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Mac – Here’s an advantage of going to bed earlier instead of being so strict about only going to bed late when you’re super sleepy. If you wake up earlier, then when you start learning to relax and fall back asleep, you’ll get more total sleep. Don’t think you “paid for it.” It’s just what your mind assumes will happen, so then it did.
Mac – that’s when you use the mindfulness and welcoming tools. These will help you create some “space” between the thoughts and yourself. The thoughts aren’t “you,” they are just thoughts, that’s all. I think Martin said to imagine them as clouds floating away. The two chapters in the book on mindfulness and welcoming explain it the best. As an example, when I was getting fearful I would feel a knot in the left side of my stomach. I decided to use the welcoming tools of giving my sensation a name and using humor. I imagined this sensation as a round, red, furry thing that was all scrunched up with worry. I called him Mr. Worry Wort. When I thought of it in that way then Mr. Worry Wart seemed so pitiful and I felt sorry for him. Then he dissipated and the knot in my stomach and fear went away. So this is how we create space between ourselves and our thoughts, feelings or sensations. Then we can do something about them instead of being dominated by them.
You use the tools both during the daytime as well as the night. It’s usually easier to do it during the day than at night when there are no distractions and they can overwhelm you more easily. The same tools are used whether people have sleep onset like me, or sleep maintenance like you.
These are skills to learn and they take practice and time to get the hang of them.
Hi JT and welcome! Just curious, how long have you had your insomnia? Also, is your type of insomnia sleep onset or sleep maintenance? Mine started in Oct 2018 and was finally healed in August.
Sorry you didn’t have a great night, Steve, but glad that you don’t feel too bad. I found that to be true for me, too, when I was practicing ACT. Most of the nights when I only slept a few hours, amazingly I usually felt decent the next day and not a zombie. That’s great that you’re living your life, too, and not letting it be controlled by insomnia.
Steve – I’m glad you had a better night through preparing ahead of time to accept whatever happens instead of getting frustrated with it. That’s great! About my medication, I’ve only missed two pills so I don’t think this is causing the relapse. As a precaution though, I’ve decided not get off the medication just yet.
It’s really not a complete relapse because I’ve basically been sleeping. It’s just the anxiety about insomnia crept back. But I’m going back to accepting whatever happens again and hopefully the anxiety will go away.
Thank you, Gdsman. Yes, it’s normal to feel fear of insomnia. It was definitely one of the hardest thing I’ve gone through in a long time. I wouldn’t wish it on my worst enemy. But I felt reassured by Guy’s statement that over time the fear will subside as we gain confidence that we can recover from relapses through using the techniques. Gdsman – glad your sleep is getting better too. Too bad about all those creeping things in your house! That would certainly keep me awake!
Mac – sorry for not getting back sooner. It turned out to be a busy day. I’d like to answer your question in a more general way instead of responding to specific questions. The overall goal of ACT is to help us learn how to “do nothing.” But to get to that point, first we have to deal with our anxiety and fears. Guy Meadows calls this process “getting to know our insomnia.” This means getting to know all the negative thoughts, emotions and sensations that are associated with our insomnia instead of running away from them. That’s why we stay in bed. As we get to know them, we then start practicing techniques to neutralize them. This is the “Welcoming” part of ACT where we do things such as “playing” with the fears, having compassion for our fearful parts, and having a sense of humor towards them so that we don’t take our fears so seriously. They are just fears and they can’t hurt us. Most of the folks here on this thread have all gone through this process. This part of ACT therapy is not easy, but essential. In the book Guy Meadows talks about Carlos who had a few really difficult, long nights in the beginning as he was getting to know his insomnia.
Once we start getting the knack of the techniques and the negative thoughts, fears and sensations start losing their power over us then the next step is “Acceptance.” This means total acceptance of the possibility of a sleepless night instead of struggling with it. When we can really get to this place of total acceptance without any expectation of sleep and just lie there in bed resting and “doing nothing,” then lo and behold, we fall asleep! This is because the mind finally gets out of the way and our body takes over. Since my recovery this has hit home as I’ve seen how when I wake up in the morning and think about the night before, I have absolutely no idea how I fell asleep. It just happened! I had absolutely no control over it.
I guess I wanted to answer your questions in this way so that you could see how ACT takes a fundamentally different approach to insomnia than CBT-I. With ACT you develop a different “relationship” with your insomnia, where you’re not concerned about any rules but only about learning to “do nothing” so that you naturally fall asleep.
