Sleep Restriction Therapy for Insomnia

[[lo...]]

Hey Aloha,

 

I am sorry to hear this is such an uphill battle. How often do you touch base with your sleep therapist? If this method is not working, it's usually because there can be improvements somewhere. And you may want to really go with a fine tooth comb with all of your habits to see what can be done with your therapist. Sometimes it's the little things that stand in your way.

 

Think carefully about what you are doing: Is the room you are in too hot or cold (it's summer time, so temps can be an issue)? Is it dark enough? Are you having any stimulants (like sugar) after 6pm? Do you exercise during the day? Do you do relaxation exercises during the day? Do you get out to the sun within a short time of waking up?

 

If you are concerned about bothering your wife, that can cause you anxiety and undermine this whole process. Can you sleep on a couch or a pull out bed for the time being? Or can she? This may be the best possible solution for the time being.

 

 

[[al...]]

Good morning Runner,

 

I managed to log 1 hour sleep last night, although 45 minutes were "illegal" since I stayed in bed beyond my allowed wake up time. I see my CBTi therapist tomorrow and will ask her what she thinks is going on.

 

I'm trying to get my wife to sleep in a different bed, but she doesn't want to. I would be more than happy to sleep elsewhere for her sake, but I was under the impression that I am supposed to train myself to be able to sleep in my own bed. I'll ask my therapist about that as well.

 

[[...]]

Hi Zuko,

 

Actually I am doing the sleep restriction as part of a broader cognitive behavior therapy for insomnia approach through a licensed therapist working with a sleep center overseen by a M.D. I was told that they are following a pre-established treatment approach with decades of experience behind it. I was advised to follow the program without making up my own rules in order to have the greatest chance for success.

 

The rules are very big on limiting attempts to fall asleep to 30 minutes or less, but there is no set time as to when I can return to bed to try again. If I start dozing on the couch in 10 minutes then I can return to bed for another attempt of up to 30 minutes. My body is to be my guide. Restricting my sleep window to 5 hours gives me a chance at a minimal level of sleep to retain my health while helping ensure an adequate sleepiness each night at bedtime. The goal is to overcome negative conditioning that connects bed with past stress from the insomnia. Oh yeah, I am allowed one 45 minute nap a day as long as it is done by 3pm.

 

I am told that it is not uncommon to go up to a week with little or no sleep with this treatment. Eventually your body will give up the fight and fall asleep and you will be conditioned to fall asleep quickly every night.

 

So far it has been easier to get through the days than I though (I did take a leave of absence from work), but the final couple of hours before my 1 am bedtime is hell. My neck is sore from all the times my head pitched forward or sideways then snapped back as I caught myself starting to doze.

 

Progress appears to be in fits and starts. Many nights saw no sleep at all while one night I was blessed with falling asleep fast and using up most of my 5 hour sleep window. Yesterday I fell asleep napping for the first time since my insomnia started, but last night I only had 1 hour of sleep. It is hard not to feel some pressure due to the 30 minute sleep attempt window.

 

Since I do not have a plan B that will allow me to see the start of another summer, I am going to stick with this program and beat this insomnia into the ground.

 

Sounds good.. Whats your drug history?

[[...]]

use f.lux for light on your laptop if you have one

[[lo...]]

Good morning Runner,

 

I managed to log 1 hour sleep last night, although 45 minutes were "illegal" since I stayed in bed beyond my allowed wake up time. I see my CBTi therapist tomorrow and will ask her what she thinks is going on.

 

I'm trying to get my wife to sleep in a different bed, but she doesn't want to. I would be more than happy to sleep elsewhere for her sake, but I was under the impression that I am supposed to train myself to be able to sleep in my own bed. I'll ask my therapist about that as well.

 

Aloha, ideally you want to be in your own bed. But if your partner is causing you problems with sleep, then by all means get the hell out of the bed and find a new place to sleep until sleep stabilizes and you aren't so sensitive. Another benzo member who successfully tried sleep restriction (she was an extreme insomniac, 1-2 hrs of sleep a night), slept apart of her husband in a different room until her sleep got back on track, and then re-joined him. This is a serious matter. Bottom line is that you may be tossing and turning, which then causes her to toss and turn, so when you fall asleep you get jolted awake because of her subsequent movements. You get the idea.

 

Do whatever it takes to get a calm, quiet, and relaxing environment.

[[MT...]]

I've found it a lot less stressful to sleep in a different bed from my husband for a while. Then I don't worry about waking him or get upset when he makes noise or moves and it disturbs me. So being in different beds can be a stress reducing move. The CBT-i is trying to get you to associate *a* bed with sleep. It doesn't have to be a specific bed. That's my understanding.

