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Sara lived with insomnia for a year and resorted to sleeping pills because she didn’t know how to improve her sleep. Luckily, Sara did discover cognitive behavioral therapy for insomnia — and after just eight weeks of implementing CBT-I techniques, she went from averaging four hours of sleep each night to six hours of sleep each night. One year later, Sara now averages seven hours of sleep and no longer takes sleeping pills. In this episode, we’ll learn more about how Sara got her sleep back on track and how she regained confidence in her ability to sleep.
Click here for a full transcript of this episode.
Martin Reed: Thank you so much, Sara, for coming onto The Insomnia Coach Podcast today.
Sara Flaherty: It’s okay. No problem.
Martin Reed: Can you start off by just telling us when your sleep problems first began?
Sara Flaherty: It was the summer of 2017. I’ve suffered from health anxiety for a long time, but it was particularly significant then. And from having been a person to have perfect sleep and could sleep anywhere at any time, I suddenly started waking up in the night with these health worries and then just got a massive fear that I couldn’t go back to sleep. And it sort of escalated from that summer.
Martin Reed: Yeah. So was your main difficulty just falling asleep at the start of the night, or was it more to do with you’d just find yourself waking during the night and then just finding it really hard to fall back to sleep? Or maybe both?
Sara Flaherty: It was a little bit of both, but more when I woke up in the night. Sometimes, though, I couldn’t go off to sleep initially, and then even waking in the night, I still couldn’t go back to sleep. But mostly it was waking in the night and then not being able to go back at all.
Martin Reed: Do you think that you had difficulty falling back to sleep or just falling asleep at the start of the night because you were worried about health issues, or was it specifically you were worried about sleep? Or maybe it started off as one and progressed into the other?
Sara Flaherty: It started off as one. It started off with waking because I was worried about certain things, but then it got to the point where that was sort of at the back of my mind more and the fact that I couldn’t sleep was the big fear. I’d wake up and I’d think, “Oh my God. I can’t go back to sleep. I’ve got to function tomorrow. I’ve got to go to work. What am I going to do?” And then I just couldn’t go back to sleep.
Martin Reed: Yeah. How long was this going on for before you… For people that don’t know that you enrolled in my online coaching course, how long were you experiencing these issues with sleep before you found out about cognitive behavioral therapy for insomnia techniques?
Sara Flaherty: It was about a year I had poor sleep, and it got to the point where it was affecting my life so badly I just knew I had to do something. So I Googled and tried to get some research on techniques to help me, but I felt I needed more than that. Where I live, there’s not a lot of support for anything psychologically as a problem. So I just had to find some help. So that’s what I did.
Martin Reed: Before you found me, before you found out about CBT-I, what kind of things did you try to help improve your sleep? Because I find that people with insomnia, they’re kind of experts when it comes to all this long list of tools and techniques that they’ve tried or they’ve heard about. What kind of things did you try, and did you find any of them helpful before you found CBT-I?
Sara Flaherty: Well, I did have to resort to sleeping medication because I just thought, “What can I do?” I was worried because I was not sleeping hardly anything, and I thought, “I need to get some sleep somehow.” So I did try herbal remedies first, and then I actually went to see a doctor and he prescribed me something which is a bit stronger. And I was sort of using those, but I was also trying to use some techniques like relaxation, music, anything really, talking to people, going on the internet, looking at forums of other people if they have any ideas.
Sara Flaherty: But I just thought I needed to speak to somebody and have more contact with them so I could have some techniques given to me. I felt I needed something more personalized.
Martin Reed: Right. Yeah. Had you ever come across sleep hygiene when you were looking into solutions for insomnia?
Sara Flaherty: Yes. I Googled everything because I’m a big Google person, and just trying a bedtime routine. And that does help to get you to go off to sleep, but then my biggest problem then was when I woke in the night, not knowing what to do then, because you’re already in bed. You’ve done all that preparation for sleep.
Martin Reed: Yeah, absolutely.
Sara Flaherty: So it’s the waking up.
Martin Reed: Yeah. It was a bit of a loaded question there because pretty much everyone with insomnia has tried and heard of sleep hygiene because it’s kind of the first thing that you hear about as soon as you Google “how to improve your sleep” or talk to people that aren’t really familiar with insomnia. They’ll always mention sleep hygiene. But it’s really interesting because you mentioned that sleep schedule, which is probably really the only quite helpful part of sleep hygiene for people with insomnia.
Martin Reed: But I think it was really interesting what you just said was it’s fine to prepare and help set the stage for falling asleep, but how is sleep hygiene going to help you when you wake during the night? Because there’s really no guidance.
Sara Flaherty: I know. You can’t get ready for bed again.
Martin Reed: Exactly. Yeah, because sleep hygiene really is this preparation process, just helping make sure the environment is helpful for sleep. It doesn’t really do anything when the struggle is more internal.
Sara Flaherty: No, it doesn’t.
Martin Reed: Okay. So let’s fast-forward now. You enrolled in… You found me. You heard about CBT-I. Had you found out about cognitive behavioral therapy for insomnia techniques before you found me, or was it you found my website and that was what prompted you to discover CBT-I?
Sara Flaherty: I was aware of cognitive behavioral therapy for health anxiety previously, so I knew that those techniques can help you rethink your way of thoughts. I hadn’t really heard of it for just insomnia, but I came across your website and I thought, “I’m going to try this.”
Martin Reed: Okay. So you started to try it. You enrolled in the course. So you start to pick up. First of all, you start just by learning more about sleep in general just because a lot of people with insomnia, they have these beliefs about sleep that either aren’t very accurate or they’re just not very helpful, like this idea that we need to get a certain amount of sleep. Eight hours is the classic. And then we move on to the more behavioral side of things with the CBT-I techniques, such as creating that sleep window to help build sleep drive to help you overpower that arousal, that anxiety that interrupts sleep, and getting out of bed when you can’t sleep, all these things that you’re now familiar with.
