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I've had insomnia for many years and it's getting worse, but I think a sleep study would be more appropriate than just assuming I need therapy.
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I've had insomnia for many years and it's getting worse, but I think a sleep study would be more appropriate than just assuming I need therapy.
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Also - attention alcoholics - $25 is a LOT less than the amount of booze you'd have to down to pass out every night!
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@HooFoot: Alcohol does NOT help insomnia and in fact it will make it worse. Passing out because of alcohol is not sleeping.
@Yoko Broke Up The Beatles: Don't know about that. If you aren't picky, you can get three bottles of bottle shelf vodka for about $25.
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Insomnia is one of those disorders like OCD or ADD that everyone diagnoses themselves with because they had a couple sleepless nights (or they like being organized or they can't always focus). I get annoyed when I hear people say things like, \"I have insomnia, I didn't get to sleep until 12:30!\"
For me, it has become increasingly severe in the last 7 years. It used to be once or twice a week, but now it's every night. I've been prescribed lunesta, rozerem, trazodone, temazepam, xanax, and ambien. I'm currently taking the last 3 to mixed results (not all together). I've tried a host of herbal supplements that worked occasionally. The Lunesta worked best but I had to drop it when my insurance switched to generics only.
Psychiatrist recommended a round of therapy as he thinks \"there has to be something\" keeping me up at night. Sometimes it is, like being unable to stop thinking about work or whatever, but other times it's as simple as a song running through my head. I am not exaggerating when I tell you that Beyonce's \"Single Ladies\" has played in my head more than it has on the radio.
I agree with shoelace that sleep studies are probably the best way to go but they take a lot of time.
Side note, GOOD CBT costs around $200 a session. There are a lot of people out there who don't know what they're doing. And most insurance doesn't cover it.
Second, less significant side note, cognitive therapy isn't the same as cognitive behavioral therapy.
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@youbastid: \"other times it's as simple as a song running through my head. \"
I've had that happen, and it honestly feels like the first step on the road to insanity. I used to bite my husband's head off when he would hum a phrase of a song when I had the really bad insomnia because I knew I'd be hearing it for the next three days while getting no sleep at all.
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@youbastid: I feel your pain. I've suffered with insomnia for most of my life--as long as I can remember at least (I'm 32). It used to be trouble falling asleep, but in the last 5-6 years it's been waking up constantly all through the night with severe exhaustion during the day b/c of it.
I've had 2 sleep studies which showed nothing but the fact that I woke up constantly during the night. I've tried Ambien & Ambien CR--I just woke up at 2:30 am & spent the rest of the night drugged off my ass. I tried Lunesta & Trazodone & I may as well have been taken nothing as they did nothing. Rozerem didn't help me sleep at night but I was a zombie during the day. Restoril gives me about 2-3 hours of sleep & then I'm wide awake.
My sleep specialist is now trying to get me to do a clinical trial studying GHB (yes, the date rape drug) for sleep problems. No thank you!
I'm a lost cause.
@Boogaloo2: Lunesta didn't do a thing for me. Never tried Trazodone, but now I'm afraid it won't work. I'll have to avoid Rozerem because my issuei s staying asleep, not getting to sleep.
What would be wrong with trying GHB? Just because it's used as a \"date rape drug\" doesn't mean that's the only use it has. Alcohol is used as a \"date rape drug\" all the time. Do you drink?
Tell your doc to contact me. Maybe GHB will help me stay asleep!
@nakedscience: If your issue is staying asleep, Ambien CR could work pretty well. If you haven't tried any of the herbal concoctions, give them a try, there are a few controlled release ones that do work for some people. SleepAssure works for my sister.
@youbastid: Herbal stuff doesn't work. The only thing Valarian does, for instance, is drive my cat insane (cats LOVE Valarian root, apparently).
I've thought about Ambien CR. Just haven't had time to see a doc yet. The only thing I'm worried about is that they'll give me plain Ambien, and I'm pretty positive that won't work.
@nakedscience: If you tell your doc that your problem is staying asleep and not getting to sleep, he/she will probably suggest CR. If they don't, you can ask them for it specifically.
@youbastid: Yeah, a few things I saw regarding CR make me nervous. The doctor has to \"recommend it\" and/or you have to try regular Ambien first. But this was a few months ago.
