Eyes Wide Shut: Waking Up to Insomnia
Chronic insomniac Abbey Stirling faces her nocturnal fears and gets some expert advice.
I AM hyperaroused. It’s not as exciting as it sounds. It is 4am and I’m awake, stirring, in a familiar agonising state. My heartbeat amplifies in my head, pounding against the pillow. The clock sneers smugly, the walls close in, the small hours suddenly feel immense. The sense of foreboding grows intense. Adrenalin circumnavigates my system like supernatural forces, rushing through me like a river of torment. Clearly this night will never end, and I will never sleep again.
Hyperarousal disorder is a state of extreme alertness that can snowball into insomnia, or sleeplessness. Once you’ve opened the door to insomnia you’ve opened the door to fear; fear of losing sleep, fear of the self-perpetuating sense of entrapment, even fear of fear itself. It is a perversely vicious circle. Forcing yourself to sleep is about as absurd as drinking yourself sober; the more you strive, the harder it is to achieve. The more you want sleep, the less you’ll inevitably receive. The bedroom becomes a battleground and your mind your worst enemy. Thoughts can be catastrophic, so learning to not think is key. Perhaps that’s why insomnia taunts people, like me, whose brains switch on as soon as the lights switch off; whose thoughts race until they’re ravaged.
Thirteen per cent of New Zealanders aged 20 to 59 are affected by insomnia, a condition characterised by difficulties initiating or maintaining sleep, resulting in impaired daytime function. Serious knock-on health effects include heart disease, cancer, hypertension and diabetes. GP and sleep specialist Doctor Alex Bartle says that sufferers would “love to be able to sleep but they can’t. They can’t switch off, so insomniacs are often very fatigued, but they’re not sleepy. They can’t sleep when they’re reading. They’re anxious and buzzy all the time.”
Once a super sound sleeper, I have endured intermittent insomnia for the past 18 months for no discernible reason. I can take pleasure in weeks of peaceful slumber, only for the fear to suddenly reappear. At worst I get two to three hours per night; sometimes none at all. This pattern can go on for days, weeks even. I have popped pills and resorted to all sorts of (bizarre) desperate measures, some of which have had a fleeting effect – until the nights loom menacing and the days blur into a delirious haze, and it’s me and my wired mind again.
Maurice Gough, 58, has been an insomniac since he can remember. He estimates he gets three to four hours’ sleep per night. “I remember my parents describing me as being a nervy person from early on. It’s not being able to wind down. I’ve always been like that I suppose, a bit obsessive about things to some degree, a bit of a perfectionist, so I keep thinking about things when I should actually just be switching off. I don’t seem to have that off switch that some people have.”
Research has shown that 37 percent of New Zealanders rarely or never get enough sleep and 46 percent rarely or never wake refreshed. Doctor Michael Hlavac, a respiratory and sleep physician at Cansleep and the clinical director of Sleep Services at Christchurch Hospital, says suicide rates are higher in those with insomnia, and their quality of life is substantially lower. “These people really are quite debilitated. They have high levels of stress hormone, and whether that’s a response to not sleeping well or whether that might be one of the reasons why they don’t sleep well, the stress hormone tends to increase your alertness and your arousal and prevents you from drifting off. And if you don’t sleep well you get more stressed, and the more stressed you are the harder it is to fall asleep.”
There’s a fine line between insomnia and insanity. Depression, anxiety and psychiatric illnesses can mimic – and certainly cause – insomnia, and its persistence may increase the likelihood of developing a mental health disorder. Modern life‘s ‘I’ll sleep when I’m dead’ mentality can drive us to burnout. Medical conditions can be masked by pills and prescriptions. We are bombarded with advice on how to eat right, exercise right, dress right and have sex right but never, it seems, how to sleep right. “A hundred years ago people slept two hours more a day than they do now on average,” says Doctor Hlavac. “So we get less sleep and I think that we sacrifice our sleep for other things and prioritise it lower down than we should.”
The biggest culprits are laptops and TVs which emit artificial light, reducing melatonin levels – the body’s sleep hormone – thus disrupting our 24-hour rhythm. “Anything that shines light into your eyes will tend to mess with your melatonin levels,” says Hlavac. “Melatonin goes up when we sleep and drops away as we wake up. Anything that lowers melatonin is going to falsely tell the body it needs to stay awake. So computers are particularly bad at that.”
Carol, 64, has suffered from insomnia for 35 years and sleeps, on average, four hours per night. “I used to be really frightened of it because I used to feel so dreadful. I used to teach and it’s a nightmare to have to go to a classroom full of children after you’ve been awake most of the night. [Insomnia] makes me angry, more than anything, and sometimes I sort of feel despair when I’m up thinking ‘oh my god I wish I was asleep. The rest of the world is asleep’.”
So how do experts recommend getting quality kip? It’s not just about curbing your caffeine intake, it‘s about silencing those internal broadcasts by stimulus control: increasing the association between bed and sleep while decreasing the association between bed and anxiety.
First: get rid of the clock, says Bartle. “You need it out of reach and out of sight. It’s fraught with anxiety. It just reinforces this whole idea that you’re not sleeping well.” Anxiety is adrenalin; adrenalin is our fight or flight – neither of which we want to do in bed. Instead, relax with abdominal breathing. If you find after 20 minutes that you can’t sleep remove yourself and your anxiety from the bedroom. Go into a warm, dimly lit space, write down your thoughts on paper or do something low stimulus like a puzzle or light reading. After 15 minutes head back to bed, and repeat as often as you need to.
“It’s retraining this mid-brain that when you go to bed, you put your head down and go to sleep. And it does take perseverance.”
Insomnia is riddled with fear, and overcoming it is about having faith that you can fall asleep as soon as you hit the hay. Lose confidence in sleep and you lose confidence in yourself, and so the negative conditioning spirals. For me, insomnia’s a mind game of mammoth proportions; it feels like my brain and body are conspiring against me, sending my inner dialogue into overdrive. Conquering it is about closing the door to fear by changing behavioral patterns, diminishing hyperarousal and nervous tension.
So seek natural light during the day, and lighten the mental load at night. Unwind. Don’t fret. And most of all: don’t fight. Fight insomnia and you’re sure to fail. Embrace sleep, however, and you’ll surely succeed.
First published in Sunday Magazine, Sunday Star Times, New Zealand, June 2012.
© Abbey Stirling