Sleep Starved: A site by insomniacs and for insomniacs who are looking for something new…
Mar
4

CBT

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The idea behind behavioral modification is that insomnia has been precipitated by a stressful event or events, and has then settled in, like a had habit. Like Pavlov’s dogs, conditioned to salivate at the sound of a bell they’ve learned to associate with food, insomniacs have developed wake-up associations with sleep and bed. “When the stressors fade away,” writes Charles Morin, leading proponent of behavioral modification and the author of Relief from Insomnia, some people “may have developed negative reactions to stimuli normally conducive to sleep (e.g., bed, bedtime, bedroom). What used to be a place and time for relaxation and sleep is now associated with frustration, anxiety, and sleeplessness… Over time, a conditioning process leads to a vicious cycle of insomnia.”

Behavioral modification is a group of therapies aimed at reconditioning us. Stimulus control therapy aims at getting the insomniac to associate the bed with sleep. Go to bed only when sleepy, use the bed only for sleep and sex, avoid naps and so-called sleep-incompatible behaviors, such as reading, watching TV, eating, talking, in the bedroom. Sleep restriction therapy requires that you restrict time in bed to the time you spend asleep. If you think that you get five hours sleep, you should go to bed at your usual time and set the alarm for five hours later. When you wake up before the alarm, make yourself get out of bed –some say after 10 minutes, some say 20, some give a “quarter of an hour rule.” Then go to another room and watch TV or read. When you begin to feel sleepy, go back to bed but if you don’t fall asleep in 10-20 minutes, repeat the process, getting out of bed and going to another room again. However little sleep you’ve had, get up to that alarm without fail, seven days a week. The idea is that by restricting time in bed to the time you actually sleep, you create what Morin calls “mild sleep deprivation, which results in more consolidated and more efficient sleep.” When you find yourself sleeping 90% of the time you spend in bed (i.e., attain 90% sleep efficiency) and sustain this for five consecutive days, you may extend your time in bed by 15 minutes. But if your sleep efficiency drops below 85%, reduce your time in bed to match your average sleep length for the past five days, but do not reduce it to less than five hours….

Taken together, cognitive restructuring, stimulus control, and sleep restriction are called cognitive behavioral therapy (CBT). Sleep hygiene is also important: sleep in a dark, quiet place, cut out caffeine, alcohol, big meals or stimulating activity late in the day, don’t exercise too close to bedtime.

Sleepnet.com tells stories of people who’ve used these methods to teach themselves to sleep again: it’s given me my life back. People who post here recommend readings that have helped them: Gregg Jacob’s Say Goodnight to Insomnia, Peter Hauri’s No More Sleepless Nights, Charles Morin’s Relief from Insomnia, and primarily John Wiedman’s Desperately Seeking Snoozin, which many insomniacs find inspirational because it’s written by someone they identify with, a “recovering” insomniac, as he calls himself, a man who has reformed his sleep by rigorously, religiously, adhering to what he and others call “the program.”
And yet, as Charles Morin acknowledges, “not many people are using CBT, it looks like.”

Sleep restriction is a crucial part of re-conditioning our sleep. Some people find this very effective, as a way of teaching themselves to sleep again. But some do not.

Your experiences with these methods?

“When you can’t sleep, get out of bed and do something else.” This also is crucial to behavioral modification. Does it work for you? Do you ever find that staying in bed is restorative?

**Some say that CBT hasn’t caught on because people don’t know about it and because the pharmaceutical industry is too powerful.
“It is in many people’s interest for us not to know about CBT as a treatment for insomnia. Because upon our anxieties, our insecurities and our feelings of inadequacy, a multi-billion-pound [dollar] industry is built.”
Laura Barton and Charlie Brooker, “Pillows, Pills, and Potions, Guardian Unlimited, UK, Guardian.Co, Feb. 5, 2008
http://www.guardian.co.uk/society/2008/feb/05/health1

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11 Responses to “CBT”

  1. Penney

    Interestingly, the sleep specialist I saw (who was only interested in sleep apnoea and gave me a talk on sleep hygiene…) said that current thinking was that you don’t get out of bed and do something else. “Thank God for that,” I said. That wakes me up so much I have no hope of going back to sleep. It’s hard enough going to the bathroom in the night which I do totally in the dark by feeling my way, no lights on, no torches, nothing.
    I absolutely have to read in bed before lights out as I have no hope of sleeping if I don’t. This may under stimulus control as I have done this before sleeping since a child. I arrange my bedtime rituals around this need eg I always have to go to the bathroom first before my husband so that I can read while he has his turn in there.
    I certainly can’t cope with deliberate sleep restriction as it causes severe depression and I wouldn’t feel safe to drive.

  2. LeeEllen

    I installed a small “Dot” light in my bathroom under a shelf as a down light, so I never have to turn on the overhead to go to the bathroom. I have not one, not two, but three layers of curtains on my bedroom windows. (I would sleep in a cave, if I could: dark & cool.) I have set my thermostat for 69 degrees from 5:30 to 7:30 AM, so I will not be fooled into waking too early by warm air in the room. I bought a new Tempur-Pedic (knock-off) mattress and tossed the old innerspring set. {Note: I just could not afford to buy the real thing, but maybe I should have “sprung” for it. Sorry, I just couldn’t resist;} I adjust the thickness of my covers for every season and still kick & toss in the bed…all night.

