[Wakeful]

I began to have chronic insomnia when I started menopause. At the time, I was a full-time elementary school teacher at a school with many behaviourally challenging at-risk students. I had a name for being an effective teacher with challenging boys (lucky me!) so I tended to get a lot of them in my class. There were family conflicts going on in my own family at the same time, one conflict after the other. I became very anxious and stressed, while appearing calm and cool on the outside. My sleep grew worse and worse. I went to the doctor for help and was prescribed zopiclone. The doctor didn’t bother to tell me it was addictive and should only rarely be used. I ended up using it nightly for over five years. I believed I could not sleep naturally ever again. Then a new doctor told me I needed to try to get off the pills and suggested CBT. I used the program and was amazed to find that it worked. However, as work stress and other issues continued to be part of my life, I still hit chronic insomnia and ended up back on the pills. I retired and got off them again.
My issue is, now that I am retired and at least some stressors have been removed, why do I go weeks at a time sleeping easily and well, then hit a period of time (like now) when I can’t sleep? I’m not particularly stressed at the moment, but I haven’t been sleeping for about a week. I stay up until very late in order to get sleepy, (3:30 am last night), I avoid the pitfalls Martin has mentioned, I get up at the same time daily, I never ever nap in the daytime, but I feel like my body is intermittently missing some essential ingredient for sleep. I am on a low dose of anti-depressants, but I do still struggle a bit with anxiety and depression even so. When it’s 3 am and I am still wide awake, it is so tempting to think of taking a pill. I won’t because I have discovered the pills increase my daytime anxiety. But still, those nights are so long and miserable, and I am just baffled as to the reason. Obviously the more nights in a row that I have like that, the more my bedtime anxiety is likely to be a factor. And the more dragged out I feel during the day.

[Martin Reed]

It sounds as though you are very clear on the initial cause of your sleep disruption and it’s good to hear that you noticed improvements in your sleep when you tried CBT-I since that means you were able to successfully tackle the thoughts and behaviors that often perpetuate sleep disruption.

One thing that I think it’s important to stress (and recognize) is that it’s impossible to experience a great night of sleep every single night. Our sleep is very sensitive to our overall sense of wellbeing so it’s completely normal to experience temporary sleep disruption at times of stress, worry, anxiety, or uncertainty.

The less we are able to react to that disruption, and the better able we are to avoid trying to compensate for lost sleep, modifying our lives in response, or putting effort into sleep, the easier it is for our sleep to recover when the initial trigger is no longer relevant.

It could very well be the ongoing investigation and wondering why you are awake at 3:00 AM, and perhaps even the very understandable desire to want to sleep, that could be increasing arousal and making sleep a bit more difficult.

I am so encouraged that you are engaged in so many positive behaviors — things like not napping during the day and only going to bed when you are sleepy (this is different to being tired/fatigued) really help build sleep drive and improve the conditions for sleep to happen. Getting out of bed at the same time each day is also very helpful!

I wonder if there might be anything you can do to make the nights a bit less long and a bit less miserable, since that seems to be a big (and understandable!) trigger for sleep-related worry. If we can make the nights a bit more pleasant, independently of sleep, perhaps that might help lower that anxiety (and create better conditions for sleep, too).

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