Monday, March 2, 2009

Topic of the Week: Insomnia-- My Life As A Zombie

This week is National Sleep Awareness Week, so I decided to make insomnia the topic of the week on my blog. I haven't done a topic of the week before, but insomnia seemed like a good thing to start with. If you know me or having been reading my blog for a while or following me on twitter, no doubt you've heard me complain about my insomnia. And I keep saying, "Someday I'll write a blog about it." Actually, I could probably write a memoir about it... though I'd like to resolve the insomnia problem so I'd have an ending for that book. For now, topic of the week will do as it will give me a few days to get in depth about my history of sleep-deprivation.

Today, let's start with an overview. We'll get into discussions about Ambien, hypnosis, and acupuncture later this week.

My life as a zombie began at thirteen. I’m not talking about the kind of zombies I blogged about over at Amanda Ashby's blog/cyber launch party last week. My brains didn’t get munched or anything. I’ve just felt like a zombie since the fall of 1992 because that’s when my insomnia started.

Approximately 70 million Americans have either chronic or intermittent sleep problems. We have busy lives and more to worry about every day. Worrying was the main thing that kept me awake at first. My first major bout of insomnia came the night before eighth grade started. My best friend had moved away over the summer and all I could think about was how I’d have an even harder time fitting in than before. I’d worry, get up for a drink of water, worry some more, toss, turn, realize I had to pee because of the water, and then the cycle would begin again. It lasted all night. I think I fell asleep an hour before my alarm clock went off.

This is still the pattern of my worst nights (though now I keep water beside my bed and try not to drink much of it to avoid the peeing). Those nights I get an hour or two of sleep. My best nights involve tossing and turning for a couple hours, falling into a light sleep for a while, waking up, and repeating the whole process. I get six or seven hours of sleep on my best nights, except for once every week or two when I totally crash and get a solid nine hours.

I’ve tried just about every “fix” imaginable over the years. I started with "good sleep hygiene," which admittedly I've never been all that great at. It seems impossible to go to sleep and wake up at the same time every single day. As a teen, my bedroom was my haven so I did everything there, though now I'm better about that. I also indulged in caffeine and nicotine a lot as a teen, though I don't now, other than my morning tea. And try not to worry in bed... ha ha! But I tried my best and when that failed, I started medicating.

First, my mom suggested Benedryl, the allergy med with side effects that make you sleepy. She's worked the night shift as a nurse for years and it always worked for her. Not me. Unisom and all the over the counter crap didn't work either. I didn't fall asleep any faster and when I did, I felt totally groggy and hungover. By junior year of high school, I was dealing with depression and the fall out of the abusive relationship, so I was prescribed low doses of anti-depressants to help with my sleep troubles. Those didn't work. So my doctor suggested herbal remedies. Valerian helped a little bit for a while, but then it stopped. My first semester of college, I took the extremely unhealthy approach of drinking till I passed out. When I came home for winter break, my friend Tai told me about a pill she'd been prescribed called Ambien—the drug that is now famous for sleep-driving and sleep-eating incidents.

Ambien deserves its own blog entry so we'll talk about my first experience with it tomorrow. But it was the first thing that worked solidly and on January 9, 1998 when I was eighteen years old,I went to my doctor and requested a prescription. At the time, doctors seemed to think it was a miracle pill, no nasty drug hangovers like sleeping pills of yore, and I was told repeatedly, “It’s non-habit-forming!” My doctor didn't blink at continually refilling my prescription and slowly uping the dosage from 10 mg to 15 mg to 20 mg. Sometimes she supplimented the Ambien with other drugs like Sonata and Lunesta. Those would work for awhile than stop. Ambien continued to work as along as I upped the doseage. Right after September 11th, 2001, when I imagine a lot of Americans were filled with anxiety, I was taking 30 to 35 mg of Ambien a night. No one was concerned about this except my mother, who'd been uncomfortable with the thought of me taking sleeping pills and/or anti-depressants and anti-anxiety meds all along.

When I had a sleep study done in spring of 2002, the doctor asked me, “But why do you want to stop taking Ambien? You could take it forever and it would never hurt you.”

I replied, “Because it’s expensive and when I turn 23 this summer I won’t have my mom's insurance coverage anymore. That's why we are doing the sleep study.” (I was in grad school at the time and was about to have really crappy student insurance.)

The overnight sleep study at Evanston Northwestern Hospital was a last ditch effort to resolve my sleep problems before the insurance ran out. It cost well over a grand, but fortunately insurance covered it. Otherwise I would have been really pissed because, guess what, they discovered nothing. I didn't have sleep apnea or restless legs. I had general insomnia. Their only solution was medication. They actually had the nerve to recommend that I go on an extremely expensive (three times the amount of Ambien, which I already couldn't afford) anti-seizure medication that had the side effects of sleepiness. My mom, fortunately, put her foot down. She would later be vindicated when paging through one of my brother's law magazines years laters and finding out about a class action suit involving that drug.

