Establish the crucial foundation of overcoming insomnia.
- What is Insomnia?
- What causes Insomnia?
- The Key Concepts to Understanding Sleep
- Sleep Efficiency: The Key Marker in How Well You Actually Sleep
- A Word on Sleeping Pills and Melatonin
- Tools to Implement This Week to Get Better Sleep
- A Pledge to Commit
- Week 1 Checklist
Hello my sleep deprived friend,
I warmly welcome you to the beginning of your journey to finally getting the sleep you deserve. You are in good company. As mentioned on the homepage, I’m Sacha and I had chronic insomnia.
I tried everything under the insomniac remedy rainbow, from ayurveda to zinc. I tried therapy, I had doctors throw pills at me, and after years of trial, error, and frustration with jackasses telling me to “just take melatonin!”, I found what actually works. I’m convinced it’ll work for you too. You have the utmost empathy and understanding from me, and I will be trying my very best to get you on the right track to a healthy sleeping pattern.
Here is how it’s going to go down:
- 🎯 At the beginning of each week, there will be a goal of what you will learn and internalise
- 🏁 There will also be an overarching mission for the week, which you should complete before proceeding to the next week
- 📍Within each week, you will complete several quests to help you achieve the main goal
**In order to effectively measure your progress throughout the program, and ultimately, understand yourself better, it is important that you complete the weekly goals, missions, and individual quests.**
To get through these five weeks successfully, I ask for you to be gentle with yourself. Just like any bad habit, it takes time and persistence to overcome it.
I don’t recall where I saw this quote, but it always stuck with me. It’s especially apt when discussing chronic insomnia because when embarking on the journey to overcome it, you are likely to have at least a few days of decent sleep but still may have a bout of insomnia for days or weeks again. It can be devastating and frustrating to make progress only to feel like insomnia is just some dark sickness waiting in the shadows to pop back up at any time.
I’m telling you right now – don’t let this be your attitude. Don’t fall one step and think it’s all over for you and insomnia is back forevermore. Like any good habit or behaviour you’re trying to form in your life, it takes patience and understanding of yourself.
You’re human. We’re all weird, fallible creatures with plenty of quirks. We slip up, and we don’t always live by our values, whether that’s getting a healthy sleep schedule, eating well, exercising, overcoming addiction, being a good parent, spouse, student, worker, or whatever else. It takes an active effort to show up for yourself every. single. day.
Of course, sometimes we miss the mark, and we don’t adhere to our values. But that’s ok. And this is especially important to realize when overcoming chronic insomnia. When we’re trying to undo months, years, or even decades of thoughts, behaviours, emotions, and habits, it might seem like two steps forward, one step back. It’s a process, but it works. You’ll be making huge strides towards feeling rested and refreshed, and one day (I expect in 6 weeks or less) you’ll realise how far you’ve come, even if it’s not perfect, linear progress.
I encourage you to give yourself compassion and grace starting now. If you slip up, just get back on that proverbial horse. I promise you that the more you practice giving yourself some slack for slipping, the more it becomes easier to not only get back on the horse, but not fall off the horse in the first place.
With that being said, let’s get you started on week 1.
In week 1, the goal is to establish the foundational knowledge to get a regular sleep schedule and get immediate help for insomnia.
The first point of understanding insomnia is important. Why? Because you have to define the beast before you slay it. Know its attributes, characteristics, and quirks. When you understand what you are working with, and what sleep actually IS, it contextualises it. It becomes a definable problem that you can solve, rather than this ineffable, static-y thing affecting your life.
The second part of this week is teaching you some immediate actions you can take to get help for insomnia. These actions will be implemented from this point on – not just this week. For as long as you want to have good sleep, you will do these things.
I would also like to reiterate that if you want help for insomnia, you need to be committed to getting better. You may not believe you can have a regular sleep schedule, but you absolutely can. There is a light at the end of this insomnia tunnel.
First things first, I want you to create a sleep diary for the next seven nights:
- The time you go to bed (e.g., When or if you decide to go to bed but not immediately sleep – for example, read, watch TV, or go on your phone. Time for sexual activity is not included.)
- The time you decided to try and fall asleep
- The time you fell asleep (to the best of your knowledge)
- The time(s) you woke up during the night, and for how long
- The time you woke up for the day
- The time you actually got out of bed after waking for the day
**THIS IS A VITAL STEP TO COMPLETE BEFORE PROCEEDING TO WEEK 2.** More details of what you’ll do with this information will follow.
Now let’s dive into what insomnia really IS, and WHY it develops.
What is Insomnia?
What is insomnia? In layman’s terms, it is a hell beast that doesn’t let your body rest and you wish you could physically beat it down with a sledgehammer. Insomnia goes against your will. You can absolutely want to sleep, but it is like a broken ‘off’ switch for your mind.
Scientifically though, insomnia is a sleep disorder where you can’t fall asleep (sleep-onset insomnia), can’t stay asleep (sleep maintenance insomnia), or you wake up too early (also sleep maintenance insomnia) (Suni, 2020). Insomnia is also not feeling rested or refreshed the next day.
Additional signs of insomnia include having difficulty concentrating, being irritable, changes in appetite, and even physical sensations such as tingling and numbness.
