Recovery from Chronic Insomnia
I recovered from chronic TMS (The Mindbody Syndrome) pain (fibromyalgia and migraine) in 2014 after using TMS healing strategies for about a year. You can read my success story on this here. However, it took me about another 3 years to finally recover from chronic insomnia. This TMS equivalent was obviously much harder for me to address than chronic pain. I finally figured out why. Here is my story.
I always had occasional and situational sleep onset type insomnia, even as a child. The night before an important event, like the first day at a new school, I would be unable to fall asleep. It usually didn't last more than a night or two throughout childhood. The frequency increased gradually in adulthood and the bouts would last longer, but usually once asleep, I could stay asleep until the alarm clock sounded. As the frequency of insomnia continued to increase, I began using sleep inducing supplements (e.g. L-tryptophan), then a sleep inducing anti-depressant (Trazodone), and when they weren't enough, I started using sleeping medication (many kinds, but not benzodiapines as they didn't agree with me.) Still, my need for sleep meds was occasional and situational, and the they took care of the problem when I needed it. But again, the frequency of insomnia increased and around 2010 or so, I began using some type of sleep medication almost every night. I knew this wasn't good, but felt I had no choice, as I had to get up and go to a responsible full-time job and complete all those other duties that we all have. Eventually, even though taking sleeping medication, I developed sleep maintenance type insomnia, where I woke up every night after about 3-4 hours of sleep. This pattern became chronic for about 6 months. I was suffering and in crisis. My doctor prescribed Gabapentin to add to the sleep medication, and this worked, giving me some relief for a while. Then I started having major side effects from the Gabapentin, and I had to stop taking it. I was back in crisis, and trying my best to apply all the TMS techniques I had successfully used to recover from chronic pain.
Some other things I tried that over the years that didn't work: sleep hygiene, different pillows, etc., yoga, Qi Gong, meditation, deep breathing, supplements (e.g. melatonin), marijuana, CBD oil, acupuncture and Chinese herbal medicine, cranial sacral therapy, massage, Somatic Experiencing therapy, EMDR therapy, aromatherapy, and a very expensive device called the Fisher-Wallace Stimulator. I'm sure there are more that I'm blocking out. I read many books and reviewed the research assiduously. I became an expert on insomnia.
Before discovering TMS, I had undergone two sleep studies about 5 years apart. They weren't helpful. In my experience, sleep clinics are geared to treat sleep apnea and don't deal with insomnia very well. The sleep clinic staff seemed surprised when I said there was no way I could sleep hooked up to a bunch of wires with a camera pointed toward me unless I took a sleep medication. Even on medication my results showed a lack of restorative and deep sleep. My sleep apnea score was low, but because they had no other solutions to offer me, I went home with a CPAP machine, which was a tortuous experience. When I returned to the doctor who prescribed it, he said he didn't think it would help me, but thought it was worth a try.
Discoveries from journaling, and finally—the missing piece
Journaling didn't make the problem go away, but led me to discover the follow insights:
- I knew my generalized anxiety disorder was a major factor in my insomnia, but now I realized how much my personality trait of perfectionism, as well as my very low esteem were contributing. The reason my sleep deprivation was upsetting me so much was I believed strongly that I could not be my best self unless I averaged around 7 hours of good sleep a night. If I'm not at my very best, then I'm not good enough to fill my valued roles—employee, family member, friend, etc. In reality, I knew my sleep-deprived self was good enough at doing what I needed to get done in all my roles. I did fine in my supervisory job, supporting and having fun with family and friends, doing my household chores, creating art, even driving, which had been my biggest fear, since my reflexes were slower. So what's really the problem? Because of my low self-esteem, I felt unless I could be at my best, I just couldn't be good enough. Sleep deprivation exaggerated my fear that I'm just not good enough.
Insomnia and outcome independence
- I realized when looking at the sleep deprivation objectively, unemotionally, that there were some benefits. If I put the frustration of it aside, I found that my mood was actually better on less sleep. I found some research that states that sleep deprivation is sometimes used to treat depression. Sometimes, I actually seemed to have more energy than when I slept well, and could get more done than usual. This wasn't always the case, but perhaps has to do with the presence of stress hormones, which though not good in the long term, can get you through a crisis period.
- During the worst and most prolonged sleep deprivation period, I found myself crying easily and often. Now I am normally someone who very seldom cries. It is hard for me to cry. At first I interpreted my crying spells as a negative--I thought I was falling apart and would soon end up in the psych ward. But I never cried in public (except once in yoga class, but they encourage it and see it as progress), and I came to view the crying as very cathartic and it actually felt good.
- Also, when I viewed my symptoms of sleep deprivation non-judgmentally, just as sensations, I realized they were not that awful. Yes, my eyes are puffy, dry, a little blood-shot, my stomach is queasy, there's some tightness in my neck and shoulders, my mind and body are moving slower, I'm not able to focus as well, my memory isn't as good. I've felt many worse symptoms, with both TMS and purely structural medical problems and illnesses.
