My journey: Cognitive Behavioral Therapy for Insomnia

What I noticed during this CBT-I:

- A long night's sleep (8 to 11,5 hours) does not bring me more energy than a short night sleep (<= 6 hours)
- Sometimes some very short night (stay late until 3 or 4h and sleep until 7h) makes me less sleepy in the morning.

One sheer good example: I slept 21:30 --> 7:15 last night, and now I'm like crap.

You might want to look into a supplement called L-Tryptophan. It works well for me in getting restful sleep.

papzombie wrote: The first night on CBT-I, I remembered about 8 times (out of the estimated 21 times as if it would be measured by the WatchPAT). The nights after I remembered much less awakenings.

Was that some psychological effect on the first night, when my brain knew that it would need to memorize those awakening, so it stayed alert ? And after that night my brain was less impressed by what the CBT-I is about ?

I think you have it backwards. On the first night the brain was so worried about what it regarded as the need to remember each and every wake, that it worked overtime to do that. On subsequent nights, the brain has relaxed into understanding that the goal of your sleep log is to find out how often you are awake enough for a long enough time for it to genuinely be bothersome in terms of your overall sleep quality. And your brain now better understands that the goal of the CBT-I is to teach your body and brain to NOT worry so much about each and every wake. That's why they asked you to estimate the number of wakes rather than trying to document each and every one of them.

I'll add this tidbit from my own experiences with CBT-I and sleep maintenance problems. When I feel at my best insomnia wise, I remember 0-2 wakes during the night, I remember NO periods of "restlessness" or "fighting to get (back) to sleep", and the data from my BiPAP indicates that I am sleeping for 90+ minutes at a time before waking up enough to turn the machine off and back on. In other words, when I feel at my best, the CPAP data indicates that I still have wakes after each and every REM cycle, but that I'm sleeping during the full sleep cycle instead of waking up multiple times between REM cycles.

robysue wrote: I think you have it backwards.

No

On the first night the brain was so worried about what it regarded as the need to remember each and every wake, that it worked overtime to do that.

I agreed

On subsequent nights, the brain has relaxed into understanding that the goal of your sleep log is to find out how often you are awake enough for a long enough time for it to genuinely be bothersome in terms of your overall sleep quality. And your brain now better understands that the goal of the CBT-I is to teach your body and brain to NOT worry so much about each and every wake. That's why they asked you to estimate the number of wakes rather than trying to document each and every one of them.

I did not know that, I am still not sure about what CBT can teach me. Now I learnt it from you.

On subsequent nights, my brain was simply getting used to the rythm of, yes, estimating the night.

I'll add this tidbit from my own experiences with CBT-I and sleep maintenance problems. When I feel at my best insomnia wise, I remember 0-2 wakes during the night, I remember NO periods of "restlessness" or "fighting to get (back) to sleep", and the data from my BiPAP indicates that I am sleeping for 90+ minutes at a time before waking up enough to turn the machine off and back on. In other words, when I feel at my best, the CPAP data indicates that I still have wakes after each and every REM cycle, but that I'm sleeping during the full sleep cycle instead of waking up multiple times between REM cycles.

Maybe I need to remember to turn off-on the machine when I do get awake. Good tip

I check the clock when I'm cognizant of the fact that I'm awake. Then I meditate with eyes closed until I drop off again. Mostly deep breathing exercises. I think a lot of my insomnia issues are related to SSRI use. It's fairly common with SSRI's, but anything I can do to help alleviate it is worthwhile.

robpiercey wrote:I check the clock when I'm cognizant of the fact that I'm awake.

Out of curiosity, why do you always check the clock when you're aware of the fact that you're awake? Why not just start the meditating with your eyes closed right away?

Then I meditate with eyes closed until I drop off again. Mostly deep breathing exercises.

This is a technique that works really, really well for a lot of people. Until I started CPAP, that was my "go to" technique. With CPAP, I find the deep breathing hard to do since (in MY case), deep breathing while using CPAP seems to aggravate the aerophagia issues that have plagued me off and on since the start.

I think a lot of my insomnia issues are related to SSRI use. It's fairly common with SSRI's, but anything I can do to help alleviate it is worthwhile.

