Dialectical Behavior Therapy (DBT): Radically Tired

When insomnia makes its unwelcome appearance in my life, there aren't many choices left for me. I am already well-versed in the management of insomnia through lifestyle changes, sleep hygiene, and pharmaceutical assistance, so I am left with the one thing I can manage on my own: psychological tools.

When chronic and debilitating insomnia stripped away the remains of my fragile mental health, I became extremely psychologically unwell. It was at this time that I started doing dialectical behavior therapy (DBT), and I was fortunate enough to have the opportunity to do DBT for 2 and a half years. I gathered a great number of tools during this time, some of which come in very jolly handy when it comes to my nightly attempts to sleep.

DBT has 4 skill modules:¹

1. Emotional regulation
2. Distress tolerance
3. Interpersonal effectiveness
4. Mindfulness

Now you know what? You don't have to be living with a diagnosable mental illness to benefit from the techniques taught in DBT. We all struggle with a little emotional dysregulation and distress from time to time. Of all the many acronyms and jargon terms I learned over those 2 and a half years, the most effective tool I have come away with is radical acceptance.

To fight or to accept?

Teaching myself to accept insomnia might just sound like giving up, but for me, it feels peaceful. Don't get me wrong – I still do everything in my power to ensure I do get sleep. I eat well and maintain a healthy active lifestyle. I avoid stimulants like caffeine and alcohol. I am intimately familiar with the rules of sleep hygiene. And I also take my prescribed medications every single night, all of which add up to some guaranteed sleep for me.

But even being heavily medicated and practicing all the mindfulness and relaxation exercises I have been taught, I still don't sleep through the night all the time. I routinely wake at 3 am for a few hours. Sometimes earlier, sometimes later. This is where radical acceptance comes in. I can choose to try and fight the waking hours, or I can choose to accept them.

Fighting leads to frustration

When I fight, I feel frustrated and annoyed. I get upset that I'm exhausted but wide awake. I feel envious of the world full of sleeping people, most significantly my husband happily off in the land of nod right next to me.

When I'm fighting reality, I get out of bed and stomp around the house feeling sorry for myself – watching television or doing dishes or attempting to read a book. There is not a whole lot to do in the middle of the night, by yourself, in a dark house where you have to be quiet so as not to wake all those other sleeping people. It is not productive – it is just filling in time until the sun comes up.

When I was at my most unwell, I developed panic just at the sight of my pillow and stopped going to bed altogether. It became a vicious circle. Fighting insomnia does not make me sleep and does not bring any sense of peace or restfulness.

Utilizing radical acceptance for insomnia

Radical acceptance, however, has taught me to find peace in a situation that is beyond my control. It is not about giving up – I still make every effort to get some sleep. But when I wake, I now stay in bed and do relaxation. I mentally stay calm and focus on keeping my body as rested as possible under the circumstances.

I taught myself to do something I call conscious daydreaming. I simply make up a story in my head and dream it into being. I have had some fantastical holidays, traipsing around Australia in a campervan or walking across a Parisienne bridge at midnight – all in my waking dreams. Conscious daydreaming is just me switching off real-life problems, and instead, focusing on positive fantasies. And the flow-on effect is really gratifying. I stay in bed, relaxing and dreaming, and all this relaxation and positivity sometimes leads to more sleep. More often than not in fact.

I will lie peacefully awake for a few hours and then sometime in the wee hours of the morning, I drift off again into a light doze. After years and years of almost non-existent sleep, a few solid medicated hours followed by some light dozes feels like a miracle.

Recognizing what is beyond my control

When a situation is beyond my control, the only thing I can do is manage my emotional response to it. Radical acceptance has taught me that giving in to frustration and envy and letting those emotions rule just adds to the problem.

Whereas fully accepting that I am awake gives me the opportunity to focus on mental and physical relaxation – in whatever way is meaningful to me. As a result, I achieve more rest regardless of whether or not I receive more sleep.