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Im new here and about to start CBT I with a local therapist face to face. My question is when you’re already going to bed around 10pm to 10:30pm and waking up at 3:50am for work each day (I work in healthcare) what’s the minimum sleep window am I allowed. I average about 4-5 hours sleep/night. But I take ambien.
The therapist if trained and certified for CBT-I will discuss your particular window. The missing piece is your current sleep efficiency. However, since your to bed and rise time is 5-5:30 hrs, you shouldn’t restrict it further. During CBT-I you can continue to use Ambien as a sleep aid until things stabilize. Just let the therapist know. He/she will almost definitely ask that.
To save time before your first visit I would recommend you starting sleep logs. You can download one online or my preference is use the CBT-I coach app. For the next 2 weeks fill it in to the best of your abilities so when you start the therapist has a good understanding of your situation rather than waiting 2 more weeks and then getting an idea on what SRT should be applied.
Sleep restriction isn’t the only component so although it is likely he/she will suggest it, other components will be in play to help your sleep become more consistent, restful and less frustrating.
I’m a client of Martin’s and he said the minimum should be 5.5 hours. So it sounds like you’re not getting enough. Are you going to get off Ambien? When I used it years ago it knocked me out right way but I was groggy when I woke up even after plenty of sleep. I eventually threw out the pills because I didn’t like being dependent on them.
I do plan to wean myself off. I’m a little nervous admittedly. I’ve been taking it for years probably now with little or no efficacy.
So what’s the difference between sleep restriction and sleep compression? I read in these forums that Martin doesn’t highly recommend sleep restriction in people with high acute careers. I’m an anesthetist. Such irony in that fact that I sleep people everyday for work but yet am having trouble sleeping myself. Hence, why I’m in bed around 10pm and up around 4am-for work. Have a 30 minute commute.
Sleep restriction results in sleep compression. When you set a time to bed and wake up time, you limit the time in bed. The objective is to consolidate sleep rather than going to bed early to catch up on sleep. This results in lighter more fragmented sleep.
That is ironic that you put people to sleep. Sleep compression and sleep restriction appear to be opposite strategies of treating insomnia. In sleep restriction you cut your total time in bed down so that it’s close to the amount that you actually are sleeping. So in my case, my actual sleeping time averaged over a week was 5.5 hours (even though I could average 10 hours in bed because I couldn’t fall asleep!) Martin added on a half hour. As your sleep stabilizes within that amount of time, you gradually increase it. I used to sleep normally about 8 hours but on this plan I’m sleeping 6 hours, from 12 to 6. A consistent time is important. This is the method Martin is using with me. It’s working really well, and since I started 18 days ago, I’ve only had 4 bad nights. Before, most nights were bad with an occasional good one or two. I’m tired a lot though because 6 hours isn’t enough sleep for me, but my anxiety has gone way down because the method is working. I look forward to my sleep window gradually increasing.
With sleep compression, you work the opposite way, picking a length of time and gradually decreasing it. I noticed that there is a good explanation of it on the internet when I googled it.
Yes Deb. Such irony in this whole situation. Congratulations on your success. I hope to share in the same as you. I’ve been battling insomnia on/off for nearly 15 years-started in my residency. It never really went away. I just medicated PRN.
Wow, that’s a long time to be struggling with that. Mine started just 3 months go in October. Just wondering, are you averaging 4-5 hours even with using Ambien?
Generally speaking, you want to determine how many hours of sleep you get each night by looking at your sleep duration taken over one or two weeks. Then, start by adding half an hour to this time and you have your new ‘sleep window’. If you add half an hour to your average nightly sleep duration and it comes in at under five-and-a-half hours, I suggest starting with a sleep window of five-and-a-half hours, regardless.
You mentioned that you read in the forums that I don’t highly recommend sleep restriction in people with high acute careers — can you clarify what you mean by this? I usually recommend sleep restriction as the first step for anyone with insomnia because it is the quickest way to increase sleep efficiency and help you start relearning to associate the bed with sleep rather than wakefulness.
delv-x: Consolidating sleep does not lead to lighter, more fragmented sleep. In fact, it usually has the opposite effect. By more closely matching the amount of time allotted for sleep with the amount of time spent asleep, sleep efficiency increases and as sleep becomes more consolidated less time is spent awake at night, leading to fewer interruptions in sleep. It’s also worth being reminded that most of our deepest, most restorative sleep occurs very early in the night.
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