Yep. SSRIs are known for creating or aggravating insomnia. But if they're doing what they're supposed to do in terms of treating the depression, learning positive ways to deal with any insomnia issues is a good way to handle the situation.

I check the clock out of habit. I really need to turn it around. I sleep on my side and if I open my eyes, it's staring me in the face. I feel like I know what time it is before I realize I'm awake, lol.
I should have been more clear, I try to meditate. I'm only 3 weeks into CPAP use and I do find it difficult to do deep breathing, even with just the pillows. I don't normally breathe through my mouth but I did for meditating.
Now I try using my nose and its different enough to be aggravating sometimes.

robpiercey wrote:I'm only 3 weeks into CPAP use and I do find it difficult to do deep breathing, even with just the pillows. I don't normally breathe through my mouth but I did for meditating.

3 weeks into CPAP is not much. Have you seen an improvement ?

Hi all,

Sorry to let this thread been inactive for a while. My brain is fucked up. I have been forgetting even this CBT-I trajectory: forgetting reading and following the deadlines.

Last night was on the better side of my nights' sleep, but my brain is still not mine. At this moment I've spent almost 1 hour trying to do some paper work (tax filing), but I don't know even which form I must use, given the clutter of tax papers on my desk.

I think I DO HAVE a serious lung problem, but so far no doctor has believed me. Fuck my life.

I tend to think that my lung is so allergic or irritated by some elements of the air, that might wake me up 4 times per hour. Why so ? Because my night is terribly worse when
- Bedroom's door and window are not opened enough. Yes, "enough" = at least 30% opened.
- When the bedroom is small (e.g. 6-7 m2)
- When there's some extra person also sleep by my side: sleeping with my wife is as OK as sleeping alone. But when my 5 y.o. child sleeps also on our bed, my night is fucked. I don't think that my child moved too much or touched me too much: because my wife lies in between me and him. I also don't think he stopped me from moving my body: because video record of the night says I almost don't move my body at all (only my head or hand sometimes).

What happens to my body. Fuck me.

Sorry I might be quite emotional today.

Doctors in my country (A western country of GDP per capita > 40K/year) don't want to invest in this.

My brain can concentrate a bit better in one of the following settings

- When I walk, then stop a bit, open the laptop, works a bit, then walk a gain
- When I sit in a train.
- Or sometimes in a busy cafeteria.

When hearing this, most doctors would say: "Interesting" !!!

papzombie wrote:

robpiercey wrote:I'm only 3 weeks into CPAP use and I do find it difficult to do deep breathing, even with just the pillows. I don't normally breathe through my mouth but I did for meditating.

3 weeks into CPAP is not much. Have you seen an improvement ?

No. Not much. It's not the machine though. I don't stay sleeping long enough.
I am starting to get more comfortable sleeping with the mask and lying in bed awake with the mask.

papzombie,

I'm sorry to hear you are still struggling.

Comments on some things you have written.

papzombie wrote:My brain can concentrate a bit better in one of the following settings

- When I walk, then stop a bit, open the laptop, works a bit, then walk a gain
- When I sit in a train.
- Or sometimes in a busy cafeteria.

So your brain has an easier time concentrating in a somewhat distracting environment (train, busy cafeteria). Or when you have been physically active (walk, sit for a bit with the laptop, then walk some more ...)

When you are trying to concentrate at home or at the office where there are no distractions around, do you find yourself getting distracted by the worries? Do you find yourself focusing in on how bad you're feeling and how hard it is to concentrate instead of concentrating on what you want to be concentrating on?

You also write:

papzombie wrote:I think I DO HAVE a serious lung problem, but so far no doctor has believed me. Fuck my life.

I tend to think that my lung is so allergic or irritated by some elements of the air, that might wake me up 4 times per hour. Why so ? Because my night is terribly worse when
- Bedroom's door and window are not opened enough. Yes, "enough" = at least 30% opened.
- When the bedroom is small (e.g. 6-7 m2)
- When there's some extra person also sleep by my side: sleeping with my wife is as OK as sleeping alone. But when my 5 y.o. child sleeps also on our bed, my night is fucked. I don't think that my child moved too much or touched me too much: because my wife lies in between me and him. I also don't think he stopped me from moving my body: because video record of the night says I almost don't move my body at all (only my head or hand sometimes).

There's a lot to unpack here. So pardon me for re-quoting pieces of the passage that needs to be read in toto.

