Insomnia Q&A #1: Managing Urination & Anxiety With Insomnia
I answer questions from viewers about urination and insomnia, managing anxiety with insomnia, and questions about my qualifications and experience.
If you have questions about insomnia, post them in the comments below the video and I’ll create a video to answer your questions.
I COVER:
Can CBT-I cure insomnia caused by the need to urinate during the night?
How does it work if you have severe anxiety when you are awake at night and feel so bad you have no energy to do something out of the bed?
What is your background in sleep study?
Are you a qualified doctor with clinical records in the success of your courses?
Can you give a brief description of what motivated you to tackle the niche category of insomnia?
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WHAT I DO:
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-Steve
00:00 Introduction and Viewer Questions Overview
00:19 (Urination) Understanding Insomnia Triggers and CBT-I
06:04 Addressing Anxiety and Insomnia
14:15 My Background and Qualifications
18:27 Measuring Success and Client Feedback
24:04 Motivation and Specialization in Insomnia
27:10 Conclusion and Call to Action
RESOURCES
#1 Way to Cure Insomnia
TRANSCRIPT
Introduction and Viewer Questions Overview
So today I'm going to answer some questions from some viewers. I'm going to be covering, how do you handle if you have to urinate in the night and how that affects insomnia? And can you overcome insomnia if you have that problem? Anxiety and insomnia. How do you deal with anxiety and insomnia? And then some questions about my background and qualifications.
Understanding Insomnia Triggers and CBT-I
So let's start with the first question, which is, Can CBT I cure insomnia caused by the need to urinate during the night?
So CBTI is the gold standard treatment for insomnia, cognitive behavioral therapy for insomnia. I've done other videos, recent videos where I go describe what CBTI is. So I won't do that here.
But this question is if you have to get up and urinate in the night and that's interfering with your sleep, can CBTI cure the insomnia?
To answer this question, you have to kind of break apart a couple things here. Number one, you need to separate the trigger from the cause. So what's a trigger?
A trigger is anything that is [00:01:00] disturbing your sleep. So that could be the need to urinate in the night. It could be loud noises outside. It could be a stressor going on in your life like a job that's very stressful or you having a relationship issue. Or even something positive like you're going to be traveling the next day and you're excited and it's hard for you to sleep.
So those are triggers that can lead to a poor night of sleep or even a couple of poor nights of sleep. But that is not insomnia yet. Insomnia is a pattern of trouble falling asleep, staying asleep over a certain period of time that's consistent. It is not just a poor night of sleep.
So you first need to separate these apart so the trigger can lead to poor sleep. But what creates insomnia is the way we react to the trigger. We get really anxious. We start worrying about our sleep and then we start doing things. We start changing our behaviors around our sleep that then actually mess up our sleep even more. These are called poor sleep [00:02:00] behaviors and that increases our anxiety more, which makes us want to try to fix the problem more, which makes the problem worse. And this creates what I call the insomnia cycle.
That is what creates insomnia, not the trigger. Everybody has poor sleep sometimes, and that's a normal part of being a human being. But that does not, necessarily lead to insomnia is how you respond to that trigger. So that's the first thing.
So one trigger of poor sleep or one cause of poor sleep can be the need to urinate.
Now this is more common with people who are getting older, let's say fifties and older and particularly with men. And this is just a normal thing because of the prostate. As men get older, their prostate Changes and they might have a more of a need to urinate in the middle of the night. And this is actually very common.
If you're doing that maybe two or three times a night, there's nothing wrong with that. And as long as you're able to get back to sleep, so you get up, you go to the bathroom and as long as you're able to get back to sleep within a reasonable amount of [00:03:00] time which is generally 20 minutes even up to 30 minutes or less. Then you don't have insomnia and it's not a problem because that's a normal part of just aging.
The problem is if that has led to you developing insomnia because when you get up in the night to urinate, you get really anxious and you get into that cycle that I just described that actually ends up creating the insomnia.
So you want to separate these two because it's not the urination that's causing the insomnia. It's, the way you're responding to the fact that you have to get up in the night to go to the bathroom. And it's that response that's causing the insomnia and that response can change.
