azurelunatic: A pajama-clad small child uses a rainbow-striped cruciform parachute. From illustration of "Go the Fuck to Sleep". (insomnia)
Azure Jane Lunatic (Azz) 🌺 ([personal profile] azurelunatic) wrote2017-02-14 12:45 am

Sleep class!

So because not only do I have insomnia, I also suffer from it, the most-recent in the chain of moderately alarmed sleep-adjacent professionals (the neurologist at Deer Creek) referred me to the Improve Your Sleep! class, which has been eating my Monday evenings over the last month.

The main feature of this class, in the eyes of the neurologist and my counselor, has been the CBT aspect of it. Apparently the number one thing that cures insomnia is CBT. So everyone was hopeful. (I had specified to the neurologist that I would in fact be running anything suggested in the CBT past my Supervisor and my therapist. Which was a good call to have made.)

It turns out that when Guide Dog Aunt loaned me a book on sleep a few years ago, the one that pointed out that there was not in fact any moral value to any specific sleep schedule, and that instead of saying stuff like "I'm lazy because I sleep until noon", one should look at it in terms of "My most productive hours are in the evening, and I schedule my life in a way that suits my sleep schedule" -- that general tool of re-framing the guilt and fear around sleep is in fact the very CBT that this class relies on. So, unfortunately, the CBT that I had hoped would be new information was not, in fact, new information at all. The book specifically addressed Negative Sleep Thoughts. The class then expanded the concepts of re-framing runaway negative thought chains in a better light, which is also a Fishmum trick that I've been teaching my little fishies and my partner...

The other main leg of this class is meditation and the relaxation response. I believe that I can trace my habit of meditative breathing in particular to the summer when I read ... some Heinlein book or other ... and thought that taking up meditation would be a grand idea. The latest that could have been was 1996. Then I formally took up meditation (and learned all of the techniques discussed in the meditation unit of this class) in 2001-ish, when I went to DeVry to get a degree in Holistic Massage join a coven. So depending how you slice it, I've been familiar with, and practicing, meditation for anywhere from fifteen to twenty years.

The main new information I got out of the class, in fact, was that sleep-maintenance insomnia was recently discovered to be associated with a sleep-time body temperature that has not dropped as it ought to for that part of the night. And I do, in fact, routinely overheat while attempting to sleep. Which means that if I'm in bed and even slightly think that I might not get to sleep soonish, I should immediately go and get the ice pack, and not try to be a hero.

Also, low doses of sedating antidepressants are also used as sleep medications. The instructor was down on this practice, because antidepressants are only good for people with depression. FUNNY THING, THAT.

Pretty much all the rest of the class was review, and (due to my internets research) I was often in possession of more detailed information than the instructor. I came to feel that I could probably have taught the class myself, given the curriculum.

The first class was pleasant enough. I think there were about ten of us. One woman came in late, and borrowed a pen from me. We had a pleasant chat while she was waiting for her husband to pick her up. She's sleep-deprived to the point that she can't safely drive, and caretaking for her autistic son has done a number on her sleep schedule and ability to stay asleep.

I reviewed the materials in the packets for the four weeks. The second week, the cognitive re-framing, was going to be hard, since the materials blithely suggested that "most people" could get away with abbreviated amounts of sleep with nothing more terrible than a loss of creativity and a bad mood. Pro tip: when your patient reports suicidal ideation and impulses tied to as little as one night of abbreviated sleep while under stressful circumstances (and the current Republican administration is nothing if not stressful circumstances) telling the patient that everything is probably going to be okay if they blow sunshine up their own ass is life-threateningly bad advice. So I realized that I had better sit next to the door in case I had to step out of the room.

During the second class, the instructor was trying to impress upon us the way that a poorly timed nap can fuck up your sleep schedule pretty badly. My friend said that this was going to be a problem for her: you put her in the car (as a passenger) and she passes out pretty much instantly.

"It should be easy to stay awake in the car!" said the instructor.

"It's hard."

"Well, life is hard."

At this juncture, I decided that the most constructive action I could take was going to be going and sitting in the hall for a bit (and angrily texting my partner). I came back in after about five minutes.

Later in the evening, the instructor planned to lead us through more meditation/relaxation, to include the rest of the class period. I abruptly realized that I did not actually feel that making myself vulnerable to and in front of this instructor was a good idea, and grabbed my stuff and left the building.

In the third class, I sat by the door. (My friend did not show up for this class, or the following week.) When the meditation/relaxation section arrived, I popped both headphones in and proceeded to listen to podcasts, and only emerged when that bit was done. At the end of class, I asked the instructor about the bits in the next one, saying without explanation that I would not be taking part in the relaxation exercise, and would likely leave the room. He said when the long one would be, and there would be another short one later.

