A Smart Person’s Guide To Insomnia
I love sleep. My life has a tendency to fall apart when I’m awake, you know. — Ernest Hemingway
The Sleep Center is easily one of the sketchiest places I have ever been. It is located in the basement of a rundown office building in Bethesda, Maryland. There is a poorly lit garage next door, for which the Sleep Center does not validate parking. The receptionist tells me that the CVS across the street will validate if I want to run in and buy something after my appointment. It is a mark of how addled my brain is, that — rather than grabbing a tube of toothpaste and getting on with my day — I spend 15 minutes wandering the aisles wondering how much I have to spend for the cashier not to think I only came in to get my parking ticket stamped. As if he cares. As if I will ever return to this particular CVS, which is nowhere near my home. This is what a lack of sleep does to you.
The sleep doctor (is there a word for that particular sub-specialty?) is pleasant enough but typical. She asks (of course) about caffeine. It is the first thing every doctor asks about. I honestly believe she expects me to say, “Well, actually I drink two or three cups of coffee every evening. Do you think that could be part of the problem?” Doctors never seem to realize that, by the time a person seeks medical treatment for a sleep problem, that person is way past caffeine and Tylenol PM and relaxing ocean noises at bedtime.
The worst thing in the world is to try and sleep and not to.
— F. Scott Fitzgerald
One of the most insidious aspects of insomnia is the way in creeps up on you, constantly redefining your definition of a good night’s sleep. Everyone has a sleepless night once in a while. Then it becomes one night a week. Then two or three. Eventually, I expect I will spend more nighttime hours tossing and turning than I do actually sleeping. I am an intelligent person. I eliminate the obvious culprits: caffeine, sleeping too late, watching TV before bed. I am still lucky if I get a few hours sleep a night.
This complete inability to sleep, even though I am exhausted, is not to be confused with sleep deprivation. Sleep deprivation happens to you when you have infant twins. I know this because I have had infant twins. I was lucky to get two hours of uninterrupted sleep. There was always a baby needing to be fed or changed or held. Frequently two at the same time. If I got one baby to sleep, the other would cry and wake her sister up. I staggered through that first year in a daze. It was awful. And I would trade my current insomnia for that sleep deprivation in a second. It is one thing not to have the opportunity to sleep, but to know that, when you finally get that opportunity, you will sleep. It is another thing altogether not to know if you will ever be able to sleep normally again.
The best cure for insomnia is to get a lot of sleep. — W.C. Fields
It is hard not to feel that there is something I am doing wrong. Sleep is supposed to be a natural part of life — something that just happens when you are tired. I can’t help comparing myself to a Giant Panda. We, humans, love pandas — big goofy, adorable creatures they are. We don’t want them to die out. But come on, really? What kind of animal can’t reproduce without human help? By the same token, what kind of animal can’t sleep without medical help?
Not that the medical profession is terribly helpful.
Sometimes, when I am awake at three in the morning, I am ravenously hungry. One night, I eat half a box of fudge bars while I watch TV. I read about a new drug that is being used off-label — with much success — for sleep disorders. When I message my doctor to ask about it, she says she won’t prescribe it because it can cause weight gain.
Many things — such as loving, going to sleep, or behaving unaffectedly — are done worst when we try hardest to do them. — C.S. Lewis
“She takes a sleeping pill every night.” I cannot tell you the number of times I have read this phrase in a novel or heard it in a film or TV show. It is always, ALWAYS meant as a pejorative. A judgment. A label: drug addict.
My first sleep medicine was Ambien. It worked for a while. The thing about Ambien is that you are only supposed to take it occasionally; if you use it all the time you build up a tolerance and it no longer works. But, when it is the only thing that makes sleep possible, it is hard not to give in to the temptation to use it every night. After Ambien, I tried other sleep meds. Some did nothing for me. Some worked until they didn’t. I have a drawer full of old pill bottles: prescription meds, non-prescription meds, vitamins, herbal remedies. Many of these, I mentally lump into a category labeled Crunchy Hippie Voodoo Bullshit. I don’t believe in any of it, but I try it anyway — that is how desperate I am. I wonder, if I were a more credulous sort of person, would these things work for me through some sort of placebo effect? Is being a skeptic just one more thing that makes this all my fault?
