“You know I can’t sleep, I can’t stop my brain
You know it’s three weeks, I’m going insane
You know I’d give you everything I’ve got
For a little peace of mind”
From The Beatles, “I’m So Tired.” The songwriting credit says Lennon/McCartney, but you know it was mostly John. John was a man who knew a little something about insomnia. Though his was probably due to heroin withdrawals.
My insomnia, on the other hand, is due to ordinary, average anxiety. About stupid stuff. Stupid stuff that’s normally two inches tall but sprouts to giant size when I’m horizontal and the clock is ticking. Ridiculous, mundane stuff that, when I’m rested, doesn’t even faze me. Like: Did I give the dogs their flea stuff? Are there wet clothes in the washing machine? Is Bini’s soccer uniform still in the hamper? Did we pay the credit card bill? Have we checked the credit card bill for credit card fraud? Why can’t I sleep? What if Bini wakes up with a nightmare? What am I going to do with two kids that can’t sleep? Should we adopt another kid?
To people with real health concerns, like migraines or Chron’s Disease or a herniated disc, insomnia must sound like a ridiculous problem. “Can’t sleep, you say? Well, I can’t walk upright without searing pain.” The answer to my problem is simple: Calm down.
I’ve tried everything, so don’t EVEN suggest a warm bath. I see your warm bath, and I raise you warm milk with vanilla, melatonin, valerian root, chamomile tea, Cortisol Manager, Ambien, Lunesta, Deep Sleep, Super Slumber Helper, Alteril — even edible pot. That was a bad idea. What do you get when you combine an anxious person with a drug that can make you paranoid? A very late, terrifying night.
So now, I’m on Lorazepam, which is a benzodiazepine for anxiety, and Seroquel, which is an antipsychotic. Yes. I’m taking a drug (albeit a tiny dose) that is given to people with schizophrenia. Desperate times.
My insomnia comes and goes. It first started when I had a horrible job that I hated, about a dozen years ago. I wound up in Urgent Care at UCSF after a three-day no-sleep bender. The on-call doctor was very kind. I told her that I’d tried melatonin, I’d tried Tylenol PM. “That’s for amateurs,” she replied, and wrote me a prescription for Ambien.
I was so relieved to be able to sleep again that I took it, off and on, for years. Mostly off. But then, about a year ago, Ambien started to make me itch uncontrollably. I didn’t have any of the high-profile side-effects of Ambien, like sleep-driving or sleep-murder. No, my side effect was that the day after taking it, I’d want to claw my face off. Sort of like a meth addict.
I went to have a sleep study. That’s when you sleep overnight in an office building with probes all over your body and a sleep attendant watches you. All night long. Yeah, no pressure there. Of course, I had to take an Ambien — two actually — because it was difficult to sleep with probes all over my body, a CPAP in my mouth, and a sleep attendant asking me if I was OK every 20 minutes.
The sleep study showed, said the doctor who met with me, that I had restless leg syndrome. “That must not be a surprise to you,” he said. “You must have an uncontrollable urge to move your legs.”
“I think I would know if I had an uncontrollable urge to move my legs,” I said, and made an appointment somewhere else.
My new sleep doctor, Dr. William DePaso, did not think that I had restless legs. He thought that I was going to sleep before I was sleepy. And because of that, I was lying awake and working myself into a lather, which is not an ideal state for rest.
Dr. DePaso also told me that I needed to get up at the same time. Every day. Even on weekends. And to vary my bedtime depending on how sleepy I was on a given night.
“Not all of us need 8 hours of sleep,” he told me. “It’s a nice round number that they throw out in magazine articles, and it makes sleep docs crazy.” Everyone’s needs are a little different, and most people need between 6 and 9 hours of sleep per night, he said.
Another rule? “No alcohol within four hours of bedtime,” Dr. DePaso said. “We all break that rule once in awhile, but alcohol destroys sleep. The ‘nightcap myth’ is terrible.”
And for the most part, these three rules have made it possible for me to calm down and sleep OK in the last year. I had my backup prescription of Lorazepam, for those nights when my mind was going like a hamster wheel. But until August of this year, I slept OK. Then, everything went to shit.
I don’t know why, but when we were in Boston for my cousin’s wedding, I couldn’t sleep. I tried taking up to three Lorazepam — hell, I even drank Children’s Benadryl one night — and I still was a zombie. In retrospect, it could have been the jet lag. It could have been that we said no to our first referral for a little boy. Whatever it was, it’s stuck around. Over the last two months, my insomnia has been persistent, and terrible.
I went back to Dr. DePaso. He gave me the sleepytime cocktail and told me it was temporary. It doesn’t feel temporary. It feels like every night, I have to take something to get to sleep, and I don’t like that. I don’t like that I can’t just fall asleep, like I’ve done on thousands of other nights. What’s different? Why now?
Dr. DePaso warned me once about “turning my insomnia into a project.” I understand where he’s coming from, but if you’re not sleeping, night after night, it’s all you think about. It’s incredibly frustrating and very lonely. Lying there night after night, with my body resolutely refusing to do what comes naturally to 99 percent of the world is bewildering, and it’s scary. The effects of my insomnia spill over into my life in destructive ways. My fuse is shorter, my brain is duller. I feel sad, I feel anxious. So yes, my insomnia has become a project, because I refuse to live like this. And I will fix it.
I just don’t know how yet.