First:

... that might wake me up 4 times per hour

Do you suspect that you are waking up as much as four times an hour or do you have evidence that the wakes are really that frequent? Or is this still based on what the WatchPat data showed several weeks ago? This is a particularly important question because of the fact that you also say that the video yourself sleeping shows:

... [the] video record of the night says I almost don't move my body at all (only my head or hand sometimes).

In other words, what makes you think that you are waking up four times an hour if you "almost don't move" your body for most of the night?

Do you remember actual wakes when you wake up in the morning? Or do you remember any restlessness during the night? (Note most people who remember restlessness also remember a lot of moving around in bed, and you say the video shows you don't move much.) Or do you conclude that you must have been waking up frequently during the night because you feel so terrible in the morning?


Next:

Because my night is terribly worse when
- Bedroom's door and window are not opened enough. Yes, "enough" = at least 30% opened.
- When the bedroom is small (e.g. 6-7 m2)

How big is the bedroom you usually sleep in? What if anything prevents you from keeping the bedroom door open enough? Given your local climate, what fraction of the year are you able to keep your usual bedroom's window open enough?

If the room that you usually sleep in is smaller than your desired bedroom size, is there a way of swapping bedrooms in the house for a bigger bedroom? Likewise, what prevents you from having the door to your bedroom as open as you want it to be? If the problem is that you go to bed earlier than the rest of the family and their lights and noise prevent you from opening the door, then it may be that you need to go to bed at the same time as the rest of the family.

There's not much you can do if you live in a place where it is just not feasible to open the windows much of the year due to inclement weather and/or severe cold. But how often do you get to sleep in your usual bedroom with the window open? And how bad does the weather have to be before you shut the window? Or is it more that you want the window open and your wife wants it shut?


Next:

Because my night is terribly worse when
...
- When there's some extra person also sleep by my side: sleeping with my wife is as OK as sleeping alone. But when my 5 y.o. child sleeps also on our bed, my night is fucked. ...

How often does your 5 year old climb into bed with you and your wife? If this only a couple of times a month, then it's not happening frequently enough to be a real factor in the day-to-day quality of your sleep. If it's happening several times a week or every day, then it's time to have a talk with the wife about trying to break your 5 year old's habit of climbing into your bed. Seriously. A five year old does not need to sleep with mommy every night, even if both mommy and the five year old seem to think the kid needs to.

It's not easy to get a kid to give up the habit of climbing into his/her parents bed. And it involves figuring out why the kid wants to be there. A random bad dream here and there is one thing. But a kid shouldn't be having so many bad dreams that they need to climb into the parents bed multiple times a night. So if bad dreams are the cause, it may be worth asking the pediatrician if there's some explanation for recurring bad dreams. If the problem is just that the kid wakes up and is lonely, that's a whole different kettle of fish. It could be that since the kid crawls into bed on your wife's side of the bed, she's not even aware that it disturbs your sleep. Have you mentioned that to her? If so what was her reaction?

You and your wife may need to more actively try to encourage your child to stay in his/her own bed. Perhaps a reward system might help. Or perhaps giving the child permission to turn their light on in the middle of the night and (quietly) play with their stuffed toys when the kid wakes up will help.

Overall, I can understand how sleeping in a small, closed room (which may become stuffy and overly warm) with a kid in the bed with you and your wife can lead to some serious sleep problems: Warm stuffy rooms are difficult for lots of people to sleep in, and even if the kid is not touching you, the fact that you are aware of the child probably makes you more aware of your own sleeping problems because you don't want to disturb the others in the bed.

But I don't see how any of this adds up to some undiagnosed problem with your lungs being allergic, super sensitive, or overly irritated by elements in the air. If it were an allergy or irritated lung problem, then you would have breathing problems in the daytime as well as at night.

My guess is that you are just a hyper-vigilant sleeper: Small changes in your sleeping environment disturb you more than they disturb most people. You notice the kid climbing into bed in a way that your wife does not. You notice the bedroom being stuffy at night, particularly if the room is small and/or the door and window are shut.

