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The Sleep to Healthy website is now a 10 lesson course on curing insomnia.
This course is not a quick fix and it is not easy. The course is based on CBTi or Cognitive Behavioral Therapy for Insomnia. CBTi is the first-line insomnia treatment method endorsed by:
- The U.S. National Institute of Health and
- The British Association of Psycho-pharmacology.
- The American Academy of Sleep Medicine.
By the end of the “Cure Insomnia” course, students will have the knowledge and tools they need to cure their insomnia. Not just now, but for a lifetime.
Did I mention that it’s free?
Go to SleepToHealthy.com to get started.
Summary: Guest: Dr. Stephanie Silberman, author of Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need:
- Silberman gives an example of a new mother who was exhausted but still couldn’t sleep and was dependent on sleeping pills but was able to achieve good, natural sleep without the pills.
- The roll of sleeping pills with Cognitive Behavioral Therapy for Insomnia (CBTi).
- How The Insomnia Handbook can be used for best effect.
- She explains what Cognitive Behavioral Therapy (CBT) is including cognitive distortions and the relationship between thoughts and feelings.
- Why CBT has a specific branch for insomnia.
- The types of issues CBTi is especially effective with.
- The main components of Cognitive Behavioral Therapy for Insomnia (CBTi): Sleep Hygiene (and which parts are most critical), Relaxation, Stimulus Control Therapy, Sleep Restriction Therapy and Sleep Logs.
- How to get started with CBTi.
- What Dr. Silberman would put in a 30 second YouTube video.
- Her recommendation for something you can do today, to sleep better tonight so you feel and function better tomorrow.
Links mentioned in the show:
Dr. Stephanie Silberman’s website: http://www.sleeppsychology.com
LinkeIn: https://www.linkedin.com/in/stephanie-silberman-phd-a8343715/
Twitter: @sleeppsychology https://twitter.com/sleeppsychology
Book: The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need
http://www.sleeppsychology.com/sleep-disorder-insomnia-books.html
https://www.amazon.com/Insomnia-Workbook-Comprehensive-Guide-Getting/dp/1572246359/
Show notes with approximate time they occur in the episode:
(Note: For your convenience, the following is paraphrasing from the interview, not exact quotes. For exact wording, listen to that part of the episode)
Introduction (the host, from the audio):
Many years ago I struggled with anxiety and depression. I am thankful for the counsellors and resources available that helped me dig may way out of that dark hole. One of the most impactful tools was a book called “Feeling Good” by Dr. David Burns. I thought the title was hookey, but the content was profound. It was a book about Cognitive Behavioral Therapy, a topic we will explain in a minute. But even more helpful was “The Feeling Good Handbook”, a book that took the teachings and converted it into easy to follow exercises.
Since then I have preferred self help books that include exercises to put theory into action. So you can probably understand my enthusiasm when I came across “The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need” by Dr. Stephanie Silberman. Here was a book that gave fundamental principles of insomnia, and then added exercises to turn the knowledge into action and decisions.
Dr. Silberman is a clinical psychologist and board-certified sleep medicine specialist, a Fellow of the American Academy of Sleep Medicine but also a working mother, wife and community activist.
Dr. Silberman, welcome to this episode of the Sleep …… to Healthy Podcast……
4:10 – Dr. Silberman talks about an example where somebody had difficulty sleeping but was able to find a way out of it. The example is one where a new mother, who despite her exhaustion found herself wide awake at night. When she came to Dr. Silberman she was physically and psychologically dependent on a sleeping pills. They went through all the things that were causing her insomnia including caffeine and getting exercise. They were able to slowly come off the sleeping pills and eventually be completely medicine free. This took only five sessions in total.
5:50 – What is the role of sleep medication with cognitive behavioral therapy for insomnia (CBTi)? In general, sleeping pills are intended to be a short-term solution but that is not how they are always used. There’s a phenomenon called rebound insomnia or insomnia rebound which is where you come off a sleeping pill your insomnia gets even worse than it was before. Then the tendency is to go back onto the sleeping pills because the insomnia is so bad.
7:40 – Dr. Silberman tells how the book is intended to be used. The book was intended for either sleep professionals who did not know about cbt-i because they are treating medical conditions such as sleep apnea, or psychologist who know about Cognitive Behavioral Therapy CBT but doesn’t know about sleep. It’s also intended for people who don’t have ready access to a sleep psychologist.
9:30 – People who come in to sessions for insomnia treatment who have already read the book make progress much more quickly.