[[al...]]

After I started this thread I thought that I would share my progress with anyone interested in cognitive behavior therapy. Unfortunately, I do not yet have any positive news to report. I have been doing the sleep restriction portion of the therapy for over a week now and do not seem to be responding to it yet. I did have a couple of decent nights that got me all excited, but the extra sleep just resulted in following nights of little or no sleep (same old pattern as before the therapy started).

 

As it is designed to do, the sleep restriction therapy is affording me even less sleep than I was getting in the past. When exhaustion sets in I finally get enough sleep to keep me from falling onto my face then the sleep difficulties just return. My doctor insists that I need not worry about my health due to not getting enough sleep, but it is hard to believe her, especially when she is not the one in potential danger.

 

My doctor agreed that my recent Ambien problem may be playing a role in my lack of progress. Ambien and benzos fry your GABA receptors, impairing their function when the drug is removed. Perhaps this therapy may be better suited for insomniacs who do not have a history of Ambien/benzo dependency, but my doctor still suggests that I attempt the therapy so that I will have less problems down the road after my brain re-wires itself.

 

The increase in lack of sleep is really hard to take. It has become shear torture trying to stay awake late at night after my family goes to bed. It is also hard to continue with this therapy when my conviction that it will work is diminishing. Since what I was doing before did not work too well and because I do not have a plan B, I see no choice but to slog on.

 

I have heard some positive feedback regarding cognitive behavior therapy from some of you. Hopefully I will be able to report a good outcome in the end.

[[Si...]]

Sorry about the continuing problems aloha. I'm in a similar boat. I've had a few rays of sunshine peek through. I had a ten day stretch of sleeping mostly decently every night. A few nights were the half awake type of sleep, but felt fine during the day, so must have been adequate. A few night of 4-6 hrs, but that's heavenly compared to none. Unfortunately the pattern broke on Tuesday night for some unknown reason. I was feeling really good physically and mentally after the 10 day stretch. Today, I feel awful. I was having one of the most agitated nights. Some of my non-sleep nights I can remain pretty calm and motionless most of the night and get some rest and not feel totally destroyed the next day. I went to a sleep doc yesterday and all he wanted to do was put me on an A/D. No blood test to see if something physical was causing it. It's probably why I was so agitated last night. Anyway, hope you start improving. I think I've read a lot of places that typically the sleep really starts working pretty well (if adhered to) in about 2 weeks. But I'm second guessing what's withdrawal now and what's my own thoughts causing my problems. I never had this problem before benzos though.

[[al...]]

Siggy,

I feel for you as well. This insomnia thing is turning me into an irrational crazy person so I know what you are going through. Its a difficult cycle since lack of sleep causes emotional instability and anxiety which in turn causes less sleep. I can only say "hang in there" and hope that I can do the same.

[[lo...]]

Aloha,

 

Remember that article I shared with you? That guy saw little to no results for over a month! You have got to stay committed to this and stay on track to see it through. It really hasn't been that long yet. Hang in there buddy!

[[Si...]]

Siggy,

I feel for you as well. This insomnia thing is turning me into an irrational crazy person so I know what you are going through. Its a difficult cycle since lack of sleep causes emotional instability and anxiety which in turn causes less sleep. I can only say "hang in there" and hope that I can do the same.

 

For sure and thanks! One of the more difficult things is dealing with getting to and from work. Once in there it's not terrible. I work in an office as a graphic designer. Usually not physically difficult but does take some mental acuity. It's somewhat easy since I've been there 15 years. If I could work from home would be nice. Driving through isn't fun even with plenty of sleep. Good luck everyone!

[[al...]]

Hi again runner,

 

To be honest, I did not read the whole article until today. I kind of stopped after getting to the part about how important getting sleep is and the bad things that can happen if you don't.

 

I see now that it is a very good article and it backs up what I'm being told needs to be done during my therapy. Reading the article gave me the idea to download some audio books to use at night when I have to leave my bed because of not falling asleep on time. I never thought of doing that and am actually pretty excited to see how much they help pass the time.

 

Of course I was hoping for an easier outcome, but now I have to suck it up and learn to endure the hardship. Funny how this situation is playing on all my major weaknesses. This could end up being a very good opportunity for change.

[[lo...]]

Hi again runner,

 

To be honest, I did not read the whole article until today. I kind of stopped after getting to the part about how important getting sleep is and the bad things that can happen if you don't.

