Restful Nights: How CBT-I Can Help You Overcome Insomnia with Paige Rome

Struggling to fall asleep or stay asleep can take a toll on every part of life. In this episode, we explore Cognitive Behavioural Therapy for Insomnia (CBT-I), the leading evidence-based approach for improving sleep without relying on medication. We explore this with Paige Rome from Common Thread Psychology. Learn more about Paige through her bio below:

"I'm Paige, a Registered Psychologist with the College of Alberta Psychologists. I was born in Ontario but now live, work and play in beautiful Alberta. I have worked with at-risk youth and their families in the Calgary area since 2015 and completed my Master's Degree in Counselling Psychology through Athabasca University in 2022. I now work with individuals, teens (13+) and couples. My area of interest and experience include anxiety, sleep issues, depression, trauma, life transitions, and perinatal mental health.

I work from a trauma-informed, client-centred and attachment-based lens. This means that I recognize the profound impact that past experiences and relationships can have on one's present well-being and overall emotional landscape.

On the personal side, I am a mom and step mom to four amazing boys and love spending my free time connecting with nature, traveling, watching live music, and creating art.

Where to find me:

social media @paigerometherapy and @commonthreadpsychology, website: www.commonthreadpsychology.com, email paige@commonthreadpsychology.com"

Transcript

SPEAKER_00 0:04

Welcome to the Inner Solutions Podcast. I'm your host, Jessica Heil. I own and operate Inner Solutions, a private practice clinic located in Calgary, Canada. Inner Solutions seeks to understand and help our clients by providing empirically supported treatments and evidence-based practices with compassion and expertise. This podcast will provide you with information regarding complex psychological conditions as well as treatments that are available. Welcome, Paige. Hi, thank you. Yeah, I'm really excited to be here. I'm super excited for this conversation today, too. We're going to be talking about what is cognitive behavior therapy for insomnia, which I think is such an important topic because insomnia is something that hits many people in this world. I think most of us have been plagued by at least some nights of having sleepless nights, and many people have had it to the extent where it would be like a full diagnosis of insomnia. So to start, I wonder, Paige, if you could just maybe share a little bit about your own experience with insomnia and how it led you to specialize in CBT for insomnia.

SPEAKER_01 1:29

Yeah, absolutely. So I have a fairly long history with insomnia, starting with a family history, I guess. Both my parents, I don't remember a time growing up that my parents slept normally or much at all. So I definitely have a bit of a predisposition to it. But my first real bout with insomnia was in my postpartum period with my first son. And I believe he was maybe five or six months old. And I remember the night so clearly to this day. And there's nothing really special or different about it, other than I just kind of out of nowhere had the thought, like, what if I don't fall asleep at all tonight? Right. And it it really sparked this fear in me. And it seemed so silly because, you know, I had slept fine. There was no reason to think that I wouldn't sleep at all. But the thought crossed my mind and I couldn't get it out. And it really, yeah, it sparked a lot of anxiety about if I didn't sleep tonight, what would tomorrow look like? How would I care for my son? How would I get up and just kind of live life in the way that I need to? How would I function? And I mean, it makes sense to everybody when you say it, but anxiety obviously doesn't contribute to falling asleep any easier. So I really fell into this cycle where every night I would think about going to bed and I would start feeling really anxious about not falling asleep, which would contribute to more and more difficulty falling asleep. And so I did, I tried kind of everything that you hear that people typically recommend when you're not sleeping well. I cut caffeine, tried all the relaxation apps, the podcasts, CBD, and none of it really helped. It wasn't until a friend actually recommended a book to me that was essentially like a self-paced CBTI, so cognitive behavioral therapy for insomnia program, that I really noticed lasting changes. And experiencing that difference personally, it really sparked a passion in me about learning the science behind it and getting trained so that I can help others who also feel stuck in that same cycle.

