This was originally written as a guest post for my good friend James at ALT Insider, and is re-posted here with his permission.
My battle with insomnia and depression had dragged on for the best part of nine months, and it was with no particular optimism that I followed the recommendation – from a fellow sufferer of both – to try something called Sleepio. Developed by a team of experts in the field of sleep problems, as well as being a mobile app, Sleepio is an online course in something called cognitive behavioural therapy (CBT). It isn’t cheap – 400 USD for the initial six-week course, along with a year of follow-up advice as a member of the Sleepio community – but it has finally enabled me to regain control of my life, and perhaps most importantly, to quit taking medication to help me sleep.
The basic, and deceptively simple, principle behind Sleepio is this: because insomniacs spend so much time in bed, stressed out and unable to get to sleep, we develop a negative mental association with our beds and with our bedrooms. In order to rid ourselves of this association, Sleepio users are advised, through various different methods, to maximise the time we spend in bed asleep, and to minimise the time we spend in bed awake, something that is referred to in the programme as ‘sleep efficiency’.
So during the first two weeks of the course, I completed a sleep diary detailing what time I got into bed (or rather, futon), what time I actually got to sleep, how often I woke during the night and for how long, what time I woke up in the morning, and what time I got out of bed. From analysing these statistics, Sleepio’s virtual Professor – a kind of animated, automated version of the programme’s founder, Professor Colin Espie – then gave me a so-called ‘sleep window’, based on the amount of time I spent asleep as opposed to the amount of time I spent in bed.
In my case, the average time I spent asleep during that first fortnight was about five hours and forty-five minutes, and for the third week of the course I was given a sleep window of six hours. This may seem fairly generous, but there was a catch, namely that even if I couldn’t get to sleep or woke for a period of time during that six hours, come what may, I still had to get out of bed at the same time in the morning, and no matter how tired I was the following evening, I was not allowed to get into bed again until the start time of my allotted sleep window.
Getting up at five a.m. every day – even on weekends – may seem counterintuitive, even counterproductive, but the incredible thing was that after a couple of weeks of getting even less sleep than usual, it slowly started to work. Essentially, I became so tired during the day that I was more likely to get to sleep naturally at night, something that, in another example of Sleepio jargon, is called ‘sleep restriction’.
Things were progressing so well that having started the course in early February, towards the end I began a run of thirty-four straight days without needing medication. Possibly because I became complacent and started to disregard my sleep window, possibly because some relatives from the UK came to stay and our household was busier than usual, and possibly because of biorhythms or pure bad luck, that run came to an end, and my problem was that on a bad night I still needed medication to get me to sleep (or rather I felt that I did, and didn’t have the courage to test whether I really would end up staying awake all night if I refused it). Then, over the following weeks, the thing I had been dreading the most began to happen: the zolpidem stopped working.
For the best part of a year, 10mg had been guaranteed to work if I was lying awake at two in the morning, anxious that I wouldn’t be able to function if I stayed that way until the children woke me up or my alarm went off. When I took a tablet, within a few minutes I would feel a tingling sensation in my limbs, along with a kind of warm, fuzzy feeling in my head and chest, and the next thing I knew it would be morning. No dreams, no getting up to go to the toilet, just three or four hours of deep, knocked-out sleep.
The friend who recommended Sleepio had warned me that as well as being addictive, zolpidem has a tendency to lose its effectiveness, and it was ironic this should happen when I was taking it less often than at any point during the previous year. Over two nights in June 2017 I took 15 and then 20mg instead of the usual 10, and came down with a mild case of heatstroke (熱中症 / necchushoh). In the heat and high humidity of a Japanese summer, heatstroke claims the lives of as many as a thousand people annually. In early June, though, the weather wasn’t that hot, and nor had I taken any strenuous exercise or drank fewer liquids than usual, so the extra zolpidem had apparently dehydrated me (its effects were, I couldn’t help noticing, similar to that of ecstasy, whose most obvious side effect is dehydration). The following week I took two more doses of 20mg, and on the morning after the second of these, felt not just guilty about the fact I had resorted to taking zolpidem, but depressed, too.
