CBT or Transition Trek?

How does the method of getting to sleep presented in In Pursuit of Sleep differ from Cognitive Behavior Therapy (CBT)? In Pursuit of Sleep‘s emphasis is the Transition Trek, an imaginary path we travel down after we close our eyes to reach Slumberland. CBT for insomnia (CBT-I), http://www.cbtforinsomnia.com, focuses on reducing daytime stress, providing a favorable bedroom environment, and having a good attitude toward sleep. They accomplish this with 5 sessions of instruction over 5 weeks. The CBT-I method also does not think much of sleep medication. I believe the CBT-I method is excellent, and this article by Austin Frakt in the New York Times would seem to prove that point. It is proven to be more effective than medication and the results of the sessions generally stay with you and improve you life. This research study published in the Journal of the American Medical Association also demonstrated considerable benefit to CBT-I. However, 9 of the 63 subjects simply walked away from the study before completion of the treatment phase because of lack of interest, which demonstrates that it isn’t for everyone. In addition, the Transition Trek method should start working the very first night.

So what does the Transition Trek method have that CBT-I doesn’t? CBT-I has nothing that actually directs the mind toward sleep. It offers nothing in the way of a psychic action to pursue sleep. Even though it provides both an external and internal environment conducive to sleep, it still expects you to “fall” asleep. The same mental processes that have prevented you from going to sleep in the past are still active although the negative influence will definitely be diminished. It does not address all the distracting elements of hypnagogia (sleep onset).

The Transition Trek method provides activities that occupy your mind and direct it toward sleep. It provides both imaginative images and a narrative to occupy your psychic voice that will lead you into Slumberland. But In Pursuit of Sleep offers much more than that. It provides a detailed description of sleep onset and the psychic environment that leads the mind astray in the first place. It is not just a corrosive external environment and internal stress that has lead you astray. These in all probability are not even the most important impediments to sleep. If you don’t understand all the elements of hypnagogia, you cannot possibly understand how to control the mental processes encountered on your way to sleep.

Perhaps the most beneficial aspect of the Transition Trek is the focus on images and the other psychic senses that position you in the psychic world where sleep occurs. In Pursuit of Sleep also makes you aware of the effects of “deafferentation” that diminish the physical irritants (like itches, cold feet, restlessness, etc) that can keep you from believing you are going to sleep. In doing so, In Pursuit of Sleep focuses on the way the mind functions while transitioning from being awake to being asleep.

The other beneficial concept presented in In Pursuit of Sleep is the “sleep propensity curve.” The identification of this curve helps you understand what has gone wrong with it and how to repair it over time, so that you have a high probability of getting to sleep and staying asleep every night.

The bottom line is that CBT is extraordinarily helpful and has been proven so, but it still has some deficiencies because it is not focused on the mental elements of actually getting to sleep. In Pursuit of Sleep fills in that deficiency.

Insomnia or Sleeplessness?

I have been pondering the article I ran across recently concerning sleeplessness. In this blog post, I referred the reader to a 2011 article in the American Journal of Public Health concerning the medicalization of sleeplessness as insomnia. The problem is that I can find no official publication that draws a distinct between the two. This confusion, if it indeed exists, goes back at least as far as 1888 as demonstrated by this article from that time period, which uses the words “sleeplessness” and “insomnia” interchangeably. A quick search of the Internet reveals no consistency in the definition of insomnia, and rarely do they discuss sleeplessness. I believe the distinction drawn by the article in the AJoPH is valid. I do not believe stress induced sleeplessness should be considered insomnia. However, I have used the terms interchangeably in IPoS because they are treated that way even within the medical community.

Is In Pursuit of Sleep directed toward sleeplessness or insomnia or both? If the distinction drawn in the AJoPH is used, IPoS primarily addresses sleeplessness. However, since the distinction is rarely drawn even in the medical community, IPoS reasonably uses the most common term for sleeplessness, which is insomnia. Hopefully, someday the distinction between these two separate conditions will be properly defined. I also believe that IPoS can be beneficially used, under certain circumstances, for the medical condition. Even the thoughts of those with a medical condition can go astray when trying to go to sleep. That is the reason I do not recommend anyone considering using the method developed in IPoS stop taking medication provided by a healthcare worker.

Does the distinction really matter? My contention is that it matters very much. The reason is that sleeplessness, using the strict definition, should be treated with thought control techniques such as that provided in In Pursuit of Sleep. My non-professional opinion is that medication for this condition should only be prescribed on a temporary basis. Insomnia, using the strict definition, is then a medical condition and should be treated with medication as long as deemed necessary by a healthcare provider, possibly augmented with thought control techniques.

