Managing Insomnia

Is there a simple answer?

Photography: cottonbro studio

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It’s 3:17am. I have insomnia. It’s terminal. That’s usually a dramatic word in healthcare but it doesn’t mean I’m going to die from lack of sleep. Terminal insomnia is simply when you wake up too early, before the end of your sleep cycle. There are several types of insomnia and myriad ways to address them. I’ve had sleep issues since puberty and tried everything under the sun, so if you’re reading this at three a.m. you might benefit from my experience on this matter.

Sleep onset insomnia is the most common type of sleep disorder. This means you have trouble falling asleep; tossing and turning; mind racing or obsessing; exhausted but not sleepy. The Sleep Foundation says you’re experiencing sleep onset insomnia if you can’t fall asleep within thirty minutes of lying down. This is commonly treated with supplements and medications, which we’ll get to shortly. I’ve had sleep onset insomnia most of my life; this waking up early thing is new.

Sleep maintenance insomnia is when you wake up at least once in the middle of the night for a minimum of twenty minutes, but ARE able to fall back asleep. Some people feel the effects of waking up at night just from getting out of bed to use the bathroom so this type of insomnia disrupts sleep quality more than quantity. It’s rarely addressed at all because they still get a healthy amount of sleep and, except in extreme cases, find it mildly aggravating rather than troublesome.

I’ve already mentioned terminal insomnia. It often leads to a cycle of going to bed too early to compensate for the lack of sleep, which of course means waking up even earlier the next day. This is completely different from sleep onset insomnia and can only really be treated with sleep deprivation. Any combination of the three is considered mixed insomnia and there’s also comorbid insomnia, a designation for insomnia associated with physical and mental disorders. For instance, my insomnia when I’m manic is comorbid: caused by a bipolar episode. If you can’t sleep because of heartburn you’re experiencing comorbid insomnia.

The Sleep Foundation defines all of this if you want to check out the link but their recommendations for “sleep hygiene” are the usual. No blue light for an hour before bed. No checking your phone. No caffeine after noon. No alcohol in the evening. Get out of bed if you can’t sleep after thirty minutes. Have a relaxing routine. Bath. White noise. Blackout curtains. Read a book. Herbal tea. None of that ever made a difference for me. I know. I tried.

I experimented on myself, keeping a detailed log: what I did, what I ate, if I drank alcohol or caffeine that day, whether it was a weekday or weekend, my mood, how long I slept, what time I fell asleep, how many times I woke up, whether or not I was watching tv before bed and what the program was and for how long. When I put the data on a scatterplot it looked like a Jackson Pollock. Zero correlation to sleep quality or quantity. It didn’t matter if I read cozy YA fiction in the tub while drinking Kava and valerian root tea before bed or watched Ninja Assassin drunk and passed out on the couch. No amount of “sleep hygiene” helped (or hurt).

I was encouraged to meditate to manage my insomnia. Meditation is particularly complicated for me because of my psychosis. I can’t clear my mind. I create entire universes of detail; scent; taste; depth; lush and vivid as a movie. My thoughts hyperfocus. The simple color meditation is like going on a ride at a theme park in my mind— a thousand times stronger than my desire to sit in stillness or whatever. It’s an impossible task for me and my brain responds with the exact opposite of meditation. “Think about a forest.” Okay I’m in the Suicide Forest in Japan surrounded by dead bodies, which I can smell, and it’s comforting. Not great for someone like me. My unguided thoughts are even darker.

Then I was introduced to Feldenkrais in college. It’s the act of mindfully breaking down large movements into their smallest components to re-wire your brain to remember the most effective way to perform said action. This focuses my mind enough to avoid traipsing off into my imagination. Mostly I do my hands, opening and closing them as slowly as possible. Then slower. Then smaller and smaller movements until I can feel the gaps in the habitual gesture and grease them with attention and gentle correction. This is extremely relaxing but does not help me sleep. Same with progressive muscle relaxation where you tense and relax body parts in a certain order. They’re both pleasant ways to pass the time when I’m trying to sleep but do they help achieve it? Rarely.

When I was in my twenties, my doctors stamped out my insomnia with a MASSIVE dose of Trazodone every night. (It would be considered unethical to prescribe that much nowadays.) It was less like sleep and more like blacking out but I got eight refreshing, blissful, uninterrupted hours of dreamless sleep every night for ten years. One night I needed to stay up late to finish a project for work so I skipped it. When I took it as directed the next night, I had a toxic reaction that put me in the hospital with serotonin poisoning. It was very sad to lose my Trazodone because, for the next seven years, I barely slept at all.

I tried homeopathic remedies. Kava kava. Valerian root. Lavender oil. CBD tinctures. THC. (If marijuana is legal in your state and you try it for your insomnia be sure to get an indica strain and avoid sativa.) Melatonin did nothing. I guess they were pretty good-tasting gummies but that’s all they were worth; empty calories with no effect. The only natural remedy that actually put me to sleep was weed but it wasn’t good quality sleep. My brain wasn’t sober enough to properly process the day and I woke up tired. I’d also get the munchies and sleep-eat.

