Insomnia

Surprisingly, it's possible to do something about it

I've always had a tricky relationship with sleep. It goes way back to my kindergarten days. Back then, naps weren't just encouraged; they were mandatory. The thought of being forced to lie still and try to fall asleep was, frankly, the worst part of preschool for me – it was just so incredibly boring. I vividly recall switching to a different preschool, and one of the biggest perks? No obligatory nap time. That was a big deal for me.

Moving forward several years, my sleep struggles only intensified. University life allowed me to set my own schedule, and I found myself adopting a nocturnal rhythm. My typical routine involved going to bed at 4 am and waking up at noon. Surprisingly, this pattern suited me quite well – I consistently clocked in eight hours of sleep. However, this unconventional schedule came with its challenges. For instance, attending an 8 am class was a no-go for me. I either skipped those early morning lectures or opted for classes scheduled at more agreeable hours. This flexibility extended into my work life too, where I often found myself in roles with highly adaptable schedules.

As time passed, my life circumstances changed, bringing new challenges to my sleep routine. A significant shift occurred with the arrival of my son. The initial years were tough, with his sleep patterns being quite erratic, but eventually, things settled into a more manageable rhythm. He didn't need to be at preschool before 10 am, which worked well for us. However, the real game-changer was when he started school, with a start time of 8:25 am. For most, this might seem reasonable, but for me, accustomed to late nights, it felt incredibly early. I had hoped to maintain my nocturnal habits, relying on my wife to manage the morning school routine. Unfortunately, to no one's surprise this naive plan... didn't quite work out.

Over time, another significant change I noticed was in how my body coped with sleep deprivation. Back in my university days, missing a night's sleep was a minor hiccup; I could easily recover with some extra sleep the next day. However, as I got older, this bounce-back strategy lost its effectiveness. Waking up early and being unable to fall back asleep became the norm, especially under the weight of stress from a demanding job. By my late thirties, the consequences of my unconventional sleep habits were becoming increasingly apparent.

The realization that I needed to address my sleep issues became unavoidable. I was averaging about four hours of sleep each night, and it was clear that something had to give. Over the years, I had made several attempts to shift my sleep schedule earlier, but each attempt ended in failure. The challenge was partly rooted in the genetic aspects of our sleep patterns – the ingrained predisposition towards being a night owl or an early bird. I was beginning to feel hopeless, questioning whether changing my sleep habits was even possible.

The turning point came with a burnout episode. It was a stark wake-up call. During a consultation about my burnout, the doctor stressed the importance of tackling my sleep problems. I shared my history of unsuccessful attempts to change my sleep pattern. That's when he suggested CBT-I, Cognitive Behavioral Therapy for Insomnia. Given my state of desperation, I was ready to try anything. So, I embarked on this new journey with CBT-I, a decision that would eventually lead me down a path of significant change.

CBT-I, I discovered, is quite a straightforward method, and there's an abundance of free resources available online. I found this guide particularly helpful: Free CBT-I Guide, though I added my own personal touches to it. It's important to tailor the approach to fit your specific needs. Some aspects of CBT-I can seem counterintuitive, so let me dive into more detail about my experience. The first step involves using your bed solely for sleep and sex, as my doctor succinctly put it. This was a significant change for me. I used to love relaxing in bed with a good book, and reading before sleep was a treasured habit. However, the problem arose when the book was too engaging – and I generally steer clear of dull books – making it hard to put it down. Another habit I had to break was using my phone in bed, which meant subjecting my eyes to bright light in a dark room. Both of these habits were counterproductive to good sleep hygiene. As for naps, they're generally discouraged in CBT-I, except in cases of extreme tiredness, and even then, they should be taken earlier in the day, ideally in the morning.

