April 14, 2022
Webinar: Healing Insomnia
Written by Rachel Eddins
Quality sleep is essential for physical and mental health. Change your habits to create better sleep.
Facilitated by Joan Mullinax, LPC.
Watch a replay of this presentation here.
Learn more about our Insomnia Therapy Services.
Here is a transcription of the webinar:
Hi and welcome! My name is Joan Mullinax and I’m with Eddin’s Counseling Group. I am a personal and career counselor, so I do counseling about grief, stress, anxiety, depression, insomnia, and quite a variety of things. Furthermore, I also do career counseling and I especially love doing career direction. I also spend time with people who are in a toxic work environment and either need to rework the environment to make it less toxic or to escape to safer grounds.
Insomnia: Restoring Restful Sleep
Let me give you an introduction to what we’re going to talk about because there are a lot of things that we can kind of smush together in one big bucket and they are not all literally insomnia.
- We’re going to talk about what insomnia is, and
- What insomnia isn’t, and
- We’re going to talk about why people get insomnia and what you can do about it.
Why Is It So Hard To Sleep?
You would think that sleep, which human beings are naturally born to do, would not be so difficult. But unfortunately, in the 21st century, we have a lot of opportunities to develop bad habits with regard to sleep and it takes some work to get us back into kilter (balance).
What Is Insomnia?
Insomnia has not just one, but several symptoms:
- Trouble falling asleep
- Trouble staying asleep
- Experiencing unrestful, un-refreshing sleep
- Waking too early and not able to get back to sleep
Insomnia impacts daytime complaints: low energy, tired, fatigue, memory loss, low attention, difficulty focusing, low mood, anxiety, and even physical symptoms such as headaches/muscle aches, stomach upset.
It’s not just one, but several symptoms. So it’s trouble falling asleep, trouble staying asleep, having unrestful or un-refreshing sleep, waking too early and not being able to go back to sleep.
Insomnia and Mental Health
Often, the last remaining symptom of:
- If insomnia isn’t treated, depression is likely to return
Insomnia has a relationship with mental health, especially specific mental health issues like post traumatic stress disorder (PTSD), depression, anxiety. Very frequently, insomnia is sort of the last residual symptom after somebody’s been treated for those. If the insomnia isn’t also treated, then the depression may return.
Treating insomnia improves depression, anxiety, and other emotional issues. It also improves inflammatory markers, meaning you’re physically more healthy. Inflammation in your body contributes to pretty much all the major chronic health issues, from heart disease to diabetes to stroke. So, the sleep is helping with the inflammation and reducing the inflammation helps maintain your health.
But Is It Insomnia?
- Sleep disturbances are common, especially during stressful life events and it goes away on its own. To be insomnia, it needs to persist for 3 months or more and it doesn’t go away on its own.
- Tired but Wired, wound up but can’t sleep
- Falling asleep during the day? NOT insomnia! More likely to be sleep apnea.
- Other medical conditions such as restless leg syndrome – medical condition, not insomnia.
- Circadian rhythm – most from 10/11 pm until 6/7 am, genetically determined.
- Can be earlier (lark) or later (owl).
- For some, it is 3-4 hours off. Not really insomnia if you sleep the full cycle (ie., on the weekends, in bed late and up late for an 8-hour cycle).
Is my problem with sleeping actually insomnia?
These are common, especially when we’re dealing with stressful events. If the sleep problem goes away when the stressful events go away, then it’s not insomnia. To be insomnia, it needs to continue for at least three months, and it doesn’t go away on its own. Very frequently with insomnia, we feel tired but wired. So we’re fatigued, but we’re wound up and we can’t sleep.
If you find yourself falling asleep during the day, that’s not usually insomnia. That’s more likely to be a sleep disorder like sleep apnea.
Sleep apnea is a condition where you actually stop breathing during the night. This is a very serious condition that we don’t take seriously enough.
It can cause heart problems and it can cause brain problems. It’s a life-threatening illness that needs to be addressed if it comes up.
