Insomnia Fails

You might not believe it, but the two posts about all the supplements and medications I consumed to treat my insomnia don't even begin to cover the myriad ways I tried to improve my sleep. Drugs are the quick and easy solution, and I, even in my addled and sleep-deprived state, knew that quick-and-easy usually also means too-good-to-be-true. So in addition to ingesting things, I also tried doing things!

I wasn't originally going to include this laundry list in my insomnia series, but 1) it's going to help illustrate a point I want to make in a future post, and 2) it's going to help illustrate a point that I want to make now, which is: if your sleep has deteriorated to the point that you're actually referring to yourself as an insomniac, minor lifestyle changes and sleep-focused activities aren't going to change a blasted thing. 

Here's a video on the subject, which does a good job of explaining why in a nutshell, but which I'm not going to cover right now. I still have a fragmented narrative about myself to get through, after all! But if you are an insomniac, I encourage you to watch the video above, and not do the things below, because they will only waste your time.

Ready, kids? Don't try these at home!

Lifestyle modifications

• Sleep hygiene —  Mention to any medical professional that you have insomnia, and they will magically whisk out a printout containing sage advice on how to improve your sleep (I got one from the doctor I saw for my chronic back pain!). These practices are known as sleep hygiene, and they do not help with insomnia. I have heard sleep hygiene compared to dental hygiene—it's great for everyone to practice regularly, but if you already have a cavity, tooth brushing is not going to fix it. Same with insomnia—adopting better sleeping habits is just not enough to break the cycle.
  
• Changing what you eat — For a while there, I suspected that my sleep problems were linked to my diet. Maybe I was eating too much sugar. Maybe I was eating too much protein near bedtime. Maybe I was eating too near bedtime, period. Maybe I wasn't eating enough near bedtime. I made a token effort to change some of those factors, but altering your diet is hard! Especially if it's only for an experiment and there's no guarantee that it will have any effect. Most of my dietary modifications lasted one day or less, and none of them had measurable impacts on my sleep.

Things you listen to

• Guided meditations — Back when we were just young'ns, my brother had this "Go to sleep quickly" self-hypnosis tape, and one of my grade-school camp counselors welcomed us on the first night with a guided meditation that I loved, so the idea of letting other people's voices coach me to sleep was probably my first experience with sleep interventions. Of course, we all laughed at the silly sleep hypnosis recording, and I never actually fell asleep during any guided meditation even when I didn't have insomnia, so I'm not sure why I had such faith in this strategy. I gave up on guided meditations completely when I started getting the twitchiness. Every pause in the speech meant I'd be startled when it started again, which did not promote relaxation by any means.
  
• Audiobooks — Back when I was doing an awful lot of air travel, I learned, quite by accident, that I actually can fall asleep while listening to an audiobook, even on an airplane! So when I stopped being able to sleep at home, my first thought was to at least fill the time with an audiobook so that my mind would have something to do, and maybe even fall asleep! Sometimes that happened, but I always woke back up again...because there was still a voice talking in my ear! Not an effective way to ensure restful sleep. And plus, I never knew what was happening in the story because I was always sleeping through parts of it!
  
• Affirmations — Go on YouTube and search for "sleep affirmations," and you'll find them. Long videos of inspiring phrases like "I love my bed." I tried listening to a few, but I couldn't get over the fact that someone else was saying them instead of me. (You love your bed? Great. Congratulations.) And I certainly didn't have the patience to do a follow-along or read from a script.
  
• White noise — While I acknowledge that white noise is great at drowning out the sound of your roommate getting up to use the bathroom every night at 3 am, I took my dedication to white noise to an excessive level. I have a white noise app on the iPad, and for a while, I was experimenting with different mixes every day, trying to figure out if there was a certain frequency or combination of sounds that would help me sleep better than others. There wasn't. But I did have my weirdest dream while sleeping to brown noise, so maybe try that if you're looking for a mental rush?
  
• Chillout music — One thing I heard/read over and over again when I first started having trouble with my sleep was that I should pamper myself with a pleasant environment in the hour or two before bedtime. Quiet, relaxing music was always one of the suggestions. While I'm sure this can't be harmful, I'm not the type to just have music on in the background, so I found that it was somewhat stressful to select a streaming channel every day, make sure it wasn't loud enough to disturb my roommates, and then actually listen to it, because I was in and out of so many different rooms, doing so many different things, that I was missing out on the music more often than I was actually hearing it. Not worth the effort!
  