The Five Types of Insomnia
Transient, Acute, and Chronic Insomnia
Insomnia is divided into transient, acute, and chronic insomnia.
⮞ Transient insomnia is quite common and happens to almost everyone at some point in their life. It is insomnia that lasts for up to one week, but sleeping habits return to normal once the temporary factor is gone (Sheil Jr., 2021). Transient insomnia usually occurs due to short term events like excitement for an upcoming trip, jet lag, sleeping in a new space (like a hotel) (Hamilton, 2016), too much caffeine (hi quadruple espresso I accidentally drank in Spain thinking it was an Americano), and stress for an interview or test the following day.
⮞ Acute insomnia is also quite common, and happens when your sleep is disturbed for at least 3 nights in one week and lasts up to three months (Sci, 2020). With acute insomnia, sleeping habits also return to normal once the temporary stress or change is resolved (or you find resolve with it). Acute insomnia usually occurs with more ongoing issues like tension at work and fighting with your significant other, but it can even happen with neutral or positive events that you’d need some time to adjust to, like moving to a new city, starting a new job, and getting married.
When insomnia becomes a problem is when it turns into chronic insomnia.
⮞ Chronic insomnia is described as having 3 or more nights of disturbed sleep per week for a period of six weeks or more (Sci, 2020). This is when insomnia starts taking on a life of its own, rather than just being a byproduct of temporary stress. It usually evolves from acute insomnia, particularly when a significant life change or stressor causes you to not sleep, and then sleep itself becomes the stressor.
Because chronic insomnia lasts for 6 weeks or more (sometimes literally decades), it affects you more deeply. You may feel like you are in a constant fog, your memory isn’t what it used to be, your emotions become more difficult to control, and other “pleasant” things like that. Chronic insomnia can also affect areas of your life like romantic relationships, friendships, work, school, connecting with family, and your physical/mental/emotional health.
Paradoxical insomnia is an interesting form of insomnia because patients suffering from it have all of the mental distress associated with insomnia, but have no actual signs of sleep deprivation (Geyer et al., 2011). People with paradoxical insomnia dramatically underestimate the sleep they get and overestimate how long they are awake. So essentially, someone with paradoxical insomnia does sleep – but as with other types of insomnia, there is an excessive worry around sleep. The treatment for paradoxical insomnia is the same as other forms of insomnia, so if this is you, this course should benefit you as well.
Fatal Familial Insomnia
I wanted to touch on fatal familial insomnia because you may have come across it when trying to learn about your sleep troubles. I want to reassure you that it is incredibly rare, and your chances of having it are literally 0.00000003%.
Fatal familial insomnia is an exceptionally rare form of insomnia. It stems from a specific variant in the PRNP gene that ultimately results in death within 6-36 months of diagnosis (Khan & Bollu, 2020). So far, only 70 families worldwide have been identified as having the gene (Cracco, Appleby, & Gambetti, 2018) though the exact number of cases is unknown.
While fatal familial insomnia is, well, fatal, the previously discussed forms of insomnia (transient, acute, chronic, and paradoxical) are NOT fatal and can be cured through treatment.
Primary vs. Secondary Insomnia
Primary (or idiopathic) insomnia is long term chronic insomnia with no apparent cause, though it is theorised that it is due to an overactive wake system or under active sleep system (American Sleep Association, 2016). It is also sometimes called “childhood onset insomnia”. With primary insomnia, the following list can ruled out as a cause for sleep disturbances:
- Lifestyle factors
- A medical condition
- Life change or significant stressor
- A mood disorder (e.g., anxiety, depression)
Primary insomnia is rare, and is likely genetic. Secondary insomnia, on the other hand, is attributed to one of the points above.
What Insomnia is NOT
Anyone who chooses to stay awake is not suffering from insomnia. If you choose to stay awake because you’re binge watching Netflix, you are not an insomniac.
If you stay up all night studying for an exam but sleep fine the next night, you are not an insomniac.
If you can’t sleep and choose to stay up, maybe you have insomnia – but you need to actually try then fail to sleep or stay asleep before you would be considered as having insomnia . For now, you are someone who chooses to work late or screw around online til the wee hours.
In short, if you aren’t trying to sleep, that isn’t insomnia – that is you are making a CHOICE to not sleep. When you choose to try to sleep and still can’t, or you can’t stay asleep, then you likely have insomnia.
Some Facts About Insomnia
⮞ Chronic insomnia is a remarkably common sleep problem for adults.
Over 50% of the people in a 2005 National Sleep Foundation poll reported having at least one symptom of insomnia.
Of those respondents, 33% said they experienced symptoms of insomnia every night or almost every night in that year. The main effects were not feeling rested the next day and waking up frequently.
Approximately 10 percent of people who reported trouble sleeping have symptoms of daytime functional impairment (like difficulty concentrating) associated with insomnia (Roth, 2007).
⮞ Women experience insomnia more than men.
This can be attributed to hormonal changes with menstrual cycles, pregnancy, and menopause (Nowakowski, Meers, & Heimbach, 2015).
⮞ Seniors also have more trouble sleeping due to changes in hormones which result in shorter slow wave (restorative sleep) sleep time (National Sleep Foundation, 2005).
