Insomnia. This is a topic many people are familiar with if not having experienced it firsthand. It’s a common issue for my patients. It’s not just my patients who struggle; I hear it from family and friends and I myself have struggled with it for years. There are varying numbers reported for what percentage of Americans take sleep medications, but a quick search yielded results ranging from roughly 18 to 30 percent. Ambien, Trazadone, or even over-the-counter supplements like Melatonin, are all commonly used sleep medications. Unfortunately, these can often have problematic side effects.
I myself have had a long history of sleep issues going back to early childhood. I distinctly remember being awake in my crib and noticing the moon for the first time. I also remember playing for hours by myself in the middle of the night, unable to sleep.
My mom implemented a strict bedtime of 8 pm, even in the summers. I’m sure she thought this would instill in me a sense of discipline and help me develop a good early-to-bed sleep routine. Instead, this resulted in me lying in bed, awake for hours, unless I got up and played by myself or read a book under the covers with a flashlight. In the summers, when it was still daylight outside at 8 pm, I would lie in bed feeling sorry for myself while I could hear my friends playing outside.
My mom never budged from this rule but my friends’ parents, who were less rigid than my mom, were on to something though they may not have realized it. Little did I know that my mother was setting me up for a lifetime of troubled sleep. The real problem wasn’t that I wasn’t trying hard enough, something I was told often. The real problem was I was trying too hard.
My sleep issues continued into adulthood and I began taking great steps to promote a good night’s rest. I made the room cool and dark. I got ready for bed early and got in bed to read. I didn’t do things that overstimulated me such as exercising or arguing. I didn’t watch TV or scroll on my phone. I made sure not to engage in things that ramped up my nervous system. I didn’t consume caffeine after noon or exercise close to bedtime.
I used blue light blocking settings on my Kindle and used a sleep mask. Despite all this I would lie in bed for hours, sometimes the whole night. If I timed it right, I would sometimes take a Benadryl and hope that it didn’t make me groggy the next morning. I tried Trazadone and melatonin, neither of which was very effective. As I go older, I even tried drinking alcohol to produce a soporific effect, but that only worked for a short time and wasn’t a sustainable solution. I would clinch my eyes shut and lie awake for hours, angry and frustrated.
I was trying so hard.
Little did I know I was doing the opposite of what I should be doing. Little did I know I was trying TOO hard.
I am currently in the process of getting certified as a CBT-I therapist. CBT-I stands for cognitive behavioral therapy for insomnia. The first thing I learned is that making an effort to fall asleep often sets you up for not being able to fall asleep. The key is to NOT try to fall asleep.
That’s right. Do not try to fall asleep. Do not make any effort to fall asleep.
This made no sense to me. How in earth am I supposed to fall asleep if I don’t make an honest effort? I was told over and over again throughout my life that I wasn’t trying hard enough. That if I would just make an effort, I would fall asleep. I was told if I would just try to go to bed earlier, I could become a morning person. So, this new advice to not put effort into falling asleep went against everything I had been told and everything I thought I knew about sleep.
Begrudgingly, I decided to try it. Following one of the guidelines of CBT-I, I had my “nest” set up downstairs ready for me if I had not fallen asleep after the allotted amount of time. A nest is a little setup that you create for yourself if you cannot fall asleep.
You can have a blanket and pillow ready along with a glass of water or a hot beverage. You can watch TV or read or any other activity that isn’t too activating. And when you have relocated to your nest you aren’t supposed to try to fall asleep nor are you supposed to sleep there. When you find yourself feeling sleepy, you are supposed to get back in bed and let sleep take you.
The theory behind this is that being in bed for anything other than sleep or sex creates an arousal state connection with being in bed. By staying in bed when you are not sleeping, your brain begins to equate the bed with waking hours and activities, instead of sleep.
So, in spite of my resistance, I gave it a try. I still practiced my routines to create a good sleep environment. However, instead of getting into bed around nine and reading, I watched TV in the living room or engaged in other activities that didn’t take place in bed.
Around 11 pm I went upstairs into our reading nook and turned on some binaural beats music and began to read. I have what is known as a delayed sleep phase syndrome so I was fully prepared for this to take a while. Around 12:30 I started nodding off a bit. I made myself stay up another thirty minutes to create a good “sleep drive” before getting into bed.
I got into bed and lay awake for a short amount of time before falling asleep. When I checked my sleep tracker the next morning it showed very little awake time and sufficient amounts of REM, deep, and core sleep. And to top it off, I felt rested.
I couldn’t believe it.
These two main components of CBT-I that I have been using have continued to work. Not making an effort to fall asleep and creating a sleep drive by not spending long periods of time in bed not sleeping have helped me transition out of insomnia. The key for me, which may not be attainable for everyone, is that I have had to accept that my natural sleep cycle tends to be later rather than earlier.
So, next time you find yourself lying in bed awake, get out of bed and go to another room with soft lighting. Read a book or watch TV. Draw or paint. Allow yourself to feel sleepy before getting back in bed. When you are in bed, do not think about trying to sleep, but instead focus on closing your eyes and resting and see where this takes you. There is value in light rest even if it doesn’t lead to deep sleep.
This is only the tip of the iceberg. This is only one component of CBT-I, albeit a very effective one. There is much more that goes into this type of treatment for long term effectiveness. If you are struggling with insomnia and looking for a long term, medication-free solution for sleep issues, feel free to contact me or my colleague, Emma Barr. We are both trained in CBT-I and look forward to assisting you.
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