Can CBT-I Cure Insomnia Caused by Nighttime Urination?
So let's start with the first question which is **can cbti cure insomnia caused by the need to urinate during the night** so **cbti is the gold standard treatment form insomnia** cognitive behavioral therapy for insomnia I've done other videos recent videos where I go and describe what cbti is so I won't do that here but this question is if you have to get up and urinate in the night and that's interfering with your sleep can cbti cure the insomnia.
To answer this question you have to kind of break apart a couple things here number one you need to **separate the trigger from the cause** so what's a trigger? A trigger is anything that is disturbing your sleep so that could be the need to urinate in the night it could be loud noises outside it could be a stressor going on in your life like a job that's very stressful or you're having a relationship issue or even something positive like you're going to be traveling the next day and you're excited and and it's hard for you to sleep so those are triggers that can lead to a poor night of sleep or even a couple of poor nights asleep but **that is not insomnia yet** insomnia is a pattern of trouble falling asleep staying asleep over a certain period of time that's consistent it is not just a poor night of sleep so you first need to separate these apart.
The trigger can lead to poor sleep but **what creates insomnia is the way we react to the trigger** we get really anxious we start worrying about our sleep and then we start doing things we start changing our behaviors around our sleep that then actually mess up our sleep even more these are called **poor sleep behaviors** and that increases our anxiety more which makes us want to try to fix the problem more which makes the problem worse and this creates what I call the **insomnia cycle** that is what creates insomnia **not the trigger** everybody has poor sleep sometimes and that's a normal part of being a human being but that does not necessarily lead to insomnia it's how you respond to that trigger so that's the first thing.
So one trigger of poor sleep or one cause of poor sleep can be the need to urinate now this is more common with people who are getting older let's say 50s and older and particularly with men and this is just a normal thing because of the prostate as men get older their prostate changes and they might have more of a need to urinate in the middle of the night and this is actually very common if you're doing that maybe two or three times a night there's nothing wrong with that and as long as you're able to get back to sleep so you get up you go to the bathroom and as long as you're able to get back to sleep within a reasonable amount of time which is generally **20 minutes even up to 30 minutes or less** then you don't have insomnia and it's not a problem because that's a normal part of just aging.
The problem is if that has led to you developing **insomnia** because when you get up in the night to urinate you get really anxious and you get into that cycle that I just described that actually ends up creating the insomnia so you want to separate these two because it's **not the urination that's causing the insomnia it's the way you're responding** to the fact that you have to get up in the night to go to the bathroom and it's that response that's causing the insomnia and that response can change so to answer this question **can cbti cure insomnia caused by the need to urinate during the night the answer is absolutely yes cbti can get rid of insomnia no matter what the trigger is** because it's not the trigger that's actually causing the insomnia it's your response it's the **negative sleep thoughts** and it's the behaviors the poor sleep behaviors that get adopted in response to the poor sleep that then actually make the insomnia worse unknowingly to you because you think you're helping your sleep but you're actually making it worse.
Then what you want to do is address the problem now if you're getting up in the night two or three times and you're you know let's say an older person 50s 60s 70s older than that that's normal that's not a problem as long as you're able to get back to sleep however if you're getting up you know five times a night eight times a night to do that that means there's something more serious wrong with a prostate if you're a man or if it's a woman it could be some other issue and that would be more of a separate medical issue separate from insomnia that you would want to address because that could disturb your sleep so a lot of things can like interrupt our sleep there could be loud noises outside the neighbors could be having a loud party your partner if they move around a lot in the bed that can disturb your sleep but **those things are not insomnia** those are things those are just like conditions that make it difficult to sleep but that is not insomnia **insomnia is internal** it's a pattern of poor sleep where your sleep system actually shifts based on those things I said earlier the shift in the way you're thinking about your sleep now you're really anxious about your sleep and you've changed your behaviors so you want to separate these two issues whatever the trigger is whether it's urination or something else and address that as best you can so if it's a real problem then go to your doctor and try to you know treat the prostate or whatever the problem is so you can be getting up less in the night sometimes it's a matter of drinking less a few hours before you're going to sleep sometimes people drink a lot of liquids in night at the night time tea things like that so you want to reduce that so you're not having to have the need to go to the bathroom as much but then if the insomnia is already there even once you remove the trigger **insomnia remains** once it becomes a pattern you have to address it as a separate issue and in that case the **gold standard is cbti** and again I've done videos on that I'll put a link to the video that I recently did or the playlist that I that I'm creating that kind of goes into cbti in more depth.