 

I see now that it is a very good article and it backs up what I'm being told needs to be done during my therapy. Reading the article gave me the idea to download some audio books to use at night when I have to leave my bed because of not falling asleep on time. I never thought of doing that and am actually pretty excited to see how much they help pass the time.

 

Of course I was hoping for an easier outcome, but now I have to suck it up and learn to endure the hardship. Funny how this situation is playing on all my major weaknesses. This could end up being a very good opportunity for change.

 

That's a fantastic way of looking at the situation. From this entire benzofuckery experience I have learned that a lot of meaningful change comes from enduring hardship. Nobody said that sleep restriction would be easy, if it was everyone would be dropping sleep aids and doing it. I think what you are doing w/ audio books is great, you are creating a treat for yourself in case sleep doesn't come. Make sure it's a super boring book. You don't want to excite your nervous system with some murder/romance novel and not be able to sleep For me personally, sound excited me, so I am better off reading instead of listening. But naturally to each his own.

 

Also, something you said about it playing off your weaknesses struck a chord with me. I used to be a fantastic sleeper, I could fall asleep in the middle of a loud party. I used to tell my husband that in my totem pole of all things I love, it goes like this: 1)sleep 2)food 3)sex. So when sleep got taken away, and I became to nauseous to eat, I thought universe was pretty fucking cruel. But damn it, I am a better human being because of it.

 

Lastly, here is the story of the buddy who used Sleep Restriction to recover. It's pretty damn inspiring: http://www.benzobuddies.org/forum/index.php?topic=48905.0

 

 

[[al...]]

Runner,

 

Thanks for the link. The more success stories that I hear, the better I feel about the sleep restriction therapy.

 

Last night was good, but pretty weird. As usual, after 30 minutes failing to fall asleep, I left my bed and started listening to a new audio book. I could not get through more than 5 or 10 minutes before I started nodding off. I returned to my bed only to put in another 30 minutes or no sleep. I repeated this cycle about 5 times. I began to notice that each time I left the bed I was feeling slightly more refreshed. In addition, I was pretty accepting of the situation instead of getting anxious over the lost sleep time.

 

I began to think that during each attempt I had indeed fallen asleep. That would account for the sense that the 30 minutes were passing a bit too fast. Something was waking me up at around the 30 minute mark and I bet that it was my internal clock having been set to fixate on the 30 minute deadline. To test this out, with about 2 hours to go to my scheduled final wake up time, I decided to not get out of bed at the 30 minute mark and instead simply role over and continue my attempt at sleep. Next thing I knew, I was waking up to my alarm clock 2 hours later. If I could have caught this reoccurring mistake sooner, I may have been able to sleep through the entire 5 hour sleep window.

[[lo...]]

You are totally right. It sounds like you were obsessing about 30 minute deadline, which in itself was stressing you out and causing you to stay up! Glad you uncovered that.

 

Btw, Jittery's story (the success story I posted earlier) was the final straw that motivated me to give this a go. She is amazing.

 

 

[[Th...]]

Runner,

 

Thanks for the link. The more success stories that I hear, the better I feel about the sleep restriction therapy.

 

Last night was good, but pretty weird. As usual, after 30 minutes failing to fall asleep, I left my bed and started listening to a new audio book. I could not get through more than 5 or 10 minutes before I started nodding off. I returned to my bed only to put in another 30 minutes or no sleep. I repeated this cycle about 5 times. I began to notice that each time I left the bed I was feeling slightly more refreshed. In addition, I was pretty accepting of the situation instead of getting anxious over the lost sleep time.

 

I began to think that during each attempt I had indeed fallen asleep. That would account for the sense that the 30 minutes were passing a bit too fast. Something was waking me up at around the 30 minute mark and I bet that it was my internal clock having been set to fixate on the 30 minute deadline. To test this out, with about 2 hours to go to my scheduled final wake up time, I decided to not get out of bed at the 30 minute mark and instead simply role over and continue my attempt at sleep. Next thing I knew, I was waking up to my alarm clock 2 hours later. If I could have caught this reoccurring mistake sooner, I may have been able to sleep through the entire 5 hour sleep window.

 

I put myself on SR for a week prior to seeing a sleep specialist and then he had me stop. He wanted a couple of weeks worth of sleep diary entries before putting me on a schedule. I suspect I'll be doing it again, but with more TIB vs the 5 hours I was allowing myself initially.

