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The CBTi experience continues

Session 2 of 5

· insomnia,Sleep,Well being,CBTi

What is sleep hygiene?

Intro: 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 for you if you’ve read books about sleep , and tried to apply some of the advice, but are not seeing lasting benefits.
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. If you don’t have a sleep disorder such as apnea, restless leg syndrome or sleepwalking. If you’ve tried psychotherapy or counselling but it does not make much of a difference to your sleep… then CBTi may help. 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 session #2 out of 5.

This time around I was late for my second CBTi course at the Royal London Hospital for Integrated Medicine at the famous 60 Great Ormond street. I walked into the small consultation room where other participants had arrived, but this week we were missing one third of all participants who came for the first session. The chatter in the room was about our experience filling out our sleep diaries for. Our group also spoke intensely about dreams – not dreaming enough, not dreaming anymore, having vivid and creative dreams. They were wondering, does it mean they were not getting good sleep?

tracking sleep... without becoming obsessive over it.

We also talked about our sleep diary as a tracking tool to measure our sleep efficiency for 2 weeks which is our time in bed versus our time sleeping. Most were confused by the methodology. Most slept worse because of the sleep efficiency tracking as they became obsessive with it. That’s the point right, to sleep well, you must NOT obsess over sleeping well… This is not a competition.

The obvious question was then asked: couldn’t sleep trackers do the job of calculating our sleep efficiency? One of the issues is that activity trackers are generally inaccurate for sleep patterns, either underestimating or overestimating sleep cycles and durations. In fact, Fitbit had to compensate hundreds of thousands for false advertising as part of a class action lawsuit in the US in 2014 for devices sold before then.

WeSleep - CBTi - Insomnia - Sleep Diary

We all agreed it’s easy to write in the initial bedtime but most of us were struggling to track (let alone remember) the rest of the night. It was difficult to recall what time we were awake and for how long. One lady explained how she sleeps long hours through the night but has hallucinations which wake her up 10 times a night for 5 or 6 minutes. Sleep doctors said that CBTi could help with this issue.

Our CBTi consultant then asked if we did the Open Eye experiment. I had not done it… (look of shame on my face). It simply sounded too daunting to keep my eyes wide open like a zombie, staring in the dark, trying NOT to fall asleep. But when I tried it again, I managed to fall asleep in less than 10 minutes not remembering the point at which I fell asleep (!).

Apparently, this experiment is based on reverse psychology, it works even if we already know WHY it works, and it gets better with time and practice. This will make you fall asleep as it heightens the urge to sleep driven by your internal sleep-wake homeostasis, the tiredness you feel from being awake for hours. It helps quieten the mind. Of course, we become more sensitive to any external stimuli by doing this, but this exercise helps us focus our attention on keeping the eyes open. And obsessive thoughts go away. The funny thing, is that you won't remember when you fell asleep! One of the attendees did it and it worked for her. She also slept better the following night.

WeSleep - CBTi - Open Eye Experiment - Insomnia

The only real way to figure out if you have insomnia and if you sleep enough, is by how refreshed you feel throughout the day… Our sleep instructor promises to teach us how much sleep we actually need in future sessions. For now, all we need to be concerned with is setting a fixed wake-up time. And to avoid obsessing, which of course is what all of us attendees did anyway!

Obsession and rumination aside, let’s talk about “sleep hygiene” ! This is our lifestyles do’s and don’t do’s to help us give in to sleep. If you are a good sleeper with occasional insomnia, then sleep hygiene might be a life saviour for you, but if you are a chronic insomniac, sleep hygiene won’t do much for you except if you combine it with specific CBTi techniques. So what is sleep hygiene in CBTi?

Obsession and rumination aside, let's talk "sleep hygiene"

Well this generally has more to do with adjustments to your lifestyle and environment, for example:

  • Avoiding caffeine in any forms after 2pm
  • Quit smoking as it is a stimulant as well
  • Avoid sugary foods
  • Watch out for medication which keeps you alert
  • Reduce and minimise the light coming from screens, and sit far away from the TV, watching only funny or relaxing programmes
  • Exercise seems to make more of a difference with sleep for those who don’t do so regularly. In which case, 3-4 times a week is beneficial but not within 2-3 hours of bedtime as your alertness will still be too high to sleep soundly
  • Take a warm bath 2 hours before bedtime and reduce your bedroom temperature to 18-19 degrees.  You can use a hot water bottle or an electric blanket to warm up your bed if needed, but switch it off once you lay down.
  • Make sure to take your last (non-alcoholic sugar free) drink 2-4 hours before bedtime
  • Create a dark and quiet bedroom environment
  • Ensure a sense of safety whichever you think means for you (door closed, locked, alarm on, dog at your bedside etc)
  • Keep  a regular bedtime and wake time schedule

This is all stuff you (and I) already heard. The key is to start here.

But when it comes to behavioural techniques promoted by CBTi experts, well this is where the real work begins, and I will explain more about they key principles of CBT for insomnia this in the next blog post #3, so stay tuned !

 

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Written by Julie Wright, Founder of WeSleep

Any questions, feel free to contact me via this website

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