It takes me a few moments to get my bearings, to recognize that I’m in bed and in the dark. My husband, Martin, is beside me, breathing heavily, obviously asleep. Down the hallway, my kids—Cayden, 10, Hadley, 8, and Brynn, 5—slumber soundly. Even the dog is silent and sacked out. I am tired but unable to sleep. Awake again.
Don’t look at the clock, I think. Inevitably, I’ll calculate how much time is left to sleep, and despair as it whittles away. What time does it feel like? I don’t hear traffic, so it’s not yet 5 a.m. Maybe it’s 4 or 4:30. Four-thirty would be good—that would mean I’ve had a solid block of sleep, with time for a little more. I’ll go with 4:30.
Slowly, I roll over to peek at the glowing digits on the bedside clock. 1:18.
1:18? It’s only 1:18? Damn.
I run through a mental list of sleeping tips: Stay relaxed, calm and positive. Don’t dwell on insomnia. Acknowledge it and move on. Try to fall asleep, but don’t think about trying to fall asleep.
Unfortunately, in the middle of the night, it’s hard to think about anything else. I can go downstairs and watch TV or stay in bed and read; my husband bought me a tiny light that clips onto a book to help me trudge through these dark hours. Sometimes reading helps to knock me out, other times it doesn’t.
Eventually—often fatigued from reading—I’ll shut off the light, close my eyes, and wait to slip away. But I can’t fool myself into sleeping, and all my stressful thoughts move in, pushing any pleasantries from my mind. Work meetings and deadlines, minor house chores or massive renovations that our old farmhouse needs but we can’t afford. Doctors’ appointments for the kids, car repairs and other speed bumps that disturb the flow of the workday. And darker thoughts, like the worry that sleep deprivation is harming my health, or that certain illnesses might run in our family. Troubling thoughts flood everything, washing away the happy, positive ones.
What’s left? At best, a catnap.
I didn’t always struggle with sleep. In fact, I slept for seven or eight undisturbed hours every night in my 20s and early 30s. Until 2004, when I was 33 and my father started displaying signs of confusion and forgetfulness. Through months of doctors’ appointments, Dad swore he was fine, but I knew he wasn’t. I started awakening each night—never consciously thinking about him, just roused, as though someone had nudged me. For five weeks, I subsisted on a few hours of sleep cobbled together every night. I had a job as a staff writer for a monthly magazine and struggled through work in a haze, sometimes ducking into the bathroom to rest my head on a stall wall and doze. Then my doctor prescribed medication for insomnia.
Three months later, my dad was diagnosed with early-onset dementia, and once that awful news sank in, I slept soundly again without any medication. For a couple of years I was fine. Then my insomnia returned and became a persistent condition. Sometimes it lies dormant—an ironic but accurate term—and I sail through the night and reach the morning well rested. But then it resurfaces, and I can’t figure out why. It’s incredibly frustrating and debilitating, not to mention lonely. But I’m not alone.
“I would love to know what it’s like to have a good night’s sleep,” says Bethesda resident Michele Wendell, a mother of two who works part time creating educational training materials for businesses. Wendell, age 39, who was diagnosed with insomnia in 2002, has undergone countless sleep studies and followed several different treatment plans. She has trouble staying asleep, as do I, and doesn’t recall a specific trigger. One study found that Wendell awakens a dozen times a night, and in the past, she’s used a mini tape recorder to help track her sleep disruptions. When sleep eludes her now, she uses that time to tidy the house or prep her kids’ school bags for the next day. “I’ve learned to deal with it,” she says, “but I know I get sick more easily. And I’m more run-down because of it.”
For John Barron III, a financial and regulatory analyst who grew up in Chevy Chase, insomnia was intermittent until he made the decision nine years ago to improve his health. At age 38, he decided to stop drinking alcohol and, as a result, his sleep suffered. “I didn’t start having significant troubles at night until my mid-20s, around that age when you start to have ‘real’ responsibilities,” the D.C. resident says. “I’d be physically exhausted, but I couldn’t turn off my mind, and drinking wine would help me relax and sleep. When I decided to quit drinking, everything changed. That’s when I realized that my insomnia was a problem.”
