This post series discusses my personal experience with insomnia and how I got my life back on track again. I wrestled with severe insomnia for several consecutive and nightmarish months, then on and off again for the course of nearly a year and a half. Throughout this time I was learning all I could about the condition, learning about natural treatments, and applying these changes as I could to my own life. Medications provided a temporary solution but were fraught with risks and side effects.
As I made changes, my condition progressively improved to the point that nights of poor sleep are now few and far between. My journey was frightening and potentially health jeopardizing. I hope to share what I have learned so I can help others in their own journey back to healthy sleep and rest.
NOTE: Insomnia and frequent awakening can be a sign of an easily treated condition such as sleep apnea. It can also be a complication of a host of acute and chronic illnesses or due to side effects from medications. This post is NOT a substitute for coordination with a licensed health care provider.
All medication decisions need to be coordinated with a qualified health care provider. While the following items helped me, everyone’s case is unique. This post is strictly for informational purposes.
A summer of sleeplessness
My insomnia had a definitive starting point, though the causes were likely numerous. It was in April 2018 and I had enrolled in my master’s program though classes were still a couple of weeks away from starting. I had been called into work the night before to work night shift due to staffing shortages.
Getting called in to work night shift was nothing new, though it happened infrequently. When it did, getting back to my routine had never been a problem. I would sleep for a few hours during the day, go to bed that night a little later than usual, wake up for day shift and I was back on track. Only this time was different.
Having only slept three hours after being up all night, I took comfort that at least I could get back on track with my sleep later that night. I was stunned when I woke up, alert and anxious and the clock said it was only midnight. Using the bathroom and returning to bed was no use. Laying on my back staring at the ceiling, I wondered how I could be so sleep deprived from the prior night, yet unable to sleep.
Sleep meditations and music: no help initially
Grabbing my iphone, I tried listening to various YouTube videos with sleep meditations. I could feel myself becoming more anxious as I lay there listening to the meditations. It seemed impossible to stay focused, instead, I worried about how I was going to feel and function at work the next morning. The voice in the meditation just became an irritant. Soft music was no better. Tossing and turning, I could feel myself sweating an anxious and sleepless sweat. I could not get comfortable.
Blocks of time swam by in this state. I would be close to falling back to sleep, or so it would seem, only to rush back to being fully awake again. Looking at the clock, soon it was 1:30am, then somewhere after 2 and then 3am, with my alarm set to go off at 5:30am. Whether I slept anymore at all that night is hard to say, I know I felt awful that morning when I had to go into work.
Work after no sleep: An unwelcome new normal
Work was rough to say the least. All morning and progressively throughout the day, I felt like I was in a heavy daze. Paying attention to tasks was difficult. My eyes felt puffy, and my face felt heavy and drawn. I pounded down the coffee, which helped to create a nervous, anxious, and hazy state.
Like any tough day, this one came to an end eventually. I attributed the bout of sleeplessness as being due to having thrown off my sleep cycle after having worked 11-7. Surely, now that I was truly sleep deprived, I would FINALLY get a good night’s sleep this night! I was exhausted, and my body desperately needed the rest.
I was that much more surprised when that same night, somewhere around 1 in the morning I once again found myself awake, alert, and anxious. How is this possible? What is going on? Little did I know that I was experiencing the first few days and nights of what would become my new normal for the next three months, with relief only coming partially over the next year. Near total resolution of my sleep problems would not occur till nearly a year and a half later.
Insomnia: A common but serious problem
Insomnia is characterized by either the inability to fall asleep or the inability to stay asleep (CDC.gov, 2017). The Centers for Disease Control and Prevention (CDC.gov, 2017) note that common risk factors need to be ruled out prior to diagnosing a person with primary insomnia. These diseases and risk factors include depression, drug and alcohol abuse, medication side effects, and medical conditions such as restless legs syndrome, narcolepsy, sleep apnea, among others.
According to the CDC (2017), adults need at least 7 hours of sleep each night for optimal health promotion and disease prevention. The percentages of adults reporting inadequate sleep duration varies based on counties and regions within the United States–from less than one in three adults reporting inadequate sleep in certain areas to nearly 50% of surveyed adults reporting inadequate sleep in other counties or regions (CDC.gov, 2017). Nearly 6-10% of adults may suffer from insomnia severe enough to warrant a primary diagnosis (Rios et al., 2019).