In the fourth class (tonight), I sat by the door, and took a chair with me when I popped out for the duration of the exercise. The instructor came and fetched me when it was done. And I did other things for the short one.

I did ask, this time, what he recommended to keep you awake when the sleep pressure is high but it's a bad time for a nap. And if there were resources on being a millennial and not having a whole house to work with in terms of keeping stress out of your bedroom. (Do something loud. And, probably, somewhere.) I asked about next steps. He recommended the meditation class, or the anxiety class. "That really doesn't seem to be a recommendation geared for someone who has been practicing meditation for fifteen years," I said, smiling aggressively.

He recommended tai chi.

"That's really rather along the same lines," I said, still smiling.

There was a class evaluation form, which asked about how much we learned from the class, and how helpful it was. It was ... not.

So I'll be asking my GP, my counselor, and my psychiatrist about next steps, then. Now that I've taken this miserable class so they'll take me seriously.
tim: Tim with short hair, smiling, wearing a black jacket over a white T-shirt (Default)

[personal profile] tim 2017-02-14 05:02 pm (UTC)(link)
Ugh. Sorry you had to expose yourself to that toxic waste.

This is a prime example of why CBT is so, so bad for anybody with a trauma history. My thoughts aren't the problem, it's my body literally trying to protect me by telling me a situation is unsafe. (Which is why I have insomnia -- I spent my childhood being forced by an abusive parent to go to bed when I wasn't tired, and in fact, not actually experiencing sleepiness partly because of that and partly because my body pretty much shut off any awareness of internal senses because that was too dangerous to have in the situation I was in. Telling myself to think better thoughts won't fix it, it'll just cause more shame because I can't perform.)
tim: Tim with short hair, smiling, wearing a black jacket over a white T-shirt (Default)

[personal profile] tim 2017-02-14 05:25 pm (UTC)(link)
I ended up wanting to expand more on that thought, so I wrote a post and linked to this one. If you don't want it linked to, I'll be happy to take it out. Thanks for the inspiration in any case :)

[personal profile] sithjawa 2017-02-14 09:46 pm (UTC)(link)
Thank you. I've been poking around thoughts similar to this lately - I believe I could theoretically do CBT w/ a trusted professional, if I met a professional I could trust to a very high degree, but the basic framing/concept behind CBT comes across to me as gaslighting. It isn't that I don't have cognitive distortions (even ones I'm aware are exactly that), but if somebody is going to poke around in my head *looking for evidence that my brain is distorting things,* I have to trust them to be *not looking for a way to gaslight me and blame all my woes on me in order to excuse the rest of society,* and that just is not an easy trust to win, considering.

[personal profile] sithjawa 2017-02-14 10:32 pm (UTC)(link)
Yeah, but there's an enormous difference between *me* (or, say, *you*) saying "that is a weasel, sp. Mustela cerebris," and some person who hasn't earned that level of trust doing it, thinking that having a degree entitles them to that level of trust.

[personal profile] sithjawa 2017-02-15 02:01 am (UTC)(link)
this is my new favorite thread about brainweasels

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jeshyr: Blessed are the broken. Harry Potter. (Default)

[personal profile] jeshyr 2017-02-15 03:06 am (UTC)(link)
This is so awesomely true...

The other thing I do with professionals who I semi-trust is bring them uncharacterised possible-weasels and ask for help with identification of said creature. How they do with this task tells me a LOT about their trustworthiness and whether they should be trusted with future situations.

It also lead me to the very odd realisation that my current therapist has more trust in me than I have in me which is ... a very odd feeling. It's nice though.
alatefeline: Painting of a cat asleep on a book. (Default)

[personal profile] alatefeline 2017-02-15 02:56 am (UTC)(link)
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[personal profile] siderea 2017-02-15 04:42 am (UTC)(link)
tim: Tim with short hair, smiling, wearing a black jacket over a white T-shirt (Default)

[personal profile] tim 2017-02-16 11:25 pm (UTC)(link)
I agree -- CBT feels like self-gaslighting to me. I didn't even cover the whole element that tends to come up in CBT workbooks of "you can be happy no matter what the external circumstances in your life", which sounds awfully close to telling people that injustice wouldn't make them unhappy if they just stopped disliking it.

There are therapists who do CBT (usually not exclusively CBT) who can be helpful, but that's because therapy has more to do with the nature of the relationship between you and your therapist than it has with theory.
quartzpebble: (frayed)

[personal profile] quartzpebble 2017-02-14 07:52 pm (UTC)(link)
There were aspects of CBT approaches that I found very useful, even while being actively (re)traumatized. They let me stop the thought-spirals and helped me accurately assess consequences and evaluate situations. I'm finding that it doesn't get to the underlying masses of shame-guilt-grief-fear, but it's helped me stop getting stuck in them in the moment and has given me some very useful skills.

