*Thanks to TMM for writing the following guest post about her experiences with sleep issues. Her advice is invaluable!*
Thank you for the opportunity to help someone who is experiencing sleep issues. Since I tend to give too much information, here is a synopsis of the text:
The number one piece of advice I can give to anyone beginning to suffer sleep issues is to give themselves a break. Take time off work, or cut back on a busy schedule. In other words, reduce the pressure to be "up and at 'em" in the morning that causes us to worry about getting enough sleep. Knowing that if you don't get a good night's sleep tonite, you'll have time the next day to snooze or rest will help you relax a bit about the problems you're having. That was one thing I did wrong - I kept trying to make it to work every day, despite my lack of sleep and the pain and fatigue I was feeling. And I failed miserably at making it to work, which only made me feel worse about myself and put more pressure on me to find a way to sleep.
And that's the number two piece of advice I would give: start dealing with the anxiety about not being able to sleep right now, because once that downward spiral starts, it's really hard to spiral back up. First we can't sleep, for whatever reason. Then we can't sleep because we're worried at bedtime about getting enough sleep. Nicole: Help her get to a place in her mind where she knows that no matter how poorly she sleeps, there will be a way to compensate for it the next day that will bring her back to an even keel. For me, it was taking a nap a few hours after a got up in the a.m. It was like starting the day over again, only this time more refreshed. And the knowledge that I could take that nap helped me relax about the rough night I was experiencing. Also, I developed a bit of a cavalier attitude toward my sleeping pills. For me, they were a failsafe. I would tell myself that if I wasn't asleep by a certain time, I would take sleeping pills. And just knowing that option was available helped me relax and sleep.
Some sleep experts will tell you not to nap, because then you won't be tired at night. And for some cases that's true. But for me, I found that I simply needed more rest than an 8-hour sleep, especially when I was dealing with pain. If you were in the hospital recovering from surgery, they would encourage you to nap. Well, you're recovering from insomnia and pain issues. You may need the extra rest. This ties back into giving yourself a break. The other day the therapist I am seeing reminded me that I am indeed in distress, and in need of help, no matter how guilty I feel about not being at work every day right now.
Here is something I discovered about myself when I first started dealing with sleep issues: I had negative associations in my mind about going to bed. I hate being cold, and in my old house my bedroom is very cold. So I associated going to bed with being freezing cold, and got stressed about being in my bedroom. Hard to sleep when you're stressed while trying to go to sleep. I bought myself an electric fireplace and some flannel blankets. I warm my room up for 30 minutes before I go to bed. It's like sleeping in a sauna, which is exactly what I like. Is there something about going to bed that distresses you? Maybe you hate the alarm clock's beeping in the a.m. and therefore need to wake to music for a change. If you have one of those digital clocks with the huge glow-in-the-dark numbers, turn it around so you can't see the numbers. You'll hear the alarm when it goes off, but you don't need to watch the clock during the night. It adds to the pressure to watch those minutes go by.
I still suffer from anxiety about getting enough sleep some nights. On those nights, I sleep on the couch where I nap. If I wake in the middle of the night, I go to bed then. There is less pressure in taking a nap than there is in going to bed for the night. Taking a nap is a treat you give yourself. As such, it's a happy, relaxing thing. For a while there, my whole life became about getting enough sleep, and all I did was try to get some sleep, which led to a complete breakdown in my social life, housekeeping habits and showering. Now I make a point of doing something every day despite being tired and in pain. Sometimes that something is washing the dishes, sometimes it's going out with friends. Whatever helps you feel like sleep issues have not taken over your life.
I'm not really sure what to say about pain. It all depends on where the pain is coming from. Is it the pain that comes with extreme fatigue? Or is it pain from, say, muscle tension. Either way, I have found chiropractic, massage, acupuncture and this spa treatment where they put you in a sauna tent to be helpful with the pain I feel from fatigue. I have arthritis in my neck, so the chiropractor doesn't 'crack' it. She uses acupuncture.
I mention heat a lot because heat forces you to relax or explode. Your choice. That's what hot yoga is all about. I am being quite serious in recommending an immediate vacation to Mexico or Palm Springs. The sun, heat and water are absolutely the most healing sensations I have ever felt. My safe place, btw, is a hot, sandy beach, with a refreshing breeze blowing around my face.