Adults reporting less than seven hours of sleep experienced higher rates of various health problems versus those reporting greater than seven hours of sleep, including elevated rates of:
- heart disease and heart attacks
- stroke
- depression
- cancer
- kidney disease
- diabetes
- asthma
- arthritis
- COPD (a chronic and progressive disease of the lungs) (CDC.gov, 2017)
Insomnia damages the body, mind, and quality of life
These correlations between less sleep and increased health problems are not surprising as many of these diseases themselves can cause sleep disruptions due to shortness of breath, increased frequency for urinating, increased anxiety, and/or pain. However, inadequate sleep appears to play a contributing role in the development and increased severity of illnesses such as diabetes, cardiovascular disease, obesity, anxiety, mood disorders, and depression (CDC.gov, 2017; Rios et al., 2019).
Not only that, insomnia has been noted to decrease a person’s satisfaction with their quality of life, negatively impact attention span, negatively impact memory, and make daily tasks of living more difficult to complete (Rios et al., 2017). Of course, if you personally suffer from insomnia, you already know this first hand! Given these serious negative outcomes, it’s important that people with insomnia take their condition serious enough to actively take sincere steps to overcome it! That typically means significant lifestyle changes. I know it did for me.
My experience with sleep medications and popular supplements
Like most people, I wanted the problem to go away and fast! I had a family to support, a new college master’s degree program underway, and high professional demands to meet at work. This sleep problem was putting all of these things at risk, and I felt powerless to stop it! My boss was patient, but I knew patience can only extend so far…at the end of the day, you are employed with the expectation of producing results.
Turning to medications: Only a short term “fix”
Over-the-counter Sleep Medications and Nighttime Cough Medications: I knew drugs such as the over-the-counter antihistamines found in night-time cough medicines were of limited use…my experience with them in the past (such as when sick) had been that I adapt to them after just a few nights. I was fearful of then simply being drugged AND awake all night, even worse off for the day. Further, I was aware that antihistamine drugs are suspected to have negative impacts on a person’s memory and contribute to memory loss (Neel, 2015).
More frightening than short term memory impairment, chronic use of strong antihistamine drugs–such as those found in over-the-counter sleep and nighttime cough formulas–may even increase the risk of dementia later in life according to emerging research!! (Gray et al., 2015). These medications are considered ineffective for use in short term and long term insomnia (Gray et al., 2015). Over-the-counter supplements and formulas including melatonin along with “sleep promoting” teas, valerian root, chamomile and others proved to be useless. In my desperation, I went to my healthcare provider and was given a prescription for Ativan.
Hypnotic and Sedative Medications: I did NOT use these at all. I refused these recommendations when offered by my health care provider. Everyone’s case is unique, I am simply sharing my experience.
Drugs such as Ambien, Lunesta, and many others fall into the drug class of sedative hypnotics. Research on this drug class continues to evolve, but concerns exist around side effects that include development of new onset sleep disorders (parasomnias), impaired thinking, auto accidents, dependency, increased risks of infection and increased rates of death (mortality) in those using such medications (Sateia, Buysse, Krystal, & Neubauer, 2017).
Prescription medications for sleep: Just buying time till i could find a better solution
Ativan: I first tried taking a tiny dose of Ativan, at half the dose prescribed for me. The tiny dose was completely ineffective. Upon waking around 1am, I simply laid there worrying about how much more tired I would be with both the insomnia and now Ativan in my system. At the prescribed dose, the Ativan worked for several nights–meaning I did not wake up or woke up only briefly–but soon I found myself waking up and staying up again. My dose required another increase. Not only that, but I felt wasted in the morning despite “sleeping” with the Ativan.
Medications classified as “benzodiazepines” (which include Ativan, Xanax, and many other prescription anxiety and prescription sleep medications) have a variety of problematic side effects. Tolerance can occur, where the medication effects weaken over time. When this happens, increased doses are required and provide diminishing therapeutic effects (O’Malley, 2018). Worse, these medications can very quickly (within weeks of steady use) cause true dependence–meaning that if you try to stop taking the medication your symptoms of insomnia can be worse than before you ever started taking the drugs.
Benzodiazepines also can negatively impact memory, judgement, attention span, can be addictive, among other issues (O’Malley, 2018). Clinical practice guidelines in the United States, Canada and Europe all recommend medication use for insomnia being limited to 3 months or less (Rios et al., 2019). However, without the Ativan, I could not sleep. I needed another option as I feared tolerance and dependence to the medication would develop quickly.
