Yet another Insomnia question, with an extra helping of Anxiety

October 30, 2020 1:59 AM

I've recently been experiencing bad insomnia. I need to know if there is hope! Is this something that might come right, or do I need to make an appointment with my GP or my therapist? Making appointments are expensive so would like to avoid if possible. Sorry for the length of this post :/

I've never been a very good sleeper, but managed fairly well up to now. But I fell down a really bad anxiety hole during our hard lockdown (I'm in Cape Town, South Africa, in case that is relevant). Lost a scary amount of weight. My GP prescribed Stresam, and I started seeing a therapist and have improved a lot since then, although am still struggling and I'm pretty sure that's the root cause of my current bout of insomnia.

I had Covid in mid September and still get the dizziness and post viral fatigue depression, although I am a lot better. I have to stop taking the Stresam (you're not really supposed to take it for more than 3 months, although my GP says it's not addictive and doesn't have withdrawal symptoms). I tapered it off gradually as I developed a strong fear that going off the medication might put me back into the worst of my anxiety.

I stopped taking Stresam completely about 3 weeks ago. My sleep got gradually worse as I lowered the dose. I also had a pretty bad stomach bug last week that kept me awake running to the toilet all night long. I have recovered from the stomach bug, but the insomnia has remained.

I can usually fall asleep OK when I go to bed, but now I wake up at about 2:30 and from then on it's difficult to sleep. I startle awake every time I start nodding off. And no, I'm pretty sure it's not sleep apnea as I don't fit any of the other symptoms and this startling awake thing is apparently a pretty common anxiety symptom.

Following the advice of my therapist, when I wake up, I get up and go do something soothing like reading a book until I feel sleepy again, then come back to bed. I wear ear plugs to cut out sound. I have the bedroom as dark as possible. I often listen to the Yoga Nidra meditation which helps me calm down a lot. I used to get bad adrenaline rushes when I wake up but I think I have those under control now. I have been trying very hard not to get anxious about losing sleep and being incredibly tired during the day but being so tired tends to aggravate any feelings of depression and anxiety that I have already.

I don't nap during the day, as I believe that will throw off my sleep cycle, but I do take time to sit quietly and rest. I have a hard time doing that! I'm very keyed up a lot of the time.

I meditate every day. I don't drink any caffeine. I don't drink alcohol. I've even stopped eating dark chocolate or drinking cocoa. I don't eat a lot near bedtime. I have a regular sleeping time and soothing go to bed routine so I'm always quite calm when I actually go to bed. I take calcium and magnesium at night. I don't use my phone close to bed time, although I do watch (soothing, non scary) shows until about half an hour before I go to sleep.

I get a fair amount of exercise every day, walking or cycling. For my depression and anxiety, I try my best to get as much social contact as I can, but it's tough. My husband is an absolute life saver, but when he's at work I'm alone for most of the day. I got myself two pet rats which does help. I'm not ready to get another dog again as I'm still grieving my beloved Pippin who died a year ago.
I've started volunteering at an animal shelter, but that comes with its own stresses so I'm not sure if I'll continue doing that (had to deal with a dog fight where somebody got badly bitten, and the other volunteers don't always do the social distancing mask wearing thing very well).
I've joined a program to mentor young writers, which is another bit of social contact at least.

I have been resisting seeing my therapist again as I feel like she's heard all of this, and given me the advice she can give me, which I'm trying to follow. She tends to do a lot of BRT which I'm not really sure works for me. And I don't want to see my GP as I'm worried she'll prescribe some other pill that I will get psychologically dependent on again as I did with the Stresam. Also, appointments are expensive.

Is it irresponsible of me to want to push through and see if this will just come right with time? My anxiety makes every single little thing seem Incredibly Important and Potentially Dangerous If I Don't Do All The Things and I'm so tired of being so focused on myself and my emotions all the time.

I suspect a lot of it has to do with my needing to be patient and accepting of my own symptoms, rather than expecting myself to be able to snap back to perfectly normal already. I had a look at the other question on here about resources for self acceptance, am hoping those will help too.

Any advice much appreciated.

posted by Zumbador to Health & Fitness (11 answers total)

It sounds like you’re doing everything right but I’ve read that getting sunlight into your eyes before 10am can really help your brain produce melatonin at night. Maybe make sure you’re doing that?
posted by pairofshades at 2:09 AM on October 30, 2020 [1 favorite]

You're still on the heels of going off a med and being sick, and sometimes it takes time to bounce back. Letting it go for a while and seeing how it turns out is not a terrible idea.

Of that ends up not working, there are still plenty of things you can try, such as sleep restriction. So you can "rest easy" knowing that even if it doesn't sort itself out on its own, there are other options.
posted by metasarah at 6:51 AM on October 30, 2020 [1 favorite]

Ugh, insomnia is the worst. I've also been suffering from it on and off. I've noticed that the less I think about it, the better--worrying just worsens things. If there are ways you can distract yourself if you start thinking about it, I think that might help. There are also some online CBT-I programs that are supposedly helpful, like SHUTI.
posted by pinochiette at 7:03 AM on October 30, 2020 [1 favorite]

I spent way too long falling asleep okay, waking up at 2 a.m for about four hours, then falling asleep again for just long enough to feel like a bag of dirt when the alarm went off 20 minutes later. For me, the answer was hydration. It sounds ridiculously simple, but for me it's magic. And I mean *lots* of water. Just not too late into the evening. But even now, if I wake up for a pee, I fall asleep again quickly. There was a recent question about hydration and muscle cramping with lots of suggestions for supplements to help with that, but it's never been an issue for me. I hope this is the simple fix for you that it was for me. Good luck!
posted by kate4914 at 7:28 AM on October 30, 2020 [1 favorite]

Make sure you also set an alarm to wake you up at the same time every day, including weekends, and never allow yourself to sleep past this alarm. (Unless you're ill, but then you have to get back on track once well.)