 

That said, are you watching the clock at night?  I removed mine from the room and moved my iPhone to a table I can't reach. I simply refuse to go and pick it up at night. Amazingly, this one thing has helped my sleep quite a bit. I'm getting about 3.5-4.5 hours in the first stretch and then dozing in and out for another three. It's not optimal, but better than before.  For me, clock checking generates a lot of anxiety and fuels the sleep loss.

 

Hang in there!

[[...]]

The first thing they suggest ^^^^

 

Remove all clocks and don't check it

[[al...]]

Hi Zuko,

 

Part of my therapy program involves filling out a complex nightly sleep log that tracks the total time spent awake in bed (all attempts at initial sleep and all attempts to return to sleep). Since I keep falling asleep and waking up it started to get kind of complicated, requiring a lot of clock checking and note taking. I finally gave up and just started going with the flow. In the morning I end up more or less fabricating my log results since it is often too much to remember. I decided to error in favor of recording too much sleep instead of too little otherwise my therapist will never reward me with a favorable adjustment to my bedtime.

[[al...]]

Started to see some real progress over the past few nights, but it seems that I was making a mistake and suffered a big set back as a result. In order to protect my wife's sleep during this sleep restriction process, I moved into another bed and let her stay in our good expensive bed.

 

I was starting to get a lot of good sleep on the other bed and found that I was feeling a sense of discomfort when I walked by my old bed. I knew that I needed to imprint back on my old bed before this therapy can be said to be a success. Last night I rejoined my wife in our room and was only able to get less than 2 hours of sleep even though the bed is very comfortable and I was very tired. I now need to do a reset and start over. Hopefully progress a second time around will come more swiftly than the first time.

 

It amazes me just how powerful cognitive conditioning is, at least for me. Since it is all in my mind, I would like to think that I could simply apply strength of will to overcome any unwanted behavior. It some ways, the realization that the conditioning is too strong to overcome without a big battle makes me feel sort of akin to a trained circus animal. No wonder so many of us have chronic insomnia.

[[lo...]]

"Trained circus animal" - LOL!!! That is exactly how I feel as well. We are totally one step away from being Pavlolv's dogs. But you are totally right, sleep is a reflex, so it needs to be retrained if it went awry.

 

Congrats on the progress you are seeing. I suggest you stick for a while with sleeping away from your spouse, and when you are feeling really strong rejoin her. She isn't going to go anywhere while you get better!

[[al...]]

Hi Runner,

Good to hear from you again. I was thinking of taking another "sanity break" from this forum, but decided to check it one last time since I am trying to stay awake and running out of ideas on how to do it.

 

I have been pretty down the last couple of days. What little progress I made with the sleep restriction seemed to vanish and I am now having very serious doubts about my ability to continue with it. Sleep was bad enough before I started and now I am getting even less of it every night. It is hard to have strength and resolve while so sleep deprived.

 

My therapist advised that I get back into sleeping in my own bed for a better future outcome. I decided that she was right since I was growing very comfortable in the other bed and was still experiencing nervous feelings when I looked at my own bed. Switching back seemed to mess up what progress I had made. I just can't believe how much conditioning is playing a role in my sleep problems and hard it is to overcome it.

 

It has been a little over 2 weeks since I started the protocol and I have yet to be able to fall asleep within my first 30 minutes of trying. I have to go through multiple cycles of leaving my bed then returning to try for sleep again before I can succeed. Meanwhile my 5 hour sleep window is growing smaller and smaller. I usually get to sleep only after I say "screw it" and refuse to follow the rules and stay in my bed. Doing this tends to put me to sleep well within the 30 minutes allowed (so I end up not cheating after all).

 

Since I have yet to obtain an 85% sleep efficiency, I have not been rewarded with any extra sleep time. It is starting to look like the third week will end the same way so I feel like I am doomed to be fighting total exhaustion all alone until my scheduled bedtime forever. I am not sure how long I can continue to do this.

 

I told my therapist that I am having a hard time with the 30 minute deadline for sleep hanging over me all the time. Too often my watch will tell me 30 minutes have come and gone, but it seems to have passed way too fast to make sense to me. I am pretty sure that I am falling asleep and not realizing it. I also think that perhaps an internal clock is waking me up at around the 30 minute mark causing me to think that sleep did not come and that it was time to leave my bed to try again later. My therapist advised getting rid of my watch and clock and just going with my gut feeling to decrease my sleep performance anxiety. Then she gives me a very detailed sleep log and asks me to fill it out as best as I can without knowing any of the times. Progress can only then be measured if my numbers point in the right direction. Doesn't make sense to me.

 

You said that you were lucky enough to be able to fall asleep within 30 minutes from the start. Has that continued? If not, I am wondering how you handle to time monitoring issue without any added stress.

