euthymiclabs 2 months ago

As many others have noted, the title is inaccurate; cognitive behavioral therapy for insomnia is a well established treatment.

There are a few other minor inaccuracies in the article: chronic insomnia requires only 3 months of sleep disturbances, not 6. And the case for the dangerousness of insomnia is dramatically overstated.

But with that said, the reality of insomnia treatment in most countries is that doctors either 1) don't know about CBT for insomnia or 2) don't have a way to refer people to see a behavioral sleep specialist. I practice in Seattle, and there are only 4 clinics that have behavioral sleep specialists. In more rural areas, it's even more uncommon.

So in truth, for most patients and most doctors, this does feel like a brand new therapy.

Thankfully, "sleep efficiency" training (aka sleep restriction) is a simple algorithm that doesn't really require hand holding, and works reasonably well when practiced through a book or online program. Motivation tends to be better when you meet with a therapist, but the recovery rates are similar for highly motivated people.

Disclosure: I provide in person CBT for insomnia and run a pay-what-you-can CBT for insomnia web app at SlumberCamp.co.

  • Apocryphon 2 months ago

    Not in the U.K., it would seem. The article gives the impression that CBT for insomnia is relatively new there.

    • euthymiclabs 2 months ago

      Good point. The science has been around since the 60's and 70's, but the evidence base has only become overwhelmingly positive over the last 20 years. And from a guidelines perspective, the European Sleep Research Society started recommending it as the first line treatment in 2017 (https://www.ncbi.nlm.nih.gov/pubmed/28875581). I'm not as up to date on NICE and NHS guidelines.

egjerlow 2 months ago

What exactly is new about this? CBT+sleep efficiency is pretty much the standard advice for insomnia (after having tried reducing blue light, regular schedule etc)

  • m0nty 2 months ago

    > What exactly is new about this?

    My thoughts exactly. I've tried all the things in the article (inluding CBT) and they are ineffective for me. This is acknowledged in the article ("we're all different") but the overall tone is that of a "miracle cure" when it's just patiently and steadily applying well-known ways to improve sleep. This is good, but it's not revolutionary.

    The only part of it which resonates for me is that the majority of doctors and other medical professionals are truly, utterly crap when it comes to insomnia. They don't think it's important and they don't care that it's a living hell - "after a couple of nights without sleep, you'll sleep through anything", as one doctor glibly told me. But I've been 100 hours without sleep and that's nowhere near a record compared to other insomniacs.

    Anyway, let's not get too distracted by a flashy headline and the overall tone of the article. The very fact that a group of medical professionals is taking sleep seriously is significant in itself. I hope it starts a trend.

    • gnulinux 2 months ago

      This is exactly like my experience. I've seen more than 10 doctors for my desperately aggressive insomnia. Neurologists, psychologists, psychiatrists. Not only in US, even in some European country. They always acted like "yeah just perform sleep hygiene and you'll be gucci" "doctor, I do do that but I still can't sleep for days" "it's ok habits take time" Uhhh. To me it just seemes like being unable to sleep (at all) multiple days a week seems alarming enough medical issue that they'd try harder. One time I was prescribed Ambien. I used it for 3 days and it gave me some sort of psychotic episode, it was a terrifying experience I was locked in my own body. My doctors reactions was something like "do you even want to get better???" I hate insomnia.

      • m0nty 2 months ago

        The drugs are appalling. They have all sorts of weird side-effects but offer only marginal benefits in terms of sleep amount and quality. I have used Mirtazapine to good effect, however, so you might yet find something which does suit you. The only other thing which has worked is just learning to accept the suffering and not get too stressed out about it. Losing sleep is bad, but getting angry about it just pushes me over the edge, so I avoid getting angry.

        • gnulinux 2 months ago

          > The only other thing which has worked is just learning to accept the suffering and not get too stressed out about it.

          This REALLY helps. Last ~8 months has been a paradise for me because my insomnia was so mild (I spent maybe a total of 2 or 3 completely sleepless nights and my previous average was 2 or 3 a week). The only difference is that I stopped giving a shit, if I'm sleepy and feel like shit, that's fine. It really does help.

          • milesvp 2 months ago

            It's my experience as well (though I'm starting to think my insomnia is very mild reading this thread). I find my insomnia tends to get worse the more I fight it. So I stay up later than I'd prefer, so that I'm more tired, and less likely to be awake in the middle of my sleep. I also will get up in the middle of the night if I can't sleep and just be awake for a few hours until I feel I can go back to sleep. But if I fight it at any step sleep seems to be harder to come by, regardless of how tired or lacking if sleep I am. I also can't use an alarm clock. If I do then the odds of sleep go way down, since now there's a race and if I don't fall asleep now, then 'I might not get enough sleep' or 'I might wake up in the wrong part of my cycle'. I've also neen experimenting with lighting. Blue lighting definitely wakes me up at night so I avoid them.