The change in hormones also causes an increase in lighter sleep, where we are more prone to waking up during the night.
⮞ Insomniacs are 10 times more likely to have depression than the rest of the population, and 17 times more likely to have anxiety (Roth, 2007).
Insomniacs are also twice as likely to abuse alcohol than non-insomniacs (Brower et al., 2010). It’s likely a maladaptive form of self-soothing for the turmoil insomnia can cause.
📍 Quest #1
Your quest this week is to define if you have chronic insomnia. There are 13 questions.
Do I have insomnia? Quiz
What Causes Insomnia?
Insomnia can pop up at any point in time for almost any one. It doesn’t discriminate, though you are statistically more likely to have it if you’re female, senior, or are financially stressed. As I mentioned in the previous section, the primary reasons for secondary insomnia (either transient, acute, or chronic) include:
- A medical condition
- Lifestyle factors
- Life change or significant stressor
- A mood disorder (e.g., anxiety, depression)
Here’s another ‘not a doctor’ disclaimer because, ya know, I’m not a doctor. Nor a psychologist. Please speak with an appropriate medical professional if you have any of the following concerns.
There are a plethora of medical conditions that can cause disrupted sleep. Here are just a few listed by the Mayo Clinic (2021):
- Breathing issues (asthma, sleep apnea, snoring, allergies, COPD)
- Pain (arthritis, back pain, fibromyalgia, sciatica, injury)
- Neurological conditions (parkinsons, MS, dementia)
- Hormones (hypothyroidism, hyperthyroidism, menopause, diabetes)
- Sleep-specific disorders (restless leg syndrome, sleep walking, sleep paralysis, sleep apnea, delayed phase disorder)
- I encourage you to look into these disorders if you believe you have one. E.g., if you can sleep 7-8 hours but only if you fall asleep at 3am, you may have delayed phase disorder and not insomnia
- Other health conditions (acid reflux, anemia, high blood pressure)
If you have a medical condition that affects your sleep, suspect you have one, or even if you feel perfectly healthy, I encourage you to see your doctor and get a physical. It’s good to get a full stock of your physical health to rule out anything that can work against you.
If you don’t have a medical condition or your medical condition is appropriately managed but you still can’t sleep, then this course will address the anxiety around sleep that may have been triggered by medical conditions.
There are also a multitude of medications that can cause sleep disturbances. Just a few of them include alpha blockers (usually prescribed for high blood pressure), beta blockers (also for high blood pressure and heart arrhythmias), corticosteroids (for inflammation), and SSRIs (for depression and anxiety) (Neel Jr., 2013). If you think that if only you were off a certain medication then you’d be able to sleep, your first course of action is to address this with your doctor. See if there is an alternative prescription they can provide.
Again, if you have changed medications and you still don’t sleep well, it has likely become an anxiety issue around sleep, and this program will help you deal with that.
Pregnancy and New Parenting
Pregnancy hormones are no joke and do all sorts of things to you during pregnancy and in the months after giving birth. Progesterone, estrogen, Human chorionic gonadotropin (hCG), prolactin, and oxytocin are at all-time highs and while they’re vital to a healthy pregnancy, they can cause a host of physical changes that make it difficult to sleep (Won, 2015). Some of these include increased need to urinate, congestion, heartburn, nausea, and edema. There is also the physical aspect of discomfort from the pregnancy itself. Pelvic pain, back pain, prodromal labour, braxton hicks, your baby kicking and punching, or just not being able to get comfortable can all lead to a poor night’s sleep.
There is also the mental aspect of being pregnant that can keep you up at night. Worries about finances, your relationship, change in lifestyle, and simply the uncertainty of it all can be a lot to contend with.
Once the baby arrives, your baby will of course be waking up to feed. This is to be expected – they need to gain twice their body weight in the first five months of life (Hoecker, 2020). If you had to gain twice your bodyweight in such a short amount of time only drinking milk, you’d be up every few hours to eat too! But as a new parent, give yourself some grace. I truly mean that. Having a baby is a life changing event, and the flood of emotions coupled with a baby that wakes up several times a night, can and will affect anyone’s sleep.
There is an expectation that your sleep will be disturbed for a few months (I discuss how to manage sleep when a baby comes into the picture in week 5). However, if you are getting anxious about sleep and have a hard time falling asleep, getting to sleep, or falling back asleep after a nighttime feed, the same rules apply to you throughout this program.
There are plenty of ways in which we conduct our lives that can throw off a good night’s sleep including but not limited to:
- Erratic sleep schedule
- Recreational drugs, alcohol, and nicotine
- Poor diet (bloating, constipation, and diarrhea can all keep you up)
- Too much daily stress
- Too much stimulation before bed (e.g, playing video games, going on your phone, working in bed)
You, of course, can’t control every lifestyle factor that can mess up your sleep (like if you work night shift or travel a lot) but you can control much of your lifestyle that promotes and even greatly facilitates sleep. We will be discussing lifestyle factors in greater detail in week 5.
Life Change or Major Stressor
A multitude of life events can jump-start a bout of insomnia. Here are just a few of the many events that can cause us stress even if it’s ‘good’ stress (Bourne, 2015):
- Change in finances
- Change in relationships (marriage, divorce, separation)
- Death of someone close to you
- Changes in your job situation (change in responsibilities, layoffs, career switch)
- Starting or finishing school
- Interpersonal conflict (with spouse, parents, friends, coworkers, boss, etc.)