SPEAKER_00 3:42

It sounds like it was a period of a lot of, I'm gonna say suffering, right? To have that many nights where you're struggling with sleep. And something that you said that really resonated with me is that it's not just about the lack of sleep, it's also the anxiety that comes with it. That feeling of like, I don't know that I'm gonna fall asleep tonight. And what is that gonna bring for tomorrow? And how long is this gonna go on for? So I can definitely see how that would perpetuate that cycle, that when we're feeling anxious, then it's going to create kind of this feedback loop where we're less likely to sleep and kind of round and round we go. So definitely lots that you said there that I think is probably quite relatable to a lot of people who struggle with being able to fall asleep, as well as then trying all these different things to fall asleep and not having any results, the outcome that we're looking for.

SPEAKER_01 4:29

Mm-hmm. Yeah. And suffering is such a good word to describe it. And it's one that I, you know, I do use with a lot of my clients now because I find like it does, it really validates the experience because insomnia is such a such a common thing. So many people struggle with their sleep, but until you've really been in the depths of it and like a chronic insomnia, it's the the pain and the suffering is really it's not well understood.

SPEAKER_00 4:56

I can imagine a lot of people potentially feel alone in it, that if there aren't a lot of people who are struggling in that same way they are to that severity, then trying to talk about it with people. And I imagine even the simplification of people being like, oh, just go try this or try that, or have you done this? And that's got to be really hard for people and quite alienating. I want to come back to this idea then of what is CBTI. So uh cognitive behavior therapy for insomnia. I think going forward, we'll refer to it as CBTI just to keep it a little bit shorter. So for anyone who's listening, CBTI, cognitive behavior therapy for insomnia. For those who haven't heard of it, what is it exactly? And how would you say that it differs from general cognitive behavior therapy?

SPEAKER_01 5:40

Yeah, really good question. So, general cognitive behavioral therapy, for those that aren't familiar, focuses on the relationship between our thoughts, our emotions, and our behavior. And it focuses on those in more of a broad sense, right? And it can be applied to so many different areas of life or so many different presenting problems, where CBTI really zeroes in on the habits, the routines, and the thought patterns that directly affect sleep. It's not so much about, you know, relaxing more or just having positive thoughts. It's it's really practical, it's targeted strategies that the goal of is to retrain both your body and your brain to sleep better. Research behind CBCI is really, really exciting. It's really positive. A lot of it shows that it's just as effective, if not more effective in a lot of cases than sleep medication with longer lasting results. So it's really great. And I don't think enough people know about it. So I'm really excited to be able to spread a little bit of the news today.

SPEAKER_00 6:48

Yeah, I love that too. I think a lot of people are going to be hearing about this and going, oh, there's hope. Yeah. One of those things that it feels like like when you're not sleeping, it feels so hopeless and feels like it's gonna go on forever and forever. It does. So the idea that there's something out there that might work and actually does work for for most people, for many people who try it, I think is is a really great message.

SPEAKER_01 7:09

Yeah, like to quote some of the research directly, it's about 80% of participants who complete a CBTI program that actually see like really significant improvements in their sleep. So yes, there is hope.

SPEAKER_00 7:22

Yeah, absolutely. I love hearing that. And that's that's a pretty significant statistic there. That's a lot of therapies, most therapies have obviously they have effectiveness to them, but that that's a pretty high rate when it comes to effectiveness in therapy. So I I'd like to just kind of highlight that that that when it comes to like the therapy world, that's pretty much as good as it can get, right? 80% is really high.

SPEAKER_01 7:41

Yeah, absolutely. And I've felt that the benefit myself as a participant, and it's also really fun for me as a clinician now to, you know, work with something that is so effective and that you can see the results from fairly quickly.

SPEAKER_00 7:56

Yes. I'm curious. It's I'm I'm thinking about my own awareness of CBTI. Is it it's 12 weeks altogether?

SPEAKER_01 8:03

It can vary depending on the program. The program that I run is typically five to eight weeks. And the difference can come because some people respond really, really quickly to the interventions, and some people take a little bit more time for their body clock to kind of reset itself. So typically around eight weeks for the program that I run, but I know there are some longer ones out there, or it can be completed in in five, really.

SPEAKER_00 8:26

It's it, yeah, the effects are pretty quick. That's very quick. And again, like considering for a lot of people, they've been struggling with this for months, if not years, that's very, very significant. Would you be able to describe, Paige, what are some of the things that people would expect if they were to go into CBTI therapy when it comes to session by session? What are some of the requests that they might have from the therapist in terms of the things that they may try for interventions or like what could they just expect if they're going to be going through a protocol of CBTI?