So to answer this question, can CBT I cure insomnia caused by the need to urinate during the night?
The answer is absolutely yes. CBT I can get rid of insomnia no matter what the trigger is, because it's not the trigger that's actually causing the insomnia. It's your response. It's the negative sleep thoughts and it's the behaviors, the poor sleep behaviors that get adopted in [00:04:00] response to the poor sleep that then actually make the insomnia worse unknowingly to you because you think you're helping your sleep, but you're actually making it worse.
And then what you want to do is address the problem. Now, if you're getting up in the night two or three times, and you're, you know, let's say an older person, 50s, 60s, 70s, older than that, that's normal. That's not a problem as long as you're able to get back to sleep. However, if you're getting up, you know, five times a night, eight times a night to do that, that means there's something more serious wrong with the prostate, if you're a man or if it's a woman, it could be some other issue. And that would be more of a separate medical issue, separate from insomnia that you would want to address because that could disturb your sleep.
So a lot of things can like interrupt our sleep. There could be loud noises outside. The neighbors could be having a loud party. Your partner, if they move around a lot in the bed, that can disturb your sleep. But those things are not insomnia. Those are things, those are just like conditions that make it difficult to sleep, but that is not [00:05:00] insomnia.
Insomnia is internal. It's a pattern of poor sleep where your sleep system actually shifts based on those things I said earlier, the shift in the way you're thinking about your sleep. Now you're really anxious about your sleep and you've changed your behaviors.
So you want to separate these two issues, whatever the trigger is, whether it's urination or something else, and address that as best you can.
So, if you if it's a real problem, then go to your doctor and, try to, you know, treat the prostate or whatever the problem is so you can, be getting up less in the night.
Sometimes it's a matter of drinking less a few hours before you're going to sleep. Sometimes people drink a lot of liquids at night, at the nighttime, tea, things like that. So you want to reduce that, so you're not, having to have the need to go to the bathroom as much.
But then if the insomnia is already there, even once you remove the trigger, insomnia remains. Once it becomes a pattern, you have to address it as a separate issue. And in that case, the gold standard is CBT-I.
And again, I've done videos on that. I'll put a link to the video that I recently [00:06:00] did or the playlist that I, that I'm creating that kind of goes into CBT-I in more depth.
Let's get to question number two.
Addressing Anxiety and Insomnia
How does it work if you have severe anxiety when you are awake at night and feel so bad you have no energy to go do something out of the bed?
So part of CBT I, part of the treatment for insomnia is getting out of the bed at a certain point when you're not sleeping. Now, I'm not going to get into that skill that's called stimulus control or in my insomnia program that I have, I call it 30 30 because I don't like stimulus control. And it involves getting out of the bed, but it involves doing it at a certain time in a certain way. There's a whole mindset around it. It's, It's probably the most, challenging skill in the process because it's both behavioral, changing behavior, but it's also, a shift in your mindset that's really key to overcoming insomnia.
And you actually don't even start doing that until the third, week of the process. And you're doing that in addition, in conjunction with a few other [00:07:00] key skills. So it's not just one skill that gets rid of insomnia. It's a combination of things done in a certain sequence.
To answer the question here, this person is asking is they're lying in bed at night, they're awake, they have insomnia and they're really anxious.
What you want to pay attention to here is the wording used in this question. Okay, because that's one of the keys to solving this problem. First of all, this person is saying they have severe anxiety.
Okay. Well, you want to first distinguish what kind of anxiety? When someone has insomnia, they have anxiety. They have anxiety about their sleep. It's called sleep anxiety. Those are caused by negative sleep thoughts.
That's things like, Oh my God, I'm never going to get over this. What's the matter with me? I've lost my ability to sleep. How am I going to function tomorrow if I don't get a good night of sleep?
Okay, that creates a lot of anxiety around your sleep, or your health, or your ability to function. And that is normal with sleep. Insomnia. Everybody that develops insomnia has [00:08:00] this sleep anxiety. Some people, if they've had insomnia for a really long time, won't have the anxiety anymore because they've just gotten so used to it.
