My sleep journey

Trying out cognitive behavioural therapy

A couple of weeks ago another night of broken sleep set me thinking about insomnia and the role that technology could play in both causing and curing it. After consulting a couple of experts about my own sleep problems I decided to try out an approach they both recommended, cognitive behavioural therapy for insomnia or CBTI.

You can go and see a cognitive behavioural therapist to talk through your sleep problems or you can take an online course. I opted for Sleepio, an online course which is available on the NHS in Scotland and in some parts of the South East of England. It consists of six weekly sessions in which an animated cartoon prof with a gentle Scottish accent takes you through what are described as “scientifically backed tools to reduce symptoms of poor sleep.”

Between sessions you are supposed to build those tools into your sleep routines, but your key task is to compile a pretty detailed sleep diary - what time you got into bed, when you tried to go to sleep, how long you took to nod off, how many times you woke up during the night and what time you finally got out of bed.

But before I got going with the course I spoke to the man behind it - who appears to be the alter ego of the online “prof”. Professor Colin Espie is a clinical psychologist who finished his training in 1980 - “so I’ve been in mental health for a long time,” he tells me.

He has spent most of that time treating insomnia and employing cognitive behavioural therapy as his main tool and seems keen to stress two things. First, that CBT isn’t “psychobabble” operating at the level of the mind alone but is a direct intervention which has a “psychophysiological effect on sleep itself.”

Second, his method has been validated by clinical trials, unlike what he implies are flaky sleep apps which have enjoyed huge success in recent years. “Most of the things on the app store  have no evidence base whatsoever. They’ve not been through trials.”

That, he says, is why Sleepio is only available from a healthcare provider, not direct from an app store: “Our approach has been that these are things that should be integrated into the healthcare system, not marketed direct to people.”

How then does it work? The “prof” explains that he is taking the offline experience of seeing a therapist and using technology to deliver an online version crafted to the individual. So the data from your sleep diary and your responses to questions asked in the weekly sessions will help craft the advice you are given the following week.

He gives an example, pointing out that, just as individuals need a certain amount of food and water, they each have different sleep requirements. Sleepio, he says “helps you to discover the ideal sleep window for you and the ideal timing of that window.”

Professor Espie explained that the priority was not the duration of sleep but a concept called sleep efficiency, how much of your time in bed was spent asleep. The programme aims to cut back the time you spend awake in the middle of the night with your mind racing.

I have now been filling in my sleep diary for two weeks and have just completed my second session with the prof. So how is it going? The fact that I started writing this at 0530 on a Sunday morning will tell you that my insomnia problem has not gone away.

Much of the advice seems fairly standard - avoid coffee and alcohol for four hours before bedtime, make sure the bedroom is dark and the temperature cool, and try to shut out light and noise.

But there are also useful techniques for me to learn - “progressive muscle relaxation” and “challenge your thoughts” - both designed to help you banish negativity and relax your way back to sleep.

My diary shows that in my second week my average time asleep, at 4 hours 56 minutes, was 5 minutes down on my first week. My sleep efficiency was also down marginally from 71% to 69%. Mind you, my sleep quality was up a bit - I had rated more nights as average rather than poor.

And I think that may be because I have taken onboard one key bit of advice from the prof - try to stop worrying too much about just how long you sleep. After all, getting up at 5am means that I have a couple of hours before breakfast to bake some bread or get a piece for this Substack newsletter written. Expect another update in a couple of weeks…