CBTi experiences?

[jaccat]

I’m currently going through a CBTi course (cognitive behavioural therapy for insomnia), at an NHS sleep clinic. It involves a combination of sleep hygiene, sleep restriction and CBT techniques to improve/fix insomnia. Most of the techniques I already know and have been practicing for years, but there is new stuff, some of which, because of my history (trauma) I’m finding more challenging. Mostly it’s the sleep restriction, which can in my case, stop me sleeping altogether.

The whole experience has me swinging between believing this might actually work and this is alright for most insomniacs, but not people like us. It doesn’t help that I already know so much of what we’re being taught. The woman running the course keeps directing us to people's testimonials online, which is all fine, but those people don’t have PTSD.

The sleep thing’s always been a big issue for me- extra complicated, but I really want to believe this course might help. So I figure I should ask here, where people do get it, or at least are more likely to. So, what I’m asking is, have you ever tried CBTi and did it work for you?

 

[HannaD]

I forgo testimonials in favor of research. I like large numbers for pooling results and a control group to compare results to. I also like to see as many variables taken into account as possible. See if you can find any research on CBT and insomnia.
I would surmise that CBT would help with insomnia indirectly. As rumination lessens, the mind quiets and rest is attainable. But, CBT requires practice and takes time to see results.

 

[jaccat]

I’ve looked. Trouble is, I can find plenty on CBTi and imsomnia, but nothing on CBTi and PTSD. I can see exactly how it would work for people who don’t have comorbid conditions, but I’m not one of them.

The woman running the course has been understanding and said it’s going to be harder for me than the others in the group, and that I can take it slower. She has had loads of experience and swears it works for everybody. Trouble is I’m not sure I believe her. My problem is I feel like I’m walking a tightrope between getting better and it all going horribly wrong.

The CBT I get, but after years of therapy that part of the course feels a bit redundant. I’m either practicing it already or it doesn’t apply to me. It’s not even that I’m scared of following the sleep restriction schedule. It’s just that past experience tells me that doing so can lead to me getting less sleep, much less, not more.

 

[TruthSeeker]

I’m currently going through a CBTi course (cognitive behavioural therapy for insomnia), at an NHS sleep clinic. It involves a combination of sleep hygiene, sleep restriction and CBT techniques to improve/fix insomnia. Most of the techniques I already know and have been practicing for years, but there is new stuff, some of which, because of my history (trauma) I’m finding more challenging. Mostly it’s the sleep restriction, which can in my case, stop me sleeping altogether.

The whole experience has me swinging between believing this might actually work and this is alright for most insomniacs, but not people like us. It doesn’t help that I already know so much of what we’re being taught. The woman running the course keeps directing us to people's testimonials online, which is all fine, but those people don’t have PTSD.

The sleep thing’s always been a big issue for me- extra complicated, but I really want to believe this course might help. So I figure I should ask here, where people do get it, or at least are more likely to. So, what I’m asking is, have you ever tried CBTi and did it work for you?

I am also a research based kinda gal, and because I think I know a lot....and I do....I have a voice in my head that is more critical than someone without the knowledge because I spent my career in the area of special needs, strategies, problem-solving, trauma, and the like. For others, I am quick to suggest programs, strategies, and give hopeful words of encouragement. My background lends me to a more individualized approach to solving strategy based issues.....Quality sleep is critical for my health. I have had times where I only got a little sleep....but I have worked really very hard to identify what I need to get to sleep, what interferes with sleep (absolutely no naps, no caffeine after noon, no afternoon/evening exercise, etc) But programs....I'm quick to negatively judge/critique and fault find programs-I look for the holes in them.

I am also quicker to dismiss programs and interventions, for reasons that "I already know it", it's not really that bad," or I'm not deserving somehow." But knowing something and practicing and learning it are two different goals...one is knowledge...one is habit (the doing part successfully and tracking that data to show progress). For example, I do have memory issues......and I've read about neuroplasticity, the brain, TBI, PTSD and memory/health, CPTSD, temperal lobe and memory, epilepsy and memory, taught memory strategies all my life, and know lots of buzz words, strategies, and facts about memory....but I still deal with memory issues myself. I was approached by my neurologist in the summer about a free memory program so I said sure (cough** cough) thinking the program will be too elementary-BORING. At the same time, I wished it would be helpful. I remember thinking I could use more practice, and tips and tricks, and memory strategies but I doubt this program will work for me. The first lesson was a piece of cake.....explaining how memory works, short-term, long-term...basics., the need for repetition, and all that..... needless to say, initially I was yawning......so I had to say to myself when I found myself doubting the process......find one thing, just one thing that I didn't know or didn't put into practice and just improve in one area....and that is my first goal....to be open to learning one new thing.