But most people who are dealing with insomnia have this. This is not unusual.
So to answer this question, it depends on the type of anxiety. If you have Other type of anxiety, if you have panic attacks, if you have, let's say PTSD, Post Traumatic Stress Disorder. Okay, that's, an anxiety disorder. So there's other types of anxiety that have nothing to do with insomnia that people can have in addition to the insomnia.
So if you have severe panic attacks, You know during the night. Yes, that is definitely going to make it difficult to sleep, because you're getting extremely anxious You're releasing adrenaline and that's the opposite state you want to be in when you're trying to sleep.
Or if you have severe PTSD and you're having flashbacks or some kind of traumatic reaction when you're going to sleep Yes, that's going to really disturb sleep.
But again, like I said in the previous question You That is [00:09:00] not insomnia. That's a separate issue that is interfering with the sleep, and then as a result, you might have also developed the insomnia in addition to this other anxiety problem.
What that means is, if you have a severe anxiety problem that's not insomnia related, meaning it's not sleep anxiety, it's PTSD or panic attacks.
You need to go and address that separately with, uh, a qualified psychologist who knows how to treat anxiety disorders. And the best treatment for that is cognitive behavioral therapy. This is just the general CBT, not CBTI, which is specifically for insomnia, but CBT. And, that's the best. There's a certain type of CBT that I'd recommend for this and I'll put a link to that in the description.
But if it's so severe that, you're paralyzed in the night or it's, it's, it's that you can't sleep, then yes, you, sometimes you need to address that. as a separate issue in addition to the insomnia.
Most likely, even if you address the separate anxiety issue, you're still going to have the insomnia if [00:10:00] it's been in place for a while, because that has become a separate problem of its own. And then in that case, you still want to do the CBTI. But if it's so severe that you're paralyzed and you can't do anything, you might have to address that first.
But what if the anxiety you're having is the Anxiety from the insomnia. It's the sleep anxiety. You're, you're having all those negative sleep thoughts. Then in that case, one way to get rid of that anxiety and to start reducing it is to get out of the bed and to do something else.
So the other part of this question, the other language that I want to focus on here is this person says, I feel so bad, I have no energy to do something out of the bed.
What you say to yourself has a huge impact on how you feel emotionally and the things that you think you're able to do.
If you say, I feel so bad, I can't get out of the bed or I can't do anything, you're kind of screwed because you're trapping yourself. You're telling yourself, I can't do anything.
And the fact is when someone is anxious and even severely [00:11:00] anxious, they can still do things. You know, if you think about people, they might be terrified to give a speech, and yet they're up in front of the audience giving a speech. They might be terrified when they're in combat, if they're, if they're a soldier, and yet they have to learn to be able to, you know, be in combat, even when they're very, very anxious and afraid, which is normal for someone in combat, because they're in, they're actually in a dangerous situation.
If you think about it, when you're anxious, you have a ton of energy, because the anxiety Anxiety is fear. Anxiety is fear. That means you're in the fight or flight response and when you're in the fight or flight response you are generating a lot of adrenaline and epinephrine and that's putting a lot of energy through you.
In addition with insomnia you have what's called hyper arousal where you're super like awake and alert.
So yes, you might be exhausted. Right and you don't feel like getting out of the bed. It's not fun to get out of the bed at a certain point But that doesn't mean you can't do [00:12:00] it and it doesn't mean that you don't have the energy to do it You're just telling yourself that and that is sort of keeping you stuck in that place Okay, this is assuming it's sleep anxiety and not, you know severe ptsd something like that.
First of all What you want to do is switch around the language and and say something like or think something like, yes, this is really uncomfortable being anxious. I'm really scared about my sleep and it does not sound fun getting out of the bed or it does not sound fun getting up and do something, but that's what I need to do to solve this problem. That's a key thing I need to do to solve the problem.
And when you actually do that with the powerful thing about this skill, is that when you get out of the bed, the anxiety goes down because you break that state.
