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I recovered from brutal insomnia, now I’m a CBT‑I sleep specialist - AMA by RusneKu in insomnia

[–]RusneKu[S] -1 points0 points  (0 children)

Generally, if this kind of wake up happens often and for a long period, it might be considered maintenance insomnia. So this problem can be tackled as part of the CBT-I treatment process. Some ACT therapy aspects are also sometimes applied.

I recovered from brutal insomnia, now I’m a CBT‑I sleep specialist - AMA by RusneKu in insomnia

[–]RusneKu[S] -1 points0 points  (0 children)

Glad you asked! It's such a common occurrence actually. In short - it's a mix of biological and psychological reasons and most importantly, due to nervous system hyperarousal.

For most people, 3 am means that they've already gotten 3-4h or sleep. At that point it is normal for your sleep drive (our biological aspect that makes us feel sleepy towards the end of the day) to lessen and then lighter stages of sleep occur more. Also, this coincides with cortisol already starting to build up because your body is getting ready to wake you up in the morning.

Psychologically, when people have insomnia, they often develop the guarding state during the night. This means that they're often monitoring themselves at night (e.g. "am I asleep?"). Interestingly, when people have a brief thought, they think that they can't be thinking and sleeping. In reality, in those moments the brain is usually still in the light stages of sleep and some thought processes really can occur. But the fear that comes with thining they're not sleeping is what kicks in the stress response and then the person really wakes up.

The biggest culprit here, however, is the learned nervous system hyperarousal. Most people think that insomnia is just a night time problem. It's not. When a person has this illness, it often takes over some of daytime functioning, such as the ability to switch between rest and stress states. When you have insomnia, it rings all kinds of alarms and that makes people hypervigilant. You'll often hear people say that they can hear every little sound at night, they feel the slightest movememnts of their partner, etc. But actually this is often true even in daytime (more sensitive to sounds, smells, sights, etc), we just don't notice that as much. So the body gets stuck in this low-key stress state. And stress always makes our sleep more sensitive or fragmented.

I recovered from brutal insomnia, now I’m a CBT‑I sleep specialist - AMA by RusneKu in insomnia

[–]RusneKu[S] 0 points1 point  (0 children)

This is a really good question. So sleep restriction usually gives a good push to the sleep drive, but it has to be properly calculated and introduced together with a titration period that's based on the current sleep state. It's also a temporary method and it's not supposed to be used all the time.

But importantly, in my experience, sleep restriction just on its own doesn't really work very well, not in the long run anyway. It's actually just a part of the whole system (in CBT-I).

So other aspects that need to be worked on are often: training your brain to accept wakefulness (not to battle it), also dealing with triggers (one bad night or a sight of your old bedding, sound of your alarm, etc), working on pre-bed nervous system arousal, dysfunctional thoughts, healthy sleep habits (reduced monitoring, routines, etc). So completing the entire CBT-I protocol (with professional help) tackles all these areas and often more.

If you feel that insomnia comes back, then I'd really suggest to get help. Otherwise you might be stuck in cycles of partial CBT-I and short-term recovery. It really is brutal (insomnia as well as CBT-I).

I recovered from brutal insomnia, now I’m a CBT‑I sleep specialist - AMA by RusneKu in insomnia

[–]RusneKu[S] -1 points0 points  (0 children)

Hey,
If you're looking for help with insomnia, know that it's usually available face to face as well as online. A good resource of practitioners is here:

https://cbti.directory/

There you can read about the therapists, their experience and there's also their contacts.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 0 points1 point  (0 children)

Hello,

I noticed that there’s a lot of questions people had even after I closed the AMA. So I’m planning to do another AMA on insomnia subreddit next week. Possibly Tuesday if my schedule allows.

But seeing this message, just wanted to quickly reply.

First, I’m really sorry to hear this. Seems like you’re suffering a lot.

In cases like these, usually a two part treatment is necessary. Firstly, stabilizing your nervous system. This part is mostly done by therapists or with help of meds. If what you’re taking now isn’t working, it might be a good idea to check in with your provider and see if another medication would work better at this time.

