Insomnia Q&A #2: Anxiety, Sleep Apnea, Menopause, Hashimoto's

Today I answer questions from viewers about managing insomnia when you have anxiety, sleep apnea, menopause, or Hashimoto's disease.

If you have questions you want answered, please post them in the comments section below the video.

// SLEEP SERVICES //
https://www.drorma.com/insomnia-services

// SUBSCRIBE //
Put Insomnia to Bed channel https://www.youtube.com/c/PutInsomniaToBed

WHAT I DO:
I help people overcome insomnia and get good sleep (without medication, drugs or supplements).

To Your Sleeping Better!
- Steve

RESOURCES
CBT-I Playlist

00:00 Introduction and Viewer Questions Overview
00:05 Understanding Insomnia and Anxiety
02:10 CBT-I and Stimulus Control Techniques
04:21 Addressing Medical Issues and Insomnia
07:38 Hormonal Shifts and Insomnia
09:43 Sleep Apnea and Insomnia
13:29 Conclusion and Posting Questions

TRANSCRIPT
Introduction and Viewer Questions Overview

So today I'm going to answer questions from viewers that were left in the comment section below the videos.

Understanding Insomnia and Anxiety

Question number one is, how do I not get anxious and start monitoring whether I'm likely to fall asleep or not? Before I had insomnia, I would just lay down and my mind would kind of wander and I would drift off. I don't seem to be able to let my mind do that now.

So this is a very common thing that happens with insomnia, and it's one reason why people have a difficulty falling asleep or going back asleep is that as they're going to sleep, they're so focused on their sleep, they're so conscious of it that they can't let their conscious mind go, because to be able to go to sleep, you have to be able to let go of your conscious mind and just sort of let your subconscious or your let your sleep system take over.

And with insomnia, what happens is we become so focused and concerned and worried about whether we're going to sleep or not, that we are observing our sleep. We're not just letting it happen naturally. We're getting in the way of it in essence.

But it's very difficult to do when you haven't slept or you haven't been sleeping for a while, it's very easy [00:01:00] to get pulled into being very focused and really worried about whether you're going to go to sleep or not, which consequently interferes with the sleep.

So, really like the way to break out of that is, you can't really just sort of stop the anxiety and the worry by just dealing with it mentally.

The more, so if you're trying to go to sleep and you are worried about whether you're going to fall asleep or not, and you're, and you're having anxious thoughts about that, and this is all normal with insomnia, the more you focus on those thoughts and that anxiety and trying not to think about. The anxiety or trying not to focus on falling asleep, the more you're going to do that, the more it's going to feed into that cycle.

This is like try not to think of a pink elephant kind of thing, right? If you try not to think of something, then that's all you're going to think about because you're giving your mind a command and it doesn't understand negatives. It just hears. Pink elephant or it just hears anxiety or sleep or not sleeping and really what you need to do is not Observe the sleep [00:02:00] at all, but just trust that you're gonna fall asleep.

Now with insomnia, because you are having difficulty falling asleep or going back to sleep, this isn't going to work most of the time.

CBT-I and Stimulus Control Techniques

The way that you overcome this is through your behavior changes. And there's a key skill with CBTI, which is Cognitive Behavioral Therapy for Insomnia. I talk about it a lot on this channel. It's the gold standard treatment for insomnia. And part of CBTI is a skill called Stimulus Control. Which is when, if you're not asleep within, let's say 20 to 30 minutes of getting into bed and trying to go to sleep. If you're not asleep within that amount of time, then what you really need to do is get out of the bed. Because if you stay in the bed, you're going to stay stuck in that cycle that this viewer is talking about, where they're just in their mind and they're aware that they're not sleeping. And then they're getting more anxious that they're not sleeping.

And at that point, after about 20, 30 minutes, if you are still in that state, It is very difficult to come out of that with staying in the bed when you have insomnia because [00:03:00] you're in this hyper aroused mode. And what you need to do is get out of the bed and break that context and go to another room.

Now, that skill takes, there's a lot of finesse and there's, there's a lot of nuances to it, both in terms of your mindset and in terms of, you know, when you get out of bed and when you get back into bed and what do you do when you're out of bed? And I'm not going to go into that in detail right now, because that's part of CBT-I.

And even if I explained it in detail, you have to do it within the context of the full treatment.

When someone has a problem like this, they try to just do like a pinpoint thing like, well, I'll try to meditate and go to sleep, or I'll try to go on my phone and try to sleep.

Some sort of in the moment thing to sort of deal with that one thing. But that one thing is a symptom of a larger issue, which is the insomnia. And to overcome the insomnia, you got to do. Really like four different things. One of those things is what I just said, but there's other parts of, of CBTI that you need to do to really break [00:04:00] that pattern of insomnia.