• Binaural beats — Binaural beats are this weird, woo-woo concept that involves tones of specific frequency, auditory illusions, and their purported effect on your brain wave patterns. You can look up how they work if you want, but it's probably not worth your time. Essentially, using them is supposed to coax your brain waves into a certain frequency, e.g the frequency that they produce during deep sleep. Supposedly that helps you fall into sleep faster. I listened to binaural beats for a half-hour to hour before bed, religiously, for about 2 weeks. During that time, I did not experience any change in my sleep patterns, and I certainly didn't feel any different while or after listening.
  

Things you do before bed

• Hot baths — One suggestion that came up often for a relaxing evening ritual was to take a hot bath. There was a lot of compelling evidence in favor of this practice. Supposedly the heat helps your body cool down rapidly once you get out of it, which can cause sleepiness. I wanted to incorporate this in my life, but have you seen the interior of my bathtub? It's not the kind of place you want to be putting your bare skin if you're hoping to relax. Besides, I couldn't conscience using that much hot water every day just to maybe cool my body by a degree or two. Do you know how much water it takes to fill a bathtub? A lot more than a shower! I compromised once by taking a hot shower at night, but then my hair was wet when I went to bed, and, ugh! Some habits are just not worth getting into!
• Yoga — Yoga is one of my favorite forms of movement, so when I started reading about insomnia, I was pleased to find out that yoga was frequently recommended as a way to relax and help promote sleep. Maybe I shouldn't have been pleased, because I should have realized that if I was already doing so much yoga and it wasn't helping, then yoga can't be a panacea. But nonetheless, I tried, spending the last hour before many a bedtime doing various nighttime yoga routines in the hopes that they'd help me sleep. Surprise! They didn't.
• Qigong — One of the people in my insomnia forum just couldn't stop gushing about this evening qigong routine she'd found on Youtube and how it had changed her life and finally helped her get to sleep! So I tried it. I liked it the first time, because it was a little more active than most of the bedtime yoga, and therefore better able to help me channel any nervous energy I might be feeling. But ultimately, I got annoyed at how repetitive it was, and didn't really feel like it did anything for me.
• Acupressure — There are approximately one million acupressure points associated with sleep, anxiety, and insomnia. Press on any known acupressure point (or just pick a random spot on your body) for 5-30 seconds, and it will help you sleep at least as well as any other acupressure point! Trust me, I've tried them all. Yes, I'm being sarcastic, and no, acupressure did not seem to relieve either my anxiety or my insomnia. But it did give me a sore thumb!

Things you do while trying to sleep

• Breathing techniques — The internet is in love with breathing as a sleep aid: "I tried this one breathing technique and fell asleep in 2 minutes!" and I click on them, every time, like a sucker. There's box breathing, and 4-7-8 breathing, and 4-6 breathing, and the main difference between them is how long you inhale vs. how long you exhale, and the main similarity between them is that they don't help me fall asleep. In fact, when I was experiencing anxiety and insomnia together, I found that deep breathing often did the exact opposite of what it was intended to do: it made me panic!
• Progressive muscle relaxation — I learned about progressive muscle relaxation decades ago. It's a simple technique in which you tense up your muscle groups one at a time and then let them go, which causes them to be much more relaxed than before you started. A variation on this, which I recall was developed by the military to help soldiers sleep in adverse conditions, is to focus on each part of your body starting with your head, and consciously let it go limp. I have used both techniques successfully in the past, but they are not much good if the trouble sleeping is more in your mind than in your body. I've gotten myself as floppy as a wet noodle, but I was still so stressed out about still being awake, that there was absolutely no chance of sleeping!
  
• Directed thought —  One of my oldest problems with falling asleep is that my mind just tends to wander to ever more interesting topics, keeping me awake for longer than I should. So over the years I learned to keep my mind on track and fall asleep by playing the Alphabet Game, which I described in an earlier post. When that stopped working for me, I came up with other ways to distract my brain: sometimes I'd plan outfits for the next day; sometimes I'd try to list things I was grateful for; other times, I'd just try to retell the events of my day. Sometimes I'd fall asleep while thus occupied, but more often than not, my brain would go into that blank state where I could no longer think but I could not sleep either.
  
• Counting down — This is a specific form of directed thought that deserves special mention, because it is commonly suggested as a way to help you sleep—despite being basically identical to the generally-accepted-as-useless counting of sheep. It's pretty simple: count down from 100. I found myself hitting zero with this strategy more times than I could count (hehe), so I upped it to 1000. I think I only succeeded in falling asleep twice. Usually it was so boring, that my mind would slip away from me and get back to its regularly scheduled ruminating or utter emptiness.
  