@nakedscience: My dr. gave me a prescription to regular ambien because my insurance covers only generics, but he thought the CR would work better, so he gave me a stack of samples. A doctor has to recommend any prescription, I don't think there's anything special about getting a prescription to CR over the regular. When brand name drugs go generic usually the manufacturer makes a \"new improved\" version of it that is only available from that manufacturer. See also: \"Prozac Weekly\"
@Chris Walters: Keep the bottle closed, and put it next to a few cats. They can smell it. I had to hide the bottle from my cat because it would drive him (and me) batty.
@Boogaloo2: Oh yeah, I also tried CBT & the guy kept trying to get me to admit that my husband (boyfriend at the time) was abusing me and that I was subconsciously afraid to sleep.
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@Boogaloo2: CBT is about becoming more aware of your own thoughts, not having someone else tell you what you are thinking...so it sounds like this guy wasn't really helpful. When seeking treatment, you may have to try multiple therapist to find one that is helpful to you. Don't give up just because of one bad experience. I wish you the best of luck. =)
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I am not exaggerating when I tell you that Beyonce's \"Single Ladies\" has played in my head more than it has on the radio.
@youbastid: Ever wake up to the noise in your head? I've had that happen a few times.
@youbastid: It sounds like the problem that I have. I take 50 mg of trazodone nightly and it does the trick.
@anthonyhasp: I take trazodone on a semi-regular basis and am suprised at how little of a \"hangover\" i get from it, but it makes me sleep drool like crazy
@youbastid: And unfortunately, the generic ambien did not give me generic sleep sex, but it did give me generic piss in the corner of my girlfriend's bedroom at 4AM.
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@youbastid: I'm sorry to hear of the problems you're having. That said, after reading your second comment I'll be cleaning soup off my monitor, my keyboard, the carpet, and every vertical surface in a 10' radius now.
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@youbastid: I've updated the headline to include \"Behavioral.\" I also lol'ed at your pissing in the corner story, although I feel your pain (as someone who's been experiencing hardcore, up-two-days-at-a-time insomnia for half a year now).
Most people that complain of insomnia and go whine to their Doc for Ambien, have no idea what insomnia is. Except for Youbastid up there. Sounds like we're in the same boat man.
Insomnia is when you've been awake for 5+ days and still can't fall asleep. So far the only thing that works for me usually on day 3 is Ambien and Xanax, topped off with Valerian. Sometimes on certain weeks this doesn't work. By day 7 you'll find yourself crumpled up on the floor wishing you were never born.
@krispykrink: \"Insomnia is when you've been awake for 5+ days and still can't fall asleep\"
No, it's not. It really infuriates me when someone says, \"LOL, I have it worse off than you, I have *this*, clearly you don't REALLY have *thisproblem* because I am way worse off than you, shut up, stop saying you have insomnia, I don't care if you've been diagnosed, you're not as bad as me, it's not insomnia!!!\"
Come on. I've been diagnosed with insomnia. I don't stay up for 5 days in a row, but I literally cannot stay asleep. I'm up every hour, on the hour. If I sleep for more than 2 hours in a row, I'm in awe. This basically means I rarely get to deep sleep. I have insomnia. Stop making it some sort of contest.
@nakedscience:Didn't mean to imply it that way, of course, that's insomnia. Actually that's how it started for me, and has progressed into what it is now where I simply can't sleep that 1 hour. What I meant, in this drugged out world of ours, is the tons of people that rush out to a doctor for ambien because of the damn drug commercials, when all they really need is maybe a cup of tea.
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@krispykrink: actually, insomnia is \"the inability to obtain an adequate amount or quality of sleep.\" you don't have to be awake for days at a time to get a diagnosis of insomnia!
i've got pretty bad intermittent insomnia and have taken various medications for it, done therapy, meditation, etc etc. when i lost my insurance i'd mix benadryl and nyquil so i could get some sleep. i'd sleep some every night--i was never awake for days at a time--but it was still hell. i'd never wish insomnia on my worst enemy. its horrible.
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Be careful. You don't want to end up making a possibly fatal mistake.
I haven't had insomnia in a long, long time (thank God!). I had it pretty bad during a bout with some pretty intense depression. But I have that stupid sleep paralysis every once in a while. I HATE that. I know what it is now so I don't get scared anymore, but it still freaks me out to wake up and not be able to move.
