There wasn’t an insomnia ‘fix’ Ingeborg van Lotringen hadn’t tried – until she realised the missing link was all in the mind. If you think you’ve read every sleep tip there is, this will surprise you
In a bright treatment room overlooking the Austrian Alps, I sit wrapped in a starched sheet (given to me by way of a comfort blanket) bawling my eyes out. My mild-mannered psychologist, Dr Erich, listens as I tell him about the wrenching pain of slowly losing my mum, who’s slipping into dementia, and my childhood home. By gently holding my head and moving my limbs using cranio-sacral and bodywork techniques, he shows me how my stress and grief seize up my diaphragm, my muscles and other parts of my body (my right shoulder is permanently locked and I’ve been told that my lower intestine is very rigid). It locks in my raging cortisol, the stress hormone, which has nowhere to go. I know the feeling intimately: it's what’s kept me from sleeping for years.
“Something makes you race ahead non-stop,” Dr Erich says. That something would be me. He literally falls forward as he touches my shoulder, evidently sensing what’s going on in my head, and says: “You’re going too fast. You feel like you’re falling.” Yup.
People come to identify with their ailments, he tells me, which leaves them physically and emotionally stuck. Insomnia is one such condition, and after 15 years of sleeping between two and five hours a night on and off, and trying literally everything in the known universe to beat it (here is just a tiny taster of the insomnia tips I have tried), I agree it sometimes feels like I’m defined by the hell of sleep deprivation.
Dr Erich says that bringing your issues up in most conversations and allowing them to dominate your mind can entrench them (he’s right; I need to stop banging on about how badly I sleep). Accepting them, by directing your focus elsewhere, he explains, can make them melt away.
He wants me to consider that I’m more than the sum of my experiences: “That is just your ego speaking. Your true self is not defined by insomnia or anything bad or good that happens to you.” It sounds a bit esoteric but I get it: if I allow my sleeplessness to be the centre of my universe and wallow in it, it will forever have me trapped.
Crucially, he teaches me how to get a grip and ground myself whenever I feel bouts of despair and anxiety. I am to do this by sitting or standing with my feet flat on the floor and my pelvis slightly sagging as if I’m sinking into the earth, breathing slowly all the while. I try it, and at last, I can feel the pulsing stress drain from my system.
Can stress relief and the right diet cure insomnia?
My session comes at the very end of a six-day stay at the world-famous Mayrlife Altaussee health resort, known for its strict gut health diet of 600 calories a day, enforced rest and a battery of bespoke doctor-prescribed treatments in breath-taking surroundings. Think Bond on an enforced sabbatical.
Mayrlife’s ‘Cure’, as they call it, is centred on digestive health and gut cleansing, intermittent fasting and alkaline (as opposed to acidic) eating, and taking supplements as a means to re-boot your entire system. The idea is to kick-start ‘autophagy’, an internal mechanism, set off by a controlled fast, for clearing out old cells and repairing decrepit ones to prevent and beat disease. The other pillar is about rebalancing the gut microbiome, because an out-of-whack bacterial gut population is a factor in all manner of physical and mental disorders, from eczema to depression. Together, these are said to be a preventative as well as curative salve to most ills.
Hoping that adjusting my physiology might provide an elusive fix for my insomnia, I’ve accepted an invitation as a journalist to give it a go. I have been assured that a full two-week programme can fix my sleep issues, but with deadlines looming and barely any time to spare, I’m only here half that time, praying that I will still make a good dent in it.
The diet (root vegetable soups until the cows come home, very small rations of gluten-free carbs such as micro buckwheat rolls or corn crackers, and miniscule portions of protein – all beautifully presented but mind-numbingly bland) is thought to be part of the solution to insomnia. It is designed to calm any gut inflammation and increase ‘good’ gut bacteria, some of which, evidence suggests, can release oxytocin, which is important for making you feel calm.
Additionally, as the medical doctor who oversees my treatment explains, the right treatments should help release my vagus nerve, which helps improve mood and anxiety but can be affected by physical or emotional trauma. Over the course of my stay, I subject myself to lymphatic drainage, detox (mud wraps, ionic footbaths) cryotherapy, osteopathy and cranio-sacral treatments to release my pent-up stress. The therapists are brilliant and teach me all kinds of helpful things, assuaging my nagging abdominal and joint pain and mild indigestion.
For some, the Mayrlife Cure works a treat – temporarily or even permanently. Fellow patients tell me that Mayrlife is the only place in the world they can surrender and relax. But it doesn’t prove to be the answer for me: over the course of my stay, I sleep about fifteen hours in total.