[personal profile] sithjawa 2017-02-14 09:48 pm (UTC)(link)
>> Even the not-traumatized members of this class would probably have been better served by affirmations like "That is a work problem, and I can think about it when I am at my desk" rather than "I will perform just fine even if I am only allowing myself to stay in bed for four hours."

wait that's abusive

(I know, I know, what have you been saying this entire post)
Edited 2017-02-14 21:49 (UTC)
quartzpebble: (you can't see me)

[personal profile] quartzpebble 2017-02-15 08:31 pm (UTC)(link)
Is that... seriously... please tell me that's an exaggeration.

(It's not much of one, is it. /o\)

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[personal profile] siderea 2017-02-15 04:49 am (UTC)(link)
Even the not-traumatized members of this class would probably have been better served by affirmations like "That is a work problem, and I can think about it when I am at my desk" rather than "I will perform just fine even if I am only allowing myself to stay in bed for four hours."

Ah, but that won't work! See, CBT-I's secret sauce is to use high levels of sleep deprivation to force sleep episodes. So if you don't sell the marks patients on the idea that the feather will make them fly they don't need sleep, how will you convince them that only sleeping hour hours a night is adequate?

CBT-I is two tablespoons of useful sleep hygeine mixed in a pound of patient-shaming and gaslighting: It's not that you can't sleep as much as you need, it's that you don't need as much sleep as you think you do. Your body will always sleep the amount you need, there is no such thing as a sleep disorder. If you think you're exhausted and under-rested after sleeping, that's because you're a whiner.
siderea: (Default)

[personal profile] siderea 2017-02-15 11:08 pm (UTC)(link)
I swear to ghu this is true: I was referred to a neurologist sleep specialist because I had been on a medication that massively screwed up my biological ability to sleep. He recommended CBT-I to me. And then said, "Okay, why is it that whenever I recommend CBT to one of you psychotherapists, you all get that look?"
quartzpebble: (Doom!)

[personal profile] quartzpebble 2017-02-15 08:29 pm (UTC)(link)

siderea: (Default)

[personal profile] siderea 2017-02-15 11:03 pm (UTC)(link)
Oh, you thought it was a mistake? AHAHAHAHA, no, that was intentional.
Sleep restriction[5] is probably the most controversial step of CBT-I, since it initially involves the restriction of sleep. Insomniacs typically spend a long time in bed not sleeping, which CBT-I sees as creating a mental association between the bed and insomnia. The bed therefore becomes a site of nightly frustration where it is difficult to relax. Although it is counterintuitive, sleep restriction is a significant and effective component of CBT-I. It involves controlling time in bed (TIB) based upon the person's sleep efficiency in order to restore the homeostatic drive to sleep and thereby re-enforce the "bed-sleep connection".[6] Sleep Efficiency (SE) is the measure of reported Total Sleep Time (TST), the actual amount of time the patient is usually able to sleep, compared with his or her TIB.


This process may take several weeks or months to complete, depending on the person's initial Sleep Efficiency and how effective the treatment is for them individually. Daytime sleepiness is a side-effect during the first week or two of treatment, so those who operate heavy machinery or otherwise cannot safely be sleep deprived should not undergo this process.
Allow me to cut through the TLAs and make this clear: if you can only get four hours sleep a night but it takes you two hours to fall asleep, CBT-I requires you to only spend four hours and 20 minutes in bed each night – waking up and getting out of bed after two hours, if it took you two hours to fall asleep – until you become so exhausted that you fall asleep promptly whenever you go to bed, and get the four hours you can in the window you've allocated.

The assumption being there will come a point when you are so exhausted that you will fall asleep in less than 20 minutes.
Cognitive therapy[4][8][9][10] within CBT-I is not synonymous with versions of Cognitive Behavioral Therapy that are not targeted at insomnia. When dealing with insomnia, cognitive therapy is mostly about offering education about sleep in order to target dysfunctional beliefs/attitudes about sleep.

[...] For instance, many insomniacs believe that if they don't get enough sleep they will be tired the entire following day. They will then try to conserve energy by not moving around or by taking a nap. These responses are understandable but can exacerbate the problem, since they do not generate energy. If instead a person actively tries to generate energy by taking a walk, talking to a friend and getting plenty of sunlight, he or she may find that the original belief was self-fulfilling and not necessarily true.
Edited 2017-02-15 23:28 (UTC)
quartzpebble: (Default)

[personal profile] quartzpebble 2017-02-16 01:24 am (UTC)(link)
"many insomniacs believe that if they don't get enough sleep they will be tired the entire following day"



I'm like, I can see the logic, and I can see that there might be people this could work for. I can't imagine that there are that many of them (especially as a car really ought to count as heavy machinery).

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