If you love your bed, (don't) let it go

A typical pre-insomnia workday

The hardest part about getting over insomnia (yes, I say every part was the hardest part!) was divesting from my bed.

As I mentioned in "Bye, Bye, Beddie," a good portion of my pre-insomnia leisure and relaxation time was spent in my bed. But the rules of stimulus control are clear: your bed should only be used for sleep (and, as they almost always tack onto the end, sex). So I stopped using my bed as a hangout spot.

You don't know what you've got 'til it's gone, and as soon as I stopped using my bed for recreation, I realized how much I had loved it. And how much I missed it!

When I would pass my bedroom during the day and glance inside, just the sight of the bed filled me with longing. Not a longing for sleep, but merely for a comfortable place to lie down.

Though I tried to replace the bed with a yoga mat, it was kind of like trying to replace ice cream with non-dairy frozen dessert—disappointing! A yoga mat is a poor substitute for a cushy (or even medium-firm, as I prefer it) mattress, and the necessity of unrolling the yoga mat every time I wanted to relax took a lot of enjoyment out of it.

The living room couch was a much softer option, but it wasn't big enough for me to chill out in one of my favorite positions—on my stomach with a game or book in front of me. I wasn't able to chill out at all when DC's famous July heat and humidity hit full force, and the only comfortable room in the house was my bedroom with its window air conditioner. The bedroom was also a place of blessed privacy—whereas in the living room, I always felt like I was on public display.

On some days when the yearning for my bed grew to be too much, I would rebelliously grab my iPad and try to take my lunch break there like the old days. But the guilt about breaking the rules always ruined it for me. I'd start to wonder whether I was sabotaging my sleep, then I'd get nervous and lose my appetite, and eventually I just gave up, abandoning my guilty pleasure and returning to an approved daytime venue.

I constantly debated with myself about whether this sacrifice was really necessary. On the one hand, I'd spent years flopping into bed whenever the mood struck, with nary a negative consequence (though it could be one reason I was never a great sleeper). I'd spent the past year+ spending almost all my down time in bed without it having any measurable impact on my sleep.

But rules are rules. The sleep experts wouldn't tell me not to do it if there weren't a good reason! Or would they?

When justification for this rule was given, it was always that you want to make your bed a subconscious trigger for sleep. If you're always doing other things in your bed, then you weaken that association.

But the rule almost always makes a clear exception for sex, and if you can make an exception for one activity, then why not make exceptions for others? How much harm would it really do, if I were to lie on top of my bed doing non-stressful activities like reading and eating? Would that innocuous behavior really jeopardize my sleep that much? Has this been quantified anywhere?

I looked it up. Although I could find plenty of evidence that stimulus control therapy does help people improve their sleep, it was unclear how much, if at all, the one behavior – avoiding the bed during the day – really contributed to the overall success, as it was seemingly never evaluated separately from other behaviors—such as leaving the bed when you're having trouble sleeping at night.

My personal suspicion was that it wouldn't make much difference. I even made a list of reasons why my patterns of recreation in bed would have minimal impact on its sleep-stimulus effect:

1. I almost always do activities in the bed in a face-down position, but when I am sleeping in the bed, I lie on my back or side.
2. I do activities on top of the covers, but I sleep underneath them.
3. I don't use pillows when doing activities in the bed, but I do when I'm sleeping.
4. When I do activities in the bed, it is sunny out or the lights are on. When I sleep, I sleep in darkness.
5. When I do activities in the bed, I always have objects to interact with (food, books, tablet). When I sleep, these are absent.

Solid reasons, sure, but all the logic in the world couldn't hold a candle to my paranoia. I didn't want to take a chance on being wrong and ruining my sleep because of it.

 

 

So I set up a bed-beside-the-bed. I folded a comforter into fourths and placed it on top of a spare yoga mat, and rolled it up for storage. When I wanted to lie down during the day, I'd unroll it onto the floor, throw down some pillows, and left it out to use whenever I felt like it that day—reading, gaming, and eating to my heart's content, secure in the knowledge that no rules were being broken.

Problem solved! But not for very long. After I'd been using my "insomnia bed" for a couple months, I began to feel discontent again. Sure, it was an improvement over the couch and the yoga mat, but it still wasn't the ideal hangout spot. It was still more rigid than a mattress, and when I lay on my belly, my splayed elbows were always contacting hard objects like the flooring and furniture. Plus, my dog, who believes that everything on the floor belongs to him, missed no opportunity to steal my food whenever I left it near this ersatz bed. When he wasn't slobbering into my water cup, he was tracking dirt all over the bedroll itself; being on the ground, it was always gritty and festooned with dust bunnies. And the final (perhaps most weighty) fact remained: there's something deeply gratifying about being able to throw yourself dramatically onto a bed and instantly relax—something that cannot be replicated when you first have to unroll the bed, arrange some pillows, and then gingerly lower yourself into the narrow space between your real bed and the cedar chest.

