Posting may be lighter during the next several weeks as I struggle to overcome a case of chronic insomnia (or “semi-chronic insomnia”) that started a couple of months ago but has been exacerbated (as is intended) by therapy. I’m not looking for sympathy here—insomnia isn’t nearly as bad as many maladies—but I’m trying to explain why posting may decline in frequency and in quality for a while. (It’s hard to think and write on four hours of sleep per night.)
Backstory: I’ve had bouts of insomnia twice in my life, both associated with stress. One was at the University of Maryland when I began my first job and was anxious to make good. The stress took the form of me being unable to get to sleep. I went to a doctor who prescribed a change in behavior. “If you can’t get to sleep,” he told me, “Get out of bed and do pushups until you’re worn out with them. Then get back into bed. Repeat every 20 minutes until you sleep.”
I suppose the idea was that I would get so revolted by having to do pushups that my body would force me to sleep.
It didn’t work: I was still an insomniac, but with an impressive set of triceps. Eventually the insomnia went away. It turns out, though, that getting out of bed if you can’t sleep is the basis for the kind of therapy I’m trying now, called CBT-I, or “cognitive behavioral therapy for insomnia.” Everyone says that it has a high success rate (about 70%), and it doesn’t involve drugs, which I don’t like to take. (My doc and I have tried to find a good sleep doctor who knows about medication for sleep, but so far without success. And I don’t know if those drugs would be efficacious—some of them have the side effect of making you get fatter!)
My current sleep issues began about two or three months ago. The issue this time was not getting to sleep, as I always dozed off within ten minutes of turning off the lights, but waking up early in the morning and trying, unsuccessfully, to get back to sleep. Sometimes I’d wake up at 1:00 a.m. and and struggle for hours to get back to sleep. (I’m told that many people had sleep disruption during the pandemic.)
I pushed my bedtime back farther and farther, until 8:30 p.m. (which of course puts a crimp in your social life), but all that meant is that I’d wake up even earlier. I was getting about 5-6 hours of sleep per night, and I know from experience that I need at least 6.5 hours to function decently and 7-8 to be in top form. (And you supposedly need more sleep as you get older.)
As for the cause of this bout of insomnia, I have no idea. I’m not particularly stressed over anything, though when I (and many people) wake up in the middle of the night, worries and dark thoughts sometimes run through the head. Eventually I trained myself to dispel this midnight anxiety by simply pushing the thoughts out of my head. But that didn’t help my sleep, either. I’d lie in bed awake thinking of nothing in particular, the hours would turtle by, and eventually I’d give up and get up for the day.
Finally, my doctor referred me to a psychologist who specialized in CBT-I, a method you can read about here. I’m told that the regimen will take 5-7 weeks, though it could be longer or shorter, and the rate of
“clinically significant improvement” in sleep (I’m not sure what that means) is about 70%. Right now I’m starting with “sleep restriction”, which is BRUTAL. Here’s what the link says about it:
This method sets strict limits on the time you spend in bed. The initial limit used is the same as the amount of sleep you tend to get on a nightly basis. For example, you may only get five hours of sleep even though you spend seven hours in bed at night. Two hours in bed are spent trying to fall asleep or go back to sleep after waking up. In this case, your initial limit would be set so that you spend only five hours in bed at night. This means that you are likely to get less than five hours of sleep.
This sleep loss will make you even more tired at first. However, it will also help you fall asleep faster and wake up fewer times in the night. This will allow a solid period of sleep and a more stable sleep pattern. As your sleep improves, the limit on your time in bed is slowly increased. The goal is to reach the point where you get the amount of sleep you need without reducing the quality of your sleep.
For two weeks I kept a sleep log, recording bedtimes, waking-up times in the night (you can’t look at a clock, so you have to estimate), and what time I finally get out of bed, as well as how I feel the next day and whether I napped the previous day. Under the regimen above, NO NAPS ARE ALLOWED! That’s the toughest part—aside from feeling half-dead. Oh, and I need to exercise regularly as part of “sleep hygiene.” I’m taking very fast walks for several hours each week, but it’s not easy when you’re dopey.
From the sleep log, the psychologist determined that I was getting about six hours of sleep per night, including naps. Ergo, the prescription: go to bed at 8:30 and get up for the day at, yes, 2:30 a.m. If you wake up in the night and can’t get back to sleep in 20 minutes, go into another room and read a book for five minutes. Then go back to bed. Lather, rinse, and repeat. If you don’t get to sleep doing this, you still have to get up at 2:30 a.m.
Oh, and you aren’t supposed to be in bed for any purpose other than sleeping. That’s tough for me, as I always read in bed, write a lot of this site in bed, and am often horizontal when I’m home, even when awake. Now I don’t go near the bedroom until it’s time to sack out for the night.
You may have wondered how I know when it’s 2:30 if I’m not allowed to look at a watch or clock. I set my phone with an alarm. I’ve always hated alarms, and never used them since I always woke up at the same time. They’re intrusive!
They weren’t kidding when they used the phrase above: “this sleep loss will make you even more tired at first”. The first day I got about 4 hours of sleep. And getting up at 2:30 a.m. is no picnic, let me tell you. There’s nothing on t.v., so I read or simply go to work. The second night I was so tired that I almost passed out, and slept the entire 6 hours without awakening. That was very encouraging, but last night was another 4-hour rest again. I’m not sure how long I can keep this up, but I’m determined to follow the regimen because it’s been shown to have a high success rate.
Well, all that is by way of explanation, but I also find the experience interesting though debilitating. But I know that lack of sleep can injure your health, so I’m worried about that, too. The upshot is that trying to work or think or write often seem like insuperable tasks when you’re this tired, but I’m soldiering on.
Again, I’m not writing this to solicit pity (or prayers!), but to explain what’s going on. I’ve found that just writing this down made me feel better—though not less tired.
Readers may wish to weigh in with their own tales of insomnia. (Please don’t prescribe things for me to do or swallow, though, as I want to stick with the plan we’ve settled on.) The disorder is said to be quite common.