    I cannot afford a sleep clinic. I can barely afford the insurance that I have, which definitely would not cover a sleep clinic. I have read the comments here and listened to others who have tried the sleep clinic. I think it is just as well that my insurance won’t pay for it, if I went I would just be out for the co-pays. Spending useless money would keep me awake, too.

  3. Liz

    I am reading a book about this at the moment. It says that cognitive therapy is the best treatment for insomnia. Is that true I wonder? The author says it hasn’t caught on because there just aren’t enough behavioral therapists who are working in the insomnia field. Even if there were how many can afford to consult a psychologist for several visits? Not me.

  4. Janet

    I am new to this forum/site but I am undergoing sleep restriction therapy as we speak. I am not sure how alternative this is considered..it’s been around for a while but it seems to be an alternative approach for me in comparison to what I have been doing for the past several years. I too have had insomnia for 20 + years and have tried many different med’s prescription and natural/homeopathic. Have gone the whole nutritional approach as well. I exercise regularly and that has kept me pretty sane but I just decided recently that I cannot tolerate prescription drugs anymore. Especially Ambien and any of that class. Too many for too long and I feel like a prisoner to pills. So, here I am on day one with sleep restriction. I am seeing a Dr. who is overseeing this method and I am keeping a sleep diary. He claims this method is 80-85 % effective if you make the commitment.
    Has anyone else tried this? I am really curious as to any other experiences anyone has had. I slept one hour last night-
    Any comments are greatly appreciated

  5. Marc

    I’m gathering research materials for a book about sleep restriction therapy, and I’d love to hear from people who have tried it, either successfully or not. There’s some interesting data showing that some may cure their insomnia as well as their depression with this technique. However, I’ve also seen sleep restriction backfire and actually cause more depression, at least temporarily. Here’s your chance to help others by sharing your experiences. Email me at onceandagainbooks@netzero.net I’d love to talk with you.

  6. emma

    The theory behind ‘sleep-restriction’ night make sense, but for people like me who for a period of 5 weeks only sleep 2 hours a night, usually in the morning hours, how much more can that tiny amount of sleep be restricted without causing me serious physical/mental harm? It’s like twisting the knife. Not an option for me. But might work for some.

  7. I’m with you, Emma (posting above)
    I go into the pros and cons of this approach in some detail in INSOMNIAC.

  8. Melba Smith

    Have any of you used the Alpha-Stim? I would like to know of anyone it has worked for in regards to

  9. Shannon

    I agree, Emma. I tried this and it almost put me over the edge. I only sleep 4 hours max as it is. Getting out of bed at 3 or 4a.m. and sitting in another room was beyond depressing.

    Being told to get out of bed after 20 minutes if you do not get back to sleep was the most ridiculous thing I had ever heard, since I NEVER get back to sleep once I wake up, which guaranteed I would be sitting in the living room all night long on my own. My CBT “professional” also told me not to go back to bed unless “sleepy.” I am always sleepy is the problem, but this does not mean I can sleep. So I was up and down the stairs all night long every 20 minutes.

    The concept works, I think, for people who have developed bad sleeping habits but I do not have bad sleeping habits,
    other than staying in bed for 3 hours or so after I wake up…since it is the middle of the night when I wake up I really do not see that going to a different room makes any difference. I am awake either way, just feel even more desperate sitting in the living room, where there is no chance of sleep,compared to my comfortable bed, where I at least feel there is some (even though minimal) chance of going back to sleep.

    As to being told I should not read in bed, I felt even more depressed about going to bed when I could not even have the pleasure of 1/2 an hour reading a good book. It felt like going straight to the torture chamber with no buffer at all.

    I did CBT for a month. I can honestly say it was the most depressing period of my life and it made not the slightest bit of difference to my sleep, but rather just added depression to my insomnia.

  10. HappyCat

    I am loathe to try CBT. One of the few benefits of being on disability for three years now is that I don’t get sprung out of bed by an alarm clock. I go to bed earlier and wake up when I wake up. That may be at 4:30 AM or 8 AM, but my body takes what it needs. And I got rid of a lighted bedside clock decades ago. Who needs all that bright light or the anxiety of watching the hours ticking away? I have a pink 4 watt motion activated nightlight in the bathroom, and it’s not for me, it’s for the boyfriend who always insisted on turning on the lights when he got up in the middle of the night. Hey guy! It’s not like the toilet isn’t right where you left it! It doesn’t grow legs and move around! I also make sure he has a flashlight right next to the bed to shine at his feet if he needs it. My other knock on CBT is where are you supposed to go during the day when you’re tired or sick? Are you to not lie in bed when you’re sick? Are you supposed to weather the flu on the carpet? And as for sleep restriction: I’ve tried it and it’s pure torture. I think I’d rather be waterboarded.

  11. I couldn’t agree with you more about using a clneit’s own language. Years ago I had rolfing done (deep tissue massage) and the massage therapist used my words to describe what I told her. The work was profound. Once a person has the experience of another really listening deeply and using the same words back to them to describe the experience, everything else pails in comparison. Nothing annoys me more now than when I share a problem with a friend and they go off into problem solving, share what they did with the problem or, tell me what to do or even worse, teach me about some technique or something they read somewhere. Our clneits need from us something they can’t get elsewhere, deep listening that comes with helping them to go where the pain is so they can deeply understood. According to Freud, the basis of neurosis is avoidance, so we as therapists need to stay with their pain and lead them into it. The best way is to use their words, name the experience and be right there with them. Graduate schools teach us a lot of theory but not how to to be with the clneit. Thanks for highlighting this on your blog. I really appreciate what you have to say! Renee

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