March 25, 2015

Dealing with Insomnia Without Pills


Last week, I wrote a post about anticholinergic drugs, medications that, according to a new study, can carry irreversible dementia risks. Many of them are popular with seniors and include most of the over-the-counter sleep aids, like the Tylenol PM that I used and abused for years. But since then I've learned to deal with insomnia without pills.

My Struggles with Insomnia:
I'm no stranger to insomnia. Here is my history:
My alcoholic years:  I was a very successful practicing alcoholic until age 49. During those years, I didn't worry about insomnia since I most always went to bed half drunk. My wife and I usually downed at least two martinis before dinner and then sipped vermouth later in the evening. But to be sure that I would be able to get back to sleep when I woke in the middle of the night to go to the bathroom, I kept a small glass of vermouth hidden under my side of the bed and would drink it before going back to bed.

In a classic example of alcoholic denial, I knew my wife was an alcoholic because she took a drink before going to work. I was convinced I was not an alcoholic because I did not do that. Taking a drink at 7am was alcoholic behavior; taking a drink at 3am was not.
Intermittent insomnia:  During the early years of my sobriety, I slept okay except when I traveled, which was often. In those days, jet lag meant constipation and constipation meant insomnia. My remedy was drinking lots of coffee and lots of water first thing in the morning. But it usually took a few days for that regimen to work.
Eight years of big-time insomnia;  My longest and worst spell of insomnia occurred when I was in my 60s, and it lasted about eight years. During that time, whenever I tried sleeping in my bedroom, my body would jerk just as I started to doze off, and I'd be awake until 4am or later. I finally discovered that I could get a good night's sleep if I bedded down on the living room couch. Every time I tried to return to the bedroom, the body-jerk insomnia recurred.

It finally occurred to me (d'uh!) that I had no trouble taking my afternoon nap in the bedroom. That led me to wonder if the nighttime culprit might be the streetlight on the other side of the road from my bedroom windows. I installed blackout curtains to replace the Venetian blinds and... what do you know? The body jerking stopped and I could sleep in the bedroom again. Yeah!
The "Summer from Hell":  Even when body-jerk insomnia ceased, I continued to have intermittent insomnia. I often used Tylenol PM to deal with the problem. When these pills began to lose their efficacy, I got a prescription for Ambien instead.
About 10 years ago, I returned from a trip to Nepal with a particularly bad case of jet-lag insomnia. For about a week, I took a half tablet of Ambien at bedtime along with a Tylenol PM.
By the end of that week, the sleeplessness was accompanied for the first time by major attacks of anxiety and depression. Over the next few months, I consulted with my regular internist, a sleep therapist, and a shrink who specialized in prescribing medication. We tried a variety of antidepressants and sleep aids over that summer. None of them worked, and several made things worse.
Finally, the pill shrink recommended a holistic approach since the usual meds weren't working. I tried a variety of things, including hypnosis and even a trip to New York City to see a therapist who's work had been featured on NBC's "Today Show." She recorded my brain waves and converted them into a customized CD of sleep music. It didn't work but I've still got the CD.
Continuing to try everything, I read The Insomnia Solution, a new book that recommended a variety of approaches, many of which combined meditation with body exercises. One turned out to be a winner.
My Recovery from Insomnia Began With Meditation
I'm a neophiliac -- someone with a strong affinity for novelty -- so I've tried various forms of meditation over the years. But none really worked on slowing down my grasshopper mind.

The exercise in The Insomnia Solution  that worked for me uses what the author calls (hokey alert) "the secret handshake" to help focus the mind while meditating. For photos of the handshake and a description of how this technique works, click here.

That was 10 years ago. I've not had a serious bout of insomnia since. Sure, I have nights when it's been difficult getting to sleep. And I've had nights, particularly when traveling, when I've resorted to sleeping pills. But I no longer worry about insomnia, a security that has no doubt has been a game-changer.

Given my proclivity for the new and different, my meditation practices are constantly evolving. Initially I used the secret handshake technique with deep breathing.

But this 85-year-old isn't about to sit on the floor and assume that familiar cross-legged meditation posture. And resting my arms on the knees -- palms upward and fingers in the Lotus pose -- doesn't feel natural to me.

I bought a secondhand Harvard chair for my bedroom that's perfect. I put a pillow on my lap, rest my arms on it, position my hands in the secret handshake, and off I go into Lotus land.

Lately I've been using mindfulness meditation most of the time. Here's a standard definition:
mindfulness meditation: a form in which distracting thoughts and feelings are not ignored but instead acknowledged and observed non-judgmentally as they arise in order to detach from them and gain insight and awareness.
I still use the secret handshake with the finger-thumb squeezes combined with counting in-and-out breaths to get started.

For a while, I was on a kick which I called my "joy of quiet" meditation at 3 or 4am, coinciding with my middle-of-the-night bathroom visit. But I've switched to meditating and exercising when I first get up in the morning.

I use the secret handshake meditation at other times of day, too. For example, I used it during the lengthy waiting times I had during the doctor visits I described in a post last week. My blood pressure was still elevated when they checked it, but I'm sure it would have been worse without the meditation.

Other Sleep Aids
My sleep these days is the best it's been all my adult life. But I don't attribute this improvement to meditation alone. Here are some of the other things that have helped:
  • After I was diagnosed with Parkinson's in the fall of 2009, I resumed using the serotonin booster 5-HTP which had helped with insomnia, mood and constipation in the past. It continues to work, but because of concerns about its potential to elevate blood pressure, I take 25mg at bedtime, by cutting in half a 50mg pill, the lowest dose available.
  • If I have trouble falling asleep within the the first 15 to 30 minutes, I get up, get out the pillow, bedsheet, and duvet that I store in the living room, and make a bed on the couch. This invariably works to send me off to sleep.
  • Keeping the bedroom cool really helps with sleep. That's been easy to do this winter.
  • I sleep on my side and use a small pillow between my knees to alleviate pressure on my bad back.
What may have helped most is the change my mindset. When I have a little trouble falling asleep, I no longer think "Jeez, I'm in for a bad sleepless night." I've lost my fear of insomnia and now assume I'm going to get a good night's sleep.

I've also discounted the myth that we need seven or eight hours of solid sleep. When I started my "joy of quiet" meditation and exercise hour in the middle of the night, I did some research and found that this idea of solid, uninterrupted nighttime sleep came with the industrial age. Before that, particularly in the more agrarian societies, people would come home from working in the fields, have a light supper, and go to bed. They would awake after three or four hours and stay up for a couple hours -- eating, talking, having sex -- and then go back to sleep. Benjamin Franklin often referred to his pleasant time spent sitting in a chair reading in between his "two sleepes." So now I don't panic if my sleep gets interrupted.

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