- Personal injury or illness
- Pregnancy and new parenting
Sometimes it is really easy to pinpoint which life change or event was the instigating factor in your insomnia. If so, it’s still worthwhile to look into why the change was so jarring. Some are obvious (death of a loved one) but others, like changing jobs or getting a divorce, usually have more layers that likely require a gentle curiosity about yourself. Try to see why the change affected you the way it did. Was it inconsistent with your values? Was it a shock to how you thought your life should be? Did it change how you thought life would unfold for you?
Sometimes, it’s not so easy to identify changes that made chronic insomnia a thing in your life. For me, it took me years to realize the series of life changes and stressors that weighed heavily on me and what they all had in common – my inability to deal with uncertainty and a lack of control.
If you’re not sure why you have insomnia, I encourage you to think back from the time you stopped sleeping until now to see if there’s a common theme to what has happened or how you have reacted to what has happened. There may be a nugget of wisdom in there.
This course obviously doesn’t deal with initial stressors, but it can help you with the sleep part. This will also help you deal with whatever your primary concern is with a lot more clarity and level headedness.
Ah, the chicken or the egg conundrum. Did a mood disorder like anxiety, depression, OCD, etc. cause insomnia? Or did insomnia cause a mood disorder?
As you can see by my amazing graphic design skills, they can play into each other. A mood disorder can overflow and create a special “cup” (or space in your mind) for insomnia. Likewise, insomnia can overflow and create a new cup for mood disorders. Then there’s a straw between them where they feed into and off of each other. Because they are both kind of assholes like that.
My guess is that if you’re here and this is your situation, they are separate beasts and have lives of their own, but still thrive off of each other. You have the mood disorder, and you also have insomnia. I’m not going to lie, it is a bit more difficult to overcome insomnia if you are particularly anxious or depressed.
If this is the case, I highly recommend seeing a registered psychologist, social worker, therapist, psychiatrist, or medical doctor that understands mood disorders. They can either help give you additional strategies, or prescribe medications that can be truly transformative in helping you get better. If you are in a financial position where therapy is not possible, there are self-directed therapies for free or for a low cost listed in the Additions Resources section in the final wrap-up.
In the meantime, I hope to empty – or at least greatly reduce – the contents of your insomnia cup. My hope is in turn, you will have a lot more space and energy to deal with your mood disorder, and anything else going on in your life.
In short, many events, thoughts, behaviours, and medical issues can cause insomnia. The one thing that all of these seemingly unrelated things have in common is they can disrupt sleep that then self perpetuates into its own problem of chronic insomnia.
The Key Concepts to Understanding Sleep
There was a point where you slept. When you were a newborn, you slept 16 hours per day. After a day of playing as a child, you fell into a heavy, restful sleep. After a random relaxing day, you fell asleep happy. You didn’t need to understand sleep, because it just happened.
But maybe those things haven’t happened in a while, and it’s like your body and mind somehow forgot to sleep. However, just as you don’t forget other basic human functions like getting hungry or breathing, you never truly forget how to sleep. Now, you have to strip away all the additional layers that have made sleep difficult.
The first layer is understanding sleep and the processes that go on to make sleep possible. Understand that yes, there are anxious thoughts, behaviours, beliefs, and emotions that make it very difficult to get sleep. But your biology also plays a vital role too.
Learning about sleep will help you realise that it’s not completely up to you and your thoughts – you can let your very own biology help you.
The Five Stages of Sleep
We go through five different stages of sleep throughout the night, and experience them in a sequential order multiple times per night. These stages serve different functions to supporting sleep and feeling rested:
Stage 1: This is when you are ‘drifting off’. Your heart rate slows, your muscles relax, and it can almost feel meditative (Lockett, 2020). The purpose of this stage is to put you into a state of relaxation that prepares you for the next stage of sleep.
If you’ve ever experienced a hypnic jerk where you jerk yourself awake, this is the stage in which it happens. And to put icing on the shit cake that is insomnia, it happens more frequently when sleep deprived (Johnson, 2019). There’s no conclusive reason for hypnic jerks, but one theory is that we are indeed just fancy monkeys in shoes, and it’s a primitive response to keep us from falling out of a tree.
Stage 2: A deeper sleep than stage 1, but still a light stage of sleep. The purpose of this stage is to restore your energy that you’ve expended during the day.
Interestingly, if insomniacs wake up during stage 2 sleep, they are far more likely to report that they were actually awake when they were in fact sleeping. (Mercer, Bootzin, & Lack, 2002)
Stages 3 and Stage 4: This is what we know as deep sleep or ‘slow wave sleep’. Our brains have the least amount of activity going on here, and some studies have even shown that 100 decibel noises can’t wake some people at this stage (American Sleep Association). Stages 3 and 4 are the most important stage of sleep to feel rested and feel renewed physical and mental energy the following day.