Unfortunately, we don’t usually notice that we have sleep apnea. We may find out that we snore when we sleep, and that’s a fairly common indicator, but not always. It’s more likely to happen as we get older. It also is more likely to happen if we are heavier or have a thicker neck size, like a 17-inch neck for men.
Most likely to report on our sleep apnea are very frequently our sleep partners, or if we have a roommate and they notice that we are stopping breathing in the middle of the night, or if you discover somebody else who has stopped breathing in the middle of the night, you want to let them know. And let them know. It’s something that needs to be looked into.
Restless Leg Syndrome
There are other medical conditions that can affect sleeping, such as restless leg syndrome. It is also a medical condition and not insomnia. I’ve had the not-so-great pleasure of my late husband having restless leg syndrome, and he would not only wake himself up in the middle of the night, he would wake me up in the middle of the night.
Circadian Rhythm Disorders
Also, there can be circadian rhythm disorders. Our circadian rhythms are normal body rhythms and for most of us, it means falling asleep around 10:00 or 11:00 pm and then getting up around 6:00 or 7:00 am. Very frequently the circadian rhythm is genetically determined. So, for example, we can have this typical pattern, 10,11 to 6,7.
But we also have:
- Larks for people who tend to naturally go to bed earlier and get up earlier or
- Owls who are more likely to stay up later and get up later
Sometimes that can be a real issue for people in their work environments. If their sleep pattern, their circadian rhythm, doesn’t match their work pattern.
Some people choose jobs based on their sleep patterns.
For some people, the circadian rhythm can be off for as much as three or 4 hours. It’s not really insomnia if on the weekends you can go to bed late, get a full eight-hour cycle, and wake up refreshed. So that’s an indication that your circadian rhythm is off, your body clock is off, and you have the challenge associated with that and very frequently are having to catch up on the weekends.
Why Do People Get Insomnia?
One of the key reasons people get insomnia is because of sleep regulation and sleep drive issues. So the sleep drive regulates deep sleep. When we go into we have light sleep cycles, we have Rapid Eye Movement or REM cycles, and we have deep sleep cycles.
Sleep regulation particularly regulates the deep sleep cycle. It can also be affecting by your body clock and how long it says that you should sleep. A very frequent phenomenon is conditioned arousal:
We have an enormous number of bad habits when it comes to sleeping because we use our bedrooms for a whole lot of other things besides sleeping.
So when you get conditioned arousal, basically what’s happened is your brain associates wakefulness with your bed and you lie down tired and drowsy and ready to go to sleep. Then, a switch flips on, and all of a sudden you’re fretting, worrying, and not getting the sleep that you need. That’s because you have habitually used your bed for something besides sleeping.
Then the other thing is the overactive mind or the overthinking. Basically, as soon as my head hit the pillow, my brain thought that the first thing I should do is review my day, see what I had accomplished, what I hadn’t accomplished, fret about what I hadn’t accomplished, and maybe make some notes and things like that.
This is the thing that we want to move earlier into the evening. Move your overactive mind and you’re worrying earlier in the evening.
Sleep Drive Improving Behaviors
Let There Be Light (and Activity!)
Let’s talk about some of the things that do work. To build up sleep drive during the day, you want to be active, especially in the morning and preferably where you’re exposed to light and especially daylight. If you can get out and take a walk, walk the dog, go for a bicycle ride. Anything that gets you light in your eyes.
That is part of what tells your body clock that this is daytime, time to be fully alert, and you want to be active during the day. If you live or work in a building that has multiple stories, sometimes you want to take the stairs instead of the elevator and keep active.
Sitting Is The New Smoking (Avoid Sitting Too Much)
Covid was a particular challenge for me because when I worked in the office, as each new client arrived, I got up, walked to the waiting room, and walked my client back with me. I would also get up and run to the restroom, or I would get up and get snacks. I would even get up and sometimes drive home and have a nap and have lunch and then drive back and start the afternoon over again.
With Covid, if I didn’t watch it, I was seeing a client and then I was, seeing another client and another client and I wasn’t moving from the couch. And as COVID stretched on, I began to realize that (and I had heard that) sitting is the new smoking.
Not moving around is physically bad for us, like smoking.
