insomnia


I get to think and talk about insomnia a lot, because it is such a common symptom in my therapy clients (at least three-quarters of them) and because I’ve had plenty of it myself over the years. (Here is my advice for insomniacs.) Based on my experience, I’d like to propose a pattern of insomnia that I believe is the most common and hardest to overcome kind of insomnia: structural insomnia.

Imagine you were held prisoner for an interrogation. Your captors might try to make you pliable by depriving you of sleep. Maybe they don’t let you lie down, or force you to do some kind of work instead of sleep, or force you to drink caffeine to keep you awake, or use lights, sounds, music, or movement to keep you from sleeping. The lack of sleep you experience would be structural insomnia: lack of sleep created by your waking or sleeping environment, or by bad scheduling.

That would be a pretty cruel way to treat someone else, but when we do it to ourselves it seems pretty normal. Here are some of the most common ways we torture ourselves with structural insomnia:

We create sleeping spaces that are not dark, quiet, still, and/or comfortable.

We use caffeine less than 6 hours before wanting to fall asleep. It takes your liver 6 hours to process caffeine. You have to give it enough time to do it’s job.

We expose ourselves to light right up to when we want to fall asleep. Light tells your brain it’s day, which keeps it from producing the hormone that pressures and allows you to fall asleep.

We work up to the last minute, or stew on something provocative. You have to give yourself some mellow transition time between being on the ball and asleep.

We do not allow ourselves enough time fall asleep and sleep adequately before we have to wake up in the morning. This is a big one! If you need to wake up at 6am, you must be lying down in the dark, doing nothing but trying to fall asleep by 9:30pm in order to get 8 hours of sleep. And that’s if you can fall asleep in 30 minutes. If you know it takes you two hours to fall asleep, you need to schedule ten hours in bed to get your eight.

We wake up at night and shine light in our eyes. Phones, clocks, TV, refrigerator lights, etc.

We set an object right by our head that will randomly light up, play music, buzz, or make other alarm-like sounds. Phones, of course. Turn them off.

If you agree that it would be torture, or at least mistreatment, if you did this stuff to someone else, consider not doing it to yourself!

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Some of my oldest memories are of lying in bed, late at night, wishing I was asleep: sleep-onset insomnia. I’m happy to say that I have largely overcome this malady. I have a sizeable bag of tricks to help me out with it (read about them here), the most important of which is having gotten over my fear of insomnia, which had become the primary source of sleeplessness. For the last several years I’ve had trouble getting to sleep just a few times a year.

For the last couple months, though, I’ve been experiencing “terminal insomnia,” AKA waking up too early and failing to fall back asleep. Most of my tricks don’t apply here. It sometimes helps to stay in bed until my alarm goes off–occasionally I will fall back asleep. Sometimes cuddling helps, too, but I’ve found nothing consistent so far. It’s become a problem: I’m getting married next week and sleep debt tends to make me clumsy, grouchy, and stupid–not the way I’d like to show up for this event!

So I complained about it to my therapist today and he gave me his hypothesis: I am chronically and habitually productive. Productivity is a way of life  for me and it’s infiltrated my groggy, should-be-going-back-to-sleep mind. He is right. I am on the go all day. It never occurs to me to slow down, much less take a nap, and that was exactly his prescription:

“I wonder what would happen if you cultivated a habit of trying, even to a ridiculous degree, whenever you noticed being really tired , just saying, ‘OK, I’m just going to lie down. I’m just going to quit what I’m doing and lie down.’ Even if it seems indulgent or incovnenient. Just ‘F*** it. I’m lying down, I’m closing my eyes, I’m relaxing. If I sleep, I sleep–it doesn’t matter. I’m just going to relax.’ Look at your tiredness as a sort of enlightened messenger, giving you the gift of saying, “Stop it! Stop working so hard. Just lie down right now and be irresponsibly lazy. Just lay out.’

