Why therapy hasn’t helped you sleep
Updated: Oct 20, 2022
One of the things that really makes me angry is when people come to me and they say, "I went to my doctor, my blood work was normal and the doctor said there’s nothing wrong, it's all in your head." The doctor totally dismisses how they're feeling. And a lot of times they know deep down that something is wrong. They might have other minor symptoms, they know that things aren't right, and that's why they aren't sleeping. Doctors can be really dismissive and the only solutions are medication or therapy.
One of the reasons why therapy doesn't always help is because it can be very focused on the past especially if you had trauma. It’s focused on how your childhood experiences might still be affecting you today and affecting your sleep. I do believe that trauma can affect our sleep and that we might have some underlying thoughts that we maybe haven't dealt with. But I find it less helpful to focus on the past and more helpful to focus on the future.
Cognitive behavioral therapy is a different type of therapy that is popular for insomnia. I agree with some components of this approach to insomnia but there are reasons why it doesn’t always work.
CBTi is great because it works on rewiring your brain and changing your negative thoughts about sleep. It looks at how worrying about sleep and your relationship with sleep can sabotage your sleep. This is definitely important and something that I include in my program. I have a previous post about changing your thoughts to change your sleep that uses cognitive behavioral therapy techniques.
I also use life coaching which helps people become aware of what they're thinking and how their thoughts are affecting them. It differs from other types of therapy that are more past focused; instead it's focused on the future. It's focused on who you want to be, how you want to think, how you want to act instead of trying to dig up all of our subconscious thoughts based in childhood. It helps to use these tools to rewire your brain to think positively about sleep and about stressors in your life as well. It can apply to pretty much anything in life, not just insomnia.
I agree with CBTi because it's important to look at your habits around sleep. But the reason you aren't sleeping isn't because you're watching TV at night. A lot of people watch TV at night and sleep just fine.
Now, it can help your sleep to not watch TV at night, especially if you're having sleep problems. When I was struggling with sleep, I started following a lot of the sleep rules and they did actually helo. It did help me to not watch TV at night and to not read in bed and things like that. But now that I'm sleeping well again, I've gone back to those habits and I can still sleep well because I've addressed the other things that were keeping me awake and it wasn't the screens.
Another recommendation that I got from cognitive behavioral therapy that I recommend to most of my clients is to get out of bed when you can't sleep. This can be really hard for people because they're worried it's going to wake them up even more. But I found for myself (and many of my clients) when I wasn't sleeping well that it did help to get out of bed. I actually got more sleep than if I had laid in bed tossing and turning for hours.
When you get out of bed, you want to keep the lights dim, you don't want to be watching TV or on your phone. You want to do something relaxing. For me, I always read but you can also listen to a meditation or stretch or do a crossword puzzle. Anything relaxing that's probably going to tire your brain. Then when you feel sleepy, you go back to bed and go to sleep. If you think that you've been awake again for more than 10 or 20 minutes (I recommend not looking at a clock for this because that's likely just going to cause more stress and anxiety), then get up, get out of bed again, go do something relaxing again in another room with the lights dim until you feel sleepy and then go back to bed.
Doing this won’t be an immediate fix. It might take a few nights for your brain to get the message that, "Okay, when I'm in bed I'm sleeping." You’re rewiring your brain so that it has a strong association that bed equals sleep, bed does not equal lying awake for a long time getting frustrated because I can't sleep. Doing this is great whether you have a hard time falling asleep at bedtime or if you're waking up in the middle of the night and having a hard time going back to sleep.
What I don't agree with in cognitive behavioral therapy for insomnia specifically is doing sleep restriction. That's where you really restrict the amount of time that you're in bed. Let's say someone is only getting five hours of sleep a night. It’s recommended that they then sleep from midnight to 5:00 AM. For me, this would be torturous. I'm used to going to bed at 10:00 so trying to stay awake until midnight and being so exhausted and then making myself get up at 5:00 sounds horrible. I do not agree that that is necessary at all. I've had quite a few clients who have gone through that and it helped for a little bit and then it didn't work anymore. It’s not the answer to why you aren’t sleeping.
Yes, you do want to limit the amount of time you're in bed. You don't want to be in bed for nine hours and only sleep seven hours. You do want to get out of bed. But forcing yourself to stay awake super late or getting up super early is not the answer.
If you aren't able to sleep and you've tried lots of things and you're following a lot of those sleep rules, then there's something in your body that is keeping you awake. At this point, it's more than just mental. This is why therapy doesn’t usually work for insomnia.
This is true even if your blood work is "normal." Blood work doesn’t look at everything. It doesn't look at how the different systems in your body are working. It's really looking to diagnose a disease or disorder once things have gotten really bad. There are other imbalances that you don't even know are there that blood work doesn’t detect.
You could have a pathogen in your gut, such as a parasite that’s active at night. It causes your body to release cortisol which wakes you up. You have no idea it's there; it might not be affecting your digestion at all. You could have hormone imbalances that are affecting your sleep. You could have heavy metal toxicity. Or liver detox issues. Or food sensitivities. All of these health issues can sabotage your sleep and you don’t even know they’re there.
I want to talk about my client, David, because he is doing great and he was really excited to get his test results back and finally have some answers. He had gone to his doctor and he was on Trazodone and over the counter sleep meds. He's a very health conscious person who takes a lot of supplements. He was trying all the things and he was so frustrated because he couldn't sleep. (I totally understand because I've been there, too.) I love it when people are so excited to actually get these answers and that's what the lab tests show.
Within a month and a half of working together, he was off the Trazodone and he had six straight nights of sleeping well in a row. He even traveled recently and slept pretty decently there. Again, this is without meds! He still has a ways to go because we're just starting to correct a lot of these imbalances in his body but he's excited because he's seeing results and he's really focusing on the progress he's made so far, which is what I really encourage my clients to do.
In another post, I talk about celebrating the progress that you've made and focusing on how far you've come instead of how far you still have to go. This is relevant for any goal. Let’s say someone's sleeping four to five hours a night feels horrible and they want to get to eight hours a night feeling great without meds. That's a big gap to cover. If you start focusing on being off meds and sleeping seven hours, that is huge progress! Celebrating all those little milestones is so important to getting better. David has been great about doing this and that's why he’s seeing results and why he's going to be successful in this program.
If you’re ready to overcome your insomnia and focus on more important things in life, we’re here for you! Book a free consultation to learn the steps you can take to sleep better soon and for the rest of your life.