10: 30 – What is cognitive behavioral therapy or CBT? It is for people whose thinking or behavior is causing a level of stress such as anxiety or depression. So for instance of person might have some irrational thoughts that could be thought of in a different way that would not cause the stress. The irrational thoughts can be corrected. So that is the cognitive part of CBT. The other part is the behavior. The behavioral side are the actions or behaviors that the person does that are maintaining or increasing the level of stress or anxiety.
11:20 – What are cognitive distortions? An example might be that someone thinks you need 8 hours of sleep a night to feel rested and restored, when the reality is that most people need something other than 8 hours of sleep a night. This incorrect thought can lead to anxiety and unhelpful behaviors. So for instance in that case you could give the person some information, and then get them to experience 6 hours of sleep good solid sleep and let them see that they can feel very alert and well-rested the next day. There are many other distortions but the basic principle is that you look at the belief, and then use a scientific principle either prove or disprove the belief, and then I make appropriate adjustments.
13:10 – Dr. Silberman talks about the relationship between thoughts and feelings. She looks at it as a circle with thoughts, feelings, and behaviors on a circle. So as an example, if you have negative thoughts about something then when something happens during the day you will respond with negative feelings, and then that feeling will lead to a behavior which tends to reinforce the original negative thought. So for instance you could have negative thoughts about social interactions such as people won’t listen to me, then when you have an social interaction you could have that thought then you have the negative feelings of isolation, and that leads to behavior which is to avoid social interactions which tend to lead towards your original negative thought. So the function of CBT is to cut in at the thought by correcting the thought or by correcting the behavior in order to break out of the vicious cycle.
15:10 – Why was a specific branch of CBT created for insomnia? The international classification of sleep disorders has over 85 sleep disorders listed. So there are many, many Sleep disorders, so it is complex and there’s not a one-size-fits-all solution. Sleep disorders is a very complex field filled with many different medical specialties involved. CBTi covers both thoughts and behaviors that you have during the day, and at night before sleep, and also if you wake up during the night. All areas are covered.
17:30 – What types of sleeping issues is CBTi especially effective with? Sleep onset insomnia, which is the problem with being able to get to sleep initially, sleep maintenance insomnia, which is the issue of being able to stay asleep and circadian rhythm disorders where the biological clock not synced, where you are not able to sleep until very late or or waking much too early. Those are termed “Advanced sleep phase” and “delayed sleep phase”. Usually the issue there is you are not synced well with the rest of society. Teenagers and those in their early twenties tend to have the issue of not being able to sleep until late, and the elderly tend to have the issue of starting to sleep early and then waking up very early. Cognitive Behavioral Therapy for Insomnia is also very effective for a lot of sleeping disorders that children have.
18:30 – Dr. Silberman goes over some of the main components of CBTi or cognitive behavioral therapy for insomnia, starting with sleep hygiene.
What is Sleep Hygiene? Sleep hygiene is our daytime behaviors that create the conditions for a good sleep. For instance getting exercise, ideally for the 5 hours before bedtime. Controlling caffeine, she recommends no caffeine 12 hours before bedtime. Another example is making sure that sleeping environment is dark, quiet, comfortable, with a correct temperature for sleeping. That activities in the bed or not too stimulating such as being on your phone or using other backlit devices, or reading or watching TV if those are stimulating activities for a person. Also making sure stressors are dealt with during the day so that they go to bed they are feeling calm cool and relaxed.
21:00 – Whether to pay attention to a few critical sleep hygiene rules or whether you have to pay equal attention to them all. Dr. Silberman encourages total discipline at the beginning of the treatment to get the most impact most quickly. Then after the person has made good progress then some things will be found to be critical and must be adhered to and other things can be taken with less emphasis. For instance, some people cannot tolerate any caffeine whereas others can have some caffeine but still need to end at a certain time of the day. Within a certain quantity. On the other side, electronics shortly before bed have been very well-documented to be pretty much universally bad for sleep.
22:30 – Dr. Silberman talks about the role of relaxation. You cannot be anxious and relaxed at the same time. Some people have anxiety throughout the day that carries over into sleep, and other people have very little anxiety during the day but having anxiety just at sleep time. Most people that have sleep issues have some level of anxiety. So does helpful to learn deep breathing, meditation, or other means to reduce anxiety.
24:10 – Dr. Silberman talks about Progressive Relaxation where you go through your body from head to toe relaxing each area in progression. Out of all these relaxation exercises she teaches, that is her least favorite. She prefers one that she has in her book and that she gives to her patients as an audio. That one is more focused on relaxing and focusing on deep breathing. You cannot just try to do relaxation exercises when you are especially anxious or stressed. You need to practice it at other times so that when you are anxious it can be effective.