......so, when I got past the "I know too much to be here....and the irony.....I need to be here cause I'm struggling to function in the memory dept. which is impacting multiple facets of my life...." (that intellectualizing part of me can kick my ass and keep me from moving forward)-then I could maybe have a chance of learning something, or learn new habits to increase retention.....because if I learned one new thing....maybe I could learn more than one thing.....maybe things could be better. So it all boiled down to getting me out of the way, and the hope and faith that the time I spend trying new recall strategies will improve my life-and getting the intellectual part and the critical part to step back and let me learn something was my first step.

The point....if you get an hour of sustained extra sleep out of the CBTi class.....you improved your health....and it was worth it. So, have faith, give it a real go, and maybe things will improve. Sleep like memory, are critical things we need in order to function everyday. It can't hurt for sure!
Good luck!

 

[Friday]

There’s some neurobiological stuff with ADHD that simply cannot be gotten around without meds... and sleep is one of them. Which means, conversely? That CBT for insomnia is one of the things that’s a core component in most ADHD treatment.

It’s not “standard” CBTI the same way that TF-CBT isn’t standard, but trauma focused. As far as I know it doesn’t have its own spiffy name for every disorder that uses it, but I know.... maybe 2 dozen?... different disorders that use CBTI to deal with sleep issues.

With ADHD CBTI one of the very first distortions that’s tackled (for both kids & their parents, if in a family setting) is one surrounding “sleep hygiene”.... that has to do with “But it works for everyone else, it should work for me/you.” Because standard sleep hygiene practices, that work awesome for neurotypical folk, tend to work badly on people who are hyperactive, hypervigilant, or have sensory issues. Like the removing all stimulus thing? :hilarious: is about as effective as asking someone who’s neurotypical... How about we have an angry man scream and beat you to sleep?!? Or a 50 piece brass marching band circle your bed whilst monkeys jump on you? :woot: ... :shifty: Cha.

It DOES NOT MATTER what works for “everyone” else.
It DOES NOT MATTER if mom does this, or dad does that, so kid “should” be able to do this or that, too.

Strike from your mind what “should” or “everyone” or blah blah blah... and concentrate on what works for YOU. Other people’s suggestions? Are just that. Ideas to try, not achievements/goals/doing it “right”.

^^^
I’ve borrowed quite a few of the ADHD sleep tricks / different ways to think about sleep & go about getting sleep... into PTSD & Trauma land. Like during my nightmare cycles? The goal isn’t to sleep without nightmares. The goal is to not let the nightmares f*ck up my sleep more than they absolutely have to. Meaning, don’t avoid sleep until exhaustion claims me so I’ve only got this teeny tiny window to get sleep in before I have to be up; don’t just decide not to go back to sleep after a nightmare (because f*ck that noise) but work on recovering faster & getting to sleep again, faster. When I’m deep in a nightmare cycle? I usually just start awake, roll my eyes, sigh, and roll back over to finish the sucker. Or not. Dreams gonna do what it’s gonna do, and I don’t give a damn. Elapsed sleep time lost? Maybe 8 seconds. When I’m out of practice with that / just starting a nightmare cycle? I may get 15 minutes of sleep... and not be able to get back to sleep for 2 days. Just because I am waaaay the f*ck too spun up, and pissed off, an f*ck that noise, I’m NOT DOING THAT AGAIN :sour: <<< Changing my mindset? means instead of missing out on whole nights & multiple nights worth of sleep (f*ck it, f*ck you, no! I am NOT goig back to bed! Are you effing insane??? NO!) I’m only losing maybe 36-64 seconds worth of sleep ( :bored: ...sigh... stupid f*cking dreams Zzzzzz).

Massive life difference when I’m waking up 9 times a night for 8 seconds... And only sleeping twice a week. And it’s “just” a different way of looking at the same durn thing.

Unlike ADHD sleep tricks? Converting the same process to Trauma sleep tricks... There’s a whole lotta “which wolf to feed” in trauma-land. My ADHD stuff is pretty durn static. It’s far more often a question of remembering (“Oooooh. Right. That. :facepalm: I forgot.”) Than having 2 very clear paths to follow (stay awake or finish the nightmare), 1 which I really don’t want to do, and the other that I don’t want the effects of. Deliberately choosing the thing I want to succeed, and feeding it, regardless of how I feel about it in the moment.

