Bye, Bye, Beddie

Before I developed insomnia, I always made sleep a priority—I stuck to a strict bedtime, never allowing myself to get derailed by Netflix binges or the other pitfalls of less dedicated sleepers. I was proud that I almost always woke up before my alarm and never needed coffee to help me function. You could say I was a bit smug about my superior sleeping habits.

Once I developed insomnia, I learned pretty quickly, though, that I'd actually been routinely committing one of the cardinal sins against sleep: I was hanging out in my bed pretty much all the time.

Do any quick Internet search for how to sleep better, and you'll find a list of tips. It is a very rare list among them that doesn't mention the following: "Use your bed only for sleep and sex."

Well, whoopsy-daisy; I'd made a habit of using my bed for pretty much everything! As someone who's spent most of her life in group living situations, I've long been used to spending much of my time in my bed, as it's the only private space where I can relax. During the COVID stay-at-home orders, my bed turned into the home base for all my leisure activities. iPad gaming, book reading, virtual happy hours, movie nights, lunch, dinner, snacks—it all happened on my bed!

As soon as I learned that daytime bed use is a sleep-hygiene no-no, I stopped. When I wanted to play iPad games, I did it at my desk or on the couch. I started eating my meals at the coffee table. On those occasions when I really needed to be alone and horizontal, I'd unroll my yoga mat and have a quick lie-down in my home office. I missed my mattress, but I was going to do whatever it took to sleep better!

Whatever it took to sleep better meant not only staying out of bed during the day, but also leaving the bed frequently during the night—specifically, I was supposed to follow this rule: "If you've been in bed for 30 minutes and still can't sleep, get up and do something relaxing until you feel sleepy."

I didn't know it initially, but this practice of getting out of bed, along with the sleep restriction that I described in my last post, is one of the hallmark techniques of cognitive behavioral therapy for insomnia, and it's known as stimulus control.

"Stimulus control" isn't a very self-explanatory term. What's the stimulus, what are you controlling, and what does it have to do with insomnia?

As it turns out, the meaning is rooted in behaviorism and the concept of conditioning. I am not a psychology professor, so if you really want to learn more about sleep-related conditioning, you might want to hear it from someone other than me, but in a nutshell, it means that if you stay in bed when you're wide awake, frustrated, or unhappy often enough, you're creating a subconscious association between the bed and those negative feelings. Pretty soon the bed itself becomes a stimulus for anxiety, stress, and subsequent sleeplessness! That explains why every time I went to bed, even if I was sleepy, I'd instantly become overwhelmed with panic and lose my sleepiness.

In stimulus control for insomnia, you get up before you start feeling frustrated, and you stop spending so many wakeful hours in bed, so it ceases to be a stimulus for those stressed-out wakeful feelings. Ideally, it should be a stimulus for the exact opposite – relaxation and sleep – which is why you're supposed to reserve the bed only for sleeping and not for all the myriad activities I had once used it for.

This is all well and good and logical, but – like all things about insomnia – not easy.

Since I'm basically a semi-sentient corpse when I'm awake during the night, I found it hard to get out of bed and find things to do, but I was committed to the cause! In early spring when my insomnia was still relatively young, I made myself a kit, complete with blanket, warm sweater, solitaire word game, book and book light, and a mug with a chamomile tea bag at the ready. With all these supplies next to my bed, I hoped to be able to drag myself to the couch and get comfy without having to exert too much brainpower.

The insomnia kit helped me feel a little more in control for a few nights, but I soon realized that reading a book on the couch wasn't always what I needed or wanted. Sometimes I was too tense to lie still. Sometimes my eyes hurt too much to read. Sometimes I was too hot for a blanket. But always, I was too tired to think. So the next development in my get-out-of-bed kit was an auxiliary brain.

I made a list of all the problems that plagued me when I couldn't sleep, and I came up with simple solutions that had worked for me in the past or that I had read in one of the many articles about sleep I'd been consuming. I compiled all these into a cute tiny deck of cards so that when I was awake during the night, I could easily reach for it, flip to whatever problem seemed to be the worst at the moment, and draw a random solution that I could try.