The National Institutes of Health estimates that as many as 70 million Americans have trouble sleeping. And nearly one out of five adults has chronic insomnia, which is generally defined as difficulty sleeping—to the point that it impairs daytime activities—at least three times a week for three months or more. Insomnia sufferers may have difficulty falling asleep (sleep onset), staying asleep (sleep maintenance) or both. My problem is with sleep maintenance; I fall asleep quickly but awaken an hour or two later. Sometimes I get 30-minute snippets of slumber, but other nights I can’t get back to sleep at all.
Over the last 10 years, I’ve gone to my primary care physician repeatedly and tried both over-the-counter sleep aids—Tylenol PM, Advil PM and melatonin supplements—and prescription sleep medications. I’ve met with a psychologist to determine if stress or anxiety factor into my insomnia. (They do.) I’ve tried to identify stress and anxiety triggers, and used relaxation techniques, such as meditation, to try to foster good sleeping habits. I’ve also undergone a study at a sleep center—I arrived in the evening and spent the night in what looked like a sparse hotel room as experts monitored my brain-wave activity and sleeping patterns. A technician stuck electrode sensors to my skin and put a belt around my chest to monitor my breathing. It was an awkward night, but that’s how I learned that I don’t have sleep apnea, a common disorder in which you pause between breaths while you’re sleeping.
Some of the treatments I’ve tried have helped—prescription medications, including Ambien, have yielded the best results—but I still struggle with insomnia, sometimes for weeks or months at a time. Friends and family are perplexed by it, probably because it’s difficult to understand if you haven’t had it. Take a warm bath and drink a cup of tea, some people suggest, and when you’re tired enough, you’ll sleep. One person told me I’m “too busy not to sleep at night,” as though this debilitating wakefulness is a matter of choice.
Studies show that insomnia affects the immune system—people who sleep less than six hours a night are more likely to get sick—and it also takes a toll on the psyche. In the past, the military has used sleep deprivation as an interrogation tool because it promotes confusion and is emotionally debilitating. (In 2004, a British TV channel aired a reality show called Shattered, in which contestants competed to stay awake; the winner endured 178 hours without sleep. Several participants suffered from hallucinations and one contestant dropped out.)
“Most people don’t understand how frustrating it is to be tired—completely exhausted—but unable to fall asleep,” says Kirsten Stade of Takoma Park, who has tried everything from prescription medications to meditation and herbal supplements. Stade, 42, works as an advocacy director for a national nonprofit.
“And it’s so difficult when you get tired during the day. I can remember times where I was almost nodding off at my desk, and I’d wonder, ‘Why can’t I do this at bedtime?’ ”
Experts suggest that chronic insomnia is more common in women, though researchers are uncertain whether this reflects a prevalence or reporting rates. What is certain is that the disorder is widespread, tricky to diagnose and even tougher to treat, because it is often entangled with other ailments—physical injury, biological changes, hormonal imbalances and mental health disorders.
“The majority of [the] time, insomnia is a secondary condition to something else,” says neurologist Samuel Potolicchio, who lives in Bethesda. “On a general level, a difficulty in initiating sleep tends to be associated with a general anxiety disorder, whereas frequent awakening can be a manifestation of depression. But there are certainly cases that fall outside those parameters.”
Potolicchio, who established a D.C.-area sleep center in the 1980s and is now a professor of neurology and a sleep specialist at George Washington University, has been treating patients with insomnia and other neurological disorders for 40 years. “We know that there are primary forms of insomnia, and we recognize that there are genetic components. And we know that various neurotransmitters are involved, such as serotonin and dopamine, but they all orchestrate sleep in a complicated way. We aren’t at a point where we can identify a neurochemical imbalance. We can’t say, ‘Oh, you are deficient in this,’ or, ‘You need more of that.’ I wish that we could.”
