When you can't count on sleep

Dateline, Portland, Oregon: We sleep to dream. We sleep to refresh and we sleep to unwind. When we can’t count on sleep, it colors every aspect of our lives.

I answer my office phone, and on the other end of the line is another person struggling with sleep. They are at their wit’s end, not sure where to turn. Medications aren’t cutting it. Their own attempts to solve the problem may well be making things worse. The sleep study is scheduled, and they are, to put it in stark terms, scared to climb into bed tonight.

Nighttime sleep may have been biologically intended to keep us from wandering in to danger in eons past, but it has always served other purposes as well. In short, there are many reasons why we feel better after a good night’s sleep. During sleep glial cells in our brains clean out the debris of the day. We also consolidate new information, storing it in our long-term memory. Dreams help us sort out our thoughts and feelings. Sleep helps us regulate mood and the intricate chemistry of our bodies. Many people find that they wake after a good night’s sleep with solutions to thorny problems.

Insomnia makes it impossible for people to go to bed at the end of the day and trust that nature will take its course. As a consequence, those with insomnia often become conditioned to experience their beds as negative and unpleasant spaces, and bedtime as highly anxiety provoking. CBI-I helps turn these automatic reactions around so bedtime can be a pleasant experience again.

When I work with a new sleep patient, I generally assure them that somewhere along the way they will come to hate me. It’s a joke. And it’s not a joke. Part of what therapists who work with insomnia do is help their patients tolerate sleep debt. Sleep debt is a patient’s friend, but for many with insomnia sleep debt is an antecedent to a variety of negative thoughts and beliefs, and consequently some less than helpful behaviors.

Insomnia therapy can help people view their bedtime routine with clarity. It provides an opportunity to objectively review what helps and what doesn’t help you get the rest you need. For example, you may not want to believe that the blue range light emitted from your phone or tablet causes you problems, and maybe you are right. The CBT-I protocol will help us know--and we will work together to decide what to do with that information.

Feel free to call me if you are wondering whether CBT-I might help with your disrupted sleep. I would be happy to tell you a little bit about the ways in which insomnia treatment might be helpful to you. I can be reached at 503-490-5793.