“And you’ll have to deal with the resistance in you too. The well-trained hard, hard worker in you will say “Now’s not a good time… maybe later,” and the challenge is to say “F*** you. I’m not buying it. I’m lying down. For at least five minutes I’m going to lie down, deep breath, deep relax, and invite myself to doze if it happens.

“It’s the next logical progression of getting over the fear of insomnia: The next step is getting over the fear of being tired. OK, I’m building into my lifestyle being tired and loving myself in my tiredness. If I’m tired, I lie down. Why the hell not?

“I want you to take it on as a spiritual practice. Seriously. A spiritual practice of just interrupting productivity as often as possible in order to be lazy and relaxed and tired and just let the earth hold you up. When you lay down, experience the earth holding you up and receive that kind of support. You are a very diligent, principled and hard-working fellow, Nathen, and we have noticed. We got the message. You’ve got that covered. You’ve acheived that already and can let your pendulum swing back in the other direction.”

He’s right that it won’t be easy. As I’ve been writing, I can feel the familiar tiredness in my face and arms, weighing me down, and I’m choosing to write instead of lie down. Well, maybe I will go lie down and finish this later…

I bought Sleep Cycle for my iPod touch because it sounded right up my alley. It uses the accelerometer in i-devices to measure how much you move while asleep to track your sleep cycles. Then it wakes you up when you will be most alert. How cool is that?

Well, it is pretty cool, but not because it tracks your sleep cycles, or because it wakes you up alert. First of all, sleep cycles are defined by brainwave patterns, not by movement. Perhaps it’s a decent analog–I’ve read that claim–but the charts that Sleep Cycle produces from my nights of sleep don’t look much like the examples of EEG readouts of sleepers.

Where in this graph was I dreaming? It looks like I fell asleep and woke up pretty abruptly, and was awake for a short period just after 6 am, but that’s all I can tell. I can also say that the app does not always catch it when you wake up. I’ve gotten out of bed to pee and not made a spike out of the sleep zone.

It is also not really useful for its primary purpose–to wake you up during the period that you will feel most rested. You set an alarm for the latest you want to wake up, and then a period of time during which it would be acceptable to wake up. The alarm is supposed to go off at the point in that period when you are moving enough to indicate that you are in shallow sleep. Supposedly, if it waited longer and let you go back into deep sleep, you would wake up groggy because of it.

Perhaps it’s just me, and perhaps it’s just that I’ve been in grad school, but I found that I never preferred to be woken up before I really needed to be up. I did not notice any benefit from being woken up when I started to move instead of when I had just enough time to get ready for school. Luckily, you can set it for “normal alarm clock mode” with no “wake-up phase.”

Still, Sleep Cycle is cool for a couple of reasons. First, It tracks how much time I give myself for sleeping. It starts counting when you set the alarm at night and stops when you wake up and keeps track. That’s how I know, for example, that I gave myself an average of 8 hours and 35 minutes to sleep in for the 155 nights before Reanna moved to Eugene. (It doesn’t work with two people in bed.) (And that included my last 125 days of grad school–not too bad!) That means I averaged fairly close to eight hours of sleep a night, with an estimated average sleep latency of 30 minutes. And that brings me to the coolest part.

As a chronic, intermittent insomniac, I’ve always wanted to know how long it actually takes me to get to sleep. Now I have a pretty good idea, thanks to Sleep Cycle. Many of my graphs look something like this:

I started trying to sleep just after 1 AM and drifted off around 1:45. I probably would have told you that I lay awake for at least an hour. Here’s another:

That looks like about an hour of insomnia. Don’t be fooled by the little initial drop–that was me lying very still, trying to sleep, before starting to toss and turn.

