My Battle With Sleeplessness

My sleep patterns are very consistent because they are artificially mediated by drugs: I am getting a respectable average of 7½ hours a night, with a few nighttime wake-ups. I find that my sleep gets choppier when I feel even mildly stressed. One night I decide not to watch the nail-biter TV show Breaking Bad before bed, only to have a dream about it that wakes me at 4 a.m. There is some evidence to suggest that my brain is working overtime. A 2004 University of Pittsburgh School of Medicine study that examined the brain’s metabolic activity determined that the brains of insomniacs are more active than those of normal sleepers.

When I bring my diary back to the clinic, Ahmad outlines my new behavioral plan. Over the years, I’ve read so much advice about “sleep hygiene” that I could recite most of the guidelines, well, in my sleep, but I’ve never implemented them. I’ve been arrogant enough to think that they couldn’t possibly help my uniquely Broken Brain. Now I agree to try them in the name of science.

• I will maintain strict sleep and wake-up times, even on weekends. My new schedule allows for seven hours, half an hour less than usual. This minor sleep restriction will supposedly harness the power of my homeostatic sleep drive, otherwise known as the natural urge to sleep.
• I will use the bed only for sleeping (and sex). This is called “stimulus control,” which sounds like something out of a psychology experiment because it is. Stimulus control is how Pavlov trained his dogs to salivate every time a bell rang. The theory is that I’ve come to associate my bed with wakefulness, an idea that is reinforced every time I get into it only to watch TV or surf the Internet. Consistency is key: If Pavlov had alternated bell ringing with tap dancing and mooing, the dogs would never have known when to drool. If I can’t sleep after 20 minutes, I should get out of bed until I feel sleepy again.
• I will get a little exercise every day, even if it’s just a 20-minute walk, ideally five to six hours before bed. It’s easier to fall and stay asleep when your core body temperature is on the decline; exercising will elevate my core body temperature for several hours, then it should be on a downswing by bedtime.
• At least an hour before I turn in, I will dim the lights and put aside the laptop. When I’m exposed to light, my brain thinks that it’s daytime, and a tiny region of brain cells called the suprachiasmatic nucleus suppresses the release of the sleep hormone melatonin. I can read by indirect light—say, a floor lamp placed next to the couch. It’s also fine to watch TV, because I’ll be farther from the light source than I would be with a computer. (And during the day I should get as much light exposure as possible.)
• Thirty minutes before bed, I will eat a light snack. Cheese and crackers is a good choice because it contains protein, complex carbohydrates, and tryptophan, which boosts the calming neurotransmitter serotonin.
• Surprise: If I need a little caffeine to power through the days on my restricted sleep schedule, then I can have it, says the doc, just not after midafternoon or so.
• I will lull myself to sleep with guided visual imagery, imagining myself in a relaxing place—preferably one I’ve actually been to (say, the beach) so that my imagination can incorporate all five senses. I need a scenario that engages me without generating too much activity in my brain. That’s why the favorite-vacation technique may be more effective than a method like counting backward from 100 by twos or naming everything I can think of that starts with a G.
• I don’t have to give up the medication right away. The plan is to get my behaviors in place first, then gradually wean off the pills.

Starting that night, I adopt the plan with religious zeal, and it makes me weirdly anxious because I’m obsessed with doing it perfectly. Which is how I wind up taking my nightly bath in the dark, trying to read by flashlight. (I fear that the bathroom light is bright enough to stimulate my suprachiasmatic nucleus.) I call Rubin Naiman, Ph.D., a clinical assistant professor of medicine at the University of Arizona’s Center for Integrative Medicine, in Tucson, and the author of The Yoga of Sleep ($20, amazon.com), to tell him that this relaxation stuff is harshing my mellow. He explains that I need an attitude adjustment. “First,” he tells me, “you have to have faith that it’s possible to sleep again.”