This is a running blog, but this post isn’t about running. It’s about insomnia. If you’ve read many of my race reports, you’ve probably read at least one that mentioned trouble sleeping the night before a race. That’s a common problem. Lots of runners get keyed up the night before a race and can’t get to sleep. For me, it’s a chronic problem. It’s worse before races, but it’s something I deal with other nights as well.
In my “Goals for 2016” post, I mentioned that I’ve been taking Benadryl to help me sleep. That’s just the most recent chapter in a long story. Here’s the whole story.
I don’t recall having any difficulty sleeping as a child. It’s a problem that developed later. When I was young, I fell asleep quickly and slept through the night. The earliest I can recall having trouble getting to sleep is when I was in college. I used to listen to music to make it easier to get to sleep. Listen to music distracted me and helped me relax. I could lose myself in the music, which helped me to stop thinking about whatever else was on my mind. Then I’d eventually fall asleep.
By the time Deb and I got married, I no longer listened to music to fall asleep. Insomnia was sometimes a problem, but once I fell asleep, I would sleep through the night. If it took longer to fall asleep, I just didn’t get as much sleep that night. When I was young, I could more easily shake off a poor night’s sleep.
Normally, your need for sleep decreases with age. Running made things more complicated. In my late 30s, I started doing ultramarathons. I was training year-round. I was training seven days a week. My body needed more sleep to recover. Now, if I didn’t get a full night’s sleep, I felt sluggish. If it happened two nights in a row, I felt really run down. If it happened three consecutive nights, I’d get sick.
Over time, my sleep disorder took on three distinct dimensions. First, I can only sleep in a carefully controlled environment. If there’s too much noise, it keeps me awake. I’ve learned to cope with this by wearing ear plugs. The ear plugs shut out most background noise. Now only loud noises will keep me from sleeping. I also can’t sleep if there’s too much light. I can usually cope with this by wearing a sleep mask.
My biggest problem is temperature. I can’t sleep if I’m too warm. By too warm, I don’t mean summer heat. What most people consider a normal room temperature is too warm for me. I need a cold room and bedding that isn’t thick. At home, I sleep in the basement, where the temperature is several degrees cooler than upstairs. In hotels, I need to use the air conditioning.
When I spoke to a doctor about this aspect of my sleep problems, he didn’t regard it as a disorder. This comes under the heading of individual variation. His recommendation was to be aware of the environmental factors that affect my sleep and find ways to control each one. I was already doing that. At home it’s not a big problem. I have a consistent sleep environment every night. Controlling the sleep environment in a hotel room is much more difficult.
Besides being easily kept awake by distractions, I’m also a light sleeper. There are different stages of sleep. Some are deeper than others. It’s normal to alternate between light and deep stages. When I’m in a lighter stage of sleep, I often wake up. For me, it’s normal to wake up several times per night. That’s OK, as long as I can get back to sleep quickly. Unfortunately, I sometimes have trouble getting back to sleep. If you have trouble getting to sleep, and you have to fall asleep several times per night, you have lots of opportunities to lose sleep.
I’ve also discussed this with a doctor. Again, this isn’t really a disorder. It’s just individual variation. Thousands of years ago, being able to wake up quickly in times of danger was an important survival mechanism. Apparently, I have traits that would help me survive in the wilderness. For me, that’s not terrible useful.
The third dimension is my sleep difficulties really is a sleep disorder. I have trouble relaxing my mind so I can fall asleep. I’ve often compared my brain to a radio. I can change the channel at will, but I can’t turn it off, and I can’t turn down the volume. This mental “noise” can keep me awake for hours. Unlike my other problems, I had no easy way of coping with this one. Every time I woke up during the night, there was a chance the “radio” would turn on and keep me from getting back to sleep.
When I discussed this last aspect with a doctor, he noted that people with anxiety often use the same analogy. I do sometimes have anxieties, but I don’t have to be worried about anything to have difficulty sleeping. I latch onto the last thought to enter my brain. It might be something as simple as getting a tune stuck in my head.
