Just lie back and claim defeat?
I’m currently going through a little bout of insomnia. Another one. Yes, I educate people on sleep hygiene, I do calming meditations to help others manage their anxious thoughts and emotions, I am trained in Cognitive Behaviour Therapy for Insomnia, and I have bouts of insomnia.
This isn’t one of those stories about oops, I’m an expert in the area and I don’t practice what I preach. I do! Every day - I practice really good sleep hygiene, I do yoga, I walk in the woods, I am mindfully present (often throughout the day), I exercise, I am careful about what comes into my world, I connect with my family, I have a job that is meaningful to me. I have spent 25 years crafting my day, my life, and my mind to be as healthy as I can.
No, this is a story about the idea of one and done. Getting rid of. The impossible pursuit of “it’s fixed.”
Insomnia… is defined as difficulty falling asleep, staying asleep, or non-restorative sleep despite adequate opportunity to sleep.
Sleep is affected in a whopping 40 percent of people who have been diagnosed with a mental health disorder(1). People who are depressed often describe oversleeping, waking too early, or sleeping during the day. Anxious people often experience difficulty falling asleep or being awake for hours in the middle of the night.
And, conversely, poor sleep may lead to psychiatric illness – people with insomnia are twice as likely to experience depression(1). The relationship also seems to be bidirectional, as lack of sleep can worsen anxiety and depression and anxiety and depression can exacerbate insomnia(2). Whew – that’s a tangled mess.
When my first bout of insomnia struck, the first thing I did was tackle was my sleep hygiene. I removed my phone from my room, and only used my bed for sleep. After I learned CBT for Insomnia, I used it to treat my insomnia. Yikes - it’s not an easy process. I was so proud of myself the first night I slept through the night. I did it! I beat my insomnia. I was officially rid of it.
A couple of months later, it came back. And again, and again, every month. The insomnia was perfectly synched with days 14, 15, and 16 of my menstrual cycle. Then it flipped to days 24, 25, and 26. No problem. I applied the principles of CBT-I over and over, and while the insomnia sucked, it didn’t make me anxious, and I knew there was an end in sight.
And then it flipped to days 14, 15, 16, AND 24, 25, and 26. My commitment to the strategies started to slip. The next month, it was day 14 through day 2…day 3…day 4…with only one or two full nights of sleep in between. It was back.
My experience with insomnia is a good example of how therapy works for anxiety. Clients want to get rid of their anxiety, just like I wanted to get rid of my insomnia. In therapy, we look inward at our thoughts and feelings, and develop coping strategies and skills to manage. We look outward at environmental and societal factors that affect our thoughts and feelings. Often, through this process, the anxiety is lessened and it becomes more manageable. We change the aspects of our life that are in our control.
But there remain pieces outside of our control. For example, in therapy we can talk about the unfairness of systemic issues and even join up in the battle against it. But that may not change in our lifetime. Or, we can create an environment that meshes with our particular temperament. But that environment can change. We can gather social supports around us. But people can move or pass on from our lives. Or there could be a global pandemic. One of the lessons highlighted in 2020-2021 is that some factors can change from being in our control to beyond our reach in a hurry.
And it’s not that the skills learned in therapy can’t generalize to new environments and new issues. They can and they do. Sometimes, we need to lean a little heavier on our skills when life challenges us. We can’t “get rid” of anxiety. We are human and humans experience anxiety.
Similarly, I can’t “get rid” of my insomnia. I can do everything in my power to prevent it. I can maintain my physical and mental health and good sleep hygiene. I can manage it when it arises. However, prevention, maintenance, and management are ongoing processes that aren’t “one and done.” As much as I can hate and resist the idea, I didn’t “fix” my insomnia. I managed it, and I’ll find the energy to manage this bout, and the next one. And I’ll be proud of myself every time I do.
The message is that therapy isn’t a place to go to “fix” an emotion or “get rid of” particular thoughts or problem. It’s a process in which you heal and learn how to cope with the inevitable curveballs that life throws at you. Many people who have gone to therapy have worked hard and made spectacular changes in their inner and outer worlds. And they can be proud of themselves each and every time they use a skill or cope in a healthy way as they navigate life.
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674021/
2. https://academic.oup.com/sleep/article/36/7/1059/2453875?login=true
Kira
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