Dealing with Severe Anxiety and Insomnia at Night
Let's get to question number two **how does it work if you have severe anxiety when you are awake at night and feel so bad you have no energy to go do something out of the bed** so part of cbti part of the treatment for insomnia is **getting out of the bed** at a certain point when you're not sleeping now I'm not going to get into that skill that's called stimulus control or in my insomnia program that have I call it 3030 because I don't like stimulus control and it involves getting out of the bed but it involves doing it at a certain time in a certain way there's a whole mindset around it it's probably the most challenging skill in the process because it's both behavioral changing behavior but it's also a **shift in your mindset** that's really key to overcoming insomnia and you actually don't even start doing that until the third week of the process and you're doing that in addition in conjunction with a few key skill so it's not just one skill that gets rid of insomnia It's a combination of things done in a certain sequence to answer the question here this person is asking is they're lying in bed at night they're awake they have insomnia and they're really anxious what you want to pay attention to here is the wording used in this question okay because that's one of the keys to to solving this problem first of all um this person is saying they have **severe anxiety** okay well you want to first distinguish what kind of anxiety when someone has insomnia they have anxiety they have **anxiety about their sleep** it's called **Sleep anxiety** those are caused by **negative sleep thoughts** that's things like oh my God I'm never going to get over this what's the matter with me I've lost my ability to sleep how am I going to function tomorrow if if I don't get a good night of sleep okay that creates a lot of anxiety around your sleep or your health or your ability to function and that is normal with insomnia everybody that develops insomnia has the sleep anxiety some people if they've had insomnia for a really long time won't have the anxiety anymore because they've just gotten so used to it but most people who are dealing with insomnia have this this is not unusual.
So to answer this question it depends on the type of anxiety if you have other type of anxiety if you have **panic attacks** if you have let's say **PTSD** post-traumatic stress disorder okay that's an anxiety disorder so there's other types of anxiety have nothing to do with insomnia that people can have in addition to the insomnia so if you have severe panic attacks you know during the night yes that is definitely going to make it difficult to sleep because you're getting extremely anxious you're releasing adrenaline and that's the opposite state you want to be in when you're trying to sleep or if you have severe PTSD and you're having flashbacks or some kind of traumatic reaction when you're going to sleep yes that's going to really disturb sleep but again like I said in the previous question **that is not insomnia** that's a separate issue that is interfering with the sleep and then as a result you might have also developed the insomnia in addition to these this other anxiety problem what that means is if you have a severe anxiety problem that's not insomnia related meaning it's not sleep anxiety it's PTSD or panic attacks you need to go and address that separately with a qualified psychologist who knows how to treat anxiety disorders and the best treatment for that is cognitive behavioral therapy this is just the **general CBT not cbti** which is specifically for insomnia but CBT and that's the best there's a certain type of CBT that I recommend for this and I'll put a link to that in the description but if it's so severe that you're paralyzed in the night or it's it's it's that you can't sleep then yes you sometimes you need to address that as a separate issue in addition to the insomnia most likely even if you address the separate anxiety issue you're still going to have the if it's been in place for a while because that has become a separate problem of its own and then in that case you still want to do the cbti but if it's so severe that you're paralyzed and you can't do anything you might have to address that first.