Martin Reed: As you were going through the course, what would you say the key things were that you learned that you really found helpful?
Sara Flaherty: Well, initially, I started off your course with sort of the trial, free trial. Your advice with the emails were enough for me to think, “Oh gosh.” I was looking forward to them, so I was thinking every day you sent me some tip. And when I got to the end of it, I thought, “I need to do more with this.” So when I actually started the course, it was… Of huge, big support for me were your feedback with emails. It was so personalized and so long, and it was almost like you were talking to me.
Sara Flaherty: All of the techniques you were giving, I knew that if I tried them I could speak to you about it. Not speak, but type to you about it. So I have to say all the things that you were telling me to do were working, and they gradually started working. The more they continued to work, the more confidence I had that it was going to be successful. But it was quite hard. It was quite hard to do. I’m the sort of person that just needs the step-by-step approach, and that’s what your course did for me, definitely.
Martin Reed: Well, that’s good. I think it’s really important to emphasize that the techniques themselves, they’re quite straightforward. They’re quite simple when you read about them on paper, but they can be really hard to implement. They can take a lot of effort and a lot of commitment and consistency, especially because it can take a little while for you to see results. For example, if suddenly you’re told to, instead of spending eight or nine hours in bed in the hope of getting more sleep, it’s suggested to you to maybe spend closer to five and a half, six hours in bed, that can be a hard initial mental obstacle to get over. And the idea of getting out of bed when you’re in bed tossing and turning, trying to sleep, that is a concept. How is getting out of bed going to help me get more sleep? These are really hard concepts. Right?
Sara Flaherty: Yeah. But do you know when you suggested the sleep window and mine was five and a half hours, I actually looked forward to not being in bed that long because I used to get so stressed being in bed thinking, “I can’t sleep”? The hardest part was for me to stay awake until 12:00 midnight, and then I was still waking in that five and a half hours and going down for a half hour, coming back, and then knowing that I was to get up at 5:30.
Sara Flaherty: But I just did it. Even when I went on holiday, I did it. I just thought, “I’m going to do this because then I’ll get more tired, and then eventually, in a couple of days, I’ll sleep for that five and a half hours.” So I just continued with it.
Martin Reed: That’s really good. I like the way you just said, “I just did it,” because I think it can be… I think the battle with the internal debate that can go on is a real big barrier to sleep, those mental gymnastics. “Should I go to bed now? Should I get out of bed? Should I be going to bed now? Should I stay in bed? Should I do this? Should I do that?” But if you just tell yourself, “I’m just going to do it,” it’s almost like pretending you’re a robot, engaging that robot mind. “I’m just going to do it.” It just eliminates all of that mental effort where, “Should I do this? Should I do that? Oh, maybe I’ll have a day off today.” You just do it. I think-
Sara Flaherty: Yeah, I did it because I had an eight-week block off from school. I’m a teacher. And I knew that that was my time to do it. I had time to implement it all without having to work as well. But you have to do it regardless because even there’s periods of time now that everybody gets problems with sleep, and stresses in work can make it more so. I still have to go to work now, but I still do those strategies. So it’s possible to do. You don’t have to have a holiday to do it.
Martin Reed: Yeah. Yeah. Absolutely. Yeah. I normally actually suggest to people to try not to make any changes to their lives whilst they’re implementing the techniques, just because if nothing else, when we go to work each day, it forces us to have that daytime routine. So it avoids that temptation of staying in bed for a little bit longer, maybe taking those daytime naps or trying to conserve energy. Also, if nothing else, work is kind of a distraction. The more you’re working or doing something else, the less time is available for you to dwell on sleep, and maybe you can just catastrophize about sleep.
Sara Flaherty: Yeah. I definitely think you have to have your mind taken off… If you’ve got a job or children, you’ve just got to get on.
Martin Reed: Yeah. Absolutely. And I think if you’re not working at the time or if you’ve taken a day off or whatever, it’s just so important to do something else, just to be active. It doesn’t mean you have to be out there running a half marathon or anything like that, but just having something to fill your days with, just to occupy your mind so not only are you less likely to be dwelling on sleep, that you’re just recognizing that you can have some good moments during the day even after a bad night of sleep.
Sara Flaherty: Yeah. I’ve definitely done that.
Martin Reed: If you do something that you really enjoy like pursue a hobby during the day, if you can do that and just engage your mind and enjoy yourself, it can just help you recognize that although a bad night of sleep is hard, is something that we don’t want to go through, it is possible to actually have a good day, if not a good day maybe just a few okay moments during the day after a really hard night. And just changing that mindset can be really helpful at reducing the pressure you put on yourself to sleep and just reducing that worry that you feel about what the next day is going to be like after a hard night.
Sara Flaherty: Yeah. Definitely. I agree with that because that is the big fear when you wake up is that… Are you going to be able to function the next day? But you can. You can do it, because I do it. I do it. If I have a bad night’s sleep, I can still do that.
Martin Reed: Yeah. I think people with insomnia are experts at getting through the day after a bad night of sleep or no sleep. They just seem to have almost this extra-human ability to get through the day, and it’s quite ironic that this is one of the main fears of people with insomnia is how to get through the day the next day. But if you just take that step back and just think of all the times you have got through the day, it’s pretty much every single time. Sure, the day might be more difficult, but you do get through that day.
Martin Reed: It’s just kind of amazing. I’ve heard stories of people that had these really important job interviews the next day. They’ve been living with insomnia for years, and of course, once you top that off with the worry about the job interview, it led this person to no sleep whatsoever. And this was a really high-pressure job interview. They got through it. They got offered the job, and that was after no sleep and years of insomnia. It’s just amazing how people with insomnia do have this incredible ability to get through the day, but yet that’s one of our biggest fears when we have insomnia.
Sara Flaherty: It definitely is.
