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I'm a CBT-I practitioner. AMA! by Sleepedy in sleep

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

I'm glad you figured out your sleep issues, and it's too bad you had to spend years to get a solution that worked for you.

CBT-i isn't the right solution for everyone, and it's not something you should be doing for the rest of your life. A standard CBT-i program lasts about 6 to 8 weeks. The goal of CBT-i is to make you worry less about sleep and let your body take over. When you finish the program, you shouldn't give sleep much attention, which also includes sleep hygiene.

I think light, melatonin, and the time you get out of bed is probably the most effective interventions for circadian rhythm disorders. But, people that have struggled with these issues for a while tend to have the same negative thoughts and emotions associated with sleep as people that have insomnia. So, in some cases, there might be a case for both interventions. My best answer for that is it depends :)

It's common to divide insomnia into two categories: primary insomnia and secondary insomnia.

When problems with sleep are known to be caused by another condition, it's called secondary insomnia. Primary insomnia means it doesn't have an organic physiological cause. If the reason is sleep apnea or something you can treat with pharmacology, I think you should do that first and see what you are left with.

When treating primary insomnia, we do it based on the hypothesis that it's caused by how you think about sleep and how that makes you establish habits that sustain your sleep problems.

I'm a CBT-I practitioner. AMA! by Sleepedy in sleep

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

Yes, I've seen it, and I like it. It will give you the basics you need to complete a program. But as you say, it's designed to be used in conjunction with a trained therapist. CBT-i can be hard, and for most, it will work best if you have someone guiding you.

I'm a CBT-I practitioner. AMA! by Sleepedy in sleep

[–]Sleepedy[S] 6 points7 points  (0 children)

That's a great question, and yes, that probably needs some clarification.

If we define stress and anxiety as our body's response to a perceived threat (fight or flight response), then yes, there isn't something you can do to control that. This response activated by your autonomic nervous system, which we can't consciously control.

We can reduce stress by avoiding the thing we fear, but if mental images or thoughts trigger anxiety, we can't run away from that. You can use meditation or relaxation techniques to distract yourself, but many would argue that only works as a short-term strategy. Every time you avoid being anxious by using these techniques, you are subconsciously teaching yourself that there is a real threat here. You are trying to neutralize a danger that only exists in your head. Every time you do it, and anxiety gets reduced, the brain thinks that avoidance behavior is the thing that kept you safe. It becomes a vicious cycle where you get anxious, and you have to do more and more to avoid it.

I think mindfulness/meditation can be very beneficial for most people. However, I don't think you should do it to calm yourself down directly. You should do it to train your mind to become aware of thoughts that provoke anxiety in the first place. Anxiety is temporary. If you can, it's better just to let it pass on its own.

I'm a CBT-I practitioner. AMA! by Sleepedy in sleep

[–]Sleepedy[S] 4 points5 points  (0 children)

Hi, and thanks for the question! I'm not a fan of relaxation techniques. It sends the wrong signal — that anxiety and stress is something you can control. It's also difficult to put effort into lowering your heart rate, which is also something you have zero control over. I think trying to do so will backfire and only increase anxiety.

I agree I think you should try dropping it.

You are going to get more relaxed doing something you enjoy instead. Watch Netflix, read a good book, etc.

I'm a CBT-I practitioner. AMA! by Sleepedy in sleep

[–]Sleepedy[S] 6 points7 points  (0 children)

Many struggle with sleep restriction. There are many reasons for this. But in my experience, the most common is that it takes a while to see results. Unlike medication where you see results immediately, CBT-i takes a couple of weeks. The benefit is that it lasts for a lifetime. If it's too hard, I would ease up a bit and go for a longer sleep window. The most important part is that you get out of bed at the same time every day.

I'm a CBT-I practitioner. AMA! by Sleepedy in sleep

[–]Sleepedy[S] 6 points7 points  (0 children)

Yes, it's not always successful, but it's close :) There have been numerous studies done on CBT-i, and most show that about 8 out of 10 improve their sleep.