Wednesday, 24 April 2013

The Cure for Insomnia

For the past five years I've lived with an insomniac.

Well, someone with Delayed Sleep Phasing Syndrome, but both terms are actually irrelevant because they are both a complete figment.

I realise this will anger any insomniacs or DSPS sufferers reading this, but it is not intended as a flippant remark; it may be the key to your cure.

The person I live with has never slept well, but it was around the time he was a student that he lost his grip on sleep altogether.

After a period of increasingly poor sleep patterns - probably made worse by the student lifestyle of late nights and late starts - he started to have occasional sleepless nights that continued into his adult life becoming gradually more frequent.

Then one day he had two nights in a row of no sleep at all.

On night two he went to bed exhausted, desperate to sleep, but didn't.

This scared him.

On the third night, not wanting to risk not sleeping again, he had a drink. It knocked him out.

From this point on he started to occasionally drink before bed with the express purpose of facilitating sleep. He then found he couldn't sleep without it.

It was very worrying, buying a litre bottle of rum every week to have by the bed. Watching him go to work hungover every day.

He was also putting on weight and his general health was suffering.

He went to his doctor but they were no help. Your average GP does less than a day of training on sleep problems. The guy was just sitting there Googling and suggesting Horlicks.

So we went to an NHS sleep clinic.

They asked him some questions about his sleep patterns. His tendency towards late bed times and late wake times got him a diagnosis of Delayed Sleep Phasing Syndrome - basically a broken body clock.

The diagnosis was a relief and a burden. Finally we had something to hang it all on, but it was horribly official, he had something wrong with him and would never sleep without help.

The doctor gave him Circadian Melatonin, which worked.

He was cured!

For a while.

After a time the Melatonin - or rather the placebo effect of the Melatonin - stopped working.

We went back and were told to increase the dosage. We did. It had a limited short term effect and then, stopped working again

We went back and were told "Well in that case, this is the end of the road for you"

An incredibly clumsy and brutal thing to say to a 30 something who can't sleep for more than 3 hours a night without booze, has a lifetime of 9-5 work ahead of him and a mortgage to pay.

So off we went to a private clinic.

They asked us to complete copious questionnaires - hundreds of pages - which we brought along to the first of many £150 an hour sessions. The constant financial drain of seeking cures (and keeping a fully stocked booze cupboard) was also very stressful.

Our notes were tossed aside without being read and the doctor asked no questions. We were given a prescription for Trazodone and Clonazepam and sent on our way.

That night he slept.

Not great sleep. Drug sleep. But he slept and that was what we needed, however we could come by it.

Yes, the drugs were strong and harsh and turned him into a zombie, gave him sleep paralysis, waking nightmares, no energy during the day. But as an insomniac, as someone with Delayed Sleep Phasing, this was as good as life was going to get, right?

Well eventually these drugs stopped working for him too.

This, in addition to the fact they were making him feel awful, pushed him to take a new approach.

He bought a book called The Effortless Sleep Method and if you have a sleeping disorder I urge you to read it. It will almost certainly cure you.

The book is written by an ex-insomniac so she knows what she's talking about.

She had tried all of the things he had tried, been to the same clinics, taken the same drugs, had the same compromised life.

Don't worry, I'm not going to get all woe is me on you, our life is pretty good, there are people with much, much worse to deal with, but it's amazing how much a sleeping problem can impact everything.

He never had any energy, so I did all of the chores, cooking, gardening, DIY, driving, errands, shopping, Christmas shopping - everything.

Didn't begrudge it for a moment, but it was sometimes tough, especially if I was ever ill myself. A memorable example of this is having to go to Sainsbury's and do the grocery shopping when I had the vomiting bug.

His lack of energy also meant that we never went anywhere. After a long day at work on three hours sleep he would, naturally, want to come home and rest. Then at the weekend he would want to stay put, having spent all week forcing himself up and out of the house.

If I wanted to go out anywhere, I went with friends or more often alone.

Some of my friends have never met him and I've known him for nearly ten years.

We have separate bedrooms.

Actually, I don't mind this one. I like having my own room and spreading out in a big double bed. Studies show you get much better sleep alone. Every cloud…

Holidays. Now they were a struggle. Choreographing flight times and paying for airport hotels at both ends so that he got the maximum time in bed. Constantly seeking out foreign supermarkets to get that half bottle of whiskey or he won't sleep tonight. Oh and he slept even worse in strange beds, so they were never restful breaks, they were kind of torturous for him.

The strange bed problem also excluded going anywhere overnight back home such as a friend's wedding or to my parent's house for a visit. He couldn't afford to have a disrupted night when he was working.

And his health. He put on weight. He got shingles. He often suffered viral fatigue.

You'll notice I'm gradually moving into the past tense. That's because this book appears to have worked.

We didn't believe it would. You get very jaded after years of quackery and failed cures. But trust me, this isn’t the next placebo, this is the end of his problems.

There's a lot of advice in there but the main point is painfully simple. None of us are born without the ability to sleep. There is no such thing as insomnia - as a concrete condition that is.

Don't get me wrong, to the 'insomniac' it is very real. If you are lying awake all night every night it feels eminently real.

My friend jumped off a bridge a few years ago because of voices in his head. They were very real to him despite not being there at all in actuality.