 

It seems that you are having a much better results with your sleep experiment that I am. I hope that you continue to make progress and end up with the final outcome that you had hoped for. I wish that I could follow along right behind you, but I my faith is lacking.

 

 

[[Si...]]

I had a very weak attempt at SR. I couldn't handle it for more than about 4 days. I was doing the day on day off for a while. I slept for 10 days in a row in mid June and then had two 0 nights with broken sleep night between and after. I'm at my mom's place now and slept good for 6 more days. Last night went back to 0. I'm feeling absolutely terrible today. Massive depression too from all of this. I wish I had a magic wand to make all of this bullshit go away.

[[lo...]]

Hey Aloha,

 

I am sorry to hear you are suffering. I don't agree with your therapist about forcing you to sleep next to your spouse which causes you inherent anxiety. Everything I've read from other sleep specialists says it's important to have a peaceful environment, even if it means sleeping away from your spouse until your sleep stabilizes. If you were having good progress with it, I don't see the reason to mess that up.

 

I am also not going to be on BBs very much anymore. I actually only checked in to see how you were doing. I find that I get more anxious if I start reading about everyone's plights.

 

My situation is slightly different than yours, I am decreasing Gabapentin right now, so my sleep always suffers for the first couple of nights after my cut. But that said, I have been able to fall asleep shortly after hitting the sack. I am actually having a really hard time staying up until 1am. Past 3 or 4 days, I passed out on the couch for 15-30 minutes around 11pm just because my body was not having any of this anymore. I've been doing the sleep restriction for some time now, so my guess is that my sleep debt has accumulated. So I need to fix that part of the therapy because that messes up the sleep drive. I usually wake up around 6:30am and then dose in and out until 7:15am (my alarm). I really want to see what would happen if I go to sleep an hour earlier. Will I still wake up at 6:30am? Or will I wake up at 5:30am?

 

I actually have a follow up appointment w/ my sleep doc today, so I will let you know what he thinks.

[[al...]]

I had a very weak attempt at SR. I couldn't handle it for more than about 4 days. I was doing the day on day off for a while. I slept for 10 days in a row in mid June and then had two 0 nights with broken sleep night between and after. I'm at my mom's place now and slept good for 6 more days. Last night went back to 0. I'm feeling absolutely terrible today. Massive depression too from all of this. I wish I had a magic wand to make all of this bullshit go away.

 

Siggy,

It sounds like you are having more good nights than bad nights. I think that sounds like progress for someone with insomnia. I found that my depression comes and goes along with my quality of sleep. Hang in there. I'm sure that you have many more good nights to come.

[[al...]]

Good Morning Runner,

 

I'm touched to hear that you logged on just to check up on my progress. After my post last night, my wife helped me adapt a major attitude adjustment so this morning things are looking a lot brighter.

 

First off, watching TV to stay up was not working for me. My neck is actually very stiff and sore from all the times I started nodding off and ended up suddenly jerking myself awake. Also one night the TV remote fell out of my hands and I caught myself from pitching forward face first onto the floor.

 

Last night I discovered a good online political forum so now I can satisfy my urge to reach out and communicate, but on topics not pertaining to my sleep troubles. I also found that the night is a good time for me to review my current life and establish/tweek my goals and affirmations. Last night it became very clear to me that I have been obsessing about my insomnia way too much and that has been giving it a lot more control over my life than it deserves. My new goal is to have my wife ask about why she has not heard my complaints for a while.

 

I also realized that this sleep restriction protocol is mine to own. I am not doing it for my therapist. Progress can be judged on my terms since I am the one living the experience. After my first cycle of getting out of bed at around the 30 minute deadline, I decided that it was going to be the last cycle for the night. I disconnect my mind from the process went back to bed and actually spent most of the rest of the night sleeping. Alternately, I could have used up most of the allowed sleep time cycling back and forth between my bed and the living room and ended up feeling awful in the morning.

 

Since my therapist is using my sleep log data in a black or white fashion to determine any changes in my sleep schedule, I am going to adjust the data to reflect my satisfaction with my own progress. I do not think that I had an 85% sleep efficiency rating since long before my recent insomnia started. Although it sounds nice, I will be happy with a little less. If one not so great night in a week prevents any schedule changes I think that I will become too frustrated and be more tempted to give up on the whole process.

 

I'm curious...it sounds like you are applying your sleep schedule progress adjustments to your morning wake up times. Why can't you apply them to your bed time instead? That way over time you will get some relief from the torture of having to stay up so long each night.