Invisible Illness
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Invisible Illness

When I Can’t Sleep, I Walk

Reflecting on my insomnia on a 3am stroll

There are no people on George Street in Sydney’s CBD. No line for cheesecake at Uncle Tetsu’s, but also no cheesecake. The traffic lights blip out their metallic song to an auditorium of cooly-lit buildings and birds. Even the trams have gone to sleep for the night. At times I wish I was a machine like them, a robot who could power off precisely at 1:56am, then resume services precisely at 5:22.

If only.

Insomnia doesn’t happen overnight. For me, it started with a few bad nights. Soon I was waking, every night at 2am, unable to nod back off.

I’m one of the 14.8% of Australians who, according to the Sleep Health Foundation, have either been diagnosed with or display symptoms of clinical insomnia. A broader 60% report trouble sleeping. Some researchers have noted that, since COVID-19, that number has risen.

Most Australians don’t seek medical help for sleep issues, chalking it up to just being a bad sleeper. When they do, it’s often tacked onto another consult. Commonly prescribed are OTC Melatonin tablets, to mixed results. When I took some, I started with 1 before needing double. By my calculations, I’d have soon needed 32,000 tablets per night.

A 24/7 security car crosses the tram-tracks ahead. It’s a Toyota Yaris. Imagine being a crook and being caught by a Yaris.

There are nangs in the gutters of Martin Place. The council’s flowerbeds shake beneath the streetlights. Purple and white. Orange. Green. Flags advertising festivals flap in the wind corridor formed between the Big 4 banks as though blown by an ancient hairdryer.

I pass a homeless man in a blue sleeping bag on a bus stop bench. I wonder which of us is having the better sleep tonight. Would he get more out of my bed than me? Probably.

The causes of insomnia are various — irregular sleep patterns, substances, certain medications. Most causes however, are mental.

“Insomnia is one of the core symptoms of many psychological disorders, including the two most common ones, depression and anxiety,” says Dr Tim Sharp, Founder and Chief Happiness Officer at the Happiness Institute in Sydney. “But in turn, insomnia can cause or exacerbate mental ill-health.”

“People with long-term sleeping difficulties often fall into a cycle of anxiety and worry,” says Lisa Stedman, principal psychologist at Mind Journey Psychology, and whom I started seeing for my issues. “The worry about not being able to sleep keeps you from sleeping, which reinforces the worry.”

This I can vouch for. As my eyes popped reliably open at 2am, I felt painfully awake — heart and mind racing, feet writhing against the bedsheets, wishing and wishing to sleep.

Perhaps the hardest thing about insomnia is how isolating it is, how quiet you have to be. The taste of your morning breath forming.

Office after office is for lease. The EzyMart at Circular Quay is closed. But in the window I see American breakfast cereals, coloured and hopeful, lit by white fluorescent tubes. Reese’s Puffs. Cinnamon Toast Crunch. Lucky Charms. On the other side of the world children would be eating this right now. The cartoon leprechaun printed on the box smiles widely — I wonder how many cavities are in his grin.

With no people around, the Sydney Opera House looks like a spaceship on a launchpad. Hundreds of seagulls circle above its brightly lit sails, thinking it’s daytime. I watch them swirl and swirl, and never once crash into each other.

My darkest night was here in 2018. My partner and I had tickets to see Kevin McCloud of ‘Grand Designs’ fame, and trying to will a good night’s sleep for it, I got zero sleep instead. Loud and paralysing anxiety that I would never sleep again, and die delirious, drowned out all of Kevin’s charming British voice.

I saw a psychiatrist after a second sleepless night in a row, locked in a spell of fear — what’s clinically called a mixed affective state, an acute state where symptoms of depression and mania coexist. He had patients’ paintings on the walls and golf trophies on his windowsill. A single white hair sprouted between his eyebrows like a sunflower. Finger by finger he listened and typed notes, his calming demeanour assuring me there was no emergency here.

I was prescribed anti-depressants and mood-stabilisers, and slept well.

“There’s no doubt medications can help some people,” says Tim. “But the question should always be ‘do the pros outweigh the cons?’”

“Sleeping pills occasionally can get you a good night’s sleep,” says Lisa, but notes these can be “habit-forming” and difficult to stop taking. She encourages behavioural strategies that address underlying anxiety and worry.

Medicine did help me. But during the first COVID-19 outbreak, my insomnia returned — and now even meds did nothing. I needed to address the deeper issue.

The seagulls outside St Mary’s Cathedral are sleeping with their red legs up. Their heads are swivelled backwards and buried in their plumage. It looks uncomfortable, but 33,000,000 years of evolution can’t be wrong.

The Coca Cola sign at King’s Cross flashes for no one but a few cabbies drinking Macca’s coffee, not Coke.

As I pass St Vincent’s Hospital I see people social distancing outside the ER. A man walks a woman with a zimmer-frame to a black Jeep with its hazards on. The sky is now the ever slightest shade of blue.

I took time off work. A concerned colleague (another of the lucky 14.8%) recommended an online program based on cognitive behavioural therapy for insomnia (CBT-I), developed by THIS WAY UP, part of the Clinical Research Unit for Anxiety & Depression at St Vincent’s.

“People with insomnia often spend excessive time in bed in an effort to catch up on sleep or give themselves more opportunity to sleep,” explains Dr Elizabeth Mason, senior clinical and research psychologist at THIS WAY UP. “The problem is that more time in bed doesn’t actually lead to more sleep. It leads to frustration.”

She adds, “A major aim of CBT-I is to help the patient retrain your brain and body so that the bed once again becomes associated with calmness and sleep.” This is done in part by restricting time awake in bed — gruelling but corrective.

Through the course and Lisa’s therapy, I gained a healthier grip on my insomnia. I learnt that stirring in your sleep is nothing to pathologise. To worry long before bedtime. To get up after 20 minutes of not sleeping, do something non-stimulating in the other room, then try again.

Moreover, I learnt that insomnia is like a very shit bedtime story. You tell it to yourself every night, that tonight will be terrible, and it is. But by slowly rewriting it, night by night, the story changes.

“Speaking from both professional and personal experience, there is hope,” says Tim. “CBT is very effective.”

“Sleep deprivation may cause irritability, reduced concentration and motivation,” says Lisa. “However you cannot die from lack of sleep.”

There are some nights I just don’t sleep. And that’s okay. I no longer read them as a catastrophe. Instead, I go to the other room, or out, for a walk.

I silently thank the clinic as I pass by. The pink patina of dawn drapes itself over the Sydney skyline. The first few birds — currawongs and lapwings — call out from still dark trees, “I am here! Here I am!”

An Ausgrid sub-station hums. Its electricity makes a smoothie inside a terrace house. A cop sits in the passenger seat of a parked police car, his face lit up by Candy Crush.

There’s no emergency here. No emergency here.

This story was originally written for and published by The Guardian Australia. It can be read here at its original source. This story has been reproduced here by the author for wider distribution and has not been monetised.

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We don't talk enough about mental health.

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Mark Starmach

Mark Starmach

Mental health, sideways. New article monthly. www.markstarmach.com

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