“I’m on Day 4 of SRT and it isn’t going well,” Jenny wrote recently. “I finally had an appointment with a sleep therapist last week. He talked to me about SRT and gave me a 7-hour sleep window, from 11 p.m. to 6 a.m. My usual bedtime is 9:30 so I had some apprehensions. But I started 4 days ago.
“Since then I haven’t slept more than 3 hours a night. It’s really hard for me to stay up till 11, and then when I get in bed I’m wide awake! In the morning I’m so tired I can hardly keep my eyes open! Is this normal? I’m afraid I may be a treatment failure. Any advice?”
People come here looking for solutions to sleep problems. Some read about sleep restriction, a drug-free insomnia treatment, and decide to try it on their own. It’s not rocket science: insomnia sufferers who follow the guidelines often improve their sleep. It’s empowering to succeed.
But self-treatment is not the right approach for everyone. Sometimes insomnia is complicated by another disorder, or what looks like insomnia is actually something else. In both cases, the best thing to do is to have yourself evaluated by a sleep specialist ASAP.
A reader—I’ll call her Chantal—wrote in June with questions about insomnia and sleep restriction. A few weeks ago I heard from her again:
I’m now in week 6 of sleep restriction and I have to say my sleep is getting better. I mostly sleep for 5.5 hours a night. When I started it was 3.
But the last couple of nights, I’ve woken up in the middle of the night and had trouble falling back to sleep. I have no idea why I’m waking up. Do you have any tips for staying asleep?
Psychophysiologic insomnia: This was my diagnosis when I finally decided to see a doctor about my sleep. I didn’t like the sound of it. “Psycho” came before “physiologic,” and to me the implication was that my trouble sleeping was mostly in my head.
My insomnia felt physical, accompanied as it was by bodily warmth, muscle tension, and a jittery feeling inside. I was anxious about sleep, too, and my thoughts weren’t exactly upbeat. But surely putting the psycho before the physiologic was putting the cart before the horse?
A few weeks ago I got an email from Julie, who’d written to me about her insomnia before. Here’s how she began:
“I am happy to share with you, 5 months later, that I am sleeping peacefully and soundly! It didn’t happen overnight, but my improvement did happen because of the sleep restriction you recommended!”
“This woman is persistent,” I thought, and read on. I discovered that, while Julie’s first attempts at this insomnia treatment were strikeouts, rather than give up, she found ways to modify the sleep restriction protocol so it eventually worked.
Last week Dan wrote to Ask The Savvy Insomniac with questions about cognitive-behavioral therapy for insomnia (CBT-I). Dan has bipolar disorder, and because of this diagnosis, his sleep doctor had reservations about him undergoing CBT-I.
So Dan tried a modified version for 2 weeks. His sleep did not improve. He was wondering if he would have to use sleeping pills and if he should continue with CBT-I on his own.
Lesley Gale was a light sleeper who began to have insomnia about 8 years ago. She consulted doctors and tried the remedies they proposed, but nothing seemed to work. Investigating on her own, she came upon a treatment called sleep restriction therapy, or SRT.
“I had heard of SRT before,” Gale wrote in an e-mail, “having seen a couple of documentaries on TV about it, and then did further reading on the Internet. But for years I dismissed it instantly as being absolutely impossible for me.” Napping was off limits during SRT, and this was a deal breaker.
Cognitive behavioral therapy for insomnia (CBT-I) is now the gold standard in drug-free treatments for insomnia. The benefits are often long lasting.
Researchers have created and are now testing a briefer form of CBT-I called brief behavioral treatment for insomnia (BBTI). BBTI isn’t widely available yet. But with health insurance companies clamoring for providers to rein in costs, BBTI is the wave of the future.