HATE HATE HATE HATE that.
@HogwartsAlum: I get the sleep paralysis where I swear someone is spooning me and whispering sweat nothings in my ear as a group of men with heavy boots are running around my apartment, just to annoy me. It's creepy.
@HogwartsAlum: That has happened to me a few times, thankfully not lately. Scary vivid dreams, wake up paralyzed, try to mentally fight myself awake, get sucked back into sleep, repeat process 4 or 5 more times, eventually wake up groggy and with a splitting headache that lasts at least half a day.
Extremely unpleasant.
@Chris Walters:The 5+ days only hits me every other month or so. Most times it's just 2-3 days.
According to my doctor, someone like you, where 2 days is your extreme CBT and mild natural alternatives would be your best bet. Melatonin, and Valerian.
I'm actually impressed with the advancements in the drugs for insomnia these days. Back in the 90's I had to use Halcion. THAT will seriously screw with your head.
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@krispykrink: Melatonin is awesome. I had problems with my sleep cycle slowly flipping on its head, and melatonin helped that a lot.
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The problem of therapy is that you have to believe in it to get results. Sort of like religion or cults based on bad sci-fi, where you have to have faith in it for it to work for you. If you know it is just some sort of money making scam you aren't going to be taken in.
@nakedscience: Didn't you know, both therapist and cult leaders force you to have sex with them, isolate you from society as a whole and force you to perform slave labor.
@Eyebrows McGee (now with more baby!): LOL!
I know therapy isn't necessarily for everyone, but even the Skeptical community is confident that it's based on science.
Cognitive behavioral therapy is kind of awesome. I recommend checking out this book if you're interested; your library probably has it. If you're having the sort of anxiety or insomnia that everyone gets from time to time, it's great. Obviously, if you are having serious issues (like some of the commenters above), you need to see a doctor.
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As someone who has suffered from insomnia due to restless leg syndrome for the past nine years, I have to agree it's crucial to find a cost-effective way to treat it. Being physically unable to sleep is hell, especially when you have a high-stress job.
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@Micromegas: There are some drugs that can relieve the symptoms of RLS. Ask your doctor for Requip (or its generic). That has helped me out tremendously.
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@krispykrink: I hear you, dude. I work the later shift for our group because I'm not going to have a problem staying up as long as I need to. The only thing that's ever worked (ambien, lunesta, etc do nothing) is trazodone. I've got to be pretty strict about adhering to a sleep schedule to even make that work though. I haven't had a full night of sleep since I was a kid, and have been up for a week at a time. It's pure hell.
I never knew CBT was helpful for insomnia. I know that it's commonly used amongst OCD, PTSD, Bi-Polar and Borderline patients.
I do have to agree with someone up there, though, that good CBT is expensive. A lot of people really don't quite know what they're doing. It also really depends on the person.
Also, a lot of insurance won't cover it and I don't quite think that 100-150$ a session is quite as cost effective, since you're probably paying the same thing for a bottle of Ambien or Xanax.
I really wish you knew what you were talking about. CBT is not \"commonly\" used for Bi-polar or Borderline (it's at best used adjunctive with meds for bipolar; and DBT is far and away more commonly used for borderline)
Second, most insurances would love to pay for CBT, as it's considered an \"empirically supported\" or \"evidence-based\" treatment. In fact, many HMO's restrict reimbursement to evidence based treatments, such as CBT. So if you're going to make these statemnts please either preface with \"this is my opinion and I think these things are true\" or provide some sort of citations for your statements.
For the record I'm a PhD clinical psychologist with extensive training in CBT and other evidence based treatments
Yes, CBT is sometimes used but more often DBT (Dialectical Behavioral Therapy) is more effectivel for those with mental issues (especially BPD).
I couldn't sleep for years, tossed and turned all night, and always woke up with back pain. I bought a memory foam bed last year, and since I've gotten it, back pain is gone, and I can fall aseep and stay asleep.Getting out of bed is the hard part now...
Worth the money? Oh hell yeah. They're not too expensive from Costco...
All these mentions of CBT's usefulness have a whole new meaning when you know what it really stands for... (Er, use the Google. I'll spare you the mental image.)
(Psst: the Census lister training? Same thing. People, find a new acronym without any painful connotations.)
sign me up!
