Changing your sleep pattern

[compsports]

Links to SA's topics:

 

 

Sleep problems - that awful withdrawal insomnia

 

Sleep Hypnosis, Guided Meditations, Calming Videos

 

Light boxes for depression and sleep disorders

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Sleep Restriction Therapy seems to be quite popular in the insomnia world. It seems quite barbaric to me as you have to stay up until early in the morning and then limit yourself to around 4 to 5 hours initially in an attempt to consolidate sleep. How does Dr. Prey feel about this Alto? CS

Edited February 27, 2017 by ChessieCat
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[Altostrata]

It doesn't apply to people who simply cannot sleep.

 

It's for people who have screwed up their sleep cycles, like night workers. They torture themselves for a little while and then the natural sleep cycle kicks in so they sleep at night like normal people.

 

Bad habits, like staying up too late, are the reasons most people have insomnia and are what sleep clinics usually address.

[compsports]

It doesn't apply to people who simply cannot sleep.

 

It's for people who have screwed up their sleep cycles, like night workers. They torture themselves for a little while and then the natural sleep cycle kicks in so they sleep at night like normal people.

 

Bad habits, like staying up too late, are the reasons most people have insomnia and are what sleep clinics usually address.

 

Hmm, that is not the impression I am getting in visiting insomnia forums as there are plenty of people who can't sleep in spite of trying everything.

 

Also, I just finished reading Insomniac by Gayle Greene, a PhD professor of literature who also has a major case of insomnia in spite of trying everything. She feels she has had it since childhood.

 

By the way, it is a great book as she gives a first hand account of the insomnia and sleep conferences. I also like it because it isn't a "how to" book as she figured people get enough of that advice.

 

Anyway, Dr. Greene questions how effective sleep restriction therapy really is and gives accounts of people who have literally tortured themselves trying the strategy. It didn't work for her.

 

CS

[Altostrata]

As I said, it's for people with screwed-up sleep cycles.

 

I'm not surprised doctors are trying it on anyone who walks in the door.

[MrsGreen]

Hello all,

 

My therapist (cognitivie therapy) offered for me to join a programme for insomnia.

I have suffered severe insomnia due to withdrawal for eight weeks now and on and off ever since my child's birth.

I also have a thyroid condition which started after the birth and which is due to be treated now that I am down to 1,5mg of amitriptyline.

It was only diagnosed five months ago.

 

The insomnia programme goes along the lines of sleep reduction, meaning that I would go to bed for 6-7 hours, setting an alarm.

Possibly eight hours, the next meeting is on Friday and we shall go into detail about that.

Currently I am going to sleep at around 9.30-10pm then waking after about 4-6hrs. I then lie awake for an hour and drop off again for another 3 hours or I cannot go back to sleep at all. (alternating nights).

 

I am not sure whether this kind of programme makes sense whilst suffering from withdrawal and thyroid related insomnia.

At the moment I am happy to get any kind of sleep. Even if it is broken into two parts.

I am extremely exhausted and have my mother here to help when my husband is at work. I can't imagine facing my alarm clock ringing at 6am when I am in the middle of my second phase of sleep...

 

Any opinions of knowledge on this topic? Could it work to reset the internal clock?

 

Thank you very much.

 

Mrs Green

[Altostrata]

This kind of program does not make sense for your withdrawal-related insomnia. Your sleep is improving on its own as you stabilize. Don't confuse your system more.

 

Your internal clock is fine -- you are falling asleep at the appropriate time. You are awakening because of withdrawal-related hypersensitivity, not because of a circadian rhythm problem.

 

Getting 4-6 hours of sleep and then another several hours is actually very good sleep for people experiencing withdrawal.

 

Sleep specialists don't understand withdrawal insomnia, either.

[compsports]

This kind of program does not make sense for your withdrawal-related insomnia. Your sleep is improving on its own as you stabilize. Don't confuse your system more.

 

Your internal clock is fine -- you are falling asleep at the appropriate time. You are awakening because of withdrawal-related hypersensitivity, not because of a circadian rhythm problem.

 

Getting 4-6 hours of sleep and then another several hours is actually very good sleep for people experiencing withdrawal.

 

Sleep specialists don't understand withdrawal insomnia, either.

 

I totally agree Alto.

