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Hi ababak01,
By SC, I assume you mean that you are having difficulty getting out of bed when you haven’t fallen asleep, and then wondering what to do. Like you, I found this difficult. The advice is to get out of bed if you haven’t fallen asleep after 20-30 minutes. Then because you haven’t fallen asleep due to sleep onset insomnia, you find yourself getting in and out of bed like a yoyo for most of the night. Worse, when you do get up, you are so tired and feel so miserable you dont feel like doing anything. If this is what you are describing then this is what I experienced as well.
Firstly, I would advise the night before to sleep to expect that you will be getting up many times, and plan out some things that might pass the time with low mental effort in the middle of the night. Also, make sure you can get out of bed and put on something warm and comfortable. Do nothing stimulating. It might be a low-key TV show. Or an easy book. Or some gentle music. Build some lego. Jigsaw puzzles. Colouring in. Go for a moonlight walk. Build a model aeroplane. Hand write a letter to a friend. Anything. Secondly, I would say it is not necessary to get out of bed every single time you can’t get to sleep. Try reading a boring book while sitting up in bed some of these times. There are even some online sites with people reading boring books to help.
If this is not the answer you were looking for, let me know.
Cheers.Hi Alice,
Mine was almost always sleep onset insomnia. I could be super tired before going to bed, dozing off. My head would hit the pillow. I would just be about to fall asleep, then BANG. Wide awake. No more sleep.
As far as depression goes, its hard to pinpoint what came first. I had terrible anxiety (triggered by a recently diagnosed genetic heart condition). Then insomnia. Then depression. In my mind these are the holy trinity of mental health issues. (Anxiety, insomnia, depression). They all feed off one another to create a very ugly vicious circle in which you spiral down. However, conversely, when one improves (eg sleep), the anxiety and depression seem to improve in a virtuous circle and you spiral back up again. My depression and anxiety is considerably better, although I still have my not so good days every so often.
Regarding the tiredness that comes with sleep restriction. Like I said, this is like torture. But that’s how it works. Eventually, you just get so tired you do actually get some sleep, then a bit more, then a bit more, and so on.
PLEASE DONT GIVE UP. Week 3 is way too soon. I kept a sleep diary, and my sleep had not started to improve after 3 weeks at all (in fact it was probably worse). It was more like 6-7 weeks before I could see any improvement. And then more than 3 months after that I had a setback and had to start it over again (but it was much quicker the second time). However, in the last 5 months I have now been sleeping pretty well. I haven’t had a bad night at all for the last 3 months, and Im sleeping 7-8 hours each night.
I understand how tempting it is to give up. But what else is there? Drugs are not the answer. I would curl up in bed and get my lovely patient wife to hold me while I cried for hours. Depressed, sick with tiredness, and desperate for sleep. But I think CBT is the gold standard of insomnia treatment because it (eventually) works.
I give you all of my heart felt wishes and prayers for you to get your sleep back again Alice. Until recently, I have never been much of a religious person, but when I started sleeping again it has truly felt like a miracle from the heavens.Hi ababak01,
I agree with you that not sleeping is very upsetting, and sometimes the CBT-I feels like it is not working. Also the sleep control/sleep restriction is extremely challenging. Forced sleep deprivation is a traditional form of torture after all!
It took me 7 weeks before I was averaging 6.5 hours sleep per night with ~ 80% sleep efficiency. However even after 7 weeks, like you I was still getting 1 really bad night of sleep per week (eg 1 hour). That is why it is so important to keep the sleep diaries, as they give the better picture of the long term trend to improvements in average sleep hours and sleep efficiency. I totally agree with Martin that you just have to try to overlook the odd bad night.
Even after 13 weeks I went through a really bad patch (in November last year) of several weeks of very poor sleep. However I re-did the sleep restriction and everything came good again.Hi Josephine,
Sorry to hear about your troubles. Don’t worry – things can get much better. What you are going through is very very common, and you are definitely not a failure for having depression and insomnia. They are closely linked together. May I suggest you take a look at some of the courses on offer by the Australian mental health group “This Way Up”. (www.thiswayup.org.au). They have a free online course on insomnia, and the cost of their courses on anxiety and depression are very low. I got a lot of help out of these courses, and they are anonymous and confidential.
All the best to you.
Hi Morning Tea,
My experience with any of these meds which mess with brain chemistry was also truly terrifying. Also what they do not tell you is that eventually withdrawing from them is even worse! This is just my view, but I would avoid any of these meds unless it absolutely a last resort. How can any drug that gives you suicide ideation possibly be a good idea ? Anyway, again this is just me, but I think that Martin’s approach to sleep restriction and Cognitive Behavioural Therapy (while very difficult, and taking a long time) is the only way to recover from insomnia. Also the ACT therapy is very gentle and effective.