But what if the anxiety you're having is anxiety from the insomnia it's the **Sleep anxiety** you're you're having all those negative sleep thoughts then in that case one way to get rid of that anxiety and to start reducing it is to **get out of the bed and to to do something else** so the other part of this question the other language that I want to focus on here is this person says **I feel so bad I have no energy to do something out of the bed** what you say to yourself has a huge impact on how you feel emotionally and the things that you think you're able to do if you say I feel so bad I can't get out of the bed or I can't do anything you're kind of screwed because you're trapping yourself you're telling yourself I can't do anything and the fact is when someone is anxious and even severely anxious they can still do things you know if you think about people they might be terrified to give a speech and yet they're up in front of the audience giving a speech they might be terrified when they're in combat if if they're a soldier and yet they have to learn to be able to you know be in combat even when they're very very anxious and afraid which is normal for someone in combat because they're in they're actually in a dangerous situation if you think about it when you're anxious you have a **ton of energy** because the anxiety is fear anxiety is fear that means you're in the **fight or flight response** and when you're in the fight or flight response you are generating a lot of adrenaline and epinephrine and that's putting a lot of energy through you in addition with insomnia you have what's called **hyperarousal** where you're super like awake and alert so yes you might be exhausted right and you don't feel like getting out of the bed it's not fun to get out of the bed at a certain point but that doesn't mean you can't do it and it doesn't mean that you don't have the energy to do it you're just telling yourself that and that is sort of keeping you stuck in that place okay this is assuming it's sleep anxiety and not you know severe PTSD something like that.
First of all what you want to do is switch around the language and say something like or think something like yes this is really uncomfortable being anxious I'm really scared about my sleep and it does not sound fun getting out of the bed or it does not sound fun getting up and do something but **that's what I need to do to solve this problem** that's a key thing I need to do to solve the problem and when you actually do that with the powerful thing about this skill is that **when you get out of the bed the anxiety goes down** because you break that state you get out of the bed and the the context in the environment you're in that's actually feeding the anxiety and when you're in that mode of anxiety and arousal it's hard to break out of it when you just stay where you are so if you get out and you go to a different environment and you put your focus on something else like a book or something like that then your body starts to calm down on its own because you're not focused on sleep or trying to relax you're forgetting about it for a while now again I wouldn't recommend trying to practice this skill out of context of the full cbti treatment in process because it's a challenging skill it's very counterintuitive there's a whole mindset thing around it and when you get out of the bed and how long you stay out of the bed and that there's all these different pieces to that and so I wouldn't recommend doing that what I wanted to focus on in my answer with this question is really focusing on how you're thinking about this and that you really want to start shifting that and that **even though you're anxious you can still do things you can still function you can still take actions** and that is actually the number one way people get over any kind of anxiety and fear is facing the fear otherwise you stay paralyzed but if you face the fear even if you're petrified that's when the fear starts to go down because you're telling yourself I'm not afraid of it and that's how you learn you're going to be okay the thing you're afraid of isn't going to happen in other words **action combats anxiety and fear** okay.
My Background, Qualifications, and Measuring Success
So let's go on to the next question someone had a few questions about my background and how I got into this first one is **what is your background in sleep study** I'm a **clinical psychologist** and clinical psychologists do not get any training in sleep in graduate school unless they end up specializing in sleep they get no training now this is true also of medical doctors medical doctors go through 8 to 12 years of training and maybe in that 8 to 12 years they get 30 minutes to 1 hour of training in sleep total okay I've talked about this before it's totally nuts sleep is fundamental to our health and our life we spend a third of our life literally asleep because it's so important to our functioning and our health and all the different systems in our body and yet psychologists social workers therapists counselors medical doctors that includes psychiatrists receive very little training in sleep and that includes insomnia there's actually a hundred different sleep disorders **insomnia is the number one** like more people suffer from insomnia than any other sleep disorder and yet people get very little training in sleep so how did I get into this?