Environmental modifications

• Lavender — Spray your pillow with lavender! they say. It'll help you sleep! they say. Well, I can tell, you, I sprayed my pillow with lavender, and all I got was a streak of essential oil on my wall that I cannot remove from the paint job to this day. It did smell nice, I'll give it that.
  
• Blue-light-blocking glasses — I'm sure you've heard by now that the blue light emitted from all our electronic devices is wreaking havoc on our circadian rhythms. Blue-light-blocking glasses are all the rage, and naturally I had to try and reduce my exposure to blue light once I became an insomniac. I had some orange-tinted sunglasses already that I co-opted for the purpose. They did not have a discernible impact on my ability to sleep, but they are one of the few things on this list that I'm still using. Can't hurt, right?
  
• Banning stuffed animals — I'm saving this one for last, because it's definitely the most paranoid thing I've done in a bid for better sleep! Yes, I confess, I sleep with stuffed animals. Hey, when you're lonely and you want to cuddle, there's no shame in taking what you can get! But after my breakup, I made the mistake of taking solace in this plush elephant that had been gifted to me by my recent ex. Every night I tried to sleep with the elephant, I slept abysmally. Uh, maybe it was because I was sleeping abysmally every night regardless, but somehow I got the notion that the elephant was contributing to my insomnia. I refused to sleep with the elephant after that, and soon eschewed all my plush toys entirely. I don't think the elephant had one shred of influence in whether I slept or not, but I still let it direct my sleeping habits to a rather large extent!
  

My forbidden friend. Look closely and you'll see the streak
of lavender oil trailing down the wall next to her left ear!

 

Now I want to make it clear that there's nothing inherently wrong with doing any of the things on this long, long list! By all means, put away your childish things if you're ready for it. Do all the yoga your heart desires, and go buy yourself a spa if you're really into hot baths! But just be aware that if you're doing these things for the express purpose of eliminating your insomnia, it's probably not going to help much, and it may even backfire.

I had to learn this the hard way, but I'll give it you for free: Sleep cannot be forced. Whenever you put conscious effort into trying to achieve it, it won't happen. Sleep is like your friend's skittish cat—you know the one! The more attention you pay to it, the farther it runs away. But turn your back and stop caring, and it'll be in your lap before you know it!

So I had to stop trying all these useless things to improve my sleep, and learn to just let it take its natural course. We're almost at the part of the story where I had that realization. Stay tuned for the turning point!

What does insomnia feel like?

"It's ___ A.M. and you're staring at the ceiling."

Insert any random hour between 1 and 3 in the blank, and you'll have the most clichéd line in the history of insomnia literature. Clichéd and completely untrue—at least in my experience!

When my insomnia was at its peak, I definitely spent many a 1-3 A.M. period painfully, miserably awake. But never, in all my sleepless nights, did I occupy my time staring at the ceiling. My eyes stayed firmly shut most of the night.

"Am I some weird freak of nature?" I wondered. "The only insomniac in the world who keeps her eyes shut?" My experience was so contrary to the stereotypical presentation of insomnia, that I began to wonder, To get a sense of what other people were going through, I asked Google what insomnia feels like. But I came up with almost nothing (except this one discussion from Quora, which was more about how people feel about their condition, rather than how the condition itself feels).

So here's how my condition feels to me! I'm sure everyone's not the same, but at least it's a glimpse into the life of one insomniac.

Nighttime

Every sleepless night starts about the same way. I usually crawl under the covers, turn to my side and roll up into a cozy ball. It's very pleasant and just right for falling asleep...except that never happens! This is the point where a lot of insomniacs report "racing thoughts." I have just the opposite problem—no thoughts at all!

If you're a normal sleeper and you're aware enough, you can usually tell you're falling asleep because your thoughts change from an internal narrative to a more dream-like quality—you hear voices that aren't your own, and see scenes play out in your mind's eye. When I'm trying and failing to fall asleep, these things don't happen. It's like as soon as I shut my eyes, my brain shuts off too! It is an absolute blank.

Sometimes (in better times), I play a game to help myself sleep, wherein I think of things in alphabetical order that fit into a given category. It's a simple game, just interesting enough to keep me focused, but just boring enough to easily drift away from into sleep. When I'm having an insomnia night, this game does not work! I am too tired to think of anything, categorizable or otherwise! I am struggling to form a thought, but nothing happens! I will lie there in a semi-comatose state, and after a half-hour to an hour, will realize I'm still awake and have nothing to show for it.