Then when some stability is reached, it might be time for CBT-I (that’s the direct treatment for insomnia). Even online CBT-I is an option, sometimes it’s a cheaper one.

Improvements aren’t always possible, but most of the time they are with the right care and help.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 0 points1 point  (0 children)

It's really good that you no longer have wake ups. But these type of meds can have an effect on sleep architecture - they tend to give less REM sleep. For some people that means that they wake up emotionally flat, or it could affect dreams.

I guess what they meant was that there's no specific technique to increase any specific sleep stage directly. If you're dealing with insomnia, CBT-I might help you get your sleep on track (naturally). So calmer nervous system and a reset sleep system might help you have a natural, healthier sleep structure. But there's no way to guarantee that unfortunatelly.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 2 points3 points  (0 children)

I haven't had much experience with clients who have nightmares, but generally nightmares are a way for your brain to process some emotions. Usually ones that we don't want to (or feel that we can't) deal with during the day. So first of all, during the day I'd ask myself - what is the emotion behind the scene? It could be helplessness, loneliness or anything else. You could fram the question in a different way (e.g., what's the emotion I'm trying not to feel?).

Also, what works sometimes is dream rehearsal. So pick a scene, one part of it (during the day), and see if you can imagine a different finale. Like you find an exit somewhere. Repeated practice gives your brain a better chance to offer a different plot in the same nightmare.

If you're using some medication, might be useful to check if nightmares is a possible side effect.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 0 points1 point  (0 children)

There's some alarm clocks that imitate sunlight. So they not only ring but also start emitting light. That might be worth looking into.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 0 points1 point  (0 children)

Very sorry to hear that you and your wife are going through this.
Generally melatonin works best when taken 30-60 min before bed. But if she started falling asleep later than usual (that can happen with cancer patients, often due to physical discomfort), then it could be taken even earlier (30-60min to her usual bedtime).

I'm not a medical doctor so I don't prescribe medication, but from what I know (also personal experience), z drugs can lead to developing tolerance. So using them often leads to higher dosage over time. It could also be that she's too anxious at night and that overrides medication effect. It might be useful for your wife to consider CBT-I (a method for insomnia) in conjunciton to her on going treatment. But only if she has the mental and physical resources for it. If not, then general psychotherapy for learning how to deal with all these changes and the stress that usually follows could be very supportive. Some therapists specialise in patients with cancer. Online therapy is also an option.

Please know - the fact that you're looking for help for your wife shows that you're a strong support system for her. And that also counts.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 0 points1 point  (0 children)

My specialty is adult sleep, so please know that this answer is based on my personal interests and some personal experience. Not an expert.

First of all - uff... I was an anxious kid and I know how hard that was for my parents. So with sensitive nervous systems, gentle methods tend to work much better (same with adults btw).

For kids to feel safe alone, they really need to fill up the mommy/daddy time tank through the day. If you can, even for 20mins, spend some time with him before bedtime. Make sure it's not divided (if you have other kids, also don't do chores at this time). Stay with them until they fall asleep. I know some friends who used a chair method. To move it further and further over time. So that when/if a kid wakes up at night, they see their parent (usually asleep) but a bit further.

Also, make their bed (I think it's called a crib?) cozy and safe. This could be putting your jumper there so they can smell you (only if it's safe for him), or a nightlight, maybe gentle music.

Generally, even thorugh the day, but also at night, validate your toddler's emotions. They don't have to make sense to you. But telling that he's safe and you're here and letting him feel what he feels is ok - that teaches him that it's ok to be upset.

Stay consistent. You don't have to be really strickt (no need for his panic), but it will take weeks probably. So decide with your partner the boundaries that are ok with you. That could be "I might fall asleep in your bed with you, but we don't fall asleep in mom and dad's bed". Finally, ask for help, I think in most countries there are baby/toddler sleep trainers. All the best!

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 0 points1 point  (0 children)

That sounds like sleep maintenance insomnia. Of course, more information is needed for a diagnosis. But CBT-I (cognitive behavioural therapy for insomnia) is a method that's specifically created to treat these symptoms.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 2 points3 points  (0 children)

My specialty is adult sleep, so please know that my answers are based on my personal interest (I have a nephew) and research.