And I've talked about that in more detail in other videos. So I'll put a link to, you know, what CBT-I is, but essentially what you need to do. to do when this happens is just basically get out of that entire context. If you're not asleep within 20 to 30 minutes, and that helps you to sort of break that anxiety pattern through a behavior shift.

Hashimoto’s and Insomnia

Question number two: “I have thyroid Hashimoto flare ups and when that hits there's nothing I can do Sleeping pills, supplements, nothing works. How does anyone get past insomnia when it's part of the Hashimoto yo yo?”

This is a question really about a medical issue. If you have a medical issue That is interfering with your sleep.

So that could be Hashimoto's, that could be chronic pain. It could be sleep apnea. It could be a lot of different types of medical issues. And I'm going to cover sleep apnea specifically later, cause that's a very common one.

But let's take something like Hashimoto's. When you have flare ups, it's affecting your body's ability to sleep because it's changing physiology in your [00:05:00] body.

Now it depends. So, what happens with insomnia is, there's a, there's a trigger. So, Hashimoto's and a medical issue does not cause insomnia. Now, could it interfere with sleep or make it more difficult to sleep? Yes, but that's not insomnia.

Having difficulty sleeping can come from a lot of things internally or externally. You could have somebody making a lot of noise next door, or your partner's moving around a lot in the bed. Or, you have jet lag. There's a lot of things that can interfere with sleep, but that's not insomnia. Insomnia is like a pattern that develops over time that then gets set as a separate problem, a separate issue apart from the original trigger, which could be Hashimoto's or another medical issue.

So once you have insomnia, you can't just get rid of it by managing the Hashimoto's and the Hashimoto flare ups are not the only thing that's causing the insomnia.

But if you only have difficulty sleeping. When you have Hashimoto's, meaning that when the Hashimoto flare ups are gone, your sleep is totally great.

Then yes, then the [00:06:00] Hashimoto's is the main issue, not the insomnia and the insomnia or the difficulty sleeping is this coming as as a result of the Hashimoto's flare up. And so in that case, you would need to address the Hashimoto's. You mean you need to put really all of your focus on how do I solve this problem?

Or how do I manage the flare ups? Or how do I change what I'm doing to either get rid of the Hashimoto's, but if you can't do that, how do I manage it? So the flare ups are not as intense or as less often and they don't interfere as much with my sleep.

But if you have developed chronic insomnia as a result of Hashimoto's or another medical issue, now you have two separate issues that are kind of feeding each other.

And what will happen is when the Hashimoto flares up, it'll worsen the insomnia, but it's not causing the insomnia at that point because the insomnia has already been set as a pattern.

So what you need to do here is, yes, continue to treat the Hashimoto's and do what you can to manage that effectively.

And the insomnia though, once it's a chronic problem, you need to address it. With CBTI, you [00:07:00] need to address it as a separate issue and that will teach you also a lot of skills and tools and make your sleep more solid. that when you have the Hashimoto's flare ups or you have some kind of medical issue come up, you're more resilient and you're more resourceful. You know how to handle those flare ups better, both mentally and behaviorally, because even then your sleep's probably not going to be perfect because you are dealing with this intense sort of like physiological change in your body, but you'll be able to handle it better. You'll be more resilient. Your, your body will be able to ride that flare up better because you've addressed The Insomnia Issue as a Separate Issue, And this would apply to any any medical issue that's interfering with your sleep.

Hormonal Shifts and Insomnia

Question number three, Do you address hormonal shifts like Peri menopausal or menopausal that trigger insomnia.

What I've seen is I've had many women in my program in their 50s, 60s, who are premenopausal or they're going through menopause and they have hormonal shifts going on. And yes, that does interfere with sleep, but that does not cause insomnia. Insomnia. Again, there's a [00:08:00] lot of women who are perimenopausal or menopausal that don't have insomnia, but they're going through and they're having these hormonal changes.

And yes, that might impact their sleep. Some, if they're having hot flashes, it might be more difficult to sleep or other hormonal shifts, but that does not cause insomnia. Insomnia comes in the response to the poor sleep that might be created from the, the menopausal, physiological symptoms.

So again, it's kind of like what I said on the previous one. You want to pull apart. Do I only have insomnia when I have more symptoms from the menopause or the premenopausal symptoms?

Or is the insomnia become its own separate issue? And if it has, then what you need to do is do CBTI.

And I've had a lot of women in my program, as I said, that are having hormonal issues from this place. And they were able to get past insomnia. And sometimes what they had to do was supplement the treatment. Sometimes I've had clients do hormone replacement therapy while they're also doing CBT I or other treatments that will help with the symptoms of, [00:09:00] of menopause.

