At War With Insomnia

      The other morning, it was 2:50 a.m. The night before that, 3:35. One time last week, didn’t make it past 2. Last night, gratefully made it all the way to almost 4 a.m. before, of course, waking up.

      I have insomnia, and, you know, I am not alone.

      Up to 60 percent of people our age have some symptoms of insomnia. That could manifest itself by more than occasionally not being able to fall asleep or not being able to stay asleep or just waking too early. Almost a third of us get less sleep than is recommended. Around a quarter of us have enough symptoms, or a sufficient frequency of symptoms or severe enough symptoms, to meet the criteria for the chronic condition of insomnia disorder.

      Like many of us, it was not always that way for me. I used to be a world-class sleeper. In my twenties and thirties, I’d stay out late, go to bed at two or three in the morning and then—if I didn’t have obligations—sleep through to the middle of the next afternoon.

      But all that has changed.

      Some thirty or so years ago, I started developing sleep problems. Sometimes it was not being able to fall asleep; just too much going on in my head. Most of the time, though, it was not being able to stay asleep. I’d wake up too early, sometimes in the middle of the night, and be wide-eyed although I hadn’t had nearly enough rest.

      Then, naturally, I’d be tired during the day. But I’d push through all the yawning because, well, I had to and I was younger and I could.

      As I’ve aged, the problems have gotten worse, and that, too, is not unusual. The prevalence of sleep problems rises with age for a number of reasons.

      We generally have less daytime physical activity or exposure to sunlight, and the lack of both can weaken what are called sleep cues. Retirement and irregular schedules also can reduce the body’s drive for consolidated nighttime sleep. Our internal clock, that damn circadian rhythm, has shifted, so we get sleepy earlier—anyone for the early bird special?—and wake up earlier. And since we spend less time in deep sleep and more time in lighter stages, we tend to wake up more easily during the night.

      Plus, many of us have chronic conditions—arthritis, heart disease, diabetes or prostate problems—that can cause pain or the need for getting up from bed at an ungodly hour to go pee.  

      Then, finally, of course, many of the common medications we take—for lowering our blood pressure, or for asthma, depression, what have you—can interfere with sleep. And anxiety, depression, and loneliness—more frequent in later life—can all disrupt sleep.

      I have tried to deal with my insomnia problem in a number of ways.

      I began more strictly following all the dictums of good sleep hygiene:

·       No late-night alcohol or caffeine;

·       Going to bed and waking up the same time each day, even on weekends;

·       No looking at screens (TV, phone, laptop) at least 30 minutes before bed;

·       Having a cool, quiet, dark bedroom;

·       Doing something calming and restful, like reading, before bed.

      And all the other incredibly obvious stuff. 

      The result? Maybe some improvement, but not much better.

      I tried meditation. I practiced mindfulness and learned muscle relaxation techniques, such as progressive attention on different body parts. I breathed deeply and focused on the breath, only paying attention to the breath.  

      Some help, but not better enough.

      Eventually, I tried CBT-I, cognitive behavioral therapy for insomnia, a multi-month online course with a licensed therapist. It is an evidence-based treatment that focuses on changing thoughts and behaviors that contribute to sleep problems. It focuses on sleep restriction, gradually reducing the time spent in bed to match actual sleep duration. It is designed to identify and challenge negative thoughts and beliefs about sleep, such as "I'll never fall asleep" or "I'm a terrible sleeper." 

      It worked OK, some significant improvement—for a time.

      Finally, I tried medication. Although I hate taking pills, I hated not sleeping enough more than that. I knew there was a risk to taking the pills—particularly the risk of dementia if you’re older—but I was also aware that lack of sleep can contribute to the onset of dementia and can lead to generally poor physical health, chronic health conditions and memory or mobility problems.

      So, after all these interventions, where am I?

      I have some good nights, or at least some acceptable nights, where I’ve gotten my six and a half hours or so and feel generally OK. But like many of us, I guess, I still have my bad nights, the nights where I’ve done everything right, taken the pills, focused on the breath, not looked at a screen—and I still wake up after an insufficient four or five hours of sleep. That is, after not enough sleep.

      I tell myself the next night will be better. It only occasionally is.