Forum Replies Created
-
Posts
-
I haven’t seen the statistics on people who have insomnia and their inability to nap. My impression is based solely on the hundreds of people I have interacted with in various insomnia forums over the last 15 years. And to be clear, I am a layperson.
There are numerous misconceptions related to insomnia that lead people to believe that their insomnia is worse than others. These include:
– I can’t fall asleep at all even though I haven’t slept in many many nights
– related to the above, I can’t nap
– I still don’t sleep well or not at all even though I am taking powerful sleep medicines
– Related to the above, I cannot fall asleep even though I have taken a ton of melatonin and smoked a bunch of marijuana
– Even when I do sleep, which is not a lot, I don’t really feel asleep. I feel awake but the time passes very quickly
– Sometimes I sleep well for about 2 or 3 hours and then I am not able to fall asleep
– Because of the above I must have some terminal illness causing my sleep issues and I will not rest until I prove this illness isI am sure there are all kinds of other variations you can add to that list but those are the ones I hear over and over again. The next misconception that usually follows is – because my insomnia is worse than everyone else’s, these “behavioral” therapies will not work. Or, related to that, I have tried sleep hygiene and it is completely useless.
Below was my personal experience when I went through my bouts of chronic insomnia:
– I went for weeks and weeks with very little sleep. And whatever sleep I got, it was not restful
– I took sleep medications. They would help me fall asleep some nights initially but only for a couple of hours. Other nights, they did not help.
– Despite being sleep deprived, I could not fall asleep during the day. I could never ever nap.
– I had panic attacks and sever sleep related anxiety
– I tried “everything” including sleep hygiene and nothing worked.Sound familiar? I can match you symptom for symptom and make the same claim that my insomnia was worse than yours. Actually, the hundreds of people I interacted with would all claim similar experiences and therefore claim their insomnia is the worst. The reality is, with many people with chronic insomnia, their experience is very similar to yours. I hate to say it but, your case just isn’t very special. It is incredibly unremarkable.
That’s all good news. It’s good news because thousands and thousands of people just like you (and me) have been helped by professionals trained in treating chronic insomnia. As to the treatment, let me just say that you are in the right place talking to the right person (Martin). The treatment approach he provides is the single most effective approach to chronic insomnia bar none. That’s not me saying that, it is several dozens of studies conducted over the last 30 years that says that. If we had a treatment for coronavirus that showed the same level of efficacy, the pandemic would be over. The catch is, his treatment approach is not an over-night fix. It takes time and you have to put in the work. This website has a nice page that describes the treatment nicely:
I don’t really have much to add – the expert (Martin) has already weighed in so I think its best for you to heed his advice.
The one thing I will say is that there seems to be this common misconception that “my insomnia is heavy duty as compared to others”. I will just paraphrase something I heard an insomnia expert once said while giving a talk on the topic – the only kind of patients this person (Donn Posner) ever treated were heavy duty insomniacs. People who have been suffering for decades with insomnia. People who had insomnia as a result of PTSD. Or people who had insomnia because of chronic pain, etc.
I don’t think it is particularly useful for you to think of your situation sleep wise to be worse than others. I think it is actually more beneficial to think of your situation to be no worse and likely, to be not as bad as others. You see, if you accept that professionals who are trained to treat people with insomnia routinely successfully treat people whose insomnia is as bad or even worse than yours, then you will come to realize that there is indeed a way to help you.
And I am not just making that up. There are dozens and dozens of studies that show that even if you are suffering from chronic insomnia and have been doing so long term with co-morbidities, with proper treatment, not only can you improve your sleep – you even have a chance at becoming a normal sleeper again.
Edit: Let me add that before I was given the proper treatment, I was the kind of insomniac who could take ambien and still struggle for hours to fall asleep. I once took a dose of temazapam (similar to valium), slept for 1.5hrs, woke up, could not fall back asleep and then took another doze and slept for 2 hours. And then I was up the rest of the night. 3.5hrs on double the prescribed dose which btw, is incredibly dangerous.
When I received the proper treatment (I was taught how sleep works, how I could manipulate my sleep system to promote sleep, I was also taught how structure my days and nights to enhance my sleep), within a couple of months, I felt confident enough to ween off of sleeping pills.