***

So, yeah. CBTI -imo- is super, crazy, ridiculously useful. As long as it’s adapted appropriately. That’s going to look different, with different disorders.

 

[jaccat]

@TruthSeeker you’re right, a certain part of it is to do with how much I already know. So far, 80-90% of what we’ve covered is stuff I already practice, much of it I’ve been doing for years. Just accepting the fact that I’d been put on the course was an issue in itself, one I talked through extensively with my T. At the same time, I’m not averse to learning anything I can from it, and I’m determined/stubborn enough to force myself to stick to the instructions regardless of the risks. But that’s the problem.

@Friday you’ve got it. The trouble I have is working out what is right for me. I’m not getting much help from the instructor there, other than the suggestion to take it slow. My T has tried to help me, but she can only go on what I’m telling her. And there is a certain amount of fear, has been all along, that if I do the wrong thing for me, I could end up making myself ill again.

I tried the sleep restriction last night- 6 hours in bed, because I’ve been getting a pretty steady 6 hours lately. Barely slept at all. I don’t know if that was because my head was doing its thing because of my concerns about the treatment (something else was also going on last night), but I do know that that lack of sleep will make no difference to my chances of sleeping well tonight. I could try again, but two bad nights hugely increases the chances of my body getting into a spiral of sleeplessness, or I could back off, spend 7 hours in bed perhaps, and see what that does. It’s frustrating.

I have probably got too much hanging on the outcome of this course. It’s not even that, after a lifetime of struggling I want it to work more than anything, which I do. I have a brother with the same issues, and if it benefits me it might help him also. And that’s just as important to me, maybe more so. I don’t do hope, but that makes it worse in a way.

 

[barefoot]

I did a group CBTi course at a sleep clinic – though it was a CBTi course slightly tweaked to give it a parasomnia focus as we were all there because we do weird things in our sleep rather than because insomnia is our main issue.

We didn't have anything around strict sleep restriction that I think can be a part of these sorts of treatments. We were encouraged to wind down before bed and to go to bed when we were tired and to only use bed for sleep etc.

I found most of the course was general sleep hygiene stuff, that I'd already been doing for years because I'd found out by trial and error what helped and what exacerbated my disordered sleep. It was quite shocking to me how many people in the group found those things helpful. As though they had never considered that light/temperature in your bedroom might be pertinent or that doing something really stimulating just before bed (like watching a horror film or firing off a load of work emails) might impact getting to sleep!

So, yeah...lots of general sleep hygiene stuff. And some basic CBT work sheets around things like, if you're laying awake worrying, write your worries down on this this list and then leave it until tomorrow...

This is the only CBT I've ever experienced but it struck me as incredibly simplistic. And, especially when there is trauma/PTSD involved, I think things are more complex and have more depth. I also think triggers coming up in these sorts of things can throw the whole thing in ways that they probably haven't considered. So, for you, the sleep restriction (which is obviously designed to help) is triggering you and not helping. With me, they kept doing body scans saying that was the best way to relax, get to sleep and stay asleep...and body scans are triggering for me so it had completely the opposite effect. I knew that, so didn't really partake in those aspects. But someone who didn't know that about themselves because perhaps they haven't done much work on themselves and this was their first step into that self-development work could have ended up completely derailed and not sure why this great technique wasn't helping them at all.

Sorry...that was a bit of a ramble and I'm not sure if really you were looking for more positive comments from people who had found CBTi useful!

For me though it was a no. Too simplistic. And some of the good ideas were a bad idea for me.

 

[jaccat]

That’s pretty much my experience so far. I’ve had to pull back on the sleep restriction because it became too dangerous to continue, but I’m still sticking to the rest of it. Relaxation is also a trigger, so mindfulness, body scans etc., are another no go (as are warm baths, milky drinks and everything else they suggested).

There has been a big focus on sleep hygiene, and like you, I’ve been practicing it for years (20 of them), so it was of no use to me. It was funny how, in the second class, one guy was declaring how much better he was sleeping and I was thinking really? I don’t fit in with that group at all. Mostly I just feel like I’m being difficult.

As for the CBT it’s all focussed on being anxious about sleeping, and as I don't get anxious (I just get triggered), it’s pretty irrelevant. I did tell the woman that as the final two classes are CBT, but she told me to come along anyway to finish the course. I have had CBT before, via the NHS, and it did very little for me at the time. I think it can be useful alongside other therapies, but you have to know its limitations. My experience was that there was no interest in cause, only in managing effects, and I don’t expect this course to be any different.

I’m trying so hard to take what’s useful to me, but it feels like I’m on my own with it.