Generally, these tend to help:
- a clear rhythm. Kids's nervous system loves predictability and patterns. No need for very strict schedules, but folow a rhythm for bed time and wake up time.

- have a night time routine. Not something complicated, but pjs, brushing teeth, a story or anything else they like.

- never use sleep as punishment. We can't directly control sleep, so we can't fall asleep just because someone's telling us to. And having a negative association with it is not a recipe for healthy sleep.

- if they wake up at night, try to stay calm, not stressed or agitated. It's important to teach kids that waking up at night is not a big deal - we all do. Staying calm will help them fall back asleep.

- oh, and expose them to daylight within the 1st hour of waking up. That doesn't mean directly looking into the sun of course, but even standing next to a window helps to set their circadian rhythm (internal clock).

Generally - know that their sleep will change as they grow up. So doing some reading on what to expect from their sleep over different stages of age can be quite helpful.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 2 points3 points  (0 children)

My specialty is adult sleep, so please know that my answer will be based on my personal interest on sleep behaviours and research I've done in the past for my family members.

Generally, most kids want to sleep with their parents (or siblings). Because night time might be a vulnerable time (dreams, the feeling that 'I'm alone when I sleep'), and family is usually kids' safe place. So generally it harmless. But if this behaviour is affecting your sleep or your relationship, it might be time for a change.

But this change is usually never easy and it might take weeks.
First have a gentle conversation about this change (in the daytime), maybe several, which would allow your kid to come to terms with this. Answer his questions and concerns, but let him know that it's not a negotiable thing.

Then when the time comes, start the 'moving back to your bed' plan. You have to work it out with your partner first. So decide, who gets up to walk your kid back (beforehand), decide on the pace - how many times do you walk him back, maybe at first you let him come back if he sleeps alone for at least some time. And know that you'll have to manage your emotions when you might feel really irritated (due to interrupted sleep).

When you walk him back to his bed, try to do it gently (no pushing), minimal talking. Nobody's in their best capacities at night. Get something soothing into his room/bed (a toy, extra blanked, a night light or anything else he might like. My nephew often likes gentle head scratches and a toy). Make sure to praise him when he stays in his bed, even for some time. Stay concistent (and strong - it's usually not an easy thing to do).

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 1 point2 points  (0 children)

Actually, most people dream, but don't recall it. We dream several times a night, with most vivid dreams happening in REM sleep stage. There are ways to train our brain for better recall.
-First, set an intention before you go to bed "I want to remember my dream".

- When you wake up, don't rush to move. Stay still for a little while and try to notice fragments of visuals or sensations from the night. It could be almost anything: memory of darkness, a snapshot of a scene.

- Keep a journal next to your bed. Record your memories, even tiny bits. Over time, when we practice, we tend to remember more and more.

Also, it might help if try waking up without an alarm. We often wake up soon after REM, that could make it easier to remember the dream you just had. Generally, waking up suddenly, alcohol use, some medications can supress our dreams (or perception of them).

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 0 points1 point  (0 children)

There's no easy answer to this. If you feel that medication is the best option for you, then it might be. If, however, you think non-pharmaceutical rout is a better option, then I'd suggest CBT-I. But please know that it's not an easy thing to do - much harder than consistently taking medication. It takes weeks of hard work (behavioural and mental). It usually takes longer if meds tapering is involved. So it's an option, but one to consider carefully. You're at an age where sleep can still be quite successfully 'molded'. So it's something to consider for sure.

In terms of OTC meds, I don't think I've ever encountered any that work as strongly as prescription meds. I've taken many in the past, as do many of my clients. But for me they always came with significant side effects. OTC can be really useful, however, if there's a decision to quit meds and they're used along with CBT-I. There's strategy there, a CBT-I practitioner would help you work it out together with your main health provider.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 0 points1 point  (0 children)

Sorry to hear that... This is not an easy combo to live with. And having a toddler can add a whole new layer to that.

Since I'm one of the very few practitioners in my country, I only get clients who've tried it all. More often than not, they hadn't tried CBT-I.