SPEAKER_01 9:00

Yeah, absolutely. Really good question. So, like breaking down the name of it again, it's cognitive behavioral therapy. So, what that means is that the program will address the way that we think about sleep or how our actual thought processes are contributing to that cycle that we talked about with the anxiety, the fear of lack of sleep, general misunderstandings about sleep and how it works. So there is a lot of time a big uh education portion because having a there's this thing about sleep where, you know, it seems like a big scary unknown. It's kind of like a big mystery how it works, right? And so a lot of that can lend itself to misunderstandings or myths about sleep that contribute to the anxiety. So developing more of an understanding about how sleep actually works can help reduce that anxiety, right? And then we look at what sort of thoughts we're having about sleep itself. Do we believe that a lack of sleep is going to be the end of the world? Do we believe that we need to control our sleep, right? All of these thought processes can contribute to greater anxiety. Then on the behavioral side, we look at things that people tend to do when they're struggling with insomnia that seem to make sense on the surface. Like just for an example, I'm gonna sleep in, right? If I have a really poor night of sleep, I need to catch up on that sleep. So I'm gonna sleep in for two hours in the morning. That once we get into some of the education about how sleep works, we realize why that's actually not helpful and in the long run is throwing off that person's sleep cycle even further. So the behavioral part comes in when we start actually shifting the habits and the routines around sleep to better support that healthy sleep cycle and to get you back on track.

SPEAKER_00 10:52

That makes a lot of sense. So there's very much a behavioral component to the therapy, but absolutely a cognitive component, the way that we think about sleep, the way we like what we believe is going to have a significant impact on our ability to get to sleep. Absolutely. Interesting. Along with that, are there any other factors that might contribute to the development of insomnia that we haven't already mentioned?

SPEAKER_01 11:17

Yeah, absolutely. One framework that I love to introduce to clients in CBTIs is called the 3P model. And it's an understanding of how insomnia is first developed and then how it's maintained. So when we talk about three Ps, we talk about number one being predisposing factors. So these are things that might make a person more likely to experience a bout of insomnia in the first place. So previously I mentioned that I have a family history of insomnia, that would be a big one. Previous bouts of insomnia as well, being more inclined to anxiety, being a light sleeper, actually being a female as well. All of these things contribute to more likely that you will experience insomnia at some point in your life. So that's the first P the predisposing factors. The second P is some kind of precipitating event. So that can be anything, usually like a big life event, an illness. Maybe you have to write a big test in the morning, maybe you just had a baby, anything that kind of throws something off can be a precipitating event. So that would be typically the first really poor night of sleep. And then the big part, the most important P when we're talking CBTI is the last P that's perpetuating factors. So again, those are habits and thought patterns that keep insomnia going long after that initial trigger has passed. So things like irregular sleep schedules, spending too much time in bed, awake, worrying about not sleeping, all of those things again are what can reinforce that cycle.

SPEAKER_00 12:58

And I can see how it would be a slippery slope. It's interesting hearing you speak about some of these and kind of like the timing's kind of funny because I'm typically quite a sound sleeper. Last night, though, I did not sleep well. And I know what it was. For me, my precipitating factor was that I'm gonna be taking a trip here in December and a seat sale came on for the uh the flights. And so I jumped on those as soon as I saw it, which was quite late at night last night. And I think my brain was just feeling quite, it was very awake after doing that, and I just couldn't fall asleep. And I remember last night looking at the clock and it was like one o'clock in the morning, and I was like, I'm going to struggle to function yesterday or tomorrow. I'm like, how am I gonna feel? And that's only off of one night of sleep. I can only imagine what that would be like to have that happen consistently for a number of nights. I can absolutely see how it would be so easy to fall into that cycle.