I was so proud of my deck of insomnia cards, but I never even cracked it open once! Turns out, when I'm awake at night and too tired to think and too frustrated to sleep, I'm also too tired and frustrated to remember new tricks. Instead of trying any of the constructive activities I so lovingly curated for myself, I resorted to the tried and true: sitting semiconscious on the couch, trying (and mostly failing) to read, or doing some light exercise until my panic would ease up. It was better than nothing, but never felt like victory.

I still struggle with stimulus control to this day. Thanks to my sleep training and several months of practice, I sleep relatively normally at present, but every once in a while, I'll think too much about insomnia during the day, and I'll get a little too anxious when I go to bed at night. Or I try to push the envelope and go to bed too early, or I have a bad night because I'm not feeling well. Then I find myself back in my old shoes, tangled up in the sheets and painfully conscious of the minutes ticking by. So I get out of bed, and wonder what to do with my time.

 

My latest idea was that I could sit on the couch and try to tell myself a story. It doesn't have to be a good story, just something to fill the time—but since sleepless nights usually find me with the mental capacity of an amoeba, I'm not sure I could even handle that. 

 

 

I haven't had much trouble falling asleep in the last month, but I know my time will come again. I can only hope that when it does, I'll be able to overcome my primal fears and waste no time getting back to bed, where I really prefer to be!

Early bird to night owl...and back again?

 

Early to bed and early to rise—that's been my philosophy ever since I was able to set my own sleep schedule. One of my boyfriends once called me "solar powered," because I always rose just after dawn and felt my energy start to wane as soon as sunset approached. To me, mornings are the best part of the day, and nights are only good for one thing: sleeping!

So for me, one of the worst parts of insomnia is that I'm forced to be awake during the night—when, even if I'm not sleepy in the slightest, I still have absolutely no motivation to do anything. Time awake at night is time completely wasted.

And yet, as I mentioned in my last post, a huge part of my treatment plan for insomnia involved deliberately staying up until very late at night in a technique called sleep restriction. It was one of the least enjoyable experiences I ever put myself through.

To implement sleep restriction properly, I had to set a "sleep window" during which I was allowed to be in bed. This sleep window was supposed to equal the approximate number of hours of sleep I averaged every night, plus 30 minutes for falling asleep—but never shorter than about 5.5 hours, because I wasn't supposed to deprive myself of too much sleep, should it miraculously occur. The sleep window was supposed to start and end at the same time every night, so that it could be the basis for a solid circadian rhythm. The start time was also known as my "earliest in-bed time." I was allowed to go to bed later than that if I wasn't sleepy yet, but was not allowed to go to bed earlier. The end time was my "latest out-of-bed time," because I was allowed to get up earlier if I was ready, but never supposed to sleep in past it.

The out-of-bed-time is the most important part of the sleep window, because getting up at the same time every day is the best way to set your internal clock and help you sleep at night. When I started this process, it was the height of summer, and the sun was rising shortly after 5am every day. Being solar powered, I would have preferred to set my wake-up time to around then, but there was a confounding factor: my social life.

It was a Hot Vax Summer, and I was taking every opportunity to go to concerts and other late-night activities. I was also dating this guy who happened to be a night owl. I wanted to align my sleep schedule more closely with his so we could have more quality time together, so I opted for a later end time of 7:30. I knew that on the nights I wasn't going out, I'd probably be able to wake up closer to 6:30, but that extra hour gave me a little cushion so I would still get a modicum of sleep on the nights I wanted to have fun.

The week I started my sleep training, I was averaging 4.3 hours of sleep a night, which meant I should set my sleep window to the minimum recommended time of 5.5 hours. Counting back from 7:30, that meant my bedtime would have be be no earlier than 2AM. Two A.M.! Every night! This early bird just about had a hairy canary before deciding 1:30 was good enough. If the sun was usually going to wake me up before 7, that made for a solid 5.5-hour sleep window most days. If a few days, I were to sleep an extra half-hour, it probably wouldn't ruin me.