You get out of the bed and the, the context in the environment you're in that's actually feeding the anxiety. And when you're in that mode of anxiety and arousal, it's hard to break out of it when you just stay where you are. So if you get out and you go to a different [00:13:00] environment and you put your focus on something else, like a book or something like that, then your body starts to calm down on its own because you're not focused on sleep or trying to relax. You're forgetting about it for a while.
Now, again, I wouldn't recommend trying to practice this skill out of context of the full CBT I treatment and process, because it's a challenging skill. It's very counterintuitive. There's a whole mindset thing around it. And when you get out of the bed and how long you stay out of the bed. And there's all these different pieces to that.
And so I wouldn't recommend doing that. What I wanted to focus on in my answer with this question is really focusing on how you're thinking about this and that you really want to start shifting that and that even though you're anxious you can still do things, you can still function, you can still take actions.
And that is actually the number one way people get over any kind of anxiety and fear is facing the fear. Otherwise you stay paralyzed, but if you face the fear, even if you're [00:14:00] petrified, that's when the fear starts to go down because you're telling yourself, I'm not afraid of it.
And that's how you learn. You're going to be okay. The thing you're afraid of isn't going to happen. In other words, action, combats, anxiety, and fear.
Okay, so let's go on to the next questions.
My Background and Qualifications
Someone had a few questions about my background and how I got into this.
First one is, what is your background in sleep study? I'm a clinical psychologist and clinical psychologists Do not get any training in sleep in graduate school, unless they end up specializing in sleep, they get no training.
Now, this is true also of medical doctors. Medical doctors go through 8 to 12 years of training and maybe in that 8 to 12 years, they get 30 minutes to 1 hour of training in sleep, total. Okay, I've talked about this before. It's totally nuts. Sleep is fundamental to our health and our life.
We spend a third of our life, literally, Asleep, because it's so important to our functioning and our health and all the different systems in our body and yet [00:15:00] Psychologists, social workers, therapists, counselors, medical doctors, that includes psychiatrists, receive very little training in sleep and that includes insomnia.
There's actually a hundred different sleep disorders. Insomnia is the number one, like more people suffer from insomnia than any other sleep disorder. And yet, people get very little training in sleep.
So how did I get into this? I developed insomnia myself after I was already a psychologist and I was a specialist with anxiety and stress.
And I developed insomnia and I didn't know what to do. You know, I had really severe insomnia for six months, difficult falling asleep, staying asleep. So I had to learn.
And I went out, and I researched, and I read books, and I found what was considered the gold standard treatment for insomnia, which is called CBTI.
And, I read on it and to get an understanding of it, the success rate is very high and I was convinced this was the thing for me.
I went through that and I was able to cure my insomnia. I got completely got rid of the insomnia. This was back in 2014. years ago and I have not had a [00:16:00] relapse since because the last part of CBTI is relapse prevention. You learn how to prevent insomnia from coming back.
So, originally how I learned it was I had insomnia myself that I wanted to overcome and I learned the treatment and I went through it and it worked and it was amazing, because to get rid of something like that feels amazing if you're dealing with insomnia, it's, it's a horrible feeling.
And so then I started, working with my clients. So I was already working with a lot of clients that had insomnia because I was specializing in anxiety and stress. So I started implementing CBTI with my clients and eventually developed an online program for insomnia. So basically anybody in the world could do this because it's really hard to find qualified CBTI providers.
So that's how I got into it. Now, I would consider myself an insomnia specialist. There's a zillion different sleep disorders like sleep apnea and those things are separate issues. They can definitely contribute or be a trigger for insomnia.
But basically my specialty is insomnia because it's the number one, it's like, [00:17:00] 10 percent of the world population suffers with insomnia.
We're talking hundreds of millions of people and that's chronic insomnia. And then if you, expand to just the number of people that get insomnia every year is something like 30 percent or 40%. It's crazy. And that's why I solely focused on that as a specialty.
Next question was, are you a qualified doctor with clinical records in the success for your courses? So I already mentioned a sort of the qualified doctor. Like I said, I'm a licensed clinical psychologist. I've been a psychologist now for, 18 years and I'm 10 plus years just specializing in insomnia.
But I also have specialties in anxiety and stress and, and a few other areas as well.