            But I consider myself lucky. I've mostly engineered my life such that I don't need to function before 10am (I think I'm genetically predisposed to a late sleep cycle, so far it looks like 2/3 of my kids may as well). I can afford to not use alarm clocks most of the time. And, it's possible my insomnia is nowhere near as bad as others'...

      • euthymiclabs 2 months ago

        Very true. I can't tell you how many of my physician colleagues still think that sleep hygiene is a treatment. It's not (https://www.ncbi.nlm.nih.gov/pubmed/17162987). Good CBT-I is different, but we still don't have great answers for the 20% of people it doesn't help!

santoriv 2 months ago

I know this isn't really the point of the article but I was having issues waking up for several hours during the night for the last couple of years.

About 5 months ago I started doing a 3-day a week weight training program which includes full body compound movements (squats, deadlifts, etc.) and now I sleep like a baby through the whole night every night.

I know that may not work for many people but it worked wonders for me.

As an added benefit I've lost a bit of body fat, feel better mentally and physically, and have been able to reduce my blood pressure medication dosage by 2/3.

  • fbr 2 months ago

    Have you changed your diet?

    • santoriv 2 months ago

      A little bit. I've been trying to eat less processed sugar, but that's about it.

rq1 2 months ago

Just fell asleep reading the article.

  • ArcticCelt 2 months ago

    We simply misunderstood the headline; It's not an article about a new cure for insomnia, the article IS the new cure.

0xcde4c3db 2 months ago

Are there any high-quality studies supporting the efficacy of CBTI? Most of the ones I've seen are terrible.

cowpewter 2 months ago

What's finally helped me fall asleep pretty consistently is listening to hypnosis videos with a pair of those sleep headphones (flat padded speakers embedded in a soft headband). I used to listen to podcasts, and it helped to have something other than my thoughts to focus on, but I'd still frequently be awake 3-4 hours after lying down. With the hypnosis tracks, I'm consistently out within an hour after lying down.

I'm particularly fond of this one: https://www.youtube.com/watch?v=bFqEWrw6jyg

Of course, my wife still falls asleep within 10 minutes (I'm so jealous of her ability to just roll over and be out), versus my 45-60, but it's a vast improvement to not be lying awake for hours every night.

exodust 2 months ago

The article lost me in a sea of introductory fluff, and I never made it to the end.

As always, the best solution is good old fashioned discipline.

Get up at the exact same time every single damn day. No matter how late you stayed up. When you wake up, and it's 7am or whenever your alarm goes, get up. Don't close your eyes again.

The rest is about pretty good diet and reasonably regular exercise.

And no, you don't need to give up coffee. Have it as strong as you like.

fredley 2 months ago

The article is very long-winded.

TLDR: CBT and observing a few physical parameters that affect your sleep (temperature, light, sound), as well as getting the right amount of sleep (not too much, not too little) will sort out most people. For me strictly banning all screens from the bedroom has helped too (I have an alarm clock with no backlight so I can't even check the time).

I did exactly this sort of thing years ago via Sleepio[1], which I highly recommend. It is a guided CBT course that completely sorted my chronic insomnia, using pretty much all the methods described in TFA. It will take you less time to sign up than to actually read said long-winded article.

1: https://www.sleepio.com

  • xyzal 2 months ago

    I cannot recommend Sleepio enough everytime someone mentions sleep trouble. The time-in-bed restriction regimen is in my opinion particularily helpful and I revert to it occasionally when I don't sleep well a few nights in a row with good results.

    • fredley 2 months ago

      Totally agree with you. It seems so counterintuitive that when you're struggling to sleep you may need less time in bed, but it really helps in the long run.

    • pratyushag2 2 months ago

      Yes, Sleepio is very helpful!

albanberg 2 months ago

Sleep can often be improved by doing a short (15 to 30 min) simple (you don't have to be limber or do difficult poses) viniyoga program that is set up by a properly trained instructor. A new client will need 3 or 4 meetings with the instructor over a couple of months. The practice/program is done at home either in the morning or at night.

doon123 2 months ago

An Honest Question, why are sleep related articles able to gather so much traction here on HN?

  • stupidcar 2 months ago

    Insomniacs have more wakeful hours available to them, so, statistically speaking, they're likely to be overrepresented amongst active HN users at any given moment, resulting in a boost to sleep and insomnia related articles.

  • ericdykstra 2 months ago

    Sleep is one of the three pillars of health. There are also many fitness and diet articles that gain traction.

    As to why health is popular on HN, it's hard to be interested in the other stuff if you're dead! (I don't actually know why, I'm interested in these all personally, but nearly never upvote the articles myself)

    • apatters 2 months ago

      Well, many developers probably aren't in the best health because the job requires sitting all day. Everyone wants to be healthy so there will be a natural demand for articles about it amongst developers.