I'm not comparing mental illness with insomnia of course but I suppose what I am saying is, things are not always as they seem.

Your mind is a powerful thing. It can create psychosomatic illnesses, it can respond to placebos, and it can certainly create a decade long sleeping disorder out of a few bad nights caused by stress.

Insomnia is not a condition, it is a symptom. Born out of a period of stress or anxiety and then maintained by the power of the mind.

You have a bad night, and another, and another and then you start to classify yourself as an insomniac, then it's a done deal. The longer it goes on the more you tell your mind, I am an insomniac, I don't sleep, this is what I do, this is what I am.

Then you get a diagnosis and that solidifies it further.

Then you take a pill and your brain gets the message that you are sick and cannot sleep without help.

This book basically teaches you to stop thinking of yourself as an insomniac and just go to sleep.

It sounds too simple but that's what sleep is to people who sleep well. Simple.

They lay there, think nothing of it and they sleep.

The 'insomniac' lays there and they think about it, they obsess over it, they worry that they're not asleep yet, they try and try, they force it when it’s not something you can force, it's not something you can 'do'.

So it doesn't happen. The opposite happens, they remain awake and aware of just how awake they are.

Then they look at the clock. Then they realise they only have four, three, two hours before the alarm. Then they panic, and who ever slept panicked?

After a while they come to fear bed time altogether. Most people skip to bed, can't wait for some nice rest.

But the 'insomniac', before they even get into bed they have an image in their head of how this is going to go down. Same as last night. I'll be tossing and turning until 3 or 4am. I know how this goes.


The other golden piece of advice is to get off the meds. In this case Trazodone and Clonazepam. Two highly addictive, super strong drugs that were given out like sweets - and with no warning - despite the horrible side effects and even worse withdrawal symptoms.

Some people need to go to rehab clinics to get free of them. Some people never get off them.

Our house was a makeshift rehab clinic for a week (update - we are now on week seven and he is still sick) It was horrible. He couldn't be left alone, he had this unspecified fear which had him sleeping in with me, if I went out on an errand someone had to come round and sit with him, his head was spinning, he was shaky, he felt sick, cold sweats, no appetite. I had to hide all of the knives because suicide was a withdrawal symptom. As was homicide.

Do not take these if you have not already started to and if you are on them, go to your GP and work out a way of reducing your dosage in a managed way so that you can get free of them.

They will damage you long term and you do not need them.

You can sleep. Everyone can sleep.

Read the book, get off the meds and sleep.


Dave said...

I'm glad that things are getting better. Lack of sleep is awful for someone and the withdrawal from the drugs sounds a nightmare!

All the best.

Anonymous said...

I have horrible horrible insomnia, I'm only a 25 year old girl...I bought that book but I just don't know how to act like I sleep when I get practically zero...I'm wondering how he did that as he seemed pretty sick at the time? Did the sleep hygiene really help? I just don't know how to go around acting like I sleep to everyone when I don't hardly at all.. Can you give me some tips about exactly what he did as far as acting loke he slept? Thank you!

Christina Martin said...

Thanks Dave!

Hi Anon
Sorry to hear you are suffering so horribly. I feel for you.
The section of the book which postulates trying to ignore the previous night's bad sleep and proceed as normal was actually something he found to be the most challenging, so don't be discouraged.
Obviously a terrible night's sleep leaves you feeling tired, low functioning and under the weather. It's pretty hard to deny.
I asked him how he followed this piece of advice and he says that he found not looking at the clock at all in the night and therefore not having a solid idea of how much sleep he had missed meant that he didn't spend the following day thinking "Oh god I only had x hours of sleep last night, how will I get through today?"
Also, because stage one sleep can feel akin to being half awake, he tried to focus on the fact that he may have slept more than he had thought, albeit badly.
Ultimately though, I think this technique is mainly intended to stop the worsening of the insomnia by focusing on it all day as well as all night. Easier said than done of course. I really hope you get there soon.
Christina x

Anonymous said...

Trazodone is not a "super strong benzo" as it is not a benzo at all but rather an anti-depressant drug.

Christina Martin said...

Hi Anonymous. Thank you for your comment that ignores what happened in my life and goes straight to the one word that needed changing in the blog. Like someone correcting a person’s grammar on Twitter, in response to a post about the death of the family cat. I don’t mind that much but just thought I should educate you back about human interaction. My old boss always used to send emails with no greeting or sign off and just one on topic line a la your comment. Everyone hated him. Don’t be that guy. Anyhoo, yes, I did indeed in haste accidentally conflate those two drug families. Clonazepam is the big bad Benzo, which is evil enough on its own, and Trazadone is part of the anti depressant family, which by no means makes it harmless. It is very addictive because it is so easy to build up a resistance to it, hence upping the dose and upping the dose as your body needs more for it to take effect, until you are up to your neck in it and all of its wonderful side effects. And then there’s the really fun part of trying to come off it, which some people never even manage. Paired with a benzo it was a disaster for us, nearly ruined our lives. So technical point noted and amended in the blog, but the larger point is rather more pressing. These drugs can be really bad for you, can take your original problem and make it a thousand times worse, and the purpose of this blog was to steer people off such meds and not end up suffering like we did.