 

And even if this was a circadian rhythm problem, I don't think a sleep restriction problem would help.

 

CS

[Nadia]

I've wondered about sleep reduction as well. My sleep cycle varies, but at best it is split into two like yours. Lately, when I am doing well, I wake up after about 4 1/2 to 5 hours, and then if I can go back to sleep it is light and filled with dreams (I always wake up after the first block of sleep with intense dreaming), but I do feel better than the nights I can't go back to sleep. Some people have suggested when I wake up in the middle of the night to get up and not go back to bed, thereby forcing my body into longer periods of the first block of sleep. I've been too much of a wimp to try it. I'm so exhausted, even just lying in bed (even with anxiety and dread) seems preferable to facing having to get up.

[Altostrata]

If you know your nervous system is recovering from withdrawal, why would you want to torture it to fit somebody else's idea of a good sleep pattern? It's doing the best it can.

 

Sleep restriction is for people who have developed a bad habit of going to bed very late and sleeping very late, like musicians or night owls. They've thrown their circadian rhythms off.

[MrsGreen]

All very well put and confirming my gut feeling. What an interesting debate.

 

I am currently doing cognitive therapy which will help with the anxiousness when facing the next night. This has developed out of withdrawal.

Unfortunately my therapist believes in medication and asked me whether I had considered going back to it until I had stabilized!

I chuckled inside, she knows that I feel that withdrawal is the problem, but I am never sure whether she really believes it.

I just said that I will go through with this and was not interested whatsoever in taking antidepressants ever again.

 

All the best to everyone,

Mrs Green

[compsports]

If you know your nervous system is recovering from withdrawal, why would you want to torture it to fit somebody else's idea of a good sleep pattern? It's doing the best it can.

 

Sleep restriction is for people who have developed a bad habit of going to bed very late and sleeping very late, like musicians or night owls. They've thrown their circadian rhythms off.

 

Hmm, I thought it was for people who had trouble falling asleep and not getting enough of it. The theory being that restricting sleep would make people so tired that they would consolidate their sleep and eventually being to sleep for a long block of time.

 

The above scenario you have mentioned refers to people who have delayed phase disorder. As an aside, I don't feel it is a disorder unless it is interfering with someone's life.

 

I understand the treatment for resetting that person's body clock is light exposure in the am and possibly melatonin in the evening.

 

But to address the main point of this whole thread. It is probably a bit too much to expect sleep professionals to understand insomnia withdrawal issues although I am going to do my best to educate my doctor.

 

However, what we do have a right to expect are treatments based on our individual situations and not the "bleeping one size fits all theory" that seems so dominant in medicine these days.

 

For example, in Mrs. Green's case, since she has days that she is sleeping all the way through, why the heck would you torture someone with sleep restriction therapy? That just makes no sense.

 

Instead, help her brainstorm solutions to the problem that would work for her.

 

CS

[compsports]

Alto,

 

I just realized my previous post might not have had the right tone and I apologize for that. Lack of sleep has made me quite cranky which is no excuse I know.

 

CS

[Altostrata]

Right, cs, people have trouble falling asleep at, say 10 p.m. because they've gotten used to staying up until 4 a.m. Sleep restriction helps these people.

 

MrsG, you might try a bit of melatonin at nightfall. It can make you feel drowsy and may reassure you, bypassing the anxiety. It is important not to be anxious that you'll sleep!

 

Magnesium also is relaxing, reduces anxiety, and is generally good for you.

[compsports]

Right, cs, people have trouble falling asleep at, say 10 p.m. because they've gotten used to staying up until 4 a.m. Sleep restriction helps these people.

 

MrsG, you might try a bit of melatonin at nightfall. It can make you feel drowsy and may reassure you, bypassing the anxiety. It is important not to be anxious that you'll sleep!

 

Magnesium also is relaxing, reduces anxiety, and is generally good for you.

 

Hi Alto,

 

See this example of someone who has similar issues to me:

 

http://www.sleepfoundation.org/article/hot-topics/cognitive-behavioral-therapy-insomnia

 

There is no bleeping way I would be able to do this and it has nothing to do with willpower. Heck, I can barely make it to 8pm as I always feel drugged after eating dinner not matter how light it is.