I missed my real bed so much! I had to put in a lot of work to overcome insomnia, but most of it made me feel good that it was helping me progress. Giving up the bed was the only part of it that actually made me sad!

In September, when I had worked myself up to at least 6 hours of sleep most nights, I began experimenting with using the real bed for activities other than sleep (or even sex!). I figured if I were facing a different direction, the conditions would be so different from the conditions for sleep, that they wouldn't interfere. I eased into it slowly, starting by lying on the bed crosswise and setting my books and entertainment on the bedside table so I wouldn't see any part of the bed. Then, I graduated to a diagonal position, facing the corner of the bed on the the side opposite where I usually sleep. This abundance of caution may sound excessive – even superstitious – to someone who has never had insomnia, but I was truly afraid to break the rules, because I didn't want to risk triggering a relapse.

Then on September 25, while researching material for this blog, I stumbled across the truth that finally set me free!

Daytime bed avoidance is a key part of of stimulus control therapy for insomnia, but it is also an element of sleep hygiene. While most insomnia experts admit that sleep hygiene is known to be ineffective in curing insomnia, I only know of one to claim that "sleep hygiene is %@$&*" and that it "makes insomnia worse!" That particular expert is Joseph Pannell.

In his video, "10 evidence - based techniques to treat Insomnia..." he cautions the viewer against making "sleep efforts," because, as we now well know, the harder you try to sleep, the harder you make it to sleep. He specifically mentions "avoidance sleep efforts," which are the things you avoid doing because they could negatively affect your sleep. Avoiding some things sometime, like caffeine and alcohol, is all well and good, but Joseph's point seems to be (and I'm paraphrasing a lot here!) that if your fear of sleep disruption leads you to constantly avoid things that make you happy, then you're reinforcing the control that insomnia has over your life.

Or, to quote his video, "Whilst these things can impact your sleep...treating your sleep like it's something fragile just causes you to obsess and worry about sleep more, and it causes you to limit your life...and take your feeling of control and agency over it. So the best way to...get that agency back...is if you've got something you enjoy and you love to do, teach your brain that insomnia is not a threat....Go and do it anyway."

To me, that was a clarion call to dive headfirst into my bed and do things! Not just sleeping and sex, but any darn thing that happens to bring me joy! My weeks of sorrowful abstinence had made it clear that using my bed as a spot for daytime relaxation does bring me joy. It's possible that doing so could slightly weaken the association between the bed and sleep, but I have an indomitable sleep drive, and this one little habit was not going to make or break it. And so I returned to unrestricted bed use.

I can't recommend that everyone follow my lead and completely disregard any rule of sleep hygiene or CBTi as they see fit. After all, I'd been playing by the book for over 3 months (longer than I'd had insomnia before starting CBTi!) before making this change. So the therapy had had plenty of opportunity to do its magic.

But for me, it was time. Once you become an expert in the rules, that's when you can start to break the rules—and I think I have reached the point where I am an expert in sleep. To me, returning to this beloved pre-insomnia habit was one of the best (and most delightful) indicators that I'd finally gotten a handle on my sleep.

I'd always loved being in bed. Now, without the fear of insomnia getting in the way, I was finally able to follow my heart and treat my bed, not like some sacred relic, but like a good friend.

Mindfulness over Matter

One thing I've heard from several recovered insomniacs is that their sleep only improved once they stopped caring about their sleep. That's something I really struggled with.

In my last post, I addressed how I stopped (or at least reduced!) my worry about sleep by acknowledging that my fears about insomnia were disproportionate to the actual harms of insomnia. But not worrying is a step below not caring. Only by not caring could I truly break free of my attachment to sleep and avoid the pitfall of simply finding a new aspect of sleep to fret about.

For me, not caring was probably the hardest thing about recovering from insomnia. Even armed with an arsenal of reassuring facts, I would still go to bed many nights and be subsumed by a wave of performance anxiety. Because I still really, really, really, wanted to sleep! And because sleep is a contrarian little cat, that of course made it really, really, really difficult to actually sleep!

To address this issue, my sleep training introduced seven principles of mindfulness for sleep, which I could use to become more calm about my situation and consequently make sleep more likely. 