Stage 5: Known as rapid eye movement (REM) sleep. As the name states, this stage is characterized by rapid eye movements, and it’s also when we dream. If you were to get a brain scan during this stage, the brain waves resemble the brain waves you’d see during waking hours (Purves et al., 2001). The purpose of REM sleep is to process and store information (including emotional information) into memory. If you’re an insomniac, you probably don’t remember a lot of your dreams because your brain is too busy trying to catch up on deep sleep when you finally do fall asleep.
As adults, we typically have 90 minute (give or take) sleep cycles. This means we go through stages 1-5 of sleep several times per night when we sleep a full night. For example, in a seven and a half hour night, we will have five sleep cycles.
And guess what? It’s perfectly normal to wake briefly after a sleep cycle, and in lighter stages of sleep. We typically don’t remember these wakings. But during an average healthy sleep, we wake up about 2-4 times throughout the night (Cunnington, 2016)
This means that the person who sleeps fine, and feels rested has actually woken up several times per night. So if you’re the type to get stressed about waking up in the middle of night, just remember this is normal and it’s part of our biology.
These night time wakings only start to affect us when it starts happening for more than a few minutes, at least three times per night.
Another thing to note is that, interestingly, our deep sleep periods are longer at the beginning of the night, whereas our stage 5 dream sleep only lasts a few minutes. And as the night wears on, the pattern reverses where we spend less time in deep sleep and more time dreaming. This is why you might notice that you remember dreams from the morning a lot better. It’s because your REM stage is now longer (National Institute of Neurological Disorders and Stroke, 2019).
This is also why our sleep grows lighter and we are more prone to waking up as the night progresses. So sleep maintenance insomniacs…this is part of the reason why you are the way you are.
Your 24 Hour Clock
Barring a disorder like circadian rhythm disorder, your brain runs on a 24-hour clock. This clock regulates your day by releasing melatonin (National Institute of General Medical Sciences, 2020):
⮞ Starting in the later evening between 9pm and midnight, our melatonin levels rise and reduce our body temperature which signals to your body that it’s time for sleep. For most of us, this block of time would be the ideal time to go to bed.
⮞ Between roughly midnight and 3am is when melatonin levels are at their highest. If you are still awake at this time, you will feel drowsy and it’s difficult to focus your attention on any one thing. Once early morning hits, between 3am and 6am, your melatonin levels gradually start to fall.
⮞ Sometime between 6am and 9am is when your body stops producing melatonin. This of course is also when the sun happens to rise in most parts of the world, which also helps to reduce melatonin concentration in your body. It’s your natural signal that it’s time to be alert and start the day.
⮞ The later morning between 9am and noon is when we are typically at our most alert, since now the melatonin is cleared out and we are producing cortisol. While cortisol is known as the ‘stress hormone’, it does much more than that including the regulation of the ‘wake’ part of your sleep/wake cycle (Sharma & Kavuru, 2010). It also regulates your blood pressure, blood sugar, and metabolism for when we are primarily awake and eating. It also manages how your body uses the food you eat, and fights inflammation.
⮞ For the rest of the day until around 9pm our cortisol levels start to drop (hence why many people become groggy around 3pm) and the cycle starts again.
Prior Wakefulness and Sleep Drive
When it comes to sleep, your daily functioning can be classified into two systems:
- Your wake system, which promotes alertness, is up and running for roughly 16 hours per day.
- Your sleep system that promotes, you guessed it, sleep, lasts for roughly 8 hours per day.
These two cycles occur because of the neurotransmitters being released by the brain. During your wake cycle, neurotransmitters called norepinephrine, histamine, and serotonin are being released and these help keep you awake (John Hopkins Medicine, 2021).
But then there’s an interplay where adenosine, which is the sleep neurotransmitter, builds up during the day and slows down the ‘wake’ neurotransmitters.
The longer the wake system is “on” (i.e., the more time you are awake in a day), the greater the internal drive will be for sleep since adenosine has more time to build up in your body. Plus, the more active you are during the day, the greater your sleep drive will be at night since activity signals your body to produce the sleepy adenosine neurotransmitter.
The F3 Alert: An Insomniac’s Nightmare
So fun story – our primitive minds can override our biological processes that help us sleep.
The flight/flight/freeze (F3) response is an ingrained response to imminent danger that was instilled in us many millennia ago (Anxiety Canada, 2021). It’s actually a pretty neat system that creates an automatic response that not only protects us from threat and danger, but has also helped humans survive.
That F3 was a great thing when we had to be on high alert for sabertooth tigers when we didn’t have proper shelter. Even now, have you ever thought “I’m going to cross the street” and something in you stopped you suddenly, only for a car to whiz by where you would have been? This is our F3 alarm to protect us before our conscious mind can even reason out what to do. These are the types of situations where a heightened level of anxiety really works in our favour.
When it becomes a problem is when our minds react like there’s a life or death danger, but in reality, we’re simply anxious about a non-imminent threat. There are many examples of this – like when you freeze during a presentation, or leave a party because you’re deeply uncomfortable in crowds (flight), or you become uncontrollably angry when someone says something that pushes your buttons just right (fight). It kicks in and triggers a whole host of physical responses like rapid heart beat, sweaty palms, cold hands and feet, and more (Anxiety Canada, 2021).