SPEAKER_01 13:50

Yeah, a hundred percent. And that's something that I really want people to understand and something that I try to impart really early on in CBTI is that a period of insomnia, of poor sleep at some point in our lives, multiple points in our lives, is so normal. Right. We're we're human beings, we're going to have times like that where we don't sleep well because life is lifing, right? Yes. And so the really important thing is to understand that and to know what can perpetuate that cycle, you know, understand sleep and how it works so that we don't fall into that fear, that anxiety about it continuing.

SPEAKER_00 14:32

Being able to recognize that there's reasons why that happened when it did, and it doesn't necessarily mean that it needs to be every night. Absolutely. Let's segue into that. I think that's a great place for us then to talk about practical tips and tools, other practical tips and tools to be able to use things that you might recommend to our listeners if they are struggling to fall or stay asleep. What might you suggest that they can try?

SPEAKER_01 14:57

Mm-hmm. So there's so many things, and we'll go through them all with each client and CBTI and see what's actually helpful or what is getting in the way of your sleep. But in general, with with pretty much every single client, there's a couple real cornerstones to setting yourself up for a healthy sleep cycle. And the first one of those is to keep a consistent wake up time. And that's that's every day, even on weekends. Sorry, listeners, I know that sucks. Yep. Yeah, I know. And nobody likes to hear that one. But if again, we're falling into that pattern where we are doing what seems to make sense on the surface and we're sleeping in in the morning to make up for a lack of sleep. All that is doing is contributing to pushing our sleep cycle further off track. Right. So it can make a huge difference to set that alarm or give yourself, you know, within 30 minutes a consistent wake up time every single day. That's going to train your body clock. Second thing that I recommend to absolutely everybody is something that, you know, in therapy, we would refer to as an intervention called stimulus control. So what our brain, our brains are meaning-making machines, right? They're constantly making associations. That's what they do. And so an unhelpful association that our brain makes when we struggle with insomnia is it starts to associate our bed or bedtime or even our bedroom in really extreme cases with being awake, with being stressed out, with being anxious. And so, for a lot of people, even like moving up towards bedtime, knowing that that time is coming, can become a trigger or a cue for us to start feeling anxious. So, what stimulus control looks like is only using your bed for sleep, right? Not lying in there scrolling on your phone, not TikToking for long periods of time. Big one is not worrying. We don't want to be spending a lot of time in bed stressing, not watching TV. Again, I know lots of people like to watch TV in bed, but if if we can keep that space just for sleep, then your brain can start to associate the bed with rest instead of wakefulness and anxiety. Another really important way that that stimulus control is applied is if you are lying awake at bedtime, or if you wake up in the middle of the night and are struggling to get back to sleep for longer than 30 minutes, we want you to get up and do something else. Something quiet, something relaxing in a space with some dim light until you start to feel those sleepy cues again. And sleepy cues would be like uh if I'm reading a book, I'm gonna read the same line three or four times instead of tossing and turning, which again is such a huge contributor to the perpetuation of that anxiety and insomnia cycle. We spend hours, if we have insomnia, tossing around in our bed, just hoping, thinking that we can force ourselves to fall asleep. And that is contributing to the problem. So these two things consistent wake-up time and just use your bed for sleep. If you're feeling really anxious in bed, get up, right? Go back to bed when you're feeling calm and ready for sleep. Again, those two things are gonna make a huge difference. They're pretty foundational in resetting the sleep system.

SPEAKER_00 18:29

That's super helpful to hear all the different tips and strategies that we could potentially try to use to be able to get better sleep. It's interesting to me that some of these interventions in CBTI seem a bit paradoxical. They're the opposite of what we would expect, in the sense that most people think, oh, like if I didn't have good sleep, I should just sleep in, try to get all of the sleep that I can. Or if I'm not sleeping at night, I just need to lie there because eventually I'll fall back asleep. And CBTI would say, no, like get up, don't spend more time in bed if it's been more than that half an hour, because you're actually decreasing the likelihood that you're going to be able to fall back asleep. And the same with having the getting up every morning at the same time, regardless of how much you slept the night before, that those things are actually so important, but they go so against, I think, what people feel that they should be doing. Because I think when people are feeling like they're fatigued, they they just think they should be trying to get as much sleep as they can, no matter how they get it.

SPEAKER_01 19:28

Mm-hmm.

SPEAKER_00 19:29

Absolutely.