What did seem to nearly ruin me, however, was actually staying awake. For someone who could easily lie sleepless in bed until dawn, I had a surprisingly difficult time staying up until 1:30.

A lot of people with long-term insomnia experience disruption to their internal clocks, and some claim to never get sleepy at all. I was (un)fortunate enough to have my prior circadian rhythms stay mostly intact, which meant that every night, like clockwork, I would start to feel extremely tired around 10 PM. Like eyes-refusing-to-open-staggering-around-the-house tired. You'd think being so tired would mean I'd sleep like a baby, but with insomnia, that is usually not the case, so it was vital that I power through the sleepiness and stick with the plan. I still had 3 and a half hours left until my sleep window, so I had to devise all sorts of techniques to keep me from crawling into bed early.

I began doing all my exercise late in the evening, just to keep me busy. I would wait until 11 pm and take my dog for a walk (fortunately we have a light-up leash that was practically made for this moment!). I would get home and do yoga at 12. Sometimes I would just pace the kitchen until bedtime approached. Occasionally a friend would call, and we'd have lengthy conversations that kept my mind off my tiredness. But often I would often get so exhausted that all I could do was sit on the couch and stare into space. At these times, I often accidentally nodded off for a few minutes.

And then, finally, the sleep window would open! I would drag myself into bed...and suddenly find myself wide awake, panicked again that I wasn't falling asleep!

One of the essential rules for recovering from insomnia is that you should never stay in bed when you are unable to sleep (I think I'll do a whole post on that topic, so hang on and find out why later), so at this point, I'd be obligated to get back out of bed. I'd return to the couch, sitting with that familiar dizzy, discombobulated, burning-eyed feeling that I get when my brain won't let my body sleep, until finally I felt calm enough to go back to bed for another try.

With results like that, was sleep restriction actually good for anything? Well, it's hard to say because it wasn't the only CBTi technique I was trying, but over the course of a few weeks, I did start to sleep longer on average. There were two things that sleep restriction definitely accomplished for me: 1 is that it helped me recognize what true (extreme) sleepiness feels like, so I could know what's an appropriate time to go to bed (hint: not when I'm just lazy and bored and tired of being awake!). 2 is that it helped me internalize the idea that you don't need to hop into bed as soon as your usual bedtime arrives. If you stay up later because you're not tired, it's totally fine—as long as you wake up at the same time in the morning to anchor your circadian cycle.

Over time, the sleepless portions of my night got smaller and smaller. When I was sleeping at least 85% of the time I was in bed, I was allowed to extend my sleep window. In early July, I pushed my bedtime up to 1:15, then two weeks later, 1:00. Only a few days after that, I pushed it again to 12:15 and then to midnight. By early August, I felt like I was making so much progress, that I stopped enforcing a bedtime, and just focused on waiting until I was sleepy and not really worrying too much about the clock. Nowadays, my bedtime seems to have stabilized at around 11 PM—more or less what it was before my insomnia started.

But if I'm being honest with myself, I have to say that I still want to do better!

During those early days of sleep restriction, I came to appreciate just how much I value the sunshine. I deeply regretted that I was missing out on an hour or more of perfectly good daylight by waking up so late, and I hated that I was spending so many of my waking hours in the pitch dark, just counting down the minutes until I could crawl into bed.

Unfortunately for me, my late-sleeping love interest didn't stay in my life very long—and as soon as we stopped hanging out regularly, I shifted my wake-up time to 7AM. Just today, I decided there was no good reason not to push it to 6:50. I am inching slowly towards the goal that partially set me on my path to insomnia in the first place—being able to wake up with the sun!

When I first started my sleep training, I was asked what my goals were. I said something about wanting to get enough sleep that I wouldn't feel like a zombie all day. To my surprise, I accomplished that very early in the training, so my goals quickly shifted: Now I want nothing more than to be able to wake up as soon as it's light and to sleep when it's dark. After having been a reluctant night owl for several months, I believe more confidently than ever that the mornings are the best part of the day and the nights are good for nothing but sleep! I never want to waste another hour of precious sunlight again! 

My old alarm clock / future self!