So I've done this with hundreds and hundreds of clients, the CBTI and insomnia. So that's my qualifications.
Really what matters with qualifications is not certifications and all that stuff.
I have the certification and the degree, but it's the experience. and the skill that the clinician has in implementing the treatment. There's very few people who know this treatment well. And [00:18:00] even the ones that say they know it, a lot of them don't know it well because they don't have the experience or they're missing certain pieces.
So when you're looking for a qualified clinician, you just want to make sure, not only, do they know the treatment well, and they're doing all the different parts of the CBTI the way it was supposed to be done and the way it's been developed over the years. But also, have experience implementing it with a lot of different clients and doing that successfully.
The second part of the question was, do I have clinical records?
Measuring Success and Client Feedback
So how do I measure success? Okay. I said in another video, I have a very high success rate in my course, CBTI alone has been studied on, on hundreds of thousands of patients and clients with insomnia, and has a very high success rate for a behavioral, treatment.
But I find that with my programs, I've had a higher success rate, mainly for one reason that, the people that come in who are really committed. You have to be really committed to go through the process because it takes some time and there's some effort. It's like, you know, losing weight or getting in good shape, that kind of thing.
It's extremely effective, but it takes effort. Um, and if you [00:19:00] put in that effort, it pays off and you get over the insomnia and it, and it's great and you know how to keep it from coming back for life.
The way that I measure success is a couple different ways. Number one, in terms of data part of CBTI is keeping a sleep log.
So in my program, I provide a sleep log, actually in a Google sheet. It's pretty simple. Each morning you wake up, you open up your, Google sheet, which is your sleep log. It asks you a few questions you answer about your sleep the previous night. And then there's calculations built in kind of like an Excel spreadsheet that will calculate some key numbers like your average sleep time, Your sleep efficiency, which is the amount of time you're actually sleeping versus being awake when you're in the bed and the actual amount of time that you're spending in bed.
And then it creates averages over the week. These numbers are the key for personalizing and applying the skills with CBTI, but they're also the measure over time of how your sleep is progressing.
So because we're [00:20:00] tracking your sleep, Week by week, night by night, over the entire course. This is over several weeks normally, when you're going through CBTI, we have an enormous amount of data every week on how long it's taking you to fall asleep, how long it's taking you if you wake up in the night to get back to sleep.
What time are you getting up? What time you're going to bed? How long are you up during the night in total? And then what is your average sleep time each night and over the week? And what's your sleep efficiency, which is a percent.
So we have all this data that tells us how you're progressing. This is how we know you're progressing, where you're progressing.
It also, like when I work with clients and I, I review their sleep logs, I've looked at thousands of these things over the years. And I can immediately see what the problem is. When I look at a sleep log, I can see if you have onset, which is a difficulty falling asleep, onset insomnia, maintenance insomnia, which is difficulty staying asleep or early morning awake, and you're waking up super early in the morning and you're not falling back asleep.
These are different kinds of insomnia. The [00:21:00] sleep log shows that. And then it shows the data over time. So is your sleep efficiency improving? Is that number going up? Is your average sleep time going up?
So those are the two key numbers in addition to the instances of insomnia. How many nights a week are you having difficulty falling or staying asleep?
That should reduce over time and eventually get to zero. And it's this data that tells us the success, right? If that's not changing or it's getting worse, we're not getting success. If that's getting better each week over time, it's improving, then, then we know that we're getting success because that is what insomnia is.
Insomnia is removal of the instances of insomnia. So you're not having difficulty falling or staying asleep anymore. And your average sleep time has gotten back to a normal state, which for most people is seven to eight hours. It could be. you know, anywhere in that range. And your sleep efficiency is 85 percent or better.
Okay. That's a normal sleep efficiency. So once we [00:22:00] get to that and that's consistent and that's smooth, we have a, we have success. We've overcome the insomnia.
So that's how I've measured it. Cause I have sleep logs and, and, and in my program, people share their sleep log with me. So I have all that data in front of me for the whole program.
