done. In the book it took the client Carlos 2 weeks just to finally relax in bed, and 2 months before he was sleeping normally. And that was with direct coaching by Guy Meadows where he could give him a phone call the next day if he was struggling or had questions.

    If it helps, remind yourself of the times when you just didn’t care, and then you were able to have a good night’s sleep. That’s your goal, to not worry anymore about it.

    #27481

    Deb
    ✓ Client

    But maybe with the foundation of all the work you’ve already done with CBT, it will go quicker for you like it’s going for me.

    #27482

    delv-x
    ✘ Not a client

    Hi Deb,

    Had another rough night. By 10PM I was already fairly tired. My eyes were heavy by 11 and hit the hay just after midnight. Took about 20 minutes to fall asleep but woke up around 2:30-3:00 am and relaxing and falling back to sleep wasn’t happening. There are streaks where this happens and I just go get some water and then fall right back but not the past few days. My thoughts aren’t about sleep, they could be about anything but what I find is that once I am relaxed enough to drift, I wake back up. This does cause frustration and hopefully something I can overcome. I did stay in bed and it was warm and comfy. Just when the tossing and turning start happening often, I am more focused about that.

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