Abby Zeveloff, LCSW, MPH
I first really discovered insomnia during pregnancy – first hormonal changes that would have me up at 3:00, awake and alert, then excruciating carpal tunnel that flared whenever I was on a flat surface. Being woken by my body shifted to being woken by my mind – the quintessential staring of new mother at her baby, wondering if he was still breathing, weeks later lying awake at night wondering why and how he had slept six hours straight, to months later gritting my teeth through sleep training. Insomnia became part of the routine. I would have every intent of falling asleep, easily, in my bed, but would find myself awake, on the couch, thumbing through a New Yorker or listening to a sleep meditation. I had a system of benadryl, melatonin, earphones, trazodone, lavender oil, eye pillows, and mundane, ideally yet ineffective sleep-inducing, reading. I explored my anxiety about sleeping in therapy and attempted to white knuckle myself to sleep with sleep hygiene.
Making sleep an enormous, yet elusive, endeavor increased my anxiety about sleep. I see many clients in the same boat – something has shifted and sleep becomes difficult. While sleep hygiene is part of the evidence base for treating insomnia, I believe it is helpful to get a view inside the sleepless nights. Does the person sleep alone or share a bed? If shared, how is the other sleeper’s sleep (I have seen a few patients who were kept up by their partner’s “good,” loud sleeping)? Are there animals or children? Where do they sleep? What is a typical work schedule? What are the middle of the nights like? Frustrating, eery, or perhaps calming in their solitude? Are they tossing and turning, looking at the clock and worrying about tomorrow’s productivity, playing on their phones, having sex, or catching up on reading or writing? How bothered are those by their sleeplessness?
What do we expect from our sleep and why do we expect it? An article on segmented sleep and Wild Nights: How Taming Sleep Created Our Restless World brings to question the “ideal” 7-9 hours of uninterrupted, solitary or partnered sleep. Sleep is malleable and our modern expectations of sleep developed due, in part, to electricity (including climate controlled bedrooms), labor laws, and beliefs about child development. If we take a sociological view of our patients’ sleep, would we find variation in terms of socioeconomic status and who can afford to try to sleep at 10 pm versus those who are working? Cultural differences in terms of child rearing and who sleeps in the adult beds? Which parent is expected to be awake for children in the middle of the night? Biologically, do people notice differences in their energy levels and sleep schedules depending on the season? Some research suggest that prior to industrial revolution, people in colder climates used winter for para-hibernation to preserve energy and food resources and slept less in the summer due to longer daylight and harvest opportunities.
How does sleep fit, energetically, into one’s life? Eastern traditions view sleep as an energetic dance between yin (quiet, still, and dark) and yang (active, bright, and productive). Sleep issues are consequences of these energies being imbalanced. The yin energy is too weak or depleted to temper the yang energy or the yang is too dominant to allow for sufficient yin. For example, if someone is busy most of the day and evenings are spent in activity (cleaning, cooking, doing work), chances are that it will be hard for the body and mind to settle into a relaxed state. So often, patients describe that once their bodies stop and get into bed, their mind starts actively racing. Encouraging yin activities, such as meditation, quiet, and witnessing the shift from daylight to sunset/dark can help restore some balance. Personally, I notice that when I am camping and away from artificial light (and perhaps it is the “vacation coefficient”), I am more easily able to relax into the shift from day to night. Infant sleep experts recommend exposing newborns to natural light in morning and at dusk to help reverse typical up all night, sleep all day newborn schedules.
There are so many electronic, pharmacological, and behavioral treatments for sleep. At times, the more we grasp onto sleep or try to trick ourselves into making it happen the more it slips out of reach. Through exploring patients’ relationships with sleep within a more open paradigm of “normality,” we may be better able to reduce the anxiety of sleep and see it as an evolving response to our daytime activities and environment. Pema Chodron writes: “We think that the point is to…overcome the problem, but the truth is that things don’t really get solved. They come together and they fall apart. Then they come together again and fall apart again. It’s just like that.” Such is sleep – at times the drifting off into deep sleep may come easily, other times night may be filled with awake restlessness. Sleep may ebb and flow, a facet of a larger picture of stress, activity, season, and environment. For me, being able to lower my expectations for sleep has helped to see it as something that may fall apart but also have the ability to again come together.
Abby Zeveloff, LCSW, MPH is a licensed clinical social worker who offers consultation and short-term therapy at the Madsen and Sugarhouse Family Medicine clinics.