When I wrote my first post on sleep, I was initially surprised to find out how many of you also suffer from insomnia. It is such an isolating affliction, it always surprises me to hear from others who go through the same thing.
But of course, many people go through it. Insomnia is the most common sleep affliction and affects 35% of the adult population in any given year.
I've had it for as long as I can remember, so I've had some time to think about and try lots of different treatments.
In graduate school, I even did a cross-cultural comparison of sleep remedies in Traditional Chinese Medicine and in the herbal medicine practiced by the Dominican curanderos who practiced out of the botanicas near where I lived in New York City while I was at Columbia.
Maybe some of these ideas will be helpful to you.
1. Valerian. Made into a strong tea--you have to simmer the root for 5 minutes or so--it smells absolutely horrific but does induce drowsiness. A couple of times, its been enough to make me sleep. You can make it taste and smell more bearable by mixing with mint, catnip, chamomile, alfalfa, or other calming herbs.
2. St. John's Wort. You can buy the tincture or buy the bulk herb and make tea, or make your own tincture. Never has been enough to conquer my insomnia demons but does replace mild anxiety with a nice feeling of well-being.
3. Xiao Yao Wan (Free and Easy Wanderer). Chinese herbal patent formula that corrects liver imbalance. I tried this years ago, in powder form mixed with hot water. It did induce a pleasant drowsiness that led to sleep.
4. Diphenhydramine hydrochloride (Benadryl, Tylenol PM). I discovered this when I was in Guatemala and taking Dramamine for the crazy bus rides; the related compound in Dramamine made me very sleepy. Sometimes, one of these is enough by itself.
There are many other remedies that others have apparently used to good effect, that haven't done much for me. These include Melatonin and many herbs such as chamomile, spearmint, catnip, passionflower, hops, and kava kava.
Then there are the allopathic remedies that most doctors don't like to prescribe because they are reputed to make things worse if you ever go off them and to require higher and higher doses to be effective. I have not found this to be the case. I've been taking one prescription pharmaceutical or the other for sleep since about 2003, and have not--as many doctors have warned me I would--had to increase my dose or found that the medication no longer worked over time.
I have realized, especially after reading the excellent book Insomniac by Gayle Greene, that most doctors don't know a darn thing about insomnia. A common allopathic pattern seems to be to refuse the few medications that actually are specific to insomnia, and instead to try to get patients on an antidepressant. This is because most doctors do not consider insomnia to be a primary ailment, but secondary to some other psychological or medical complaint.
After doing battle with countless practitioners who tried to convince me that I was depressed or had an anxiety disorder, I am happy to finally have gone to a sleep specialist who understood that I'm fine in every respect except that I just can't sleep. Even this doctor didn't talk to me much about the underlying causes of insomnia, which Greene discusses in Insomniac--the possible overproduction of cortisol, the hormonal imbalances--but, with a seeming sense of resignation that echoed my own, he did prescribe some things that have been helpful.
1. Alprazolam (Xanax). An antianxiety drug that I got over the counter when I went to Mexico in 2003 and used for most of that year and the next. A low dose made my mind just shut down, in a good way.
2. Zolpidem tartrate (Ambien). I was first prescribed Ambien in 2002, have been taking it in small doses fairly regularly since 2005 when I started graduate school. I take a lower dose than I started with and have only increased it during stressful times. Just lets things shut down.
3. Ambien CR. This is for when Ambien gets you to sleep, but doesn't keep you asleep. Didn't make a huge difference for me.
4. Gabapentin. Tashi took this for her arthritis so I was surprised when the sleep specialist prescribed it for me. It's also used to control seizures in epileptics. Sometimes it gets me to sleep by itself, other times I have to take a bit of Ambien too. When it works, I wake up so rested and pain-free I think at first that I slept on a different mattress. When I slept without any prescription for a few weeks recently, it was after taking Gabapentin and no Ambien for a night. I felt so relaxed the next evening that I decided to try sleeping without a pill, and succeeded, and kept on succeeding until I got a cold and lost that sleep mojo.
It feels strange to divulge the full extent of my sleep problem, and especially to discuss at length the prescription meds I take to manage it. I sound like a wacko and a druggie.
But the stigma and the misconceptions about insomnia are the reason I'm writing this. The perception that it isn't a real ailment, is only secondary to some sort of other disorder and that if I would only stop drinking coffee (which I don't drink) or alcohol (which I drink only occasionally) or get more exercise (I ride my bicycle about 40 miles a week and walk the dogs easily 10 miles a week) or treated my anxiety and depression (I'm generally pretty happy and only a little anxious) or ate meat (don't even start), I'd sleep.
So I'm writing this for any of you bloggers who look at your blissfully snoring canines with envy, and feel like a bit of a freak that you can't just join them wherever they go when they snooze off. If you had diabetes or high cholesterol or any number of other chronic conditions, you'd take your meds in order to function and not beat yourself up about it. I do believe that insomnia is a primary physical ailment resulting from some sort of chemical thing going on in the brain and nervous system--too much of something that makes us alert or too little of something that makes us able to shut down--and that some of us need outside help in getting those things to balance.
I'd certainly prefer not to patronize the drug companies that profit from my imbalance, and to find a way to sleep that is more in keeping with my "natural" groovy crunchy way of life. But sleeping sure does make life easier, and for those nights when a tiny snoring foster piglet is not enough, I'm glad there are other options.