Because he had just graduated from university, the JTE in charge of second grade classes was keen to delegate as much of his workload to me as possible, and for the most part I didn’t mind the arrangement. There could be times, however, when I didn’t necessarily get the help that I needed in keeping the students quiet, explaining what they were supposed to do, or guiding them during an activity. That day I was to teach fifth period, and was already on edge as we began a speaking activity I had prepared. Most of the students were either slow on the uptake or paid no attention when I told them what to do, and as the activity progressed, appeared to be neither talking nor moving around the classroom as they were supposed to. At first I tried the sarcastic approach, but when that didn’t work, I lost my temper, slammed my hand down on the lectern at the front of the classroom and shouted at them. I was sweating and twitchy, in what felt like a cross between a panic attack and a drugs comedown. Nothing as severe as this should be triggered by a couple of nights of poor sleep, so the culprit was clearly zolpidem.
That day I resolved never to take zolpidem again, or indeed any other drug to help me sleep. Despite plenty of bad nights since – including a couple like that very first one way back in May 2016 when I didn’t sleep at all – the depression has gone, and as time has passed, I have finally been able to enjoy being a father again.
An interesting irony is that since I began keeping a diary for Sleepio at the beginning of 2016, the average amount of time I sleep each night has remained at a constant five hours and forty-five minutes. By spending less time in bed awake, however, my ‘sleep efficiency’ has improved. Also, I now sleep more soundly and am less likely to wake if, for example, it is noisy. The main change, however, has been in my attitude. This time last year, if I only slept for three or four hours I would feel a sense of failure, and that the whole next day was a write-off, during which I would neither enjoy myself nor accomplish anything worthwhile. Now, though, I can stay positive even after a bad night, and convince myself that the following day won’t be a disaster.
Not that I would necessarily choose them as role models, but luminaries such as Donald Trump, Margaret Thatcher, Madonna and Napoleon apparently get – or got – by on just four hours’ sleep a night, and I suspect there are many more people out there who if they cannot sleep do not dwell on it, but instead get up and do something constructive (or for that matter, even pointless) with their nocturnal ‘bonus hours’.
Furthermore, it seems to me that insomnia is like alcoholism, in that once you have it, you are stuck with it for life. As I write, it has been a year and nine months since mine began, and even now I have, on average, a night or two a week when I cannot get to sleep straight away. As far as possible I try to stick to the Sleepio rules, including the so-called ‘quarter hour rule’ – aka ‘QHR’ – which states that if you are unable to get to sleep for period of more than fifteen minutes, you should get out of bed and do something else: in my case so-called ‘progressive relaxation’, a yogic breathing exercise called pranayama, listening to guided meditation videos on YouTube or sleep inducing apps like Pzizz, and occasionally even going for a walk or a drive in the early hours of the morning.
A very wise man once told me that you’ll never find a girlfriend if you’re looking for a girlfriend – in other words, romance comes along when you’re working towards a completely unrelated goal – and as time goes on, I have begun to see that the same rule applies to insomnia. So last spring I began taking a camera with me on my evening walks, and have amassed several hundred photographs since, some of which illustrate these guest posts. As well as reigniting my long-dormant creativity (I stopped writing the Muzuhashi blog a couple of years ago), the photography also gave me a goal to aim for other than that of overcoming insomnia: in this case to take some decent photographs, post them online, and get some (hopefully) positive feedback. The next thing on my to-do list was Movember, and in January I drew up a list of New Year’s resolutions that should keep me both busy and motivated for at least the remainder of 2018.
I would love to have been able to write this post in the past tense, as evidence that the insomnia is behind me. Sadly I cannot, but I have come to realise that the most important thing I have achieved is to accept it as a part of my life. In an ideal world I would also like to be able to quit my job and become a freelance translator, but because I know how much pressure that would put on me, for the moment it will have to wait. So for the past few months I have been trying to develop a more positive attitude to being an ALT. Sure, the work can be monotonous at times, or too easy. I can be undervalued, underappreciated and underused. But the wages are respectable and the hours are short, the people I work with are friendly, and even if it is only occasionally (remember, these are self-conscious teenagers we’re talking about, not genki elementary school kids), I do get a positive reaction from my students. My job also gives me time to write posts like this, holiday in the UK with my family, and study Japanese. As long as Kim Jong-un doesn’t combine with Donald Trump to start World War III, there are also many things to be thankful for about living in Japan, a first-world country where the vending machines work, the toilet seats are heated and the trains run on time.
So there’s a happy ending to my story, but what if you find yourself in a similar situation, a long way from home and with no one to turn to for help?