If I was to guess, I would say that 90% of people with chronic insomnia would improve their sleep enormously just by following sleep restriction. The first time I had horrible chronic insomnia (15 years ago), that’s pretty much all I did – followed sleep restriction properly (fixed bed times, no laying around during the day, no naps greater than 45 mins, living a regular life during the day) and within 3 months, I was sleeping better. Not as much as I would like but well enough that my life was more than bearable. I followed that routine for quite some time and by around 18 months or 2 years, I was completely recovered.
The second time around (roughly 3 years ago), I came down with a medical condition that made it very difficult for me to sleep. The medical condition is not curable and there is no treatment to reduce the symptoms. So not only was the medical condition affecting my sleep, knowing that my medical condition was not treatable, I was also completely freaked out because I knew I was headed down the road of chronic insomnia. Though I am well versed in CBTi techniques, my sleep spiraled out of control and within 2 weeks, I was a complete mess. In terms of fixing my sleep, I knew that there is nothing out there that is better than CBTi. I got all my notes out, re-watched a bunch of CBTi videos and got to work implementing a proper sleep schedule.
I was suffering from severe anxiety due to the other medical condition. That was compounded by not being able to sleep very much so I felt like crap pretty much always. And as we all know, when we are suffering from anxiety, it makes it doubly difficult to sleep at night.
I followed sleep restriction but to help manage my heightened anxiety, I started working on relaxation techniques. My objective for relaxation techniques was less about reducing my anxiety at the moment but rather to build up skills to help me manage anxiety in the long term. They say that relaxation techniques (PMR, deep breathing, meditation, etc.) take a lot of practice so I never worried about them “not working”. I just felt like I needed something to do to take more control of my situation even if the benefits did not materialize right away.
In my previous bout with chronic insomnia, sleep restriction was enough. The second time around, I did not feel like I was making progress as quickly. There were other tools in the CBTi bag that I wasn’t using – namely, stimulus control. I tried stimulus control for a few nights but I found that it actually made me more alert. I was constantly monitoring. Am I still awake? Has it been 15 minutes? I know what the studies say about stimulus control but something felt counter intuitive for me.
In thinking about it, stimulus control is supposedly meant to break negative associations with your bedroom/bedtime/bed. They tell you that the way to do this is not spend time in bed if you are not asleep. For me, I reasoned out that my objective should never be to fall asleep. My objective for my sleep window is to find relaxation. In most cases, if you have sleep debt and your body clock is aligned, if you find yourself relaxed, you will fall asleep.
So instead of doing stimulus control as prescribed by CBTi, I made a modification – during my sleep window, I go to bed. If I am in bed and relaxed/happy, I stay in bed. Whether I fall asleep or not is not important. If I am in bed and not relaxed or am feeling agitated, then I get up and go to another room for 15-30 minutes. Then I go back to bed again to see if I can lay down and be relaxed. They say that it is incredibly difficult to fall asleep if you are trying too hard to fall asleep. So for me, I don’t go to my bed to fall asleep. I go to bed to relax and think about happy/fun stuff.
So the second time I had chronic insomnia, it felt harder and it seemed to take longer. I had to use more tools to get myself right. But I am happy to report that I have slept well for well over a year now. I have had 1 night in the past 8 months that I did not sleep well. That’s it. For the past year, I have had maybe 3 nights where I did not sleep well.
So to summarize:
– For me, the foundation for fixing sleep is sleep restriction. Following this correctly fixes a lot of what breaks your sleep. It fixes your body clock, it generates sleep debt and it minimizes the amount of time you spend in bed agitated.
– I followed my own version of stimulus control. I am sure the pros would object to my version of stimulus control but this modification worked well.
– When my anxiety was at its worst, I practiced relaxation techniques. It gave me something that I could actively do to help myself feel better. Even though in the beginning the relaxation techniques did not yield any significant relaxation or reduction in anxiety, I looked at it like putting money in the bank. Over time, the more I practiced, the better I would get at it.Yes, my recovery was up and down.
Even though I followed my sleep schedule and other CBTi techniques, I would have setbacks.