 

To ensure I would remember them, I made a big, ritualistic production of writing them all out in colorful calligraphy inks onto a piece of cardstock. Then I leaned them up against the back of my medicine cabinet, so I could look at them every night as I was brushing my teeth.

In an apropos twist, I was so eager to finish my work of art that I left off the final principle – patience – but I don't think I was harmed too much by its absence.

On my difficult nights, I would try to recite them all by heart, to remind myself to LET GO of my frantic desire to sleep and TRUST that my body would sleep when it was ready. And even if that wasn't to be that night, I should be able to ACCEPT my sleepless state and avoid working myself up into the kind of despair that I experienced in the past.

For a while there, during my insomnia's darkest days, "I'm at the end of my rope!" was basically my catchphrase. But I learned  to approach insomnia with equanimity, and that has made all the difference! I can't always control my sleep, but I can control how I react to it. 

If you choose to dwell on the positives rather than the negatives, you find that even when you do have insomnia, it's really not that bad. And if you truly believe that, your mind can relax and finally give you the sleep that you finally stopped striving for.

It's paradoxical, but it works!

Adventures in Cooking: Pasta with veggie dogs and mustard sauce

When I first became a vegetarian as a teenager, I was cuckoo for veggie dogs. But, over time, they became less and less appealing, until, the last time I bought them, I ate one and realized I just couldn't eat any more. But not wanting to waste food, I stuffed the remainder of the package in the freezer, and tried to think of ways that I could make them more palatable.

I think the veggie dogs alone have a texture that could make any processed-food-lover run for the hills, but I had always enjoyed them more when encased in a hot dog bun. The only problem with that is I'd stopped buying bread a long time ago, making do with whatever happened to come along with my restaurant orders, so I never have enough bun-like material at home to accompany an 8-pack of veggie dogs. Besides, vegetarian food is pretty high in carbs already, so there's no need to stack the starches by adding a nutritionless hunk of white bread. What other flavors could I use to give these veggie dogs a second chance?

Pasta was my first thought. While I have nixed the purchasing of bread, I still make an exception for chickpea pasta, which is relatively high in protein and low in carbohydrates. I always keep a box in the pantry for emergency situations like this. The solution to my glut of veggie dogs was a pasta dish with veggie dogs mixed into it. 

 

The next question was, what should I use to give the pasta flavor? I hate, like many foods, the most popular pasta topper: tomato sauce. So that was a no-go. I have some jarred alfredo sauce, but I didn't want to ruin it on a dubious experiment. Using the memory of my once-boundless love for veggie dogs, I recalled my favorite condiment on them was mustard. So if I could find a pasta sauce based with mustard, I'd be golden! (Just like the mustard! Get it!?).

You might think a mustard-based pasta sauce sounds a little unusual (I did), but the Internet usually delivers. A quick Google search turned up a recipe, and I was on the road to an Adventure in Cooking! And now, lucky reader, so are you!*

Pasta With Mustard Cream Sauce and Veggie Dogs

Ingredients

• 1 box rigatoni pasta 1/2 box chickpea penne
  
• 1 1/2 tsp salt, divided ummm, some salt
• 1 tsp oil Did that say 1tsp? Oops, I misread! Use 1 Tbsp oil
  
• 1/4 cup chopped onion Sprinkling of dehydrated onion
  
• 2 cloves garlic, minced Sprinkling of garlic powder
  
• 1/4 cup chicken broth vegetable stock
  
• 1/2 cup heavy cream frozen half-and-half, thawed and reconstituted as well as you can get it, though it will never return to its formerly creamy glory
  
• 3 Tbsp Dijon mustard
• 1 tsp dried tarragon ... or, if you don't have tarragon, just consider what you think tarragon probably tastes like, and then pick the most similar spice you have, which for me, turned out to be my last few desiccated sprigs of rosemary.
  
• 1/4 tsp black pepper
• Fresh Parmesan classy Kraft Parmesan from a jar
  
• Fresh basil
• Veggie dogs
• Canned mushrooms (but only if you happen to have the remains of an unfinished can in your freezer).
  

Instructions

1. Heat a large pot of water over high heat. Add 1 tsp salt and pasta. Cook for 6 minutes. Seriously, my friend, your time is too valuable and your indoor humidity too high to be cooking pasta over a stove. Get thee an Instant Pot (or a low-budget alternative), and cook your pasta according to this formula... or just wing it from memory, add two minutes instead of subtracting two, and still come out with most acceptably cooked pasta, and some overcooked bits of it splattered all over the inside of your pressure cooker. Don't forget to add the salt, though—that's one rare thing the original recipe got right!
   