Of course, pharmaceutical companies would resist this distinction because they want to treat both conditions with medication from now to the end of time. It increases the demand for their products and produces higher profits.

Oh If It Were Only True!

In my continuing saga exploring the historical pages of the New York Times, here is one article that proposes that eye defects are the cause of insomnia. Too bad it didn’t turn out. Anyway, here are the first four paragraphs of a very long article from Sunday, April 25, 1915. The headline is: “EYE DEFECTS CAUSE OF INSOMNIA, Practically All Cases of Insomnia Traced to Some Ophthalmic Trouble by a London Specialist.”

First 4 Paragraphs of 1915 New York Times Article on Insomnia

First 4 Paragraphs of 1915 New York Times Article on Insomnia

You can read the entire article here. Too bad Dr. Pronger’s theory didn’t meet the test of time.

What I find most interesting is the seriousness of the impact of insomnia even back 101 years ago, the reference to “the actual wastage of human lives by suicide, wrecked brains, and shattered nerves.” I realize that insomnia has been a part of the human experience going back as far as written records allow us to probe, but to have this degree of suffering caused by it, I just had no idea.

Of course, Dr. Pronger was a consulting ophthalmic surgeon to Harrogate Infirmary and would have seen the worst of it. I cannot say with any sort of certainty that the method I present in In Pursuit of Sleep would have helped any of them, although I do believe it could have helped many. However, there were people in the world then and there are today who have sleep problems that can only be addressed effectively with medication.

A Cure for Sleeplessness from 1876

Here is another article I ran onto today in the New York Times historical records. It was published on Saturday, December 30, 1876:

Short Article in the New York Times on Saturday December 30, 1876

Short Article in the New York Times on Saturday December 30, 1876

What intrigues me about this article is the suggestion by the American physician, Dr. Cooke, that, “…in numerous cases of sleeplessness it is only necessary to breathe very slowly and quietly for a few minutes to secure a refreshing sleep.” In In Pursuit of Sleep, I call this method “sleep breathing.” See pages 31/2. Of course, this is only one of several components of the Transition Trek method. But I suggest initiating sleep breathing at the very beginning of the Transition Trek, which then triggers the start of several physical processes that lead toward sleep.

A Cure for Sleeplessness from 1888

I ran onto this today by accident. From the New York Times, Saturday, August 11, 1888:

Short Article in the New York Times on Saturday August 11, 1888

Short Article in the New York Times on Saturday August 11, 1888

This brief little article suggests that someone having difficulty sleeping might think of a previous dream and go “over and over the scene it presented” to induce sleep. This is the subject of Chapter 6 Chasing Hypnos, pages 67-80. In that chapter, I recommend documenting five dreams and reading over them before bed. Then if you have difficulty getting to sleep initially or back to sleep after waking during the night, that you can use those five dreams to assist you getting to sleep. Of course, I also appropriate Hypnos, Greek God of Sleep, and Hermes, Guide of Souls in the Underworld, as aids with this.

The article also confirms my experience that, “counting numbers or repeating easy-flowing verses” frequently fails. Of course, In Pursuit of Sleep does suggest (Chapter 5 Controlling Your Psychic Voice) that poems can be used to augment the Transition Trek, but that is completely different from requiring the poem go it alone.

Anyway, interesting voice from the past with a couple of interesting thoughts on insomnia.

(Note that the article originally appeared in the London Figaro, a periodical founded by James Mortimer in 1870. It ended publication in 1897 due to a significant decrease in readership.)

Public Health Concern: Medicating Sleeplessness

Here is an extraordinarily interesting article in The American Journal of Health from August 2011 titled, “The Medicalization of Sleeplessness: A Public Health Concern.” What I find most interesting is the way the article draws a distinction between insomnia and sleeplessness. Here is the article abstract:

Sleeplessness, a universal condition with diverse causes, may be increasingly diagnosed and treated (or medicalized) as insomnia. We examined the trend in sleeplessness complaints, diagnoses, and prescriptions of sedative hypnotics in physician office visits from 1993 to 2007. Consistent with the medicalization hypothesis, sleeplessness complaints and insomnia diagnoses increased over time and were far outpaced by prescriptions for sedative hypnotics. Insomnia may be a public health concern, but potential overtreatment with marginally effective, expensive medications with nontrivial side effects raises definite population health concerns.