In the late 1990s, my insomnia began to interfere with my life in a big way. At the time, I was taking night classes. I was working on a master’s degree in software engineering. I was about halfway through my curriculum, and I was putting a lot of pressure on myself to get straight A’s. I had a stressful job by day, and I was taking two classes in the evenings. I got so wound up that I couldn’t sleep. After two completely sleepless nights, I had to call in sick. The next night, I had trouble sleeping again. I called in sick for a second straight day. Realizing something had to give, I met with my boss and project manager. I quit school. After that, I was once again able to get enough sleep to function at work. I never completed my master’s degree.
Over the years, I tried different things to make it easier to sleep. I tried self-medicating with melatonin. I also tried Benadryl. My doctor told me he could prescribe something if it got worse.
Eventually, it got worse. About 11 years ago, I was under a lot of stress, and I was only getting 2-3 hours of sleep per night. My doctor prescribed Trazadone, which is an anti-anxiety medication. It worked. It was like having a button to turn off the radio. I could turn off all thoughts and fall asleep.
One of the problems with a medication like Trazadone is that you can build up a resistance to it. Over time, I had to increase the dosage. Twice. I didn’t want to be on a prescription anti-anxiety drug for the rest of my life, so I asked my doctor if there was something else I could take. He had me try Ambien. Ambien worked, but it wore off about halfway through the night. Then I’d wake up, and I wouldn’t get back to sleep. There was a time-release version of Ambien, but it wasn’t covered by my insurance. I asked my doctor if there was something else I could try. He prescribed Clonazepam.
Clonazepam is another anti-anxiety drug. It’s actually a stronger drug than Trazadone. I had reservations, but started taking it. It worked great for quieting my mind, but it didn’t actually make me drowsy. It helped if I followed a consistent routine and went to bed at the same time each night. Even still, I sometimes had trouble getting back to sleep when I woke in in the middle of the night. Unlike Trazadone, I never had to increase the dosage. Instead, I started taking Benadryl again. In combination, the two drugs helped to get to sleep quickly and then get back to sleep each time I woke up during the night. My doctor was OK with that.
Every so often, I had to get a new prescription for Clonazepam. I was on it for years. Then I started seeing a different doctor. He was concerned with how long I had been taking Clonazepam. It’s a strong drug, and it’s not a good idea to be on it long-term. Unfortunately, it’s extremely habit-forming. If I stopped taking it, I might not be able to sleep at all for days. That’s also not a good idea. He wasn’t sure if there was something else I could take, so he sent me to a sleep clinic. Before making any recommendations, they wanted to do a sleep study, to collect data about how I sleep.
There are many types of sleep disorders. Many years ago, when I referred to my condition as “insomnia,” Deb tried to correct me. She thought the correct term was “sleep apnea.” She checked out a book on sleep disorders. I learned that sleep apnea refers to a specific sleep disorder, which involved irregular breathing. People with sleep apnea are able to fall asleep, but interruptions in their breathing cause them to abruptly wake up. Insomnia, while sometimes used as a generic term, refers to different sleep disorder, involving difficulty falling asleep. I was pretty sure insomnia was the correct term for my problems.
When I had my first consultation with a sleep specialist, she seemed to assume I had either sleep apnea or another sleep disorder called “restless leg syndrome.” One of the symptoms of restless leg syndrome is sudden jerking motions during light sleep, which can wake you up.
For my sleep study, I slept at the clinic. I had all kinds of electrodes and other sensors hooked up to me. The technician could monitor my breathing, my eye movements, my brainwaves and whether I moved my legs. Getting to sleep with all those wires wasn’t easy. If I don’t fall asleep right away, I tend to toss and turn. Turning from one side to another while I was hooked up took care. That made it even harder to fall asleep. I didn’t get a lot of sleep, but I fell asleep in a few different positions, and they were able to get data for different stages of sleep.
My breathing is textbook. I don’t have any irregularities when I sleep. I don’t have sleep apnea. I also don’t have restless leg syndrome. While I’m asleep, I remain perfectly motionless. There was nothing abnormal about how I sleep. I just have trouble getting to sleep. I have plain vanilla insomnia. It’s not very common, but that’s what I have.