Look into the idea of buying a new bed. Not everyone having a rough time sleeping needs a new bed, but when you climb into bed, you should feel your whole body relax and be enveloped in peace and comfort and contentment. I discovered this when I went to Sleep Country and lay down on all the beds, and when I found the one that was right for me, my whole body relaxed and I almost fell asleep right there. I hadn't felt that kind of relaxation for months, so I bought that bed. And a pillow of the appropriate firmness.
And an odd tip my mother gave me, which worked really well for me: try bundling yourself up in your blankets like you would swaddle a baby. We do it to help babies go to sleep, so why not as an adult? Also, she suggested I pull out my rocking chair from when I had babies and spend some time each night rocking myself to sleep. It's not a bad idea: find something that lifts your spirits - maybe classical music or your favorite sitcom - and expose yourself to it right before bedtime. Then keep thinking about that uplifting experience as you go to bed. Punt every other thought into the next day's agenda.
And avoid alcohol and caffeine and sugar after 2 p.m. Caffeine can wake you up hours after you've finished your coffee. I noticed a direct connection between drinking Diet Coke at the movies with waking up at 2 a.m. and not being able to get back to sleep for two to three hours. It's not as much fun, but now I drink water at the movies.
I found deep breathing to be very helpful in helping me fall asleep. Nicole: You can teach her abdominal relaxation breathing and help her learn to drop her shoulders and relax her jaw, or wherever she holds her tension. Breathing in a deep, relaxing way is a habit we learn through disciplined practice and mindfulness. You can help her with that. She has to go into herself, by taking her thoughts internally to what's happening with her body, so she can focus and relax, rather than letting her thoughts roam around the outside world, where all the pressure is. Ingraining the habit of going to her 'safe place' while doing relaxed breathing will help with this. The trick is to occupy the mind with something relaxing so it doesn't have the room for worried thoughts. It's hard to do at first, but it's a habit that will make all the difference.
Now, I didn't learn all this overnight, but after two years and a lot of reading and trial and error, I manage my sleep quite well, still with some pharmaceutical support. I'll touch on drugs and then I'll list some of the resources I've used to help me.
I am in no position to prescribe drugs, but I can tell you what's worked for me and a few friends. Zopoclone (immovane) is the sleeping pill I take. It's short-lived so you don't feel drugged in the morning. However, you become dependent on it and then you need more and more to get the same sleep. My problem was that I would wake up in the middle of the night and couldn't get back to sleep. My physician and I made the mistake of having me take the Zopoclone when I went to bed, and because it's short-lived, I would still wake up in the middle of the night, just a little later than before. I learned to get myself up at 2 a.m. to take the pill so I could then sleep through the hours I normally spent tossing around, and I was able to get up to my alarm at 6 a.m. feeling like I actually slept the night.
A little side note: It's normal for women to get up in the night to pee, and I do. Sometimes I walk around the house for 5 minutes in the dark, to get myself mentally ready to go back to sleep. I go straight back to sleep afterwards these days. If you don't, try the movie theatre exercise in the I Can Make You Sleep book. I found it useful for putting dreams out of my head and falling back to sleep. My aunt is in her 60s, and of course she's retired, so she watches an entire movie when she wakes up in the middle of the night. She finds that by the time the movie is over, she's ready to go back to sleep. Then she sleeps in until 10 a.m. to compensate, and she has an 30-minute nap every day.
I did read one book that encouraged insomniacs to be productive during their sleepless period in the middle of the night. It even provided instructions on what to include in a bed-side creativity kit for 2 a.m. wakings. The author probably doesn't have to get up and go to work for 8:15 a.m. 5 days each week, so I pretty much dismissed her advice. But on the weekends, if I find myself wide awake at 2 a.m., I sometimes reverse my way of thinking about insomnia and spend time with the delicious freedom of being awake while snuggled safely in my warm bed, with no pressure to get up in the morning. It's like a secret knowledge that only you and the cat have, a different attitude towards being awake in the middle of the night. When there's no pressure to be up in the morning, being awake when no one else is is a treat. If you're a reader, you can relate this to staying up past your bedtime to finish a really good book. It's no wonder cats prowl at night.
Back on topic: I have found that the antidepressant Celexa, taken in the morning, helps lift my mood and energy levels and takes away some of my fatigue.
I am currently replacing the Zopoclone with Trazedone at bedtime, which is an old antidepressant that is now prescribed only for its power to make you drowsy, thus helping you fall asleep. I actually still take a minor dose of Zopoclone with the Trazedone, to ensure a good night's sleep. A friend of mine takes Nortriptyline, which is another old antidepressant that is now used for its ability to help you sleep. This one also helps reduce headaches, apparently.
