Friday, April 5, 2013

In the Realms of Night (Part 1)

What is sleep?  No one knows for sure.  We all know we need it.  Health authorities say most Americans don't get enough of it.  Most of us wish we had more of it.  What regular transition do we make in the day that is more difficult than going from sleep to waking?

There is a paradox about sleep though.  Even though most of us want more sleep, we don't want to take the steps needed to get more of it.  There is almost a stigma against sleeping well.  If you go to bed early, or do whatever else it takes to ensure enough rest, people view you a little strangely.  At best you are seen as dull and nerdy with no life.  The cool people stay up late.  At worst you are seen as unproductive.  If you are spending a third of a twenty-four hour period sleep, when are you actually doing anything?  You should be up late doing work or playing with your children or paying your bills or working on your backlog of emails to friends and family.

I really don't care what people think of me if I get enough sleep.  I should be so lucky as to sleep so much that others can judge me for it.

I have been a chronic insomniac most of my life.  I'm not one hundred percent sure of exactly when the episodes started, but I can definitely remember them as far back as the middle school years.  I have always fallen asleep easily and early.  I have never been a "night person".  Despite falling asleep easily, I don't stay asleep.  I am often awake at 2 AM, sometimes I don't ever fall back to sleep again.  I can go for a week or two at a time without a full night's sleep. 
Over the years I have found some creative ways to amuse myself during those waking hours.  As a kid I used to just enjoy roaming around the house, enjoying being the only one awake.  I would raid the refrigerator.  I would see how quietly I could do ordinary tasks.  I learned that one of the local TV stations played an old movie every morning at 3 AM and so I caught up on many old movies.   As I grew older I would even leave the house.  If the dog was awake, I would take her for a walk.  By the time I hit my twenties, I would sometimes just get in the car and take a drive.  I can't think of the number of times I would be tempted to head to the diner and order a sandwich, just for the novelty of eating a meal at that time for no real reason, sitting among the post-bar crowd.

In some ways I did enjoy the idea that I was one of the few people roaming around at night when most people were asleep.  When I was younger it felt exciting.  Being up in the middle of the night was  not my natural state since I'm a day person.  To be up in the middle of the night was to be in another world.  It has always been my one consolation for winter days when I wake up in the dark.  If it's 5:30 AM and it's still dark outside, I still feel as if I'm the only person awake in a sleeping world.  In a small way I enjoy walking down the empty street on my way to the gym.  I always see one or two other people out and sometimes it's interesting trying to figure out what their reasons are.

These days it's a little more difficult to keep myself occupied.  I live in a much smaller home, so walking around and trying to amuse myself is harder to do without waking my husband.  I try to read.  I watch TV episodes on my Ipad with headphones.  I go online and write blogs or do random Facebook postings. 

The things I do to keep myself occupied are the worst amusements for insomniacs.  They all require light and light is the enemy of sleep.  TVs, computer screens, and reading lights all play with brain signals for sleep.  I try to tell myself that reading and watching TV are supposed to distract me from sleeplessness and that I will drift off if I pay attention, but really that only works about half of the time.  Maybe I should go for a walk - except that would make my husband mad with worry.  I have tried yoga, but somehow lying on the floor trying to push my body into poses just makes me long for my warm bed, even if I can't seem to fall asleep in it.

I know that while reducing light is not a perfect solution, I am trying to work on how I can reduce the amount of light I'm exposed to at night.  One problem I have in my bedroom is that we have very translucent shades.  That is on purpose.  I hate waking up in a dark room.  I want to see the morning sunshine.  Unfortunately while our shades let all of the morning sunshine in, they also permit moonlight and street lamps to shine through all night as well.  Last year the solution came to me.  I don't know what took me so long.  I now wear a sleep mask.  It's not a perfect solution.  I still have insomnia, but it seems less severe when I block light from my eyes.  When I wake up in the morning, all I have to do is take off the mask and I can enjoy my sunny morning bedroom (assuming I don't have to wake up before sunrise). 

Insomnia is still something I can't take lightly.  I have a job.  I work out.  I need to function during the day.  A good night's sleep is important.  As I get older, I wonder about other root causes.  Although I have suffered with the problem most of my life, it has become much worse in the past ten years or so.  I also notice certain hormonal patterns.

