A couple of years ago during a routine checkup, I told my internist I’d been having trouble sleeping for quite some time — at least a year. He nodded with a sympathetic smile and said, “Get used to it.”
He explained that for many women, the combination of aging and the hormonal shifts that come with menopause is a killer cocktail for getting proper rest. Some women have a hard time falling asleep, others struggle with staying asleep and some lucky ducks, like me, wrestle with both.
My doctor prescribed sleep meds and suggested supplements, all of which I’ve dutifully tried. Ambien worked fairly well but made me feel sad the next day. Lunesta made my mouth taste like nickels. Trazodone made my heart race and my head spin. For me, Duane Reade over-the-counter sleep tabs work just as well as the prescription meds, but they result in a pretty dense fog the morning after. And even as the shelf in my medicine cabinet gets more and more crowded with drugs, still I never get a true good night’s sleep.
On my best nights, I cobble together about five hours of zzzs, though they are never in a row. On my worst nights, which far outweigh the better ones, I sleep three to four hours in total, and then I’m often awake in the middle of the night for up to two hours at a clip. And no matter what time I finally drift off, my latest weekday wake-up time is 7:00 a.m., when my husband’s alarm goes off and my dog comes sniffing around for her morning walk.
I know I’m not alone. Sleeplessness is epidemic according to the media, with up to 22% of Americans coping with chronic insomnia that occurs at least three nights a week and lasts more than a month. As for anecdotal evidence, just last month over dinner with my girlfriends, each of us bemoaned our insomnia-fueled fatigue and scattered-ness. “I never sleep,” said Deb, the mother of two young sons who also works a long day bookended by a crappy commute. “Haven’t slept in years,” chimed in Diane, who runs a stressful family business and cares for her frail mother.
This conversation was prompted when I shared the news that I had just visited the Center for Sleep Medicine at New York-Presbyterian/Weill Cornell Medical Center. I filled out an extensive questionnaire about my health history and my eating, drinking, exercise and sleep habits. Then I met with the co-director, a kindly, sixty-something clinical psychologist and we talked for the better part of an hour. His diagnosis: “There is nothing physically wrong with you. You are simply hyper-aroused.”
That term sounds like it should be a lot more fun than it is. But in fact, hyperarousal (or psychophysiologic insomnia) is what lies at the heart of much sleeplessness, according to researchers who believe insomnia to be a state of 24-hour hyperarousal brought on by the interplay between psychological and physiological factors.
Here’s the deal: For normal snoozers, sleep is involuntary and automatic. But for people like me, sleep is anything but automatic. And the more we try to engage in voluntary sleep, the more we impede the natural process and maintain a state of arousal. In other words, we worry so much about not sleeping, we can’t sleep.
The doctor said that my sleep pattern has gone off the rails and that we needed to right this train. The recommended course of action: a combo platter of cognitive behavioral techniques designed to decrease the amount of time I spend in bed not sleeping, and increase the amount and quality of the sleep I get when my body is ready for it.
My five-point sleep strategy (for the next month, at least):
1. Ditch the Drinks and Drugs: I’ve bid adieu to my meds, along with my nightly glass(es) of wine and my weekend cocktails. (Caffeine’s a no-no too, but I’m not a coffee drinker so not an issue for me.)
2. Stay Up: I must stay awake and out of bed until midnight no matter how tired I am, and set my alarm for a 6:00 a.m., must-get-out-of-bed wake up, even if I was dead asleep when the buzzer went off.
3. Journal My Worries: I am supposed to write in a two-column chart every night — on the left side I list my worries and on the right, a few words about how I can deal with them, so I can put ’em “to bed” for the night.
4. Breathe: I practice a deep breathing technique designed to put the focus on my breath rather than on the fact that I’m (still) awake.
5. Record and Repeat: Every morning, I record my data in a sleep diary, noting when I got into bed the night before, the approximate time I fell asleep, when I woke during the night and when I got out of bed the next morning.
I’ve also been extra diligent about sleep hygiene, making sure the bedroom is dark and quiet, and eschewing stimulating activities before bed (like watching Breaking Bad or playing Words with Friends on my iPhone). At the one-month mark, the doctor will fine-tune the schedule, hopefully giving me an earlier bedtime and later wake-up call.
Today is day 19. Ditching the drinks has been tough and so has staying up late. I cop to a beer here and there (does beer really count as alcohol?) and to sometimes skipping the worry chart. Ask me if the program is working and my quick response is, “Hard to say.” But when I look at my sleep diary, I’ve made definite progress. Over the course of week two, I got four more hours of sleep than usual, and it took 100 less minutes for me to fall asleep overall. Last night (and the night before), it took me 15 minutes to fall asleep and I slept more than five hours.
Can I trust the changes? Could it really be this simple? It’s too soon to tell, but I share this experience because I know how many women suffer from the anxiety, fatigue and mental exhaustion that come from insomnia. My friend, Rachel, a lifelong insomniac and sleeping pill aficionado, took a similar cognitive behavioral approach last summer and reports sleeping six hours a night now, no meds. (I would consider that a home run.) If it worked for her and if it works for me, maybe it can work for you.
Stay tuned for updates.