The next principle went against everything I thought about changing my sleep habits: I shouldn't try to go to bed earlier, but only when I'm truly sleepy. This was a complete reversal from my previous attempts of just lying in bed, trying to force myself to sleep. Additionally, if I go to bed and can't fall asleep within about 20 minutes, the guidance is to get up and engage in a quiet activity, like reading a book or listening to music. And it's perfectly fine to repeat this process as many times as needed. There's a part of me, my inner child, that finds this concept rather exciting – no more enforced bedtimes!

However, there was another aspect of CBT-I that my inner child was far less enthusiastic about: the requirement to wake up at the exact same time every day. When I asked my doctor, somewhat apprehensively, about weekends, the answer was unwavering – the same rule applies, even then. This meant getting up at 7 a.m. every single day, without exception. The thought was daunting, to say the least. The idea of not being able to luxuriate in bed a bit longer on weekends seemed almost unthinkable. But, as I've mentioned, I was at a point of desperation. So, I decided to commit to it and see it through.

Discovering that I didn't need to force myself to sleep was surprisingly freeing. My concerns about turning into a sleep-deprived zombie thankfully never materialized. It turns out, if you only get 3 or 4 hours of sleep for a few nights in a row and consistently wake up early, your body naturally starts to crave sleep by the end of the day. You become so sleepy that the usual sleep-sabotaging activities – like beginning an intense, captivating movie late in the evening or diving into a video game session – lose their appeal.

Adding to these two key interventions, another important component of CBT-I is tracking the amount of time you spend in bed versus the actual time spent sleeping. There are various ways to do this, from manual logging to leveraging technology. I opted for the tech route, using apps designed for sleep tracking. My choice was SleepCycle, which not only tracks sleep automatically but also aims to wake you up at the most optimal point in your sleep cycle, which is quite impressive.

For instance, imagine you go to bed at midnight but don't fall asleep until 2 am, spending those two hours time listening to a podcast and trying to sleep for 20 minutes in a loop. Suppose you finally fall asleep for 1.5 hours and wake up at 3:30 am. You get out of bed, feel sleepy after an hour, and fall back asleep at 4:30 am, eventually waking up at 7 am. In this scenario, your 'bedtime' spans from midnight to 7 am – a total of 7 hours. However, you've only actually slept for 4 hours. This means your sleep efficiency is around 57%.

Once you've been tracking your sleep for a while, and your sleep pattern begins to stabilize – and by stabilize, I mean you're feeling tired but not quite in full-on zombie mode like in the initial week – the next step in CBT-I might sound a bit radical: you start going to bed even later. Yes, that's correct – later. This strategy is aimed at improving your sleep efficiency, even if it potentially reduces your total sleep time.

So, taking the example we discussed earlier, if your regular night involves waking up at 7 am, under this new approach, you wouldn't allow yourself to go to bed until 3 am. This means if you slept for 4 hours, your sleep efficiency would be 100%. It's a counterintuitive method, focusing on the quality of sleep rather than the quantity, and gradually adjusting your sleep schedule to a more sustainable pattern.

This approach might seem daunting, especially for someone already sleep-deprived and struggling to fall asleep by midnight. But as counterintuitive as it sounds, this strategy is actually quite ingenious. It fundamentally changes the dynamic of your struggle with sleep. Previously, you were trying to force yourself to sleep against your brain's wishes to stay active. Now, the roles are reversed: your brain is craving sleep, but you're intentionally keeping it awake. It's like turning the tables and gaining a new form of control.

In practice, this method isn't as harsh as it might initially seem. As an insomniac, you weren't getting much sleep before starting this intervention anyway. And if you happen to fall asleep earlier than planned, that's actually a positive sign – it means you're on the right track.

Of course, sleeping only 4 hours a night isn't sustainable in the long run. That's where monitoring your sleep efficiency becomes crucial. If your sleep efficiency reaches 90%, you can start going to bed slightly earlier. If you maintain high sleep efficiency, you can gradually shift your bedtime earlier every few days. This gradual adjustment helps in finding a balance where you can enjoy both sufficient sleep and high sleep efficiency.