2. In a medium skillet, heat 1 tsp oil over medium heat. Add onion and cook for 3-4 minutes or until softened. Add garlic and cook for one minute. Y'all, what is this obsession in the cooking world with pre-sautéing your aromatics!? Does it really taste so much better that it's worth the additional time and oil burns all over your arms? I think not. You have my blessing to just dump your powdered spices straight into the mixture without following this gratuitous step. But if you're curious, as I was, and realize you're going to need to turn on the burners eventually, you might as well try to pre-roast the spices in a dry saucepan before adding the remaining ingredients. Does it improve the flavor? Does it ruin it? I don't know, but at least it will neither take very long nor result in oil splattering everywhere!
   
3. Add chicken broth and cook for 2-3 minutes.
4. Whisk in mustard and tarragon and cook for another 2-3 minutes.
5. Whisk in heavy cream and cook for 1 minute. Forget about all this laborious adding of ingredients and stirring and adding more! What are you, made of minutes!? You can put all the remaining ingredients (except the basil, Parmesan, pasta, and dogs) in one saucepan, stir it up, and set it all on the back burner to simmer while you work on the main event: the dogs. Stir periodically if the spirit moves you.
   
6. 
   Since you never used the oil that was intended for roasting the garlic and onion, you can use it to fry your veggie dogs. Pour some liberally into a skillet and let it heat up, while simultaneously slicing your still-slightly-frozen veggie dogs as thin as possible (the better to minimize their flavor when you eat them!) into the skillet.
   
7. Dump the frozen chunk of mushrooms into the skillet with the veggie dog slices. As it thaws, you can peel off mushrooms until all of them are mixed in and somewhat warm. Simultaneously push the veggie dogs around in the oil until they start to look cooked.
8. Add hot pasta to sauce and toss to combine. Cook for an additional minute.
9. Add veggie dogs to sauce and toss again.
   
10. Wonder why the original recipe mentioned basil and Parmesan in the ingredients list, because that was the end of the instructions, and their function was never explained. Figure they're supposed to be for garnish, so pour yourself a bowl of this pasta mastapiece, sprinkle with some Parmesan cheese, and then top with a few leaves of basil from your garden. You had a fresh herb on hand, which totally gives you chef points! High fives!
    

High fives also, for completing this recipe! When you eat it, you will no doubt be delighted. Or at least you won't go hungry for the night.

It's actually not that bad, and it looks so cute with the fresh basil on top and the fall decor in the background! But the veggie dogs are still barely palatable. Let this be a reminder to never buy veggie dogs again, no matter how cheap they are on sale!

 

*If you're not an adventurous cook, but you like the idea of pasta in creamy mustard sauce, I suppose you can try the original recipe, here.

Mission: Cognition

Sleep restriction and stimulus control were the main behavioral interventions for tackling my insomnia, but they don't call the treatment cognitive behavioral therapy for nothing! A large portion of it involved addressing the thoughts and fears that were contributing to my lack of sleep.

It's easy to follow a bunch of rules: Get out of bed at the same time every morning! Don't go to bed if you're not sleepy! Don't stay in bed if you can't sleep! It's a lot harder to change your unconscious responses and entrenched beliefs, but these were probably the biggest factors that were keeping my insomnia alive.

"I can't sleep." "Why am I still awake?" "I have forgotten how to sleep." "OMG, the sun is rising in 2 hours and I still haven't slept!" "What if I have fatal insomnia?" Thoughts like these are not restful thoughts! They are the kind of thoughts that get your your mind racing and your heart to follow suit, until your entire body is on high alert.

Learning to recognize these thought patterns and how they were sabotaging my sleep was vital in my recovery. And the first step was gaining a basic comprehension of how sleep works. I don't want to pass myself off as any kind of expert, but here's the gist of what I learned, told maybe just slightly more dramatically than how I learned it.

 

Sleep is basically controlled by a constant, epic battle between two forces: sleep drive and arousal. Sleep drive is, in essence, a measure of how badly your body needs to sleep. When you first wake up in the morning, your sleep drive is low because you're well rested, and it builds up over the course of the day until you're (normally) ready to fall asleep again at night. Sleep drive is controlled by one factor and one factor only: how long you've been awake. Longer wakefulness = more sleep drive, and enough sleep drive always leads to sleep eventually.