Trazodone & priapism: A rare but terrifying side effect
Trazodone: My care provider listened to my concerns about using ativan alone and prescribed another option–trazodone. An antidepressant, trazodone is also frequently used to help relieve insomnia due to sedative effects. However, working in the nursing field, I looked up side effects before taking it. One side effect in particular caught my attention: priapism.
Priapism is a prolonged state of erection occurring irregardless of sexual arousal that can cause severe pain, lack of oxygen to the penis, and permanent erectile dysfunction even in spite of rapid emergency medical treatment (Levey Bernie & Mulhall, 2018; Pal, Biswal, & Ghosh, 2016). For example, one study evaluating outcomes for patients presenting for emergency treatment of priapism found of 19 patients with priapism, only 6 recovered full, normal function of their penis despite all 19 sufferers being treated with emergency treatment (Pal et al., 2016). While priapism is relatively rare as a complication, it was a complication I would rather do without.
One horrific case study I found in the medical literature noted a case of priapism attributed to trazodone that resulted in a penile amputation (Hoffmann, Neu, & Neu, 2010). In this case, it appears the patient had additional unique risk factors. However, the more I read about trazodone and priapsim, the more wary I became. Risk factors are not fully known making it impossible to predict who will experience this awful side effect, and the risk exists regardless of medication dosage. Finally, while other medications have this risk, trazodone in particular seems to be a significant culprit (Hoffman et al., 2010).
I took one dose, with trepidation. I slept great, though decided I was not going to roll the dice. Even though the side effect was rare, the stakes in my view were too high! Further, like any medication induced sleep, I still felt sluggish the following day.
Vistaril: Knocks you out both night and day
My health care provider was patient with me! I shared my concerns around the trazodone, and she prescribed Vistaril in its place. This medication definitely put me to sleep and kept me asleep. The downside was that the hangover effect was substantial, and worse than the Ativan’s hangover. Staying fully awake and focused during the day was a challenge. However, at the time I was happy to not be awake staring at the ceiling overnight. Another concern is that Vistaril is a powerful antihistamine, which as already noted has been linked to memory problems and even dementia with long term use.
A temporary cycle: Rotating Ativan and Vistaril
I was fearful of becoming tolerant and non-responsive to the Ativan, so I rotated it every other night with the Vistaril. On nights before having a day off from work, I would challenge myself to go without the medications entirely. These nights without the medications were spent restlessly. I would go down in the basement after waking around midnight or 1:00am and toss and turn on a recliner, play very soft music from my iphone, read scriptures, pray, stare at the ceiling, and sleep in chunks of time off and on. I did not want to be dependent on drugs for the rest of my life, and still felt lousy and hung over the next day when I took them.
A non-sleep medication that helped: Lexapro
A precursor for my case of insomnia may have been due in part to my having weaned myself off my antidepressant, Lexapro, approximately six months prior to my initial onset of insomnia. Anxiety and depression risk is high in my family, implying a genetic underpinning. I tried to take myself off of the Lexapro after learning and practicing routine meditation and having been in excellent exercise habits for years. At the time, I thought I was eating healthy, though in the diet department I had a LOT to learn (see my post “My Personal Experience: Switching to a Plant-based Diet” and also “Anxiety, Depression, and Diet Connections — Current Evidence“).
Anxiety definitely was a major fueling factor for my insomnia. I never dealt with depression, but anxiety was animal I knew well. After 2 weeks of wrestling with my insomnia, I acknowledged the need to get my anxiety under control and that my non-medication approaches for anxiety by themselves were not enough. However, going back on Lexapro DID NOT end my insomnia, not 3 weeks later, not 3 months later, not 1 year later. I believe it was necessary for my recovery, but by itself was not enough–it was a PART of the total puzzle.
My insomnia started in April of 2018, I started my Lexapro that same month. The insomnia continued in its most severe form into September of 2018 (where I needed medications every night to sleep, and without them was awake most of the night). It continued as I mentioned though (with gradual improvements) for a total of a year and a half.