Desperate, I tried hypnosis. Again, this deserves it's own blog post, but the results were, I got down to 5 mg of Ambien, but wasn't able to sleep soundly without it. My psychologist had recommended the hypnotist and when that failed, he found a psychiatrist doing studies on different sleep meds.

This doctor was the first to be upfront and honest with me: Western medicine has no idea how to treat general insomnia, which he told me was what I had. We talked about my history of depression and how it started around the same time as my insomnia when I was 13. He admitted that the insomnia could have caused the depression or vice versa. But now that I was depression-free, obviously the insomnia was it's own beast. How did we treat said beast? You guessed it, with more drugs! Fortunately, since I had crappy insurance, he treated me for free, as part of his research. I was also given sample drugs. There was the new longer-lasting Sonata and the new Rozerem, which he was very hopeful would work with me. It didn't. Not as well as Ambien at least. We also tried some different anti-seizure meds, which worked to get my Ambien dose down, but never got me completely free. 

Desperate because Ambien was so expensive, I tried some older sleep meds on the recommendation of both the psychiatrist and my regular doc. Halcion (which I just found out when googling it to check its spelling, Jeffery Dahmer used to sedate his victims) caused side effects similar to the horrible comedown I had the one time I did acid. And I admitted this to my mother when I woke her up, freaking out over my racing heart, dry mouth and weird hallucinations. Restoril gave me a drug hangover that left me feeling as strung out as I felt on codeine when I got my wisdom teeth out. Last but not least, was chloral hydrate... you know the stuff you pour in someone's drink when you are "slipping them a mickey." Well, that didn't work on me at all except by upsetting my stomach the next day.

Ultimately I just continued to charge Ambien on my credit card until I got a real job with real insurance.... and of course right around then is when Ambien finally went generic. Sigh.

But I did have to change doctors when I got my real insurance, since I needed someone who accepted HMO. My mom was pretty glad I had to switch since she felt my doctor had really let us down by letting my Ambien use go on for so long. When I talked to my new doctor, she wrote me an Ambien script, but advised acupuncture, saying "Really, Western Medicine doesn't do shit for insomnia." She actually swore. This is why I like her.

Before I tried acupuncture, I tried meditation. 2007, I made it my New Years resolution to get off of Ambien. After all, I'm very picky about what goes into my body. You know, I'm vegan and I quit smoking because I didn't like being slave to something that was bad for me and Ambien really felt like the same thing. My pilates instructor was kind enough to make me some recordings of meditations she did when going through cancer treatment. As usual, they worked sometimes better than others, but never as good as the Ambien. My resolution failed that year, so I bid on acupuncture treatment at a silent auction for a charity organization that Christmas. 

I won and scheduled my appointment for soon after New Years 2008, swearing again that this would be my year to get off the stupid sleep meds. Acupuncture will also get it's own blog, but right away I knew I liked it, but I need to find a practitioner closer to home. Fortunately my pilates teacher knew someone and she turned out to be perfect. Of course we both agreed that I needed to be off the Ambien for the acupucture and herbal remedies to work.

At that point, I’d been taking Ambien for ten years. The sleep study doctor among others swore to me that I wouldn’t experience withdrawal when I stopped taking it, “just a little kickback.” That “little kickback” actually translated to no sleep for almost an entire week. I’m not even exaggerating. 

But acupuncture worked. I was sleeping like a normal person for almost a month. Then a good friend was killed in a motorcycle accident last June and I haven’t slept the same since. My acupuncturist has been trying to get me back on track, but I'm still struggling. I'm proud to be off of Ambien (though I have a supply of it for really stressful nights or times when I have to get up and be functional super early). It helped to quit my 9 to 5 and be able to go to bed during the time that my body dictates, which is more like 2 am to 10 am than 11 pm to 7 am like the workaday world dictates. And I'm still holding out hope that one night I’ll lay down, drift off effortlessly, and stay asleep all night and it will keep happening night after night, week after week. 

So tomorrow, I'll tell you more about my struggles specifically with Ambien. I really do think that drug is evil and believe that if I'd combined therapy with acupuncture back when I was 18, I might be sleeping normally now.

But what about you? Are you the one in ten of who struggles as hard to sleep as I do? Or are you the one in three who gets less than six hours of sleep each night during the work week? (You need seven to nine! You may think you don't, but seriously, medically, that is what your body needs. Period.) Or do you drift right off like my fiance who I'm terribly jealous of?


Liviania said...

I must admit, I get at least eight hours of sleep a night and I can drift off anywhere, anytime. I'm afraid people who don't know me well suspect I'm narcoleptic because when I'm tired I make myself comfy, clutch my belongings tight, and go to sleep.

Natalie Hatch said...

My insomnia is caused by my twins getting up in the middle of the night. I haven't really experienced it like you have. I wonder if stress is at the root of all this how you would treat it?

Erika Lynn said...

I have very strange sleeping habits. I have always been more of a night person and I also tend to sleep more like 2-10. I can also function on very little sleep without it seeming to bother me. I have always had trouble falling asleep, i have to have music or the tv on. My problems don't seem nearly as bad as yours but I definitely have some sleep issues