So you want to be active and awake during the day. That’s part of what helps to set your sleep drive so that you are ready to sleep in the evening.
Wait Until You’re Sleepy to Go to Bed
Another thing that can disturb your sleep drive is if you go to bed too early. So maybe you’re tired now. Tired is more of a physical thing and less of a mental thing. Sleepy is what we’re looking for. So you know that sleepy you get where you almost fall asleep in front of the television. That’s what we’re looking for.
If you go to bed too early, you may not have built up enough of your sleep drive and you’ll wake up in the middle of the night and may not be able to go back to sleep. So to build a good sleep drive, you want to avoid excessive time in bed, like reading in bed, or watching TV in bed. All the things that we’ve taken to doing in bed.
Avoid napping at least while you’re getting your body clock reset. Definitely no napping later in the afternoon. Your nap should be short, set a timer for 20 minutes. That way you never get a chance to go into the deep sleep cycle.
Don’t go to bed early. Wait until you’re sleepy to go to bed.
- Inactivity can disrupt your sleep drive.
- Sleep effort or trying to go to sleep can make it worse.
These sleep drive improving behaviors are an investment in your future of good health and good sleep.
If you do it now, you will sleep better later.
Sometimes it takes a little while, like maybe a couple of weeks to adjust your sleep cycle, but it’s worth doing. It’s very good for you and you will be much more satisfied with your sleep.
Increasing Sleep Drive – Sleep Efficiency Training
Here’s some more information on creating a sleep drive and some sleep efficiency training.
Stay Up Later
Stay up later until you’re tired then you sleep through the night with deep sleep.
So initially, this may be only six hours of deep sleep, but that’s better than eight hours of light sleep. It’s a deep sleep that’s really going to get your brain to do the things that it needs to do while you’re sleeping. It does a lot of housekeeping work while you’re asleep.
A long period of time in bed will lead to shallow, fragmented sleep, the kind where you wake up and you look at the clock and go: “Oh my God, the alarm is going to go off in three hours, and I don’t know if I can go back to sleep or not.” So you start developing sleep anxiety. This is not what you want to happen, and if you keep doing it, it can increase over time. Don’t spend a long time in bed when you’re not sleepy.
What is Your Average Sleep Time?
Part of what you want to figure out is what is your average sleep time now. Healthy sleep should be 7 to 8 hours a night.
People who get less than 7 to 8 hours a night actually have an increased risk for a wide variety of chronic illnesses, from heart disease to diabetes to stroke.
If you feel like maybe you need to sleep more than you’re sleeping, then you want to add 30 minutes to that total that you come up with for what you’re normally sleeping. Then you’re going to go and look and see what time you need to get up in the morning.
Ask Yourself, “What Time Do I Need To Get Up?”
For me, if I need to be somewhere at 8:00, I have to get up at 6:00 am. If I’m going to be somewhere at 9:00, I have to get up at 7:00 am. As a therapist, since I work in the evenings, I get up at nine. So anybody that wants anything before nine is going to encounter my protective measures on my phone.
Determine the time you’re going to wake up and then subtract from that the number of hours you want to sleep. That tells you what time you want to go to bed. What we’re going to do is we’re going to start with that number and we’re going to gradually increase it by 15 minutes a night until you really feel like you’re getting a good solid night’s sleep.
Get out of bed shortly after waking.
If you lie in bed and doze it’s really not very healthy sleep. It’s not deep sleep, and it’s better to go ahead and get up. So when you get up to make your first trip to the restroom in the morning, you might think, “Let me just go ahead and jump in the shower while I’m at it, or maybe I’ll go in the kitchen and make some coffee or I’ll start breakfast.”
So go ahead and start your morning activities or maybe get outside in the light and it will tell your brain that this is morning and it’ll start setting your biological clock accordingly.
To improve your sleep efficiency, stay up until you’re tired. That way you’ll be more likely to get deep sleep even if you don’t get as much sleep to begin with.
One of the things that happen from this process of working on insomnia is in the short term, you may actually be getting less sleep. That sounds like absolutely the wrong thing to do. This is well-researched science. Do what this program talks about and if you don’t have a sleep disorder like sleep apnea or sleep or restless leg syndrome, this will make a difference in how you sleep.