Sometimes I get tantalizingly close to sleep. It's at times like this that I feel sleep is an iced-over river. It's flowing just beneath me. I'm skittering along on the surface, so close, but I can't break through the ice! The moment I feel I'm about to fall into the stream of unconsciousness, I'll become aware of what's happening, and come fully awake with a jolt! I know at least in this I'm no weirdo; it's one of the most common topics of discussion in my insomnia forums.

Anyway, after several episodes of this, checking the clock each time and seeing the hours march relentlessly onward, I start to get anxious. My heart starts to pound, my entire body will get hot. I begin to feel trapped, like I have to escape! It's my fight-or-flight response kicking in, and once that happens, it is actually terrifying to stay in bed. I'll get up and try to do something physical – squats or pushups, laps around the kitchen – to release some of the tension.

The funny thing about this late-night wakefulness is that even though my mind is fully alert, my body most definitely is not! Some people supposedly do constructive things when they're unable to sleep at night: cleaning, or reading, or art. Most of the time I'm way too tired to do any of those. The best I can manage is to just sit on the couch and zone out. I'm slow and clumsy when I move; I can barely keep my eyes open. If I try, they burn with the fire of a thousand suns! Late enough into the night, not only are my eyes hurting, they're also rolling all over the place because I can't even get them to focus. Whatever I'm doing, I am definitely NOT staring at the ceiling!

Daytime

The amount of sleep I got on any given night actually has very little bearing on how I feel during the day. Some days I feel very tired; others, only a little tired. But yes, always some tired! 

 

The day after a night of bad sleep (which was, for me, for a while, every day), I always feel dazed and a little disconnected from the world. I want to constantly lie down and close my eyes. I feel run-down, unmotivated, and a bit stupid. My memory is like a sieve. Creativity is almost nonexistent. This is pretty much the same for every insomniac everywhere, so I don't feel the need to go into a lot of detail about those symptoms here.

One thing that felt a little unique, at least to me, was the anxiety. I've always been a mildly anxious person, so no stranger to the occasional panicky moment, but the early insomnia days were very intense. The slightest thought or startling sound would set off a cloud of butterflies in my stomach. Sometimes I'd even feel the shock like a kick in the head. I was always on edge and felt nauseated pretty much all the time.

While the constant nerves calmed down after a couple of months, I still to this day have a symptom that I have labeled "twitchiness." Sometimes I just get hypersensitive to the sounds that are around me. It feels almost like there's a direct line from my eardrums to my stomach, and whenever I'm in a quiet place and there's a sudden sound—even one as inocuous as a door opening down the hall, or my dog sighing—My stomach lurches, or sometimes my eyes blink or my head jerks involuntarily. It's as though I'm about to leap out of my skin but just don't have the energy for so much action. There are moments when I'll feel suddenly startled, and I won't even know why...until I review the past few moments and realize it was triggered by a sound that I wasn't even paying attention to consciously. I've asked other insomniacs about this and they say that it's relatively common. I've heard it varyingly labeled hyperacusis, misophonia, or even myoclonus, but it doesn't seem to be well documented as an insomnia symptom, aside from anecdotal accounts. 

This twitchy feeling can get quite irritating, especially when there are several incidents within a few seconds of each other. But the good news is, I've gotten pretty good at just ignoring all the other symptoms of insomnia and powering through my day!

 

The even better news is that lately, insomnia has barely bothered me at all! While I'm by no means achieving the amount of sleep I used to get before insomnia, I am sleeping much better than I was back in May and June. There's hope for insomniacs yet! Stay tuned—in the next posts, I'll be sharing how I finally started to turn my abysmal sleeping situation around.

Insomnia: It's probably not fatal

If you've never had insomnia, you might never have heard of the illness called fatal familial insomnia. If you have insomnia, however, fatal familial insomnia (FFI) is one of the first things that will come up in your paranoid searches about your condition.

FFI is rare. So rare that it affects less than one in a million people each year, and only those who happen to be carrying the disease's specific, inherited genetic mutation (which is only found in 50-ish families worldwide). However, among the unlucky few who inherit that gene, those who fall ill from it will eventually die. Inevitably. It starts with gradually worsening insomnia, progressing to a complete inability to sleep, concomitant with a whole host of horrifying neurological symptoms, eventually leading to a complete loss of cognitive function and death.