Martin Reed: You also mentioned… What I thought was interesting was when you were observing this shorter sleep window, so you were allotting less time for sleep just to help consolidate your sleep more, that you actually ended up looking forward to not being in bed.
Sara Flaherty: I did. Yeah.
Martin Reed: I thought that was interesting because a lot of people, they feel a little bit worried or maybe it triggers a little bit of anxiety when you suggest to them to spend less time in bed or to get out of bed when they’re struggling. So can you tell us a little bit more about this? What was it about allotting less time for sleep that you liked? Just explain a little bit more about this whole feeling of looking forward to not being in bed.
Sara Flaherty: Well, for me, I was so anxious trying to go back to sleep. Sometimes I would go to bed earlier to think, “Oh, I’ll have longer now in bed to have more opportunity to sleep.” But it made the anxiety worse. So for me to just know that I had five and a half hours to deal with, it just made me have a schedule for my night and that that was the only amount of time I had to sort of think I’d be worrying, so that that half hour/half hour throughout that night I’d have some sleep within that five and a half hours. But I knew that I could then just get out of bed and not worry anymore. It sounds really silly, but it seemed a lot better for me to have that than be in bed for 10 hours with even more stress because most of that time I’d be awake.
Martin Reed: Right. Yeah. I think that’s a really important insight. The reason I wanted to just explore that a little bit more was because it is a common concern among people when they’re first implementing the CBT-I techniques, spending less time in bed, getting out of bed when you can’t sleep, because the concern is, “Well, that’s going to just make me more awake.” Did you find that the process of getting out of bed during the night when you couldn’t sleep… Did you feel that that led to less sleep or made you feel more awake?
Sara Flaherty: No, it didn’t make me feel more awake, because I was already quite awake. The only thing I found with the knowing it had to be a banked half an hour was that I knew I wasn’t supposed to look at the clock, which I didn’t. But what helped me know that I was only in bed for half an hour when I was in bed was I used to put a meditation CD on and just listen to that, which was exactly half an hour. So I knew that if it stopped that I’d been in bed for half an hour and I need to get up again. But quite often, then, I’d be asleep halfway through that.
Sara Flaherty: So I sort of used my timing with that. But, no, it didn’t make me feel more awake. Definitely not. As I was going through that five and a half hours, I was getting sleepy, and you definitely sleep within that time anyway. I don’t think there was one night where it was like half an hour throughout the five and a half hours and I didn’t sleep at all.
Martin Reed: Yeah. Yeah. That’s-
Sara Flaherty: I managed to sleep.
Martin Reed: Yeah. That’s important. I think, too, you kind of hit the nail on the head there where it’s not pleasant to be in bed when you can’t sleep. It just doesn’t feel good, that tossing and turning, the frustration, the worry, just the way your mind works. So I find that it’s often just more pleasant just to get out of bed when you’re going through that struggle, so rather than seeing it as this process that’s just going to be torturous, “Getting out of bed is just going to be torture for me,” well, a lot of the time just staying in bed can feel just as bad, if not worse.
Martin Reed: So if you’re in that unpleasant place where you’re just really battling sleep and you’re in bed and you feel like you’re fighting with it, then usually it’s more pleasant… A more pleasant alternative is to just get out of bed and just do anything else, anything that you find relaxing and enjoyable, until you just feel a little bit more calm again, and then returning to bed and just seeing what happens then. It’s almost like this mental reset switch. Just get out of bed. Take a breather. Distract yourself with something else and then go back to bed. Do you find that familiar? Did you find that helpful, the just getting out of bed to reset things?
Sara Flaherty: No, it was. And I can recall mostly the first part of that cause. I was actually in a cottage with my parents, and so we went away for a week. I was implementing all this then, and I would. I’d just go down and just be in the quiet lounge for a little while, and then I’d think, “Right. Okay. That’s about half an hour.” I’d sort of calm myself down and go back to bed, put that CD on again, and it was just a routine to me that helped me know that I was doing things that I should be doing rather than just lie there thinking, “Am I going to go to sleep? I’m not going to go,” because I was actually telling myself, “I’m not going to go to sleep.” So, for me, that window, that sleep window, I needed it definitely.
Martin Reed: Yeah. That’s great. Okay. So we talked about these two specific techniques that you were following, the sleep window, sleep restrictions, just reducing the amount of time that you’re allotting for sleep, and getting out of bed when you’re struggling. It sounds like you found those helpful, but were they helpful right from the start? Were there any particular techniques that you found really hard to implement or struggle with? Maybe they got easier over time or you just felt, “No, this isn’t for me. This is not going to work for me.”
Sara Flaherty: The sleep window was hard initially, but then you just get used to it.
Martin Reed: Upon reflection, when you think back over just all the techniques that you learned over the eight weeks of the online course, what would you say were the key things that you learned as you went through the course that had the biggest effect on improving your sleep?
Sara Flaherty: I think the restriction of the sleep, and then eventually, I knew that I could increase that and as I was getting better, I could have a longer sleep window. All your advice, and when I had little hiccups… At one point I… Because I Google quite a lot and try not to now, but I was getting worried about the health effects that the insomnia could have on me. You were great in getting back to me and just putting my mind at rest that it’s not such a big problem. I remember some things you typed to me, just, “It doesn’t matter if you don’t go to sleep.” That was a big help for me.
Sara Flaherty: I’d tell myself that if I woke up. “Oh, sorry, it doesn’t matter if you don’t go to sleep.” And then it sort of just eases your mind. It makes you think in a different way, “Don’t put such large, huge thoughts about your sleep.” And then the sleep gets better, and you just try and keep calm and just think rationally more, which I wasn’t doing. But, no, I just think you have to sometimes follow the tips you’re given and just keep going with it because nothing comes easy. I think some people want an instant cure, and you haven’t got an instant cure.