 

Example of the person who lies in bed for hours who can't sleep who is a prime candidate for this therapy:

 

http://www.psychologytoday.com/blog/sleepless-in-america/200907/cognitive-behavioral-therapy-insomnia-part-4-sleep-restriction

 

Usually, the person who deliberately stays up until the early morning has a body clock that points him in that direction. Sleep restriction therapy would be a disaster just like it would for advanced phase syndrome. In my opinion, light therapy is the best option although obviously, I am not a doctor.

 

CS

[Nadia]

Those articles are interesting. I don't know about sleep restriction, but there are probably some sleep "hygiene" measures that could help us with withdrawal insomnia, like not amping yourself up at night.

 

Today I woke up after sleeping about 4 1/2 hours and just could not go back to sleep, or perhaps had a bit of stage 1 sleep like the article describes. Perhaps it would have been better if I got out of bed. Maybe I would have suffered less. I don't know that lying in bed drowning in dread and anxiety was really helping me.

 

I wonder about retraining the locus coeruleus... it seems sleep restriction is one method for doing this. I wonder if there is a "friendlier" way for those of us in withdrawal.

[compsports]

Those articles are interesting. I don't know about sleep restriction, but there are probably some sleep "hygiene" measures that could help us with withdrawal insomnia, like not amping yourself up at night.

 

Today I woke up after sleeping about 4 1/2 hours and just could not go back to sleep, or perhaps had a bit of stage 1 sleep like the article describes. Perhaps it would have been better if I got out of bed. Maybe I would have suffered less. I don't know that lying in bed drowning in dread and anxiety was really helping me.

 

I wonder about retraining the locus coeruleus... it seems sleep restriction is one method for doing this. I wonder if there is a "friendlier" way for those of us in withdrawal.

 

Hi Nadia,

 

In rethinking restriction therapy, maybe it could work. But I would need to do light therapy after dinner so I could stay awake until midnight and sleep the restricted hours. Without that, you would have to hold me against a wall to force me to stay awake:)

 

What time do you go to bed and when do you wake up?

 

CS

[compsports]

Barry Krakow, in Sound Mind, Sound Sleep says no.

 

CS

[Nadia]

Lately I've been going to bed between midnight and 1am. I try to aim for midnight. This seems to give me the best results. (If I go to sleep earlier I wake up after a couple of hours, if I go to sleep later I just get less sleep).

 

I found it interesting that the article that explained sleep restriction says it's better to change your bed time as opposed to your wake time. I don't know that that would work for me, because although I seem to wake up lately after about 4 1/2 or 5 hours of sleep, I get such an anxiety surge in the early morning that even if I go to bed at 5am, I'm not going to be able to sleep past 7 or 8am (which is when I feel the worst of the cortisol surge lately... much better than the 4 or 5am surge I used to get!). Or maybe that is the whole point, to push your cortisol surge until later. Which is what I've been able to do by going to bed at midnight instead of 10 or 11. My line of work requires working until 10 or 11pm regularly, sometimes later, so I don't really have a choice about my schedule.

 

I have no answers. My boyfriend brought up the whole "first and second sleep" issue: http://www.bbc.co.uk/news/magazine-16964783 which makes you rethink all this too.

 

At the same time, he can sleep 10 hours straight without waking up, no problem, just like I used to be able to (before ever being on ADs and while being on them). And I certainly have felt MUCH more rested the days I've been able to sleep through 6 to 8 hours straight (I can count them on one hand, though).

[compsports]

Hi Nadia,

 

You have to do what works for you. As Alto implied, most insomnia advice is not applicable to our situation.

 

Actually, I think most insomnia advice is too simplistic in general and that is why the Krakow book appeals to me because he treats his readers as unique individuals who are intelligent and not idiots.

 

CS

[Shanti]

I read a good article about our sleep patterns. Did you know that it's only been the last 100 years or so that we've changed from sleeping in spurts at night to sleeping in one big 8 hr block? It used to be very normal to wake up at night and spend a couple hours awake, reading or meditating, ruminating, etc. Everyone did it. Even bed partners would wake up at the same time, not try to go back to sleep, and they'd simply get up and have a snack and talk. But then came the "studies" of how it's better to not stay awake and force yourself to go back to sleep and then that became the "norm". In the article, it said that it is natural for us to wake up, and that when we were told it was abnormal, it caused anxiety and fear, and then you have insomnia. I'll see if I can find that article again and post it here. I thought it was very interesting! It might be hard to find because I can't remember the name of the author or anything like that.

