This was originally written as a guest post for my good friend James at ALT Insider, and is re-posted here with his permission.
Some of you may be aware of this police dashcam video of Tiger Woods, which was taken when he was found asleep in his car and given a series of tests to assess whether he was intoxicated. As it turned out, Woods hadn’t been drinking that night, but a toxicology report detailed five different types of medication in his system, including zolpidem (apparently, a recent back operation had left him not just in pain but unable to sleep). The story of another celebrity zolpidem user – comedian Akira Ishida, who is one half of the duo Non Style – aired last year on the Japanese TV show Za! Sekai Gyohten News. Ishida was prescribed zolpidem for insomnia, and as a result, would wake up in the morning with leaves in his pockets from some nocturnal expedition he could not recall, a pile of DVDs he had no memory of renting, and sometimes lying in the street outside his apartment.
Probably because I never took zolpidem in combination with anything stronger than antihistamines, my reaction to it wasn’t as extreme as that of Woods or Ishida. But if you do a Google search – leading to, for example, a ‘rate my meds’ site like drugs.com – you’ll find that zolpidem, which is sold in the U.S. under the brand name Ambien and in Japan as Maisurii, can have a variety of side effects, one of those being depression.
Looking back, it’s hard to say whether my depression was brought on by the insomnia, the zolpidem, or both, but one thing became clear, namely that if I couldn’t sleep and artificially knocked myself out, the following day brought with it an unwelcome mixture of frustration, disappointment, guilt and melancholy. At work I often found myself on the verge of tears – while reading aloud from the textbook, for example, or eating lunch with the students – but the most painful aspect of my illness was that I had ceased to enjoy being a father. Rather than charming, M Jr and M Jr II had become irritating, and rather than inspiring me, their energy became an obstacle to my making it through the day. Because I had lost patience with them, even the simplest of tasks, like cleaning their teeth or putting on their clothes, would frequently degenerate into a shouting and crying match.
When the aforementioned Gaijin Pot article about depression was posted on Facebook, at least two readers left comments saying that expat acquaintances of theirs had committed suicide, and in Japan, rarely a week goes by without news of an overworked company employee or a bullied schoolchild throwing themselves from a tower block or in front of a train (see, for example, this fascinating documentary about the Aokigahara Forest around Mt. Fuji). Research has shown that the more media coverage a mass shooting or a terrorist attack gets, the greater the likelihood that a similar incident will follow in its wake, and you could argue that suicide, too, is ‘infectious’, in that the more people hear about it the more likely they are to do it themselves. It wasn’t long before my own thoughts turned to suicide, and while deep down I knew that I would never act on the idea, I wonder whether it had been more likely to enter my mind because I was immersed in a culture in which suicide is so prevalent.
At least in part, such feelings of hopelessness arose from the shame of becoming what was effectively a drug addict, but they also came about because every time I took zolpidem, I knew that I my insomnia had yet to be cured. In other words, there was something ‘wrong’ with me, something broken that needed to be fixed. Despite whether or not I could get to sleep at night being just one aspect of my day-to-day existence, it had come to dominate my every waking moment, to the point where I thought of almost nothing else. As well as our children, my fragile mental state began to put pressure on my relationship with Mrs M, although it wasn’t long ago that she had been through a similar experience.
When our son was born in 2014, Mrs M’s job as a mother became more than doubly difficult, because not only was she faced with having to look after two small children, but M Jr II turned out to be much higher maintenance than his older sister. He woke up more often, took more time getting back to sleep, demanded more attention, and was ill on an almost permanent basis. Mrs M began to suffer from post-natal depression – ironically, this was at least in part as a result of her being sleep deprived – and rather than enjoying motherhood, could barely stand to be with the children.
At her lowest ebb, my wife considered going to see a psychiatrist (精神科 / seishinka), but was talked out of it by her father, who said that all they would do is put her on anti-depressants – in other words, a temporary, artificial fix for a serious psychological problem. While I, too, was averse to the idea of taking anti-depressants, I also knew that I needed help, and was eventually referred to a specialist by the doctor who had treated me for my throat infection.
