Miles to go before I sleep (like I used to)

Once upon a time, long before I ever had insomnia, I used to tell people I needed nine hours of sleep a night to feel well rested. Those were the good old days, when I went to bed around 10:30, hopped out again around 7:30, and spent most of the intervening hours sound asleep. Or so I thought.

In 2019, I inherited a used Fitbit with a sleep tracker, and for about a month, I used it to monitor my sleeping patterns. I never once slept nine hours—reaching a maximum of 8 hours and 19 minutes one night, and averaging about 7.5 hours. Of those 9 hours I was spending in bed every night, I was usually awake for one and a half of them! So it could be said that I was an objectively bad sleeper even when I didn't have insomnia...which is helpful to remember now that I'm attempting to get over my insomnia.

These days, just like then, I usually head to bed around 10:30 and drag myself out of it around 7:30. Most nights, just like then, my Fitbit reports dozens of forgotten wake-ups and a total sleep time of around 7 and a half hours. By all standard measures, I'm sleeping like I used to.

There's just one difference: back then, I never had anxiety about my sleep, and now I do. Here is the way things used to go in my good old pre-insomnia days:

• Some nights, I would go to bed at 9 just because I didn't feel like being awake any more. There was no way I was going to sleep that early, but I would lie in bed and rest until I fell asleep. I never worried about it.
  
• Some nights, I would get into an organizing frenzy and stay up until past 1AM moving furniture around. I never once told myself that I needed to stop and get to bed or I would hate myself in the morning.
  
• Some nights, I would go to bed and get captivated by a cascade of interesting thoughts. Before long it would be almost 1, but I still wouldn't feel bad about it. In fact, I'd be excited about all the cool new ideas I was having!
  
• Some nights, for no particular reason, I found myself still tossing and turning at 2AM. At that time, I'd usually put a few hours of sick leave on the calendar for the next day at work, so once I did fall asleep, I'd have the chance to stay that way until I was ready.
  

In all those circumstances, I never stressed about my failure to sleep. I knew I'd fall asleep eventually, and more than likely, I'd catch up by sleeping earlier the next night.

Then, insomnia. What insomnia took away from me was not my ability to sleep, but my confidence in it. After several nights of terrible sleep, I could no longer trust that I'd catch up the next night. And once I lost my confidence about the next night, I lost my equanimity about being awake right then. Soon, every moment that I was awake at night was a cause for extreme anxiety!

Well, since my sleep training and several months of practicing mindful sleeping, I no longer have the kind of anxiety that keeps me awake all night worrying about whether I'll be awake all night. But I'd be a liar if I said I had no anxiety at all. Most nights, there's still a brief wave of it—a moment or two after I pull up the covers, when my stomach does a backflip and my mind melodramatically proclaims, This is the moment of truth! The moment that separates the sleepers from the non-sleepers! When the dust settles, which side are you going to be on!?

Fortunately, I now have a pretty large bank of decent sleep saved up to give me confidence, and all it takes is a little mental un-pep talk to calm the irrational panic enough to let my sleep drive take over. Most of the time. But woe to me if I go to bed too early! Then I will lie under the sheets, my thoughts buzzing around like bees, until they inevitably turn to the question of whether this is going to be the night that I just don't fall asleep at all! Dun dun dunnnn!

Then I still have to resort to the stimulus-control tactic of dragging myself out into the living room, calming myself down, and only returning to bed once my eyes are like sandpaper and I can't string 2 thoughts together and it's almost certain that I'll fall asleep as soon as I hit the pillow. By this time, it's usually close to 4AM, so I can say with assurance that going to bed early usually backfires spectacularly. But on the plus side, just like the good old days, this night of terrible sleep is usually followed by catching up during the next one.

It is quite clear that thinking about my sleep is the largest contributor to my not getting enough of it, so it's probably time that I quit it for good. I recently read the story of a recovering insomniac's conversation with a recovered insomniac. The recovered one's way of dealing with insomnia after her sleep had started to improve was this: "I paid absolutely no attention to ‘it’ whatsoever. I pretended it wasn’t there. I decided I’m not going to give up another second of my life to this ridiculous problem."

I think it's time for me to do the same. While I'd say my insomnia is more in remission than absolutely cured, I don't believe there is any more that I can do on a conscious level to improve my sleep. There's nothing I can say to help other insomniacs that I haven't already said.

So, after 4 months and 16 posts, I'd like to declare this chapter in my blog closed. I sincerely hope I'll never have to write another post with the label "insomnia." I hope that soon, this entire saga will feel like nothing more than a bad dream. The best way to make that happen is to move on and abstain from insomnia blogging.

So, in closing, allow me to paraphrase the immortal words of everyone's favorite fictional insomniac: "The first rule of Sleep Club is you don't talk about Sleep Club."

Thank you, and good night!

