From gq-magazine.co.uk
By Tom Ward
One sleepless writer sets out to rewire his brain in the quest for kip
Like 10-15 per cent of Brits, I suffer from insomnia and have trouble sleeping. Hours of staring at a dark bedroom ceiling are turning me into a grouch, groggy at the prospect of doing pretty much anything the next day. Jaded on the usual sleep advice (“Don’t look at screens! Don’t drink coffee six hours before bed!”), I decided to take things up a notch, turning to an old method newly trending with VIPs and CEOs called Cognitive Behaviour Therapy for Insomnia. There are 14,000 TikTok videos on the subject, one calling it “the most effective treatment we have for chronic insomnia.”
CBT-I promises to rewire your brain and reconceptualise your relationship with sleep in the process. It came highly recommended from my mate Jack, who gave it a crack after becoming a father to three kids in the space of five years. “I’d spend hours awake every night. Either I couldn’t drop off, or if I did, I’d wake up a few hours later and just lie there thinking of everything that could go wrong,” he says discussing how to cure insomnia. “It was only when I gave CBT-I a go that I really understood sleep, and how to fix it. It works.”
I don’t have kids, but Jack’s existential night terrors sounded familiar, so I reached out to Dr David Garley, founder of The Better Sleep Clinic, a private facility promising to improve sleep within two to four video sessions. We met for a first session via Zoom, and I was relieved to see Garley looked incredibly well-rested.
What causes true insomnia?
“You start building adenosine from the moment you wake up, while the circadian rhythm kicks up during the wake phase and keeps you feeling alert during the day,” Garley explains. If the two systems are aligned, our circadian rhythm naturally dips towards sleep just as our adenosine levels are reaching their peak. The result is sleep. If you stay awake, your adenosine continues to build, making you feel exhausted. At the same time, we might be awake so long that our circadian rhythm then tells us it’s time to wake up. Essentially, our brain is receiving two conflicting signals. This is insomnia.
What exactly is CBT-I?
CBT-I aims to cure sleeplessness by altering our thoughts and behaviours around shut-eye. You might go to bed later than usual and think ‘Now I’m never going to sleep’ or, like me, you might wake up for a pee and spend the next hour thinking about all the emails you have to send the next day. CBT-I asks us to reframe these nagging thoughts and be systematic about ditching the bad sleep habits. It’s an evidence-based approach, very similar to CBT (Cognitive Behavioural Therapy), the popular method used to treat mental health issues.
Garley starts by asking me about my lifestyle. I tell him I thought I had good sleep hygiene, but that the melatonin tablets and meditation were no longer cutting it. He hands me a diagnosis of chronic insomnia, which he defines as difficulty falling or staying asleep that affects you three or more times per week, for longer than three months, and has an impact on you during the day. Check, check, check.
“By the time they've booked in with us, most people have been around the houses, they've done everything, and nothing's worked,” says Garley. “With chronic insomnia, it's nearly always treatable in the vast majority of cases. It's absolutely my expectation that your sleep will get better.”
How do you get started with CBT-I?
When it comes to behavioural changes, CBT-I draws upon a number of core techniques, with experts like Garley choosing from the wider menu on a case-by-case basis. Some of these you’ll have heard of before. ‘Relaxation Techniques’ like meditation and muscle relaxation can fall under CBT-I, with the goal of calming the mind and body before bed. Likewise, ‘Sleep Hygiene Education’ features prominently (keeping your room quiet, dark, and cool, and not eating a massive meal just before bed). ‘Stimulus Control Therapy’ encourages us to keep the bedroom reserved for sleep and sex only.
What grabbed my attention about CBT-I is that it’s highly structured, science-based and goal-oriented. You’re meant to leave the programme with a new sleep routine that you can implement on a nightly basis. ‘Sleep Restriction’, for example, requires limiting time spent in bed to the amount of time you spend actually sleeping. So if you’re only able to sleep 5 hours a night, then you limit yourself to 5 hours in bed. Initially, this means losing a bit of sleep, but by gradually increasing the time in bed over a few weeks, the patient should naturally sleep longer to fill the time. According to Oxford University, a whopping 42 per cent of patients reported better luck falling asleep six months after trying this treatment.