I just take the ambien.... No sleep sex yet sadly...
I have sleep sex all the time and it blows - no pun about it.
I either wake up in the middle of it or afterward, with no recollection of how it got started, or finished for that matter.
It makes arguing about the last time I had sex difficult, because it turns into a he says/she says argument.
Oh, and I don't take any medication or anything that would make me do it, like caffeine or sleeping pills, etc.
i worked in the sleep industry for 3 years in college, and i heard a LOT of success around CBT, even for people who were semi- addicted to sleeping pills and had been taking them for decades.
me? i literally count sheep every night, i rarely get above 20, and i sleep like a baby:) i highly recommend it.
I cannot stay asleep. Falling asleep is usually not a problem (usually), but staying asleep is. It's ridiculous. I'm 28. I shouldn't be waking up every hour or two, like clockwork. Some nights I can get 4 hours of solid sleep in, but after that I'm awake every 45 minutes. I fall asleep, and literally wake up as soon as I start to dream. It's driving me batty.
OTC sleep meds just make it worse--mys leep is even more disjointed and I feel like ass for hours upon hours the next day. Benadryl and I are not friends.
Once I had two (large) glasses of wine, a xanax, and two somas (muscle relaxers) because I was exhausted but couldn't sleep. Still woke up every hour. It's ridiculous. (And one reason why I'm afraid of Ambien: It probably wouldn't work, and I'd just run around outside naked all night.)
@nakedscience: speak to your doctor about a sleep test, if you haven't had one. i ran these for years (and my mom has worked in the industry for 15 years, so i grew up with it) and if we see patients who wake up suddenly, its often because of sleep apnea, and they stop breathing without knowing about it.
Sleep apnea can lead to heart issues, brain damage, etc, so its worth getting checked out - most insurances will cover the test and the treatment, and nearly every patient i've ever had says it is a lifesaver.
A few of you have touched on \"hypnagogic hallucinations\". I find them fascinating, because I have them quite often.
A friend of mine gets weird noises in her head, and she had no idea what they were. I told her about \"hypnagogic hallucinations\" and I thought she was going to kiss me, she was so happy. She said it helped to know she wasn't crazy.
People who claim to have been abducted more than likely actually had a \"hypnagogic hallucination\". It used to be called the \"old hag syndrome\" because, before ET and UFOs, people saw ghosts and \"old hags\". Spiders are a REALLY REALLY common one as well.
@nakedscience: Ooooh, I've had the \"Tetris Effect.\" I thought it was just my brain's way of telling me I'd been playing waaaaaaay too much of video game X.
@Eyebrows McGee (now with more baby!): Hey! I get the Tetris Effect all the time! And yeah, it's only when I've gone all crack pipe on a video game. It sort of feels like I've accidentally lined up all the neurons in my brain to focus on one particular problem-solving activity and now I have to wait for the normal thoughts to come back.
It's fun to name things.
@juri squared: That's it, I'm never going to do a sleep study. I can't stay asleep as it is. And I really can't sleep on my back.
I had serious, ongoing insomina for about ten years. I would fall asleep relatively well, then wake up between two and four in the morning and remain damnably awake for hours -- usually until the alarm went off, or just before, so I could still get the jarring wake-up. This was more nights than not for the entirety of that decade. I was miserable -- depressed and nonproductive, which at the time I did not attribute to the sleeplessness and now wonder.
I resisted medications for a long time because I thought taking them at 2 or 4 a.m. was a mistake. Finally, I started taking them before I went to bed, even though falling asleep had never been my problem. I found that I still woke up -- but instead of lying there for hours, I went back to sleep fairly quickly.
Since then, I've been able to go off the meds, but that was after about two years of medication. I think I taught myself during that time to go back to sleep when awakened and not to let my brain get caught up in thinking about things. I would go back on drugs in an instant if it came back. Insomnia is just brutal.
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Last Friday I had a sleep study done. They aren't so hot. Part of the problem with them is that you are supposed to sleep normally while in a strange bed and place, with about 30 wires glued to and hanging off your body, including 2 breathing sensors stuck up each nostril. If you don't sleep much or well during the study, the problem may not be found. Also, sleep studies are usually done for people who experience problems in their sleep, not for people who cannot sleep--that problem is self evident. If your doctor doubts that you have insomnia, leave repeated messages on his/her answering service in the middle of the night.
