I’ve struggled with insomnia my entire life. As a kid, it would take me half the night to fall asleep, and in college, I once went three full nights without sleeping for even a minute (which feels like going insane). I’ve rearranged my life in countless ways to combat insomnia, eliminating exercise and screens past seven in the evening as well as anything that had even the possibility of interrupting sleep. Before you ask, I've tried most prescription and natural sleep aids, and vitamin supplements. Some worked better than others, but I didn't want to become reliant on any. And, for the most part, my insomnia has been relatively manageable. It wasn’t until I started waking up at 3 A.M. every single night a few months ago that I finally started Cognitive Behavioral Therapy for Insomnia (CBTI), at the suggestion of a reader.
CBTI is considered by many to be the “golden standard” for treating insomnia. The goal of CBTI is to link up the Homeostatic Process (the longer you stay awake the more sleepy you become) with the Circadian Process (you feel sleepy at certain times of day). The sessions can be expensive and the treatment is difficult, mainly due to its focus on "sleep restriction." But it was easily worth it. I walked into CBTI with a sleep efficiency* of 72% sleeping an average of 6 hours a night, and now have a sleep efficiency of 95% percent sleeping 8 hours a night. This post is in no way a replacement for seeking out the help of a professional trained in CBTI, which I highly recommend, and my recovery took place quicker than most, but I thought I'd share some of the biggest takeaways my therapist gave me in the hopes they help you:
Healthy sleeping habits are predicated on creating a healthy environment for sleep. We all know not to do anything that gets our heart rate up too high before bed and to avoid caffeine too late in the day and screens close to bedtime. But it's equally important to keep your bed reserved for sleep and intimacy alone. You want to train yourself to have a Pavlovian response to your bed: As soon as your head hits the pillow, your body knows it's time to fall asleep. Try to avoid watching TV, reading (this one was tough for me!), and even worrying in bed (more on that below!).
Short-term insomnia usually begins with an event (it could be a traumatic experience or a series of stressful nights that prohibit sleep). To combat continuing insomnia, we adopt habits that help us sleep, for a time—but those habits and the obsession with sleeping can actually perpetuate insomnia and lead to chronic insomnia. Instead of "living to sleep," as my therapist called it, we should aim to "sleep to live." Start winding down the hour before your bedtime, but no earlier. Because my current bedtime is 10:30, I ideally start reading in my guest room, instead of my bed in low light (I use this reading light), at 9:30, until it's at least past 10:30. Then, as soon as I'm feeling sleepy ("sleepy" with drooping eyelids—is different from "tired"), I close my book and go to bed. I'm often able to fall asleep within minutes, if not seconds.
My CBTI therapist compared the ability to sleep for extended amounts of time to a ball of pizza dough. If you stretch pizza dough out too quickly, it gets holes in it. The best way to fix those holes is to roll it back into a sphere and roll it back out, more slowly this time. It's the same with sleep—I was giving myself eight hours in bed, but sleeping closer to six hours (my dough had a lot of holes), so I had to "ball back up" my sleep and roll it out more slowly, if you will. This process is known as "sleep restriction." During my first week of CBTI, I was only allowed to spend six hours in bed, from 12:30 to 6:30 each night. I was extremely sleep deprived, but that's all part of the process! Once I'd mastered six hours (which took about a week because I'd already been sleeping around six), I moved to seven hours, and finally to eight. Now I'm not "allowed" to go to bed earlier than 10:30, no matter how sleepy I am, so I can sleep until 6:30. Eventually, I may even move up to 8.5 hours! Everybody is different, and it may turn out that you need six—or ten!—hours of sleep each night. Sleep restriction can help you figure that out.
To maintain your Circadian Rhythm, it's important to be strict with your wake-up time—even on the weekends! My therapist encouraged me that, even if it's a Saturday night and I have a night of insomnia, to still wake up at 6:30. One bad night of sleep just means you'll sleep better the next night, but waking up late could mess with that process. This past weekend, for example, I had two events that kept me awake until 1 A.M. (which is very rare for me), but I still had to wake up at 6:30 each morning. I was exhausted, but after sleeping eight hours the past two nights, I felt back to normal! You may be tired for a day, but rest assured you'll sleep well the next night!
This tip is related to the idea of only using your bed for sleep. The last thing you want to do is associate your bed with worry, so get out of bed if you can't fall asleep, and go read in a place with low light (don't do anything productive). If you suffer from negative thoughts in the middle of the night (I frequently wake up with the irrational, 3 A.M. fear that that morning's blog post won't go live), create Flashcards of positive thoughts you can refer to in the middle of the night, when your brain doesn't have the capacity to calm itself down. My therapist had me calculate how many times a midnight post hasn't gone live because I scheduled it incorrectly. It's happened twice in my three years here—so .02% of the time. In the middle of the night, I say to myself something along the lines of, "Chill. Your mess-up rate is point oh two percent, and guess what? It's fine if you do mess up." It calms me enough to fall back asleep.
There are a billion sleep aids on the market—CBD is everywhere even though the limited studies about its impact on sleep often use a tiny sample size—and I've tried most of them. For a while, I relied on a tincture of 1:1 THC to CBD to fall asleep, which worked until I developed a tolerance to it (the same can happen with Melatonin as well as most prescription aids). When I asked my therapist if I could use it occasionally, when I needed to fall asleep, she suggested I don't for the simple reason that if you're following CBTI correctly, you should be able to fall asleep naturally. If you take an aid, you may credit it to your ability to fall asleep, when you would have fallen asleep anyways!
While I'm sleeping better than I ever have, I still have my fair share of bad nights. Last week, I was up for two hours in the middle of the night. But those nights are few and far between, and I'm not nearly as frustrated by them, since I know now that they're all part of the process! The key is to not look at your clock, and treat those sleepless moments as sacred—don't try to do anything productive (you may be surprised by how quickly you can fall back asleep, even when you're "wide awake"). I curl up with a book and try to welcome the unexpected reading time my body has gifted me with (ha).
*How to calculate sleep efficiency: total sleep time (how much total sleep you got, in minutes) divided by sleep opportunity (how much time passed between getting into bed and getting out of bed, in minutes)
P.S., See my 'insomnia' Highlight here to follow my process with CBTI!
Again, if you're really struggling with insomnia, please consider reaching out to a professional. They may advise you to go to a sleep clinic for a medical condition, or have advice that pertains to your specific case! Psychology Today's list of therapists is an excellent online resource. From there, go to the therapists' websites to get a better sense of who they are, what they treat, and what sort of training they have, then consider scheduling a call before booking your appointment!