After 15 years of sleeplessness, I’d come here believing what I always had: that simply discovering the right relaxation hacks, tablets or treatments would eventually get me back to sleep. It’s not until my last day, despairing I’ll never sleep again, that I book in with Dr Erich, the counsellor. It’s a revelation. He helps me to finally see the light: insomnia can be both a symptom of something that ails you, and akin to a mental health condition. It’s my mind I’m going to have to treat first and foremost, and that’s the lesson that I take back home. I need therapy.
What is CBT-i and does it work?
A month later, I’ve found just the right person to help me. London ‘sleep psychiatrist’ Dr Dipesh Mistry, is one of only very few people to combine psychiatry with CBT-i, or cognitive behavioural therapy for insomnia. It’s a highly specialised version of CBT (a talking therapy available on the NHS applied in a generalised way to a number of mental health conditions).
CBT-i is medically-validated with more than 30 years of clinical data, and involves a five-week crash course (one hour a week with Dr Mistry via Zoom) in sleep science. It allows you to learn the difference between medical sleep facts and the unbelievable amount of misleading sleep fiction out there. There’s a bespoke programme of evidence-led sleep techniques plus rigorous sleep scheduling (scroll down for a sneak peek of his best advice). What sets Dr Mistry’s CBTi approach apart, however, is his special interest in sleep disorders like mine that are rooted in mental health conditions such as anxiety.
The mind occupies a central role in his 360-degree take on insomnia therapy. Insomnia, he tells me, is a condition that often develops over years and requires a multi-pronged treatment approach. “There’s no one single silver bullet; people waste their time looking for it, especially with the deluge of unproven ‘fixes’ out there,” he says.
What is sleep psychiatry?
First, I have a face-to-face psychiatric consultation with Dr Mistry, which homes in on the same issues as my session with Dr Erich – and elicits the same amount of crying. This time, there is an actual diagnosis: I appear to have moderate generalised anxiety disorder, meaning I can (and do) fret over anything.
This is brought on my perfectionist mind and tendency to control and catastrophise – things I’ve adopted from my dear mum over a lifetime. It’s causing me plenty of stress ageing too. Dr Mistry tells me that “anxiety manifests physically in the body and needs help being released” (where did I hear that one before?) and prescribes weekly deep-tissue massages for at least eight weeks. Not bad so far!
Those will become part of my treatment ‘curriculum’, which is no picnic. I fact, it’s hard work, because the sessions with Dr Mistry are just the beginning. There are lifestyle adjustments (such as switching off your screens early in the evening) and lots of homework in the shape of tracking your sleep on Excel spreadsheets, practising essential techniques such as constructively analysing and putting to bed your worries, and incorporating sometimes time-consuming habits such as daily yoga into your everday life.
How does sleep scheduling work?
The central tenet is ‘sleep scheduling’, which means strict bed- and wake-times, no matter how much you lie awake in the night. The Excel spreadsheet makes calculations that tell Dr Mistry how efficient your sleep is. If you do well (in the shape of spending little time awake in the night), your time between being allowed to go to bed and having to get up in the morning is extended by 15 minutes the next week. If your sleep efficiency is below par, 15 minutes are shaved off of your ‘sleep slot’. The limited time in which you have to do your sleeping and the fact that you are not allowed to ‘make up’ for time spent awake in the night means initial additional sleep deprivation, and for a permanently sleep-deprived insomniac, that’s bloody hard to take.
My slot is not that bad – based on my first-week ‘baseline’ Excel sheet, I am allowed to do my sleeping between 11pm and 6.20am (this is entirely personalised so don’t go thinking you can copy this). But when a stressful week has me spending too much time wandering about at 3am, I have to go to bed even later but still get up at 6.20am the next week. It’s about consolidating sleep - read more about this in my 11 sleep tips list below.
Some of Dr Mistry’s techniques, such as cutting out caffeine after 2pm and journaling (more about this below), will be familiar as they are widely recommended by stress-relief experts and life coaches (CBT-i cherry-picks those that are clinically supported). But, he emphasises, they will not work in isolation. Trying to cobble together your own programme is similarly unlikely to succeed as CBT-i is personalised to your obstacles and sleep physiology. “Insomnia is a complex condition that sets in over years and has multiple contributing causes,” he says. “Therefore, only a multi-layered, bespoke programme, implemented over an extended space of time, can truly fix it.”
My verdict: I’m getting better
The average recovery time (during which patients continue the programme unaided) is six to 18 months, but some patients notice improvements in a matter of weeks and I’m one of them. As I complete my final session, I average six hours of sleep, well over an hour more than when I started. I feel, for the first time in years, a real sense of control over it.
