Monday night I went to bed at about 10, as usual. By midnight, I hadn’t fallen asleep, so I got up and read for an hour and a half. I went back to bed, lay there till about 3, fell asleep, woke up at 3:30. I wasn’t completely awake the whole period from 3:30 until my alarm went off at 6, but I wouldn’t say that I really slept. I dozed off a few times for a few minutes.
That was a particularly bad night. Here’s a good night:
I go to bed at 10 and fall asleep within 20 or 30 minutes. I wake up around 2 or 3 for maybe 20 minutes, and then again every hour until 5 when I wake up completely and wait impatiently for my alarm to go off at 6 so I can get out of bed. That’s a good night. Most nights are somewhere in between, maybe I wake up 2 or 3 times an hour, and I almost always wake up around 5 and don’t fall asleep again no matter how much or little sleep I got before that.
When I was young, I had night terrors, lots of recurring dreams and intense nightmares, sleepwalking, waking dreams, through my 20s, but never difficulty sleeping. Used to be, if I didn’t set an alarm I was in danger of sleeping all day. It used to be, in fact, difficult to wake up. Now even when I take a nap I wake up every few minutes.
I’m fairly certain I started having trouble sleeping a few years before my mother died, but that’s when I remember it getting bad enough that I felt like it was an “issue.” That was also when I started having difficulty reading, or concentrating on anything for more than a few minutes. Those problems have abated somewhat, though not disappeared. I can read for long periods again, but I still have a hard time with the sort of dense non-fiction that used to make up most of my reading.
I also connect this change to the 2016 election — I am without doubt more constantly anxious than I ever remember being since adolescence — but, again, the trouble sleeping started before that.
Somehow related, though I’m not sure how much or in what way, is my sleep apnea. For as long as I can remember I have from time to time woken up abruptly, feeling like I was being choked. It’s terrifying. At some point I read about sleep apnea and thought “yeah that’s exactly what I have.” I figured out that it always happened when I fell asleep on my back, so I started sleeping on my stomach. Some time later I realized that the chronic neck and shoulder pain I’d been feeling, which I’d assumed was due to playing guitar, was actually a result of sleeping on my stomach, so I started sleeping on my side. It’s not the most comfortable way to sleep, but it’s better than worrying about whether I’ll die in my sleep.
For years I felt like I was managing. Until this insomnia thing.
A year or two ago, I mentioned this problem, the insomnia and the self-diagnosed apnea, to my former G.P., and he referred me to an ear, nose, and throat doctor who sent me to the Cornell sleep center for a sleep test, which did in fact show mild obstructive sleep apnea, for which they prescribed a CPAP machine. I guess most people are familiar with those now, they’re pretty common. You sleep with a hose connected to your face through which a machine pushes air into your mouth to keep your passages open.
I had resisted the CPAP for a hundred reasons (I happen to like falling asleep with my arms around my husband, for one) but the sleeplessness was obviously untenable, so eventually I gave in. I thought, finally, I will sleep! I really thought it was going to change my life.
It was a nightmare. Not only did it not help me sleep, I couldn’t take a deep breath on my own so it made me feel like I was suffocating, and after about 3 hours of meditating, telling myself “it’s okay, you can breathe, you’re okay, just relax,” I would start to panic and rip it off. But I persisted, assuming it could take a while to get accustomed to. After two weeks it was still the same scenario every night, no sleep, no increase in the time I could tolerate the machine. I got a phone call from the vendor who leases the machine telling me I was noncompliant and my insurance company would cease paying for the machine rental if I didn’t wear it at least 4 hours a night. I sent it back. (That’s something you might not know about CPAP machines. The vendor is monitoring in real time when you go to bed, your breathing patterns, when you put on and take off the mask, when you wake up. Not your doctor, but the pharmaceutical vendor.)
My old G.P. moved away and now we have a new primary whatever they call it. (He’s a N.P., so I never know what to call him.) At my first visit, he asked if there was anything else I wanted to address so I reluctantly brought up this sleep issue. I say reluctantly because I feel a little shame about not being able to use the CPAP. I got the feeling he thought I was trying to score some oxycontin or something. I didn’t ask for sleeping pills. If I thought it would help and not just cause more problems, I’d take them in a heartbeat, but I’m a Judy Garland fan. I know where that road goes. (I think it’s a bugaboo of this nurse: a few months later he was strangely adamant about not prescribing pain meds for my broken toe, meds which I hadn’t asked for and didn’t want anyway because it didn’t hurt that bad.)
So he said, well, if the CPAP didn’t do it, then “we need to talk about sleep hygiene,” and he gave me that litany — the weight of your blanket, temperature of the room, no alcohol, turn off the TV and computer for a while before you go to bed, yada yada. I know it all, have tried it all, it has no effect.
(My apprehension about drugs notwithstanding, I was for the last few years occasionally taking Benadryl on particularly difficult nights. It seemed to help a bit. I could go from waking up a dozen times a night to waking up 4 or 5 times. But in the last few months — I think only on those nights I’ve taken Benadryl — I’ve woken up a few times feeling the beginning of a panic attack, so I stopped taking Benadryl.)
So that’s where I am. I read and work in the morning until I can’t keep my eyes open, then I take a 1/2 hour nap, which often will at least keep me awake for the rest of the day. But if I start dozing again later, I take another 1/2 hour nap. It’ s not ideal, obviously. Those half hours are disruptive and they add up. I get less done. And even with the naps, I am always tired, always sleepy, always a bit dull-headed.
As long as I can remember, my father has talked about waking up for an hour or two in the middle of the night. He says that he used to use that time productively, that he felt extra lucid and would lie in bed and solve problems that vexed him in daylight hours. (He worked as an engineer for an electronics company, so solving problems was, I think, his job.) Now, 85 and retired, he says his mind is not as clear and he doesn’t have pressing problems to solve, so those middle of the night vigils are just frustrating.