Long before I developed my own case of insomnia, I knew of FFI thanks to voracious reading and a morbid curiosity about exotic diseases. In fact, when I first acknowledged that I was suffering insomnia, I thought to myself, "Well, at least it's not fatal familial insomnia."

Or was it? Once that seed of an idea was planted, I couldn't help but worry. Wasn't there a possibility that FFI existed in my bloodline and it had just gone undetected?

On May 5, I took my third dose of mirtazapine, took 2 hours to fall asleep, and slept for a grand total of 4 hours. On May 7, I began reading all the information I could find on fatal familial insomnia. I didn't really think it ran in my family, but it never hurts to learn more, right? I knew, for example, that the usual progression of FFI meant that insomnia starts off mild but progresses to total sleeplessness by about 4 months. But how mild is mild? Does the amount of sleep per night decrease gradually until it hits zero? Or is it more fitful? Perhaps several nights in a row of no sleep, followed by a night of a little sleep? Did my sleeping patterns align in any way with those of an FFI sufferer?

I could find none of that online (even though I used my credentials as a university employee to get the full text of some scientific papers!). But what I did find was a terrifying tidbit of information. Fatal familial insomnia only runs in families, but there is another form of fatal insomnia (sporadic fatal insomnia, or SFI) that can arise spontaneously and affect anyone! SFI is even more rare than FFI – only 24 cases have been documented in history – but those were 24 people who could just as easily have been me! I know from my browser history that this freaked me the heck out, because on May 10, I visited 15 web pages about SFI before calling it quits.

Here's what I knew. There's this illness characterized by steadily worsening insomnia. Meanwhile, I'd had insomnia that was steadily worsening! This illness is untreatable even by the most powerful sleep drugs available (benzodiazepines); in fact, I'd heard that benzodiazepines have been known to make it worse. Meanwhile, I'd never taken a benzo, but the sleep aids that I had tried were not doing anything!

You know me, I'm an admitted hypochondriac. I've diagnosed myself with labyrinthitis only to realize I just needed to lay off the cough suppressants. I've wheedled my doctor into prescribing me antibiotics on the off-chance that I had whooping cough. So it's not surprising that, when faced with trouble sleeping, I immediately jumped to the worst possible conclusion and assumed I had a rare and deadly prion disease. But in this case, I wasn't alone. It seems that there comes a time in every insomniac's life when they conclude that their case of insomnia is one of the rare fatal ones.

I know this because there is a pinned post at the top of one of the more prominent insomnia forums, admonishing me for drawing that very conclusion. If you think you're the special individual who has fatal insomnia, the post goes in a rather superior tone, guess what! So does everyone else! And not a single one of them has ever come back and said that their suspicions were confirmed.

Oh, so I'm not really that unique after all? That stung a little, but it was also oddly comforting. It was unlikely that I had FFI, but even if I did, I consoled myself with the knowledge that I knew what to expect. FFI takes about 4 months before the patient cannot sleep at all. I was two months in; I only had to wait 2 more before I could either rule it out completely or come out with an I-told-you-so. So I waited. I still harbored a little niggling fear, but I tried to be rational and tamped it down.

And it wasn't long before I admitted to myself that fatal insomnia, of any sort, was probably not what I was facing. When I began to get a little panicky over the prospect, I thought back over the facts and usually found them reassuring. Here's what they were for me.

1. Fatal familial insomnia runs in families. I had no evidence that anyone in my family had ever had any kind of insomnia, let alone died from it.
   
2. Fatal insomnia is kind of a misnomer, because insomnia is just a symptom. The disease is basically your brain eating itself, and consequently comes along with other telltale signs (behavior problems, excessive sweating, jitteriness, extreme weight loss, etc.). I had none of those.
   
3. In the sporadic form of fatal insomnia, sleeplessness actually tends to appear rather late, after other symptoms. My sleeplessness came first.
   
4. Fatal insomnia usually appears without warning; the fact that my insomnia was coincident with a stressful life event was a strong indicator that it was probably just your average, run-of-the-mill, non-fatal kind.
   

If you, or someone you know, has been having trouble sleeping, and that trouble has been getting worse, I urge you to learn the lesson millions of insomniacs have learned before you: you're not going to die of insomnia. The trouble sleeping is probably getting worse because you're worrying about it, so take a few deep breaths! You're not going to die, you're not going to die!