But basically once insomnia becomes a separate issue, you have to address it separately or address these things at the, both at the same time.

I would say you have to kind of find out what's going on. If you've had insomnia for a really long time, then it's probably, it's a separate issue you should address.

And again, like the previous one, that will help you make your sleep more solid and be able to handle those things when you are having those hormonal issues. It'll help you ride that out.

I also with my program I have a resource list because sometimes people need extra support beyond just the CBTI. They have severe depression or they have a medical issue or they're going through menopause and I work with, doctors who are specialists with sleep and with menopause who can help manage that while you're also going through the CBTI.

Sleep Apnea and Insomnia

And the last question here is, I have insomnia and sleep apnea. My health took a nosedive three years ago, but I've slowly started to recover. I think balance enough CPAP success through the night with the constant waking up. I really don't mind the CPAP, but it's quite intrusive. And I think I'm just a sensitive [00:10:00] sleeper. I'd love to get an hour extra sleep or just better quality. I get anything between five and six and a half hours of sleep. Any thoughts?

So, sleep apnea is a very common sleep disorder, especially these days. It's just being diagnosed a lot more. And yes, sleep apnea can definitely interfere with sleep.

There's certainly levels of severity. Some people have very mild sleep apnea. It doesn't interfere with their sleep very much. Some people have more severe sleep apnea where they're waking up, you know, 20, 30 times a night, and that is going to be very disruptive to sleep, particularly to the quality of sleep.

But again, sleep apnea does not cause insomnia. There are many, many people with sleep apnea that don't have insomnia. I've had many people with sleep apnea come into my program. They overcome the insomnia and they still have the sleep apnea.

So again, you want to piece these things apart and figure out what is going on here?

Again, if you don't have insomnia, like this person didn't say whether they had insomnia or not. They said mainly their sleep is of poor quality and they're getting like five to six and a half [00:11:00] hours on average per night.

Yes, that's not optimal amount of sleep. Five to six and a half hours isn't optimal for most people. Six and a half isn't bad, especially if you're older and you're, you're taking a nap during the day to supplement it.

But for most people you probably want at least around seven hours on average to be getting enough sleep to go through all your stages.

If you don't have insomnia and you have in sleep apnea, but it's interfering with the quality, then yes, you want to manage the sleep apnea as best you can, which it sounds like this, this person is doing and they have a CPAP and they're handling that okay.

But the quality of the sleep isn't going to be as good because if the apnea is interfering with it, if it's making you wake up or it's making the sleep lighter because you're having more difficulty breathing, then you have to do what you can to sort of increase the quality of the sleep.

Sometimes this is where sleep hygiene can help. Now I've talked about sleep hygiene a lot and how sleep hygiene does nothing for insomnia. But if you don't have insomnia and you just have poor quality sleep, then sleep hygiene things can help. And that could be things like [00:12:00] exercising during the day, making sure your diet is really good, getting sunlight exposure, having good sleep habits, being consistent with sleep.

You know, things like this can help with the quality of the sleep, managing stress in your life. If you have a very stressful life, that could be brought into sleep. And the more you can reduce that stress and manage it, the better quality sleep, the more relaxed you'll get at night. So, it's more doing things to offset the poor quality sleep.

But, If you have sleep apnea and you have insomnia, again, I recommend you do CBTI for the insomnia and you manage the apnea as best you can through a CPAP or whatever kinds of treatment options work best for you because the CBTI, the treatment for the insomnia, will eliminate the insomnia or definitely improve the sleep. If it doesn't completely eliminate the insomnia, it'll definitely improve the sleep, make it better, improve the quality, make you more resilient to the apnea, and also give you tools for on those difficult nights how do you respond to that effectively so it doesn't worsen the sleep.

So kind of a big theme with all the questions today where there's some [00:13:00] medical issue that's interfering with the sleep, that's making it more difficult to sleep.

And what you have to do is piece apart these things and figure out is my sleep only bad when, I'm having trouble with this other issue when there's a flare up or something.

Or do I have insomnia and has that been chronic and ongoing for a long time? And if that's the case, then it's a separate issue at that point. And you, and you need to address it with CBTI. While you're also doing your best to manage the, the medical or the physiological issue that's going on.

Conclusion and Viewer Engagement

So I hope these answers were helpful. If you have any questions about that, just leave that in the comment section below and I do these Q& A's whenever I get questions in the comment section about the videos or any questions you might have about insomnia, you can post those in the comment section below any video. I read through those comments every week.

And when I see good questions like this, I'll, make a list. And when I have enough, I'll do a video like this and answer your question, in a video.

So hope you found that helpful. Hope you have a good rest of your week and I will see you next time.