SPEAKER_01 19:29

And I love that, you know, that paradoxical word that you that applies to so much of it, right? It's it is counterintuitive. A lot of it feels like it doesn't make sense. And that's kind of a big part of why I love this work so much, because it's not intuitive. And I fell into that trap myself when I was struggling. I, when I had my son and I wasn't sleeping, my first strategy was to go to bed increasingly early. And I remember trying to go to bed and go to sleep at like 7 p.m. because I hadn't slept well the night before. But all that did, because my body isn't naturally ready for sleep at that time, it just gave me more time in bed to toss and turn and feel stressed that I wasn't sleeping. So it was adding to the problem. And it wasn't until I found CBTI and I learned more about the sleep cycle and sleep pressure and how that all works that it started to make sense.

SPEAKER_00 20:21

And what's really neat about this therapy too is because it's so science-backed, I think that for anyone who's listening who's kind of feeling a bit skeptical about that, just go and dive into some of the science and it will make a lot more sense. You'll you'll read and be like, okay, like I get this now. And that may help with your buy-in to trying these different strategies so that potentially you could get better sleep. Absolutely. Paige, looking ahead, what do you wish more people understood about sleep? And what gives you hope in your work with clients?

SPEAKER_01 20:53

Oh gosh. Um I wish, I wish more people knew that sleep can't be forced and that struggling with it doesn't mean there's anything wrong with you. It's it is a very normal thing to go through periods of time like this where you are struggling with your sleep a little bit. Things need to be adjusted, right? But it's it's okay. When we fall into the problem, is when we start to really stress, when we start to worry, when all of these things start to build up, and we fall into the trap of I need to control my sleep. I need to figure out a way that I can make myself fall asleep right now, right? And we try all the things. But at the end of the day, sleep can't be forced. It's a natural process. Our bodies know how to do it. C BTI, a lot of the time, is about learning to step out of our own way so our body can do its job. I also wish people knew more about CBTI itself, and that there are really effective alternatives to. Sleeping pills. I wish more doctors knew, because a lot of time, if you if you go to see your primary care physician for insomnia, which a lot of people do, they'll give you sleeping pills, right? I completely get the appeal. I try them myself, but sleeping pills don't treat the root problem with insomnia. If you stop taking them, your insomnia will come back if you haven't dealt with it. And they don't actually give you truly restful, restorative sleep. So I wish more people knew about CBTI in general. And I wish more people knew that sleep is not something that can be controlled. And a lot of the work is giving up that control. It's another sort of paradoxical part of it. And what gives me hope is seeing how resilient people's sleep systems really are. Even clients who've had, like you said earlier, like years of insomnia, decades of insomnia can turn things around with the right strategies. And watching that, I've seen that happen myself, 30 plus years, right, of really chronic severe insomnia. When people start sleeping again, watching that ripple into their energy, their mood, and their daily life is it's just incredibly rewarding. So I have a lot of hope that the more people learn about this and the more people know that there are real changes that you can make that will have a real difference. I have hope that people will start sleeping better.

SPEAKER_00 23:30

I love that. And I would absolutely agree with that. When people start to sleep better, longer and have higher quality, then generally their whole world is going to improve. Their mental health, their emotional regulation, their well-being, everything just gets to be so much better when they're getting consistent good sleeps. Absolutely. 100%. Excellent. Paige, if people want to find you, where can they look for you?

SPEAKER_01 23:58

Yeah, absolutely. So I am my practices is in Airdrie. I am able to see clients in person in Airdrie at Common Thread Psychology. And I can also see clients virtually across Alberta. So if you want to check out the website, it's www.commonthreadpsychology.com, or you can reach me at page at common threadpsychology.com and also find me on Instagram. Same name, Common Thread Psychology or Page Room Therapy.

SPEAKER_00 24:29

Amazing. Thank you so much, Paige. This has been absolutely insightful and I just really appreciate your time. Yeah, absolutely. Thank you for having me. Thanks so much for listening. If you found today's episode helpful, please go ahead and leave us a review. And you can also follow the show so that you don't miss out on any future episodes. For more information about us, you can check out our website, www.innersolutions.ca.