25:50 – What is Stimulus Control Therapy? It is effectively saying get out of bed when you cannot sleep. If you stay in bed when you cannot sleep, you are reinforcing the belief that the bed is not a good place to sleep, and whatever other negative associations you are making with the experience of being in bed. Such as being anxious. So you want to get out of bed, go somewhere else, and do something that is boring or relaxing, wait until you are feeling sleepy again, and then return to bed,. It starts to recondition the brain and makes the association with the bread have more positive and relaxing Association.
27:20 – What is Sleep Restriction Therapy? Sleep restriction is the nuts and bolts of cognitive behavioral therapy for insomnia. During treatment you keep a sleep log which records how many hours you are actually sleeping, as compared to how many hours you are spending in bed. So you keep that sleep log for a minimum of one week and you figure out what the average sleep time is that you have, and then you restrict the amount of time in the bed to that number. She gets a lot of resistance to this part of the therapy. The minimum time they allow is 5 hours. Sleep restriction creates sleep consolidation which means you’re spending more time sleeping and less time awake in the bed.
30:50 – What is a sleep log? Often when people come into see her about their sleep issues they don’t see any relationship between what they are doing during the day and how well they sleep at night. So sleep logs helps to establish the cause and effect and lets you see some of those relationships and patterns. It helps to show which things for that particular individual helped and hindered sleep. You can see patterns that you would not otherwise be aware of. It helps to take a situation from being unpredictable to being predictable. From uncontrollable to be controllable.
32:50 – Other aspects of CBTi. Some people benefit a lot from focusing on the other cognitive distortions or negative thinking that causes excess stress during the day. Other people benefit more by focusing on the behaviors that need to be changed.
34:00 – How do you get started with cognitive behavioral therapy for insomnia, CBTi? She would recommend seeing a sleep specialist if there is one available, or going to a sleep lab, not to do an overnight sleep study but to get a referral to a sleep specialist. The American Board of sleep medicine has a list of providers, or you could do an internet search for local resources.
35:00 – How to use Dr. Silberman’s book (The Insomnia Workbook) for best effect. She recommends that you actually work through it and do the exercises as it is meant to be hands-on, it is not meant to be a book that you just passively read. Many people benefit from the help with a professional in addition to the book because some aspects are difficult to do on your own such as sleep restriction therapy. Having somebody such as a sleep specialist to be accountable to can help a lot.
36:40 – What Dr. Silberman would put into a YouTube video. It would be a superwoman who comes in and knocks out all the sleeping pills and the pharmaceutical industry and tells people to be hopeful and that they absolutely can find wonderful sleep on their own. That it is a process and it does take work, and it gives you control but it does not require a sleeping pill. It would end by emphasizing how much better they would feel and how much better medication-free sleep is. That is something Dr. Silberman sees over and over again is that people didn’t realize they could feel so good and have such good sleeps after they got off the sleeping meds.
38:10 – One thing that listeners can do today to sleep better tonight to feel and function better tomorrow. Put away the electronics at bedtime. If you have children or teenagers, do not allow them their have their electronics in their room at night. Not even charging their phone. It is too enticing.
Summary:
Let’s see if we can pull out some gems from today’s episode:
One thing that struck me was Dr. Silberman’s comment that the core of Cognitive Behavioral Therapy for Insomnia is Sleep Restriction Therapy. In the media we hear mainly about quantity, how many hours to get. But she is saying that it is more important to focus on quality. Restrict your sleep until you are getting high quality sleep, then ease up and maintain the quality. When you think about it, this is the same for developing any skill. You need to practice towards perfection, not continue to practice your bad habits.
Perhaps the 2nd is to not give up hope. We have heard this same theme from other guests and will here it in the future. In the Sleep to Healthy Podcast, we try to present many different perspectives and methods for improving sleep. So if you are still struggling with sleep, keep on listening.
The final gem is the role of sleeping pills and sleep. Dr. Silberman is a board certified sleep medicine specialist, so when she recommends that we use sleeping pills as a temporary measure, we should probably listen. The alternatives are not going to be as convenient as handing over some cash and popping the pills, but the results will be worth it.
As always, you can find detailed show notes about the interview with Dr. Silberman along with all the links at sleep-to-healthy-dot-com.
This concludes our episode for today.
Other episodes related to todays topic include:
- Episode 9 with Michael Schwartz titled “Sleep on Demand” where he discusses Intensive Sleep Retraining.
- Our next episode, Episode 11 with Dr. Wallace Mendelson titled “Sleeping Pills” where he covers the role of sleeping pills and their benefits and risks.
- Episode 12 with Dr. James Alexander. If you are looking for some fresh & effective methods to improve your sleep, Dr. Alexander will not disappoint.
Thank you for keeping me company today. I look forward to you joining me on the next episode of The Sleep to Healthy Podcast.
Sleep To Healthy Thoughts