What's actually happening with this approach? There are several reasons why falling asleep can be a challenge. One major factor is that we often come to associate our bed not as a place for sleep, but as a space for other activities like reading news, scrolling through our phones, or lying awake filled with anxiety about the impending day. This method effectively strips away these associations – by the time you actually get to bed, you're so exhausted that the energy to do anything but sleep is simply not there.

Admittedly, the initial phase of this process was tough, and I felt quite miserable. But as I gradually adapted to the idea that my bed is primarily a place for sleeping, things began to improve significantly. Now, my sleep efficiency hovers between 85% and 90%, and I tend to fall asleep in around 15 minutes. Sure, there are times when I bend the rules and glance at my phone in bed, but I'm careful not to let it become a habit again. This journey has taught me the importance of maintaining these new sleep habits to ensure continued progress.

In addition to the CBT-I techniques, there are other strategies that can further enhance sleep quality:

1. Optimize Your Bedroom Environment: It's crucial to make your bedroom as comfortable as possible. Investing in a quality mattress and pillows can make a significant difference. Also, maintaining a cooler room temperature can aid in better sleep. Using curtains or blinds that effectively block out light is another smart move. These small changes can create an ideal environment for restful sleep.

2. Morning Routine Inspired by Andrew Huberman: Following the advice of everyone's favorite neuroscientist Andrew Huberman, I make it a point to get outside soon after waking up, ideally within the first hour. My routine includes drinking two glasses of water, using the restroom, brushing my teeth, and then taking my dog for an hour-long walk in the park while listening to a podcast. This not only delights my dog but also exposes me to natural light, which is beneficial for regulating my sleep-wake cycle. Even if you don't have a dog, a morning walk is a great practice. Just remember, if you do have a dog, don't leave them behind – they might just hold a grudge!

3. Utilize Smart Lightbulbs: I'm a big fan of smart lightbulbs, like Philips Hue, despite their software not being the greatest. Their ability to change color is particularly useful. I use brighter light in the morning and dimmer, warmer light in the evening to mimic natural light patterns. Additionally, I've set them up to gradually turn on 10 minutes before my alarm goes off, which helps in waking up more naturally.

Speaking of Andrew Huberman, of course he has a lot of great advice about sleep. Read his Toolkit for Sleep, or listen to his podcast's episode (it's 3 hours, but I feel it's a good investment):

This journey has also transformed how I view different times of the day. Previously, mornings were just a transition period between waking up and reaching full mental capacity, while evenings were my peak productivity hours. Now, I've flipped this on its head – I schedule my most important tasks for the morning. Additionally, I've become much more attuned to my body's signals. When I start feeling tired and sleepy, unlike before, I don't try to push through it. Instead, I listen to my body and simply go to sleep. This change in approach has been a significant and positive adjustment in my daily life. Of course, I'm aware that life is unpredictable, and there may be circumstances that cause me to fall off the wagon with my sleep routine. However, having gone through this process once, I've realized it's not as daunting as I initially feared, even after years of poor sleep hygiene. This experience gives me confidence that if needed, I can go through it again. It's reassuring to know that I have the tools and knowledge to regain control over my sleep, should I ever find myself straying from these healthier habits.

This journey has fundamentally altered my perception of the day. Mornings, once a sluggish transition to full alertness, are now reserved for my most critical tasks. Evenings, my former peak productivity period, have taken a backseat. More importantly, I've learned to heed my body's cues for rest. Gone are the days of battling against the tide of sleepiness; now, I embrace it as a natural signal to rest. This shift has been a profound and positive change in my life. I recognize that circumstances may change, and I might deviate from this routine. But having navigated this path once, the journey seems less intimidating. Years of poor sleep hygiene have been overturned, leaving me with a sense of empowerment. Should I ever veer off course, I'm equipped with the tools and understanding to realign myself with these healthier sleep practices.

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