It's 3 A.M. -- Expert's Insomnia Cures Fail

Losing a night's sleep over losing a night's sleep happens to me multiple times a month. I get locked in a mental spin cycle of to-do lists and accounting. So mundane and yet frustratingly mind-griping.

I take Ambien way more often than I admit to anyone. When I get brave and forgo it, I toss and turn and sometimes pop a pill with disgust at 4 a.m., knowing I'll be a wreck the next day. I would be anyway.

"Insomniacs can't turn their minds off," says Michael J. Sateia, M.D., director of sleep medicine at Dartmouth Hitchcock Psychiatric Associates in New Hampshire. "[More women] struggle with it. Low-level anxiety and sleep issues work together in a self-perpetuating cycle. Little sleep means daytime impairment. You can't accomplish things, which leads to more anxiety and ruminating about tomorrow, more negativity, less sleep, impairment again."

The term "rumination" means thinking about the same things, over and over, in tiny detail, making lists, playing out scenarios, without reaching a satisfying conclusion. You'd think ruminating -- the same thoughts, over and over -- would be a cure for insomnia. Just like budgeting. Makes no sense. But don't lose sleep over it.

My pre-Ambien insomnia strategy was to attempt various relaxation techniques (quieting each body part in turn, visualize the room in minute detail, counting my breaths). Trying to relax only ratchets up my tension. "You'll only feel increased anxiety when you fail," said Sateia.

He recommended two re-habituation strategies for falling and staying asleep in bed:

Sleep restriction, or limiting the amount of time spent in bed -- for any reason. "Insomniacs associate bed with anxiety," he said. "Diminish the opportunity for anxiety. If you ordinarily spend nine hours in bed, but only six hours asleep, start out giving yourself only a six-hour window."

Stimulus control, or not laying awake for more than 20 minutes at a time. If you're still awake after 20 minutes, you have to get up and do something else for 20 minutes before you can return to bed. "The idea is to reduce the time you spend in bed awake," he said.

He warned me that I might get really tired before I habituated myself. Understatement of the year. For a week, I've been using both strategies. I get about four hours of sleep a night -- my six-hour allotment under sleep restriction, minus three 20-minutes intervals of stimulus control.

I miss my bed. Even more than sleep. I pine for chilling on it, reading the Kindle and watching TV, both of which might cause wakefulness due to the brain-energizing bright screens. (I should not be typing this post, for example.) My husband and I used to end the day by e-reading side-by-side before occasional sexy time. Lately, there's been none of that. I guess I'm not very alluring. "You really put the 'bitch' in 'habituate," he said.

During my 20-minute intervals, I sit on the couch in the living room, body swaying and then jerking upright. Tonight, I stared at the dark wall for 30 minutes, willing myself to pass out and wake up eight hours later with my cheek stuck to the leather couch by drool crust. When will sheer exhaustion fell me as if hit by a tranquilizer dart? I long for it! Sleep should be a physical process, not a mental one, and definitely not a weepy, emotional one. But if I don't get to sleep soon, I will cry.

I have to be careful that my self-pity sobs don't wake my husband. I'm a basket case on no sleep. But he's a zombie. And not a cute movie zombie-with-a-heart-of-gold either. Total brain eater.

Starting to feel a woozy. I'm going to lie down again, and try to take a Zen approach. At some point in my life, I will sleep again. Maybe not tonight. Or tomorrow. But someday.

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