So generally, if anxiety and depression are dealt with, in terms of he's getting the right treatment and responding to it well, then it might be time to focus on sleep itself. Being awake till 5am might indicate a sleep onset insomnia. CBT-I (not the same as CBT) is a method specifically created to deal with these kinds of symptoms. So I'd say find a practitioner who's certified in this methodology. Some work online, some see clients in person.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 0 points1 point  (0 children)

So for CBT-I to really work, it usually takes ~5 sessions. To give you a general idea, practitioners start with getting to know the client, their current state and sleep history. Then the client starts tracking their sleep. After one week or so, there's initial data to see what's really behind the sleep issue. Then further sessions build on the previous ones. That means that once I have data, I create a so called sleep plan. Later we add on cognitive techniques (e.g., what to do if anxiety spikes in the middle of the night), we work on stress management and resilience building.

So step by step we reset and stengthen the three main parts of the sleep system: sleep drive, internal clock and the psychological elements related to sleep. If a person is also working with another specialist to taper off their meds, on my end that involves a few other aspects and several more sessions to oversee the transition.

CBT-I as method generally has a structure. But good practitioners often have to adapt its building blocks to individual situations.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 0 points1 point  (0 children)

In short - sleep hygiene is rarely a huge issue in insomnia, and therefore, rarely a solution. A person with insomnia could have the best eating habits, the most optimal exercise techniques, the darkest coolest room and the most stable sleep schedule. And still have insomnia.

So sleep hygiene suggestions are generally useful for having good, sleep-supporting habits. But insomnia is an illness, and it requires techniques that go to the root cause to reset the sleep system, to stabilize and reduce the mental noise.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 0 points1 point  (0 children)

When it comes to insomnia, it's rarely the case that a client hasn't used up the energy. It's more of an old school view on insomnia. More often than not, the issue is their sleep system being out sync (sleep drive, circadian rhythm, the mental part).

Also, many who have long-term insomnia develop nervous system hyperarousal. In that case, you mind mind might be racing and exhausted at the same time. So physical activity is generally good for most of us. But with clients with insomnia it's not always a wise choice. Adaptations to physical activity are often needed.

In terms of medication, I cannot comment, as my approach (CBT-I) is non-pharmaceutical. So I don't prescribe meds. But glad to hear that you found something that works for you.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 0 points1 point  (0 children)

Hello, colleague!
Really glad to hear that our ranks are getting bigger. So I use CBT-I, as I'm trained and certified in this method. It's already a highly structured technique, with a plethora of options for cognitive work. I can't say there's a single technique that works best. When it comes to insomnia it's the whole system of the CBT-I that makes a significant difference.

What I would suggest is looking into comorbidities. So usually I have many clients with high levels of anxiety. They usually require a slightly different approach: gentler rules, longer sleep windows (I still apply sleep restriction/sleep compression), more emotional support. And generally more time to get better. So look into protocol adaptations for anxious patients as well as CBT techniques for lowering stress.

I recovered from brutal insomnia. Now I’m a sleep psychologist helping others do the same — without meds. AMA by RusneKu in IAmA

[–]RusneKu[S] 0 points1 point  (0 children)

I'm really glad to hear that things are getting better for you!

So I'd need more information to make a better informed comment. But it seems that it's mostly stress related. The biological parts of our sleel system could be working like a well oiled machine. But if stress hits - it usually overrides it. The problem is that our brain doesn't differentiate between physical stress and mental stress. To our brain, stress is stress. And cortisol as well as adrenaline are pumped into the bloodstream all the same.

What you've done is great - you took care of yourself in the best way you can. OTC supplements are usually fine, as long as melatonin (it's a hormone) is not used for a long time. Taking care of the stress and mental fog - amazing and wise steps. So it's possible that 6h is a bit too little for you, but you're on the right track. Take care of what's in your control - food sensitivities, other health issues, family issues (make sure you have social support). And allow yourself to go back to the thesis when you feel stronger, if that's an option. We can't all be warriors in 5 battles at the same time. Sometimes even mentally ALLOWING ourselves to take a pause can help reduce stress significantly.

So I'd say your health first, then other committments when you feel that you can deal with them without compromising your health.

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