Sleepedy logo

An Insomniac's journey to normal sleep

From meditation to medication and finally CBT-I.

I'd done everything right, yet it was 2 am and I still couldn't sleep. I had meditated for 30 minutes before I went to bed. I even took a couple of melatonin pills right after to be sure. Yet, here I was wide awake dreading how exhausted I would be the next day at work.

My problem wasn't unique. In America, one in every 10 adults will experience chronic insomnia1. It takes just one poor night of sleep to devolve into long term sleeping problems. This is because the majority of sleeping problems stem from anxiety and worry2. The more you worry about not getting enough sleep, the worse your sleep gets.

For me, my sleeping issues began right out of college. I had started a job as a software engineer and I was starting to feel the pressure. I had a couple of big deadlines coming up and I found myself tossing and turning unable to sleep one night. My mind kept racing, thinking about all the work I had until I finally fell asleep.

I thought that was it — an abnormal night, but then it happened again. This time, my outlook changed. I started worrying about how not getting enough sleep would affect my day. I looked up basic sleep hygiene tips online and decided to go to bed extra early to make sure I made up for lost sleep. This ended up backfiring and it took a few hours before I could finally sleep.

At this point, my sleeping struggles started becoming more regular. I downloaded a couple of meditation apps in the hopes that meditating and listening to soothing sounds would help me sleep better. I even resorted to over the counter sleeping aids on nights when it took me too long to fall asleep. The results were mixed — I'd fall asleep faster but over time I'd revert back to having poor sleep.

I finally caved and decided to try prescription medication. I had read a lot about them and was very reluctant because of their long term side effects. On a visit to my doctor, I asked her if she could prescribe me something to help me sleep. She said she said she could, but it wasn't going to be medication. Instead, she put in a referral to a CBT-I (Cognitive Behavioral Therapy for Insomnia) therapist.

CBT-I is an evidence-based (proven in clinical trials) technique used to treat sleep problems3. Two driving forces induce sleep — sleep drive & mental arousal. Your sleep drive is how sleepy/tired you feel when going to bed. Your mental arousal is the racing thoughts and alertness you feel when you go to bed. When your sleep drive is high and your arousal levels are low; it is easier to fall asleep. CBT-I prescribes a sleep schedule that ensures you have a high sleep drive. It also teaches you techniques to worry less and reduce your arousal.

CBT-I is extremely effective in treating sleeping problems. Clinical trials have shown that 80% of people that follow a good CBT-I program will have normal sleep by the end4. The results are also permanent, unlike sleeping aids which are effective only as long as you are taking them5.

There were three main rules that I had to follow -

  1. I could only sleep within the sleep window my therapist prescribed. This ensured that I only went to bed when my sleep drive was high.

  2. Every time I couldn't sleep, I had to make sure I didn't stay in bed for over 20 minutes. This way, I would subconsciously re-train my mind to not associate my bed with wakefulness6.

  3. No day time naps and no caffeine after 2pm.

I was sleeping around 5 hours at the time, so we set a 6 hour window within which I could sleep (1am - 7am in my case). I kept a log of how long it took me to sleep, how long I was awake in the middle of the night and how long I slept. This data was recorded to the closest 15th minute and is self reported. At the end of each week, my therapist would alter my sleep schedule based on the previous week's data. Note: Time awake is the time it took me to fall asleep + my night time awakenings


At the end of week 1, I was sleeping about the same as I was before. My time awake at night though had fallen by an hour. I was falling asleep faster and I was having less interrupted sleep. We decided to stick to the same sleep schedule for week 2.


At the end of this week, my sleep had increased and I was consistently awake for less than an hour. We decided to expand my window by 15 minutes for week 3.


We followed the same rules and either expanded or kept the same sleeping window for the next few weeks.


At the end of the 10 week program, I was sleeping over 7 hours a night. More importantly, I wasn't spending my days worrying about my sleep.


CBT-I isn't an easy solution. The sleep schedules are hard to follow and the results aren't instantaneous. It takes time and effort but the reward of permanently improved sleep is well worth it. Let me know if you do decide to try it and if it helps you improve your sleep. Here's to hoping you get better sleep soon.


If you'd like to know more about CBTI and other behavioral therapy techniques to improve sleep, check out our website!

References

  1. Insomnia Awareness Day by the American Association of Sleep Medicine

  2. Sleep Disorders by the Anxiety and Depression Association of America

  3. CBT for Insomnia: A comprehensive guide

  4. Trauer, James M. et al. “Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med. August 2015 163(3) : 191-204

  5. Phily Mag interview with doctors on efficacy of sleep supplements

  6. Stimulus Control: Stanford Healthcare