Enter Sandman

My insomnia story is taking longer to tell than it has taken to play out. For the parts that are chronological, I've only shared as far as early June, and here it is halfway through September! In that time, my sleep has improved a lot, but it's a slow process, and sometimes it regresses. Insomnia thrives on attention, and I have noticed that my sleep tends to be worse on the days I've been writing blog posts or spending too much time in insomnia discussion forums. I'm glad I've finally reached the part of the story where things started looking up. Hopefully the gains I experienced in my past will translate to gains in the present!

I had barely been an insomniac a month before I heard about one of the more effective techniques used in treating it: sleep restriction. With this strategy, you give yourself a "sleep window," a limited set of hours during which you're allowed to be in bed—typically about the same number of hours as you're actually sleeping, on average. With this restrictive window, you're more likely to actually be sleepy when you go to bed and thus more likely to actually fall asleep, and your sleep time is compressed, which generally means it's going to be higher quality with fewer mid-night awakenings.

Sleep restriction is just one of a whole suite of techniques for overcoming insomnia, known collectively as cognitive-behavioral therapy for insomnia, or CBT-i.

I decided to try it for myself, choosing a sleep window between 2am and 7:30am on April 20th. Trying to keep myself up until 2 felt like the hardest task I ever set myself to! To keep myself occupied, I watched the 1997 version of Cinderella on Disney+, and – I'm sorry Brandy – but you will be forever associated with that traumatic night. All for nothing, too, because since I was doing it on my own with limited knowledge and no support, I failed miserably. I only tried sleep restriction 5 days, never once actually making it to my target bedtime, before I gave up.

I decided that if I was going to do CBT for my insomnia, I was going to have to do it with the assistance of a professional. The psychiatrists I saw never even suggested therapy as an option, and I was reluctant to seek out a therapist on my own while I was still receiving treatment. I was also still hoping against hope that my insomnia would resolve itself, as I still hadn't hit the magical three-month mark at which insomnia officially becomes "chronic."

On June 7, I hit that mark. Three days later, the day my second dose of Lunesta utterly failed me, I acknowledged that this brand of treatment was a waste of my time, and if I was going to get serious about fixing my sleep, I was going to have to start therapy. However, given what I knew about the availability of real-time therapists, and the inevitability of their costs, I decided to try a free option first: a 2-week email sleep training course, taught by none other than Martin Reed, the mystical Insomnia Coach from last post! I had become a huge fan of his Sleep Snippets videos and found lots of useful information in the forums on his website, so I figured I'd give his sleep training a try before forking over any big bucks.

Spoiler alert: It changed my life! 

The sleep training consisted of reading an email a day with behavioral tips, mindfulness tips, and information about how sleep works. Each day there was a question that I was expected to send in an answer to. Occasionally Martin even wrote back with personal replies! In the second week, the rubber met the road, as I was instructed on how to properly implement sleep restriction.

In the course of the two weeks, I didn't really start sleeping any better, but I gained a ton of confidence about my ability to sleep. I no longer felt like a prisoner of my insomnia. And even though I was barely sleeping any more than I had been, I felt 10 times happier and better rested during the day, simply because I had gained knowledge and skills and no longer lived in a constant state of despair.

After months of waiting, the Sandman had finally entered the building. But he wasn't about to sprinkle me with magical sleeping dust just yet! I was going to have to work for it.

 

In a future post, you'll hear exactly what that work looked like.

Insomnia Demystified

My insomnia story is just one among millions, and as it turns out, it's very similar to that of others. It's so similar that it can be predicted, with uncanny accuracy, by a fake mystic with a fake crystal ball in a pre-recorded video! Take a look.

In the video, Martin Reed, Insomnia Coach extraordinaire, tells me exactly who I am: "You're perhaps someone who's a bit more predisposed to sleep issues. You might just be a naturally light sleeper....Maybe you could be someone who's a little bit more reactive to stress, maybe a little bit more susceptible to anxiety." Right on, Insomnia Coach, right on! As you read in a past post, all of those claims are true.