One thing that helped me a lot when I had setbacks is just knowing the stats. A guy named Donn Posner was a clinician in the east coast of the US for several decades. According to him, in the years he treated patients using CBTi (thousands of patients), he could remember less than 10 that followed his instructions and didn’t see significant benefit. Dr. Posner treated all kinds of people. People with PTSD, with depression, with chronic pain, with cancer. Regardless, if his patients followed CBTi, their sleep would improve.
The lesson I took fro this was that all I needed to do was follow the CBTi guidelines and I would sleep better. Sure enough, it did. In the first year, I had setbacks. But things did improve.
Congratulations.
My personal experience is that over time, sleep only continues to get better. 3 months after starting CBTi, I was sleeping much better and felt like I had my life back though I was not back to being a normal sleeper. I still worried about sleep and had the occasional rough night. But I was sleeping well enough most nights during the week that I was basically able to live my life normally during the day.
After 6 months, I found my sleep and my confidence about sleep was even better. I rarely thought about let alone worried about sleep.
After a year, I was completely and fully recovered. I had no issues traveling to other timezones for multi-day business trips. I even travelled to the other side of the world. Of course, I had jet lag but I used the techniques I learned from CBTi to help me overcome jet lag over the course of my business trip.
So long story short, its great to hear you are doing better. But you ain’t seen nothing yet.
I should add – when I was first taught CBTi, my clinician did not ask me to stop taking sleep meds (ambien). She taught me the techniques, had me follow them and record my progress. She never made a recommendation about sleep meds, one way or the other. She told me to take them if I felt like I needed them.
Over time, I came to my own conclusion that using the techniques, I would be able to manage my sleep even with less medication. So over several weeks, and with the guidance of my clinician, I started to taper down my usage of sleep meds. Eventually, I just stopped meds altogether.
All that to say that CBTi is not necessarily an either / or type of thing. As far as I know, CBTi can be used in conjunction with sleep meds / aides.
Yes. Many many people have used sleep restriction along with other CBTi techniques to “beat” insomnia. Information from a presentation given by Dr. Donn Posner, adjunct professor of psychology at Stanford University:
Studies show that ~80% people who use techniques of CBTi (cognitive behavioral therapy for insomnia) gain significant improvement over their sleep (50-60% symptom reductions on sleep onset latency and wake after sleep onset). Further, ~40% become normal sleepers over time.
According to Dr. Posner, this isn’t just people who are squeeky clean – people who only have insomnia and no other issues. This includes people who have comorbid insomnia (insomnia either caused by or occurring other conditions) also see this benefit. For example, people who have PTSD, chronic pain, anxiety and depression, etc.
Personally, I was able to beat insomnia using CBTi techniques 12 years ago. Not only did my sleep improve over several weeks, over time, I became a normal sleeper.
One thing to note, sleep restriction is only one of the techniques that is part of CBTi. In my opinion, it is also important to go through the sleep related education that is part of CBTi. Part of what perpetuates insomnia is a lack of understanding how sleep works and what we can expect from our bodies. For example, it is not uncommon for me to hear about someone trying to go to sleep at 8pm because they have been having trouble falling asleep. Knowing how sleep works, in my opinion, will greatly help in easing some of the angst people experience when they have troubles with their sleep.
Similarly, people might lay in bed for hours unable to sleep. Personally, I find it uncomfortable and frustrating to just lay there when I am not able to sleep. CBTi teaches a technique such that one doesn’t lay around in bed when not sleeping.
So put another way, I would recommend not to ignore the other key elements of CBTi as they are also very helpful in the journey to conquer insomnia.
Have you read all the resources provided in this website? Its absolutely the very first place to start:
About 12 years ago, I had my first bout of chronic insomnia. It was pretty bad – I had terrible anxiety over it and even had one night of a huge panic attack.
I did all the usual stuff that people with insomnia (and unaware of how sleep works) would do. What they call “maladaptive” behavior. I started spending more and more time in bed. I would lay in bed frustrated, tossing and turning. I would try to nap during the day. I tried sleeping pills which worked a little at first but soon did not. I was freaked out.