Speaking of sleep-eating: Let’s talk about medication. When I could no longer take Trazodone, my doctors threw every other prescription at me. I gained fifty pounds on Belsomra from my unconscious forays into the pantry. I lost most of the weight after switching to Lunesta (the one with the cutesy little butterfly commercial) which made everything taste like metal and stopped me from eating anything at all— even during the day. Another switch and I packed on thirty more pounds from raiding the refrigerator with my eyes closed on Restoril. Xanax, Valium, and Klonopin only dulled my thoughts; they didn’t make me tired but their side-effects were less severe.

When they prescribed Ambien I started sleep walking. I’d wake up fully clothed in the shower, putting shampoo in my hair but no water running. ‘Come to’ in front of the stove with the burner on under an empty pot. Find myself sleeping on the hardwood floor of the guest room in the morning. When discovered that I’d torn out six pages of my favorite Michio Kaku book and neatly arranged them on the coffee table, I’d had enough. No more sleeping pills.

I repeated my original experiment with updated advice but none of it helped. My results were posted every day on social media to help myself keep track and my cousin noticed. When I gave up and opined about being an insomniac for the rest of my life, she had an idea. Without any reason other than kindness, she sent me a weighted blanket because there were rumors those helped.

It worked like magic. From that first night unto this day, I fall asleep in under twenty minutes every night. It’s like being under the heavy quilts at my grandmother’s house as a child. That blanket is more effective than any prescription medication I’ve ever taken with the exception of Trazodone, which is no longer prescribed for sleep and somehow classified as an antidepressant now. I’m so used to going to sleep at the same time every night that I usually don’t have trouble sleeping without it when I travel; it helped me establish an internal clock. Sometimes I lie under it just to de-stress for a few minutes during the day. It’s exactly the right amount of pressure to soothe.

Now I buy weighted blankets as gifts— the glass-bead breathable ones so that they don’t get hot. Any time a friend says they’re struggling with sleep I immediately order one for them. So far, they’ve all raved about how much of a difference it makes. One by one, I’m converting people away from the Ambien zombie cult to the Order of the Weighted Blanket. Safe. Simple. Natural. No side-effects. Not cheap but it’s a one-time purchase you don’t have to refill. And if worse comes to worse and it doesn’t work for you: you have a really comfy new blanket.

Unfortunately it does nothing for my terminal insomnia. I fall asleep quickly between 10:30-11:00pm under what feels like being gently embraced from every angle. At 3:00am, my eyelids snap open and I’m fully awake. Bright-eyed and bushy-tailed and ready to take on the day… but the rest of the city is asleep. I fight to wait until 10:30pm to sleep. I force myself to stay awake by watching noisy action movies because I’m too sleepy to focus on an Oscar winner. I’m definitely not coherent enough to write like I am now, mid-morning. It takes discipline for me not to just pass out after dinner because maybe then I’d get in seven hours before waking up at three.

I can’t drink caffeine. At all. Ever. Covid made me allergic to it and even weak black tea makes me projectile vomit within minutes of ingesting it. (Anecdotal side note: My anxiety significantly abated immediately after I could no longer drink caffeine.) I usually have two gin rickeys right after I get home from work but never more or later. Depending on your time zone you might have noticed that I’m rarely online in the evening around bedtime. I still practice “sleep hygiene” because I think it’s important to have a routine and my mental health is directly affected by the quantity and quality of sleep I get.

It’s unclear why I wake up at three a.m. and I haven’t found a solution to it yet, but at least I’m not awake until that time with sleep onset insomnia. I’d much rather have the waking-up-too-early type than the not-being-able-to-fall-asleep type. No question. The sleep I do get is high-quality and it’s actually somewhat pleasant to spend the early hours of the morning reading in the still silence, or lounging in the bath listening to music, or snuggling with my dogs in the guest bed so I don’t wake up my husband. There’s something private about that time of day. Maybe that’s the problem: it’s reinforcing. For now I’ll be happy that I don’t spend hours attempting to find the ‘perfect’ position and desperately trying to stop my racing thoughts every night on my way to dreamland. I just always seem to leave the party early.

If you have issues with insomnia you should definitely evaluate your sleep schedule and daily routine to determine if there are any contributing factors. Practice “sleep hygiene” and all that— apparently it helps most people to do those simple things. But if your sleep has not improved after cutting out every other possible determining factor, your insomnia is serious and merits treatment.

I am not a medical professional and you should consult your doctor about issues concerning your sleep habits.

That being said: when meditation doesn’t help, before you try the tea, and the supplements, and the medications… maybe buy yourself a weighted blanket and just see if it works. I receive no compensation from Big Blanket for this recommendation; it is given in earnest. There’s zero risk of harm— simply go by the weight charts so you don’t feel stifled. It’s the only thing that has consistently worked for me (sometimes with a Feldenkrais or PMR boost) and I encourage you to give it a try before you turn to something more invasive.

Good night.
Sleep tight.
Don’t let the Zipperump-a-zoos bite.

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