To keep your body clock working properly, try these suggestions:
- Set a standard wake-up time and get up at the same time every day, even on weekends, and
- Get regular exposure to sunlight, preferably in the morning, because that helps to set your biological clock to daytime mode, and
- Eat regular meals, and
- Reduce the light level to low levels in the evening, and
- In the evenings, reduce the blue light out of your electronics because those increase your wakefulness. If you have a newer TV or an iPhone, you can set the time when it automatically turns down the blue light when it’s time for you to start resetting your brain
- Get exercise regularly, but not two hours before bed, because that’s going to activate your system instead of calm it down, and
- To prepare yourself for bed is to take a hot bath before you go to bed, and
- Keep your bedroom cool as the last thing you want to do is wake up to toss covers off in the middle of the night.
Conditioned arousal is whenever your brain associates bed with wakefulness, and it’s basically a learned condition and we have lots of practices in modern life that contribute to this. So if you’ve got a television in your bedroom, move it. If you’re doing computer work in your bedroom, stop. If you’re worrying in your bedroom, get up!
You do not want to condition your brain to associate the bed with wakefulness.
You don’t want to have nights of tossing and turning, and you don’t want to be worrying when you lie down in bed. We’re going to talk about some strategies for how to avoid that.
Note about Trauma
If you have experienced trauma that occurred at night and it wakes you up with nightmares or panic these days, our methods for treating trauma have improved dramatically, and they’re much more gentle than they were in the past. If that’s something that’s affecting your sleep, contact a therapist that specifically does trauma work because there are specific methodologies for treating trauma. You use things like EMDR, somatic experiencing, or SCP. There are other modalities besides that.
Combatting Conditioned Arousal
Let’s talk about combating this condition of arousal. First, don’t do any activities associated with being awake in bed.
I know that you’re probably thinking that I’m a crazy lady, but this actually works, and it’s really important. So, only go to bed when you’re sleepy, not tired or bored. When you’re dozing off in front of the TV, that’s an indication that you’re sleepy. You can feel the drowsiness.
There’s a difference between tired, like fatigue, and drowsy, which is sleepy. If you can’t sleep for more than 20 to 25 minutes, get up. That’s going to be a key thing to de-program this conditioned arousal. You’re going to create a cozy nest somewhere in your house with mildly pleasant things to do (not bills or anything that’s worrisome).
I have a nice, long list of things to do that includes things like folding laundry, picking out what you’re going to wear to work the next day, and reading something that’s not overly stimulating (no thrillers, no homicidal maniacs, no Game of Thrones, or you won’t get sleepy because it’ll keep your brain stimulated).
Don’t get back into bed until you’re sleepy, but you can try again after a chapter of a book or an episode of a program, you can go back and see if you’re feeling sleepy.
Don’t look at the clock!
If you need to turn the clock around so that you’re not seeing it, do that. Because otherwise, you’ll get into this: “Oh, my gosh, it’s so late!” And the alarm clock is going set off the worry again. If you need to turn the clock around so that you won’t see it, do that before you go to bed.
Maintain a consistent get-up time every day, including on the weekends, especially while you’re trying to change your sleep cycle. So while you’re learning this new method of sleeping healthy sleep and not having anxiety and arousal associated with your bed, you want to make sure that you’re getting up at a consistent time every day, including on the weekends.
Sometimes after two or three weeks, your cycle will start to shift. If you want to sleep an extra hour on the weekend, that’s not going to disturb things. If it does go back to the practice of getting out at the same time every day.
Only use the bed for two things: sleeping and sex.
No TV, no computers! And preferably no pets, because our pets wake us up at night. Get your pet a bed next to your bed. When I first get a dog, if they’re going to whine and keep me awake all night, what I’ll do is I’ll just take some sofa cushions, put them down next to the dog bed, I’ll lie next to them, and put my arm out so that they can get a sense that their bed is their bed and it’s their place to sleep. Not between me and my partner, where my boxers would do bench presses between me and my partner to make enough space for them.
