The Sleep Thief

“Classic” in­som­niac Sharon Stephen­son doc­u­ments her wake­ful jour­ney to a good night’s kip. Part of the prob­lem is that many peo­ple who can’t sleep ac­cept it as nor­mal and in­som­nia is not nor­mal.

The Dominion Post - Your Weekend (Dominion Post) - - Feature -

It’s 3am on Wed­nes­day, a time when only nurs­ing moth­ers, shift work­ers and die-hard partiers are awake. I’m none of the above, yet I am bright-eyed and bushy-tailed, star­ing at the bed­room ceil­ing in­stead of at the in­sides of my eye­lids. I am a chronic in­som­niac, un­able to fall asleep and stay asleep, both equally frus­trat­ing sides of the dis­rupted sleep coin.

Sleep and I have never been good friends, or even ca­sual ac­quain­tances.

This is what usu­ally hap­pens: I go to bed and toss and turn for hours wor­ry­ing that I can’t get to sleep/ have to get up soon/haven’t sent an im­por­tant email/ need to add some­thing to the gro­cery list, etc. On par­tic­u­larly bad nights, ran­dom thoughts and wor­ries bounce around my brain like an out-of-con­trol game of ping pong.

I try count­ing sheep, list­ing the things I’m grate­ful for, reg­u­lat­ing my breath­ing and med­i­tat­ing and when none of th­ese work, I try to bar­gain with God/ Bud­dha/al­lah/any­one that if they grant me a good night’s sleep, I’ll be a good girl from now on. Iron­i­cally, the only thing that all that wor­ry­ing and bar­gain­ing does is to fur­ther stim­u­late my brain, ratch­et­ing up the anx­i­ety and mak­ing sleep even more elu­sive.

Even­tu­ally, an­noy­ingly, I fall into an ex­hausted sleep, only to wake up a few hours later to watch day­light creep around the cur­tains.

If in­som­nia was an Olympic sport, I would have a per­ma­nent place on the podium, gold medal firmly clasped around my neck.

It’s not as though I haven’t tried to sleep: over the years I’ve taken chamomile and mag­ne­sium, fit­ted black­out cur­tains, done yoga, eaten ba­nanas and sipped warm milk (not at the same time), ex­er­cised in morn­ing sun­light, given up cof­fee and lim­ited al­co­hol. I’ve tried deep-breath­ing ex­er­cises, lis­tened to pod­casts and gob­bled mela­tonin tablets (and when those didn’t work, I got a pre­scrip­tion for sleep­ing tablets which do work but which I only take when I re­ally, re­ally need to). I’ve eaten lots of carbs and given up carbs and, once on a work trip to a health re­treat in Queens­land, had acupunc­ture from the bloke who used to stick nee­dles into Princess Diana. Heck, I would pound my chest in a drum cir­cle while hang­ing naked from a chan­de­lier if I thought it would help.

And even though in the wee small hours, when my rock-solid sleeper hus­band is hap­pily lost in dream­land and it feels as though I’m very much alone, fig­ures show I’m any­thing but.

New Zealand’s Na­tional Health Sur­vey 2013-2014, for ex­am­ple, re­vealed that 37 per cent of Ki­wis aged 30-60 never, or rarely, get enough sleep. Those most at risk in­clude women (in­som­nia af­fects twice as many women as men), shift work­ers, the el­derly, young adults, trav­ellers, women in menopause, drug abusers and al­co­holics.

Dr Alex Bar­tle, di­rec­tor of New Zealand’s Sleep Well Clin­ics, be­lieves up to 15 per cent of adult Ki­wis have chronic in­som­nia which af­fects their wak­ing lives.

“That’s a fair num­ber of peo­ple who have dis­rupted sleep at least three nights a week, and have had for more than three months,” says Bar­tle.

“Part of the prob­lem is that many peo­ple who can’t sleep ac­cept it as nor­mal and in­som­nia is not nor­mal.”

Although we spend about 24 to 26 years of our lives asleep, how much we re­ally need varies from per­son to per­son. The gold stan­dard for an av­er­age night’s sleep, set by the US Sleep Foun­da­tion, is six and a half hours. “Any less than six hours and we don’t com­pute very well,” says Bar­tle.

He’s right: when we’re sleep de­prived we tend to be grumpy, un­pro­duc­tive and of­ten un­able to think straight. Re­search from the Univer­sity Col­lege Lon­don Med­i­cal School re­vealed that peo­ple who fail to get a full night’s sleep score sig­nif­i­cantly lower on tests of logic and vo­cab­u­lary and, more wor­ry­ingly, have slower re­ac­tion times which can im­pact on ev­ery­thing from op­er­at­ing ma­chin­ery to driv­ing.

The grim news doesn’t stop there: chronic in­som­nia can lead to a laun­dry list of ill­nesses, from high blood pres­sure and di­a­betes to an in­creased risk of heart at­tack, Alzheimer’s dis­ease, problems with the im­mune and lym­phatic sys­tems and even death (re­mem­ber the 24-year-old In­done­sian wo­man who died in 2013 af­ter pro­longed sleep de­pri­va­tion?).