This response can also be triggered at night if we get anxious enough about sleep. Even if you’re not thinking about anything in particular, your body is responding to the signal of you going to bed with F3 alarm bells. Your heart starts racing, your muscles tense, and your palms are cold and clammy. Then your sleep is interrupted anyway since that F3 alarm causes stress hormones to course through your body and make you have to pee.
Funny how the mind works – you can be lying there in a warm, cosy bed. If someone were to walk into your room, they would see you’re just lying there in a warm cosy bed – there’s no immediate threat. Yet your brain is reacting in a way that is far more appropriate for when you confront a bear on a hike.
In the tools you will be implementing this week, I will share a few methods to override the F3 alarm so your biology has some space to do what it needs to do to get you to sleep.
Sleep Efficiency: The Key Marker in How Well You Actually Sleep
Sleep efficiency is the difference between how much time you sleep in bed versus how much time you spend in bed. The effectiveness of this interplay between hormones and neurotransmitters that get you to fall asleep greatly assist in having high sleep efficiency. Sleep efficiency is scored as a percentage (Reed & Sacco, 2016). Anyone that scores over 85% is doing great.
Let’s do an example.
You didn’t sleep well two nights ago, so last night you decided to go to bed earlier.
- You went to bed at 9pm to watch a show, but didn’t try to fall asleep until 10pm
- You ended up falling asleep around 11:30pm
- You woke up at 3am, and couldn’t get back to sleep until 4am.
- You then woke up at 7:00am but didn’t get out of bed until 8am.
In other words:
- You spent a total of 11 hours (between 9pm-8am), or 660 minutes in bed.
- You spent 1 hour (60 minutes) in bed watching TV
- It took you 1.5 hours (90 minutes) to fall asleep.
- You spent 1 hour (60 minutes) awake throughout the night
- You took 1 hour (60 minutes) to get out of bed after waking up
Here’s how to calculate your sleep efficiency for this night:
Total time in bed (660 minutes)
– Total time awake in bed (time in bed before attempting to to sleep (60) + time it took you to fall asleep (90)+ time you were awake during the night (60)+ time you spent in bed after waking (60) =[270 minutes])
= actual sleep time: 390 minutes (6.5 hours)
divide your actual sleep time (390 minutes) by total time spent in bed (660 minutes) = 59%.
This number represents your sleep efficiency for that night. Again, the ideal is 85% or greater, though anything above 75% is decent.
Improving your sleep efficiency is one of the key pieces of overcoming insomnia. If you haven’t already, you should start tracking your sleep as described in the “Mission” at the beginning of this week. This diary will be very important as we move into next week.
A Word on Melatonin, Over the Counter Sleeping Pills, and Prescriptions
Melatonin is probably one of the first ‘natural sleep aid solutions’ you came across when you began your research to treat insomnia, besides sleeping pills.
It’s a naturally occurring hormone that makes you sleepy when it is released into your body from your pineal gland. Your melatonin levels are elevated for about 12 hours starting around 8-9pm, and are undetectable during the day.
However, it is important to note that melatonin is NOT a natural sleeping pill or some miracle pill. It is more like a signal to your body to prepare for sleep. It has been shown to be effective when combating jet lag, or in minor cases of insomnia where sleep is delayed by an hour or less. However, there is no evidence to suggest melatonin helps chronic insomnia (Sateia et al., 2016).
It can also have side effects including headache, dizziness, nausea, and drowsiness. Other side effects, though less common, are feelings of depression, confusion, increased anxiety, and abnormally low blood pressure (Bauer, 2020).
It should also be noted that melatonin can interact with many different medications, including diabetes medication, contraceptive drugs, immunosuppressants and more (Bauer, 2020).
Some physicians worry that taking melatonin can reduce your ability to produce it naturally, however short term studies have shown no such effects (Matsumoto, Sack, Blood, & Lewy, 1997). No long term studies have been conducted to prove or disprove this concern from what I can find.
You can find it in grocery and drugs stores, normally in a dose of 3mg though I HIGHLY RECOMMEND speaking with a pharmacist or doctor if you are taking any medications to confirm there will not be any harmful interactions with melatonin.
Over the Counter Sleeping Pills
Everyone who reached for over the counter (OTC) sleeping pills when they first couldn’t sleep, say “I”! I know that was my first course of action after not sleeping for six weeks.
There are two (at least in Canada) OTC pills you’ll find:
- Diphenhydramine (Benadryl, TylenolPM, ZzzQuil)
- Doxylamine succinate (Unisom, Nyquil)
These types of pills don’t cause a dependency in the physical sense, but they can cause a psychological dependency by thinking you need to take them to sleep (Skinner, 2016). I don’t know about you, but these could be made strong enough to take down a horse and they still wouldn’t do anything for me because they don’t treat the anxiety around sleep.
Plus, the longer you take them, the less effective they’ll be. Though according to Harvard Health, there is no long-term data on the side effects of sleeping pills other than causing confusion and dizziness in seniors (2018).
My goal is for you to sleep without the assistance of any pills. However, it takes time — and effort — to change your habits and attitudes around sleep. So in some cases, a combination of sleep medication along with therapeutic self analysis is necessary.
If you are currently taking OTC pills and feel a psychological dependency, I encourage you to talk to your doctor to see if they are right for you.
