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And JT, you’re not “having pretty good luck”, you are realizing the positive effects of CBTI techniques on your sleep! It’s all because you are making the appropriate behavioral changes, not luck. Great job!
Mike
Thanks for describing your insomnia story Phil. Great to hear you are doing better. Yes it can be a long, curvy path with bumps and delays, but sounds like you are moving forward.
I have seen chronic insomnia start with nightmares, fear of going to sleep. It’s not uncommon, and I think many people don’t want to mention it. For an adult, it’s often with PTSD, but not always of course. That’s very challenging.
You mentioned the NHS CBTI course – although free, do you feel it was too inflexible? Not individualized enough? Just curious. Not everyone proceeds through CBTI at the same pace as you described. You’ll find Martin’s program is very personalized, which is so important for effective CBTI.
Again, thanks for sharing.
Mike
Hi Moorj,
Shift work is super challenging sleep wise. It’s basically a constant circadian disruptor. In my experience working graveyard shifts in the past, and working with people with sleep disorder now, I feel it’s basically impossible to adapt to that schedule. This is mainly because people don’t stay on a night schedule when they’re off work. Almost all shift workers flip two days at least to some degree when they’re not working.
When I worked graveyard shift in my 20s and early 30s (ironically as a sleep tech), I would typically sleep 4-5 hours during the day after a shift. Very simply, I used light and caffeine to try to become more alert when i needed to be, wore dark sunglasses on the way home after working, and tried to exercise before a shift. Also I stopped all caffeine about 5 hours before end of shift, and tried to not each a big heavy meal at work. These strategies helped me a bit, but honestly I don’t think it’s possible to get sufficient sleep when working graveyard shifts.
Any chance getting on day work?
Good luck to you!
Mike
Hi Anna,
CBTI can definitely take longer than a couple weeks. Everyone is different. I’m a big fan of not knowing the time all night. I think it reduces performance anxiety that comes with knowing the time. So it might be something to add to your CBTI efforts if applicable. Do you enjoy your time before bed? I also think some people can try to bore themselves to sleep, and this doesn’t work, so would encourage trying a book, craft, TV show, etc that you enjoy.
Mike
Hi Redeyeguy,
Insomnia can be really unpredictable. I think it’s very helpful to make sure that you’re not adjusting or limiting your daytime activity after an occasional poor night of sleep. Be active, be social, eat commonsense good food, all of that regardless how the night goes. Basically don’t give in to an occasional night of insomnia. Natural sleepiness will build back up, your brain will sleep deeper to recover, and things will get back on track. Also, you mentioned remaining calm all night. Make sure you’re not in bed for long stretches of time a week as this will lead to classical conditioning over time. Find something enjoyable to do in another room if you are not sleepy at night. Have your alarm set for the same time each morning, obey it, and avoid knowing the time all night long helps too.
My 2 cents.
Mike
Hi Delv, Hi Steve,
The 2012 RCT used subjects who primarily struggled with SOI, not SMI. Some struggled with both. So the positive benefits to SMI were not as clear. Anecdotally, I will get various messages from users that comment about how the app did help with their SMI. One such person for example was Dennis, the host of the Sleep to Healthy podcast. And a common experience seems to be “the app helped with my insomnia but it’s hard to articulate how”. Again, this is all anecdotal and I want to make sure I’m clear on that.
In my mind, the seems to be a productive use of time for someone doing CBTI waiting for their target bedtime. Not every night, just after particularly poor nights. Maybe more helpful than watching TV perhaps.
As it follows the ISR research idea, the app is programmed to not allow more than about 2 min of sleep. Then user is instructed to physically get out of bed for a couple min, then repeat. It is not a perfect measure of sleep onset, but it’s not too bad:
Hope this helps. Always happy to try to explain ISR or my SOC app.
Mike
Hi All,
Wanted to share a couple thoughts about ISR. I like to describe ISR as a way to essentially “practice” falling asleep: repeated sleep-onset opportunities, done for awhile around bedtime, with immediate awareness feedback. In a lab, sleep onset detection is simple (EEG). At home, stimulus response seems to be simplest.
The Sleep On Cue app uses audio stimulus (faint tones) and behavioral response (slight smartphone movement). Thim uses vibration/slight finger movement via ring device linked to smartphone via Bluetooth.
The 2012 RCT used a 24 hour protocol, with sleep trials on the half hour. The SOC app (and I think Thim too) uses a variable sleep trial time, so the user can achieve a larger number of sleep onsets per hour. This is why I suggest 15-20 sleep trials, around bedtime, ideally after a poor night of sleep. At the end of the sleep training session, no need to engage with the phone – just put it down for the night.
It’s not a sleep tracker – it’s a sleep trainer. The 2012 RCT study looked at 3 treatment conditions: 24 hour ISR, multi-week stimulus control (SC) therapy, and 24 hour ISR + multi week SC. The combined ISR + SC condition showed the largest positive effect. And all positive effects were maintained at 6 months.
Hope this help with the discussion!
Possibly either. Does not strike me as clinical bruxism (teeth grinding). It does seem to be in sync with your breathing. Do you experience any other sleep-related issues (e.g., daytime sleepiness)?
Hi njf,
To me it sounds like mild upper airway resistance from mild nasal congestion with a little post nasal drip. My guess is you are also in supine (back) position too. Might try some saline flush before bed and a non-sedating OTC antihistamine too if you think it could be allergies. And also keep filters and bedroom clean. Lots of smoke from wildfires where I live, and many patients experiencing nasal issues here.
If your wife says you seem to make these sounds only when sleeping supine, you could try staying off your back. Some people sew a pouch in back of their pajama top and out a couple tennis balls in to make a lump that encourages side-sleeping. There are also special pillows, angled foam wedges to elevate your upper body, and other positional devices you can try, but they may cost $$.
Also minimize alcohol consumption. Alcohol can destabilize your upper airway during sleep by causing increased relaxation of the smooth muscle supporting your airway. It’s also a CNS depressant, a dietetic, and a short-chain carbohydrate, all of which can fragment your sleep (especially REM seep).
Lastly, if these simple suggestions don’t help, talk with your doctor about obstructive sleep apnea. Left untreated, it can be dangerous. It can be easily tested and fairly easily treated.
Michael
