[kynkari]

Hello!

My name is Sheri and for the past 7 months I have been suffering from insomnia, anxiety and recently, depression.  It seemed to happen overnight, after having been an excellent sleeper prior, and since then I haven’t had many good nights and feel miserable each day and like I can barely function.  I’m not sure if the depression caused the insomnia or the insomnia caused the depression, but I didn’t get depression until several months after this all started, and certainly I have tremendous anxiety around sleeping at this point.

Can sleep restriction work for someone with depression as well?  I am seeing a therapist and doctor regarding the depression, but I’m worried about taking antidepressants as most cause insomnia and I have trouble enough as it is.  I feel like if I could start getting enough sleep each day, a lot of my depression and anxiety would get better.

I’ve also struggled with determining what a sleep restriction schedule for me should look like.   I have trouble falling asleep, some nights I wake up every single hour, and I always wake up between 4 and 4:30 am.  I don’t want to wake up then!  I’d much rather wake up at 6, but my body clock wants to wake up at that time.   Some nights I get 2 hours of sleep, others 5 or 6.  Usually I have a pattern of several nights of bad sleep (2-3 hours, or none at all) and then I’ll sleep a little longer one night, but not adequately as I still feel awful the next day, but it’s just enough to keep me in this pattern.   If I get much less sleep than 7 hours a night, I feel horrible the next day and can’t think straight, but on average I probably get 4-4.5 hours of sleep a night across a week.  I haven’t gotten 7 hours of sleep in a night for this entire 7 months!

If I automatically wake up at 4:00 am, and I have to go no lower than 5.5 hours in bed, that puts bedtime at 10:30 pm, which is when I go to bed now.  How would sleep restriction work in this case since I have mixed insomnia (onset and terminal)?

 

• This topic was modified 6 years ago by kynkari.
• This topic was modified 6 years ago by kynkari.

[Martin Reed]

Hello Sheri. Welcome to the forum, and I’m sorry to hear about your struggles with insomnia, anxiety, and depression.

All three conditions are related — and so your question about whether the depression caused insomnia or insomnia caused the depression is an appropriate one.

Research suggests that the relationship runs both ways, with sleep problems exacerbating depression and depression exacerbating sleep problems.

The best way to calculate your sleep restriction schedule is to take a broad overview of your sleep over at least one week (ideally two). Once you have your average nightly sleep duration, add half an hour. As long as this is more than five-and-a-half hours, you now have the amount of time you should be allotting for sleep. If it is less than five-and-a-half hours for sleep, then you should be allotting five-and-a-half hours for sleep.

Unfortunately, we cannot control sleep — so although you don’t want to wake at a certain time, if that’s when your body wants to wake, that is when it will wake. However, over time, as your sleep stabilizes, you should be able to make adjustments to your sleep schedule to get it closer to where you want it to be.

The fact that you experience nights of very short amounts of sleep followed by a night of longer sleep suggests that your sleep is being disrupted by your arousal system. This can temporarily override sleep drive, but because sleep is a biological function, sleep drive eventually reaches the point where it forces sleep regardless of your arousal system. After a night of longer sleep, your sleep drive falls and so your arousal system takes over and makes sleep difficult once again. CBT for insomnia helps break this cycle by weakening the arousal system and strengthening the sleep/wake cycle and sleep drive.

Sleep restriction works because it reduces the amount of time you spend in bed awake at night, tossing and turning, and worrying about sleep (all of which make sleep more difficult). As a result, it increases the amount of time you spend in bed asleep rather than awake and, over time, this makes the bed a stronger trigger for sleep.

It’s also worth mentioning that when you have set your sleep window, the start of the sleep window is the earliest time at which you can go to bed. If you don’t feel sleepy when your sleep window begins, you shouldn’t go to bed until you do feel sleepy. However, regardless of what happens during the night, you should always be out of bed by the end of your sleep window in the morning.

I hope this helps!

—

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.

[kynkari]

Hi Martin,

I think my recovery nights are when I break down and take a benzo to get a little more sleep.   I currently take Remeron and lunesta, both given to me by doctors for the insomnia. Unfortunately neither of them work well anymore.  If I don’t take them, I get zero sleep, but with them I’m only getting 3-4 hours a night.  The occasional benzo will give me another 2, if I’m lucky, but I don’t do that often at all and only when I’m very, very desperate.

I also have shifting patterns in the insomnia.  I was having a lot of trouble falling asleep initially, but once I fell asleep I could usually stay asleep until 5 am.  Lately, I’m falling asleep (with some trouble but I still get there) but waking early, at 4 am.  This last 4 days I’ve woken at 3 am and cannot fall back asleep.   It’s horrible!