Garley’s first piece of advice surprised me. He said that rather than go to bed around 9:30pm as I had been doing, I should stay awake and out of bed until 11pm (or later if I still didn’t feel tired). Then, when I woke up at 7am, I had to get up and get on with my day. What’s more, if I didn’t fall asleep at night within 20 minutes, or if I woke up and couldn’t get back to sleep within 20 minutes, I had to leave the bedroom entirely and go do something relaxing, like a puzzle or reading in another room, until I felt sleepy again. Only then could I go back to bed. “The body is triggered to fall asleep through the association of the bed,” says Garley. “Spend too long awake in the bed, and this becomes weakened.”
Meeting with Garley two weeks later, I was happy to report that it had worked. Previously, I could mostly fall asleep quickly, but I’d soon wake up around 11pm, sometimes staying awake until 4 or 5 am. By staying up later, I found that not only did I have more time to do fulfilling, relaxing things in the evenings, I was genuinely tired when I went to bed.
How to cure insomnia; change your 3am thoughts
In our second appointment, I asked Garley if CBT-I could help me rethink my anxious thoughts. Having felt Cognitive Behavioural Therapy useful for day to day, waking anxiety in the past, I had high hopes that some Cognitive Restructuring now could help me sleep. “The second we’re in bed, not being able to sleep, our brains just spiral down into a vortex of progressively negative thinking because they have nothing else to do,” he says.
Some sleep influencers might suggest distracting yourself by doing exercises like trying to think of an animal for every letter of the alphabet. Garley says this doesn’t work because the thought is still there. “Try not to think of an elephant, and it’s all you can think of,” he says. Advice like this is tricky because it becomes a form of ‘sleep effort’, i.e., just one more thing to worry about. “Sleep as a human process is extremely unique, in that the more you try to do it, the less likely it is to happen,” says Garley.
The answer again is to get out of bed and do something gently reassuring, like listening to the Shipping News or getting back to that puzzle. In time, the brain should calm itself and drift back toward sleep. Long-term, the solution is ‘constructive worry’, ie, converting anxious thoughts into actionable problem-solving. Concerned about that big meeting tomorrow? Spend five minutes going over the plan then forget about it until the morning. “Our thoughts are naturally more negative at night,” says Garley. He suggests I take half an hour to write down reflections on the day, two to three hours before bed. “This can be worries about work, your to-do list, or anything that is on your mind. You can also write down any worries about sleep itself.” Once the thoughts are down on paper, Garley encourages me to spend some time planning how I could deal with them. Crucially, I’d then set a time to next think about this list in the morning – not as soon as my head hit the pillow.
Does CBT-I really work?
The evidence points to yes. A meta review published in the American Journal of Lifestyle Medicine found that CBT-I is indeed an effective tool to help cure insomnia, with sleep efficiency – the amount of time we actually spend asleep while in bed – improved by 10 per cent on average.
A month into my journey, Garley's techniques are helping. I’m sleeping better, waking up fewer times in the night and feeling more refreshed in the morning. And, I’m generally less anxious – which in turn, improves my sleep even more. Garley says we can also help ourselves by suspending our judgment of how our night’s sleep went until we’ve been awake for a few hours and are out of the groggy just-woke-up mindset.
Halfway through my CBT-I course, I came up against a real test. I’d travelled to the US for a half-marathon and was feeling nervous. Already jet-lagged, I’d need to be up at 5am to prepare. It just so happened that our hotel was blasting music until 4am. No rest to be had. After hours of trying to sleep, I thought about Garley’s advice and decided to change tack. I told myself, yes, I would be tired, but having travelled across time zones, I was always going to be tired. Instead of worrying, I told myself to wake up at 5am, go all out for two hours, then feel tired later. I got up and ran the race.
https://www.gq-magazine.co.uk/article/30-days-of-cbt-i-to-cure-my-insomnia-heres-what-happened
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