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Deb, I think ACT as a tool has actually been around longer than CBT-I. Personally, I believe it it most effect as an alternative for Stimulus Control and used in conjunction with SR. It is certainly more difficult because SC and SR are very prescriptive and ACT is all in your head.
Mac0908, I developed a hyperawareness of body sensations like breathing during the night with my insomnia, I used ACT tools like welcoming and imagining a space within myself for my “awareness” to coexist. This has helped ease my frustrations and much of the hyperawareness then also subsided. This was a huge help to keeping myself in bed and sleep longer.
Steve – have you ever tried Xanax for your anxiety? It is a miracle worker but has to be used sparingly. I have found that on a very difficult night, taking a low dose Xanax 4-5 hours before bedtime is very effective to eliminating sleep onset anxiety.
I have not posted in awhile but thought I would give an update on my struggle with insomnia. I too have read the Guy Meadows book and am a big believer in ACT. ACT as a tool has helped me tremendously in dealing with my OCD issues and many think Insomnia is just another OCD anxiety based condition. My sleep today is much better than it was. I now consistently get 5 hours most nights and some nights have even slept 7+ hours which was unheard of before. I attribute much of this success to being able to reduce my anxiety using ACT techniques and now lying in bed longer without getting extremely frustrated like I used to. This has enabled me to fall asleep more often, even though I still have too many awakenings and light sleep during the night.
While I have seen much improvement, my sleep is still too inconsistent to consider myself “cured”. I think the problem is that I have been real lax with sleep restriction and while I am sleeping longer, my body has still not adopted to a consistent schedule. So this week, I have once again started with a 6 hour sleep restriction window along with using ACT when I am awake in bed(which effectively replaces the despised Stimulus Control). I think I was not ready to eliminate SR which hurt my sleep drive and led to inconsistent sleep.
Hopefully combining the two tools will make my sleep stronger and more consistent like a normal sleeper! I am actually surprised ACT has not been formally taught and included as a tool within CBT-I, along with breathing exercises and progressive muscle relaxation for reducing anxiety.
Borgesbi, is it possible that you are having all these awakenings after sleeping 5 hours that you are just not that tired anymore? Sleeping from 9:30 to 6:30 is a 9 hour window and I do not know many adults that can sleep that long without waking up several times.
Deb, correct me if I am wrong but there really is nothing incompatible between ACT and CBT-I. Practicing acceptance techniques to reduce sleep anxiety can be used in conjunction with SC. The beauty of combining both therapies is that as you get better and better at accepting your situation, you are going to be less frustrated and thus have less need to implement SC. I also see SR as compatible and actually while you can be successful without it, you are much more likely to shorten insomnia’s duration by spending less time awake in bed.
My concern with going back and forth between both therapies is the possibility the insomniac is not ready to fully accept the bad nights. In that case, they are better off remaining consistent with CBT-I and incorporating ACT, than going back and forth.
Deb, sounds like a miracle…congrats!!!!!
Deb, I agree being relaxed is a huge factor too. My only point was that it is unlikely for our bodies to go from sleeping 3-5 hours for months to 7-8 hours over night just because we are now relaxed. Our bodies need to get reconditioned to sleeping longer.
Glad you slept 8+ hours. An inspiration for all of us!
Steve, one more thought. The fact you can fall asleep pretty easily at the beginning of the night is a blessing. I am sure there are many folk here who would consider that alone to be a major success! I firmly believe you (and I) are having a hard time falling back to sleep at 3-4am because our bodies are now used to having very little sleep. It will just take time to slowly build back the sleep drive so I expect to have mixed results getting back to sleep for the time being. I am just grateful to get the consistent 4-5 hours early in the night and have faith that the rest will return over time.
Steve. Congrats. Sounds like you had a pretty good night and you are in a similar place to where I am too. I have been averaging 4.5-5 hours for the past week. I know I would like to sleep more right now but it is probably just not realistic. It takes time to rebuild your sleep drive after dealing with insomnia for many many months. Increasing my total average sleep time by 15 minutes per week is my goal, so I hope to average 5.5-6 hours in a month.
It is a slow process!
Deb, were you taking an SSRI too? I know you had mentioned you were taking an anti-depressant. I have been on Zoloft for 2 months and it fully stopped my sleep anxiety. I am not yet sleeping consistently well but am improving slowly every week. I plan to get off Zoloft as soon as my sleep stabilizes. If you are no longer taking meds, did you have any issue getting off?
Hi Steve. Glad you have had no problem riding. For me it is the best therapy. Takes my mind off of everything but the road. My Harley is 1,750 cc. Big bike but all you do is cruise. Not as nimble as your bikes.