Sleep–free of medications: sources I found
In my next post, I will share the non-drug interventions that I found helpful as I weaned myself off of sleep medications and began my path to recovery. My heaviest reliance on medications occurred from April 2018 through September 2018 approximately. During this time, I was learning all I could regarding lifestyle interventions and other non-drug interventions to improve my sleep. I did not make all the changes at once, but gradually adopted more as I learned.
During the worst of my insomnia, the following resources were extremely helpful in building my knowledge on how to overcome this nightmare.
“The Effortless Sleep Method” by Sasha Stephens
I cannot recommend this book highly enough! I bought it in e-form on my Nook app, but no matter how you get it, the information within played probably the greatest role in my recovery!! It was not by any means the only factor, or my only resource.
While perhaps not the most “eloquently” written book I ever read, it is VERY practical and it works. I believe it did contribute the most tools in my efforts to overcome insomnia. You can purchase a copy here.
“The Model Health Show” Podcast by Shawn Stevenson
This podcast is excellent for a huge variety of health and fitness topics. The host himself wrestled with insomnia and even wrote a book about it–though I did not get his book till later in my insomnia journey. I did, however, listen to his podcast episodes on sleep early on. Here is a link to his site and episode on sleep (he has several episodes on sleep, they are all good): https://themodelhealthshow.com/21-cures-sleep-problem-pt1/
Summary for part 1
This post covers my experience with insomnia during the worst of its symptoms. My next post will explore the non-medication lifestyle interventions I used to help me recover from insomnia. For approximately the first 4 months, I was fully dependent on medications to sleep.
I did discipline myself to use no medications when I had days off from work. Perhaps if I knew some of the non-drug approaches I learned from Effortless Sleep, I could have shortened this duration of drug dependence. And, perhaps, if I followed the lifestyle interventions I now follow after all I have learned from the experience, I would have never experienced insomnia at all!
On a final note, I do believe that the onset of my insomnia did correspond with going off my Lexapro six months prior, the start of a master’s program, and a high-stress job combined with my genetic tendencies for anxiety. Anxiety has multiple underlying causative factors. A person can increase their resistance to stress through numerous lifestyle interventions, but at times their genetic makeup may need medication interventions as well. Find out more on how to harden yourself against the stresses of life in my posts on resilience: “Resilience Against Stress: Genetics or Lifestyle?” and “Stress, Science, & Scriptures.”
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Related posts
My Insomnia Experience: Part 2, Taking My Life Back
My Insomnia Experience: Part 3, Sleeping Naturally at Last
References
CDC.gov. (2017). Sleep and sleep disorders. Retrieved from https://www.cdc.gov/sleep/about_sleep/key_disorders.html
Gray, S. L., Anderson, M. L., Dublin, S., . . . Larson, E. B. (2015). Cumulative use of strong anticholinergics and incident dementia: A prospective cohort study. JAMA Intern Med, 175(3), 401–407. doi:10.1001/jamainternmed.2014.7663
Hoffmann, P., Neu, E. T., & Neu, D. (2010). Penile amputation after trazodone-induced priapism: a case report. Primary care companion to the Journal of clinical psychiatry, 12(2), PCC.09l00816. doi:10.4088/PCC.09l00816gry
Levey Bernie, H. R., & Mulhall, J. (2018). Priapism: summary. Retrieved from https://bestpractice.bmj.com/topics/en-us/505
O’Malley, G. F. (2018). Anxiolytics and sedatives. Retrieved from https://www.merckmanuals.com/professional/special-subjects/recreational-drugs-and-intoxicants/anxiolytics-and-sedatives
Pal, D. K., Biswal, D. K., & Ghosh, B. (2016). Outcome and erectile function following treatment of priapism: An institutional experience. Urology annals, 8(1), 46–50. doi:10.4103/0974-7796.165717
Neel, A. B. (2015). 10 drugs that may cause memory loss. Retrieved from https://www.aarp.org/health/brain-health/info-05-2013/drugs-that-may-cause-memory-loss.html#quest1
Rios, P., Cardoso, R., Morra, D., Nincic, V., Goodarzi, Z., Farah, B., … Tricco, A. C. (2019). Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: an overview of reviews. Systematic reviews, 8(1), 281. doi:10.1186/s13643-019-1163-9
Sateia, M. J., Buysse, D. J., Krystal, A. D., & Neubauer, D. N. (2017). Adverse Effects of Hypnotic Medications. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 13(6), 839. doi:10.5664/jcsm.6634