Lessons learned from insomnia

It took me about 4 months to go from normal (though light) sleeper, to full-fledged insomniac, and back again, and let me tell you—sometimes it felt like 4 years! Time does have a way of dragging out when you're awake for 20 hours a day, and so much of that time was wasted in delays and false starts. If I could go back into the past and apply my 20/20 hindsight, I think I could have shrunk those 4 months down to just one, or maybe to none at all.

But the next best thing to saving myself from 4 months of sleepless torture is to save someone else! So all you fledgling insomniacs out there, take note!

Here's what I would do differently if I had to live through my insomnia all over again.

Get intervention sooner

The longer you have insomnia, the more difficult it becomes to treat. I slept poorly for 6 weeks before I even considered seeing a doctor, 7 weeks before I was able to get a prescription for sleep aids, and about 8 weeks before I actually took my first dose. By then, my insomnia was so entrenched, it had become a part of me, and no pharmaceutical was going to take it out. Looking back, I am confident that if I had had just a little help getting me over the stress of the first few days of my breakup, my sleep would never have become so disordered in the first place. I wish that I'd sought treatment for my sleep troubles as soon as I started worrying about them. It may have been difficult to get a prescription for sleep aids at that early phase, but I think I could have persuaded my doctor to give me a small supply of Lunesta if I emphasized that my sleep was getting progressively worse instead of better, and I wanted to break the cycle.

If you are getting medical care, advocate hard for yourself

I felt like I was swimming alone in the ocean during my brief stint as a psychiatric patient. I was given very little information about how to take my prescriptions and no information about what I should do if they weren't working. Since my appointments were 4 weeks apart, I wasted precious time, allowing my sleep to deteriorate even further, waiting to find out what I could try next. In retrospect, I wish I had been a lot more proactive. First, I should have only filled a small portion of my prescriptions, rather than a whole 30-day supply which subsequently went to waste along with my money. I should have also asked my doctor for a lot more information, such as: How long should I wait before I can expect to see an improvement in my sleep? In my experience, a sleep aid works best on the first night, and if that's not happening, then you need to try something else. If that were the case, I should have asked my doctor what I should do next. Try  changing the dosage? Try changing when I took it? Could I possibly have small quantities of multiple drugs to try on successive days, to make the most of the time between appointments? I don't feel like the psychiatrists I saw were invested in finding a solution with me, so I wish I had put less faith in their expertise at the beginning and worked harder to chart a course that would work for me, even with minimal participation from them.

Don't believe the numbers you hear—believe how you feel

When I finally diagnosed myself with insomnia, I took great stock in the published dichotomy – acute if it's been occurring for less than 3 months, chronic if more – and patiently waited for it to go away on its own, until it was officially chronic. Three months is an awfully long time to wait when you have a health condition where time is of the essence. Pretty early on, I knew instinctively that my insomnia had become self-perpetuating, but still I waited to get serious about treatment until I had crossed that arbitrary 3-month threshold. It is also helpful to remember that each individual has her own individual sleep needs. Many people start to develop insomnia because they start worrying about their sleep, even though there's nothing to worry about. They hear that you should be getting 8 hours of sleep a night (or you will die a horrible, slow death of cognitive decline and cardiac failure!), and they start to panic because they're not sleeping that much. Some people feel like they're not sleeping at night when they really are, and so they worry about it incessantly even though they're not tired during the day. When it comes to sleep, what's most important is how you feel. If you're not tired, you're probably getting enough sleep! Stop watching the clock and counting the hours, and just let your body do its thing!

You don't have to get out of bed if you've been lying awake for 30 minutes.

Another case where the numbers you hear are all but irrelevant is what I'm going to call the 30 minute rule. It goes like this: If you've been in bed for 30 minutes and you're still not asleep, get out of bed and do something relaxing until you feel sleepy. I saw this rule everywhere as soon as I started having sleep troubles, and it is by far the worst insomnia advice I ever got. I followed it religiously, which was silly, because never in my life had I been able to fall asleep within 30 minutes, and now I was expecting it to happen when I was having more trouble with sleep than ever before! For me, following this rule was 100% counterproductive. If I had been in bed for close to 30 minutes, I'd start to get anxious, knowing that in a few minutes, I would have failed in my endeavor and would be forced to get up. It put me in a constant state of anxiety that of course made it impossible to sleep! I believe that following the 30-minute rule actually made my insomnia even worse. A much better wording of this rule, and only one I learned after several months of doing it the wrong way, is "If you've been lying in bed for a while and you're starting to feel stressed out or increasingly awake, get out of bed and do something relaxing. But if you're lying in bed and you're still comfortable and relaxed, feel free to stay in bed!" This rule follows stimulus control principles, without the stressful feeling of being in a race to get to sleep.

So there you have it: 4 ways to make 4 months of insomnia a much less likely prospect. If only my past self could have read this blog...this blog wouldn't even exist!