So, my question for you is, how do I set my wake time when I wake at 3-4 am?  Do I set it for when I WANT to wake up, or when I always wake up?   I think another concern I have is that the sleep restriction will not work for me because of underlying depression that is not being treated with meds. I’ve tried a number of antidepressants but none of them helped and exacerbated the insomnia.  I am going to therapy but not sure there is much left to try for the depression, so can the sleep get better despite of the depression and anxiety?  I’ve read conflicting information on this.  Some say you can treat the insomnia and the anxiety and depression will improve.  I’ve also read the insomnia won’t respond to restriction therapy because of the underlying anxiety and depression.  What are your thoughts on this, and how to set a wake time when I wake so early in the morning?  If I set my ideal times, and kept it at 5.5 hours, it would be waking at 6 am and then going to bed at 12:30 am, however, that’s likely to result in sleeping from about 1-3 am for me, which is much less than the 5.5 hours allotted.  Any thoughts?

By the way, I hate being on the sleep meds and am tapering down off of them slowly but feel I need to get this sleep thing under control a bit more to finish the taper.

[Conny]

Helo Sheri,

I have a similar insomnia pattern like you take Temazepam 15 mg to fall asleep without I don’t and sleep only about 3-4 hours.

My Nervous System is very affected from the insomnia

I am currently trying to calm my nervous system with massage cold showers etc. But also  at the end of my wisdom

Conny

[Martin Reed]

Hi Sheri. One study that looked at individuals with both depression and insomnia found that addressing insomnia using cognitive behavioral therapy helped alleviate both insomnia symptoms and depressive symptoms. Cognitive behavioral therapy for depression also helped alleviate depressive symptoms and insomnia symptoms, but focussing on sleep was found to have the best long-term results.

So, my thoughts on this are that insomnia and depression are related, with both feeding off one another. I also have no reason to suspect that following CBT-I techniques will be less effective simply because an individual is also living with depression.

For best results, sleep restriction should be combined with stimulus control so that the time you spend in bed is spent asleep, rather than awake. Over time, this makes the bed a strong trigger for sleep.

There are two ways of determining your ideal sleep window. Once you have figured out how much time to allot for sleep, you can either count back from when you need to be out of bed to start the day, or you can count forward from when you normally feel drowsy and ready for sleep.

If you wake during the night and don’t fall back to sleep within about half an hour, you should get out of bed for about half an hour before returning to bed and repeating the process. Of course, this will lead to less than five-and-a-half hours for sleep, but the opportunity is still there for five-and-a-half hours of sleep, and this is what is key.

Nights of less than five-and-a-half hours of sleep will build sleep pressure, so as long as you don’t do anything to reduce this sleep pressure (such as going to bed before the start of your sleep window, napping during the day, or staying in bed past the end of your sleep window), sleep becomes increasingly more likely over the coming nights.

It’s also important not to have any expectations regarding your sleep. You mentioned that a sleep window of 12:30 am to 6:00 am would mean you would only be asleep from 1:00 am to 3:00 am — however, you have no way of knowing that with absolute certainty. I would imagine that sometimes this would be accurate — but not always!

I hope this helps.

—

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.

[Alice]

I just found this old thread and I have a question for you, Martin. You mentioned above, that if you wake up during the night, and can’t fall back asleep within half an hour, you should get out of bed for half an hour (and do some activities like reading I guess?). After half an hour you should go back to bed. What if I still can’t sleep after that? Should I stay in bed for half an hour again and then get out for half an hour again?

You also mentioned, that if you don’t feel sleepy once your sleep window starts, you should wait until you get sleepy. If my sleep window is from midnight to 6 am, and I only start feeling sleepy at 2 am, should I still get up at 6 am? Or should I add those 2 hours and get up at 8 am? Thanks in advance!

[Martin Reed]

The short answer is, if you get back into bed and are still finding sleep difficult, it’s helpful to get right back out of bed! I am moving away from encouraging people to estimate 30 minutes and moving towards simply determining when to get out of bed based on whether or not it feels good to be in bed.

If you are awake and it feels good to be in bed, it’s OK to stay in bed since conditions are right for sleep! If it doesn’t feel good to be in bed, getting out of bed to do something relaxing and somewhat enjoyable can be a more appealing alternative to staying in bed!

Furthermore, getting out of bed when being in bed doesn’t feel good to do something else can help distract the mind so it’s not obsessing/worrying about sleep and prevents you from associating the bed with unpleasant wakefulness.

To answer your second question, if your sleep window is from midnight to 6:00 AM and you only get sleepy and go to bed at 2:00 AM, it’s a good idea to still get out of bed by 6:00 AM. Here’s a short video related to this: Should you worry about how long it takes to fall asleep when following a short sleep window?.

—

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.

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