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Check out Guy Meadow’s book, The Sleep Book, which is based on ACT. There’s a thread on this forum for people using ACT and another thread for people doing sleep restriction (SR). They are two different approaches to healing insomnia. I used both methods, but ultimately ACT helped me recover more completely.
Jamie – The 2 days out of 7 that I couldn’t sleep while doing SR I also experienced that the sleep drive did not override the anxiety. It was very frustrating. That’s why I decided I needed to try ACT which deals directly with the anxiety. Are you able to practice mindfulness during the day? It’s easier to learn how to do it during the day than at night when the anxiety is so high and there are no distractions. Once you get the hang of it then you can practice it at night too.
Also with CBT-I many people see results fairly quickly. In my first week I was sleeping 5 out of 7 nights. My body seemed to love SR and it fell into the groove of the strict sleeping schedule quite naturally. Results may not come quite as quickly for you, but they may come quicker than using ACT. Seeing progress will do a lot towards reducing your anxiety.
Jamie – just one more idea that came to me concerning you. Maybe for you at this time it might be better to just completely focus on doing SR & SC and doing it religiously for at least four to six weeks. It might be too much for you right now to think about trying to change your thoughts and practice acceptance.
Martin said that when doing SR & SC, you should do like a ROBOT, without thinking at all about it. It’s just something you have to do every day even though you don’t feel like doing it like driving to work each day during rush hour. Don’t think about anything at all and JUST DO IT (like the Nike commercial). It might be better for you to even get off this forum while you’re doing it so you don’t get confused with all the conversation about ACT, changing our thoughts, acceptance, etc. (Or you can just ask for get help with CBT-I. We’ve all got plenty of experience). Then your mind can relax because you know that you’re doing what you need to do and that’s all that matters.
It might work really well for you like it has for many. There are lots of testimonies on this website from people who have recovered using only CBT-I. When I did CBT-I I started sleeping 5 out of 7 nights which was a huge improvement. My anxiety went way down because of that and my confidence in my ability to sleep went way up. Maybe this would be more helpful to you right now. You could always come back to ACT later if you wanted to. But it seems that right now you really need help to get your anxiety down and CBT-I might be better because you don’t have to think about anything – you just do the program.
Just curious, Burn, why don’t you just let your mind wander? You said you would love to be able to do this.
Jamie – Acceptance with extreme discomfort will never put you to sleep. So you need to find a way to calm yourself in bed and during the day. That’s where mindfulness and welcoming come in. Maybe do what Borgesbi did. She worked on her negative thoughts and feelings before she went to bed. At first it took her 2 hours. Within a few days it took only 15 minutes and even less after that.
Sorry about everyone’s rough night. I’m still not fully recovered from the relapse and last night I was awake for a long time even though I went to bed exhausted. But overall I got enough sleep and feel fine today.
I think I’m lucky in some ways because I’ve always had only onset insomnia. So I’ve learned to accept whole nights of wakefulness, unlike you folks with sleep maintenance who wake up too early and then practice acceptance for a few hours. So when I go to bed I accept that I may not fall asleep the whole night. When I’m not able to sleep it could be 2, 3, 4:00 or even later before I finally fall asleep. I don’t know for sure because I don’t look at the clock but I can tell it’s been a long time. Somehow I manage to get enough rest though, whether it’s a few hours at the end of the night or maybe I’m in light sleep part of the night, thinking that I’m still awake. That’s how it was last night. I’m fine today.
So from the very beginning of the night I’m accepting that I might not sleep all night. But through experience I’ve found that if I have this attitude of complete acceptance and letting go of any expectations, eventually I do fall asleep or am in light sleep and wake up feeling pretty good the next day.
I’m saying this to try to encourage those of you like Delv and others who get frustrated. Frustration doesn’t help. Acceptance is the key.
Mac – that’s great that you’re implementing ACT. You may also want to add acceptance of your sleeplessness when you wake up. Then eventually you’ll fall back asleep and maybe stop waking up early as well.
Mac – I’m sure that you remember that my primary frustration with CBT-I was that it wasn’t getting to the root of my anxiety. 5 nights out of 7 I managed to keep the anxiety at bay and fall asleep, but on the other two nights the anxiety won out. ACT gets to the root of anxiety and helps you learn how to let go of it so it’s not there underneath the surface ready to spring up just when you think you’re cured. I agree with Steve, too, that hanging out in bed was a good thing. It’s creating an association of relaxation with your bed. Of course there is always going to be the honeymoon period for a few days because you get your hopes up. But then reality hits. The thing is to keep doing what you’re doing so that eventually the fears of hanging out in bed will go away. The goal is letting go of all anxiety which is the cause of insomnia in the first place.
Delv – It sounds like you’re doing well overall in comparison to months ago. You’re relaxing more and more about sleep, not worrying about your sleep window or doing a sleep diary and other things. I’m sure as you continue to learn to relax, you’ll continue to get better.
Jamie – I’m so sorry that you’re depressed. All of us have been there, believe me. Maybe especially within the first few months because we go from sleeping normally to this horrible condition and wonder if we’ll ever recover. But you will. I was so bad that I had to go to the emergency room for help with my despair. I finally got on an antidepressant which took off some of the edge. But I kept going, trying different things – first CBT-I for 2 months with Martin, then 1 month of ACT but without any help, then back to CBT-I for another 2 months and then back to ACT, but this time with help from Dr. Kat from Guy Meadow’s clinic. When I finally implemented ACT the second time and understood how to practice acceptance, I recovered in two weeks. So never give up. Continue CBT-I for a few weeks to see if it helps. If not then switch to ACT. We can help you here with ACT because it’s more tricky. You don’t “do” things differently like practicing SR or SC in CBT-I but you learn to “think” differently, which is more subtle and needs some coaching to understand and get the hang of it.