In the video, my clairvoyant sleep coach continues: "Now I can see an event...something that triggered this sleep disruption and made sleep more difficult." That would be my breakup and ill-advised installation of programmable window blinds.

So far the crystal ball had a 100% success rate at predicting the course of my insomnia, and it's not about to disappoint me now! As Martin the mind reader describes it, "Even after this initial trigger was no longer an issue and not really relevant any more, your sleep issues remained....You might have maybe started thinking about sleep more than you ever had before...researching insomnia, worrying about sleep....More and more time during your day was spent thinking about sleep....You just started to modify your life in response to your insomnia."

Modifying my life in response to insomnia? Heck yeah! In addition to all the terrified researching and self-medication and desperate consultations with the doctor, there were loads of things I tried unsuccessfully to get my sleep back on track.

At this point, if Martin were a real psychic and not just playing one on YouTube, I'd be nodding eagerly and ready to hand over my life savings in order to find out what the spirits said about my prognosis. But in reality, what he does next in the video is debunk the entire magic act and explain exactly how he knew what was wrong with me, without actually knowing me!

I'm no special snowflake, he seems to imply as he shakes the snowglobe he was passing off as a crystal ball. Like that of practically every insomniac since the dawn of insomnia itself, my condition followed, as he describes it, "a well trodden and predictable path." Fortunately for fans of alliteration, that path is marked out by three easily remembered P-words: Predisposing factors, a Precipitating event, and Perpetuating factors.

For me, the predisposing factors were my natural tendencies that made sleep a little more challenging throughout my life. The precipitating event was the breakup that broke my brain. But most people survive a stressful event without becoming insomniacs. I myself have suffered many a previous breakup without permanently breaking up with my sleep! So what gives?

Here's a fun fact about sleep: Sleep deprivation can cause anxiety. Anxiety can cause sleep deprivation. In worrying so much about my breakup, I caused a major disruption to my sleep. The less I slept, the more I ramped up the anxiety, and the more the anxiety, the more likely I was to sleep poorly! And then, (because who wouldn't worry when they hadn't had a good night's sleep in 2 months!?) I began feeling anxious about that.

And thus, I introduced the third P of insomnia into my life: perpetuating factors. Perpetuating factors are the behaviors that insomniacs adopt, unwittingly, to keep their insomnia alive and kicking — and I had plenty of those. All that time I spent obsessing over my sleep, researching fatal sleep disorders, and whining to everyone who would listen about how horribly I was sleeping? Those were all actually making the problem worse! The more you worry about sleep, the harder it is to sleep. The harder you try to sleep, the more elusive it becomes!

While the predisposing and precipitating factors were basically just dealt to me by fate, the perpetuating factors were things that I actually had control over. In other words, I broke my own brain!

I discovered the YouTube video in this post after about 2 months of suffering insomnia. It was right around the time that I was beginning to worry in earnest about fatal insomnia...so this reality check was a huge relief to me. If I was just like every other person with insomnia who had ever lived, then I probably wasn't going to die of it. I might even be able to be cured! It was shortly after watching this video that I decided to take more deliberate steps towards fixing my sleep, by adopting the evidence-backed approach advocated in the video: cognitive behavioral therapy.

In a future post, I'll be telling you all about how that went!

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!

Insomnia: The self-medication phase

This is the hardest part of my story to tell. In the previous chapters, I was a victim—you can't change someone else's actions, and you can't change your nature. But from this point onward, I was in control. I didn't know it at the time, but it was my thoughts and choices during the early days of insomnia that led me to my most desperate state. If you've never had insomnia, read this part carefully...and then don't do what I did! You might be able to save yourself from a dismal fate.

When my breakup with my boyfriend was still a fresh, gaping wound on my psyche, I spent a lot of time crying. I cried all day, in between work meetings and necessary interactions with my housemate. I went to bed as early as I could and usually cried myself to sleep, only to wake up after a few hours, obsessively thinking about the disaster that had befallen me. Most nights, I couldn't fall back asleep until 4 or 5. Some nights, I didn't fall back asleep at all.

