• Cognitively behaving myself

    A few weeks ago I finished a five week course of document based (as opposed to therapist-visit based) cognitive behavioral therapy (CBT) for insomnia. That is, recommended by my doctor, I paid about $40 for access to a web/paper based course. So far, the results are good, which I easily could have guessed from the literature. What I could not have guessed as easily was why (in my view) it worked for me.

    First, let me give you the data. Unfortunately, I did not collect extensive, pre-CBT data on my sleep patterns, but I do have my subjective experience to guide me, along with my sleep log during the course, which I’ve continued to maintain since completion. Since the first week of the course, my average nightly sleep duration has increased by about 30 minutes. Though it is true that I sleep longer, most of the gains come from less frequent very low sleep duration nights. For example, I had a night of only 5 hours of sleep during the first week of the course. Since then, no night’s sleep has been shorter than 6 hours. The vast majority are considerably longer. I’m currently on a streak of several weeks of 7+ hours per night. Those 5-hour (or shorter) nights were fairly common before the course. Even in a good month, I could expect a few. In a bad month, they were weekly if not more frequent than that. To go well over a month with no night quite that bad is a remarkable achievement.

    So, CBT worked, but why? My answer is simple: discipline. Having struggled for consistent, good sleep for much of my life, I already understood sleep hygiene. I had already largely rid myself of the negative thoughts that I used to associate with poor sleep: “My day will be ruined.” “I’m failing at sleep.” And so forth.

    What I was not doing was being exceptionally disciplined about these things. I was sloppy around the edges. I let myself sleep later on weekends. I got anxious if I didn’t get to bed by 10PM, if not earlier. I blamed many of my daytime feelings of fatigue on my inability to get consistent sleep. These were not big deviations from the ideal, but they were enough to upset a fragile sleeper’s rhythm. I could not afford such luxuries.

    That all ended with CBT. Now I rise no later than 6AM every day of the week, including weekends. (Yes, this feels like a sacrifice, but the long-term reward far exceeds the cost.) I go to bed at 10PM most nights, but no earlier. I redirect my thinking every time anything negative about sleep comes to mind. Such thoughts are not helpful. So, out they go. I am aware when my mind starts problem solving in the night and redirect my thoughts to a relaxation technique.

    I’m blessed with an ability to be very aware of my mental process and to change my thought patterns. This is not hard for me. It just takes awareness and discipline. I was being mentally lazy before CBT — though I didn’t realize it — and now I’m not. It’s a lot like healthy eating. Be mindful. Don’t fall into bad habits. Constantly strive to do the right thing, but don’t beat yourself up when you slip a little. Or, plan your “slip up” mindfully and “savor” it. Know that working until 10PM at night will likely cause reduction in sleep duration, so choose to do it with awareness (and enjoy it!), or don’t do it.

    The final thing that helped me is keeping a sleep log. In advance, I’d have thought this would not be helpful, as it makes plain when one has not slept as much as one would like. (My nightly target is 7 hours.) I would have thought that it would stress me out to see that on paper. But, for me, it is very reassuring to see that I achieve or exceed my sleep goal many days. Even when I don’t achieve the goal, I am typically not that far off: 6.5 hours or even 6 now and then really isn’t a big deviation. It’s no big deal. And not seeing those 5, 4, or even shorter sleep duration nights on the log is just amazing.

    Without the data, in the past, I probably mentally marked a 6-hour sleep night as “a bad night.” That’s because I didn’t know I slept 6 hours. Or, I could have known, but instead of focusing on how much I slept, I focused on how much I didn’t. I’d think, “Crap, I was awake from 2-4AM, so I feel terrible.” Who needs that?

    So, I’m very pleased with CBT. I will continue the techniques I learned and maintain my sleep log. If you have not battled anything like this, this probably seems like a banal achievement. For me, this is very exciting, but, fortunately, not exciting enough to keep me up at night. Just the opposite, in fact. 🙂

    @afrakt

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    • Thank you for writing this article and thank you for having the courage to try CBT. I use CBT for obsessive compulsive disorder (OCD). I also use medication, but only as a “water wings approach.” The medication helps take the edge off while I learn to swim through the rough waters of OCD.

      As an OCD patient and as a future physician (just finished first year!!) I believe that too often patients and doctors look for a miracle drug and overlook the need for discipline and mindfulness. I hope to see more use of CBT–teaching patients to fish rather than just giving them a fish.

    • Congratulations.

    • Thank you so much for sharing! It’s amazing that $40 saw a huge improvement in your sleep – without having to resort to medication.

      Keep at it, and turn this into a long-term improvement! I’d love to read a future update in a month or so.