My History:
I’ve been on APAP for about a year, the first 6 months absolute hell, inconsistent therapy and problems until I had a septoplasty and turbinate reduction to fix a severely malformed septum. The surgery improved things dramatically, though not completely. Since surgery, my therapy has been terrific, with the help of CPAPTalk I’ve reduced my AHI to about 0.4.
My one nagging problem has been sleep maintenance insomnia. I wake several times a night, to a point of being very alert and then unable to get back to sleep for a long time, if at all. Occasionally, I had trouble falling asleep, but my main problem was staying asleep. Prior to CPAP, maintenance insomnia had never been a problem.
Results:
After completing the 5-week CBT-i program, it has been a huge success. Not 100% successful, I still wake up once, maybe twice a night, but not the same level of alertness, and I’m asleep again in minutes. When I go to bed at night, I’m asleep within minutes.
Although, I’m now done the formal part of my therapy, my expectations are for more improvements as I continue better sleep hygiene.
Details:
- 5 weeks
- Cost: $113 (CAD) - $85 (US) per session
- 85% of cost covered by my insurance
- Weekly 30-minute meetings with therapist via computer video conference, with weekly tasks between sessions.
- Complete daily sleep dairy
- CBT-i was suggested by my Sleep Doctor
Pre-Therapy:
- Set up account with online site
- Downloaded video conference software
- Exchanged emails with therapist and set up first appointment
Week 1:
- Met my therapist (video conference) and chatted about my particular sleep issues
- Discussed CBT-i program
- Discussed good sleep hygiene (thanks to CPAPTalk and ChicagoGranny, my sleep hygiene was already on point)
- Set a target bedtime, I set mine to Midnight. Target bedtime is important because in week 2 we will be consistently getting only 6 hours sleep. i.e. If you go to bed to early say 9:00 then you get up at 3:00.
- Completed sleep diary every day
Good Sleep Hygiene:
- Comfortable bedroom
- Dark
- No Pets
- Bed only for Sleep (and Sex)
- No TV, radio, podcasts
- Reduce caffeine, for me 2 coffees a day, non-after 10:00 AM
- No Napping (if I have to max 45 minutes, not after 3:00PM)
- No late-night bingeing
Week 2:
- Discussed Week 1 and sleep diary
- Told to set alarm to 6:00 AM everyday
- Consistent bedtime 12:00 midnight, 6:00 AM
- The idea is to be very fatigued come bedtime. (Which I was)
- Complete sleep diary, which calculates sleep efficiency. Time asleep / Time in Bed as a percentage.
- If I meet 85% sleep efficiency, I get to increase sleep time from 6 to 6.5 hours.
Week 3:
- Discussed week and sleep diary
- Met my 85%
- Increased sleep to 6.5 hours, wake time now 6:30 AM
- Still tired at night, less daytime drowsiness
- Discussed breathing and calming exercises
Week 4:
- Discussed week and sleep diary
- Met my 85%
- Increased sleep to 7 hours, wake time now 7:00 AM
- Little to no daytime drowsiness
- Never did any breathing and calming exercises
Week 5:
- Final session
- Discussed Week and sleep diary
- Met my 85%
- Increased sleep to 7.5 hours, wake time now 7:30 AM
- Instructed to continue with sleep diary
- Continue to increase sleep time if I meet 85% efficiency, but probably limit to 8 hours based on previous results. If my sleep efficiency drops below 80% reduce sleep again
- Try to find my sweet spot for nightly sleep times.
- Keep consistent bed and wake times
- Don’t revert to bad sleep habits
- If insomnia creeps back in, step up CBT-i practices again
Observations:
- During the early stages I was very drowsy during the day and evening. Fell asleep in my chair twice, but only for a moment. This hasn’t happened since starting CPAP
- Ease of falling asleep at night continuously improved, now I’m asleep in minutes
- Nightly awakenings reduced from many to 1 (maybe 2)
- Intensity of awakenings reduced dramatically, now when I awake, I’m asleep again in minutes.
- Waking up refreshed with no daytime drowsiness
- My AHI and CPAP therapy stayed consistent throughout the therapy.
Final Thoughts:
I consider it a success and believe CBT-i could benefit many suffering from insomnia. I also believe that there is no reason a similar program could be completed with a therapist and the cost. Though for me, an important part of consistently hitting the midnight-rise time targets was because of a sense of obligation instilled by my therapist. I never cheated and not sure I would have had the discipline had I done it on my own.
A Google Search can be used to find CBT-i support sites and tools should you wish to try it on your own.
Daily Sleep Diary:
- I woke up at:
- I got out of bed at:
- At breakfast time, I felt (energy level):
- I went to bed at:
- I turned out the lights at:
- Minutes to fall asleep after lights off:
- After falling asleep, I woke up ___ times:
- I got out of bed ___ times (for awakenings > 20 min):
- Approximate total duration of all awakenings was (in minutes):
- Overall, the quality of my sleep last night was:
- I took ___ (number of) naps:
- Approximate total duration of my naps was (in minutes):
- My level of fatigue during the day was:
- Number of servings of:
- Alcohol:
- Coffee:
- Tea:
- Cola:
- Chocolate:
- I took medication for sleep (Name/Dosage):
- I practiced relaxation (Yes/No):
- I used "Clear Your Head" time (Yes/No):
- I completed a thought record (Yes/No):
If anyone has any specific questions, feel free to ask.