I **developed insomnia myself** after I was already a psychologist and I was a specialist with anxiety and stress and I developed insomnia and I didn't know what to do you know I had really severe insomnia for 6 months difficult falling asleep staying asleep so I had to learn and I went out and I researched and I read books and I found what was considered the **gold standard treatment for insomnia which is called cbti** and I read on it and to get an understanding of it the success rate is very high and I was convinced this was the thing for me I went through that and I was able to cure my insomnia I got completely got rid of the insomnia this was back in **2014** so this is 10 years ago and I have not had a relapse since because the last part of cbti is **relapse prevention** you learn how to prevent insomnia from coming back originally how I learned it was I had insomnia myself that I wanted to overcome and I learned the treatment and I went through it and it worked and it was amazing because to get rid of something like that it feels amazing if you're dealing with insomnia it's it's a horrible feeling and so then I started working with my clients I was already working with a lot of clients that had insomnia because I was specializing and anxiety and stress so I started implementing cbti with my clients and eventually developed an **online program for insomnia** so basically anybody in the world could could do this because it's really hard to find qualified cbti providers so that's how I got into it now I would consider myself an **insomnia specialist** there's a zillion different sleep disorders like sleep apnea and those things are separate issues they can definitely contribute or be a trigger for insomnia but basically my specialty is insomnia because it's the number one one it's like **10% of the world population suffers with insomnia** we're talking hundreds of millions of people and that's chronic insomnia and then if you expand to just the number of people that get insomnia every year is something like 30% or 40% it's crazy and that's why I I **solely focus on that as a specialty**.
Next question was **are you a qualified doctor with clinical records in the success for your courses** so I already mentioned sort of the qualified doctor like I said I'm a **licensed clinical psychologist** I've been a psychologist now for **18 years** years and 10 plus years just specializing in insomnia but I also have specialties in anxiety and stress and and a few other areas as well so I've done this with hundreds and hundreds of clients the cbti and insomnia so that's my qualifications really wouldn't matters with qualifications is not certifications and all that stuff I have the certification and the degree but **it's the experience and the skill that the clinician has in implementing the treatment** there's very few people who know this treatment well and even the ones that say they know it a lot of them don't know it well because they have they don't have the experience or they're missing certain pieces so when you're looking for a qualified clinician you just want to make sure not only do they know the treatment well and they're doing all the different parts of the cbti the way it was supposed to be done and the way it's been developed over the years but also they have experience implementing it with a lot of different clients in doing that successfully.
The second part of the question was do I have clinical records in the success so **how do I measure success** okay I said in another video I have a very high success rate in my course cbti alone has been studied on on hundreds of thousands of patients and clients with insomnia and has a very high success rate for a behavioral treatment but I find that with my programs I've had a higher success rate mainly for one reason that the people that come in who are really **committed** you have to be really committed to go through the process because it takes some time and there's some effort it's like you know losing weight or getting in good shape that kind of thing it's extremely effective but it takes effort um and if you put in that effort it pays off and you get over the insomnia and it's great and you know how to keep it from coming back for life.
The way that I measure success is a couple different ways number one in terms of data part of cbti is keeping a **sleep log** so in my program I provide a sleep log actually in a Google sheet it's pretty simple each morning you wake up you open up your Google sheet which is your sleep log it asks you a few questions you answer about your sleep the previous night and then there's calculations built in kind of like an Excel spreadsheet that will calculate some key numbers like your **average sleep time** your **sleep efficiency** which is the amount of time you're actually sleeping versus being awake when you're in the bed and the actual amount of time that you're spending in bed and then it creates averages over the week these numbers are the key for personalizing and applying the skills with cbti but **they're also the measure over time of how your sleep is progressing** so because we're tracking your sleep week by week night by night over the entire course this is over several weeks normally when you're going through cbti we have an enormous amount of data every week on how long it's taking you to fall asleep how long it's taking you if you wake up in the night to get back to sleep what time are you getting up what time you're going to bed how long are you up during the night in total and then what is your average sleep time each night and over the week and with your sleep efficiency which is a percent so we have all this data that tells us how you're progressing this is how we know you're progressing where you're progressing it also like when I work with clients and I I review the sleep logs I've looked at thousands of these things over the years and I can immediately see what the problem is when I look at a sleep log I can see if you have onset which is difficulty falling asleep **onset insomnia** **maintenance insomnia** which is difficulty staying asleep or **early morning awake** and you're waking up super early in the morning and you're not falling back asleep these are different kinds of insomnia the sleep log shows that and then it shows the data over time so is your sleep efficiency improving is that number going up is your