Traditional CBT, such as that explained in the popular books by Dr. David Burns (which I highly recommend), often asks you to write down your negative thoughts and then evaluate them for accuracy and truthfulness. This works well in most cases. Once you see that your anxious or depressed thoughts tend to exaggerate or make illogical or irrational statements, their power over you begins to fade a little. Then you can write down new replacement thoughts that are more rational, realistic and truthful.
But I don’t include this technique in my articles on CBT, and there are two reasons for that.
One reason is, people with chronic insomnia are really, really impatient and I don’t want to add more steps to a process unless absolutely necessary. I believe that CBT can still work fine if you eliminate the evaluation step and simply combine it as part of the rational response when possible. This makes the process shorter and simpler, a helpful thing when you’re feeling sleep deprived.
But the second reason is more important. Most people’s sleep anxiety thoughts sound very, very true to them. As an example, “If I don’t get any sleep tonight, I will feel absolutely terrible tomorrow.” You know this is the truth because it has already happened many times. It doesn’t feel like an exaggeration. You look for signs of inaccuracy, and it’s just not there. You WILL feel terrible if you don’t sleep all night. It’s a miserable feeling and it’s the undeniable truth.
In fact, it’s important to acknowledge the truthfulness of what you have just expressed. For example, the rational voice might say…
“Yes, it is true that I will feel pretty bad if I don’t get any sleep all night. I am caught inside a sleep-anxiety-paradox endless feedback loop. I am trying to learn ways to step out that loop, ways to convince my unconscious mind that worrying about sleep, no matter how much I need it, is causing me to sleep less. The CBT I’m trying, and other methods, aren’t magic pills, and they need time to work. But I know I will get there if I keep practicing and don’t give up.”
Then the negative, anxious voice says, “Well, what am I supposed to do in the meantime? Huh? Answer me that, O Great and Holy Know-It-All Rational Voice.” (The negative anxious voice can get really snarky sometimes.)
Then the rational voice says, “I need to find ways to cope with that miserable feeling. I can say to myself, yes, I feel truly miserable, but it’s not the end of the world, and this feeling will not last. When I get home tonight, I will work again in my CBT notebook and try to beat this thing. I will not give up no matter how much you whine and complain, so take that and stuff it, O Whiny Annoying Negative Voice.”
OK, just kidding. Your dialogue needs to stay amicable, so if you find yourself veering off into a fist fight between your two voices, it might be time for a break. Give your voices a time-out and start again later.
But let’s get real for a second. The dialogue I recommend between your two voices will not always go smoothly. The Rational Voice will not always be winning the debate. The Anxious, Negative Voice often seems to have the upper hand, especially when you first begin your CBT practice. It will sound louder, more convincing and more in touch with reality, while your Rational Voice will sound, by comparison, well-meaning but naïve, weak, or deceptive, like it is just making stuff up.
At first, the anxious thoughts represent stark, gritty reality. The rational, calming, reassuring thoughts sound like nice fairy tales. Your brain, especially the unconscious part, just isn’t buying it.
This will change as you keep practicing. In spite of the convincing cynicism of the anxious voice, if you keep up the conversation, you’ll soon realize the rational and calming voice DOES know what it’s talking about. Especially when it continues to point out an undeniable fact: worrying about sleep is NOT HELPING you sleep better; therefore it is an utterly pointless and completely useless activity.
Sure, right now it’s a deeply engrained habit. But not for long. Once the absurdity of the anxious thoughts are fully exposed, the brain realizes that their power grab is over. The rational voice emerges as the winner in the truth-and-logic department.
But it’s still not a done deal.
The anxious voice may become quieter but it still is a driving force for the anxious emotions that make your heart beat faster and your body to feel restless and wide awake when it should be relaxing into drowsiness. It doesn’t take much to get the cycle going again even if you’ve experienced remarkable improvement in your sleep for a surprisingly long time. Sleep anxiety is always waiting in the wings, so to speak, to reenter your life at the first opportunity for relapse.
So here is when the rational voice needs to step up its game a little. And how, exactly, does it step up? Here’s how.
If the basic facts of insomnia-reality aren’t showing any signs of going away soon, your job is not to change immovable facts. You just need to shift your perspective a little.
You already know that when you can’t sleep, there is very little you can do to put yourself to sleep. You can take a sleeping pill. It might work tonight if you’re lucky. But it will do absolutely nothing for tomorrow night or the night after that. And if you have ruled out the sleeping pill for any variety of good reasons, and let’s just say for the sake of argument that you have… you really have very few options to MAKE yourself fall asleep. The odds are against you. You know this. But you don’t want to accept it.
The Rational Voice Has Two Jobs
The rational voice is multi-talented. It can calm and comfort you in times of stress, but it can also help you accept the unacceptable when that’s the only option available. When you can’t sleep and you know nothing will help you sleep, then it is time to accept that miserable reality and make peace with it.
You can’t sleep. You will feel miserable tomorrow. Your brain will feel foggy. Your limbs will feel heavy as lead. You might not be able to comprehend complicated concepts. You might not even be able to say the words “complicated concepts.” You might not be able to offer as much to the world as you usually can. You will find it hard to focus on work and the daily routine. You will feel less able to cope with the daily problems of life. You might not find anything to laugh about. Or you might find too much to laugh about because you’ll feel a little punch-drunk with fatigue—not much better. It will be tough. A rough day.
But you can get through it. You have before. And you can do it again. You will not have a fun day. But it won’t be the end of the world. You can look forward to the time when you will be sleeping better. And you WILL be sleeping better. It is truly inevitable that you will get over insomnia. The odds are highly in your favor. You are doing the work. You are making the effort. You understand what needs to be done. You realize that you’ve developed a habit of worrying about sleep that, in a paradoxical and extremely frustrating way, prevents you from getting any sleep. It is utterly absurd and you know it, but you haven’t yet established a habit of letting go of these worries. But you will.
Soon you will work it out. Your insomnia will go away. If not today, well, maybe tomorrow. If not tomorrow, then maybe next week. But it will happen. Yes, tomorrow will be miserable. But you can get through it. You will be OK. You will come out of this better, stronger, more mentally fit to solve problems in your life. And it might not turn out as bad as you think. You might find some rest, some comfort, some hope during this miserable day—a few minutes maybe, here and there. Maybe during lunch. Something nicer than you expected might even happen. But even if it doesn’t, you will be OK. Because you’re in this for the long haul. You don’t need every day to be wonderful or even average. It can be worse than average. It can even be terrible. But you will get through it. You will be OK.