Helen Minnis explains how her sleep improved after taking part in a randomised controlled trial of Cognitive Behavioural Therapy for Insomnia (CBT-I)
[Posted on 2 November, 2021, by Helen Minnis]
Professor Maj-Britt Posserud’s wonderful blog on sleep got me thinking about my own sleep journey.
As the proud owner of a neurodevelopmental profile that makes me energetic and rather restless at times, I have never been particularly interested in having a lot of sleep. I remember, as a young child, I would hear my father coming to bed, playing his radio, at around midnight and I would still be restlessly playing with my dolls and soft toys rather than sleeping. He didn’t believe that I had really been lying awake for that long until, at breakfast, I started whistling the tunes his radio had been playing the night before.
When I saw an advert in the University of Glasgow looking for participants in a randomised controlled trial of Cognitive Behavioural Therapy for Insomnia (CBT-I), I jumped at the chance and was randomised to the active intervention group.
Being a short sleeper wasn’t a problem until 11 years ago when treatment for breast cancer caused me to develop a more serious problem with sleep. I got into bad sleep hygiene habits – going to bed and falling asleep to the sound of a podcast, waking again quickly, getting up to watch YouTubes on my computer and being awake in the night for hours, sometimes ruminating about silly work-related things. When I saw an advert in the University of Glasgow looking for participants in a randomised controlled trial of Cognitive Behavioural Therapy for Insomnia (CBT-I), I jumped at the chance and was randomised to the active intervention group.
Despite my scepticism I gave it a try and started reading on the living room sofa, then staggering through to the bedroom once I had started to nod off.
CBT-I consisted of an exploration of any “automatic negative thoughts” (ANTs) that might be keeping me awake and focusing on my sleep-related behaviours. My therapist quickly realised that I didn’t really have any ANTs – I am lucky to have no real mood problems – but she soon realised that I had a poor sleep routine and what she called “nesting behaviours”. These can include things like going to bed with a hot water bottle or a teddy, or reading in bed. My nesting behaviour was reading or listening to a podcast in bed, and she explained that it was fine to do this even in a chair beside the bed, but NEVER in the bed itself. The CBT-I mantra is that “beds are only for sleep or sex”. I found this quite hard to accept. I had believed since childhood that I could only get to sleep if I read in bed first. Despite my scepticism I gave it a try and started reading on the living room sofa, then staggering through to the bedroom once I had started to nod off. That wasn’t as bad as I had thought. The therapist also insisted that I got up at exactly the same time every day – even at weekends. Since we were doing our therapy in the depths of last winter’s lockdown, getting up at 6.30am on a Saturday and Sunday was quite a shock to the system, but I complied. Miraculously, within about three weeks, my sleep was much better. Since completing the eight therapy sessions, I nearly always sleep through the night.
What I found fascinating was that as soon as my sleep routine improved, I no longer had any ruminations in the wee small hours. I was also generally much more relaxed. This has made me think a lot about the physiology of both sleep and mood: those of us who work in mental health know that rumination in the night hours and early morning wakening are characteristics of depression. My own CBT-I experience has made me wonder if the primary problem in mood disorders might be sleep and perhaps related to neurodevelopmental conditions – just as Maj-Britt suggests in her blog – and the ruminations and any subsequent mood problems might be secondary to that.
This, of course, is my own personal experience and what worked for me won’t necessarily work for everyone. I am not a sleep scientist, but I loved Maj-Britt’s reminder to all of us just how important sleep is!
[This is a blog. The purpose of the blog is to provide information and raise awareness concerning important issues. All views and opinions expressed are those of the writer and not necessarily shared by the GNC.]