Look at me! I've crossed that pivotal 4-month mark and then some, and my insomnia hasn't deteriorated into dementia. I'm still kicking, still getting at least some sleep, and still writing long-winded essays about my experiences. And I still have more in store, so stick around for another blog post soon!

Adventures in Tofu

Are you tired of hearing about insomnia yet? I am, too, so let's talk about something much more pleasant: cooking!

Wait.

Is cooking pleasant?

I'm not so sure—and if you agree, you'll love this ultra-low-effort recipe that doesn't require any cooking at all!

It starts with a block of tofu. Much like quinoa, tofu is a protein-packed health food with absolutely no enjoyable qualities whatsoever. While quinoa tends toward bland and grainy, tofu tends toward bland and squishy. No matter how "extra-firm" the package label claims, the substance inside provides nothing to sink one's teeth into.

Sometimes I buy tofu anyway, because I'd like to eat a little healthier. And then it sits in the refrigerator, burning a hole through the shelf while I try to come up with palatable ways to prepare it. This time around, I came across a recipe for "methi tofu," which sounded interesting because it was the only tofu recipe in pages upon pages of search results that didn't scream "flavorless-but-spicy!!"

However, I took one look at the ingredients list and threw up my hands. This was a dish that was going to require cooking. So much cooking! Suddenly, in the blazing heat of the July day that I set out on this mission, I knew there was no way I was going to fire up a stove and sauté anything!

So I did what any lazy chef would do: I cut some of the tofu into cubes, sprinkled it with some crushed methi leaves from my spice cabinet, salted it, and put it in the fridge to "marinate."

In case I were to find my artless methi tofu unappetizing, I took the remainder of the tofu block, and mixed half of it with some bean stir fry sauce. Then I took the other half, added some Italian dressing mix and (because I was really getting creative now!) some diced green tomato, and left those to marinate, too.

 

After a day, I ate all three and found them...underwhelming? But really not any worse than how they probably would have come out if I'd actually cooked them. This is tofu we're talking about—even the most loving of preparation methods leaves something to be desired in the eating.

When I ate the leftovers the following day, I improved upon my work by tossing some thawed frozen peas into the methi tofu. This added a little texture to the mix, and raised the palatability from just-choke-it-down health meal to almost-enjoyable cold entree! I think the key to making this recipe is not to think of it as a tofu dish, but rather as a tofu-based salad. 

 

In case you'd like to experience this culinary marvel for yourself, here's a recipe!

Cold Tofu Salad

Ingredients:

• 1 block extra-firm tofu (if you want it even firmer, you can press it first)
• 1 seasoning of your choice (some ideas: salad dressing, spice packets, stir-fry sauces)
• Salt, if the seasoning doesn't contain it
• Vegetables to complement your dish (Because this is a no-cook meal, I recommend frozen vegetables that you have thawed, or something like tomatoes or leafy greens, which don't need to be cooked).

Steps

1. Cube the tofu.
   
2. Mix all ingredients together.
   
3. Refrigerate for 24 hours.
   
4. Eat and enjoy!
   

Insomnia: The pharmaceutical phase

Once my doctor recommended I see a psychiatrist, the first task was to find one. I contacted more local clinics than I ever want to recall. Almost all of them were not accepting new patients, or weren't accepting patients like me, or had a waitlist, or just never picked up the phone! Imagine being someone desperately in need of support and having to go through all that! Trying to find a psychiatrist is enough to make you need a psychiatrist!

Anyway, I eventually succeeded in setting up an appointment for the last week in April. The virtual appointment was just as nerve-wracking as the original search had been—the audio on the video call was so bad that I spent the entire appointment asking the doctor to repeat himself and cringing at the sound of my own words echoing back at me 1 second after I'd said them. Somehow I survived my psych appointment with my sanity intact, and came out the other end with a prescription for mirtazapine.

I was afraid to take it.

I have always been a little leery of prescription medicines. I'm fine with taking a course of antibiotics or whatever is necessary to rid myself of some temporary invader, but the idea of using drugs to alter the way my own body functions kind of gives me the willies, especially if there's a possibility that I'll become dependent on the drug forever. My limited experience with pharmaceuticals also tells me that the side effects are usually just as bad as the condition they purport to treat! I won't digress too far with the tale of when I was prescribed Nexium, but let me just say that a few days on the purple pill made me feel worse than no pill at all, and it took me over a month to get back to feeling normal!

