Why are sleep techs so scared of insomnia? I faced my fear and now train others in CBT-I.

By Cali Bahrenfuss, CCSH, RPSGT

When starting my career as a sleep tech, I didn’t put much thought into the sleep-wake implications of being an overnight employee. Despite my expertise in sleep, I assumed being exhausted was unavoidable when doing shift work and that I was doomed to experience insomnia even when I had the opportunity to sleep. Even though I loved my job and it paid well, the overnight shifts and the long commutes—I was a traveling sleep tech in a rural setting, driving up to four hours each way for one night of sleep studies—the experience took a toll on my body.

A few years into my traveling night shift job, I had a baby and struggled with an undiagnosed thyroid disorder, so I decided my tiredness and insomnia warranted a talk with my doctors. I was prescribed a sleeping pill to help increase my hours of sleep. Though I didn’t want to take medication to sleep, I was hopeful a pill would help. But after a bad reaction to the medication, my doctor said I didn’t have many other options and reminded me that I worked the overnight shift and had a toddler, so I was going to feel tired. At the time (about 20 years ago), prescription sleeping pills were the standard therapy for insomnia, so I don’t fault my doctors. 

My experience is common among sleep techs, who usually start our careers working overnight shifts. Ironically, the very people entrusted with helping others improve their sleep are seemingly doomed to poor sleep ourselves. It is also ironic that I was in the sleep industry but didn’t truly understand the mechanisms of sleep. Sure, I knew all about the stages of sleep, obstructive sleep apnea, periodic limb movements, and REM sleep behavior disorder, but I knew almost nothing about insomnia. I have only recently realized that shift workers are not doomed to poor sleep and constant exhaustion; once I opened my eyes to the literature about insomnia and its treatment options, I realized what a difference small changes could make.

Why Are Sleep Techs Scared of Understanding Insomnia?

Early in my career, I figured insomnia was a sleep disorder for the day shift to handle. Even when I became a manager of a sleep lab and worked a day shift, I still did not know how our facility dealt with people presenting with insomnia. I left that up to the sleep physician. In my experience, insomnia is like the haunted house of the sleep field. We’re scared of it. We avoid it, and we don’t really want to talk about it. We just hope it just goes away on its own.

My lack of insomnia knowledge was as much my fault as anyone else’s. But I don’t think I’m alone in dismissing insomnia. I’ve worked with hundreds of sleep professionals throughout my career at different facilities, and no one ever talked about how to improve insomnia in their patients or even within their own staff. As shift workers, we weren’t given information on how to sleep better. Any information we gleaned was from senior sleep techs who learned by trial and error. This is sad because if we as a sleep industry could make small modifications to help improve our own sleep, we should know how to do that, right?

Some of you do know about insomnia and how to treat it. But overall, in the sleep medicine subspecialty, do most sleep techs and clinicians learn about the recommended first-line approach to insomnia? (Hint: It’s not pharmaceuticals.) Do we know how to maintain a healthy sleep pattern while working the night shift, which goes against our natural sleep/wake cycle? We should know these answers just as much as we know sleep stages and sleep apnea indexes.

Discovering CBT-I

More recently in my career, I have been lucky to work under an amazing physician who pioneered early insomnia research and taught me about cognitive behavioral therapy for insomnia (CBT-I), which is now the recommended first-line approach. So I’ve spent the past several years helping people with insomnia improve their sleep by understanding how sleep works and what changes to implement. The experience of coaching others has made me think back to my insomnia-filled night shifts and wonder how my life would have been different if I’d known about CBT-I. If only I had understood how the circadian rhythm and homeostatic sleep drive work together, how light affects sleep (and how we can use light to our advantage as shift workers), how to increase our sleep drive, and how to minimize sleep anxiety. 

I have also opened Delta Sleep Coaching, where the goal is to help others understand how sleep truly works. Coaching clients through CBT-I is such a rewarding experience. I get to help people improve their sleep in just a few short weeks. I’m helping people who, like me, were told there aren’t many options to improve sleep because they work overnights. I’m helping those who were prescribed medications no longer need sleeping pills. I’m helping business owners who want to improve the sleep of their employees and clinicians who want tips on how to sleep properly while working overnights. I’m even helping other sleep labs incorporate their own CBT-I programs, and I’m helping sleep techs learn about CBT-I.

I ensure my clients not only understand CBT-I techniques but also understand the hows and whys behind the things that affect sleep, so they understand why what they’re currently doing might not be conducive to good sleep. I want them to understand why set bed and wake times are important, how electronics may interfere with sleep (and how they may be appropriate at times), what to do when we can’t sleep, and how much caffeine is OK. Their behaviors and thoughts around sleep can be restructured without having to upend their lifestyles. While I’ve helped many people improve their sleep, I am also sad there aren’t nearly enough CBT-I professionals like me to make a dent in the insomnia world.

As sleep clinicians, few of us know what to do when insomnia happens. I want to change that, and I’m hoping other sleep techs do too. I’m hoping others will want to help banish the haunted house stigma of insomnia. The world needs more CBT-I professionals to help the millions of people who have insomnia. Sleep techs are a seemingly perfect fit to help coach people with insomnia through CBT-I programs.

To start, ask yourself these questions. Does your practice utilize CBT-I to improve insomnia in your patients? Do you teach your night-shift employees how to improve their sleep by utilizing CBT-I techniques and methodologies? Do you know how or where to learn more about implementing a CBT-I program?

If the answer is no to any of these, I challenge you to research CBT-I. Reach out to an experienced insomnia professional for guidance, download a CBT-I app and go through the techniques yourself, and read some books about CBT-I by physicians currently practicing it. 

CBT-I can be life-changing for so many people, including your own sleep techs. So try providing light therapy devices for your sleep techs. Talk about how melatonin may benefit shift workers. Try new relaxation techniques before bed. Talk about what time to drink coffee at night. Try wearing sunglasses on the way home from work in the morning. The key here is to try.

If everyone on your sleep team learns more about insomnia and CBT-I, it may not only improve their own sleep (which may increase their productivity as employees), but it also improves their overall knowledge of sleep. Let’s help sleep techs by giving them the knowledge and understanding of CBT-I they need to help others. If sleep techs can improve their own sleep by using CBT-I, they can use that experience to coach others to do the same.

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