FAQ for Patients
1. What's Optimal Sleep?
Predictable
Our body follows a regular schedule for feeling sleepy, falling asleep, sleeping for a certain duration, waking up, and how we feel upon waking up.
Consolidated
Once we are asleep, we tend to stay asleep throughout the night, with only short moments of wakefulness. This includes taking around half an hour or less to fall asleep initially, and being awake for less than half an hour altogether during the night.
Restorative
When we wake up, we feel refreshed and energized, like our body and mind have been recharged.
Sufficient
We dedicate sufficient time for sleep in bed every night, which matches our individual sleep needs. This ensures we're giving our body the right amount of rest it requires.
2. How much sleep do I need?
Like most adults, your sleep need is probably close to 7 hours to 9 hours per night to function at their best the next day. Maybe a bit less, maybe a bit more. Some people genuinely need a lot less, and some people genuinely need a lot more.
3. What controls sleep?
We all have 2 brain mechanisms that control sleep: the sleep drive and the biological clock.
First, the sleep drive keeps track of how long we have been awake. The longer we are awake, the higher our sleep drive and the sleepier we get. The only way to decrease sleep drive is to sleep.
Second, the biological clock keeps track of the time of day, promoting wakefulness and alertness during the day, and promoting rest and repair during the night. When these two processes are aligned and working together, we maximize the likelihood of optimal sleep.
5. What can trigger and maintain insomnia?
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Sometimes insomnia runs in the family and makes one more vulnerable to insomnia. But that does not necessarily cause or maintain insomnia.
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A bad mattress, a noisy sleep environment, an unsafe neighborhood, a bedroom temperature that is too warm or too cold, and too much light in the room are some of the environmental factors that can prevent or disrupt sleep. Over time, these can contribute to shallow, fragmented sleep.
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The birth of a child, a new job, financial stress, retirement, menopause, anxiety, depression, and unmanaged pain are some of the factors that can trigger nights of bad sleep. When these persist, or even after they subside, insomnia can continue.
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Other undiagnosed or untreated sleep disorders such as sleep apnea and restless leg syndrome can masquerade as insomnia, or exist with insomnia.
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Repetitions of poor sleep habits, such as spending too much time in bed while awake, using one’s bed and bedroom to activities that are incompatible with sleep (e.g., playing video games, screen time), long naps, excessive caffeine use, irregular sleep routines, etc. can trigger and maintain insomnia.
These factors can precipitate and perpetuate insomnia by misaligning the 2 sleep systems that control sleep: the biological clock and the sleep drive.
When these 2 systems are out of sync, problems falling and staying asleep, and poor sleep arise, resulting in daytime fatigue and other short- and long-term consequences of poor sleep.
4. What's insomnia?
We all experience sleepless nights once in a while. Nothing’s wrong - just a “glitch”. Maybe too much stress, maybe too much food, maybe too much stimulation - or not enough - that day. That’s nothing alarming.
But when you have insomnia most nights, for more than three months, your sleep system is likely out of whack, meaning, your biological clock and sleep drive are “misaligned”. That means that they are not working in sync to help you fall asleep and stay asleep throughout the night and help you wake up alert and clear-minded during the day. That can be corrected with new habits to retrain your sleep system.
6. What’s the best and safest treatment for insomnia?
CBTI. It stands for cognitive-behavioral therapy for insomnia, and it’s a collection of techniques that help retrain your brain to produce optimal sleep, i.e., sleep that is predictable, consolidated, sufficient, and restorative.
CBTI is typically delivered over the course of 4-8 weeks. Most people can expect to experience improvements in their sleep in 4 weeks. CBTI is effective for individuals who in addition to insomnia are experiencing physical or mental health challenges such as chronic pain, depression, or anxiety or who are currently taking sleep medication(s). CBTI has very few side effects, although it is common in the first few weeks of treatment to experience increased sleepiness. This is an expected and temporary side effect as you retrain your sleep (like muscle pain after a new workout).
7. How does it work? What can I expect if I practice the techniques of CBTI?
You and your sleep provider will work together to develop a personalized plan for how to tailor CBTI techniques to the specific sleep difficulties you are experiencing. Here is what you can expect:
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You’ll complete a daily sleep diary, where you will track each and every day your sleep behaviors such as approximately how long it takes you to fall asleep and the time you wake up to start your day,
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You’ll practice and develop skills for managing unhelpful thoughts or worries that interfere with sleep (the C or cognitive component of CBTI)
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You’ll have replaced your current sleep and daytime behavior habits with new ones that promote re-alignment of your sleep system (the B or behavioral component of CBTI).
**8. Is “sleep hygiene” the same as CBTI?**
No! “Sleep hygiene” - or healthy sleep habits - are good for everyone to maintain good sleep, just like a healthy diet or exercise to maintain good overall health. It’s not a treatment for insomnia. CBTI treats insomnia. Good sleep habits maintain good sleep. If you don’t have optimal sleep, CBTI is the way to get there, and good sleep habits will maintain your optimal sleep.
**9. Can I have both sleep apnea and insomnia? Does CBTI work then? **
Yes. In fact, the occurrence of both sleep disorders in one person is common: 40% of people with insomnia also have some sleep-breathing difficulties. And 40% of people with sleep apnea also have insomnia.
Left untreated, insomnia can make it hard to adhere to the treatment for sleep apnea and get the full benefits. Similarly, undiagnosed and/or untreated sleep apnea will maintain daytime consequences of poor sleep often seen in insomnia including sleepiness, concentration problems, and lack of motivation.
If you do CBTI and still feel sluggish during the day, you may also have sleep apnea. Talk to your doctor about your sleep habits, how CBTI was personalized for you, and what symptoms are left to determine the next best step for you.
10. What about sleep medications prescribed by my doctor?
Your doctor may prescribe one of the medications that can help insomnia. There are different types of prescribed sleep medications, and you and your doctor can determine which may be best for you. Taking the medications at the same time, allowing enough sleep time, and getting up at the same time every day are some of the healthy sleep habits that can help you feel the full effects of sleep medication. There may be side effects. It is best to get the information from your doctor and your pharmacist.
11. What about the insomnia apps and sleep trackers?
There are few apps that have been shown to be effective for reducing or eliminating insomnia. We do not know if the free insomnia apps help. The ones that have been shown to help insomnia are typically not easy to access and they are not free.
Sleep trackers can help monitor your sleep habits, but they can also generate sleep performance anxiety… Trust your own assessment of your sleep quality: no device can measure the goodness of a solid night of sleep! These devices simply collect data from you, and display your data back to you in a way that allows you to see trends over time. That’s all they do. Sleep trackers do not measure sleep directly (sleep is created by your brain, not in your wrist, ankle, or finger). Typically they estimate sleep based on your level of activity (you don’t move much when sleeping), the time of day, your heart rate, and other measures taken by the device.