[amesydoodle]

Hello,
My name is Amy and I have been dealing with chronic insomnia this time for six months but have had bought of it for thirteen years. I have developed a lot of anxiety about my sleep and my sleep fluctuates from either trouble falling asleep to being awake for hour in the night, to waking early. A sleep medicine doctor locally told me that CBTI probably wouldn’t work for me since I have anxiety and depression and that I just need to work with a psychiatrist and maybe take more klonopin. The problem is I have been taking medication for six months to try to fix the anxiety and insomnia and nothing has brought lasting relief. I may sleep well a couple nights or even a week and the something changes or there is a stressful event and I have a rough night and then the insomnia is back. Right now my worry is just that nothing will help.
I think acceptance is helpful but many nights my mind just races and it’s hard to get to a point of resting in bed.
So how do I deal with those anxious nights? If I say I have to get out of bed in 20 minutes I stay awake all night because I feel so much pressure to hurry up and fall asleep. I really don’t want to have to take anti-anxiety medication to sleep forever especially since I seem to develop a tolerance in a month or less.

[Martin Reed]

I am so sorry to hear that a doctor told you that CBT-I probably wouldn’t work for you since you have anxiety and depression and that medication would be a better solution. Since cognitive behavioral therapy for insomnia (CBT-I) specifically helps lower sleep-related arousal, it’s a great way to improve sleep when sleep-related worry and anxiety is making sleep difficult.

One of the best things to do when it comes to anxiety is to see if you can identify the thought that is causing anxiety. Anxiety doesn’t occur by itself — we have a thought and this triggers an anxious response. So, next time you feel anxious, ask yourself what is going through your mind.

If you can uncover the thought(s) that are causing the anxiety, you can then evaluate the accuracy of those thoughts. When you do this, very often you will see that the thoughts that are generating such powerful anxiety aren’t even particularly accurate — and this, in turn, can reduce the power of the anxiety they generate.

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.

[amesydoodle]

Thank you Martin. I think some of the cognitive aspects of CBTi could help reduce my anxiety about sleep. Too bad there seems to be so few people trained in it and most doctors only know medication.

[Martin Reed]

I completely agree!

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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.

[LCF]

Hi Amy,

I, too, suffer from both sleep onset and sleep maintenance insomnia, and it’s been getting worse over time.

Your comments about your insomnia and CBTI could be me talking, especially the part about feeling that you had to “hurry up and fall asleep.” That was what I found so difficult about CBTI. After I got out of bed once, that was pretty much it for the night. All I could think about was, “Twenty minutes. Twenty minutes. I have to get up in twenty minutes.” No way to go to sleep with that in your head, right?

Because I had a failure with CBT before, precisely for the reason you expressed in your post, I haven’t fully embraced the whole CBT thing all at once this time, not yet, but I am taking small steps to get to it because it does seem to be the one thing that can help — aside from medication, which both of us know is a dead end.

I do still use medication occasionally because I have to sometimes, but I would love to live my life without it. Right now I’m bound to a life that depends on having a doctor willing to prescribe sleep medications, and those are few and far between here in Canada. It ties me to a small town that I would like to leave some day as I get older.

My first step towards instituting CBT is a simple one. Normally I stay in bed for ages, trying to get as much asleep as I can before I finally give up. I might sleep two or three hours or less over eight or nine hours in bed, and I might get out of bed anywhere between 5 am and 9:30 am. Last week I decided to get up at 7 am every morning, no matter what. I can be in bed and not be asleep as long as I’m comfortable and not flipping out, but I have to get up at 7 am. I will note that I was using medication this week because this is an especially stressful time for my husband and I (it’s the week before he has a CT scan to see if his chemotherapy is still working).

After one week, I am most encouraged by the fact that I woke up five to ten minutes before my alarm for the last three mornings, even though I am taking medication.

It may not seem like much, especially since I was using medication, but to me it’s a little victory. It means my circadian rhythm can reset even with the medication. It’s a tiny little change for the better. And 7am is a time that I can stick to under any circumstance and I can do this for the rest of my life. It’s not too early, it’s not too late, it doesn’t preclude the odd late night out, and I can be up and about and have a full day.

Yes, it will be a lot harder to do without medication, and I’ll be trying that next, but I’m sticking with it. It’s the one thing I can do, precisely because it doesn’t involve launching myself out of bed twenty minutes after I lie down.

A final thought. One of things that has always plagued me most is the thought that I’m alone with this. I lie awake and feel so alone. I wish I could be normal. I feel like I’m never going to feel better. I feel as though I’ll never have any kind of life. I only started to reach out to other insomnia sufferers recently, and it helps me to know that I’m not the only one and that my insomnia isn’t the worst experienced by any human being ever in the whole course of history since the dawn of time. It seems there are quite a few people who have had success with CBTI and maybe, in spite of our reservations about it, we can too.

Martin very generously does a free two-week course by email that I’m finding really useful, too. It challenges you to think about your preconceptions about sleep and insomnia. You might find it helpful. I have.

[amesydoodle]

LCF,
Glad to hear you have seen improvement in your sleep this week. Does that mean you are falling asleep quicker now too? Sounds like you have a lot of stress with your husband going through chemo and I wouldn’t feel bad for taking sleeping medicine during a stressful time.
I tend to do what you were doing, by spending a long time in bed hoping to sleep more. Maybe not helping.
Yes, insomnia can be very lonely and it is nice to know other people suffer and others have recovered.

[LCF]

Amy,

I took medication so I can’t really say I fell asleep faster because of this change (I did fall asleep, thanks to modern chemistry). I do know that having a consistent waking time is really important for the circadian rhythm, so that’s why I started there. It seems like it’s a really important part of the whole sleep/wake cycle.

According to the theory behind CBT, spending long periods in bed without sleeping is counter-productive. It’s hard not to do it, though, especially if sometimes you do eventually go back to sleep for a couple of hours after being awake for ages. I often lie awake for an hour or two, sleep for an hour, then wake for two to three hours, falling back to sleep at aroun6 am and sleeping until 8, at which point I feel groggy and useless.

Fun.

[LCF]

Interesting. Another morning waking up ten minutes before the alarm. And I’m starting to yawn a lot and feel sleepy even before I take my medication. I’ve been turning the light out at around midnight for the last week — about an hour later than my usual shut-down time.

[amesydoodle]

Woohoo! Sounds like your body is getting into a good sleep pattern. Maybe soon you can wean off the sleep medicine and continue to sleep soundly.
I am back on klonopin to reset my pattern but am hoping to be able to slowly taper in a week or two without rebound insomnia. Trying to practice mindfulness during the day and acting more like a normal sleeper.

[Author]

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