
A new insomnia therapy - rapnie
https://www.theguardian.com/news/2018/sep/14/finally-a-cure-for-insomnia
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egjerlow
What exactly is new about this? CBT+sleep efficiency is pretty much the
standard advice for insomnia (after having tried reducing blue light, regular
schedule etc)

~~~
m0nty
> What exactly is new about this?

My thoughts exactly. I've tried all the things in the article (inluding CBT)
and they are ineffective for me. This is acknowledged in the article ("we're
all different") but the overall tone is that of a "miracle cure" when it's
just patiently and steadily applying well-known ways to improve sleep. This is
good, but it's not revolutionary.

The only part of it which resonates for me is that the majority of doctors and
other medical professionals are truly, utterly crap when it comes to insomnia.
They don't think it's important and they don't care that it's a living hell -
"after a couple of nights without sleep, you'll sleep through anything", as
one doctor glibly told me. But I've been 100 hours without sleep and that's
nowhere near a record compared to other insomniacs.

Anyway, let's not get too distracted by a flashy headline and the overall tone
of the article. The very fact that a group of medical professionals is taking
sleep seriously is significant in itself. I hope it starts a trend.

~~~
gnulinux
This is exactly like my experience. I've seen more than 10 doctors for my
desperately aggressive insomnia. Neurologists, psychologists, psychiatrists.
Not only in US, even in some European country. They always acted like "yeah
just perform sleep hygiene and you'll be gucci" "doctor, I do do that but I
still can't sleep for days" "it's ok habits take time" Uhhh. To me it just
seemes like being unable to sleep (at all) multiple days a week seems alarming
enough medical issue that they'd try harder. One time I was prescribed Ambien.
I used it for 3 days and it gave me some sort of psychotic episode, it was a
terrifying experience I was locked in my own body. My doctors reactions was
something like "do you even want to get better???" I hate insomnia.

~~~
m0nty
The drugs are appalling. They have all sorts of weird side-effects but offer
only marginal benefits in terms of sleep amount and quality. I have used
Mirtazapine to good effect, however, so you might yet find something which
does suit you. The only other thing which has worked is just learning to
accept the suffering and not get too stressed out about it. Losing sleep is
bad, but getting angry about it just pushes me over the edge, so I avoid
getting angry.

~~~
gnulinux
> The only other thing which has worked is just learning to accept the
> suffering and not get too stressed out about it.

This REALLY helps. Last ~8 months has been a paradise for me because my
insomnia was so mild (I spent maybe a total of 2 or 3 completely sleepless
nights and my previous average was 2 or 3 _a week_ ). The only difference is
that I stopped giving a shit, if I'm sleepy and feel like shit, that's fine.
It really does help.

~~~
milesvp
It's my experience as well (though I'm starting to think my insomnia is very
mild reading this thread). I find my insomnia tends to get worse the more I
fight it. So I stay up later than I'd prefer, so that I'm more tired, and less
likely to be awake in the middle of my sleep. I also will get up in the middle
of the night if I can't sleep and just be awake for a few hours until I feel I
can go back to sleep. But if I fight it at any step sleep seems to be harder
to come by, regardless of how tired or lacking if sleep I am. I also can't use
an alarm clock. If I do then the odds of sleep go way down, since now there's
a race and if I don't fall asleep now, then 'I might not get enough sleep' or
'I might wake up in the wrong part of my cycle'. I've also neen experimenting
with lighting. Blue lighting definitely wakes me up at night so I avoid them.

But I consider myself lucky. I've mostly engineered my life such that I don't
need to function before 10am (I think I'm genetically predisposed to a late
sleep cycle, so far it looks like 2/3 of my kids may as well). I can afford to
not use alarm clocks most of the time. And, it's possible my insomnia is
nowhere near as bad as others'...

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euthymiclabs
As many others have noted, the title is inaccurate; cognitive behavioral
therapy for insomnia is a well established treatment.

There are a few other minor inaccuracies in the article: chronic insomnia
requires only 3 months of sleep disturbances, not 6. And the case for the
dangerousness of insomnia is dramatically overstated.

But with that said, the reality of insomnia treatment in most countries is
that doctors either 1) don't know about CBT for insomnia or 2) don't have a
way to refer people to see a behavioral sleep specialist. I practice in
Seattle, and there are only 4 clinics that have behavioral sleep specialists.
In more rural areas, it's even more uncommon.

So in truth, for most patients and most doctors, this does feel like a brand
new therapy.

Thankfully, "sleep efficiency" training (aka sleep restriction) is a simple
algorithm that doesn't really require hand holding, and works reasonably well
when practiced through a book or online program. Motivation tends to be better
when you meet with a therapist, but the recovery rates are similar for highly
motivated people.

Disclosure: I provide in person CBT for insomnia and run a pay-what-you-can
CBT for insomnia web app at SlumberCamp.co.