  • davidhyde 2 months ago

    That's a good question. Maybe its because we are so hungry for information here on HN. Reading HN articles is a mild addiction for me. Perhaps not as detrimental as other addictions but the one adverse thing it does affect is my sleep.

    To me, writing software is primarily a research activity. It always has been, no matter how proficient I think I am at a language. That's probably why HN articles appeal to me so strongly; it's what I do all day long.

  • gnulinux 2 months ago

    Because (1) sleep is very important for health (2) most doctors won't give a shit if you can't sleep (3) insomnia is a living hell.

  • Insanity 2 months ago

    Because a lot of software engineers tend to have bad sleeping schedules perhaps.

    I do enjoy explorative coding at night and often end up staying awake too long for getting enough sleep.

bryanlarsen 2 months ago

TLDR: limiting caffeine and other stimulants and "sleep efficiency training" is successful for 80% of patients.

The description of sleep efficiency training starts at the picture labelled "A patient at the sleep clinic". That section appears to contain highly actionable advice.

nemo1618 2 months ago

I really can't stand how articles like this bury the actual information (in this case, basically just CBT) deep in anecdotes and other context that I don't care about. Is it just me, or has it gotten worse lately? Maybe in the Age of the Short Attention Span, journalists have to come up with other ways of making the reader stick around?

  • tragomaskhalos 2 months ago

    Totally. Sometimes, if one is really interested in the material and has time, it can be enjoyable to plough through the human interest fluff to get to the meat, but the majority of the time it just seems like a pretentious annoyance.

    Same deal with most popular science on TV - who has the time or energy to sit through an hour of tortuously drawn-out explanations interspersed with tangentially relevant video sequences, just to harvest the at most 5 mins of actually interesting fact?

  • Angostura 2 months ago

    Probably best not to read the section of the paper explicitly called 'The Long Read'dwhich are designed as colour pieces.

    • beaconstudios 2 months ago

      You'd expect articles in that section to be long because they cover a deep topic, not because the author felt the need to pad out the article with fluff.

  • emerongi 2 months ago

    Is there a name for this writing style?

    I remember writing essays in school padded with a lot of babble, just because there was a word limit. As an adult, anyone who writes like this is just wasting my time. It's low information density.

    • thecatspaw 2 months ago

      its long form journalism

      excerpt from wikipedia

      > Typically this will be between 1,000 and 20,000 words. Long-form articles often take the form of creative nonfiction or narrative journalism.

      • ianai 2 months ago

        Long form journalism conveys an equally large amount of information as length. Articles like this just add fluff - anecdotes and tangential subjects that don’t add meaningful contextual value.

    • pixelrevision 2 months ago

      Well there’s “click bait”. The headline does not match up with the content at all. The article is about insomnia, the headline is about a cure.

      • barking 2 months ago

        There's this new cure for insomnia and everybody is saying the same thing about it!

        • diegoperini 2 months ago

          The cure is reading the article.

    • swingline-747 2 months ago

      Copy-writers' job security and greater eyeball time to sell ads.

      Succinct or GTFO. ;)

  • pasta 2 months ago

    As others point out: it's the click bait title.

    You open the article because you want to know about the cure. But the article is about insomnia.

    So you start skimming the article until you give up.

    If the title created an expectation to learn more about insomnia you might have read the whole article.

    • chippy 2 months ago

      >So you start skimming the article until you give up.

      I scrolled to see how long the article was, gave up and thought "the HN comments will have what it is about". Then thought bad about not reading the Featured Article, mentally shrugged, then clicked to the comments.

  • monkeynotes 2 months ago

    The problem is the article has a misleading headline and the author/editor are playing the click bait game. I think this becomes obvious if the nuts and bolts of the claim in the headline are not in the stand first. This is why I tend to abandon reading and go to comments if I don't see the headline affirmed in the first couple of paragraphs.

    It's not really about attention spans in my opinion, I simply don't have time to read all the hyperbole on the internet.

  • Aardwolf 2 months ago

    Also hated it, started skimming paragraphs, still didn't get to the point, then came to the HN comments for a TL;DR

    I think there does exist an audience for this writing style though, so I'm not against those articles existing, it's good to have diverse styles, at least there is actual work put into writing this (it's not a "14 ways to improve sleep, number 8 will surprise you" page by page slideshow)

  • pixelrevision 2 months ago

    This article is excessively long and spend much more time talking about insomnia than the treatment.

    • amelius 2 months ago

      I almost fell asleep reading it :D

  • fredsted 2 months ago

    The longer you stick around, the more ads can be shown.

Void_ 2 months ago

There's one instance of f-word in this article. Would it have been so hard to replace that one word with something kid-friendly?

Seems like a very sneaky way of putting language like that in readers' minds.