To finish off, here are a few other graphs, just so you can see some of the variety:

I’ve had chronic, intermittent insomnia for as long as I can remember—at least since I was eight years old. I can remember at that age how my younger brother, Ely, in the bunk above mine, fell asleep so much sooner than I did that I would get lonely. I would keep him up as long as I could by starting conversations or, more often, asking him to tell me stories. He told me a great series of mean stories about a couple of girls we didn’t like–I think their names were Ingrid and Gretchen–with spectacular endings involving the girls being catapulted into huge vats of poop. They were hilarious and I loved them. One night, though, I asked for a story and he told me I’d used them all up, and he never told me another story. I still feel a little sad about that.

At that time, the loneliness was the worst part of it. I was homeschooling, so I didn’t have to wake up at a particular time, unless it was the year we had a TV, and it was Saturday morning and I had to clean my room before watching any cartoons. Once I was in public school, though, and on into college and jobs, insomnia became a curse. There were so many times I woke up with only a few hours of sleep, nauseous and primed to catch whatever cold was going around.

Thirty years later, I’ve pretty much overcome the problem, and in the process I’ve thought and read about it a lot and collected or invented a bunch of strategies for dealing with it. I’ll share the ones that have been consistently helpful. This post is so long I feel like I should give some meta-advice, too, like how to use this advice. I’m not sure. I came upon this stuff incrementally, and I’m not sure how it would have been different if I’d come across this information all at once. Also, I’m not sure how specific a lot of this stuff is to me, the specific causes of my insomnia, and the training I’ve had in meditation and therapy. If you are an insomniac, I suggest reading the whole thing and trying things out, one at a time, until you find something that helps. If you are not an insomniac, I suggest reading “Things to know” and then moving on to something else.

Things to know

1. It is important to understand that insomnia is never in itself a disease or a disorder. It is always a symptom of something else going on, usually too much stress. This means that you have  to deal with your stress or other underlying problem to deal with your insomnia.

2. Because of that, while there are situations in which it is smart to take sleeping meds, I find they are extreme and rare. Sleep meds are habit-forming and not a good substitute for natural sleep. If I’m pretty sure I will not sleep at all during a night, I might take something, but I find that the quality of sleep I get on meds is so much worse than natural sleep that I’m better off with four or five hours of natural sleep than eight of medicated sleep. This piece of advice is influenced by my anti-allopathic stance, but I believe that it is important to encourage your natural sleep cycle to emerge, and that taking meds will usually move you away from that, rather than towards it. I will occasionally take melatonin, which is moderately effective, or more often valerian. I like valerian the best because the liver processes it quickly–it helps me get over the hump into sleep, and that’s it, so I’m not so groggy in the morning.

3. Along the same lines, if you are serious about sleeping easily and well, do not mess with caffeine. That includes chocolate, which has caffeine and several other stimulants. Just don’t do it. You need to start paying more, not less, attention to the sleep pressures your body is giving you.

4. Don’t be afraid of napping. I didn’t nap for decades because I wanted to be as sleepy as possible went I went to bed at night. I thought I was “saving up my sleepiness.” This is not how it works. I now think that resisting the urge to nap is more like practicing not sleeping when your body wants to sleep. If you are an insomniac, you do not want to get better at this skill! Consider the fact that first-world humans are the only primates that don’t nap. It’s a pretty small club. I bet that club has most of the insomniacs in it, too.

5. Don’t be afraid of “oversleeping.” Sleeping is like peeing; when you are done, you stop. The exception is clinically depressed people, and I’m not talking about very sad people, or even people who just fit the DSM criteria–I’m talking about people who are so massively depressed that they’ll sleep for 17 hours and still not be able to get out of bed. These folks are not insomniacs, anyway. Incidentally, I won’t be surprised if we eventually discover that many cases of clinical depression is are a type of sleep disorder. It’s not well known because there’s no way to make money from it, but by far the most effective treatment for depression is sleep deprivation. Staying up all night every third night or so completely eliminates the symptoms of real depression.