Martin Reed: Yeah. Absolutely. I think what you just explained is going to sound… A lot of people that are listening are going to really identify with what you just said in terms of the Googling and the reading about the health effects of insomnia and that feeding into the worry, and maybe then just trying to put that pressure on yourself to sleep, to try and control sleep. Sleep is one of these things that the more we try and control it, the more difficult it becomes. It’s kind of this thing that’s the exact opposite to everything else we know.
Martin Reed: For example, I like to say if we decide we want to become doctors, we go to school. We put in all that intense effort. We study. We sacrifice things. We just make that our goal. And if we put in enough work, enough effort, then we reach our goal. We get our degrees. We do our residencies. We become a doctor. But with sleep, if we want to improve our sleep, as soon as we try to sleep, as soon as we stop studying all about sleep and researching sleep and just spending all of our days reading about it and putting effort into sleep, it just does the exact opposite outcome. It makes sleep more difficult.
Martin Reed: I think that it’s really important to just emphasize that. The thing with sleep is it’s really just… Because it’s this internal biological process, it’s something we just need to learn to leave alone and just kind of have to trust in our body’s own ability to sleep because just as our body will breathe by ourself… We don’t need to pay attention to our breathing. It will sleep if we just take that step back and try to worry less about it and certainly try to control it less.
Sara Flaherty: Yeah. I think, definitely, that is the case with the control because I do like to be in control of everything, and I think that’s when you feel that you’re out of control. But I tell myself that everybody’s capable of sleep. Everybody can sleep. Everybody goes through the sleep cycles and wakes up throughout the night. It’s just that some people aren’t aware of it very much because they go straight back into another sleep cycle, and some people are much more aware of it. And the fear starts when you’re out of that sleep cycle for a period of time and worry about it.
Sara Flaherty: But I know that I can sleep, and I also know now, even if I do have bouts of difficulty sleeping, it won’t be for long because I just do the strategies again. I don’t take sleeping tablets anymore, and I did used to have to take them. So they’re not a long-term solution, and I know with my health worries that I didn’t want to take them for long term anyway.
Martin Reed: Yeah, and I think it’s important… What you just said, as well, is so important, that it is normal to wake during the night. Wakefulness is part of sleep, so it’s completely normal to wake during the night. And, like you suggested, it’s more to do with just our reaction to those awakenings that determine-
Sara Flaherty: Yeah. It is exactly.
Martin Reed: … if they’re going to be a problem or not. So if we worry about them, it’s going to make it immediately harder to fall back to sleep. The people that just don’t give sleep a second thought, that have never experienced insomnia, they’re still waking during the night for these short periods of time, but they just don’t pay any attention to these awakenings. So they’re very short, and they probably don’t even remember them even occurring.
Sara Flaherty: I know exactly the same. That’s how I used to be before I went on the course. Most people are not aware that they wake. It’s the people who’ve got insomnia that are.
Martin Reed: Yeah, and again, that’s another really important thing that I like to try and emphasize, is that when you have insomnia, it’s really tempting to talk about sleep with people that don’t have insomnia, just to compare your sleep with others. If you talk to someone that’s never thought about sleep, “Oh, well, how much sleep did you get last night?” well, first of all, they’ll probably give you this little blank stare because they don’t know because they haven’t really paid any attention to it. But then they kind of just think, “Well, okay, I got in bed at 11:00. I got out of bed at 7:00. So eight hours.”
Martin Reed: But it’s very unlikely that they actually spent that full amount of time asleep, because it takes time for us to fall asleep as soon as we get into bed. It’s very unusual to just… Your head hits the pillow and you’re asleep. All these awakenings during the night, even if it’s just to go to the bathroom, and then a lot of us will gradually wake up a little bit before we get out of bed. So once you add up all those little awakenings, time taken to fall asleep, time taken to wake up and get out of bed, they’re probably closer to six, maybe seven hours of sleep.
Martin Reed: So that can just lead to more worry because you’re thinking, “Well, this person’s getting eight hours. This person’s getting eight hours,” when in fact they’re probably getting much less than that, but it’s no problem for these people because they’re not thinking about sleep. They’re not monitoring their days for the effect of their sleep. And they just take this hands-off approach, so they have no problem with sleep.
Sara Flaherty: Yeah. I’ve had conversations when people have said to me, “Oh, but you’ve got to have a minimum of eight hours’ sleep.” I said, “Well, actually, you don’t, because as long as you’ve got five and a half hours of core sleep, you’re fine. You can function.” And I don’t care what they say to me. I just say, “You don’t need eight hours’ sleep every night.”
Martin Reed: It’s such a big myth, and nobody really knows where that idea that we should be getting eight hours comes from. There probably are some people out there that need eight hours of sleep, but they’re going to really be in the minority. Everyone has their own unique sleep requirement. So someone might only need five and a half or six hours every single night, feel great during the day, and that’s fine. Someone else might need seven. Someone else might need eight.
Martin Reed: Everyone is different. It’s kind of like shoe sizes. Everyone has a different shoe size. It doesn’t make any sense to say to someone, “No, you’ve got to fit in a size-eight shoe.”
Sara Flaherty: No, I think that.
Martin Reed: It just leads to more worry, and it can trigger insomnia, too, because if you’re someone that does perfectly fine on, let’s say, six hours of sleep, you feel great during the day. You’re healthy. You’re not fatigued during the day. You never really think about sleep. As soon as then that you try to get more sleep, it can lead to even less sleep and then more worry, and then it triggers this whole cycle of worrying about sleep and less sleep and that leading to even more worry.
Martin Reed: So this myth that we all should be aiming for eight hours is something that we really need to get rid of and we really need to somehow stop people talking about because not only is it inaccurate, but it can actually be a big driver of sleep-related anxiety.
Sara Flaherty: Yeah. I definitely think too much emphasis on that makes it all worse.