- So when looked at non-judgmentally sleep deprivation was really not all that bad. I had been catastrophizing about it. I felt like a victim and disempowered. I had tried everything and still couldn't make myself sleep. I was a failure. I had a strong belief that if I didn't sleep enough, I would begin to fail at everything. I would not be good enough. This fear put so much pressure on me that it was no wonder I couldn't sleep. It was like I was addicted to the idea of sleep. Take it away from me and I will suffer. This was when I realized the missing piece in my recovery efforts—I had not been able to cultivate a state of outcome independence with regard to sleep.
I am no expert on outcome independence, but I did figure out how to apply the concept to my chronic pain, and I believe it was the most fundamental part of my recovery. Why couldn't I get there with insomnia? To apply the concept to insomnia, I needed to believe that whether or not I was able to sleep the night before, I could still have a good day. I could be good enough. I already had enough evidence that this was true. I remember experiencing long periods of the day while sleep deprived where I actually forgot all about it. I was absorbed in what I was doing, and yes, actually having fun. It was possible!
Outcome independence is a very nuanced concept, so it can be difficult to fully understand and embrace. It is like trying to thread a needle without your reading glasses. For me, it is not about achieving a state of denial about the difficulty of insomnia. It's not positive thinking. I'm not trying to convince myself that insomnia is a good thing. I articulated some positive things about it and how benign some of the symptoms associated with it are (at least in the short term), as this helped lessen my fear about it, stopped my catastrophizing about it, and led to me being able to embrace what Alan Gordon describes as "authentic indifference." Whether I slept or not, I now believed I could perform well enough to get done what needed to get done, and I could even have fun and enjoy the day. This took away the pressure and fear that was feeding it.
Some quotes that helped me:
"What you fight strengthens, what you resist persists." Eckhart Tolle
"When I argue with what is, I lose, but only 100% of the time." Byron Katie
"Pain is inevitable. Suffering is optional." Buddha
"My definition of health: coming to terms with things as they are." Jon-Kabat
What I did
- I stopped trying to sleep, which is a contradiction in terms. Sleep is about letting go—a not doing. We can't make it happen.
- In line with the above, I stopped all sleep hygiene techniques (a couple of exceptions below), supplements, anything special designed to help me sleep (e.g. aromatherapy), reading and researching about insomnia.
- I gradually weaned myself off sleeping medication.
- I tried to return to common sense about sleep. I went to bed only when I felt sleepy (e.g. yawning, eyes droopy), rather than when feeling tired, which didn't always mean I was sleepy.
- I washed my face, brushed my teeth, etc. early in the evening so that when I did feel sleepy, I could go right to bed and not risk waking myself up by throwing water on my face.
- When I went to bed I told myself these words "Whether I sleep or not, I'll be fine either way."
- I didn't stay in bed if not sleeping for more than about 30 minutes. This is to address conditioning. The bed should be where you sleep, not fret, worry, etc. When I first lie down to sleep, I put on a non-fiction audio book at low volume with the sleep timer set for 30 minutes. If I'm still awake when it shuts off, then I get out of bed. If I wake up in the middle of the night, I do the same thing.
- When I get out of bed in the middle of the night I stay busy listening to podcasts, audio books, watching videos, watching the sunrise, making a big breakfast..........in other words, live life. I tried to make the best of the extra free time I had.
- When I get up after what feels like too little sleep, I say these statements "This is how I sleep now. It's OK. This is how I feel now. It's OK. I'm fine. I'm safe." I say this throughout the day if I start to worry about lack of sleep. It cultivates a stance of acceptance.
- I didn't mention my sleep deprivation to anyone. I feel it would just reinforce the narrative that there is something wrong with me.
- I didn't use my sleep deprivation as an excuse to not do something, within common sense limits. And if I truly didn't feel like I could do something, I didn't beat myself up over it.
- I tried not to clock watch (add up hours I had slept) or calendar watch (add up days with or without sleep)
- Since insomnia is a result of anxiety, healthy strategies to lower anxiety will likely be helpful in the long term (e.g. yoga, 4-7-8 Breathing, meditation, somatic tracking, etc. )
I don't remember exactly how long it took for me to get to a point where I was sleeping 6-8 hours a night on a regular basis. I truly was trying not to calendar watch. I know that it was very gradual, maybe a month or two . First I found I could sometimes fall back to sleep after waking up in the middle of the night. Then I slowly and gradually began sleeper for longer times before waking up. Falling asleep took less time. I remember the joy and gratitude I felt when I had my first uninterrupted night of 7 hours of sleep with no medications. Success!
I would love to say my progress went forward in a steady, linear manner. It didn't. I still had occasional sleepless nights and bad days when I couldn't reach that attitude of "authentic indifference". I just accepted it and started again. It wasn't starting over. My previous success didn't go away and was still there to build on. I eventually reached my goal. I recovered.
But just as with my other forms of TMS, I have an occasional relapse. This especially occurs when I travel, and I believe this is conditioning, as I always had trouble sleeping when away from home. So I need to continue to work on this. With each relapse, I just go back to the steps outlined above. They work quicker and easier now. I am no longer burdened by this form of TMS. If I can do this, so can you!
Namaste and pleasant dreams.....