Next, we talked about what things can keep me from getting to sleep. With respect to controlling my sleep environment and eliminating distractions, I was doing all the right things. I was told to keep sleeping in a cold environment, keep wearing ear plugs, and keep wearing a sleep mask. With respect to quieting my mind, they advised following a consistent evening routine and always going to bed at the same time. Those things usually work. If I can’t get to sleep quickly, it’s usually because I have something on my mind. Clonazepam was an appropriate medication, but they agreed I shouldn’t stay on it any longer. In the short term, I needed to wean myself off it very gradually, so I wouldn’t have severe side-effects. In the long-term, I needed to learn other ways to control anxiety, so it wouldn’t keep me awake.
I reduced my dosage of Clonazepam 25% at a time. I alternated between a full pill one night and a half pill the next night. At first, I had trouble sleeping on the nights I took a half pill. Sometimes I also had diarrhea. That’s a withdrawal symptom. Eventually, I stopped having withdrawal symptoms and my sleep became more uniform.
I kept stepping down the dosage. Next I switched to half pills every night. Then I cut back to half pills every other night. Eventually, I only took half pills on nights I was wound up. Usually that was the night before a race. Finally, I was able to stop taking it completely.
I’m getting better at managing anxiety. More often than not, if I’m too wound up to sleep it’s because I’m worried about not getting enough sleep. That becomes a self-fulfilling prophesy. I’m most prone to those worries if I have to get up unusually early. If I have a small sleep window to begin with, and I don’t fall asleep right away, I get more and more wound up. I can lie awake for hours. This is most likely to happen the night before a race.
Before a race, I’m usually sleeping in a hotel, so it’s harder to control my sleep environment. Sometimes the air conditioning is inadequate to cool the room down. Sometimes the pillows or duvet covers are too thick. Sometimes it’s too noisy. Race mornings are the mornings I’m most apt to have to set my alarm early. Race days are the days I’m most concerned about the consequences of not getting any sleep.
It’s taking time, but I’m learning to control these anxieties. I know from experience that I can race well with only an hour or two of sleep. I know it’s possible to race well even without any sleep, although it’s not my favorite thing to do. Knowing that, I tell myself that it’s OK if I don’t fall asleep right away. As long as I fall asleep eventually, I’ll be all right.
I’m getting pretty good at falling asleep initially, but there are still nights when I wake up during the night and have trouble getting back to sleep. The longer it takes to get back to sleep, the more wide awake I feel. I tell myself to have faith that I’ll get back to sleep eventually, even if it takes a couple hours. I usually do. Knowing that makes the self-talk more reassuring. I’m now confident that if I’m patient enough, I’ll eventually get back to sleep. I’m also confident that I’ll be OK even if I don’t get back to sleep. The more I believe my reassuring self-talk, the more it works.
I’m completely off Clonazepam, but I’m still taking Benadryl. I also developed a dependency to that. It’s not a strong medication, but I’ve been taking it for years. If I skip a night, I can’t get to sleep at all. I’m attempting to wean myself off it just like I did with the Clonazepam. So far, it’s working. I’m currently taking half a pill each night. I can’t say I’m sleeping great, but I’m getting enough sleep to get by. When I adapt sufficiently to half pills, I’ll see if I can sleep with no pill.
It helps that I’m home for two months. I sleep much better at home than I do on the road. It also helps that the days are shorter at this time of year. I’ve always been sensitive to daylight. In summer, I can’t get back to sleep once the sun comes up. In the winter, it’s easier to sleep late. This morning, after one of our cats woke me up, I managed to get back to sleep, and I slept until 8:00. I could never do that in the summer.
I envy people who can takes naps. It’s almost impossible for me to sleep during the day. I’ve done 24-hour races where I not only didn’t sleep during the race, but couldn’t sleep after the race. I had to wait until it got dark again. This is one of the reasons I stress about getting enough sleep at night. I can’t make up for it with a nap. I don’t get another chance until the next night.
I mentioned earlier that you need less sleep as you get older. That’s now working in my favor. When I was in my early 30s, I needed eight hours of sleep to feel refreshed. The average person needs seven and a half hours, but that varies quite a bit from person to person. When I took up ultrarunning, I needed more sleep. For a while, I was needing closer to nine hours. With age, that’s gradually decreased. Now I do fine with seven hours. I sometimes get by with five or six.
If you’ve never had insomnia, count your blessings. If you have, maybe you can learn something from my story. Or, if nothing else, maybe reading it will help put you to sleep.