The psychiatric clinic seemed normal enough, and as I looked around the waiting room, along with one or two elderly people with dementia and younger adults whose eccentric behaviour set them apart, the majority of my fellow patients appeared perfectly normal (apart from being the only white person there, I wondered if that was how I seemed to them).
I had expected the psychiatrist to sit me down on a chaise longue and have me, Woody Allen-style, tell him about my childhood. As I discovered, though, he was to all intents and purposes my dealer. So having discussed some of the information I had relayed to a nurse beforehand – about my background, my condition and how it had come about – he said that I was suffering from mild depression, renewed my prescription for zolpidem, and suggested that I try anti-depressants. I declined, and just as I was about to leave, he mentioned that the clinic also offered counselling. This is what I had been hoping for all along, and the following month I turned up for my first session.
The counselling cost 5000 yen for fifty minutes, and at least initially was of some help, as it gave me a neutral listener upon whom to offload my worries. ‘Hey, my language skills have improved so much that I can get counselling in Japanese!’ I thought with some irony, although the language barrier meant that the scope of what we could discuss was limited. Not only that, but counselling seemed to be more about reassuring me than an active attempt to solve my problems, and I soon began to look for an English-speaking alternative.
Friends of ours located a couple of Japanese counsellors who spoke English, but their offices were inconveniently far from where we live, and in any case, I sensed that I needed not just a native speaker, but someone who would delve a little deeper into my psyche. A search via the .co.uk version of Google (I wasn’t just after English-speaking, I was after British English, and all the shared cultural knowledge that implies) led me to a site called UK Therapy Guide, through which I found a psychotherapist who was willing to talk to me on Skype.
As I told her during our first session, I didn’t necessarily expect to be ‘cured’ of my insomnia. Rather, I was hoping to improve my overall mental state, something that, in theory at least, would help me deal with the anxiety that both caused and arose from the insomnia. Whereas my counsellor would listen to my worries and then persuade me not to dwell on them or be too hard on myself, from a similar starting point – i.e. talking about a recent experience that was either directly related to my insomnia or had caused a negative emotional reaction – my psychotherapist would question me in more detail, force me to confront my feelings regarding any issues that arose, and try to find what caused them in the first place, usually by making a connection with experiences from my past. In this way, I learned a great deal about why I became the person that I am, and why I was predisposed to suffering from insomnia.
While all this was going on – the depression, the medication, the counselling and the psychotherapy – I searched the internet for practical advice as to how to tackle my insomnia. So-called ‘sleep hygiene’ seemed to be important: for example, not drinking caffeine too often or too late in the day, not drinking alcohol (while alcohol can help you get to sleep initially, it disrupts your overall sleep pattern, causing you to sleep more fitfully and wake up earlier), eating your evening meal early and avoiding rich food and desserts, cutting down on so-called ‘blue light’ from TVs, computers and smart phones, and sleeping in a separate bedroom which is kept as dark, quiet and at as conducive a temperature as possible. Non-strenuous exercise is also recommended for insomniacs, and of all the DIY strategies I tried, probably the most effective was to take a walk after the children went to bed. Starting in November 2016, I have done this almost every night since, even in the pouring rain, when the temperature outside was below freezing, or when I was so tired I could barely keep my eyes open as I walked.
So as 2016 wore on, my condition was improving, albeit very slowly, to the point where over the Christmas holidays, I went for ten nights in a row without needing medication to help me sleep. No matter what I tried, though, the insomnia showed no signs of going away altogether, and on a bad night, I sensed that if I did not have my beloved zolpidem, I would be plunged once more into the purgatory of complete sleeplessness, followed by three weeks’ worth of the same, another illness, and more time at the doctor’s office. Every time I tried something new – hypnotism, for example, or reciting a mantra – it wouldn’t be long before another bad night came along, and my hopes of finding a miracle cure were dashed. In fact, the more time went on, the more I began to think the insomnia, the drugs and the depression might never go away.