However, sleep drive doesn't operate in isolation. It can be suppressed by the other major player in the sleep arena: arousal. No, I'm not talking about sexual arousal—come on guys! It's just a word that means... well... the opposite of sleepiness. Lots of factors can contribute to arousal—being uncomfortable or in pain, chemical stimulants, excitement, emotional distress, and fear. When you have enough mental arousal, it overrides your sleep drive, and you will not be able to sleep.

Arousal typically has an edge over sleep drive, because you need to be awake in order to respond to potentially dangerous situations. However, in the mind of an insomniac, sleep itself gets conflated with a dangerous situation (because of all the conditioning that has linked bedtime with worry and wakefulness). Consequently, the insomniac develops more fear and worry about sleep, experiences more nighttime arousal, and sleeps even less!

It seems so obvious when I see it explained like that, but it was a breathtaking revelation to me when I was still in the thrall of insomnia. My sleep wasn't some magical entity that had decided to abandon me; I had driven it away with my own thoughts! In order to sleep well again, all I had to do was replace my negative and erroneous beliefs with reassuring facts, and gain control of my feelings about sleep.

Here are the facts that helped me turn the corner on insomnia.

1. You can sleep.

This is the tagline on all of Martin Reed's Insomnia Coach videos, and with good reason. When I was struggling with insomnia, I worried extensively about my ability to sleep. At times, I thought I really had lost it entirely. This was of course completely silly, because I did sleep, every night. Maybe for only one or two hours, and maybe only with the aid of some substance or other, but I always did fall asleep. This should have clued me in to the fact that I hadn't lost my ability to sleep, but I needed to hear it in words. And I did. At the height of my insomnia, I would watch a Sleep Snippet video every evening, just for the reminder.

2. You can't force sleep.

Learning how sleep drive is the one and only thing that can make a body sleep was an immense weight off my back. I was immediately liberated from all the time-consuming practices I'd adopted to help me sleep. All that nighttime yoga, the binaural beats, the experiments with meals and their timing, the neverending guided meditations and breathing exercises—I could throw them all away, because none of them were going to make me sleep! They might help me relax a little, and they certainly weren't harmful, but they weren't going to make any significant difference. All I really needed to do was wait to sleep until my body was ready for it.

3. Sleep always wins.

This is another direct quote from Martin Reed, but I found it incredibly reassuring. In the epic battle between sleep drive and arousal, arousal may take the upper hand for a while, but even chronically sleep-deprived folks experience micro-sleeps, and even hardcore insomniacs crash after several days awake. It's impossible to go without sleep forever, and once I internalized that fact, I was able to go to bed with confidence that eventually I would fall asleep again. In the past, I had felt like I was at the mercy of my insomnia, but now I realized, my insomnia was only just barely holding its own against my indomitable sleep drive.

4. You're probably sleeping more than you think you are.

One fact (backed up by research) I keep hearing is that "normal" sleepers generally overestimate how much sleep they get, whereas insomniacs tend to underestimate it. I found a video explaining that if you are woken up during stage 2 non-REM sleep, you only have a 50% chance of believing that you were asleep at all! Knowing this, I could recall plenty of nights when I thought I hadn't slept, but time had seemed to pass much too quickly for me to have been awake. Another sleep expert said that if you can't tell whether you were asleep or awake, you were probably asleep. Deciding to believe that I'd actually been asleep during those ambiguous times made me feel a lot better! Even if I wasn't sleeping great, I was still probably getting some amount of much-needed rest.

5. Going without sleep is not a catastrophe.

This one walks the line between fact and belief, but it's rooted in logical analysis and an evidence-based conclusion. One of the things I was encouraged to do in my sleep training is interrogate my beliefs about sleep. For example, when I was lying in bed at night and starting to panic over the fact that I was still awake, I was supposed to ask myself things like, "What is the worst thing that could happen? What is the most likely outcome?" When I put my thoughts to the test, I realized the worst-case scenario was that I would not sleep at all and start a run of several nights of no sleep, resulting in a mental breakdown and administration of benzodiazepines in the ER (it's a story oft told in my insomnia support group). Honestly, I think that would be a catastrophe—but it had never happened to me. It was much more likely that I'd at least sleep a couple of hours once I calmed down, and the sleep deprivation from this night might even make it easier for me to sleep the next night.

Arming myself with these facts had an almost immediate positive impact. I no longer stressed about sleep all day long. Once I stopped thinking about sleep all the time, I also stopped feeling tired all the time. So even though I was sleeping much less than I ever had before, I still felt pretty energetic during the day. It was a great shift, and it helped give me the emotional strength to tackle the greatest challenge yet—adjusting my attitude.

But I'll save that topic for another post.