One other note about CBI-I. Because I was sleeping consistently 5 days out of 7, I got back my confidence that I could sleep and my anxiety was reduced. So when I went into ACT I had less anxiety to deal with.
Slept well again last night.
Steve – I only relapsed once, but it took me awhile to hunker down and start practicing ACT again. Now that I know that I can get back into the groove again fairly easily, I won’t waste weeks struggling and will get back with the program sooner.
Burn – Just let your mind wander all over the place when you go to bed just like you did before the insomnia. Then your brain will start associating going to bed with making no effort and you’ll start falling asleep more quickly.
CBT-I gave me back confidence that I could sleep. But ACT is what helped me learn how to “stop thinking.” The change in attitude from struggling with insomnia to accepting it on a nightly basis led to this nonthinking state at night. Once I knew what acceptance “felt like” then I could push that “acceptance button” as Borgesbi said awhile back. Then my mind would relax and start wandering and eventually I would fall asleep. In the beginning it was just one or two hours of sleep, or light sleep or in and out of sleep all night. But over time the sleep lengthened and deepened.
Hi Everyone,
I was out out of town for 4 days and after catching up on other things at home, I’m finally catching up on the posts here. Last week I had finally begun to re-implement ACT after a few weeks of resistance, confusion, traveling and sleeping pills. I had just finished my second night of ACT when I last wrote here. I slept well that night and felt I was back on track again. Then something unexpected came up and I had to go out of town that very day. At that point I didn’t feel completely confident about my sleep since it had only been two nights, so I brought along my sleeping pills just in case. Sure enough, I couldn’t fall asleep after a couple hours so I took a pill that night and the rest of the nights I was gone because I really needed to be alert during that time.
I got back home Monday and started up ACT again that night. I was awake most of the night or in light sleep, which I figured might happen, since I was giving up my prop, the pills. But I woke up the next day feeling fairly decent and was able to function fine all day. Last night I fell asleep soon, so I’m feeling again like I’m back on track.
Steve – that’s great that you are sleeping an average of 6.5 hours each night! You have made so much progress over the weeks. I agree with you that acceptance of whatever happens including a sleepless night is the key, and it’s why you’re improving so much. When I talked to Dr. Kat, she said this was the number one factor that determined how long it would take to recover. It can take some people awhile to finally really understand what acceptance is. I can see that you really “get it” so now you’re sleeping so much better. Also, I really love this method because when there’s a relapse, I don’t have to do or worry about anything. I just go to bed, relax and let my mind wander, just like I did before the insomnia.
Jamie – just want to clarify a big difference between ACT and SR and how there is some incompatibility between the two. In ACT, sleep is not “driven” by building up the sleep drive, but by relaxation and getting your mind out of the way so that the body automatically takes over and puts you to sleep. So you don’t work on building up your sleep drive. You just go to bed when you’re tired and then relax. You don’t have to get super tired and sleepy, but just get to the place of the usual amount of tiredness like before you had the insomnia.
TiredDad – when practicing ACT it’s best to stay in bed. If you’re experiencing anxiety and you feel that you can’t calm yourself down in bed, then get up for awhile, calm yourself and then go back to bed, relax and accept the possibility of a sleepless night. This attitude will eventually result in you falling asleep, maybe not the first night or second, but eventually. Listening to a podcast on the couch is not going to help you reach your goal either. On my first night of giving up any props (in my case alcohol or sleeping pills – in your case the couch and the podcast) I usually have a long night of wakefulness. But I stay in bed and eventually I do get at least a little sleep, even if light, and usually feel functional the next day. Then the next night it gets better. So it’s best to stay in bed and accept the fact that it might be a long night and you might not fall asleep. The more you do this, the more likely you are to fall asleep and the periods of wakefulness or light sleep will become shorter over time.
Dazzio – have you read Guy Meadows book? He talks about the importance of using mindfulness during the daytime to calm ourselves down, which in turn will help us feel calmer in bed at night. When we stop worrying about our insomnia and tiredness during the daytime, we’ll feel less anxious at night.
Burn – I don’t understand why you don’t just let your mind wander. What did you do before the insomnia? Both Steve and myself let our minds wander and are sleeping better. Remember, you’re trying to get the mind out of the way so that the body can take over and put you to sleep. Any kind of mental effort is going to get in the way of that.
Mac – yes, you can do external things too, but the internal anxiety has to be dealt with. As I remember you saying earlier, you tried a whole bunch of different external things before you heard about CBT-I and they didn’t really help. Since you’re cutting out the pre bed walk which gave you anxiety, don’t be surprised if the anxiety shows up while hanging out in bed.
Fell asleep last night without any problem. Hoping I’m on the mend. Mac, the great thing about ACT is that you finally learn to deal with any anxiety related to sleep. Even for myself, I’ve had to face the anxiety of a relapse and hopefully now having faced that, it will be less fearful next time and it won’t take me a whole month to finally get around to dealing with it! So the thing is to face all your anxiety, whether it is relaxing in bed before sleeping, sleeping in bed instead of the couch, etc. As we face and learn to deal with our anxiety, then it becomes less threatening and loses its power. Then we become more and more free to sleep under any circumstance, not being limited by our fears.