All the best,
wshI am not a medical specialist, but I wonder about your use of Lamictal if you are not bipolar. In any event, that is a an anti-seizure drug and one of its side effects is dizziness and drowsiness. I took an anti-seizure drug (Gabapentin) for a while as well and it made me feel horribly dizzy, tired and brain fogged. You might want to look at tapering off this first, because with 7 hours sleep per night I don’t think you have insomnia.
Thanks for all of your kind responses. The most difficult thing with insomnia is that it is so debilitating that we all desperately want to “fix” it. So we madly try “solutions” here there and everywhere, disrupting our inner calm. Of course, the irony is that the harder we try to fix it, the more problematic it becomes. When we are children, generally sleep just comes without us even thinking about it. I think that taking steps in adult life to recover some of that wonder of being a child helps a lot with sleep.
Bluesky – My little suggestion , is to buy a journal try for a while and write down 3 nice things that happened to you each day, and that you were grateful for. For example, it might just be that someone smiled nicely to you on the bus (regardless of whether or not you were sleep deprived). It helped me to start reclaiming some of the joy and wonder in everyday life. Somehow if you write down good things that happened to you in your day – particularly after night(s) of bad sleep, the insomnia starts to lose its grip a bit.TiredTwinDad – That has been my pattern as well (ups and down) but long gradual improvement. Don’t be discourage by 3 bad nights in a row – I had that too. I am in the middle of week 5 of SR. I am now getting up to 7 hours solid sleep and am asleep within 5 mins of my head hitting the pillow. However, I am still fully expecting to have future relapses and will not worry about that if it happens. Here are my stats so far:
Week Average Sleep Time (hrs) Sleep Efficiency (%)
1 5.7 79
2 5.4 82
3 5.4 76
4 6.3 90
5 6.7 96
Go for a walk outside for an hour or so if you can (or maybe inside on a treadmill). I do that and it stops me micro sleeping before the sleep window starts.
Hi Ron. Good to see you are making progress. I am into week 5 of SR and really starting to see the benefits. Like last night I had 7 hours of sleep and was in bed for 7.25 hours. In the last 9 nights I have only had one bad night where I could not get to sleep for a while, but even then I got 6 hours sleep (by breaking the rule about sleeping in only on that night). I am confident that I am really improving now (although still fully expect some future relapses, which won’t disrupt me). I have graphed my sleep hours over the last 3 months and I wish I could share this, as the graph clearly shows how the SR works over time, with much more consistent sleep. Stick with it.
I agree. I am into week 5 now of the CBTi. Last night I slept for 7 hours straight, and have had good or very good sleep the last 9 nights. I have lost the dark patches and baggy eyed look too (and I am 57). I have compared photos of me now and before the insomnia and I look exactly as I used to. So I reckon that for a younger girl with more elastic skin (when the sleep starts happening consistently again) you will go back to the way you used to look before.
Hi Martin,
Many thanks for your reply, and the video link was really helpful. I am not currently working on CBT-i with a therapist, but if you are offering I am keen so let me know whether this is something you can offer. Send me a private email on this please. Actually the sleep clinic I went to in Australia was not as helpful as I would have liked. After a rather expensive sleep study (with a very poor sleep as a result of having a large number of wires and tubes hooked up to me) they told me I didn’t have sleep apnea (which I already knew). They just gave me a prescription for Gavipentin (leaving the dosage up to me), told me to do any online course on CBT-i for insomnia and pretty much left it at that.
Anyway, I am currently just about to finish week 2 of sleep restriction. I am using a 6.5 hour sleep window. So far in week 1 my total sleep time averaged 5.0 hours, and sleep efficiency was 73%. In week 2, total sleep time improved to 5.6 hours, and sleep efficiency has been averaging 86%.
On the basis of these numbers, do you still think it is a good idea to reduce my sleep window from 6.5 hours to 5.75 hours ?
Kind Regards,
Bill Hunter.
I think it helps a bit. I take 300 mg about 1-2 hours before bed, which is a fairly low dose. I am no expert in finding solutions to insomnia, so I am trying quite a few things in parallel at the moment, and it is a little difficult to say which things are working and which are not. I have only taken benzodiazepines in desperation about 4 times in my life (I am 57), and they definitely put me to sleep. Once on those things I slept for 12.5 hours straight, but they are not a viable long term solution because of all the problems associated with them.