Proper and appropriate CBT is merely a form of specialized patient education to teach people how their thoughts, feelings and behaviors contribute to their problems, and how to correct these things. It is not symbolic analysis and there should be no emphasis on the expression of feelings--although emotions may be investigated if they contribute to the problem--and the therapy should be relentlessly problem-focused (in this case, on getting proper sleep).
Look up \"sleep hygiene\" online to learn about the means for dealing behaviorally with insomnia. Although insomnia fortunately isn't a big problem for me, I have found that things as simple as light and sound contribute hugely to my (in)ability to sleep. For instance, when I go camping and there are no lights or sounds at night, I become tired easily at night and sleep quite soundly. At home with stereos/ televisions/ computers/ lighting, all these things keep me from winding down and sleeping. My opinion is that many of us are over-inundated with stimuli and the solution is to scale back, with quiet evenings, dim lights, and no television/ computer/ music/ heavy mental activity an hour before sleepy-time.
Sleep Hygiene is an important for sleeping well, but the scientific evidence suggests that fixing sleep hygiene problems rarely eliminate the insomnia symptoms.
Unfortunately, conception that Sleep Hygiene = CBT for Insomnia is common, even among physicians. But this is not the case.
Sleep Hygiene is a set of guidelines -- some of which may apply to you -- that may help you sleep better. But if you have insomnia, unfortunately, the available data does not suggest that this alone will fix the problem.
You will need to talk to someone about CBT-I (see my post below).
Good luck!
@ChuckECheese: I've had three of those suckers (I have sleep apnea) and yeah. They really suck.
Plus, they make you sleep on your back. I never sleep on my back, and then they wondered why I barely slept. I had to get the doctor to make a note on my chart so they would stop that.
@ChuckECheese: I agree - sleep studies like the one you had (polysomnograms) tend to be most effective if they are done on people who sleep ALL OF THE TIME (9+ hours per night and a nap) and are still always tired. These patients almost always have Obstructive Sleep Apnea and its because while they think they are sleeping, they really aren't getting quality sleep.
The reason they perform them on patients who are \"insomniac\" is because often, when people say \"i lied awake all night and couldn't sleep a wink!\" they actually did sleep a few hours and either didn't notice or didn't count it. What these tests measure is a) why they didn't sleep, or b) what woke them up.
Sometimes patients can't sleep because of fibromayalgia and you can see the brain waves that indicate that (although many doctors think it is a fake disease, a lot don't, and its difficult to deny if you know how to read a polysomnogram) and some patients have difficulty staying asleep because they have sleep apnea, and they stop breathing while they sleep and their brain wakes them up. to them it feels like they never slept, but they actually got a few winks before their brain started freaking out about lack of oxygen.
Also, i found that most of my patients slept fine with all of the wires - they bitched and moaned but they either slept or they didnt, the same way they always had.
Picardia, I have the same problem as you. I awaken in the middle of the night, and can't get back to sleep for hours. The prescription aids that I took for several years usually didn't prevent waking up (like clockwork, around 3:30am), but I did fall back asleep faster on them, instead of being awake until 6:30 or so.
Recently, I became pregnant and had to stop taking everything. I had about three months of only 4 hours of sleep a night. Sheer hell. Now, I seem to be getting up to about 6 hrs, because I can fall asleep again a little more quickly.
And like Youbastid, I often have useless things going on in my brain the whole time, not worrying about things in my life. Mostly music, too: songs, trying to figure out in my head how to play them on piano, or translating the lyrics into Spanish. What a waste of time.
Does anyone know if CBT can help shut one's brain up?
Insomnia does not have to mean that you can't fall asleep or that you fall asleep, wake up and can't get back to sleep. Insomnia in simple terms is dissatisfaction with sleep, which obviously contains most laypersons definition of insomnia. Cognitive Behavioral Therapy or Cognitive Therapy typically will work to treat insomnia because although insomnia is listed as a disorder in the DSM-IV-TR most psychologists believe that it is in fact a symptom of some other psychopathology, ie depression, anxiety, etc. And the best part about pretty much any psychotherapy is that you can achieve great results in very little time, CBT typically works with depression and anxiety related problems in as little as 10 weeks, compare that to the potential years you could spend on meds, which can be addicting and if taken incorrectly, deadly.
