How a Sleep Specialist Cured My Insomnia — and Cleared Up My Misconceptions About Sleep
I glanced at the clock, 4:30 a.m. stared back at me. It was the morning of Alpine’s annual Growth Summit, and I was slated to give the keynote speech in just three and a half hours, but I had been tossing and turning since 2 a.m. Lying there wide awake, I was getting increasingly stressed. My body seemed to think it was the middle of the day!
I considered getting out of bed and starting my day, but worried I’d be too groggy. I considered taking a sleeping pill, but I wasn’t sure I had enough time for it to fully wear off before my speech. I decided to try to meditate. I did the Wim Hof breathing routine, which calmed my mind, but was it just making me more awake? I settled down and counted my breaths. Long exhale, “one,” inhale, long exhale, “two… three…” then my mind wandered. I thought, “I don’t like the ending to my speech; it’s too technical; there is no real closing or call to action; I feel too preachy; I’ve practiced this so much; why is the ending still falling flat? I’m going to set my alarm for 6 a.m. so I can rewrite the closing… four… exhale… five.”
I wish I could tell you that night was unique, but being awake for two to four hours per night had been my pattern for a few months. My insomnia started one night when I traveled back to California from the East Coast. The combination of my body clock being off and the fight-or-flight response to a super stressful week caused me to lie awake several nights in a row. But, as is often the case with insomnia, even after the initial stress and jet lag wore off, my new sleep pattern persisted, leaving me restless for several hours every night.
“Despite prioritizing sleep more than nearly anyone I know, I quickly realized most of what I thought I “knew” about sleep — at least concerning conquering insomnia — was not only wrong, it was prolonging my insomnia!”
If you’ve experienced insomnia, you’re likely nodding your head because you know how crippling it can be. It can make any sane person desperate. I tried Benadryl, Ambien, melatonin — you name it. These sometimes helped me sleep, but the next day, I felt zombie-like or hungover (and I don’t drink alcohol anymore, so that was an especially unwelcome feeling). I figured I was better off without the sleep drugs. I used earplugs and eye shades; I installed a cooling pad on my mattress; I tried going to bed earlier, sleeping in later, breathing, and meditating. No matter what I did, I still ended up staring at the ceiling at 2 a.m.
A friend recommended I see a sleep specialist, which I previously thought was only an option for people with sleep apnea or severe sleep disorders. I envisioned myself sleeping in a lab connected to wires with a breathing mask over my face, but was surprised to find my appointments were instead a series of 45-minute Zoom calls — a very reasonable ask to get to the bottom of this problem.
After my first call, I realized that I wasn’t going to need the wires, masks, or overnight visits. I came to understand the cause of my insomnia through a simple example my doctor offered: “Graham, imagine I came in and blew a bullhorn in your ear at 2 a.m. one night. That would wake you up startled, right? And if that only happened one night, you would probably be fine the next. But if, instead, I blew the horn the next night, and the next night, and the next night, at some point, your body would wake automatically at 2 a.m., and you would be in an aroused fight-or-flight state, anticipating the bullhorn blowing.”
This all made perfect sense. My 2 a.m. “bullhorn” started with the time change, and I stayed in the heightened state because of the stress in my life. Once that happened, I started doing nearly everything wrong. Despite prioritizing sleep more than nearly anyone I know, I quickly realized most of what I thought I “knew” about sleep — at least concerning conquering insomnia — was not only wrong, it was prolonging my insomnia!
My doctor introduced me to two key concepts that were new to me: sleep pressure and sleep efficiency. He also introduced several tactics that helped me fall asleep faster and stay asleep longer.
NOTE: I am not a medical professional and this is not medical advice. There are many reasons for insomnia, and I am only offering my personal story and the solutions that helped me. Please consult a doctor for any medical issues you may be facing.
Create Sleep Pressure
My doctor said the “cure” for the type of insomnia I had was to reset my body’s natural circadian rhythm back to my ideal sleep schedule. To do this, I needed to create “sleep pressure,” or in scientific terms, I needed more adenosine. Adenosine levels increase in your brain in correlation with the length of time you’re awake. The buildup of adenosine signals to your brain that you are tired and makes you feel sleepy. Conversely, time spent sleeping reduces adenosine, allowing you to feel more awake and refreshed. Counter-intuitively, my doctor told me to allow myself to feel more tired during the day (at first), so that when I laid down at night, my body would naturally sleep, and over time, I would reset my body’s natural circadian sleep rhythm.
He recommended several tactical methods to help me create healthy sleep pressure:
Get up at a consistent time, whether you feel rested or not. Prior to my insomnia, I woke up every morning between 5:45 and 6 a.m. But when I was consistently waking from 2 to 5 a.m., I had been allowing myself to sleep in past 6 a.m. to get a little more rest. Sleeping in was counterproductive because it reduced sleep pressure and prolonged my poor sleep schedule. I started getting up early again.