6. This is the most important thing to know about insomnia: Not being able to sleep is no big deal. It’s really not that bad. Unfortunately, this most important advice I have is not useful to hear, it is only useful to know, and I don’t know how to make you know it. Being freaked out about not being able to sleep has been the cause of most of my insomnia. I could tell, too, but that didn’t help. It only helped when I realize that it was no big deal to not get to sleep. Ever since then I’ve been able to sleep much easier and when I don’t sleep it doesn’t cause much discomfort. Perhaps the trick is getting a real problem–in my case it was having my heart broken.

7. If you are in love, having insomnia is normal. If you are in love and find yourself complaining about the insomnia, this probably means that you are a chronic complainer and that you are focusing on the one unpleasant aspect of your situation.

Getting ready for/setting the stage for sleep

Allow your life to revolve around sleep for a while:
8. One way to decrease the I’m-not-falling-asleep-fast-enough anxiety is to give yourself lots of time to in which to sleep. If you need 8 hours—and you do, at least—give yourself 10 hours in which to sleep. This should be a sacrifice of “night guy,” not “morning guy.” If you have to wake up at 8 am, get in bed and close your eyes by 10 pm. That way, you can fail to get to sleep for two hours before it starts to matter. If you don’t think you can afford to lose those two hours, do some thinking and talking about that idea–somewhere in there is the anxiety that is keeping you awake. Plus, if this technique works, you’ll only lose the two hours for a few weeks. After that you’ll be falling asleep around 10:30 and waking up before your alarm, giving you that extra time back.

8. Another plug for going to sleep before you think you need to: It takes normal people 20-30 minutes to fall asleep. If your alarm is set for 8 am, lying down at midnight is ensuring that you don’t get enough sleep. That’s not insomnia, it’s just silly, but I’ve done it many times.

9. Set aside some time to do only relaxing things before you get in bed. I recommend no electric light for an hour before bed; a certain number of lumens of light hitting your suprachiasmatic nucleus tricks your brain into thinking it’s day. Other than that, just pay attention to what is relaxing and what is not. For me, any kind of internet is out, writing is out, and talking or thinking about emotional subjects are out, unless I’m getting good, loving attention while I’m talking. Edgy TV or reading is out. School work is out–any kind of work that will remind me of deadlines etc. Mild cleaning, like picking up laundry, is OK. Stretching, yoga, and physical therapy are good. Calming meditations are in. Drinking herbal tea is in.

10. Stay in bed with your eyes closed. Many insomnia-advice lists will tell you to get out of bed and clean or read or something until you feel sleepy, but I disagree, for a couple reasons: (a) You want to establish regular sleep patterns. It is better to get used to being in bed, doing nothing at the same time every night. Consider the possibility that, as an insomniac, you are no longer good at knowing when you are sleepy. (b) You do not necessarily know when you are awake or when you are asleep. You may be having the vivid experience of continual wakefulness, but unless your eyes are open you could be going in and out of stage 1 sleep without knowing it. Nurses often report waking up snoring patients from stage 1 sleep who insist that they had not yet fallen asleep.

11. Do not have a clock visible from your bed and do not get up to check the time, both because it violates #10, and because it will only make you more anxious. It’s better not to know.

12. Be limbically well-regulated. You are a social animal whose brain and body work best in contact and concert with others. Get plenty of cuddling and other forms of physical affection. Have a lover and friends and children around who you feel safe with and loved by.

The sleep train

13. I think of the wave of sleep pressure that comes about 20 minutes after I lie down as a train, because it’s moderately regular and easy to miss. Missing the sleep train is a product of being too alert or anxious, and this problem is best dealt with by doing the stuff I’ve recommended above. The only technique I’ve used with any success for catching the sleep train is anchoring on a sensation. Usually if I’m awake enough to use a technique, I’m jolted awake by the rushing, falling sensation of falling asleep. Several times, though, I’ve been able to pay total attention to a sensation, usually in one of my ears, and ride that all the way into sleep. This is the way I have had most of my lucid dreams. I have the experience of moving directly from being awake to having a lucid dream. It’s unlikely that this is actually happening, since beta-wave REM sleep is usually separated from alpha and beta-wave wakefulness by some time and two sleep stages, but the experience is vivid. It’s pretty cool, but if you miss the train, it can be quite a while before another one comes. Most of my tricks have to do with bringing on the train.

