Op-Ed
Tue, 05/30/2006
To sleep, or not to sleep
By Sharon E. Best
Loyal readers of the Herald might remember that I wrote an article last year that described my bout with liver disease and obesity. I hired a personal trainer, lost 60 pounds (all of which are still gone) and changed my life by incorporating healthy eating and regular exercise.
Well, I thought all that exercise would help insomnia, another problem I've had for around 15 years. It didn't. For years, I've been waking up many times during the night with power surges. (Ladies of a certain age, you know what I'm talking about!) After waking up, I've had trouble getting back to sleep. Some people with insomnia have trouble getting to sleep in the first place; while others, like me, can't get back to sleep after waking up. Whatever happened to my youth? In those days, I fell asleep before my head hit the pillow and stayed asleep until pried out of bed by the sound of some obnoxious alarm clock.
It has been agonizing to wake up in the middle of the night and be bombarded by my own thoughts, thousands of seemingly random thoughts, going off like explosions for hours at a time. I was totally out of control and it's been hard for a control freak, like myself, to accept that I haven't been able to control my own mind. My answer to this problem has been to redirect my mind by turning the TV on and watching mindless drivel (or sometimes interesting things) in the middle of the night until I get tired enough to fall back asleep. I've spent a lot of time in bed, but not so much time asleep.
The advertising drumbeat for Ambien CR and Lunesta caught my attention and I went to my doctor begging for a prescription. Life would be perfect, I thought, if I could take a pill and sleep for eight straight hours, waking up rested, refreshed and eager for another great day! The doctor was a little less eager to prescribe the cure. She advised me that, despite the advertising, there was little knowledge about the long-term effects of these drugs. She did give me a trial prescription, but strongly advised me to go to the Virginia Mason Sleep Disorders Clinic to see if there was an underlying problem that could be corrected rather than masked.
I did that. I went to a nice young doctor who looked down my throat and saw no obvious sagging tissue that could obstruct the airway. I even went to their overnight sleep clinic and got electrodes pasted everywhere on my head and body that they would fit. I was really wired that night! This sleep test is designed to discover physical problems that may lead to insomnia, such as sleep apnea, restless leg syndrome, positional snoring, etc. While I discovered that I roll to my right all night long in a never ending "alligator roll," the test results revealed no major physical causes for my insomnia.
Well, if the problem is not physical, what could it be? Psychological? Not me! Well...ok...maybe me. I decided to participate in a group "class" consisting of six weekly sessions with 10 other insomniacs. I was very skeptical at first. Was I being lumped together with a bunch of kooks? I discovered they were 10 very normal people. We were lawyers, researchers, professors, homemakers, historians, business people and retirees. The ages ranged from late 30's to late 50's. Most had had insomnia for over 15 years and most were taking one or more prescription drugs for insomnia and wanted to lesson or eliminate their reliance on these drugs.
The education on insomnia and the available treatments was enlightening. The interaction among the group was excellent. The doctor who led the sessions was invariably gentle and highly complimentary of insomniacs in general. (He said we make great employees because we're always thinking about work!) There was absolutely no inherent criticism of the condition. One usually struggles with insomnia alone, so it was comforting to know that other otherwise normal people were in the same boat. It was also good to know that others were trying each new thing that was introduced and to hear how well (or poorly) they had fared.
One technique that worked well for me, but not everyone, was to shock our systems by severely restricting the amount of sleep we got. We limited the amount of time in bed to the time we estimated we actually slept. For me, that was 6 hours of my 10 hours in bed. Staying up until 1 a.m. then getting up at 7 a.m., with no naps, was really hard and very exhausting.
Another rule was to get out of bed if you were awake more than 15 minutes and do something else until you tired. I ended up with 4 hours of sleep several nights in a row. It was really really hard to put that all together for an entire week. I felt exhausted, just like "finals week" in college when I crammed an entire semester of reading into one week!
At one point, I fell asleep in the insomnia class, a Gary Larson cartoon moment. But, the sleep restriction worked and I ended up sleeping through the night without waking up. Gradually I extended the time in bed by 15 minutes each night until I could sleep a full 8-plus hours each night.
We also worked on stress management, often a significant issue with insomniacs. Not surprisingly, insomniacs tend to be Type A, driven people, unable to turn off at night. The many thoughts that surface at night reflect life's major and minor stresses: "Am I a good mother/father? Can I get that important job done on time? Should I let my child have a cell phone? Am I going to get fired? I hope I didn't offend Elizabeth last night! What color shoes should I wear tomorrow? Do I have enough savings to retire? Did I leave the oven on?"
How well or poorly you can turn those thoughts off at night governs your ability to sleep.
During the class, we discussed several techniques for stress management, including deep breathing, meditation and yoga. The stress management technique that worked the best for me was to set aside a certain time to "worry" every day and invite all the concerns of the day to enter in and swirl around. Every night at 9 p.m., I worry (think) about whatever it is that's on my mind but I supplement my worry time with a moment to savor the many wonderful things in my life so that I can end my "worry" time on a high note.
Between modifying the time spent in bed and deliberately addressing the stresses in my life, I can happily report a significant improvement in my sleep pattern. Now, even if I wake up, I am usually able to get back to sleep fairly quickly without medication of any sort. Six weeks is an amazingly short time to fundamentally change a 15-year pattern. I now smile at the drug companies' TV spots because I am beating this chronic condition without drugs.
My strongest recommendation for others is to seek help with an open mind and a willingness to really try the recommended techniques to find out which might work for you. Wishing you all sweet dreams!
Sharon E. Best is a West Seattle attorney and can be reached via wseditor@robinsonnews.com