I have not let up on my daily CBT-i practices and sleep scheduling since the course ended. I won’t until I stop thinking about sleeping and just do it – which is the moment, Dr Mistry says, an insomniac knows they’re out of the woods. I have binned all my ‘sleep’ and relaxation supplements which Dr Mistry says don’t work (and I know have never brought me any significant relief). And despite it being really hard to get up so early when I’ve had a bad night, it’s really working for me: it gives me a sense of pride and efficiency and I really like the quiet mornings. Best of all, it definitely means I’m more tired at night and sleep through the night more and more often. The only way, for sure, is up.
Dr Mistry (sleeppsychiatrist.com) charges from £445 per consultation.
A 7-day Mayrlife Cure (mayrlife.com) starts at £4390
11 evidence-based tips for beating insomnia that everyone can try
These are just some of the facts and hacks that I learned that will contribute to better sleep – but again, don’t expect them to bring long term-relief in isolation!
- You don’t need 8 hours’ sleep
It’s a myth – and hearing this was a huge relief. “Unfortunately, a few years ago, a professor of sleep medicine published a book in which he claims that less than eight hours’ sleep leads to dementia and other diseases – and that idea stuck,” explains Dr Mistry. “It simply isn’t true and his claims have been disproven. We all have a unique sleep physiology, which means our sleep requirements differ. There are even people – although rare – who truly just need four hours of sleep a night.” In addition, everyone will naturally sleep less and less as they get older.
- Nobody gets that much deep sleep
The ‘deep sleep’ stage is very important and restorative, but it makes up less than 20 per cent of your sleep ,while 50 per cent of every night is spent in light sleep. Moreover, the body prioritises deep slumber to happen early on in your sleep, so even if you wake up in the night and can’t nod off again, the most essential ‘sleep work’ has been done.
- Napping is a no-no
We have such a thing as a ‘sleep tank’: a supply of the sleep chemical adenosine that builds up in the brain when we are awake and drops off when you sleep. Once it’s empty, you wake up. That means that every nap in the day uses up some of the ‘sleep petrol’ and will have you lie awake in the night. So no more naps from now on.
- Consolidate your sleep – no lie-ins
By the same token, put an end to lie-ins to catch up on sleep. It’s essential to get up at the exact same time (earlier is allowed, later is not), seven days a week, no matter how little you’ve slept. At night, you should aim for the same bedtime as well: later is fine, earlier is not. The aim is to consolidate all your sleep into a regular block, improving its efficiency and quality before you can improve its length. How long this ‘block’ is, is entirely personal and based on the average length of time you sleep in your first week of CBT-i.
- Your bed is for sleeping – no reading in bed
Re-learn to associate your bed with sleeping only. Apart from sex, nothing else is allowed – not even reading. If you’re awake longer than 15 minutes, you must get up and do something restful, such as reading, ironing or listening to calm music, outside of the bedroom until you’re truly sleepy.
- Have an early bath
The body naturally cools down to prepare you for sleep – at around 9pm. That means that a hot bath or shower after that time, or any less than two hours before you turn in, will delay sleep onset and it drives your temperature back up again. Women are much more sensitive to these temperature fluctuations than men, so move that bath time forward.
- No caffeine after 2pm and no alcohol 3 hours before sleep
Ignoring either of the above will interrupt your sleep. By caffeine, think coffee, green tea and chocolate.
- The two hours before sleep are crucial
A two-hour pre-bed buffer zone, where you put the day to bed and stop doing anything stressful or strenuous, is an important daily practice. Half an hour of calming Iyengar yoga every night has been proven to settle the mind, as has 20 minutes of progressive muscle relaxation (PMR), where you tense, then relax, all the muscles of your body, progressing from top to toe. “It officially works better than a benzodiazepine such as Valium,” says Dr Mistry. You can find free guided PMR on Soundcloud and Iyengar yoga sessions on YouTube.
- Keep a journal
At the beginning of your pre-bed buffer zone, write down everything that has upset or stressed you out that day, as well as everything that made you feel happy or grateful. Use a one-page-a-day diary without any frills. Then make a to-do list for the next day and note which tasks will be truly essential. The next morning, make the to-do list the first thing you look at without fail, even if it’s blank. But between the buffer zone and the morning, be done with it.
- The eyes-open challenge
If you lie awake in the night, stare into the darkness, trying to keep your eyes open. It is tiring and difficult and stops you from ruminating. Often, it actually helps you fall asleep. This is just one of many techniques that can help you doze off, control intrusive thought patterns and manage anxiety. For much more practical and helpful advice, Dr Mistry recommends the free resources (think in-depth information, videos and exercises) on the CBT website Getselfhelp.co.uk, which, he says, boil down a lot of what psychiatrists learn about anxiety and some other mental health conditions in university!
- Don’t try to force yourself to sleep
“Stop trying to sleep; you can’t force physiology,” says Dr Mistry. “But you can train it to once again become the second nature that it is. Trust in the process; the past is no longer relevant.”