I’m having a bit of a relapse again, but maybe it’s actually anxiety about a relapse. I was very tired last night but couldn’t fall asleep. That old fear was in the back of my mind. I got up and pulled out Dr. Guy’s book and started flipping through the section on relapse. Funny how even though you have read something before, this time it jumps out at you as if you never read it. There was a very encouraging sentence right at the very end of the section (page 214), “Repetition of the process reduces the power and frequency of insomnia recurrence until it fades away.” In other words, there will be relapses, but over time they will fade if we practice the tools when we relapse.
So then I went back and re-read the whole section on relapse. I realized that I’ve slipped back into my old pattern since the first relapse a couple weeks ago. I started having a drink again before going to bed, hoping it will knock me out and no fears will creep in. In a way I’ve been extending my first relapse by slipping into the old pattern of trying to push things away instead of accepting my fears and my insomnia. So it’s time to get back to the place of acceptance.
There’s an interesting testimony there too (page 213) where a woman talks about how she relapsed after six months. She desperately pulled out all the tools and practiced them one after another trying to “fix” things and get back to normal. Finally she was able to step back and recognize what was happening and then was able to let go and go back to “doing nothing.” So interestingly, we can even use the insomnia tools to keep us awake!
Hi Mac – So sorry for your bad night. Maybe it’s time to convert completely over to ACT since the same thing seems to be happening over and over with SRT. The anxiety is always under the surface ready to rear its ugly head. I would get help if I were you. Maybe contact Dr. Kat from Guy Meadows clinic and work with her. She’s really helpful. Or maybe get in touch with the guy that Martin interviewed recently, Nick Wignal (mentioned in some recent posts here). He uses both CBT-I and ACT and seems to have a lot of experience working with more complicated cases. Take care!
That sounds like a good plan, Steve. Just do something to get your mind off the struggle and frustration. Petting cats is always a good idea! My faithful cat has been with me practically every night I couldn’t sleep for the whole 9 months of insomnia. He’s a grey and white tuxedo and lays next to me on the couch. He stretches out on his back revealing his soft white tummy. Stroking that soft, warm tummy always gets my mind off my troubles!
Steve – Just this week I started weaning myself from Effexor. I’ve had the minimum dose of 37.5 mg and I think I won’t notice the difference when I’m off it completely. That’s how it was several years ago when I weaned myself after having taking it for maybe 9 or 10 years.
When I accepted my wakefulness, I would just lie there and do nothing and let my mind wander, just like before the insomnia. I don’t think frustration is compatible with acceptance of wakefulness, at least not while you’re in bed. You want to do nothing and think nothing in particular. When you’re frustrated, you’re “struggling” with your insomnia again. Check out page 72 in the book.
Whenever I “caught myself in the act of struggling” in anyway with my sleep, then I knew that I needed to push that “wakefulness acceptance button” again. Lots of times I would get up and journal because it was hard for me to get out of that struggling state while in bed. Once I started writing in my journal my mind would become clearer and then I would realize that I was struggling again, smile at myself, push the button and then go back to bed (and usually fall asleep).
Maybe it should be called ACT-I just like cognitive behavior therapy specifically for insomnia is called CBT-I.
Ron – great to hear from you again and glad you’re doing better. Hope your plan helps you get better sleep. About ACT not being formally taught, I wonder if most people just never heard of it. Just like a lot of sleep doctors never heard of CBI-I, ACT is even less known since it hasn’t been around that long. Also, probably those who have heard about it, haven’t heard much success stories. Like many of us who first started ACT without any help, it was confusing and takes some time to develop the skills. So they might have heard more stories of people who tried ACT and then gave up.
Borgesbi – like you said, acceptance of wakefulness is the key. When I learned to accept this, then I finally started to fall asleep. Dr. Kat said that this is the main factor that determines how long it takes people to recover.
Steve – I took a medication for anxiety, Effexor, and I think it took some of the edge off my anxiety. So I see nothing wrong with taking something for the anxiety.
Karen – that’s great that you’re sleeping well! It sounds like you still have some anxiety though, which I know I do too. Having this insomnia was traumatic and there’s still some fear of it coming back. So sometimes like last night I find myself worrying that I might have trouble falling asleep after I get in bed, for whatever reason. Then I get up for awhile and go back when I’m feeling more tired. I’ve done this now for a few nights and it’s messing up my schedule.
So I feel as though I’ve healed from the insomnia, but now I’m in a stage where I need to heal from the fear of it coming back. Sort of like a secondary level of healing. Oh well. Wish I could be completely free of this and any after effects and go to bed completely worry free like the old days.
Sorry you had a bad night, Mac. The exercises I did you already heard of – welcoming and acceptance. Welcoming anxiety neutralized it and then acceptance of whatever was going to happen each night put me to sleep.
I’m sleeping very well these days. Just a short relapse of 1 day a couple weeks ago when I started to worry about relapsing. Let that thought go and soon I was back to normal.