Martin Reed: Yeah. I completely agree with you. So you just kind of mentioned this, that you were taking sleeping pills at one point but now you’re not. I think, actually, when you very first enrolled, when you started working with me, you were actually also taking them. But then, by the end, you weren’t. So can you just tell us about that process? Did you follow a specific tapering-off process? Did you force yourself to stop? Or was it more of a case of you just started to notice improvements in your sleep, and so you felt less reliant on them?
Sara Flaherty: I didn’t taper off in such a methodical way. I sort of mentally just told myself that if I… They were always there, and that maybe twice a week, if I absolutely had to, that they were there. But it was more of just as something in the back of my mind that I didn’t throw them out. But I didn’t rely on them then. When I was doing the course, as I was progressing through the course, I knew that I needed to do the strategies to change my way of thinking. I knew that I had to change the way that I thought about it all to get better because the tablets I couldn’t take for the rest of my life.
Sara Flaherty: So I didn’t just every other day… That sort of process coming off them. I more or less just stopped them, and I just knew that I had them there and mentally in my mind that I could fall back on if I ever had to. It’s like just a last resort.
Martin Reed: Yeah. Did you find that you ever had this really bad night, for example, and you felt that you just weren’t going to sleep unless you took that sleeping pill, so then you reached for that sleeping pill? Or did you find that you were actually quite disciplined about it and you were just determined and decided that, “Yes, they’re available, but no, I’m not going to use them”?
Sara Flaherty: Occasionally, if it was maybe once or twice, I would take one. But then you can’t implement all the strategies when you do that.
Martin Reed: Yeah. I think-
Sara Flaherty: And the following day, you’re over it. You’re sluggish. So you don’t think properly then.
Martin Reed: Yeah. I think one of the issues when… I think a lot of people are going to identify with this idea of just having them available because that can just be quite reassuring. But sometimes what the problem can be if you take a sleeping pill contingently… So let’s say that tonight you’ve decided that “I’m not going to take a sleeping pill no matter what.” And then you get to 2:00 or 3:00 in the morning, and you’re really struggling. And then you reach for that pill, and then you get those few hours of sleep.
Martin Reed: The only potential issue there can be is that you can kind of learn to think that you only slept because you took that pill, so you can kind of lose this… Just lose trust in your own ability to sleep because you don’t associate… The risk is you don’t associate that sleep you got just with your own ability to sleep. You attribute all that sleep to the sleeping pill, and just for the long term, sometimes that can be a problem because one of our aims with these CBT-I techniques in terms of changing the way you think about sleep is just to help you get that confidence back and for you to recognize that sleep is this core biological function that never goes away. You can always sleep.
Martin Reed: Just having that trust in your own ability to sleep is just so important. And sometimes if you just take a sleeping pill here or there, if you attribute that sleep just from the pill, it can erode that confidence and make it harder for you to get that confidence in your own ability to sleep back.
Sara Flaherty: No, I definitely think that. It was usually if I knew I had… Like the first day of work, the beginning of the week, because you’ve had the weekend off. And then you think it’s going to help you. But most of the time I’m fine. This is since I’ve done the course. Most of the time, I’m absolutely fine and I do just go back to sleep. I wait for a little while sometimes, and then I just think, “Don’t worry about it.” And as soon as I start telling myself not to worry about it, it doesn’t matter if I go back to sleep. That’s what I say. It doesn’t matter if I go back to sleep. And then you do just go back to sleep.
Martin Reed: Yeah. That’s really important, I think, is just to try and remove some of that worry because let’s say that you wake up and you think, “Oh, I’m not going to fall back to sleep.” Okay. That might be true. It might not be true. I’m sure there are times you’ve thought you’re not going to fall back to sleep and you did, and vice versa. But let’s say that you end up not falling back to sleep. Sleep drive is still going to be building, so it’s not like all that sleep is gone, and it’s not all doom and gloom because sleep… If you’re not sleeping, sleep drive just keeps building. The sleep pressure just keeps building and building and building, and eventually you will sleep.
Martin Reed: It’s completely impossible for you to stay awake indefinitely. So, as long as you restrict that opportunity for sleep during the sleep window, when that sleep happens, it’s going to be happening at a time when you want to be sleeping. And by making sure that you’re only in your own bed when you sleep, it’s going to be happening in your own bed. So sleep does improve. It’s just about taking that worry away from it and just really just learning to trust your own ability to sleep. And your body will give you the sleep that it needs when it needs it.
Sara Flaherty: Yeah. It does happen, definitely. You just can’t keep going, as you say, without any sleep at all. You just get so tired in the end that you do sleep. And then you get confident with it.
Martin Reed: Yeah, and that’s key, right? It’s just that confidence. I can just tell that just in talking to you, where you’re saying, “I just don’t worry about it.” That’s just a key symptom of confidence: just not worrying about it.
Sara Flaherty: But also realizing… Because, you know, throughout your life you do go back to moments where you have trouble sleeping. There was a time within this year of completing the course where my dog was very, very sick, and it really affected my anxiety levels because we didn’t think she was going to get better. But she did, thank goodness. My sleep pattern changed then, and I worried. I did worry, honestly, if this is going to start all over again.
Sara Flaherty: But then I just quickly tried to put those strategies back in and tried to take my mind off my dog and just telling myself, “Yeah, you can sleep. And tomorrow you’ll be fine.” I didn’t have any time off work. So I just carried on through it and got up when I needed to get up, went back to sleep, got up, just carried on with the routine. And then I overcame that period where I did slip back again with my sleep, and I just thought, “No. I’m not going to go back to that. I know I can sleep. I’ve done it before, and I’ll do it again.”
Martin Reed: Yeah. Absolutely. I think that’s so important, too, is just to recognize that there are always going to be bad nights of sleep every now and then. Whenever we go through a stressful period like you just explained, it would be unusual for you to sleep really well if you were worried about your pet’s health, for example. That would be really unusual for you to still just sleep completely undisturbed.