Upon waking, go outdoors for sunlight or use a blue light (for seasonal affective disorder) for 10-15 minutes.

If possible, when you are watching those shows before bedtime, use a device that can be set to nighttime mode with warm-toned light.
posted by xo at 9:06 AM on October 30, 2020 [1 favorite]

My treatment and medication regime differ from yours, but perhaps I can share the benefits of my own experiences: I think you're doing most of the right things for sleep hygiene and setting yourself up for success when you try to sleep. It just isn't enough. I know you're concerned about Yet Another Pill, but that's sort of the point of medication: to help your body when it's not successful being healthy on its own. Doing all the right things and still not succeeding should be a sign to you that you need additional support on this.

I've brought the subject of my difficulty with sleep in front of my mental health doc repeatedly. While my treatment is different from your own and my attitude around medication is also a little different, it's been valuable for me to have my mental health person in my corner on tackling this problem. She has been open to making medication and treatment changes in hopes of finding something that works, is sustainable, and makes me feel healthy.

I suggest you bring this to the doc. You shouldn't have to "push through" anxiety in hopes of an uncertain reward on the other side of it, suffering when there are supports available.
posted by majick at 9:22 AM on October 30, 2020 [2 favorites]

Try melatonin. Start with 5 mg one hour before bed, and increase daily by 5mg until it works. Idk about South Africa, but in the US you can get it cheaply over the counter.

You could also try a low dose of Trazadone, which is a different non-addictive prescription medication for insomnia. It's short acting, so if you wake up in the night you can take it then, though I usually find if I take it at bedtime I sleep through my usual 2am cortisol spike.
posted by ananci at 10:28 AM on October 30, 2020

You should definitely talk to your therapist about this, specifically about whether she can give you some exercises to relieve some of the pressure about sleeping that's going on in your head.

Your sleep hygiene sounds good, but from personal experience with anxiety related insomnia, it might actually be detrimental to actually getting some sleep. How much time would you say you spend worrying about doing sleep "right"? How much of your routine is made up of things that actually help and how much of it is advice you're following because it's supposed to help? One critical aspect of CBT for insomnia involves unpicking what usually has become performance anxiety about the act of sleeping, which can be exacerbated by building up huge expectations and failing at them ("I'm doing everything right, why aren't I sleeping?" etc).

For me, I actually started sleeping again when I ditched all of that stuff and focussed on what I actually knew helped me. I stopped being totally rigid about what I brought into the bedroom and tried to make it a safe, relaxing space where I could "fail" without pressure. When I laid down, I stopped saying "I need to sleep" and started telling myself "it's okay if I just lie here with my eyes closed, I'm still resting, this is still good for me". Bizarrely, telling myself I was just lying down for a nap worked wonders. I had created so many worries about Being Good At Sleep and the insomnia itself that once I stripped those away, it helped a lot.

YMMV of course, but worth thinking about. I hope you find something here helpful, it's a totally annoying (and TOTALLY temporary) thing to deal with!
posted by fight or flight at 10:34 AM on October 30, 2020 [1 favorite]

I don't think this is just a sleep problem, it's an anxiety problem, that has likely been worsened by covid!. This is exactly what I was like before I was diagnosed with panic disorder/generalised anxiety. The starting awake/adrenaline at night etc. was, for me, the build up to night panic attacks. I also gave up heaps of different foods. I exercised and did everything 'right,' everything the dr. told me to do. I actually think the giving up of foods is a symptom of anxiety. It definitely was for me.

You don't say whether you're on meds for anxiety but the only thing that helped me was getting on escitalopram, which I have now been taking for years. I have 2 coffees a day and chocolate after dinner. Most nights I sleep like a baby, though of course that took time. (I'm still anxious about covid and the general state of the world, but it doesn't tip over into panic anymore.)
posted by thereader at 12:26 PM on October 30, 2020 [1 favorite]

I think you're doing most of the right things for sleep hygiene and setting yourself up for success when you try to sleep. It just isn't enough. I know you're concerned about Yet Another Pill, but that's sort of the point of medication: to help your body when it's not successful being healthy on its own. Doing all the right things and still not succeeding should be a sign to you that you need additional support on this.

This is my feeling. And anxious people are often really concerned about medication, but sometimes it can be the reset button you need to help the anxiety stay away so you can get enough sleep to be able to have the emotional toolkit to properly regulate your anxiety. I've had a few up and down weeks since COVID times and right now I'm managing a toothache that has me spiraling (What if it gets WORSE??) kinda of things and honestly, this is what I have the "as needed" pills for. Having a "dumbo's magic feather" (that actually works) for when you really need it can help anxious people balance all the things in their lives that require them to get some decent sleep.
posted by jessamyn at 4:46 PM on October 30, 2020 [1 favorite]

Response by poster: Reporting back in case this helps anyone in the future.
I ended up seeing my therapist again, and it was the right thing to do. I've been having weekly sessions and it has helped me enormously. Not so much to solve the insomnia, although I think I am making some progress there. We are focussing more on getting my anxiety under control, and hopefully that will also help with the insomnia.
posted by Zumbador at 3:22 AM on November 27, 2020 [1 favorite]