It’s why I take my­self to Bar­tle’s Welling­ton clinic on yet an­other day when I need pegs to prop open my eyes. I’m clearly not the only one, be­cause I’ve had to wait three weeks for an ap­point­ment with the Auck­land-based doc­tor who made the switch from gen­eral medicine 10 years ago when he re­alised the ex­tent of New Zealand’s in­som­nia prob­lem.

“In­som­nia isn’t just a case of not sleep­ing, it’s also about fear, an over­whelm­ing but com­mon anx­i­ety that can paral­yse your sleep,” says Bar­tle.

We talk about my his­tory with dis­rupted sleep, how fa­tigued I am dur­ing the day (very) and how I man­age to mud­dle along with around four to five hours shut-eye a night (not al­ways suc­cess­fully). We dis­cuss my cur­rent sleep­ing sit­u­a­tion – black­out cur­tains (good), dog sleep­ing on the bed, not so much – and if I watch TV, read emails and scan the in­ter­net while in bed (yes, yes and yes).

“You’re a classic chronic in­som­niac, some­one who’s tired and wired and can’t turn off the in­ter­nal di­a­logue or to-do lists,” Bar­tle tells me.

It is, ap­par­ently, pos­si­ble to re­wire my brain to give me the con­fi­dence I need to fall asleep and stay that way us­ing Cog­ni­tive Be­havioural Ther­apy for In­som­nia (CBTI), which helps to man­age the un­der­ly­ing stress that in­ter­feres with sleep. CBTI, which nu­mer­ous stud­ies have shown to be more ef­fec­tive than sleep­ing pills, piv­ots on a sim­ple con­cept – that in­som­nia is caused by learned thoughts and be­hav­iours which can be un­learned or changed.

We start with sleep hy­giene, a slightly icky term which ba­si­cally de­scribes the rou­tines and rit­u­als around bed­time that let the brain know it’s mov­ing into the sleep phase. Th­ese in­clude en­vi­ron­men­tal fac­tors such as dim­ming the lights, tak­ing a hot shower or bath an hour be­fore bed, avoid­ing ex­er­cise and snacks be­fore lights out and, most im­por­tantly, not do­ing any­thing in the bed­room ex­cept sleep­ing

and sex. Which means no watch­ing TV or mind­lessly scrolling through my phone while in bed.

Bar­tle says my sleep ef­fi­ciency is also some­thing that needs to be tack­led. “You’re cur­rently go­ing to bed at 11pm, get­ting up at 7.30am and sleep­ing for around four to five hours, which is only a 50 per cent sleep ef­fi­ciency rate.”

He sug­gests I re­strict the time I spend in bed by go­ing to bed at mid­night, which should help to con­sol­i­date my sleep. “Turn off all elec­tronic de­vices around 11pm and read a book un­til it’s time to go to bed.”

So far, so doable. What doesn’t sound so easy is drag­ging my­self out of bed if I can’t fall asleep within 10 min­utes of re­tir­ing (or af­ter wak­ing dur­ing the night). The CBTI tough-love ap­proach is to get out of bed, go to an­other room and read a magazine for 20 min­utes be­fore re­turn­ing to bed.

“You can’t make your­self sleep, so the trick is to re­lax enough in or­der to al­low sleep to hap­pen,” says Bar­tle. That in­cludes pro­gres­sive mus­cle re­lax­ation which, as the name sug­gests, in­volves work­ing up or down the body re­lax­ing var­i­ous mus­cle groups. That old chest­nut – mind­ful­ness – and vi­su­al­i­sa­tion, tak­ing my mind to a happy place (cur­rently a de­serted beach in Fiji), can also help.

“Some peo­ple pray, do self hyp­no­sis or have mantras they re­peat, ba­si­cally what­ever re­lax­ation tech­nique works for you.”

It’s prob­a­bly noth­ing I didn’t al­ready know but it helps to have some­one of Bar­tle’s ex­pe­ri­ence put it in prac­ti­cal, easy-to-fol­low terms. I leave the clinic feel­ing more con­fi­dent about sleep­ing than I have in a long time.

“Just re­mem­ber, it takes time to re­train your brain,” he says kindly as I leave.

One month down the track and although I haven’t quite nailed this sleep­ing six hours a night thing, it def­i­nitely feels more man­age­able. I’m go­ing to bed later, switch­ing off the elec­tronic dis­trac­tions ear­lier and read­ing more books than I have for ages. Thank­fully, I’m also sleep­ing for longer stretches and sel­dom wak­ing be­fore the alarm. But, best of all, I’ve al­most for­got­ten what 3am looks like.

SEED HER­ITAGE CHIL­DREN’S HAT, $35

Aus­tralian fash­ion chains such as Coun­try Road, Seed and Witch­ery seem to de­sign par­tic­u­larly good-look­ing ac­ces­sories. They’re of­ten more ex­cit­ing than the clothes. Seed’s kids’ ac­ces­sories are adorable – lit­tle won­der, as the brand started life as a chil­dren’s boutique, with a sin­gle shopfront. I’m a sucker for clothes and ac­ces­sories that have ears, so this wo­ven cap made me smile.

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