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Comment by egjerlow | Hacker News Reader

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)

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> 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.

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.

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.

> 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.

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'...

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!

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