This morning I awoke at six-fifteen. I could feel a dull ache across my temples and a familiar burning in my eyes. I had little enthusiasm for the events of the dawning day, even those I might normally enjoy. I am, with minor allowances for a late night here and there, an eight-hour person, but I had been asleep only half that long.
Following a few minutes of thrashing around to get comfortable and several more of strained stillness to encourage a return to slumber, I capitulated and arose, knowing the futility of this endeavor. I have had insomnia for twenty-eight years.
I have explored my battered psyche during innumerable hours of therapy, uncovering my nonproductive behavior patterns and neurotic tendencies. I have visited pharmacological remedies, with side effects that intensify those of sleeplessness. I have employed meditation, Yoga, breathing exercises, biofeedback, and surrendered myself to an electrosleep machine created in Russia, all to no avail. I follow rules of “healthy sleep habits"-- my bed is comfortable, my room well-ventilated; I avoid caffeine in the evening. Yet, my system continues to rebuff this desperately needed process, year after year, no matter how appropriately I set the stage.
I remember sleep. I recall the sharp, crispy feeling in my head and eyes after a full night of slumber. I even remember the last time I slept till noon, like someone marks a wedding or a graduation. It was September 23, 1973, two days before my thirty-third birthday. Like most people, I took sleep for granted in those days, even felt it was a luxury. That was another life, another person; they preceded my incarceration in the prison of sleeplessness.
In this alternate life I wear a vise around my head, like the handcuffs of arrest clamped around the wrists. No one can see it, but I am ever aware of it bearing on my temples. The tightness encompasses my entire face, what they call “drawn," I guess, taken beyond the cliché. There is heat in my skin, like a raging fever, although the thermometer registers normal. No one can see me shaking, either, but I feel jittery, and my heart races as though I’ve been running.
I look as different as I feel, in this altered state: the strange hollow shape my eyes take, their lids red and swollen; my skin tone red, as though burned by the sun. This variation of my self has a different spirit, too: heavy and weighted down, it perceives most activities, even enjoyable ones, as taxing and overwhelming. No wonder babies cry when they’re tired.
Sleep returns for short periods, when life feels manageable: six weeks one year; eight weeks in another, four or five inexplicable reprieves too brief to mention-- a week here, two weeks there. Each begins suddenly, ten sound hours of playing catch-up the first few nights, awakening stunned, with vertigo and a migraine (I remember sleeping late on weekends as a teen and experiencing a headache of this type). The ten hours taper off gradually, alighting at about eight, and the headache and dizziness abate in a few days. My catch-up period over, I am young and spirited again, dreaming and planning, a virtual bird out of its cage, until I fly back into the snare of tension and stress, slave that I am to whatever demons lead me there, and, once again, the door slams shut.
I have reason to believe that sleep was always an issue for me: voices from my parents’ radio drifting up to my room long after they’d tucked me in; my mother’s difficulty getting me to nap. When she died accidentally just as I turned nine, I was awakened for the news.
There was the self-imposed sleeplessness of my early teens, when I thought I was invincible. At fourteen, I was proud to be the only girl at my slumber party who stayed awake all night and throughout the entire next day. I wasn’t worried; sleep could be postponed for more important activities, then summoned when needed, like a butler when unexpected guests arrive. A move during my later teens left me depressed, without appetite, and longing for my friends left behind. What followed were a series of bad choices-- a cessation from school, marriage too early, to the wrong man, and children I had no means to support.
During my twenties, the arduous combination of poverty and single parenthood required work and wakefulness for twenty hours of out of twenty-four; I endured embarrassing afternoons yawning over my typewriter, eyes watering, skin itching as though infested by a wandering insect.
At thirty, I couldn’t understand why I felt flushed and jittery and mildly depressed, and why my hands and feet were puffy. “I must be coming down with something," I stated to co-workers at regular intervals, being certain to get to bed early to ward off the impending illness. Awakening symptom-free each time, I finally realized that it was the sleep that brought relief. There’d been no cold, no flu, no pesky virus; my “illness" was the nervous exhaustion the doctor had cited, and the prescription was sleep. I simply had to listen to my body, he told me. I would soon discover that one’s body does not always listen to itself.