And so I know with each person, how they've progressed. And how successful they've been. And this includes medication. So if you're taking medication, which a lot of people do for insomnia, and you want to come off it, In week 2 of CBTI, you start to taper off your medication and we track that in the sleep log as well.
So we have the type of medication you're taking and we have the dosage and then we see the continual reduction of that over time. Because you're slowly tapering off the medication while you're implementing the skills. And then we see how that affects the data. As you're coming off the medication, How is that affecting the insomnia and your average sleep time and your sleep efficiency?
And the powerful thing is you see that these things are not very [00:23:00] correlated at all. And that helps you get over the worry about giving up. Get The Medication and see that you have the ability within yourself to sleep.
So that's the main way in terms of data and tracking the success of my programs is the sleep log and the data that comes from that.
The second one is just self report from clients. If a client is going through, I have a couple different options for programs. One is self guided. So those clients I don't actually interact with directly much.
But I have a program, an online program that includes support from me and those people I interact with every week, and they share their sleep logs with me, so I see their data and I know how they're progressing and they tell me how they're doing.
So again, with self report, people will say, you know, it's great, I'm getting better, I'm very encouraged, or I've gotten off my medication, they'll post, um, I have a community within the platform that I use where people can post successes and wins. So I see it there.
But ultimately they'll tell me if it's working, if they're [00:24:00] improving, how it's going, and I'll see the data. And that's how I measure the success in my program.
And the last question I pretty much answered, it's, can you give a brief description of what motivated you to tackle the niche category of insomnia?
Motivation and Specialization in Insomnia
And mainly it was because of my personal experience of having insomnia. I had no awareness or very much awareness of insomnia or sleep issues until that point. I slept totally fine until I was 44 years old and then I developed the insomnia and then now it became, it became a major focus and I realized how many millions of people suffer from this.
I also learned, as I said, that the gold standard treatment for this, which has been around for decades is just.
not highly recommended by medical doctors and therapists is they simply don't know about the treatment because they're not trained in sleep. So it's not even in their awareness. And instead, what they'll do is just prescribe a medication or they'll tell you to do sleep hygiene, or they'll tell you to meditate or these kinds of things or supplements.
And none of these things work. And so people end up staying [00:25:00] frustrated and stuck for years with insomnia because they're not given the right path. They're not given the right treatment for it, which is CBTI .
So part of my motivation was I had a personal connection to it and Saw that I could help my clients who are already dealing with insomnia.
I liked that it was a very specific area like for me as a therapist. I like to be Amazing at what I do, like some therapists and doctors are just generalists. They like to work with everything, but I don't think you can become really, really excellent an expert if you work with everything because it's too, it takes too much time and experience to To be able to become an expert at something, you can't become an expert at everything.
This is why doctors specialize and I think therapists should do the same. So I specialized very early on in anxiety and stress. And then when I developed insomnia, I added that as a specialty. And now essentially that's probably 90 percent of what I work with is insomnia.
And what that does [00:26:00] is, first of all, I like it. I know the treatment extremely well, and I like being able to help people with this problem because I know that there's a real shortage of qualified providers. There's also a shortage of access. So even if there is a provider in your area, many times there's a huge wait list. Like there could be five, six month wait list sometimes to be able to do this, which is just ridiculous.
Or in some parts of the world and even in the United States, there is just no providers at all. And that's why I created an online program so people can access that from anywhere in the world, as long as they have an internet connection and some kind of device. To consume the material and I have actually found doing it online is better than doing it even one on one because basically, you can go through the trainings on your time and also you still get the support and it's more flexible You don't have to drive to an office And there's a lot of other things, but that's what I have found.
So, that is why I turned it into a specialty, because I really wanted to focus deeply on this [00:27:00] issue and just be, the best I can be at this and be able to help as many people as I can, um, with this problem who are finding it difficult to get treatment.
Conclusion and Call to Action
so I hope you found these answers and these questions helpful. If you did, just press the like button and let me know and I'll do more of these Q& As. I'll create a whole series.
And if you have questions, any questions yourself about insomnia or any of these things related to what I talked about, then just leave them in the comments section below the video and I will do more of these Q and As. And I'll see you next time.