How to cure your insomnia

I suffered from insomnia from the age of about 23 to 29. It got really bad in 2014-15 where I would sleep for about three hours each night for a year. The problem began when I started having to get up at night to go to the toilet. I eventually became so stressed by this that I couldn’t get back to sleep. Later, the sleep stress became so great that I couldn’t get to sleep in the first place. I would spend 11 hours in bed, waiting desperately to fall asleep, becoming ever more frustrated and less likely to sleep. (The tendency to spend more time in bed is quite common in insomniacs, but is the opposite of what you should do.)

I spoke to doctors about this, and they put me on sleeping pills of different types, which didn’t help very much. The thing that cured me entirely in 2016 was CBT for insomnia. The treatment is non-pharmacological and does not require a trained therapist. Not only did this work for me, there is also good evidence for it and it is the frontline recommended treatment for insomnia, according to major health bodies in Europe, the UK and US. See the NICE page for a review.

I think the most impactful aspect of this course was sleep restriction, which is limiting the amount of time you spend in bed. Sleep hygiene is are also useful, but is secondary to sleep restriction.

Sleep restriction

This is a guide to sleep restriction. First, a definition:

Sleep efficiency = (Total sleep time / Time in bed)

The goal is to reduce time in bed in the short term, such that sleep efficiency increases. After a few weeks, total sleep time also increases.

  1. Pick a set time that you get out of bed (e.g. 8:00am)
  2. Over one week, work out how much you sleep and how much time you spend in bed by keeping a sleep diary – logging what time you get into bed, when you woke up, when you got back to sleep. Suppose you find that you usually sleep for 5 and a half hours.
  3. The difficult bit: you now have to stay out of your bedroom and your bed until 5 and a half hours before your waking up time. For you, this is 2:30am.You are not allowed to nap in the day or sleep outside of your bedroom.
    1. In bed, you are only allowed to sleep or have sex – you are not allowed to read or watch TV or listen to music.
    2. Track your sleep efficiency with your sleep diary.
    3. If you do not sleep for 40 minutes, get out of bed and do something boring in a different room, like meditation or tidying.
    4. (Note: You should never reduce time in bed to less than 5 hours throughout this whole process).
  4. Next you have two options
    1. If your sleep efficiency is >90% after 1 week, then increase time in bed by 30 minutes. i.e. set your bedtime to 2:00am, so you have 6 hours in bed.
    2. If your sleep efficiency is <80% after 1 week, then reduce time in bed by 30 minutes. i.e. set your bedtime to 3:00am, so you have 5 hours in bed. (Remember not to spend less than 5 hours in bed per night throughout this whole process)
  5. Repeat step 4 until you are getting your goal amount of sleep. If you feel normal and refreshed after 7 and a half hours of sleep, then you should be going to bed at 12:30am, and getting up at 8:00am.

This process will take several weeks or months to complete, depending on your response. To maintain your healthy sleep, only use your bed for sleep or sex and stick to your bed time and waking time, plus or minus 1 hour.

Sleep hygiene + tools

Sleep hygiene is the control of the environment and behaviours that can affect sleep. I also suggest some tools I think are useful. The three most important things to consider are chemicals, light and your bed set up.

Chemicals: Cut out caffeine and alcohol. Caffeine has a six hour half life so if you have a double espresso at 2pm, this is like having an espresso at 8pm. Most coffees in coffee shops are double expressos. Drinking caffeine is a vicious cycle. You want to do it when you are tired, but it makes you less likely to sleep the next night. Your body also habituates to caffeine after a while so all you are eventually doing by drinking it is adjusting to the withdrawal symptoms. Alcohol makes it easier for you to fall asleep but reduces the quality of your sleep.

Light: Natural sleep hormones are strongly affected by light exposure. You want lots of light in the day and little light from 7pm onwards. I used to think I was a natural night owl because found it hard to get out of bed before 9am. Then I had a child, which meant I had to get out of bed at 6am every day. I no longer believe I was a natural owl: I got out of bed late like a teenager because I am more sensitive to blue light than other people and I stared at my computer, TV and phone for too long in the evening. If you want to get to sleep earlier, you have to limit your exposure to blue light. So, I think you should dim the lights in your house three hours before bed – get dimmable lights or turn off the bright lights. Avoid very bright bathroom lights by getting dimmable lights for your bathroom. Don’t stare at your TV, computer or phone within two hours of going to bed. Gradually dim your screen brightness after 6pm. In the day time, get a sunrise wake up lamp like a Lumie. Use a SAD lamp in the day. Also, getting natural sunlight is a good move.

Mattress: I recommend a 2.5cm memory foam mattress topper on top of a medium-firm foam mattress. It’s impossible to overspend on a mattress, but my set up cost about £400 and my bed set up now is very comfortable. I find that very firm mattresses leave me with a frozen shoulder as I have quite broad shoulders, and memory foam toppers prevent that.

Pillow: The IKEA Rosenkarm pillow is the best pillow I have tried, and only costs £15. The good thing about it is that due to the shape, it provides neck support, and it is comfortable whether you are on your back or on your side.

Exercise: Exercise in the morning or afternoon seems to improve my sleep

Food: Don’t eat big meals right before bed. Don’t go to bed hungry.

Eye mask: 3D eye masks are good.

Curtains: Get blackout curtains or blinds.

Ear plugs: These JVC marshmallow earphones are the best ear plugs I have tried, as they are reusable and the wire makes it easier not to lose them. You can also listen to pink noise on them…

Pink noise: I find pink noise on Spotify quite useful for getting back to sleep after waking up.

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