Saturday, March 17, 2007

Provigil, CBT, and Continuing Insomnia, 070317

Near the Western Edge of the time Zone at the beginning of the new, earlier Daylight savings time, it is completely dark at 7 AM. There’s fresh snow outside. It was completely dark at 6 AM and at 4:30 AM. I had insomnia again. Not the worst insomnia, but insomnia never the less. It’s a boring topic because it happens so often, but it’s still a problem. This version of insomnia came with restlessness and itchy skin verging on being crawly. I don’t like it, to say the least.

Since I didn’t get to sleep until after 1 AM and was awake before 4:30, I got less than 3 and a half hours of sleep. And that was restless and disturbed. My concern is that besides being tired and unable to concentrate, I may get cranky and I hate it when I get cranky! I'm afraid my sweetie will get angry and stop loving me; that he'll confuse my condition with me.

I’d like to know what causes this to happen, why I sleep better sometimes and worse others. I took the exact same meds. I ate similar foods to other days when I felt fine. I did have a late-night snack because it was recommended for insomniacs to have a small late-night snack of turkey, potato. I had a few corn chips and potato chips, two slices of turkey sandwich meat and a few raisins—it was supposed to help me sleep. No such luck.

I am on Rozerem and Provigil now, a trial. I think generally I am sleeping a little wee bit better but not last night. I am unhappy about being on meds when we don’t know what the long-term effects will be. The Provigil made me wildly nervous and agitated at first and my insomnia was worse. But now it doesn’t seem to do that much. The combination of the two certainly does not STOP insomnia!

I’ve been reading about Cognitive behavioral therapy, or CBT1 for Insomnia. It’s supposed to work better than sleeping pills. I’ve been trying some of the techniques and they seem to help somewhat. (I still think I have a physiological problem caused by food sensitivities or something.) Some of these are a bit counter intuitive: Sleep restriction (for example), getting up after 20 minutes of not sleeping and reading for 20 minutes, and cognitive restructuring.

Here are some questions to ask for cognitive restructuring:

1. Is this thought really true?
2. Am I overemphasizing a negative aspect of this situation?
3. What is the worst thing that could happen?
4. Is there anything that might be positive about this situation?
5. Am I catastrophizing, "awfulizing", jumping to conclusions, and assuming a negative outcome?
6. How do I know this situation will turn out this way?
7. Is there another way to look at this situation?
8. What difference will this make next week, month, or year?
9. If I had one month to live, how important would this be?
10. Am I using words like "never", "always", "worst", "terrible", or "horrible" to describe the situation?

When I am laying awake worrying about things, I am supposed to ask these questions. I am supposed to challenge my negative automatic thoughts (NATs). But that isn’t so much what I do when I can’t sleep—what I do is try to solve problems. I try to work out solutions to things that are bugging me, rather than just “awfulizing” things. And then I try to tell myself, I don’t need to solve this now, I can solve it tomorrow. But I know how that works, LOL! I rarely do solve things because there is too much to be done.

I am supposed to use the "double standard" technique developed by Dr. David Burns. This technique is based on the idea that, when it comes to explaining adverse events, we are often much harder on ourselves than we are on our friends. We operate on a double standard: we have realistic and fair standards that we apply to others whom we care about and we encourage them to reframe their reactions to negative events. In contrast, we set unrealistic standards for ourselves when we explain stressful events to ourselves.

To use the double standard techniques, I need to examine my NATs and then ask myself: "Would I say this to a close friend with a similar problem? If not, what would I say to him or her?". The idea is to reframe NATs by giving myself the same encouraging, empathic messages I would give a friend. It certainly is true that I am harder on myself than I am on others in some respects. (In other respects, I am harder on others, LOL!)

It doesn’t seem, however, that this aspect of the technique applies that well to me. I’d like to short circuit the worrying altogether, at night, anyway. It seems that if I were sleeping to begin with, I wouldn’t be worrying!

Sometimes, when I am lying there wide awake, I plan a poem, a story or an art piece. Then later, I actually do it. But I only do that because I am awake and bored. Of course, once I get started thinking about it, I’m engaged and less likely to sleep.

So who wants to waste time worrying about worrying? Not me. And if worrying makes the insomnia worse, I probably shouldn’t worry about the insomnia, either. So there. (Hard to not when you're laying there awake hour after hour, though!)

(PhotoArt piece: Measuring the night. By me. Brand new. The orginal photo was from a gravestone--measuring a person's life, I guess.) Posted by Picasa

No comments:


Blog Widget by LinkWithin