So I approached the use of prescription sleep aids with extreme trepidation and read the entire list of side effects before I began. There were a ton, and they were all very worrisome! I really, really, really, didn't want to become dependent on mirtazapine, but I did have high hopes that it would at least give me a few nights of decent sleep, so that my body could remember what it felt like.

Oddly enough (or unsurprisingly, depending on how you look at it), as soon as I had received the prescription but before even taking it, I started sleeping better (from around 4 hours a night to 6). Just believing that relief was only one pill away helped me relax immensely. But curiosity won out, and I decided after a few days to try the prescription.

I don't really recommend reading the next part, unless you're a glutton for overly procedural accounts of solutions that didn't work and near-infinite variations thereof. If you're not that sort, I'll catch you after the curtain. If you are that sort, settle in for what can only be described as a shitshow—in 4 acts!

ACT 1: Mirtazapine

I took my first mirtazapine dose five days after the appointment. It did not help me fall asleep any faster (I still lay awake for 2 hours), but I slept for 7 hours straight, which was a nice change! Unfortunately, it made me extremely groggy the next day (I didn't stop feeling tired until early evening), and never worked as well again after that. Most nights when I took the mirtazapine, I slept for four miserable hours, and felt like a zombie the day after.

I feel that the medical institution let me down during this phase. I barely got any instructions on how to use the medication (I probably wouldn't have been able to hear them if I had) and no instructions on what to expect or what to do if it didn't work as expected. So I had to figure it out all alone. I was told to take one-half pill an hour before bedtime, and that's what I did. I felt tired within minutes, but I forced myself to stay awake for the full half hour.

This, I have since learned, is a mistake. When you take a sleep aid, you should be prepared to go to bed immediately, and ideally, you should already be in bed when you take it. That way, when the sleepiness hits, you can just lie down and hopefully zonk right out. The longer you spend powering through the drowsiness and trying to stay awake, the less likely you are to sleep (and with some drugs, the more likely you are to engage in strange semi-somnolent behaviors like sleep-driving and extreme eating). But no one told me that, so I missed the optimal timing by trying to do it by the book.

And then I compounded the problem by experimenting. I tried taking the pill even farther in advance of bedtime (hoping that this would reduce the next-day drowsiness), not knowing that this was going to make it less likely to help me sleep. 

 

I also experimented with the dosage. I had found enough information online to learn that mirtazapine is more likely to help you sleep if you take a smaller dose, while higher dosages can actually be stimulating. I tried taking smaller and smaller doses, but that didn't do anything. One night, I took double the recommended dose, and I was up half the night, not only unable to sleep, but also afflicted by weirdly twitching thigh muscles. Never again!

I was supposed to follow up with the doctor after 4 weeks, but I hated the mirtazapine so much that I called the office after 2 weeks and was able to schedule a 15-minute chat with a different doctor. This consultation was over the phone, so I found it much more pleasant (no maddening audio issues this time), and the doctor was helpful and reassuring. I told him that since taking the mirtazapine, my insomnia had actually gotten worse. "Don't worry," he said, "We'll get you to sleep."

ACT 2: Trazodone

This time, I was prescribed trazodone. I researched the mechanism of action of that and mirtazapine and was disappointed to find that both of them do essentially the same thing: act antagonistically on various histamine receptors, to cause a sedating effect. If one histamine blocker had failed to help me sleep, I doubted a different one would do anything, but I dutifully gave it a shot anyway.

The results were even worse than before! This time, the instructions were to take the pill at bedtime, but I had found something on the internet that said you should take it 2 hours before bedtime. I split the difference, took the pill an hour before bed...and proceeded to lie awake for the next four hours! After a few days, I found different advice on the internet saying that best results are obtained when you take your dose as close to bedtime as possible. For a few nights, I took the trazodone just before bedtime and slept, but only for a paltry few hours.

Trazodone is not known for helping its users stay asleep, whereas mirtazapine is, so I decided to have another go with the mirtazapine, this time armed with the knowledge of proper administration timing. For one night, I had an almost perfect 7 hours of sleep! And then the next night, it was back to my old ways—took the pill, went to bed, lay there until, in desperation, I drank some alcohol. You're not supposed to combine alcohol with sedatives, because that's what people do when they want to die, but 1 or 2 shots is probably not going to make the difference between life and death, if the sedative isn't having any effect anyway. That was my rationale in any case—don't construe it as advice! Given that the mirtazapine wasn't effective at anything but making me feel comatose the next day, I gave it up and waited for my next 4-week appointment.