I’ve read that insomnia often begins with a crisis and lingers beyond the resolution, and that’s just how mine began. I was already anxious, wondering how I’d manage for ten more years; my kids becoming older and more expensive and showing signs of stress. I’d noticed that, with increasing frequency, I couldn’t fall asleep no matter how sleepy I was. When a promising romantic interest suddenly withdrew his attention and married someone else, I felt abandoned and permanently entrapped, and the relentless albatross took hold: I went to bed each night, sleepy as usual, surprised when nothing happened until nearly dawn--“delayed sleep onset," they call this--when I’d doze fitfully for an hour or two. I told myself, for the first several weeks, that my body would rescue itself, that the exhaustion would take over, and a cycle of sleep would kick in. When it didn’t I was scared. I felt totally out of control.
Reading about insomnia allowed me to see some of my symptoms verified. Subjects in sleep labs who volunteered to stay awake for days at a time experienced hallucinations and “a tight band around the head." A radio marathon, in which two subjects alternated thirty-minute broadcasts, was halted after seven days because of the participants’ deteriorating mental and physical states and because they both developed ankle edema. I found the edema especially interesting, since I’d been told by a co-worker that I was out of my mind to blame sleep deprivation for the puffiness in my hands and feet.
Reading further, I was surprised to learn about all the activity that goes on during sleep. Once we leave the relaxed state of awakening called “alpha," sometimes referred to as the “threshold of sleep," we pass through stages one, two, and three, which are fairly uneventful.
Stage one lasts several minutes and is characterized by a floating sensation and idle thoughts and dreams and, if interrupted, no realization that any sleep has occurred. Muscles relax, the pulse grows even, and the temperature begins to fall. Stage two, which lasts thirty to forty minutes, is simply a downward progression, in which the eyes roll around and are without vision, even if they’re open. A moderate noise might arouse the sleeper at this point. It would take a much louder noise to interrupt stage three, which lasts about ten minutes. Muscles have further relaxed, the heart rate has slowed, and blood pressure has dropped.
The fourth stage, called Delta, is the deepest and most difficult to interrupt. Those who wet the bed or sleepwalk will usually do so during Delta. The heart rate continues to slow, blood pressure lowers further, and dreams, if any occur, can’t be recalled.
After Delta comes the REM (Rapid Eye Movement) stage, and the action begins. The eyes, though closed, dart back and forth; breathing is fast and irregular; the metabolism, heartbeat, and pulse speed up. Body temperature, lowered during the first stages, rises slightly, as does brain temperature. Sexual arousal occurs in both male and female sleepers.
Strangely, with all that activity, chin muscles are slack, and the body is limp-- some theorize, to prevent us from acting out our dreams, which are the hallmark of this stage; they are often vivid and remembered in detail. This cycle, from stage one to REM, is repeated about five times throughout the seven-hour night, with progressively less time spent in the deeper stages and more in REM. Each cycle takes about ninety minutes. I didn’t average much more sleep than that on any given night.
By the time I quit my job in 1978, my sleep pattern had changed. Where I had initially been unable to fall asleep upon going to bed, I was falling asleep at a relatively early hour and awakening during the night without returning to sleep (termed “intermittent insomnia," “terminal insomnia," or “broken insomnia"). It was nothing for me to lie awake from one in the morning until dawn, then attend to my job and my kids. By afternoon, my face was red and burning and my eyes felt as though their whites were being pierced by pins. It seemed not to matter how little I slept; there was no crashing, no catch-up the following night, when unwillingly, desperately, I’d repeat the pattern, often awakening at exactly the same moment each night for weeks, as though programmed by some sadistic force. “What am I going to do?" I’d ask myself during these dark moments. I could come up with no answer; I had no control over the awakenings nor their dreadful consequences.
It was at a sleep disorder clinic later that year, tucked into the stiff hospital bed in the lab, my head adorned with a bevy of electrodes, that I discovered yet another variation my sleep disturbance takes. I had noticed that on certain days my normal sleep-loss symptoms were stronger; I was unusually wired, depressed, uncomfortable in my own skin. Upon awakening, my jaw was clenched, and strangely, a song ran through my head-- sometimes one heard recently, sometimes old and forgotten. In addition to their familiar burning, my eyes hurt when moving my gaze from one object to another. My sleep on the preceding nights, according to the electroencephalograph machine, was “alpha-delta," a/k/a the more descriptively appropriate “non-restorative." That means that when I should have entered Delta, I ascended back into alpha and missed the deep, physically rejuvenating portion of the cycle. There were six patients in the clinic with this distorted sleep pattern, and we all, without any meetings or discussions, reported the same complaints.