~~~
Apocryphon
Not in the U.K., it would seem. The article gives the impression that CBT for
insomnia is relatively new there.

~~~
euthymiclabs
Good point. The science has been around since the 60's and 70's, but the
evidence base has only become overwhelmingly positive over the last 20 years.
And from a guidelines perspective, the European Sleep Research Society started
recommending it as the first line treatment in 2017
([https://www.ncbi.nlm.nih.gov/pubmed/28875581](https://www.ncbi.nlm.nih.gov/pubmed/28875581)).
I'm not as up to date on NICE and NHS guidelines.

------
cowpewter
What's finally helped me fall asleep pretty consistently is listening to
hypnosis videos with a pair of those sleep headphones (flat padded speakers
embedded in a soft headband). I used to listen to podcasts, and it helped to
have something other than my thoughts to focus on, but I'd still frequently be
awake 3-4 hours after lying down. With the hypnosis tracks, I'm consistently
out within an hour after lying down.

I'm particularly fond of this one:
[https://www.youtube.com/watch?v=bFqEWrw6jyg](https://www.youtube.com/watch?v=bFqEWrw6jyg)

Of course, my wife still falls asleep within 10 minutes (I'm so jealous of her
ability to just roll over and be out), versus my 45-60, but it's a vast
improvement to not be lying awake for hours every night.

------
santoriv
I know this isn't really the point of the article but I was having issues
waking up for several hours during the night for the last couple of years.

About 5 months ago I started doing a 3-day a week weight training program
which includes full body compound movements (squats, deadlifts, etc.) and now
I sleep like a baby through the whole night every night.

I know that may not work for many people but it worked wonders for me.

As an added benefit I've lost a bit of body fat, feel better mentally and
physically, and have been able to reduce my blood pressure medication dosage
by 2/3.

~~~
fbr
Have you changed your diet?

~~~
santoriv
A little bit. I've been trying to eat less processed sugar, but that's about
it.

------
rq1
Just fell asleep reading the article.

~~~
ArcticCelt
We simply misunderstood the headline; It's not an article about a new cure for
insomnia, the article IS the new cure.

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0xcde4c3db
Are there any _high-quality_ studies supporting the efficacy of CBTI? Most of
the ones I've seen are terrible.

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exodust
The article lost me in a sea of introductory fluff, and I never made it to the
end.

As always, the best solution is good old fashioned discipline.

Get up at the exact same time every single damn day. No matter how late you
stayed up. When you wake up, and it's 7am or whenever your alarm goes, get up.
Don't close your eyes again.

The rest is about _pretty good diet_ and _reasonably regular exercise_.

And no, you don't need to give up coffee. Have it as strong as you like.

------
fredley
The article is very long-winded.

TLDR: CBT and observing a few physical parameters that affect your sleep
(temperature, light, sound), as well as getting the right amount of sleep (not
too much, not too little) will sort out most people. For me strictly banning
all screens from the bedroom has helped too (I have an alarm clock with no
backlight so I can't even check the time).

I did exactly this sort of thing years ago via Sleepio[1], which I highly
recommend. It is a guided CBT course that completely sorted my chronic
insomnia, using pretty much all the methods described in TFA. It will take you
less time to sign up than to actually read said long-winded article.

1: [https://www.sleepio.com](https://www.sleepio.com)

~~~
xyzal
I cannot recommend Sleepio enough everytime someone mentions sleep trouble.
The time-in-bed restriction regimen is in my opinion particularily helpful and
I revert to it occasionally when I don't sleep well a few nights in a row with
good results.

~~~
fredley
Totally agree with you. It seems so counterintuitive that when you're
struggling to sleep you may need _less_ time in bed, but it really helps in
the long run.

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albanberg
Sleep can often be improved by doing a short (15 to 30 min) simple (you don't
have to be limber or do difficult poses) viniyoga program that is set up by a
properly trained instructor. A new client will need 3 or 4 meetings with the
instructor over a couple of months. The practice/program is done at home
either in the morning or at night.

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doon123
An Honest Question, why are sleep related articles able to gather so much
traction here on HN?

~~~
ericdykstra
Sleep is one of the three pillars of health. There are also many fitness and
diet articles that gain traction.

As to why health is popular on HN, it's hard to be interested in the other
stuff if you're dead! (I don't actually know why, I'm interested in these all
personally, but nearly never upvote the articles myself)

~~~
apatters
Well, many developers probably aren't in the best health because the job
requires sitting all day. Everyone wants to be healthy so there will be a
natural demand for articles about it amongst developers.

------
bryanlarsen
TLDR: limiting caffeine and other stimulants and "sleep efficiency training"
is successful for 80% of patients.

The description of sleep efficiency training starts at the picture labelled "A
patient at the sleep clinic". That section appears to contain highly
actionable advice.

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nemo1618
I really can't stand how articles like this bury the actual information (in
this case, basically just CBT) deep in anecdotes and other context that I
don't care about. Is it just me, or has it gotten worse lately? Maybe in the
Age of the Short Attention Span, journalists have to come up with other ways
of making the reader stick around?

~~~
emerongi
Is there a name for this writing style?

I remember writing essays in school padded with a lot of babble, just because
there was a word limit. As an adult, anyone who writes like this is just
wasting my time. It's low information density.

~~~
thecatspaw
its long form journalism

excerpt from wikipedia

> Typically this will be between 1,000 and 20,000 words. Long-form articles
> often take the form of creative nonfiction or narrative journalism.

~~~
ianai
Long form journalism conveys an equally large amount of information as length.
Articles like this just add fluff - anecdotes and tangential subjects that
don’t add meaningful contextual value.

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Void_
There's one instance of f-word in this article. Would it have been so hard to
replace that one word with something kid-friendly?

Seems like a very sneaky way of putting language like that in readers' minds.