average sleep time going up so those are the two key numbers in addition to the **instances of insomnia** how many nights a week are you having difficulty falling or staying asleep that should reduce over time and eventually get to zero and it's this data that tells us the success right if that's not changing or it's getting worse we're not getting success if that's getting better each week over time it's improving then then we know that we're getting success because that is what insomnia is insomnia is **removal of the instances of insomnia** so you're not having difficulty falling or staying asleep anymore and your average sleep time has gotten back to a normal state which for most people is **7 to 8 hours** it could be you know anywhere in that range and your sleep efficiency is **85% or better** okay that's a normal sleep deficiency so once we get to that and that's consistent and that's smooth we have a we have success we've overcome the insomnia so that's how I've measured it because I have sleep logs and and and in my program people share their sleep log with me so I have all that data in front of me for the whole program and so I know with each person how they've progressed and how successful they've been and this includes medication so if you're taking medication which a lot of people do for insomnia and you want to come off it and we two of cbti you start to taper off your medication and we track that in the sleep log as well so we have the type of medication you're taking and we have the dosage and then we see the continual reduction of that over time because you're slowly tapering off the medication while you're implementing the skills and then we see how that affects the data as you're coming off the medication how is that affecting the insomnia and your average sleep time and your sleep efficiency and the powerful thing is you see that these are not very correlated at all and that helps you get over the worry about giving up the medication and see that you have the ability within yourself to sleep so that's the main way in terms of data and tracking the success of my programs is the **sleep log and the data that comes from that**.
The second one is just **self-report from clients** if a client is going through I have a couple different options for programs one is self-guided so those clients I don't actually interact with directly much but have a program an online program that includes support from me and those people I interact with every week and they share their sleep logs with me so I see their data and I know how they're progressing and they tell me how they're doing so again with self-report people will say you know it's great I'm getting better I'm very encouraged or I've gotten off my medication they'll post um I have a community within the platform that I use where people can post successes and wins so I see it there but ultimately they'll tell me if it's it's working if they're improving how it's going and I'll see the data and that's how I measure the success in my program.
And the last question I pretty much answered it's **can you give a brief description of what motivated you to tackle the niche category of insomnia** and mainly it was because of **my personal experience of having insomnia** I had no awareness or very much awareness of insomnia or sleep issues until that point I slept totally fine until I was 44 years old and then I developed the insomnia and then now it became it became a major focus and I realized how many millions of people suffer from this I also learned as I said that the **gold standard treatment for this which has been around for decades is just not highly recommended by medical doctors and therapists** they simply don't know about the treatment because they're not trained in sleep so it's not even in their awareness and instead what they'll do is just prescribe a medication or they'll tell you to do sleep hygiene or they'll tell you to meditate or these kind of things or or supplements and **none of these things work** and so people end up staying frustrated and stuck for years with insomnia because they're not given the right path they're not given the right treatment for it which is cbti so part of my motivation was I had a personal connection to it and I saw that I could help my clients who were already dealing with insomnia I liked that it was a very specific area like for me as a therapist I like to be amazing at what I do like some therapists and doctors are just generalists they like work with everything but I don't think you can become really really excellent and expert if you work with everything because it's too it takes too much time and experience to be able to become an expert at something you can't become an expert at everything this is why doctors specialize and I think therapist should do the same so I specialized very early on in anxiety and stress and then when I developed insomnia I added that as a specialty and now essentially that's probably **90% of what I work with is in insomnia** and what that does is first of all I like it I know the treatment extremely well and I like being able to help people with this problem because I know that there's a real shortage of qualified providers there's also a shortage of access so even if there is a provider in your area many times there's a huge weight list like there could be five six month weight list sometimes to be able to do this which is just ridiculous or in some parts of the world and even in the United States there is just no providers at all and that's why I created an **online program** so people can access that from anywhere in the world as long as they have an internet connection and some kind of device to consume the material and I have actually found doing it online is better than doing it even one-on-one because basically you can go through the trainings on your time and also you still get the support and it's more flexible you don't have to drive to an office and there's a lot of other things but that's what I have found so that is why I turn it into a specialty because I really wanted to focus deeply on this issue and just be the best I can be at this and be able to help as many people as I can um with this problem who are finding it difficult to to to get treatment elsewhere okay so I hope you found these answers and these questions helpful .
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