Some experts feel that alpha-delta sleep is stress-related, but within the constancy of my stress-filled life, it occurs sporadically, without specific instigating factors, and I could find scant literature to explain why or to head it off. I did learn, on a recent sleep clinic visit, one avoidant tactic.
I should soak, the director told me, for one-half hour, in water as hot as I can stand it, two hours before going to bed. The heat will cause my body temperature to rise, thus, the thrust to reduce it will bring it down to a level that allows sounder sleep (as noted before, temperatures drop as sleep progresses). Unfortunately, the treatment for alpha-delta conflicts with the following advice for deterring early awakenings.
Keep a log, for two weeks, of hours slept. Add, then divide the total by the number of nights, which will be fourteen. This answer constitutes your average. Let’s assume it’s five. Choose a wake-up time, say, for example, seven o’clock. Count back the number of hours slept per night, which will take you to two o’clock. This is your new bedtime; honor it, no matter how sleepy you are. Always arise at seven, even if, by some miracle, you could sleep longer.
The idea is to continue this practice nightly, with the hope that your sleep will eventually extend to reach your selected wake-up time. Once it has done so for one straight week, set your bedtime back one half hour per week, until you have reached the desired number of hours of sleep per night.
Ironically, my time to sit in the tub matches that in which my urge to sleep is strongest; those hours from ten to twelve, in which I must fight the sleep I so desperately need, are those in which I can be assured of drifting off. The hot water makes my grogginess more intense; I have a stack of books rumpled and swollen from being dropped into my purported healing spa, the splash jolting me back to consciousness.
Many find it inconceivable that I cannot lick this affliction-- with will, or by: drinking warm milk; taking some bottled remedy; thinking positive...fill in the blank. They may believe that the extent of my sleep loss is exaggerated. “You probably sleep more than you think," they conclude. One acquaintance said disdainfully, “I stayed up until three this morning," thinking her singular intentional short night commensurate with my endless enforced ones. Some will see me yawn and say, “Oh, that’s a good sign," not realizing that the logical progression of sleep following drowsiness does not exist-- not for me.
In my various psychiatric forays, I have been declared depressed. The question in my mind then is, “Do I not sleep because I am depressed, or am I depressed because I do not sleep?" I have reason to answer “yes" to both questions.
In The Promise of Sleep, renowned pioneer in sleep medicine William C. Dement, M.D., Ph.D. (1999), says that “...the general problems of sleep deprivation and of mood among normal individuals need much more attention.... Sleep-deprivation studies have shown consistently that sleep-deprived subjects are more irritable, more volatile, and more depressed than control subjects."
Three British psychologists say that early bereavement is a source of depression. Antonio Bifulco, Tirrill Harris, and George Brown, determined that “the loss of the mother before the age of seventeen years, either by death or separation for a year or more, doubles the risk of depressive and anxiety disorders among adult women."
An American psychologist, Camille Lloyd, says so, too, in “Life Events and Depressive Disorder Reviewed." She cites studies that compared the incidence of childhood bereavement or other childhood loss among depressed patients and controls; most found an increased incidence among the depressives. “The childhood loss of a parent by death," she postulates, “generally increases depression risk by a factor of about two or three."
Concurrently, I have been advised by consulted professionals that the persistent nature of my disorder may stem from a combination of the incessant sleep deprivation of my youth and a resurgent depression that replays with trauma or events that produce anxiety. The latter happens, one suggested, because a depression that accompanies a life crisis or loss alters the brain’s chemistry, imprinting its reaction, is then easily repeated when something else upsetting occurs.
Did my loss at thirty-three send my brain on a path of no return-- a replay of my mother’s death perhaps, a now well-worn path of anxieties born out of the blunders of my youth?
There is no precise conclusion, only faint hope that tomorrow will forge a new path, traveled bright-eyed, devoid of daytime grogginess, inertia, and the fear I entertain each day that I might never sleep again.
Tamara Shaffer's work has appeared in various publications, including Woman’s World, Chicago Tribune, Chicago Reader, Chicago Sun-Times, Interrace, The Bulletin, Futures, Today’s Chicago Woman, Streetwise, Phoebe, Chicago Life, New City, True Confessions, and Vital Times.
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