14. Sleep in a dark, quiet place. If this is not possible, I use a fan and/or earplugs to mask noises and a bandana over my eyes to block light. The best earplugs are the 30 dB white foam cylindrical ones from Walmart. I don’t much care for Walmart, but good sleep is more important than my dislike. Avoid the shiny, colored, or airplane-shaped earplugs. They are crappy. Silicon earplugs block noise well, but put too much air pressure on the ear canal. You could use those if you always and only sleep on your back. The best way to use the foam earplugs is to flatten them completely into little circles, squeeze the circles a little smaller, and then insert them as deeply as possible–to the point where the ear canal enters the skull. [And, since I don’t know you or how smart you are, I should also say that you should never put anything in your ears, much less as far in as you can. You run the risk of puncturing an eardrum, or having to go to a doctor to get something removed, or pushing your ear wax back to form a plug that can eventually cause ear infections and hearing loss. Don’t do it.]

15. Sex is good for bringing on the sleep train if you are allowed to fall right to sleep after your orgasm. Otherwise, it’s a wash.

16. More limbic regulation: I find it very effective to have someone spoon me, so I can feel their body breathing along my back. Nothing feels more comforting or brings on the sleep train better. One caveat: For this to work, you either need to have a good, non-twitchy sleeping partner, or be able to fall asleep before they do. In situations where spooning might be uncomfortable, because of homophobia or whatever, I’ve also found it helpful to rest my head on someone’s chest. It seems like it’s the intimacy and the sensation of someone else breathing that does the trick.

17. Get a massage. This works great but, like sex, only if you are allowed to fall right to sleep afterwards. The overall relaxation is great, and there is sleep magic in my ilio-tibial band (outside of the thigh) and my calves. For you it might be somewhere else.

18. Stop thinking. This is a big one. The main way I accomplish this is by paying attention to physical sensations. I have two methods. One is body scans–feeling the sensations in each part of my body, starting with my head, down to my feet and back up. The other way is just staying on one part of the body. For me the most effective is staying on my eyelids. Relaxing my eyelids is one of the quickest ways to bring on my sleep train. It’s so quick that I have to be careful not to do it before I’m calm and sleepy enough to catch the train.

19. The other way to stop thinking I found listening to an Ekart Tolle book on CD. He recommended listening to the space between his words, rather than his words–the underlying silence. The first time I tried it I fell asleep almost immediately. Subsequent uses have been less dramatic, but it’s reliably given me a chance at the sleep train. This only works with calm voices talking about calm things, of course.

20. For co-counselors: I’ve experienced profound relaxation and easy sleep during and after a “standing guard” session. If you’re not a co-counselor you probably won’t get this, but here’s a brief description: The client relaxes, eyes closed. The counselor stands guard, occasionally reassuring the client that they are safe and that if any worries are arising, the counselor is taking care of it.

21. Check in with the sleepy and tired part of yourself. I adapted this from Genpo Roshi’s Big Mind meditation, in which you tell yourself, “OK, now I’m talking to the part of myself which has no need to search for anything and no need to grasp ahold of anything….” He took the idea from some therapeutic modality in which you have discussions with parts of yourself–I forget the name of it. I decided one particularly alert night to check in with the part of myself that was sleepy and tired and it was remarkably effective. I think it’s important to do it in a kind, relaxed, parental voice. In my head I say “OK, let’s check in with the sleepy, tired Nathen.” Then I respond, “Hi, this is the sleepy, tired Nathen speaking.” “Hi, sleepy, tired Nathen. What does it feel like to be sleepy and tired?” Then I describe any sensations that feel sleepy or tired–my body feeling heavy, my eyelids feeling scratchy, whatever is there. This has consistently brought on the sleep train.