I have heard recently that meditation in bed is also unallowable. Don’t nap unless it’s a safety issue. So if you’re driving and you’re drowsy, take a nap.
The best time to take a nap is not late in the afternoon, and the best nap to take is a short nap (20 minutes or less).
The nap has to be 20 minutes or less so you don’t get into a deep sleep cycle because that will disrupt your evening sleep. This will work as quickly as two weeks if you give it time each night. So this is a practice and with a lot of things with mental health, if you actually practice them consistently, you get the benefits of the programs. This is well researched. We know that these programs work.
What To Do About Overthinking?
The first is to increase your sleep drive by limiting your time in bed. If you’re worrying in bed, get up and go to another room until you feel sleepy. What I recommend is that you set aside time earlier in the evening to worry. Make a list, consider what’s troubling you, decide what you’re going to do next to solve the problem, get a nice list made, and then set it aside.
You can also create an unwinding time, a buffer zone.
This might be reading something that’s soothing. It might be taking a hot bath. It might be visualizing a peaceful scene that also keeps you interested enough that you’re not ready to go to sleep yet. Journaling is a great thing to do when the overthinking is not so much work-related, but maybe emotionally related.
My preference for journaling is that I don’t edit when I write because I know my brain is very tricky and it will say, “I don’t want to say that”. And I’ll edit and get rid of the very thing that was the problem thought. So I go ahead and write down the problem thought and then I’ll go back and read over what I’ve written later and then find the problem thought again and then reflect on it.
Set aside a time other than in bed to reflect on your day, because if you don’t, your brain will take the time when you get in bed to do the reflecting. Get it out of the way.
Worry ahead of time.
I know the first time I heard this, I was like, you’re crazy. It’s like my clients aren’t going to believe me if I tell them this, but the fact is that I have used this myself, and it works. And I’ve used it with clients, and it works. And there’s considerable research to support this. This is good old CBTI cognitive behavioral therapy for insomnia, well researched, empirically supported method for improving insomnia.
Q & A Regarding Insomnia
Can I do adult coloring before going to bed?
Coloring in bed for about 20 minutes maximum before I sleep is also okay. If it’s soothing and relaxing to you and you find that you fall asleep easily after you’ve done the coloring, I would say that falls somewhat in the same ballpark as meditation, as long as it’s soothing and relaxing and it doesn’t disrupt your sleep.
What if you get up at 2 am or 3 am and aren’t tired after reading a couple of hours?
First of all, I check and see what are you reading. Are you reading things that are calming and possibly even boring so that it doesn’t stimulate your brain? Newspapers are not a good plan. News and newspapers are recipes for wakefulness. I recently heard something that said the rules for journalism these days. They used to be four seeds of journalism, and they were things like clarity and conciseness and things like that. They’re working off a different set of C’s in journalism these days, and it’s conflict, catastrophe, and controversy.
I’m taking sleep medicine, so I’m too drowsy to get out of bed sometimes. Thoughts?
You want to gradually get away from sleep medicine because unfortunately, it is addictive and makes it difficult for you to sleep without using the sleep medicine.
I have to get up to go to the bathroom and then I can’t go back to sleep. How do I fix this?
So number one, if possible, don’t turn the lights on in your bathroom. If you need some kind of light, get some kind of red nightlight where you can see where you’re going, but it doesn’t activate the wakefulness circuits in your brain.
So we’ve got a couple of folks with insomnia problems off and on for 15 years. Part of what you want to think about is as we’ve gone through this information on insomnia, which causes do you think are contributing the most to your insomnia? Is it worrying? Is it spending time in bed where you’re not sleeping so that you’re beginning to associate wakefulness with your bed? Do you have a sleep disorder? Do you have restless leg syndrome that’s waking you up?
Try working with journaling and or list-making before you go to bed to try to kind of do your pre-worrying so that you don’t aren’t as anxious once you get into bed.
Sleep apnea wakes me up, how can I fix this?
If the sleep apnea is waking you up, and that one you need to take care of, see if they have something better. You know, there are enough people that have sleep apnea these days that are using machines to sleep that they may have something better than the one that you had last time. But whenever it’s sleep apnea that’s keeping you awake, that’s a medical issue. And this particular program is not designed to treat that medical issue. There are different treatments for the medical issue.