@youbastid: other times it's as simple as a song running through my head.
Can you always make out what the music is? I hear voices - not in the schizophrenic way, but more like if someone had left a television on in a room at the other end of the house with the door closed, and I can hear just enough to know it's on, but not enough to hear what they're saying. Sometimes it's music, or laughter, or sound effects. I use white noise in my bedroom, but that doesn't help when the noise is in my head. (All it takes to \"turn it off\" is to turn my head.)
A sleep study showed that I spend ~80-85% of the night in REM, as opposed to the more usual 20-30%. Ambien worked for a while, then stopped; Ambien CR never worked at all. Halcion has been working for the last 6-8 months, but at 50 mg instead of the usual/recommended 25 mg, and I'm starting to notice effects on my memory (short-term and long-term). Which really sucks, but at least I can function through a day now, and not wake up so tired I want to cry. Well, not as often, anyway.
These comments illustrate a few common misconceptions in the general public regarding insomnia, CBT and CBT for insomnia.
So that you know I am credible, I have a PhD in this area and am an active member of the sleep research and sleep medicine field. And I'm a Consumerist reader (writing this from the SLEEP 2009 conference in Seattle).
Insomnia, as defined medically, is a disorder that includes (1) difficulty falling or staying asleep and (2) daytime impairment. The details are different among people, but generally insomnia is suspected when it takes at least 30 minutes to fall asleep, at least 3 days per week. Often insomnia is thought of by the public (and many doctors) as a symptom (like pain) rather than a condition on its own, but the existing data suggest that even if something else brought it on, insomnia takes on a life of its own, for reasons you learn during CBT.
CBT is a type of psychotherapy. It is NOT psychoanalysis. In many ways, it is the OPPOSITE of psychoanalysis. Psychoanalysis takes years, and you spend lots of time talking about your feelings and reliving the past. CBT takes WEEKS, and there is almost NO talk of the past or about feelings. The focus is on problem-solving in the here-and-now. It is PRACTICAL and there are DECADES of data and THOUSANDS of research studies showing that it produces relatively QUICK RESULTS. Unlike psychoanalysis, which has almost no data to support it at all. (Though its proponents disagree.)
This is not the \"therapy\" that you see on TV. It is problem-focused, practical and uses specific tools and techniques from the cognitive domain (ways of changing thoughts and questioning unhelpful beliefs) and behavioral domain (doing things that help, whether you want to or not). These work. Talking about feelings often doesn't.
CBT for Insomnia is a special kind of CBT. It is extremely specific and is almost completely bahavioral. It is extremely practical and uses very well-defined techniques. And if you're following the manual, it takes 8 weeks.
CBT for insomnia (or CBT-I) takes specialized training, even for someone who does CBT as part of their practice. There are, unfortunately, very few practitioners certified by the American Academy of Sleep Medicine. But the numbers are growing.
The data on CBT are very good. It will take a couple of weeks before you see benefit, and, if you're doing it right, you will get worse before you get better. But the data show that those who stick with it do about as well after 8 weeks as someone on medication, and better and better as more time progresses, as opposed to medication where effects fade over time.
Insomnia is very common, and there is much more scientific literature available than most people realize. We are learning more and more about how it works, especially as we are learning more about the physiology of sleep and how it works.
For more information, go to the websites (an easy Google search) for the American Academy of Sleep Medicine, the Sleep Research Society, and the National Sleep Foundation. To get a glimpse of the scientific data, if you are someone with the qualifications to understand it, check out PubMed by searching for Behavioral Sleep Medicine or CBT-I.
Insomnia is very treatable by someone who knows how. There is no data supporting a lifetime of medication use, yet there is a wealth of data showing that using what you learned in CBT not only keeps insomnia away, but helps you sleep better the longer you use it.
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Insomnia SUCKS. I had repeated, extended bouts in law school. (I've had short bouts my whole adult life, but two days of insomnia is really different than four weeks of it.)
I haven't tried CBT but I'd definitely be up to try it if I had another extended bout. I've had pretty good luck with Sonata and other drugs as a one-night or two-night sleep aid that kicks my sleep cycle back into its normal setting. But those weren't so good when I had the looooooong bouts.
NYTimes link at the bottom is misdirected, btw.
@Eyebrows McGee (now with more baby!): Thanks - fixed.