Don’t take naps. Naps are generally okay, but if you’re suffering from insomnia, naps will reduce sleep pressure and prolong your body’s ability to stay awake in the middle of the night. Naps became off-limits for me.
Exercise. Many studies show that exercising during the day allows you to fall asleep more quickly and sleep longer. I made sure to stick to my workout routine.
“The news no one wants to hear: avoid your bed unless you’re sleeping. Avoid watching TV, reading, scrolling social media, meditating — or, in my case, lying awake tossing and turning — while lying in bed. ”
Increase Sleep Efficiency
Sleep efficiency is the ratio of time that you’re actually asleep to the total time you’re in bed. To get restful, high-quality sleep, this ratio should be as high as possible. The news no one wants to hear: avoid your bed unless you’re sleeping. Avoid watching TV, reading, scrolling social media, meditating — or, in my case, lying awake tossing and turning — while lying in bed.
There are several tactics you can try to increase your sleep efficiency, including:
Go outside and get natural sunlight. Your body has a natural circadian rhythm set to be awake during the day and asleep at night. The more exposure you have to sunlight — particularly in the morning and the evening — the better you will be able to stay awake during the day and asleep at night. If you're on a schedule — for work, parenting, or otherwise — that does not allow you to expose yourself to sunlight upon waking or winding down your day, consider using a red-light device, which mimics the light you would take in at sunrise and sunset.
If you’re up for more than 30 minutes in the middle of the night, get out of bed. Tossing and turning for an extended period can cause you to subconsciously associate your bed with being awake. Instead, if you’re awake for more than 30 minutes, get out of bed and do a relaxing activity that doesn’t involve a screen (try reading a book in low or red light). Then when you’re sleepy again, go back to bed.
Spend less time in bed. My sleep doctor basically said if you want the highest quality sleep and highest sleep efficiency, then sleep when you’re in bed and do pretty much everything else — reading, watching TV, checking your phone — outside of bed.
Slow Your Racing Mind
Do you ever notice that, at 2 a.m., everything seems like a problem, and every problem seems like a crisis? Things can get super depressing when you’re left to your own thoughts in the middle of the night! The good news here is that you’re not spiraling for no good reason, there is a neurobiological explanation for this phenomenon. When you go to sleep, your prefrontal cortex, the rational part of your brain capable of solving problems, starts deactivating and significantly decreasing activity. And yet your amygdala — the center for stress, worry, and fight-or-flight response — remains alert. Scientists hypothesize this stems from ancient times when the fight-or-flight part of our brain remained active to watch out for imminent physical danger.
Unless there are tigers lurking in your bedroom, try the following:
Stop problem solving. Once you recognize your brain is playing tricks on you in the dark, you can give yourself permission not to try to solve problems. The problems will seem more significant than they are (because of your active amygdala) and you won’t be able to solve them in the middle of the night (because of slowed activity in your prefrontal cortex). Keep a pad of paper by your bed to write down your issues, then stop dwelling on them and go back to sleep! They’ll likely look a lot better in the morning, and if they don’t, at least you’ll have the capacity to tackle them properly.
Slow your breathing. Slow, controlled breathing engages your parasympathetic nervous system, encouraging your body to move out of stress mode and decrease your heart rate. Several studies have shown that taking slow, deep, deliberate breaths can decrease the time it takes to fall asleep, lead to fewer night wakings, and increase sleep efficiency.
My Sleep Journey
The night after I spoke to the sleep doctor, I fell asleep quickly, but then, as was customary for me, I woke up at 2 a.m. on high alert. After tossing and turning for 30 minutes, I got out of bed and went into our living room where I meditated and read a book for 45 minutes. As I got more and more tired, I went back to bed and quickly fell fast asleep until I woke up to my alarm at 6 a.m. I was a bit groggy that day and had to fight hard to get out of bed, but I powered through (sadly, I don’t drink caffeine anymore, which made battling the exhaustion a bit tougher).
That night, I stayed up as late as I could and then fell asleep quickly again. Like clockwork, I woke up at 2 a.m., but this time, I wasn’t quite as wide awake as usual. After a few minutes of deep breathing, I fell back asleep. I woke up once more, but quickly fell asleep again until my 6 a.m. alarm. I continued this cycle until the time it took me to fall asleep got shorter and shorter, and ultimately, my struggle with insomnia dissipated completely.
My doctor told me that it’s normal to wake up several times at night after completing a sleep cycle. If you can create sleep pressure during the day, generate sleep efficiently at night, and slow your racing mind, you may be able to get yourself back to sleep with increasing ease during those windows.
Quality sleep is one of the most essential elements of our overall health, so I hope these tips can help you as much as they helped me.
Good night, and good luck!
Graham