My advice is to see if you can make your sleeping environment better fit your needs and tastes. If your usual bedroom is not big enough, then move things around and start using the biggest, least stuffy bedroom in your house for YOUR bedroom. Keep the bedroom cool to cold at night by shutting the heater vents (in the winter) and if others in the house can tolerate it, by turning down the thermostat in the overnight hours. When the night time temperature is in the 50s F (low teens C), open the windows in your bedroom up. When you can't open the windows, try running a fan in the bedroom. And work with your wife on figuring out a way to keep your five year old from crawling into the bed on a regular/semi-regular basis.

robysue wrote: When you are trying to concentrate at home or at the office where there are no distractions around, do you find yourself getting distracted by the worries? Do you find yourself focusing in on how bad you're feeling and how hard it is to concentrate instead of concentrating on what you want to be concentrating on?

I often realize that I don't concentrate well, after finding me doing something else other than the thing I wanted to do.

I now think "bad short term memory" might be the reason of a bad concentration: my brain forget what it wanted to do, when there's something new coming. In fact yesterday I had to ask my wife and another friend if they have done a thing X, only to find out that I must have done that thing X because my wife and friend have not done it.

First:

... that might wake me up 4 times per hour

Do you suspect that you are waking up as much as four times an hour or do you have evidence that the wakes are really that frequent? Or is this still based on what the WatchPat data showed several weeks ago? This is a particularly important question because of the fact that you also say that the video yourself sleeping shows:

... [the] video record of the night says I almost don't move my body at all (only my head or hand sometimes).

In other words, what makes you think that you are waking up four times an hour if you "almost don't move" your body for most of the night?

Do you remember actual wakes when you wake up in the morning? Or do you remember any restlessness during the night? (Note most people who remember restlessness also remember a lot of moving around in bed, and you say the video shows you don't move much.) Or do you conclude that you must have been waking up frequently during the night because you feel so terrible in the morning?

- I am often aware of my micro awakenings only 1-2 times per night. My WatchPat-200 said it's 3-4 times per hour. But there are 2 nights in the last 3 months that I remembered many more micro awakenings: (1) The first night on CBT-I and need to estimate how many awakenings I have done, (2) A sleep study (polysomnography) I did 1 week ago on CPAP. Seems that some special excitements from those two nights did wake my brain up enough to remember those awakenings.
- The video shows I move my hand, or scratch my face, or move my neck a bit. I am not sure if those movements are attached to those micro awakenings.

If the room that you usually sleep in is ....

- Now that summer comes, I slept in once small room (7m2) once and opened the window enough. Voila I feel less tired in the morning than if I did not open the window.
- My kid wakes up 1-2 times per night, cries of some bad dreams or because he feels lonely in the dark. I am talking to a pediatrician about this. When my kid cries I often have to call him to come to our bed, or come to him to hug him and convince him to sleep further (but I fail most of the time). <--- I am receiving help from some child care professionals in how to deal with my kids.
- My rooms are now 14-16 Celcius degree at night.

Talking about feeling bad after sleeping with the kid and my wife: one psychologist said probably I am unconsciously fearing that I would touch the 2 persons sleeping beside me, that I don't move comfortably enough at night --> this harms my sleep. I don't know what to think on this.

But I don't see how any of this adds up to some undiagnosed problem with your lungs being allergic, super sensitive, or overly irritated by elements in the air. If it were an allergy or irritated lung problem, then you would have breathing problems in the daytime as well as at night.

Yes, during the day I concentrate better if I put the mask on. Doctors and people think I am crazy using that for better concentration.
Also during the day I sometimes feel better if I breath deeply (taichi style), but this people could understand somehow.

My advice is to see if you can make your sleeping environment better fit your needs and tastes. If your usual bedroom is not big enough, then move things around and start using the biggest, least stuffy bedroom in your house for YOUR bedroom. Keep the bedroom cool to cold at night by shutting the heater vents (in the winter) and if others in the house can tolerate it, by turning down the thermostat in the overnight hours. When the night time temperature is in the 50s F (low teens C), open the windows in your bedroom up. When you can't open the windows, try running a fan in the bedroom. And work with your wife on figuring out a way to keep your five year old from crawling into the bed on a regular/semi-regular basis.

I am about to sleep with a window widely-opened tonight.

Thanks.

My psychologist now suggest I should take Depression into account, and that depression (10-15 years or more) has consumed my energy too much that I feel tired all the time.
I am planning to read more about this now