If you’re one of the millions who struggle with insomnia, you know it’s more than just a nighttime problem. It affects your energy, concentration, and overall quality of life. The good news is that you don’t have to live with sleepless nights. This article will guide you through practical strategies, drawing on evidence-based methods, to help you reclaim your sleep.

Understanding the Insomnia Spiral

Insomnia often becomes a cycle. You may have experienced an initial sleep disruption, perhaps due to stress or a change in your routine. However, it’s usually the way you respond to that initial disruption that can turn a temporary problem into a chronic one. The 3P model explains how this occurs. Predisposing characteristics, such as a high-energy personality or an overactive mind, can make you vulnerable. Then, a precipitating event, such as the birth of a baby or a stressful period at work, can trigger sleep problems. Finally, the perpetuating factors, your thoughts and behaviors in response to poor sleep, keep the insomnia going. These factors can include spending more time in bed trying to sleep or worrying about the consequences of inadequate sleep. Understanding this cycle can be enlightening and empowering, as it provides a roadmap for breaking free from the grip of insomnia, bringing a sense of relief and control.

A Hybrid Approach: CBT-I and ACT

The most effective treatment for insomnia combines Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). This hybrid approach, sometimes referred to as CBT-I, is a beacon of hope for those struggling with sleep. It addresses the behaviors and thoughts that fuel insomnia, offering a path to better sleep. It’s not about forcing sleep but creating the right conditions for your body to naturally rest, instilling a sense of hope and optimism in your journey to better sleep.

Behavioral Strategies: Retraining Your Body

Several behavioral strategies can help you break the insomnia cycle:

• Stimulus Control Therapy (SCT): This method aims to strengthen the association between your bed and sleep. To do this, you should:
  • Limit the activities you do in your bed and bedroom to sleep and sex. Avoid watching TV, using electronic devices, working, or engaging in other stimulating activities in bed.
  • Go to bed only when you feel sleepy. If you are not tired, stay out of the bedroom and do something relaxing until you feel sleepy.
  • If you are awake in bed for more than 20 minutes, leave the bedroom. Do something boring or relaxing, and return to bed when sleepy.
  • Do all of your sleeping in your bed. Avoid falling asleep in a chair or elsewhere.
  • Wake up at the same time each day, regardless of how much sleep you get.
  • Do not nap during the day.
• Sleep Restriction Therapy (SRT): This approach consolidates your sleep by restricting the amount of time you spend in bed to match the actual time you sleep.
  • Use a sleep log to calculate your average total sleep time.
  • Set a sleep window matching your average sleep time and the hours you typically sleep the best.
  • Stay out of bed until your set bedtime and get out of bed at your set wake time.
  • Increase your time in bed by 15 minutes each week as your sleep efficiency improves.
• Combined SCT and SRT: You can also combine stimulus control and sleep restriction for a more intensive approach.
• Sleep Hygiene: This refers to healthy sleep practices that include:
  • Limiting caffeine and alcohol, especially close to bedtime.
  • Creating a relaxing bedtime routine in low light.
  • Making sure your bedroom is dark, quiet, and calm.
  • Getting regular exercise, but not too close to bedtime.
  • Limiting screen time before bed.
  • Avoiding napping.

Cognitive Strategies: Changing Your Thoughts

Your thoughts can significantly impact your ability to sleep. Cognitive strategies can help you manage your thoughts more effectively.

• Cognitive Restructuring: This technique involves identifying and challenging unhelpful or distorted thoughts about sleep.
  • Use a thought record to identify negative thoughts related to sleep.
  • Challenge these thoughts with more realistic and helpful alternatives.
  • Consider how these alternative thoughts impact your emotions and behaviors.
• Designated Worry Time (DWT): If you tend to worry at night, set aside a specific time during the day to focus on your worries. This can help you keep worry contained and less pervasive.
  • Schedule a specific time each day to worry.
  • Only worry during that time and do not problem solve, reassure yourself, or seek reassurance from others.
  • If you worry at other times, acknowledge the worry, validate your feelings, and remind yourself that you have scheduled time to worry about it later.
• Mindfulness and Cognitive Defusion: These acceptance-based tools can help you manage a busy, active mind.
  • Mindfulness helps you focus on the present moment and observe your thoughts without judgment. Practice mindfulness exercises like focusing on sounds or your breath.
  • Cognitive defusion helps you see your thoughts as merely thoughts rather than facts, reducing their power over you. Use techniques like repeating a word until it loses meaning or imagining your thoughts as leaves floating down a stream.

Acceptance and Willingness: Shifting Your Perspective

A crucial part of ending the insomnia struggle involves accepting your sleep challenges rather than fighting against them. This doesn’t mean giving up but rather letting go of the struggle to control sleep.

• Willingness to Make Changes: If you are willing, you will be more likely to make the sometimes uncomfortable changes to your sleep habits. Consider the benefits of making these changes and whether they outweigh the costs.
• Willingness to Not Sleep: Paradoxically, accepting that you might not sleep can reduce the pressure and anxiety that often keep you awake.

Creating Your Personalized Plan

The program emphasizes the importance of individualization. What works for one person might not work for another. The first step in creating a personalized plan is to collect data using a sleep log. This log should include the time you go to bed, the time you fall asleep, the time you wake up, any awakenings during the night, total hours in bed, total hours asleep, and a calculation of your sleep efficiency. You should also monitor how rested you feel each day. This personalized approach ensures your unique needs and challenges are understood and valued in your journey to better sleep.

The next step is to assess whether insomnia is your primary problem. Suppose you are excessively sleepy during the day and have symptoms of sleep apnea, restless legs syndrome, or a circadian rhythm disorder. In that case, you might need to see a medical professional first. You should always seek a professional opinion if you are experiencing severe daytime sleepiness. You should consult your medical doctor if you have any questions about whether you might have a condition other than insomnia. You may benefit from a sleep study to rule out other medical conditions that could be causing your sleeplessness.

Once you’ve ruled out other conditions, use your sleep log data and an assessment of your daytime consequences of insomnia to identify which treatment strategies are most appropriate for your specific needs. You don’t have to use every tool in the toolbox. You should focus on what you are willing to do fully. Start with one or two strategies and gradually add more as you become more comfortable with the program.

Maintaining Your Gains

Once your sleep improves, you will naturally want to relax some of the rules you followed during your program. You may wish to begin reading in bed again, nap occasionally, or sleep in on weekends. It is important to change only one element at a time. This will allow you to assess the impact of the change on your sleep and adjust your program as needed.

Be aware of potential triggers for sleep disruption. Prepare for stressful events and travel, and know which specific thoughts and behaviors will most likely pull you back into the insomnia spiral. If you do experience a relapse, return to your complete CBT-ACT program right away. The earlier you act, the easier it will be to get back on track.

A Journey, Not a Destination

Ending the insomnia struggle is not about perfection but about progress. There is no “one size fits all” solution. Some of the information you have been given here will not be relevant. You have to choose which tools will best suit your individual needs. It takes time and practice to change old patterns, but the improvements you experience will be worth the effort. Be patient with yourself, trust the process, and remember that your brain knows how to sleep; you just have to get out of its way. This program aims to help you sleep to live, not live to sleep.

Reference

Ehrnstrom, C., & Brosse, A. L. (2016). End the insomnia struggle: A step-by-step guide to help you get to sleep and stay asleep. New Harbinger Publications, Inc