At my last doctor appointment I asked my doctor about possible causes of sleeplessness.  She told me that while it's a little early for menopause, it can't be ruled out completely.  The problem is she can't test me unless I discontinue current medications, which would mask the hormones.  That seemed like too much of a gamble to have to cycle out of meds and then cycle back into them if the tests are negative.  Instead she offered a prescription for Ambien.  She has age-related insomnia issues herself, and that after a few continuous nights, an Ambien can help break the cycle. 

I had my reservations about Ambien.  I had heard about all of the crazy side effects.  I managed to put it in perspective.  I'm not prone to sleepwalking (I had once incident somnambulism in my life when I was about ten years old).  Even if I did get out of bed and started doing things around the house, I'd likely wake Kevin and he would be able to stop me before I started trying to cook or get into the car and drive.  (It's a good thing I have stopped doing that on purpose when I can't sleep.)  Would a good night's sleep be worth the risk?

Even after I had my new bottle of Ambien, I wasn't sure what to do with it.  I just liked taking it out of the medicine cabinet and looking at it.  I loved the fact that I had it.  That bottle was almost like a security blanket.  I seemed to sleep better just knowing it was there. 

One of the problems with taking it was that there are so many conditions behind taking it.  I have to make sure I can devote 7-8 hours to sleep if I take it.  That could be risky on mornings I get up early to work out.  I can't drink alcohol with it.  On weekdays that's fine, but it does mean no wine when out to dinner on weekends (although I really don't consider that a tragedy).  I have to take it on an empty stomach to make sure it works in a timely fashion.  That's difficult on weeknights when Kevin comes home late and we don't eat until 9PM (I tend to fall asleep around 10).  Even if I were having a week that was really bad, would the time ever be right to take my Ambien?

Last weekend I finally tried it.  The weekend had been extremely busy.  Friday I had spent a day in the city at the Museum of Natural History and then came home to start making dessert for a dinner party on Saturday night.  I spent Saturday night cleaning the house and cooking, and then there was the dinner party itself.  Sunday was Easter.  I worked out in the early morning, went out for an early Easter brunch an hour away from home, and then went riding.  Sunday night I felt tense and couldn't relax.  I had been running around all weekend.  My heart was racing when I got into bed.  I had eaten an early dinner that night and while I had drunk a nip of wine with it, the effects had worn off.  I had no plans to work out the next morning.  The time had come to start my grand experiment.

I took it.  My heart seemed to stop racing a minute or two after I took it.  I didn't feel sleepy as soon as I lay down despite the warnings that it would make me sleep right away.  I had one "false start" where I had a brief hint of a dream coming on but then woke up again.  I don't remember much else after that.   I slept.  I slept the entire night (or at least have no memory of waking up).  I woke up after Kevin's alarm (an hour before mine) but before my own.  I was a little groggy when I woke up, but I was no groggier than I usually am, and felt better than I do when I'm awake from 2AM to 4:30AM.  All this week I have been sleeping better than usual.  It's usually a bad week in the cycle for me, but I have managed to sleep through most of the nights.  I have also faithfully worn my sleep mask every night, which probably helps as much as the Ambien did.

One solution I refuse to try is to wire myself up with caffeine to compensate for lost sleep.  I know this is the preferred solution for many of my peers.  I see this as putting a Band-Aid on a hemorrhage. All caffeine does is give a jolt to the nervous system, which creates a sense of alertness, but does not really make up for lost sleep.  It just creates a cycle of dependence whereupon the user has to continue to increase dosage just to stay out of a crash.  I do not want to be in a cycle like that.  Eventually it will only be more disruptive to my sleep patterns.  Any caffeine I consume has to be drunk before lunch.  I can't risk shaking up my already confused nervous system.

I also don't give my credence to "natural" cures.  Melatonin has proved useless to me.  Herbal teas are a a joke.  Drinking tea before bedtime makes me wake up more often because I keep having to pee.  As long as Ambien works for me as an occasional way to break the cycle of sleeplessness, I will keep taking it.

For the time being I seem to have reached a pleasant pause, although probably not the end, of my quest for a good night's sleep.  The Realms of Night have been interesting over the years, but if I really am going to spend less time within them, I doubt I'll miss them much.

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