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!