The last refuge of the insomniac is a sense of superiority to the sleeping world. — Leonard Cohen
According to the American Sleep Association, 50-70 million Americans have some sort of sleep disorder. Yet, there are few things that make a person feel so alone as insomnia.
I do not resent other people for being able to sleep. I envy them, certainly, but I don’t resent them. What I resent is the implication that the reason they can sleep while I can’t is something other than luck. That there must be some simple solution I have overlooked. Meditation? Yoga? “Have you tried cutting out caffeine?” (Really? Caffeine interferes with sleep? Why hasn’t anyone told me this before?)
The sleep doctor wants me to do a sleep study, where I spend the night at the center and am monitored while I sleep. It is, she tells me, just like being in a hotel room. I find this fairly implausible. I have trouble enough sleeping in my own bed, so I cannot imagine that I would be able to sleep in a strange place with electrodes all over my head and body. Not to mention the fact I am a private person, and the idea of being observed while I sleep completely creeps me out. I also know (I have done my research) that, unless you have sleep apnea, it is very unlikely that you will get any helpful data from a sleep study. If I could not walk or pee or breathe, doctors would search for physiological causes. Infection. Autoimmune disease. But, because a why is so difficult to find with insomnia, I feel like doctors are just going through the motions — like they have already decided that it’s all in my head.
Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real? — J.K. Rowling, Harry Potter and the Deathly Hallows
Because it is all in your head — or, more scientifically, your brain — insomnia suffers the same stigma and misunderstandings as other disorders of the brain, such as depression and anxiety. For some reason, no matter how enlightened and aware our society thinks it is, there is still a feeling that these are things a person should be able to snap out of. If anything, the current mindfulness craze has reinforced the misconception that if we are having the “wrong” sorts of thoughts, all we have to do is decide to have the “right” sorts instead: My life is good, so I’m not depressed. My fears are irrational, so I’ll just ignore them. Sleep is a natural process, so if I think I can’t sleep, I must just be mistaken. Walk it off. Rub some dirt on it. There’s nothing wrong with you.
Or maybe there is. A 2015 study published in the Journal of Immunology Research found a link between sleep disturbances and viral, bacterial, and parasitic infections. Apparently, these infections can cause changes — many on the cellular level — which can affect brain wave patterns and lead to disordered sleep.
It appears that every man’s insomnia is as different from his neighbor’s as are their daytime hopes and aspirations. — F. Scott Fitzgerald
When you are a new parent, everyone wants to give you advice. Some of the worst advice is about how to get your baby to sleep through the night. People who are lucky enough to have babies who sleep through the night are sure that this is because they have THE ANSWER. And, okay, as a new parent (especially if you are a new parent of twins), you really, really want there to be an ANSWER. So you try everyone’s advice. You get books from the library with titles like: “You CAN Get your Baby to Sleep Through the Night: a Foolproof Guide.” But, eventually, you realize that a sleepless baby is not a machine with a faulty setting that needs to be adjusted. A baby is an individual human being with her own individual quirks, and you must figure out what the answer is for your baby.
What’s true for a sleepless baby is also true for a sleepless adult. I had to figure out what worked for me through trial and error. I have a routine of carefully staggered medications (all prescribed by the same doctor, who knows what I am doing). Interestingly, the medication that finally put me on the road to being able to sleep is the same one that a previous doctor wouldn’t prescribe because it might make me gain weight. It hasn’t but, even if it had, I resent the years of sleep I lost because most of the medical community thinks it’s better to be sleep-deprived than fat.
Part of my bedtime routine is also to watch TV as I fall asleep, which is a big NO in the “sleep hygiene” community. But focusing part of my mind on something outside of myself helps get me past that common insomniac’s problem: not being able to sleep because you are worried about not being able to sleep.
And so I continue my tenuous relationship with sleep. It is an on-again, off-again love affair. We have been in an on-again phase for a few years now. Sure, we argue once in a while — maybe go a day or two without speaking — but, lately, sleep returns to my bed more often than not. Yet, as in any dysfunctional relationship, there is always that feeling of insecurity. That nagging question: the next time sleep leaves me, will it be for good?