Happy World Sleep Day 2020 !
This blog series is for *you* if you tried a lot of the sleep tips you’ve read in the media, which helped for a while but didn’t last. This is for you if you’ve read lots of books or articles about sleep, and tried to apply some of the advice, but are not seeing lasting benefits. This is for you if you don’t have a serious medically diagnosed sleep disorder such as obstructive sleep apnea, restless leg syndrome, narcolepsy... It might help if you suffer from a parasomnia like sleepwalking, sleep paralysis, sleep related hallucinations or REM disorders. And if you’ve tried psychotherapy or counselling but it does not make much of a difference to your sleep… then CBTi may help.
Most of us are familiar with Cognitive Behavioural Therapy also known as CBT. But not many of us have heard of CBTi. The little “i”, by the way, stands for… Insomnia. Sleep medicine experts swear by it, with scientific studies to back it up, so I decided to try the CBTi course and technique for myself and share my experience over the 5-week insomnia treatment course. This, is the first CBTi session blog which I decided to launch on World Sleep Day 2020 ! The theme this year : Better Sleep, Better Life, Better Planet. And now, the adventure begins...
For years I struggled with sleep issues, in fact I’ve even built a business to help others improve their sleep. It’s called WeSleep based in the UK. Over the years I have experimented and learnt so much about the different ways to improve sleep. It’s become a passion and I could talk about the subject for hours. But one thing I had never done was an overnight sleep study also known as Polysomnography. After insisting to get a referral from my primary care doctor, I was able to finally have one done at Guy Hospital’s Sleep Disorders Centre in London.
Sleep technologists are super heroes. I am truly grateful.
Polysomnography is a test done as an overnight sleep analysis used to diagnose sleep disorders. It records brain waves, oxygen level in the blood, heart rate and breathing patterns, as well as any eye, arm and leg movements while sleeping. I think that sleep technologists and night nurses are superheroes, especially since they might be putting their own health at risk by staying awake to watch us sleep all night. You see, watching us sleep can cause serious disruptions to their own natural circadian rhythms and sleep-wake cycles. So I am truly grateful.
I thought that my historical Restless Legs Syndrome or my snoring (both of which drove my partner insane at the time) would show up in the results. But guess what…. my study showed no significant appearance of any sleep disorder, at all, what-so-ever… not even snoring at 0%... How disappointing! Yet I often felt exhausted and unable to function. I should say that the room had a very comfortable temperature, was quiet with white noise in the background and my head was more elevated than usual on the hospital bed. Perhaps I slept in the best of conditions that night !
My Polysomnography results
Yet, even though this overnight study didn't show any disorders, I needed to know what I could do to feel and function better without sleeping pills for sure. I didn’t want to be a statistic :10 million sleeping pills are prescribed in the UK alone every year (!) My sleep consultant from Guy’s Hospital suggested that I get a referral to the Royal London Hospital for Integrated Medicine and explore CBTi as a solution. I didn't think too much about it at the time, but thought, why not try...
The wait for CBTi
It was a lengthy wait to enrol into the RLHIM CBTi course. 24 months wait through the British nhs medical system… Yup you read it right… 24 months ! 3 months to see a sleep doctor; 2 months to get the polysomnography done; 15 months to get an appointment at the RLHIM; 4 months later, I managed to squeeze into the course earlier than planned due to a lucky cancellation.
Ok, I won't complain, at least I did manage to get treatment.
24 months before being able to enroll on the nhs CBTi course...
The Royal London Hospital for Integrated Medicine is a specialist alternative medicine hospital located in Central London on the famous Great Ormond street. Same address as the Children’s hospital. It is a part of University College London Hospitals (UCLH) NHS Foundation Trust. It is the largest public sector provider of complementary medicine in Europe.When I heard of this hospital, I really loved the idea of a non-pill based alternative approach. The scientific and medical staff there understands the thin line between conventional and evidence-based alternative medicine.