Martin Reed: What can happen is when we’ve experienced insomnia in the past, we can worry. When that completely expected night of bad sleep occurs, we can worry that the insomnia is coming back. “I’m back to square one. It’s all happening again.” But then what can happen is just the very process of worrying about that entirely expected bad night heightens your anxiety and then leads to a second night of poor sleep. So you kind of exacerbate the problem by being concerned about it.
Martin Reed: So I think it’s also really helpful not only to expect bad nights every now and then, because they’re completely normal, but just when you do have a bad night, just spend a few seconds just thinking, “All right. Was there an external cause for that bad night?” So just like you experienced, “Oh, my dog has this health issue, so therefore it’s completely normal I would have a bad night,” and just recognizing that can just be really helpful in terms of keeping your sleep on track for the long term.
Sara Flaherty: Yeah. I do think you just have to accept that you are going to have these ups and downs in life and when you get them that you may have sleep problems, but that it’ll improve because those problems in your life improve, generally. It’s like you said earlier. It’s how you react to things. People who are positive and react in that positive way to any example of stress have an easier time dealing with it. Anything, it’s how you react to it. Trying to react more positively than negatively is the answer.
Martin Reed: Yeah. I would agree with that. One of the models that we have for how insomnia develops is it starts off just with… Some people are just more predisposed to sleep disruption, so they’re already a little bit higher up on that starting scale of sleep disruption risk. We might just be more reactive to stress or anxiety, or we might have stressful jobs or anything like that. So we’re more susceptible to that one or two nights of sleep disruption.
Martin Reed: But it’s always, always our response that determines if it’s just this one-off event or if it’s going to be a longer-term problem, whether that’s just a thought process response or a behavioral response such as spending more time in bed and trying to rest or conserve energy, or maybe a combination of the two. That’s what moves it just from these one or two occasional blips to a longer-term problem.
Sara Flaherty: Yeah. It is. It’s how you react and how you think about it. It’s all about how you think about it.
Martin Reed: Yeah. I completely agree. When you were going through the course, you did make some really good progress. I just want to just briefly… When you first enrolled, for example, I think it was taking you almost two hours to fall asleep at the start of the night. And then, by the time you ended, that had dropped to around 15 minutes. I think your average nightly sleep duration when you first enrolled, the first week it was about four and a half hours. And then, by the end, it was six hours.
Martin Reed: But I think what’s really, really encouraging for a lot of people listening to this was just the long-term improvement. You stopped working with me after eight weeks, and then I just do these follow-ups after one month, three months, six months, and a year because you finished over a year ago now. And still I think it still takes you very… You’re falling asleep pretty quickly, 10 or 15 minutes, averaging 7 hours of sleep. Does that sound right? Am I reflecting on your results and your progress accurately here?
Sara Flaherty: Yeah, definitely, because I hardly take any time to go to sleep now. My job’s still quite stressful, but I enjoy… I really look forward to going to bed. I’ve got a new bed, and it’s really comfortable. And I just think, “Oh, this is nice.” I do have about seven hours on average in the night.
Martin Reed: Yeah. That’s amazing. And I think just that key, the fact that you now look forward to going to bed, you look forward to sleep, is just such a change in mindset because I’m sure that if when we first started working together I’d have said to you, “Well, it’s bedtime in an hour or two. How are you feeling about that?” it probably would have been a little bit different.
Sara Flaherty: Yeah. I used to get so stressed about the time that was leading up to go… I used to actually get anxious about it in the evening. I wouldn’t be enjoying my evening because I’d be thinking, “Oh my gosh. It’s getting closer to the time. I’ve got to go and try and go to sleep.” It was such a fear. I had built up a massive fear about the whole thing. And if I could have got away with not sleeping at all, I think I would have because I was so worried about going to bed to try.
Sara Flaherty: I’ve got some things I do. I put lavender lotion on, those little things that mentally just help me to prepare to go to bed and I’ll go. And just lavender, little lavender spray and little things like that that I still use because it helped me. It helps to just unwind and have a shower, have all these nice smells, and it just prepares you to go to bed anyway. I don’t think that hurts to carry on with.
Martin Reed: Yeah, absolutely. I think those processes are all fine as long as you just recognize that they’re just things that you find enjoyable and relaxing. The only time that they can be unconstructive is if you think that somehow they’re generating sleep or that if you miss that one night of putting lavender on your pillow, then you’re not going to sleep. If you see them as a way of generating sleep, then that can be a problem. But if you see it as just something that you enjoy that helps you relax-
Sara Flaherty: Yes. It does. That’s what I do. It’s like a relaxation thing. Listening to nice, calming things before you go to bed is nice to do rather than being on… A lot of people are on their phones all the time, and their brain is wired before they go to bed. So just try and relax in some way before you go to bed is helpful.
Martin Reed: Yeah, and everyone is different. So, whereas one person might enjoy the smell of lavender or listening to calm and relaxing music, someone else might, I don’t know, like to do crosswords or watch a movie. Everyone is different. As long as you just do anything that you just find relaxing, that you personally just find helps you unwind and just distracts you maybe from thinking about sleep as well, is fine. There’s really no hard and fast rules for what you should be doing shortly before bed other than something you find relaxing and enjoyable and something that you don’t come to believe is creating sleep for you.
Sara Flaherty: Yeah. Definitely.
Martin Reed: You can just end up going down the rabbit hole. I’ve had clients that believed that this certain brand of tea that they drank at night, if they didn’t drink it, then they wouldn’t sleep. So then the problem is then you’re looking for this new type of tea or this new supplement or this new sleep crutch to create that sleep for you because you don’t recognize that it’s just your own body that’s generating that sleep.
Sara Flaherty: Yeah. It is.
Martin Reed: The tea is nice if you enjoy drinking it, and if you find it relaxing, that’s fine. But it’s never creating sleep. As long as you recognize that, anything you do at night is fine.
