Defeating mild insomnia for good
I've been dealing with mild insomnia since early January, triggered by Christmas disrupting my routine and some anxiety around sleep. It was quite bad, along with the evening anxiety about it. But it resolved on its own after a couple of weeks without any intervention.
Things went back to normal, completely, but just before a holiday I had a bad night which sent me into a spiral of hyperarousal and bad anxiety for 2–3 weeks. I went to my GP, started online CBT-I in early March, and I've largely recovered. I follow the protocol correctly, stimulus control, routine, the lot.
The specific issue is sleep onset, not maintenance. Once I'm in deep sleep I stay there, but getting there is the problem. Early on I was getting jolted awake by quite big hypnic jerks; that's settled down, but I still seem unable to drop into deep sleep easily. I've also recently stopped 2.5mg melatonin (which I'd been taking for several weeks), thinking it might be propping up "managed" sleep and preventing a full return to autopilot.
Most of the time I don't feel much psychological anxiety, it's more like a physiological state of arousal that persists even when I'm not consciously worried. Occasional bad nights still seem to kick off a run of poor sleep. I had 4–5 great nights in a row recently where I fell asleep within 15 minutes and slept right through, then one bad night knocked me back. This has happened a few times over the past few months now.
I'm starting to accept bad nights more. When I can't sleep I'll read on the sofa, and I'll either drift off there or return to bed. I'm not getting the 4–5 hour nights I had at the start, more like slightly short but manageable sleep. But it still concerns me enough to post here.
Two questions:
1. Is there anything beyond standard CBT-I I could be doing to help my nervous system recalibrate?
2. How long does this kind of residual hyperarousal typically last, and can I expect sleep to eventually become fully automatic again?
I can relate to recovering from the psychological anxiety but the physiological stuff lingering. My body likes to dump a ton of adrenaline into my system right on waking, before I'm fully aware. It's fun. I manage through practiced anxiety tools from CBT/DBT ... breathing exercises, various forms of mindfulness, supportive self-talk etc. Maybe it would help to have occasional check-ins with your CBTI provider, or maybe a different modality of therapy to address other issues that might keep you from fully letting go into rest?
I'm not an expert, so take all that with a grain of salt. Best wishes to you. -Melissa, team memberHi
. Welcome to the community! Unfortunately, we're not medical experts and these questions are pretty specific. Have you ever seen a sleep specialist, preferably one with a background in neurology? CBT-I has the highest success rate, so I would imagine the next step would be medication of some kind. However, if CBT-I worked for you before, maybe you could try another round of it before resorting to medication. It's possible your approach might have to change a little. What do you think? - Lori (Team Member)