When I arrived at the small but perfectly formed human-sized building, I saw such a variety of people looking for help. It felt good to see so many other patients also looking for alternatives after trying everything with traditional medicine. I then joined 8 other insomniacs for our 5-week course. Interestingly, there was only 1 man and 8 of us ladies. 4 were between 45 and 60 years old, 2 between 30 and 45 year old, 2 over 60 years old, and a young student lady under 21.
CBTi 101... the beginning
Our instructor looked like a postgraduate probably not older than 25 years old. Yet she is currently instructing 7 groups on the topic of CBTi for better sleep. She tells me that her background is psychology and neuro-psychology but I wonder when looking at her if she even ever had issues with sleep or insomnia herself. She looked so fresh ! 😊
She explains that the CBTi technique is evidence-based, and the course is taught in 5 sessions over a month and half and that a sleep consultant will check-in individually with us 6 months after the course is over. “You will not be left alone on this journey!” she said. That did make me feel safer and supported.
The first session was about understanding insomnia and understanding the difference between insomnia and sleep deprivation. I had a lightbulb moment when she explained that Insomnia is about the ability to sleep whereas sleep deprivation is about the opportunity to sleep.
Ability versus opportunity.
It’s mind boggling that as an insomniac you feel both tired and alert at the same time. The famous tired and wired state, where the wrong part of your nervous system is activated at the wrong time of the day. Which seems to happen particularly just when you need to fall asleep.
This first session was very much about shattering myths about sleep and dismantling the fear and anxiety about the negative impact of insomnia. There are many scary articles, books and studies about sleep deprivation and insomnia shared in the media about the risks to our health and our life span. We are being reassured by the instructor that insomnia is a common condition and does not shorten our lifespan and is not the cause for Alzheimer’s and dementia. Yet many research studies seem to have established a link between the two. I guess we ought not to confuse "correlation" with "causation".
The medical “jury is out” on many issues and beliefs related to sleep issues and disorders. Listening and reading a lot of them, having attended sleep medicine conferences and events, I can say that sleep experts, academics and scientists don’t all always agree. Some studies are inconclusive. The bottom line is that sleep has not been studied for long enough, and we simply don’t know everything.
Our instructor explained sleep cycles and REM sleep (rapid eye movement) and reminded us that deep sleep only makes up only 20% of the night on average and that the second half of the night is naturally lighter sleep. Which is all normal.
She confirms that the right amount of sleep for you is whatever makes you feel alert, refreshed, energetic, clear minded most of the day, and on most days.
She also asked us to try the Open Eye Experiment if we can’t sleep during the night. That’s right, keeping eyes wiiiide open. Laying down in the dark, focusing on keeping the eyes open for as long as possible, all night in fact! And if we were to wake up during the night, we should continue the experiment. I am not sure if and when I can actually do this, but I shall try.
The Open Eye Experiment
Our other homework for the week is to fill out a sleep diary which helps us work out the average time spent sleeping and our sleep effectiveness based on time in bed versus hours slept in bed. Mine came up to 91%. Which sounds good after all, yet I can’t say I’ve been feeling alert and refreshed in months.
Remember one important thing though : the rules for insomniacs are not the same as for good sleepers. Whatever doesn’t prevent regular sleepers from sleeping, might create huge issues for insomniacs. For example watching TV or reading in bed. Or napping.
Towards the end of the first session, our group spoke intensely about dreams…. : not dreaming enough, not dreaming anymore, having vivid and insanely creative dreams. We were wondering, does dreaming so much mean that we were not getting good sleep? Dreams is part of a brain process to manage emotions and information. It is also a creative process which keeps us sane. Dreams take care of our mental health.
On the way out, I already knew that the most important thing to be successful with CBTi was to have a positive outlook throughout the process. And be ready to embrace new habits. Experiment. And commit.
Like myself, my peers in our CBTi group have so much knowledge about insomnia, through experience, informing ourselves and experimentation. Yet the hardest part is coming ahead.
Stay tuned for session #2 next week, when the real “fun” begins…. Watch this space!
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Written by Julie Wright, Founder of WeSleep
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