Some segment of the population suffers from sleep apnea. I don’t know the numbers but some percentage. And a fraction of those who have sleep apnea have disturbed sleep which eventually lead to insomnia. My guess is that sleep experts like to screen for sleep apnea. They have minimally invasive therapies like CPAP that help. All that to say, no matter what advice you get on how to sleep better, it might be good to get your self checked for sleep apnea.
On to the business of sleeping better…
Trying to sleep for 9 hours is counter productive. Increasing your sleep opportunity won’t necessarily increase the amount of sleep you get. And whatever sleep you are getting is fragmented and likely not very deep. Wouldn’t it be better if you could sleep for a solid chunk of time (e.g. 6.5 hours) and most of it being restorative sleep?
Believe it or not, the way to get better sleep is not to spend more time, it is to spend less time in bed.
The guy who set up this web site put up really good information. Its all in the “Resources” link at the top of this page.
As I said, 12 years ago, I had my first bout of chronic insomnia. Using the techniques described in that resources link, I was able to not only sleep better but eventually, became a normal sleeper again. It took time (a few weeks for a better sleeping pattern to emerge, a few months for the sleep anxiety to die down, a few years to become a completely normal sleeper), it took work, there were plenty of set backs but my sleep got better and better.
Have you educated yourself on how sleep works and what to get your sleep back on track? What’s your nightly / sleep routine look like?
One thing that might be helpful is to adjust your expectations – maybe it is not 8 hours of sleep you need. Maybe what you need is enough sleep to feel refreshed and recharged. And maybe for you, that number for now is 6 hours.
The pursuit of 8 hours of sleep is counter productive for people who have sleep issues. For me, I consider 6 hours good. In fact, I am good with a solid 5.5 hours. When I was a normal sleeper, I needed about 7 and could sleep about 8 hrs on weekends. Right now (in the middle of chronic insomnia), I find that anything between 5-6 is plenty.
My first “sleep coach” told me to land my helicopters before going to bed every night. What she meant was:
- Write down all the things that I needed to attend to. That way, I could look at the list the next day and attend to them.
- Set aside about 1 hour before I go to bed to do something relaxing / not physically or mentally arousing. For me, this was watching re-runs on t.v.
By writing down all the things I needed to attend to, the hope was I would not find the need to ruminate about all the different ways the world would end if I didn’t take care of something. And by spending about 1 hour to do something relaxing, that I would transition from problem solving mode to chill out, you are done for the day mode.
Darin,
Normal sleepers are different than people who are in midst of chronic insomnia. At least, this is what I experienced for myself and what I observer with my family.
All of us have a body clock (a.k.a circadian rhythm). This body clock helps tell us when to sleep, when to wake up, when to eat, etc. One of the strongest anchors for your body clock is the time of day you wake up. If you wake up at a consistent time of day every day no exceptions, then you will feel sleepy roughly the same time every night.
If you go out on Friday night and sleep in on Saturday morning, as a normal sleeper, you will likely tolerate it reasonably well. You will be able to go to sleep at close to normal time on Saturday night.
Do this occasionally and likely, you will barely even know the difference. Do it a lot and you will find it more and more difficult to go to bed early at night. Why? Because your body clock is adjusting to a later wake up time and is shifting your go to bed time accordingly. This is the same experience you feel when you travel to a different time zone. We call that jet lag.
As a normal sleeper, I used to want to get up at the same time every morning. But it wasn’t at all easy. I did the best I could but some mornings, it was just tough to get out of bed. My personal recommendation, if it is not at all inconvenient, keep pretty close to the same get out of bed time + or – 1 hour on the odd occasion that your go to bed time shifts.
As someone who is in the midst of chronic insomnia (which I myself am currently working my way through again for the 2nd time), I would recommend to keep your wake up time the same. I don’t know if it is easier to throw off the body clock of someone with chronic insomnia but I do know that mentally, there is a lot more going. For me, it is not only best to get up at the same time every day, it is also easiest.
One thing to note, I went from someone who was going through chronic insomnia back to a normal sleeper again about 12 years ago. I found that when I became a normal sleeper again, my sleep became every bit as robust as it was before I experienced chronic insomnia.