Sara Flaherty: But yeah. I think the relaxing part is important if you’re sort of an anxious person because that relaxing of your mind before helps you to mentally think in the positive, correct way rather than going to bed anxious.
Martin Reed: Were you someone that had always tried these relaxation techniques or things like that? Or was this something that you learned or practiced only after you started developing insomnia?
Sara Flaherty: No. I’ve had relaxation, like guided therapy things, for health anxiety. So I’ve always believed that it’s nice to calm your mind. It can distract your mind away from things and put your mind in a better place to take on board all the techniques you need to do as well.
Martin Reed: Yeah. The reason I asked you is just because a lot of people don’t recognize or don’t realize that relaxation is actually a skill. It’s not something, “Oh, I’m going to try a meditation tonight,” for example. And then you try to meditate, and your mind is going a mile a minute. And you just think, “Oh, this isn’t working. This is not for me.” And then you just stop. It’s really important. There is a skill, and it takes a lot of practice in order to get good at relaxation.
Martin Reed: It’s also just important to make the goal of relaxation relaxation and not sleep. As soon as we make sleep the goal, we undo any of the potential benefits of that relaxation process.
Sara Flaherty: Yeah, definitely. Relaxation is just nice anytime, just mindfulness, as well. I think that’s important to just be aware of what’s going on at that moment, not anything else.
Martin Reed: Yeah. I completely agree with you. That’s really interesting because don’t you find that when you have insomnia, a lot of your worries were about the future? For example, “How am I going to get through the next day? Am I going to sleep tonight?” So mindfulness is really helpful, I think, because it just brings you back to the present. “Well, why am I worrying about that now? Because that stuff is in the future. That doesn’t matter now. So I’m just ruining my entire day or my entire night thinking about what-ifs, whereas all I should really be focused on is just the now.”
Sara Flaherty: Yeah, definitely. My husband had a good strategy with when you just wake, just be aware as your head’s on the pillow. Enjoy the pillow. Just relax into it. Relax all your body. Feel the bedsheets on your body. Just think about those things, and just calm your mind because your mind just escalates otherwise into, “What if? What if? What if?” Just think about what you’re actually doing and just try and calm your heartbeat down. I do think that it’s important to try and relax your mind, and relaxing your body helps to do that.
Martin Reed: Yeah. A lot of people, as well, with these stimulus control techniques, the CBT-I technique that suggests that you should be getting out of bed if you’re struggling to fall asleep, is I like to say if you’re awake for roughly half an hour and you’re really struggling and you’re battling, then get out of bed. But if you’re in bed and you’re still feeling calm and relaxed… Maybe just what you were describing, you’re just enjoying just that feeling of lying on your pillow, being in bed. It feels cozy. You’re calm and relaxed.
Martin Reed: Really, there’s no need to get out of bed because you’re calm and relaxed. So the conditions are right for sleep. It’s only really a concern we want to be getting you out of that environment when it becomes unpleasant to be in bed.
Sara Flaherty: Yeah, and as I was, if you’re at that stage where you aren’t relaxed and not able to do that, then it’s pointless being there in bed because you’re just fretful. Getting up and just having that little time where you think, “Right. Let’s try again,” and just go back and see what happens. It’s just see what happens. I think a really big thing to me was just keep telling myself, “It doesn’t matter if you don’t sleep,” because it’s such a pressure to make yourself to sleep. And as soon as you tell yourself it doesn’t matter if you don’t, it really works. You just go to sleep.
Sara Flaherty: It’s just trying not to pressure yourself, thinking, “I have to go to sleep. I have to go to sleep,” because you don’t have to. It doesn’t matter if you don’t sleep at that moment. That’s what I tell myself all the time if I wake. It doesn’t matter. And then, before I know it, I’ve gone back to sleep. And then sometimes I don’t even know if I’ve gone back to sleep or not. And then I think, “Oh yes. I can remember that dream now. I did go back to sleep, actually.”
Martin Reed: Yeah. Yeah. I think that’s great. It’s like so much of it is just changing your mindset, don’t you feel? Like just learning not to worry about sleep. And as soon as you remove that worry or that temptation to try and control sleep or force sleep, sleep just becomes so much easier.
Sara Flaherty: Yeah, it does. And then I just feel much more normal now, but I didn’t feel normal before. You just almost feel as if you’re on your own, even though you know there’s lots of other people who have insomnia. Well, I did, anyway. I just felt, “Oh, I’m the only person with this. Nobody else can be as bad as me. Look at me.” I mean, at one point, sometimes I’d have an hour and a half sleep and I’d be thinking, “Oh my goodness. Everyone else is having a normal life, and I’m not.”
Sara Flaherty: It got to the point where I was thinking, “I can’t do nice things because I’m too tired to do them.” As soon as you change that way of thinking, you have to sleep. You start to sleep again and also realize that you aren’t on your own and there are lots of people who have similar struggles and people like you who can help. You can talk to people who’ve got the knowledge to know what to do to improve it because going on the internet, looking at Google, it gives you so much other things that make you worried.
Sara Flaherty: I try really hard not to do that anymore because you type in “insomnia,” and it comes up all these other crazy things that you don’t know about and I’m not knowledgeable enough to know what’s right from wrong with regard to things like worrying about not getting enough sleep and the impact on your body. There’s all sorts on there that are not actually true that could scare people and make their insomnia worse.
Martin Reed: Yeah. Absolutely. So much of the sleep-related worry and fear is, I think, generated by all these articles that are online and even just in newspapers and magazines that look at these studies. But one thing that’s really important to bear in mind is that very few of these studies actually look at people with insomnia. They tend to look at sleep deprivation, which is different. Sleep deprivation is more about burning the candle on both ends. You’re not giving yourself enough opportunity to sleep, and so therefore you’re not getting enough sleep.