 

Cool, I found it. I forgot that I had emailed the link to my mom as she has insomnia. Here it is. The Myth of the 8 Hr. Sleep.

[Nadia]

Hmm... I'll look for the Krakow book.

 

Yeah, that's the article I posted! I think someone had posted something similar on another thread. That is fascinating. Right now I write down all the times I wake up, but I think it would be better to judge the success of my sleep just by how rested I feel.

[MrsGreen]

Barry Krakow, in Sound Mind, Sound Sleep says no.

 

CS

 

Do you mean he says no to restriction therapy in general or in the case of withdrawal, CS?

 

Thank you!

Mrs Green

[compsports]

 

Barry Krakow, in Sound Mind, Sound Sleep says no.

 

CS

 

Do you mean he says no to restriction therapy in general or in the case of withdrawal, CS?

 

Thank you!

Mrs Green

 

Hi Mrs. Green,

 

I am glad you asked because my first response was not totally accurate.

 

He does talk about tapering sleep meds but because I haven't read it thoroughly, I don't don't want to risk giving an inaccurate summary.

 

Anyway, he refers to sleep restriction therapy as an emotionally anguishing approach to solving insomnia. As an FYI, people in other sleep forums have said they have been told that if you prone to anxiety, it is not for you.

 

Dr. Krakow goes on to say that he rarely offers or recommends it in severe cases until a patient has made sufficient progress in other areas such as developing emotional processing skills. He does say it can have some benefits as far as consolidating sleep although I am sensing he recognizes the limitations of it particularly for people who are anxious.

 

In reading the various sleep forums, it seems to be a mixed bag as far as effectiveness.

 

CS

[MrsGreen]

Thank you CS, it makes perfect sense to me. Thank you for clarifying.

 

Many regards,

Mrs. Green

[Altostrata]

I have more information about sleep restriction therapy.

 

After 4 years of sleep fractured by withdrawal syndrome, over the last couple of weeks I've started to wake up at 6 a.m. As opposed to 3 a.m. Cross fingers this new pattern is not just a fluke.

 

My sleep specialist, Dr. P, could not be more pleased. He said he's been waiting for this forever.

 

Dr. P says its time for sleep restriction for me. I should get up when I wake at 6, have breakfast, and start my day.

 

He emphasized having breakfast shortly after getting up. (This reinforces the daytime energy cycle of your internal clock.)

 

I'm still not getting a lot of sleep, as it seems I cannot fall asleep for a couple of hours when I get into bed, after getting drowsy while watching TV. But at least I'm not alerting at 3 a.m. and wide awake for a few hours.

 

He says this is a sign my sleep cycle has "thrown out an anchor" at 6 a.m., an absolutely normal time for waking, and this gives us something to work with regard sleep restriction. He said I'll be very tired for a couple of weeks, then my system will start putting me to sleep earlier -- which would make my sleep cycle normal. !!!!!

[dalsaan]

Thanks Alto, looking forward to hearing how you go with this.

 

I have tried sleep restriction but it was at the height of withdrawal. It didnt

help and it was torture.

 

But interested to know how it works in different circumstances

[Altostrata]

Yes, sleep restriction is not going to work if your nervous system is ignoring all sleep cycle signals.

[Foggyhead]

Does it make sense to put one's self through the hell of Sleep Restriction Therapy while still in withdrawal? I am having a tough time with it and I do not think that my Sleep Doctor understands why I am still having broken sleep two weeks into the therapy. They have no concept of withdrawal symptoms. The theory behind this therapy makes sense in order to get your circadian rhythm back into place but if I am not going to benefit from it now, why go through the anguish because it is not easy.

 

Have anyone else had success with it during AP withdrawal/tapering?  

[KarenB]

This was from Alto, two posts up.

Yes, sleep restriction is not going to work if your nervous system is ignoring all sleep cycle signals.

 

I think you'd be better off managing one issue at a time.  W/d is enough.  Perhaps stop the sleep restriction for a while at least, and work through the ideas in our insomnia threads. 

[ChessieCat]

I've added the links to SA's sleep topic in Post #1.