Can an insomniac ever learn to sleep again?

From telegraph.co.uk

With lockdown condemning millions more to nightly wakefulness, Miranda Levy explains how she finally managed to get her shuteye again

Everyone knows how rough a bad night’s sleep feels – all the more so over the past year, when disturbed rest has affected half of the nation. Rates of insomnia – defined as wakefulness for significant portions of the night, for months or years at a time – have also risen sharply, from one in six pre-pandemic to one in four. It can leave sufferers feeling “like a shadow of a person”, according to Miranda Levy. The sudden end of her marriage saw her tortured by an inability to sleep for eight years, eroding her work and home life in the process: in her new book, The Insomnia Diaries, she recounts the fractured moments of rest accrued over that near-decade, and how she learnt to sleep again.

A study published last year in the journal Nature Human Behavior revealed that women have far greater difficulty falling asleep at night than men, with insomnia typically affecting those in the 45-54 age bracket worst. Those afflicted in the short term are typically diagnosed with acute insomnia, caused by a particular ailment or trauma, an unfamiliar bed or excess noise, while the 10 per cent of the population who suffer from the chronic kind experience sleeplessness lasting at least three days a week for more than three months. For Levy, now 52, one gave way to the other: when her husband of nine years announced he wanted a divorce, what she assumed might be a few anguished nights turned into “eight years of hell”.

“The problem is that the longer you’ve had a sleep problem, the less likely it is that a few generic tips and tricks will hold the key to unlocking better sleep,” Dr Sophie Bostock, founder of the Sleep Scientist, writes in the foreword to The Insomnia Diaries. Regularly struggling to get to sleep, lying awake for extended periods, feeling exhausted on waking and difficulty maintaining concentration, energy levels and even relationships are all tell-tale signs that trouble is afoot. “Sleep science is not rocket science but the sleep system does have quite a few moving parts. The longer it’s been broken, the harder it can be to twist the pieces back into shape.”

'The longer you’ve had a sleep problem, the less likely it is that a few generic tips and tricks will hold the key to unlocking better sleep'

There is no magic number for how much shuteye a person should have, but most studies pitch it around the seven-hour mark: getting fewer than six hours each night is associated with a 12 per cent increased risk of premature death, while poor sleepers see their likelihood of future anxiety and depression double. “We are only scratching the surface” of insomnia’s real impact on brain and heart health, explains Guy Leschziner, professor of neurology and sleep science at King’s College London.

The NHS advises that those experiencing periods of insomnia practise good sleep hygiene, achieved through regular bedtimes, a restful bedroom environment and a healthy lifestyle. It also suggests visiting the GP, should problems continue.

In Levy’s case this led to a prescription of sleeping pills which, according to the Sleep Charity, are regularly being taken by one in 10 adults. But the drugs doled out each year in their millions – usually benzodiazepines and zopiclones (or “Z-drugs”) – are not an effective long-term cure: there was no difference in the quality or duration of sleep among those taking them compared with people who didn’t, researchers at Brigham and Women’s Hospital found this month. Worse still many – Levy included – find themselves in the throes of addiction as a result.

Why are we so reliant on treating a restless night by reaching for the medicine drawer? “People are used to getting a pill, aren’t they?” Levy mulls of her former reliance on clonazepam, and valium. “I needed a quick fix: go to sleep, wake up, look after my kids and carry on working. I think a lot of people feel like they need [that].”

The debilitating effects of sleep loss cannot be overstated: it can fuel brain fog and weight gain, trigger type 2 diabetes, harm fertility and dent libido. If pills don’t work, though, what does? The Brigham study suggested cognitive behavioural therapy for insomnia (CBT-i) should be used in lieu of long term medication, as this “aims to essentially re-programme your brain’s association between bed and sleep,” Prof Leschziner says. “It uses a variety of techniques, including relaxation therapies, good sleep hygiene, and sleep compression (making sure you do not spend prolonged periods of time in bed while awake and using your brain’s own mechanisms of sleepiness in the face of sleep deprivation).”

CBT-i usually attempts to reframe unhelpful thoughts about sleep, such as worrying how little you’re getting, as well examining the connection between the effects of our habits on our ability to rest. “It’s not for everyone,” he says. “It is quite challenging and difficult to do.” But over the course of the average four to six week treatment, “60-80 per cent respond very well to CBT-i alone” – the maximal benefit being reached at the 8-12-week point. “Many of the drugs doled out work for some people some of the time in the short term,” he adds, “but we know CBT-i is the treatment of choice”; one that, in the long term, is “more effective” than medication.

CBT-i can be expensive to undertake, and NHS waiting lists mean an average of 6-18 weeks post-referral for a first session to take place: apps such as Sleepio (free to all through an NHS referral or on request) provide a virtual six-week programme to follow, which may at least be an interim solution. Resolving insomnia really comes down to one thing, says Prof Leschziner: understanding its root cause, be it physical or psychological. His patients share fears they’ll never sleep properly again “all the time,” which “actually fuels the insomnia” (made yet worse by the vogue for digital trackers, he points out, which encourage unnecessary micro-focus on total rest reached). Levy was struck by this message in her CBT-i treatment: “Don’t turn the insomnia into a worry that itself prevents you from sleeping. Some nights, as I lay there at 3am or 4am I’d say this aloud to myself: ‘Don’t turn the problem into a problem.’”

With CBT-i, a weighted blanket and a committed exercise regime, Levy finally began sleeping again two years ago – and has continued to do so, even in the face of a national coronasomnia crisis. “It didn’t happen overnight,” she says of her recovery, but now – after six or seven hours of rest – she wakes each morning with “a thanks to the gods of sleep”.

Levy believes the abiding message for any insomniac distressed they may never recover is that their situation is temporary. “Be patient, give yourself some leeway, just power through it. Eat well, continue to exercise, socialise as much as you can, don’t catastrophise, try to keep perspective,” she advises.

The fear of returning to those dark, sleepless days will likely never dissipate entirely. “It certainly doesn’t preoccupy me,” Levy says. “I’m really happy I’m getting on with my day, getting on with my life, and looking ahead.”

https://www.telegraph.co.uk/health-fitness/body/can-insomniac-ever-learn-sleep/