Martin Reed: A lot of these studies, they will get people that have no issue with sleep, put them in a lab or tell them that they’re not allowed to sleep for more than two or three hours, and kind of extrapolate results from there. Even ones that do use insomnia, the common trait is none of these studies are finding causation. Some of them are finding associations, but it’s just in the some way that if you look at houses that have ash trays, perhaps there might be a higher instance of cancer in those households. That doesn’t mean that the ash trays are causing cancer. There’s something else causing the cancer.
Martin Reed: That’s so important to bear in mind, is that all these articles, when you actually dig into them and you look behind the headlines, you’ll see words like “may” or “could” or “associated with.” There’s never anything that says short sleep or insomnia causes any health problem whatsoever. There’s not one single study that’s found that. So that’s something that’s really important to just emphasize because that is generally what you’ll find any time that you Google “insomnia” or “sleep deprivation” or “insufficient sleep.”
Sara Flaherty: No, definitely, because most people are using the internet to try and find a solution, and along the way, they get worried more because of ill advice.
Martin Reed: Yeah. I would just encourage anyone that’s struggling with insomnia, if you are going to look online and use Google, is to just Google “cognitive behavioral therapy for insomnia,” because it’s just this great collection of techniques. You kind of touched on this. One of the reasons why I’m such a big fan is because, in a way, it’s just this skill set. And it stays with you for life. So any time you feel that you’re struggling again in the future, you just put the techniques back into place, and it helps get your sleep back on track because it’s just a collection of skills that never go away. They’re always with you.
Sara Flaherty: They are. And you do need to use them occasionally. They’re embedded because you’ve done it for a long while. So you know what to do. You just need to just implement them when necessary.
Martin Reed: Exactly. All right. Well, Sara, I’ve taken a lot of your time, and I really appreciate it. I did just want to ask you one more question that I always ask people right at the end, so here’s the question. If someone with chronic insomnia is listening and feels as though they’ve tried everything, that they’re beyond help, they can’t do anything to improve their sleep, what would you tell them?
Sara Flaherty: I would honestly say… And this is really from my heart. I would definitely say to do your course because you were so personal with your help for me, and I’m sure you are with other people, just as personal and helpful. I actually felt through all the strategies and emails and all the videos and everything that I did along the way was catered just to me. I don’t know how you made me feel like that, but I felt as if you were like my personal therapist of sleep, sleep coaching.
Sara Flaherty: I could just feel that I could rely on you and that you didn’t mind me emailing you, and you always responded. So I felt that I wasn’t alone anymore and that you were definitely going to sort me out. I just had faith in you. I don’t know how other courses would be, but I would 100% guarantee success because as long as you do all the things that you advise, then it works. So my advice to anybody, and I think I’m the worst that’s ever had insomnia, is to do your course because you get better.
Martin Reed: I really appreciate that. It’s very humbling to hear you say that. I really appreciate it. I just want to say just in response that I just want you to also recognize that all of the success that you’ve enjoyed is down to your effort. I kind of see myself as the guide. I can explain to you techniques that are helpful and help you change your way of thinking about sleep, but it’s really up to you or up to anyone that I work with to take that information and to use it and to be really committed to the techniques and to implement them because, like you explained earlier, some of them are hard.
Martin Reed: So I really want you to recognize that you are the driver of your success. I was there next to you to guide you along, but really, all the success you’ve enjoyed is just down to your own efforts and your own commitment to the techniques.
Sara Flaherty: Oh, thank you as well. No, I think it’s a two-way process.
Martin Reed: Yeah. Yeah. I would agree with that. It is important to have a good relationship with whoever you’re working with. It takes back and forth. You need to have someone that you believe in and that you feel comfortable communicating with, and then at the same time, you need to be accountable and just implement the techniques. I completely agree with you, too, that you will be successful if you just are consistent and you are committed and make your focus just implementing the techniques. “This is what I have to do. this is what I’m going to do,” and just removing all that mental gymnastics and all that self-doubt and all the question marks and just going all in, going all in to say, “I’m just going to go all in for a few weeks and just see what happens.” And, far more likely than not, you’re going to get results. And I think that’s really important.
Sara Flaherty: Yeah. Definitely, you get results.
Martin Reed: Yeah. All right. Well, Sara, thank you so much for giving up so much of your time. I think that what we’ve discussed, a lot of people are going to recognize their own insomnia experience in what you’ve shared. And hopefully it will just motivate people to look more into CBT-I and just give them the belief that they can get through their insomnia just like you did. So thank you.
Sara Flaherty: That’s okay. Good luck to everybody.
Martin Reed: Thanks for listening to The Insomnia Coach Podcast. If you’re ready to implement cognitive behavioral therapy for insomnia, CBT-I techniques to improve your sleep but think you might need some additional support and guidance, I would love to help. There are two ways we can work together. First, you can get my online coaching course. This is the most popular option. My course combines sleep education with unlimited support and guidance and is guaranteed to improve your sleep. I will teach you and help you implement new CBT-I techniques over a period of eight weeks. This gives you time to build sleep confidence and notice results without feeling overwhelmed. You can get the course and start right now at insomniacoach.com/online.
Martin Reed: I also offer a phone coaching package where we start with a one hour call. This can be voice only or video, your choice. And we come up with an initial two week plan that will have you implementing CBT-I techniques that will lead to long term improvements in your sleep. You get unlimited email based support and guidance for two weeks after the call along with a half hour follow up call at the end of the two weeks. You can book the phone coaching package at insomniacoach.com/phone.
Martin Reed: I hope you enjoyed this episode of the Insomnia Coach Podcast. I’m Martin Reed, and as always, I’d like to leave you with this important reminder. You can sleep.
I want you to be the next insomnia success story I share! If you're ready to move away from the insomnia struggle so you can start living the life you want to live, click here to get my online insomnia coaching course.
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