22. Exercise–use with caution. Most exercise wakes me up. There are two exceptions, and they are both so difficult that I rarely use them. One is a full set of Bikram yoga. Several times, on particularly bad nights, I’ve gotten up at 2 am or whatever and done the full 90 minute set, and each time I’ve fallen directly asleep afterwards. The second only takes a half hour, but is even more unpleasant. I got this from Jonathan Elkins: Flex the muscles in your feet as tightly as you can and hold it. After several minutes, flex the muscles in your calves as well. Over the course of a half hour at least, flex the muscles up your body, like squeezing all of the toothpaste out of a tube. Remember, when you get to your head, your feet are still flexed; your entire body should be completely rigid. If you do it right, it’s incredibly difficult and uncomfortable–barely or maybe not worth the sleep that comes afterwards. But it works.

23. I’ve used a few meditations on CD that have helped. A few versions of the yoga nidra meditation–it doesn’t seem to matter which, as long as I just listen to the body-relaxation bit and then take off the headphones. The delta wave pattern part of Centerpointe Research Institute’s level one CD seems to have been helpful. Mostly, though, I’ve used the first meditation on Roberta Shapiro’s Sleep Solutions CD. (Thanks, Mom, for the gift!) I like it best because the volume tapers off as you go, so it’s possible to actually fall asleep with the headphones on. It’s always a drag to wake up enough to take them off, or else get woken up by the next loud word or sound. What I’d really like is a CD player that monitors my brainwaves and fades the sound out at the onset of theta waves. That would be great.

Waking up too early

This form of insomnia is fairly new to me, but here’s what I have so far:

24. Don’t drink water for a while before bed, so you don’t have to wake up to pee. Yes, you wake up dehydrated, but well-slept. Alternatively, if you are male, keep a pee-jar by the bed so you don’t have to walk to the bathroom.

25. Don’t underestimate your ability to fall back to sleep. Stay in bed with your eyes closed until your eight hours are up. You can fall back to sleep, but you won’t if you get up and start your day.

11 years worth

11 years worth

I have started this blog inspired by my friend of just over a decade, Jeannie Lee. I’ve been waving her away about it for years because of the time commitment: learning curves and then continuing to post. I’d already stopped writing in my precious journals in favor of a voice recorder because of how much time it took. I already have plenty of ways to keep myself a little too busy: university, learning to dance, making money, reading, writing music, keeping up with friends and family…. Jeannie’s rebuttal was that I could put as little time as I felt like into the project, which is true, of course, but not usually how I operate.

I think two things tipped me. One is that I’ve been thinking a lot about how difficult it is for me to write well, and that it’s because of how difficult it is for me to think clearly. But good, clear thinking is important to me. I decided I could stand to nudge my daily activities in that direction. Another push was from my new friend, Reanna, who told me she liked the little rants I’d put up on my (feeble) myspace page. She’s smart and a writer and I have a crush on her, so that convinced me to make better friends with the part of myself that says things. Plus, the few writings and images she has up online give a sense of her personality and life that mine do not. I’m jealous.

NME 32, 33 & 34

NME 32, 33 & 34

So here it is, starting September 29, 2008, the first day of my 38th year. I’m calling it Nathen’s Miraculous Escape after a zine that I made for a while about my year, each year, for Christmas presents. (I stole the name from the title my dad gave to the film of my brother Ely’s birth: Ely’s Miraculous Escape.) I hope this blog will serve the same purpose as the zine—make it easier for you to stay connected with me during the times (most of the time, actually) that I’m working on projects and neglecting the loved ones in my life who I don’t see every day.

I’m excited about this project. I always get a creative rush around this time because I always spend a lot of time brainstorming about my new year, clarifying my goals and visions. This year’s creative rush has been bigger than usual, though. The last several days I’ve woken up after only a few hours of sleep and lain awake until morning, thinking about how to organize this page, how I can include all of my inspirations. Normally I’m not a big fan of insomnia, but this has been fun. I hope you enjoy it.

Love,

Nathen