By this time, I was regularly consuming all sorts of chemicals to help me sleep. Because of the window blinds situation, I had already been taking melatonin or Benadryl most nights in a (unsuccessful) bid to stay asleep through the night. When my sleep patterns deteriorated further because of the breakup, I started taking them more regularly...not that it helped at all! My new roommate recommended magnesium, which I tried, to no avail. CBD was supposed to help with sleep, so I tried that, even though it had never helped me sleep previously. Once, I even tried a THC/CBD gummy,* which made me so relaxed I couldn't get out of bed, and simultaneously so anxious that I just lay there having a panic attack for an hour! In the end, I usually resorted to alcohol after everything else had failed, leaving me the next day both sleep-deprived and mildly hungover.

I don't really recall too much about those early weeks of insomnia (after all, sleep cements memories and I wasn't getting much sleep), and all these nights of rampant substance abuse kind of blend together. Since I still didn't know this experience was going to turn into a saga I'd be writing about months later, I can only reconstruct the progression of my condition by examining my browser history. It was around 2 weeks after the breakup that my searches began to change from things like "stages of grief" to "benadryl vs unisom."

I was getting over the breakup. I certainly wasn't crying continuously and bringing obsessive thoughts of it into bed with me any more, so I couldn't understand why I wasn't sleeping, They say that stressful events can cause sleep disruptions, but sleep usually returns after the stressful situation has resolved. The only explanation I could think up (and indeed, I was thinking about it a lot) was that the stress of the breakup had been replaced by stress from not sleeping.

It was four weeks after the breakup that I began Googling my symptoms (Oh no! Retrospective red alert!), and right around the same time, I officially labeled my condition as insomnia. This I know because that was also when I started keeping a sleep diary, a recommended part of the treatment plan for most insomnia sufferers.

In the sleep diary, I religiously recorded when I slept, when I didn't sleep, what I'd ingested in a bid to sleep, any activities I'd done that might have contributed to or detracted from sleep, and how I was feeling. I was feeling pretty awful. I'd begun noticing strange symptoms that are often linked with anxiety. I felt twitchy and on-edge, constantly getting butterflies in my stomach for no apparent reason, startling at the quietest of sounds. I wasn't really thinking anxious thoughts, but it seemed (I guessed?) anxiety had become a part of my physiology.

The sleep diary wasn't doing anything to help me improve my sleep, but it does provide a useful record of how my sleep continued to decline. At the beginning of April when I began the log, I was still falling asleep without much difficulty on most nights, and waking up in the middle of the night or too early in the morning. I was also sleeping 5 – 7 hours almost every night. By insomniac standards, I was sleeping great! But that all took a turn for the worse around mid-April. The change occurred rather suddenly, after I got my second Covid vaccine on April 15 (Moderna, thanks for asking). The second night after the shot, exhausted by my intense immune response, I slept a whopping 8 hours! And then the night after that, and every night following, I slept hardly at all! I'd gone from losing a few hours of sleep from mid-night awakenings, to lying awake most of the night. Over the next week, my nightly sleep time plummeted down to 3.5 – 5 hours a night.

After that one glorious night of 8 hours asleep, the wakeful nights were even harder to bear. I desperately purchased chamomile tea and started yet another dietary supplement (this time an expensive herbal blend) and again saw no results. My insomnia was clearly getting worse, nothing I could do was fixing it, and I was freaking out! So, six weeks after my first night of troubled sleep, I saw a physician, who referred me to a psychiatrist. Seven weeks into suffering insomnia, and I visited a shrink for the first time in my recollection! Did I finally get the help I needed? You'll soon find out, in the next chapter of this story!

*For the purposes of chronology, it must be explained that I took the THC gummy the same night following my psych appointment. He had prescribed me something, and I guess I wanted to try one last natural sleep remedy before leaping into the arms of Big Pharma.

Insomnia: How it all began (for real)

When people ask me, I tell them my insomnia started with a bad breakup. But looking back, I can really see that I'd been working my way up to insomnia my whole life. So let's hop into the wayback machine and dig up this case of insomnia right at its roots!

