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Mindful : December 2015
ten that all I wanted to do was sleep. And I did—soon, without pharmaceu- tical help. I’m cured! I thought to myself. Free at last! The cold went away and still, I slept—about six, sometimes seven, hours. Oh, I’d wake up in the middle of the night, but more often than not I’d drift back. The ease with which this took place seemed like a blessing bestowed by a beneficent universe— especially the falling asleep part, my greatest challenge. A new story was emerging—a fragile chrysalis. It didn’t occur to me that my turn- around had anything to do with the fact that it was taking place during the holidays. I had no deadlines and few obligations. Then January rolled around and with it, a pressing deadline. The old story came rushing back and took possession of my mind and body like some kind of spooky apparition. Each night became a bat- tle royal between my desire to sleep unaided and the fear that I couldn’t, and the weeks of grace came to seem more like a blip than the start of a new story. Feeling defeated and defective, I reached for my stash of Xanax. Though I was still determined to sleep drug-free, I cut myself some slack. Clearly, healing my sleep dis- order was going to be a process, not a quick fix. And I needed help. I talked to an holistic doctor and an acupunc- turist, who each suggested herbal remedies, while my more mainstream internist recommended trazodone, a tetracyclic antidepressant that has some side effects, but doesn’t seem to rot your brain like hypnotics do. These things helped some, as did my morning meditation and a soothing bedtime visualization recording made for me by a psychotherapist. Still, I continued to resort to hypnotics off and on, especially when I felt stressed. It was obvious I needed more help. For the past several years, the gold standard, non-pharmaceutical treat- ment for insomnia has been Cognitive Behavioral Therapy for Insomnia— or CBTI, which in numerous studies has been shown to be more effective than sleeping pills. In fact, CBTI is now recommended as the number one treatment for chronic insomnia by the National Institutes of Health. The program is based on a sim- ple concept: Insomnia is caused by learned thoughts and behaviors that can be unlearned or changed. In other words, it deals directly with the story. Sowhydidittakemesolongto check it out? Delusion, perhaps. Another story I told myself, about how I should be able to conquer my insomnia on my own. Although there are sleep clinics that offer CBTI in the San Francisco Bay Area where I live, I decided to try an online program that’s available to anyone, anywhere. For $44.85, I signed up at cbtiforinsomnia.com and got the five-week program, plus a few extras, including evaluation of my weekly sleep diary by Dr. Gregg Jacobs, an insomnia specialist at the University of Massachussetts Memo- rial Medical Center. The basic drill, week by week, is this: 1) education about the stages and functions of sleep; 2) sleep scheduling and stimulus control (i.e., don’t spend too much time in bed awake, and only sleep or have sex there); 3) cognitive restructuring and medication reduc- tion techniques (!); 4) daytime relax- ation techniques and stress-reducing attitudes and beliefs; 5) bedtime relaxation techniques and lifestyle practices for improving sleep. In case I thought I was special, I learned that the themes in my personal narrative were among the 10 most common negative thoughts about sleep, and were addressed head-on. For example, a corrective to I will never fall asleep is My brain wants to obtain my core sleep (5.5 hours—and I most likely will). An antidote to the I will not be able to function tomorrow belief is Sleep loss does not always have a significant impact on my functioning. All first-rate stuff. I began relying less on the pills and sleeping more or less the way I imagined normal people do. In fact, I thought I was doing brilliantly until I got this email from Dr. Jacobs after submitting my sleep diary. “ Your time allotted for sleep (lights out to arising time) was 8.5 hours on many nights. Because you averaged 6.5 hours of sleep, your time allotted for sleep goal should not be more than 7.5 hours from lights out to arising time. Therefore, you need to reduce time allotted for sleep by 1 hour on many nights. This is the most crucial goal for improving your sleep and you did not meet this goal for the past two weeks of this five-week pro- gram. If you do not meet this goal this week, you are unlikely to experience significant improvement in your sleep from this program.” Really? So I read in bed more than half an hour on several nights and lingered a bit in the mornings; is this a crime? Did Dr. J. (or his canned bot) have to be such a scold? Couldn’t he at least comment on how well I was doing, how much less medication I was taking—also noted in my diary? The program was certainly valuable in helping me to reframe my story, but I could have done with a bit more friendly reinforcement. A newer approach that shows great promise, but is still in the develop- mental stages, is Mindfulness-Based → 35% increased risk of cancer People who took more than 132 sleeping pills a year had a 35% increased risk of developing cancer within 2.5 years. December 2015 mindful 47