ACT 3: Lunesta

At this appointment, I had gotten a little wiser about the audio problems on the virtual meeting, so I was able to communicate better. I told my doctor that neither of the prescriptions had helped thus far. He asked me if I had ever tried Ambien. At this point, I bashfully (bashful because, like combining alcohol and sedatives, you're really not supposed to share prescription drugs) mentioned that someone had once given me a Lunesta and it had worked pretty well! So I left that appointment with a new prescription for Lunesta.

Oy vey, the Lunesta cost a pretty penny! I coughed up the 92 dollars for a month's supply, and really hoped that it would do the trick.

But — surprise! — it didn't!

By this time, I felt like an expert at taking sleeping pills, and the first night I took Lunesta, I did everything right. I'd been off caffeine for days, I took it right as I crawled into bed, I waited to get sleepy and then lay down my head. Instead of falling asleep, I started to get more antsy! I had a few intense muscle twitches, and after I'd been lying there for 2 hours, I began to feel hot and anxious. I had to get out of bed and walk around to calm myself, but even that didn't work, so I took comfort in my old standby – a shot of vodka – and finally slept for four hours. I woke up too early and didn't sleep again, and my anxiety skyrocketed! My ace in the hole, Lunesta, hadn't helped! I was pretty sure there was something wrong with me that couldn't be fixed.

But "pretty sure" isn't 100% sure, and I didn't have anything else to do but keep trying, so a few days later (after I had steeled myself against undesirable results), I took the Lunesta again—this time the maximum prescribed dosage of 3mg (the previous dose had been 2mg). This time, I fell asleep almost immediately and slept like a baby. That is to say, I kept waking up all night, but at least I slept! I was so pleased with myself, that I had another Lunesta the next night, and...got 2.75 hours of sleep. What had gone wrong!? I didn't know, but I was so disheartened.

I'd never planned to take sleep aids for the long term, but I'd really hoped that if I found the right one, I could take it enough days in a row that my body would catch up on sleep and stop perpetuating the cycle (did you know that sleep deprivation can actually cause physical symptoms that make it harder to fall asleep!?). But it was not to be. I was out of hope. I didn't think I wanted to try any more drugs, and I was just going to have to buckle down and do things the hard way: with cognitive behavioral therapy, However, that will be a topic for another post. In this one, we still have one more prescription to talk about.

ACT 4: Quetiapine

At my second 4-week follow-up with the psychiatrist, I explained my failed experiments with the Lunesta, and he said he was out of ideas. I should probably go get a sleep study. But first, there was one more thing I could try: quetiapine. Quetiapine is a little different from the other drugs I'd been prescribed thus far. Whereas Lunesta was designed specifically for sleep, and mirtazapine and trazodone are actually antidepressants prescribed off-label for insomnia, quetiapine is an anti-psychotic. It sounds powerful, right? It goes by the more common name of Seroquel, and several members of my insomnia support group (which I had joined in the midst of this saga) swear by it.

Although I was pretty weary of the revolving door of prescriptions, I filled this one, too (I'd asked for only a 7-day supply after the fiscal fiasco with Lunesta). My doctor had recommended that I take it jointly with the Lunesta, but I tried it one night by itself because I wanted to see its effects without being combined with other drugs. It took me almost an hour to fall asleep, but by this point, I had acquired some emotional regulation skills, so I refused to panic—I just stayed in bed, eventually drifted off, and clocked a delightful 7.5 hours! Victory! I knew better than to try and tempt fate by taking it another night, but I was pleased to find that drugs still could help me sleep...if I let them.

CURTAIN

You see, over those 2½ months of medical trial and error, I'd learned a lesson. Insomnia (in most cases, and definitely my own), is largely psychological. It comes from a misdirected activation of primitive survival instincts, and no exogenous chemical is going to override your survival mechanisms for very long (unless you take enough to kill you). 

 

Ask almost any long-term insomniac, and they'll happily (or grimly) tell you exactly how many prescriptions they've been on and how long it took before they had to switch to the next one. Every drug eventually stops working, because to truly overcome insomnia, your mind has to be a willing participant!

By early July, I'd learned how to help it do that, but it was with no thanks to conventional medicine. My psychiatrist certainly never had anything to offer but a drug and some crossed fingers. I promise I'll tell you, eventually, what set me on a better path... but first, I must share a little interlude, about a particularly wrong path! Tune in soon for the next terrifying installment of my insomnia chronicles!