Prescription Sleeping Pills
Prescription sleeping pills come in many forms, and have many names including:
- Ambien, Ambien CR (zolpidem tartrate)
- Xanax (Alprazolam)
- Dalmane (flurazepam hydrochloride)
- Sublinox (Zolpidem)
- Ativan (Lorazopam)
- Lunesta (eszopiclone)
- Prosom (estazolam)
- Restoril (temazepam)
- Rozerem (ramelteon)
- Silenor (doxepin)
- Halcion (triazolam)
I completely understand the need to turn to prescription drugs to sleep. I was prescribed Sublinox in the strongest dose (20mg) but never ended up taking it out of fear of the side effects. I did take far too many Ativans, to the point where they were no longer effective.
The goal of this program is to not have to take anything to get to sleep. However, I encourage you to continue taking what was prescribed to you and eventually lighten your dose:
- when you are ready, and
- under the care of your doctor
A lot of these drugs can be addictive and have withdrawal symptoms that need to be monitored by a physician.
Tools to Implement This Week to Get Better Sleep
Ok, now let’s get into some actions you can take this week that will help you get on the right track to overcoming chronic insomnia.
Get out of bed
If you only listen to one thing I say this week, let it be this:
Get out of bed when you can’t sleep, or aren’t ready to go to sleep.
This is absolutely VITAL if you want to overcome insomnia.
You need to disassociate your bed from wakefulness and stress starting tonight. And you need to do this even after you overcome insomnia and you have a random sleepless night. If you go to bed and don’t fall asleep in 20-30 minutes, get out of bed.
I can’t stress how important this is.
Chronic insomnia is a conditioned response. Somewhere along the line, you started to associate your bed with anxiety. To overcome insomnia, you need to work on reconditioning your brain.
If you are not familiar with the concept of conditioned response, it is based on an experiment by Ivan Pavlov. His famed experiment, Pavlov’s dogs, involved reconditioning dogs.
Before the experiment, the dogs would salivate when someone would bring them food (conditioned response). When a metronome was heard, it was a neutral stimulus that dogs did not salivate to (unconditioned response). Pavlov then performed the experiment in which he would turn on the metronome and then feed the dogs. The dogs were now conditioned to salivate at the sound of the metronome (new conditioned response) (McLeod, 2018).
That’s why even if you prepare yourself perfectly for bed, sometimes you just can’t fall asleep. You can tell yourself over and over that you’ll sleep, but your subconscious mind is hard at work to prove otherwise because it’s a conditioned response.
If you only go to bed when you are sleepy, you’ll recondition your brain to associate your bed with sleep rather than restlessness and stress. Every time you stay in bed when you’re tossing and turning or ruminating, you are reinforcing that bed = stress, wakefulness, and being alert.
Same goes with scrolling on your phone, watching TV, and potentially even reading. If you’re reading a really engaging book that you can’t put down, get out of bed.
If you’re just reading for a couple of minutes because it’s part of your bedtime relaxation routine, then that should be fine. But as soon as it interrupts your sleep, you’ve got to – you guessed it – get out of bed.
You want to start associating your bed with ONLY sleepiness and sexual activity. Nothing else. So if you’re not sleeping or having sex, get out of bed.
If you need to set up an air mattress so you can lay down in another room, do it. Just don’t associate your bed with stress. When you feel yourself getting tired, try going to bed. If you don’t fall asleep within 20-30 minutes…
👏 Get 👏out 👏of 👏bed.
If you end up falling asleep not in your bed, that’s ok. But you want to try to get to bed before you fall asleep to create that positive association with it.
Control your nervous system
Remember that F3 alarm bell I spoke about early this week that causes you to be anxious and not sleep, even when your conscious mind is like ‘ok, tonight will be fine, everything is good’?
Let’s calm that part of your nervous system down so you at least have a chance to get to sleep.
Here’s how you do 4-7-8 breathing:
Inhale through your nose for 4 seconds. Hold your breath for 7 seconds. Then open your mouth and exhale completely, making a “whoo” sound for 8 seconds.
The reason you do this is because it activates your parasympathetic nervous system which slows down your heart rate and increases oxygen in your bloodstream (Russo, Santarelli, & O’Rourke, 2017). This also helps to override your F3 alarm that is occuring in your autonomic nervous system. You’re essentially telling your monkey mind “what’s happening now is relaxation. There’s no room for stress right now”. Do this 10 times, or for as long as you feel the need.
Progressive muscle relaxation
Progressive muscle relaxation is where you purposefully tense muscle groups for five seconds, and then relax them. You can start by doing individual body parts like feet, lower legs, upper legs, butt, abs, etc. until you go through all major parts of your body.
If this is the relaxation response that works for you, note that the ‘goal’ of progressive muscle relaxation is to eventually do your entire body at once. So if you clench 16 different parts of your body, try doing larger sections and do 8 once you feel comfortable to do so. For example, instead of dividing your legs into upper and lower, do your entire legs at once. Then once you feel comfortable subdividing your body into 8, try doing 4. Then 2. And finally, you’ll be able to relax your entire body at once.
Passive muscle relaxation
Passive muscle relaxation is much the same as progressive, except you don’t tense your muscles – you say in your mind “I am relaxing my feet”, “my calves are now relaxed”, “I’m softening my jaw”, etc.
