Dealing with Insomnia

Something totally unrelated to RPGs, which I throw out there in case somebody finds it of use.

There was a six-eight month period in my life in which I had very serious insomnia. Throughout that time, I would sleep at best about 2-4 hours for two nights in a row, and then get a good night's sleep on the third night because I would be so exhausted I could barely keep my eyes open. The cycle would then resume. (Nobody knows better the tyranny of hope than a chronic insomniac waking up the morning after a good night's sleep.) Some nights I would have literally no sleep at all and have to go to work the next day feeling like I'd just gone 12 rounds with George Foreman. Every evening at around 4pm I would be stricken by pains in my chest, caused by the sheer dread of having to face another night of struggle. You only had to mention the word 'sleep' to me and my heart would start pounding. I was in a very bad place.

I am sure that this situation would have lasted for years if I hadn't come across Guy Meadows's 'Sleep School' approach by sheer accident when browsing in a bookshop. It took a little bit of time to figure out his system, but once I had done, it helped enormously. I still do get the odd bad night here or there - maybe once every three months or so. But when I do, I know what to do.

Most sleep therapists - there are many who post online - recognise that chronic insomnia is the result of associating being in bed with being awake. It begins because, for whatever reason, you can't sleep for a few nights. Gradually, you get more and more used to getting into bed and being awake as your brain starts to associate bed time with wakefulness. This causes frustration and anger every time you get into bed, which makes you even more alert. As a result, your brain begins to more and more strongly associate being in bed not with being asleep, but with being restless, irritated, and wide-awake. 

The remedy most sleep therapists suggest is to get out of bed when you can't sleep, in order to break that cycle. If you get into bed and can't sleep for, say, 10-15 minutes, they recommend you get up and do something boring until you start feeling sleepy, and then go back to bed. Rinse and repeat. Eventually you will fall asleep, at which point you can start trying to form a virtuous circle and re-associate being in bed with sleeping.

This approach never worked for me. I would get into bed each night practically counting down the seconds until 15 minutes were up and I could get out of bed again. And I hated getting out of bed, almost as much as I hated being in it. It was torture.

Meadows's approach is counter-intuitive. It involves embracing the feeling of being in bed and not being able to sleep. His insight - and, speaking as an insomniac in remission, it is a profound insight - is that the real problem most insomniacs face is anxiety about lying in bed, awake. If one can accept having to lie in bed, awake, then it gradually ceases to be a cause of anxiety. Once it ceases being a cause of anxiety, the anxiety itself loses its power, and one can gradually thereby begin to sleep normally again. His method, then, is not designed to help you to sleep. In fact, he strongly advises against insomnia cures which advertise themselves as helping you to sleep - at best they will become crutches that you have to rely on forever, but often they will actually just make things worse by resulting in you getting yet more frustrated at their failure to work. No - his method deploys a range of techniques designed to help you accept being in bed, awake (and also to accept being tired the next day, doo). Once you can accept being in bed, awake, and being tired the next day, anxiety about those things loses its grip, and so does insomnia as a result.

The method, then, is very simple - although meditation is indispensable to it, and you have to be prepared to do the hard miles in that regard. You go to bed like a normal sleeper (say, at 11pm). You get up in the morning like a normal sleeper (say, at 6.30am). And you stay in bed all the way through - no matter how tough that may feel at first. And you learn to accept being awake, and feeling like shit the next day. Gradually - although it doesn't take that long; weeks rather than months - you find yourself getting back into a normal sleeping pattern. All of a sudden, you find yourself sleeping every other night. Then for two good nights in a row, and one bad. Then for three good nights in a row, and one bad. And so on. Slowly but surely, you get there.

Partly this is because you are very gently depriving yourself of sleep. A big problem insomniacs face is what I described at the start of this post - you sleep terribly for two nights, but on the third night, get this blissful 12 hour catch-up binge sleep. The issue then is that because you've slept so long, you're then not tired enough to sleep properly when you go to bed the following night, and the frustration begins again. By sticking to a roughly 7-8 hour schedule, you avoid that. 

But that's not the real reason Meadows' method works. The real reason it works is meditation. When you get into a habit of meditative practice (it doesn't have to be a huge amount - 10 minutes, twice a day) your brain begins to function differently. What you begin to realise is that your conscious mind is separate from the parts of your brain that deal with emotion, memory, personality, impulse, and so on, and does not have to be bound by them. Your conscious mind can in fact stand aside from, and observe, those other elements of your psyche as they go about their business, free from their influence and control. You gain freedom of action - freedom from yourself. 

Meditation works for insomniacs not because it helps you relax and go to sleep. Far from it (and Meadows cautions very strongly against this). It works because it allows you to observe yourself becoming anxious and frustrated, when getting into bed, or lying there, awake and unable to sleep. In observing yourself feeling those feelings, your conscious mind frees itself from them and you can control your behaviour. You gain the ability to elect to stay in bed regardless of how it makes you feel. Meditation doesn't diminish the feeling. It just causes it to lose its power to dictate how your conscious mind responds.

It is important to meditate properly, and Meadows provides a range of techniques for this, but I found the old Zen trick of concentrating on breathing works best. Just close your eyes, sit still, and focus on the feeling of your breath as it goes in and out of your nostrils, or between your lips. Whenever your thoughts stray, acknowledge they have strayed, and refocus on breathing. They will stray more than once a second. This is normal. You are not meditating to relax. You are meditating to train your conscious mind to observe yourself thinking, and feeling, and in the act of observance, gain distance. Once you have distance, you will be freed from unbidden thoughts and feelings. You will still get into bed and think "Argh, another night!" You will still get into bed with your heart pounding with anxiety. But you will be able to observe those feelings and get into bed anyway - and stay there until morning. Pretty soon, you will end up falling asleep when you do.

If you do have chronic insomnia and this strikes a chord, try it. My rule of thumb: never, ever meditate in bed. The temptation is to try to use it as a relaxation device, which it isn't. Do it at set times during the day when you're unlikely to nod off. And good luck. Guy Meadows's 'Sleep School' stuff is out there if you Google it - and he has online courses and therapy sessions, although the book itself seemed to work for me on its own. Don't expect it to work straight away (although it might). Once I had started taking every element of it seriously, especially the meditation, was when it really clicked for me - after about a month. And no, I've been paid nothing to advertise!