Further down, the article address the issue of possible over treatment more specifically:

It is unclear … if the United States is facing a true insomnia epidemic or a surplus of diagnoses and drug prescriptions. … Awareness raised by public health and pharmaceutical agencies may facilitate new diagnoses. Medicalization may also contribute to the increased perception, diagnosis, and treatment of sleeplessness as the medical condition insomnia.

This situation within the medical community is precisely what In Pursuit of Sleep is intended to address. If insomnia is a medical condition and sleeplessness is a behavioral issue, insomnia should be treated with medication and sleeplessness should not. If sleeplessness is diagnosed as insomnia, the wrong treatment can be prescribed and actually harm the patient.

The big problem, of course, is that we don’t have an effective treatment for sleeplessness. The reason for this is that the medical profession and scientific research community are not addressing what is going on within the mind during the transition from being awake to being asleep that is causing sleeplessness. Here is a quote from In Pursuit of Sleep (pages 16-17), which includes a reference that fully explains the situation:

The strange thing is that, although hypnagogia [sleep onset] has been studied, it is rarely, if ever, addressed when discussing insomnia. Yes, you read that right. When professionals deal with the problems of getting to sleep, they rarely if ever discuss the nature of the transition state and how to deal with it.

…we know neither why nor how we fall asleep. The study of sleep has for the most part focused on measures obtained during established sleep, and many of the events and phenomena of sleep onset have been ignored. [Sleep Onset, Normal and Abnormal Processes, edited by Robert D. Ogilvie, PHD and John R. Harsh, PhD, Washington DC: American Psychological Association, 1994, page xviii]

Again, researchers are focused on the physics and chemistry of brain function during sleep because they are developing medication to put you in that state, and they specifically exclude the subjective personal experience of sleep onset (hypnagogia). This is incompetence on a colossal scale. It is difficult to understand how this could be happening without conscious disregard for the origin of the sleeplessness problem because to do so would result in behavioral solutions that would cut into the profits of pharmaceutical companies, perhaps putting some of them out of business. This situation is intolerable and In Pursuit of Sleep is intended as a first step in remedying this situation.

Ambien and the Elderly

Here is an article in the NY Times about sleeping pills and the elderly from a couple of years back. Seems a CDC study (online here) reported that it is not a good mix. Here is the most potent paragraph in the NY Times article:

The data also showed that Ambien, the use of which has soared in recent years, accounted for one in five E.R. visits among those older than 65, more than any other medication.

Concern over prescribing medication as a sleep aid for the elderly prompted this comment by a well known geriatrician:

“I’m not comfortable writing a prescription for these medications,” said Dr. Cara Tannenbaum, the geriatrician at the University of Montreal who led the weaning study. “I haven’t prescribed a sedative-hypnotic in 15 years.”

So what should an elderly person with insomnia do?

Well, I am elderly, 74 years old, and I use the Transition Trek method of getting to sleep as presented in In Pursuit of Sleep. I have found it practically foolproof. I use it every night, multiple times if necessary, and it works every time.

Insomnia and Type 2 Diabetes in Women

Getting to sleep and staying there is the cornerstone of health, both physical and psychological. Now we have a new study reported in the NY Times that insomnia can increase the risk of Type 2 Diabetes in women. Insomnia is rampant throughout the world, and it is healthy people who are developing it.

What has gone wrong?

It seems that research scientists (pharmaceutical companies, wouldn’t you know) are concentrating exclusively on drugs to put us into a sleep-like state instead of investigating the mental process that prevent us from sleeping. If it is not drugs they want us to take, they tell us about all the things we can do before we close our eyes to improve our chances of going to sleep. And they have a CBT course you can take online or in seminars that cost hundreds of dollars and take weeks if not months. All with marginal results.

Here’s the problem: They do not concentrate on the 5 to 10 minute period of time following when we close our eyes and go to sleep. And yet, that is where insomnia starts.

The time between being awake and being asleep is called “sleep onset” by scientists but also goes by the term “hypnagogia.” This short period of time under normal circumstances can expand into hours if we cannot get our thought processes under control. Sleep onset is complex and has creative, problem-solving and worry elements. These distracting elements of sleep onset can be controlled with a mental process that leads the mind safely through this hypnagogic quagmire and into sleep.

But you can’t just lie there waiting for sleep to come to you. You have to go get it. The method of doing this is presented in In Pursuit of Sleep. It is really easy and doesn’t take much time and costs very little money.