Picture a peaceful scene
This really depends on you as a person and how imaginative you can be. Some people can get lost in the details of a peaceful scene that they have created in their head. Or they paint a detailed picture in their minds. I personally pictured my fish in my fish tank, and imagined watching them swimming around. It can relax your mind.
Distraction (reading in low light, plan something not too exciting)
Sometimes distracting yourself can help from spiraling into anxiety around sleep. Reading in low light, for example, can take your mind off of stress without signaling you to ‘wake up’ with a bright light. Or you can try to plan something in your head. For example, I would plan outfits I would wear. I’m not exactly fashion-forward, so it wasn’t very exhilarating for me to think of outfits.
Another way to potentially relax yourself (again, depends on the type of person you are), you can listen to music that is calming to you, whether that’s something you’d hear in a spa or death metal. As long as you find it relaxing, it’s worth a try.
I’m not a big advocate for turning on the TV, and it’s generally not recommended. But if it helps you to settle and distract yourself from anxiety long enough to fall asleep, put on something relaxing but set a timer so it turns off after 30 or 60 minutes.
If you can’t sleep, do not go on your phone unless it’s for listening to something calming. DO NOT mindlessly scroll through social media. Do not read the news. Do not play a game on your phone. All of these activities are all too passive and designed to keep you on your phone.
Pledge to Commit
This week, I want you to pledge to yourself that you are willing to put in the work to get better.
The thing about taking committed action is it should relate to a value of yours rather than just achieving a goal. This is true for anything in life.
For example, if you look at weight loss goals, someone is more likely to stick with eating healthy and exercising if they are basing it off of their values of good health, individual improvement, or mastery. Whereas someone who bases their weight loss off of a goal like seeing a certain number of the scale or on a measuring tape, it disincentivizes the continuation of eating healthy and exercising once those numbers are achieved.
The same goes for sleep – it’s a lot easier to be persistent with getting a regular sleep schedule if it relates to a value rather than a goal of sleeping ‘X’ hours per night. This is for three reasons:
- If you don’t reach your ‘goal’ of sleeping ‘X’ hours per night, you’ll feel like you’ve failed yourself (whereas you haven’t failed if you’re working towards a value and you’ll try again tomorrow night to take committed action towards a restful sleep)
- Once you do reach a point where you have a good sleep schedule, you may be inclined to fall back into habits that make it difficult to sleep again if you don’t base it off of a value
- When you do relate sleep with a value, sleeping well then becomes something greater than getting a good sleep itself – you are sleeping because you want to live a fulfilling life in some way
📍 Quest #2: So what values does having a good sleep relate to?
Will having a good sleep serve you in the sense of having more energy for your kids?
Will sleeping well serve your value of being more creative?
Will a regular sleep schedule help you towards the value of showing patience?
If you’re not sure what your values are, here’s a giganamo list of values. See which ones resonate with you, and how sleep can be conducive to helping you take committed action towards your value(s).
It takes persistence every day to take committed action (like having a regular sleep schedule) to live by your values. But it’s what makes life feel fulfilling and worthwhile.
Week 1 Checklist
Let’s recap this week:
- Complete your sleep diary
Your sleep diary will be your guide for next week. It is imperative that you complete this so you can jumpstart your recovery next week.
- Take the “Do I have insomnia?” quiz
Start with a base reading of where you’re at with insomnia. I hope that in six weeks, you’ll say ‘no’ to more questions when you take the quiz again down the road.
- Get out of bed when you can’t sleep
Clap hands emoji.
- Calm your nervous system down
It should be noted that some of these may resonate with you while others won’t. It should also be noted that these can take time and practice to get the full effect of relaxation. Keep trying, and keep experimenting to see which one works for you.
I also encourage you to practice these during the day at times when you aren’t overly stressed. It’s a lot easier to practice when your mind isn’t hellbent on working against you in a certain moment. The more you practice during the day, the easier it’ll be to use these tools when you really need them.
- Talk to your doctor
Notice how many instances I mentioned talking to your doctor throughout week 1?
I understand not wanting to go to a doctor – I was reluctant for a long time to go because I felt embarrassed and ashamed. I think I subconsciously knew the real reason I wasn’t able to sleep was deeper than what a pill could fix.
But, I was desperate to get some sleep – it was ruining my life. I couldn’t handle my work, my relationship was suffering, and underpinning it all was the fact my mental health was suffering because I couldn’t sleep.
As bad as it sounds, I wanted there to be something physically wrong with me so it could be fixed. I was secretly hoping it’d be something “easy” like a thyroid problem. When I say easy, I mean that I hoped for a physical disorder that could be addressed and cured, and then my sleep problems would magically disappear. I wanted a solid reason for not sleeping, and not something abstract like the thoughts in my mind.
After getting blood and urine tests, it was determined that I was physically healthy and it was indeed my mind. At least then though, I knew what I was dealing with and could take action from there.
I greatly encourage you to talk to your doctor about your issues with sleep. They may take a full stock of your physical health to ensure there are no underlying issues causing you insomnia. They may refer you to a sleep study or a psychologist. They may throw sleeping pills at you to wrestle your consciousness to sleep.
Whatever the case, it’s important to get a medical professional to help you.
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