I've tried some of the other sleeping pills, including Seraquil, which is actually an anti-psychotic, but it makes you drowsy. I've found most of those types of pills to be like a 1970s acid trip. Fun, but not conducive to lucid conversation the next day. They made me feel hungover.
Resources I've used:
The book 'I Can Make You Sleep' by Paul McKenna is a Godsend. It comes with a hypnosis CD, or you can download it from iTunes. Go straight to the tapping exercise to help you with anxiety about getting enough sleep. And counting backwards from 300 helps focus my mind so I can relax. There are so many good tips in this book that I recommend it to everyone. You can also get it from the Edmonton Public Library, if you want to just read it instead of buying it.
Also, the CD 'Meditation for Beginners' helped me learn to breathe in a relaxing way. (So did the chiropractor.) I have never gotten past the first section, so I don't actually meditate. There is another CD about relaxation - Progressive Relaxation: The Relaxation and Stress Reduction Audio Series by Patrick Fanning and Matthew McKay that I found helpful in the beginning. It makes you tense and relax your muscles so that you begin to know what relaxation feels like. The premise is that you cannot be tense in your mind if you are relaxed in your body. It was one of the original relaxation guides, and is still widely in use today.
Edmonton has a sleep clinic that I have not checked out yet. It's called the Northen Alberta Sleep Clinic. Here's the website address: http://www.medsleep.com/clinic-locations/detail/northern-alberta-sleep-clinic. They might be able to give you something more than the usual 'sleep hygiene' advice (have the same routine every night, keep your room dark, don't drink caffeine, etc), but I haven't looked into their services too deeply. And I have found sleeping in a darkened room a bit creepy, I don't drink caffeine anyway, and my dog sleeps on my feet every night, so for me, the so-called 'sleep hygiene' items did not apply. But they are starting points that may help you. You just have to find what works for you.
I am doing EMDR therapy. Nicole can tell you all about it, because she introduced me to it. It may be more than you need right now.
I am also taking a melatonin supplement I got at a GNC store. I tried the supplements from the health food store, but they taste like dirt. This one tastes reassuringly like a plastic pill. I am taking the time-release melatonin, because my problem is staying asleep, so I need the extra boost long after I've gone to bed. You can also get the regular stuff. Melatonin is the hormone that regulates sleep, so in theory the supplement will put more melatonin in your body and thus reset your sleep cycle. I have no idea if it's working, because I take it with a couple of other pills at night, but I do know that it's not stopping me from sleeping, so I keep taking it.
OK, so last advice I have to share: get walking. Exercise is the number one way to cure insomnia. You don't need to go all hard core at the gym, and you don't want to do strenuous exercise within 3 hours of bedtime. But a 10-20 minute brisk walk once or twice a day is a good way to begin. Then build up to 45 minutes. You'll find yourself addicted to the walk, and sleeping like a baby. I find that right after dinner is the best time for my walk. It also helps you digest your dinner. Try enrolling in a walking clinic at a Running Room. They start you small and build up your walking habits and teach you how to get a workout just by walking. (I'm assuming you're not already running marathons as a hobby. If you are, then this advice does not apply.) And you'll meet people to talk to about not being able to sleep. The Running Room's phenomenal success is based on their model of providing a sense of community and support while building healthy habits, and support is something you may need. You are not alone. I like to joke that they cast zombie extras in movies from the ranks of insomniacs, to get the most accurate portrayal possible ;)
There is no magic cure for pain and sleep issues, as I have discovered, and you are going to have to work a bit to overcome them and they may never completely go away. But be good to yourself and nurture yourself, and you will find a balance that works for you. Don't expect consistency for a while. If you're especially tense about something, you might need an extra cup of herbal tea or an extra half a Zopoclone that night. It doesn't necessarily mean that you're insomnia is getting worse. NIcole will tell you that recovery is never a smooth slope uphill. I have learned to tell myself that if the cocktail of pills and the habits I've built put me to sleep last night, they will do so again tonite. And if they don't, there is always the extra half a sleeping pill in the medicine cabinet. In other words, eventually I will sleep.
I'm a psychologist, activist, and writer. I believe in sharing our stories and wisdom as a tool for our own healing as well as the healing of those around us. For this reason I've chosen to share what I'm learning, as well as guest posts from other people who've been there.
About the Blog
This space will provide information, stories, and answers to big questions about some of my favorite topics - boundaries, burnout, trauma, self compassion, and shame resilience - all from a feminist counselling perspective.