I am not really doing ACT. I do mindfulness mediation when I wake up in the middle of the night which seems to help get me back to sleep quicker when I have difficulty. My main problem with insomnia is sleep anxiety and I starting taking a SSRI 2 months ago which has helped me to be more relaxed about sleep. I am now getting 5 hours every night which I am very happy with. For me light sleep is when I do not even know I have slept. Last night I woke up and 3am and struggled to get back to sleep. I started tossing and turning thinking I needed to get up for SC and then I looked at the clock and it was 4:30am. I clearly slept almost an hour. That made me feel good and I rolled over and went back to sleep.
I am a firm believer that sleep is all about anxiety and first and foremost you need to get that under control, even with medications if necessary. SC is a great tool if you are getting frustrated lying in bed. If you are calm and relaxed (using ACT tools) then there is no reason to get out of bed. Sleep restriction is all about sleep drive and if you are consistent, it will help you sleep and most importantly it will consolidate your sleep. Of all the tools we have for overcoming insomnia, Sleep restriction is the most valuable, at least for me.
I think you can cure insomnia using only sleep restriction, but it would require using a sleep window that is much shorter than 5.5 hours when the person is getting 2-3 hours of sleep. It is really really hard to do, and I think that is part of the reason many of us have struggled.
Hi Steve. A little off topic but what do you ride? I live in AZ and have a Harley Road king. One of my big problems with insomnia has been not being able to ride. I just don’t feel safe riding with less than 5 hours sleep over several nights. I have slept better this week so was able to ride this morning. It was great!!!
Sorry to hear the consolidate sleep went away. I think ACT is great, especially the mindful practices to help accept our current reality and hopefully reduce anxiety. I believe it makes sense to stay in bed if your are calm and not tossing and turning. I would just question if it makes sense to have a longer SW when your sleep is now more fragmented. I think SR is the most important tool in CBT-I and we need to be 100% consistent on the wakeup time and not moving the window until we have 85% efficiency. While SC is important, I believe you can cure insomnia with SR alone. Does Martin agree with the longer sleep window?
Either way good luck. This is quite a journey!
Hi Steve, would you rather have 4 hours of consolidated sleep or 6 hours of fragmented sleep? On week 2 of my SR, I got a few nights of 6 hours very light sleep. I psychologically felt great because I thought I was going to quickly beat this thing. The following week I returned to 2-4 hour pattern but my sleep was somewhat more consolidated. I am now getting 4-5 hours of consolidated sleep but I have not to be able to sleep past the 5 hour mark again since my early SR success.
The funny thing is I feel pretty good with the 4-5 consolidated sleep, certainly as good as I did with 6 hours fragmented. I feel good enough that if you told me I had gotten 6-7 hours sleep last night, I would think I did not have an insomnia problem. It feels like my body has (at least for the time being) adjusted to 4-5 hours as all that I need.
So, psychologically, I would prefer to get 6-7 hours but I am not sure my body is agreeing, at least right now. I am trying to tell myself, that this is just my sleep cycle right now and it is ok because it is consistent, consolidated, and I feel pretty good during the day. I hope that over time it will elongate back to where it previously was but I am trying to celebrate the success I have right now and hopefully not stress about what it is not.
This is the third major bout of insomnia in my life and I am finding that it is a MUCH SLOWER process this time too. I think small part of the problem is I am older now and probably do not require as much sleep as I did when I was younger. My sleep is lighter and more broken up today than 10 years ago, so I think it is just harder to correct. I also know I have not been as consistent as I was the first time I completed Sleep restriction. The first time, I was sleeping 2-3 hours a night so I did a sleep window of only 3.5 hours and I never went to bed early and got right up out of bed. It was very tough but I think it accelerated progress.
This time I am using a 5.5 hour sleep window which is easier but is probably too long. I can see the same slow progress as you, but I think if I had used a tighter window, the improvement would be faster. I have also been a little lazy some nights which I did not do the first time. Consistency is the key to progress and I have not been as good as I was the first time.
It took 7 weeks the first time to sleep well again. I think 4 months sounds about right for me this time too.
Hi SleeplessinHB. I am on week 4 of doing the standard SR. My current sleep window is from 11:30 to 5:30 which may be too long. I always fall asleep right away and sleep from from 2.5-3.5 hours. Then I have a very hard time falling back to sleep. Last night I slept till 3am and then did not fall back to sleep at all. That is why my friends approach was interesting. Does it work better for my type of sleep maintenance insomnia since I have a very hard time getting to the end of my sleep window?
Do you know anyone that has tried my friends approach or did you get in from my post??? Either way, good luck and would love to hear your progress. I am going to give the standard SR some more time, but if I continue to struggle and you make some progress, I will probably try my friends approach too.