I've had minor trouble with sleep for as long as I can recollect. Some of my earliest memories involve nap time—specifically, hating it because I wasn't tired at all and I certainly wasn't sleeping! Or a few years after that, lying awake in my childhood bedroom, weeping because it was taking me so long to fall asleep!

The late-night pity parties ended once I realized I always did fall asleep eventually, and I learned to compensate for my poor sleeping skills. As an adult, I routinely budgeted 9–10 hours for sleep every day—just so I could spend 1-2 of them waiting to fall asleep at night and trying to drag myself out of bed in the morning. If I missed out on sleep (which wasn't often, because I valued it immensely and was zealous about protecting it), I was completely unable to nap. I also couldn't sleep on airplanes, or sleep in a car, or sleep pretty much anywhere except lying down with no ambient light (not even the tiny LED on a laptop charger!) and no distracting sounds. I always needed a long wind-down period before sleeping; if I did anything stimulating whatsoever in the hour before bedtime (including watching a movie or listening to slightly upbeat music), I'd find myself struggling to fall asleep. Even being in a little too good of a mood before bed was a guarantee I'd take longer to drift off than usual.

"Light sleeper" was practically my middle name. I used to pride myself on being able to wake at sunrise without an alarm, or to be up and ready with a receptacle in time to catch the mess before it hit the bed when my dog indulged in some nocturnal puking. Similarly, I always thought I was great at being able to stay up when needed. Though I had an early bedtime by choice, if something exciting was happening—a party or a great concert—I was always one of the last ones standing at 4 AM. One time I spent the whole night wide awake on an airplane, because a kid in my traveling party had gotten sick. Every passenger was catching Z's (including the sick kid himself!), but I couldn't even rest my eyes, so vigilant was I to make sure nothing else would go wrong. Those "skills" may have been useful when my sleep was more consistent, but they also made me a prime candidate for insomnia when my sleeping conditions changed.

What changed my sleeping conditions? Well, as you already know, the breakup was a huge factor, but it might not have knocked my sleep completely off the rails if it hadn't been for another disruptive circumstance that preceded it.

The story goes like this. Being the light sleeper and easily stressed person that I am, I hate alarm clocks because they startle me and subsequently put me in a bad mood. I prefer waking up naturally to the sunrise, but that became impossible when, around the beginning of this year, the city installed an impossibly bright LED street light right across from my bedroom window. I loathed it. I had to find a way to cover up my window completely...but still allow sunlight in the room in the morning.

I settled on programmable window blinds. I got thick wood ones that blocked out most of the light at night, and I set them to open slowly around 6 AM, so the morning sun would filter into the room and awaken me in a peaceful way. In reality, what happened was the blinds lurched themselves open in a series of loud tick-tick-tick noises over the course of 5 minutes. That did not make for a peaceful awakening.

Photo taken before I knew my new blinds
were going to ruin my life!

Over the next few weeks, I tried various things to get myself accustomed to the blinds (like having them open at 5AM, when I'd be more likely to be deeply asleep), but all I succeeded in doing was conditioning myself to wake up extra-early, even before the blinds! Being the sound-sensitive soul I am, I would rather (says my subconscious, apparently) wake up unprovoked in pitch darkness than be jolted awake by the ticking time bomb of a motorized blind.

I began to take Benadryl right before bed, in the hopes that the drowsiness usually persists in the mornings after taking it would keep me asleep. It didn't. I also tried melatonin and CBD, with the same effect. Finally, I decided to just give up on the smart blinds and go back to an alarm clock.

This is the state I was in when my boyfriend broke up with me. I was already accustomed to waking up too early in the morning. My sleep was already mildly disturbed. I was already in the habit of consuming chemicals to ostensibly help my sleep. If the blinds had been the only issue, I think I would have returned to normal soon, but then the breakup sent my sleep into a nosedive from which I could just not recover. Goodbye, boyfriend; hello, insomnia!

And that's the whole story this time!

Or is it? The real story of my insomnia doesn't begin when I started having trouble sleeping; it begins when I continued having trouble sleeping! So next post, I'll share all the gory details of exactly how trouble sleeping turned from a minor issue into a major ordeal.