The key thing with anxiety is to try to work through the issues that are having you anxious before you go to bed. A couple of hours before you go to bed, try to process it. Talk to a friend about it. If you’re not in therapy for anxiety, make sure you’re in therapy for anxiety.
There are techniques for helping to manage your anxiety because it’s hard to work on your sleep. If you can’t work on your anxiety, breathing exercises, nice inhalation, a nice slow exhalation, EMDR therapy for trauma, and medication. You’re doing the work to get you prepared for being able to do the insomnia work.
So you need to deal with the trauma that will make an eventual difference. You can certainly try these methods and see if they help.
But if you’re dealing with trauma, you got to deal with the trauma.
I wish I had magic answers. Unfortunately, you have to take care of mental health issues. This particular methodology is specifically for insomnia disorder, which is three months or more of having trouble sleeping, and it’s without another mental health condition.
So you’ve got to deal with the other mental health condition, and then you can try these practices and see if they work. If you try them consistently, you might get some results. But also talk to your therapist about the fact that you’re having trouble sleeping and see if they can give you some tools for relaxation.
A Mindfulness App
I personally have a mindfulness app that I subscribe to, and I have found it really helpful. I actually used it to help me stay calm and peaceful during the freeze when I was without electricity for three days and my house was below freezing. Fortunately, I had sleeping bags, but I was by myself in the house. And, I needed to keep myself calm.
So I used one of the things that I used that I found really helpful was a mindfulness exercise. It’s by Dr. Dan Siegel. He’s got a wheel of awareness that’s a very powerful mindfulness exercise. use that whenever I was lying in bed alone during the freeze to keep myself calm and keep from getting anxious in the face of what – without my sleeping bags – would have been a life-threatening issue.
We have several EMDR therapists in our practice. We also have a somatic experiencing practitioner. So it shouldn’t be any kind of difficulty, even within our practice, to find somebody who does EMDR. You’re welcome to read the reviews about our practice. We get excellent reviews. We’ve been very thoughtful about who we’ve brought in, and it shows in the reviews. So I hope you will take advantage of the services that we provide.
Does Insurance Cover Insomnia Therapy?
It sounds like mostly what we’ve got going on that’s contributing to the problem is trauma, which needs other treatment before you get to this point, you may use these practices and they may be helpful to you or they may not be until the trauma is treated. With anxiety, these may be useful. Most of our therapists do not take insurance, but we will be happy to provide you with a receipt that you can submit to your insurance.
Sometimes if you call our main number and you say, I’m looking for a practice that takes this particular kind of insurance, they may be able to give you the name of someone who takes your insurance. But the best place to go if you want to find somebody that takes your insurance is to go to your insurance database. So it kind of depends on your insurance company as to whether or not it’s a specialized form of treatment that you’re having trouble finding within your insurance plan. They may make an exception for that.
Does Medicare Cover Insomnia Therapy?
Medicare has its own lists. You do have a supplement, so that opens a whole lot more doors than if you don’t have a Medicare supplement. You might check with your Medicare supplement and see who they’ve got on their list and then start Googling and looking at the reviews that those particular practitioners have. It is worth investing your time and energy to find somebody that you can work effectively with. It sometimes does take time, and I’m sorry to say that, but it does. I wish I had a magic wand on that one, and I don’t.
The only time I’ve seen our founder upset is when she was working with insurance companies. And basically, their arrangements with their practitioners are they pay half as much and make you work twice as hard because you’re perpetually working with clerks who are trying to count the number of visits that you’ve had. It would be different if you were talking to somebody who actually knew about therapy but they’re dealing with somebody who’s got a table of a number of visits.
Monthly Focus on Wellness Webinars
We do these free Focus on Wellness webinars once a month so you can always go to our website and find out what particular topic we have going on in a given month and they range pretty widely. I did one on Establishing Healthy Boundaries before. We cover a really broad spectrum of topics, including trauma.
To see a listing of our upcoming webinar topics, click here.
Grounding & Self Soothing
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