Staff Perspective: Doctor, Heal Thyself - When a Sleep Psychologist Has Insomnia
Often in Cognitive-Behavioral Therapy for Insomnia workshops, the personal reactions of the providers attending to recommended interventions is palpable in the room – even when the room is virtual. On the surface, so many of the interventions are counterintuitive: Reduce time in bed when a person is that sleep deprived? Don’t go to bed early even if they actually feel sleepy for once? Wake up early on weekends even without any schedule obligations? Don’t relax in bed before bedtime? Of course, once we explain the rationale things seem much more logical. The goals are quite simply to boost sleep drive consistently over time (rather than say focus on one night), facilitate optimal consistent circadian placement of the sleep schedule, and re-condition the bed and bedroom for sleep.
Understanding the rationale helps providers better implement the CBTI protocol with patients as we can explain interventions more clearly. So the reactions of providers learning about CBTI does not necessarily seem to be about hesitation helping patients use it to improve. Rather, in my experience, reactions stem from a personal perspective. Do I need to start making all these changes to my sleep tonight? This sounds miserable! No, we who train CBTI reassure them, only people with insomnia need to use them. If you’re fine with your sleep, no need to change anything.
Except…what happens when I’m not fine with my own sleep? I’m a sleep psychologist, surely that should not happen! Well, unfortunately it does happen, and it probably happens for many of you providers yourselves reading this.
Personally, while I would not whip out a sleep log and start CBTI from the very beginning every time I have a bad night of sleep regardless, I must confess I do not always practice what I preach. Generally, once our patients have mostly good sleep and have learned the skills, after even one night of poor sleep I tell them they should immediately resume stimulus control to prevent a relapse. Instead, for myself I don’t always get out of bed for every awakening, and on occasion I have tried to sleep in or rest in bed on weekend mornings or even shifted back my alarm a few minutes on other days. Worse – gasp – I have indeed doom-scrolled on my phone in bed. I lay there at oh-dark-hundred filled with imposter syndrome thinking How did this happen? I’m supposed to be a sleep expert! What if I’m up for hours? I’m only going to get six hours of sleep…no, five now…maybe four. Ugh.
Whenever these bad nights occur, I accept that they will be miserable and acknowledge to myself they could continue further since I’m actively choosing not to make use of stimulus control skills in the moment. Fortunately, because I do at least limit sleeping in to an hour or less during these episodes and only a day here or there I have been able to build back a high enough sleep drive that bouts of insomnia only last a night or two. If they persisted, I would plan to give in after about five to seven nights and resume stimulus control, and I’d wait a bit longer to move to sleep restriction.
I still wouldn’t recommend this approach to patients. After all, there is a difference between a few bad nights of sleep and Insomnia Disorder. That said, if you too have occasional bad nights of sleep, even if you use CBT-I in your clinical practice for patients, I think it is alright to give yourself some grace in choosing how you handle them. Just remember you’re ultimately in control because you know how to get back to better sleep – and just don’t tell your patients!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Diana Dolan, Ph.D., CBSM, DBSM, is a clinical psychologist serving as an Assistant Director of Training & Education with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland..
Often in Cognitive-Behavioral Therapy for Insomnia workshops, the personal reactions of the providers attending to recommended interventions is palpable in the room – even when the room is virtual. On the surface, so many of the interventions are counterintuitive: Reduce time in bed when a person is that sleep deprived? Don’t go to bed early even if they actually feel sleepy for once? Wake up early on weekends even without any schedule obligations? Don’t relax in bed before bedtime? Of course, once we explain the rationale things seem much more logical. The goals are quite simply to boost sleep drive consistently over time (rather than say focus on one night), facilitate optimal consistent circadian placement of the sleep schedule, and re-condition the bed and bedroom for sleep.
Understanding the rationale helps providers better implement the CBTI protocol with patients as we can explain interventions more clearly. So the reactions of providers learning about CBTI does not necessarily seem to be about hesitation helping patients use it to improve. Rather, in my experience, reactions stem from a personal perspective. Do I need to start making all these changes to my sleep tonight? This sounds miserable! No, we who train CBTI reassure them, only people with insomnia need to use them. If you’re fine with your sleep, no need to change anything.
Except…what happens when I’m not fine with my own sleep? I’m a sleep psychologist, surely that should not happen! Well, unfortunately it does happen, and it probably happens for many of you providers yourselves reading this.
Personally, while I would not whip out a sleep log and start CBTI from the very beginning every time I have a bad night of sleep regardless, I must confess I do not always practice what I preach. Generally, once our patients have mostly good sleep and have learned the skills, after even one night of poor sleep I tell them they should immediately resume stimulus control to prevent a relapse. Instead, for myself I don’t always get out of bed for every awakening, and on occasion I have tried to sleep in or rest in bed on weekend mornings or even shifted back my alarm a few minutes on other days. Worse – gasp – I have indeed doom-scrolled on my phone in bed. I lay there at oh-dark-hundred filled with imposter syndrome thinking How did this happen? I’m supposed to be a sleep expert! What if I’m up for hours? I’m only going to get six hours of sleep…no, five now…maybe four. Ugh.
Whenever these bad nights occur, I accept that they will be miserable and acknowledge to myself they could continue further since I’m actively choosing not to make use of stimulus control skills in the moment. Fortunately, because I do at least limit sleeping in to an hour or less during these episodes and only a day here or there I have been able to build back a high enough sleep drive that bouts of insomnia only last a night or two. If they persisted, I would plan to give in after about five to seven nights and resume stimulus control, and I’d wait a bit longer to move to sleep restriction.
I still wouldn’t recommend this approach to patients. After all, there is a difference between a few bad nights of sleep and Insomnia Disorder. That said, if you too have occasional bad nights of sleep, even if you use CBT-I in your clinical practice for patients, I think it is alright to give yourself some grace in choosing how you handle them. Just remember you’re ultimately in control because you know how to get back to better sleep – and just don’t tell your patients!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Diana Dolan, Ph.D., CBSM, DBSM, is a clinical psychologist serving as an Assistant Director of Training & Education with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland..