Paige Rome, RPsych | CBT-I Meets ACT: A More Flexible Approach to Insomnia

some difficulties.

Yeah, so in your story about that first night and then maybe how it was reinforced, there was this... bottom up level of it, of just your body not being able to sleep that night.

And then there's the way that it was almost like an intrusive thought that came in of like, what if I can't sleep and I can't care for my baby? So there's this merging of like bottom up and top down processes that at least started in your retelling of that first night.

Is that often what it's like for people with insomnia? I'm sure there's many different rivers that flow into people not being able to sleep, but maybe let's just define insomnia and some of the different ways it might look for people.

Yeah, absolutely.

Insomnia is a word, I think people use it pretty loosely.

And we'll say, you know what, I slept a couple poor nights this week, I have insomnia.

Or I have one night of really poor sleep, I must have insomnia.

Or even, you know, I had insomnia last night, you know, used to describe a night of poor sleep.

But to diagnose with insomnia, there's a few benchmarks that you have to reach.

And that would be at least three nights per week of really difficult falling asleep and staying asleep throughout the night.

And those would be two different ways that it can present their sleep onset insomnia.

So can I fall asleep normally at the beginning of the night? And their sleep maintenance insomnia being, can I stay asleep

throughout the night? Yeah.

Hmm.

Yeah.

And so keep, go ahead.

No, you keep going.

So on top of the, so three, three nights a week, you're going to want to see to, to diagnose insomnia anyways, that show up, right? You're also going to see it at least for three months if you're going to say, okay, this has now become chronic insomnia because insomnia can show up for a brief period of time, which is very common.

About 30% of the population will experience insomnia symptoms at some point, but for it to be considered chronic, that's at least three months of three nights a week of struggle that's really impacting your ability to function in the day.

Yeah.

And with this, there's working with people who have struggled with this and knowing people and even nights where I've struggled sleeping.

It's so tough because it's one of these things that you want so badly, but there's nothing you can do ultimately to make it happen.

And so there becomes this real paradoxical energy of the very thing you want being completely out of your control, which I think we're going to get to as well.

But in both of those, like sleep onset and the maintenance side of it, which I'm sure people can have both, right? In that, there has to be some merging of those bottom up and top down too.