Tag: insomnia

Over the past few years, more than a couple of friends have discussed with me their own battles with insomnia. Based on personal experience, the following is an edited version of the advice I have given them. A lot of the basics are borrowed from Sleepio, which I have recommended on these pages before.

1) The Golden, Number One, Disobey-at-Your-Peril rule is:

If you are unable to sleep, do not stay in bed. Instead, get up and go to another room.

Sleepio recommends fifteen minutes as a cut-off point, but I find there is usually a moment when despite your best efforts, you realise that sleep is not going to come (basically when you find yourself saying “Fiddlesticks!”), and whether that is five or thirty minutes after you went to bed, that is when you need to get up and go to another room.

2) When you do, there are two things you are aiming for: firstly to distract yourself from your worries about the fact that you cannot sleep and about whatever you have to do the following day, and secondly to calm down and relax. My tried-and-tested (although not guaranteed to be successful) techniques at this point are:

a) Progressive relaxation

After well over four years I still do this almost every single night. Instructions are as follows: i) Lie in a darkened room on the floor/sofa/spare bed with your arms by your sides. Breathe deeply and slowly. ii) After five deep breaths, clench your fists. After five more deep breaths, unclench them and take five more deep breaths. iii) Hunch/shrug your shoulders right up towards your ears. After five deep breaths, un-hunch (de-shrug?) and take five more deep breaths. iv) Close your eyes tightly while at the same time clenching your teeth. After five deep breaths, relax and take five more deep breaths. v) Pull your toes up towards your knees to stretch your calf muscles. After five deep breaths, relax and take five more deep breaths.

Believe it or not, this will take about fifteen minutes in total. If you are really lucky, you may fall asleep part way through. If not, the progressive relaxation should at least calm you down and reduce your heart rate.

One thing I also do is to try and keep my eyes open (apart from during step iv when I am deliberately shutting them, of course), and subsequently finding that you are unable to do so can be another sign that the progressive relaxation is having the desired effect. The more time has gone on, the less bothered I have been about counting the number of breaths I take, to the extent that nowadays, my progressive relaxation sessions sometimes go on for about thirty minutes. “But you’re wasting valuable time keeping yourself awake!” I hear you say. Well, no: one of the secrets of overcoming insomnia is not to be in a hurry to get to sleep (being in a hurry to get to sleep is, after all, a contradictory situation).

b) Yogic breathing

The technique that I found is called pranayama, and is another way of forcing you to concentrate on breathing deeply, in order to calm you down and distract you from your thoughts. Again, for this I lie down in a darkened room and try to keep my eyes open.

Instructions are as follows: i) Cover one nostril with a finger and breathe out and in through the uncovered nostril. ii) Switch nostrils and breathe out and in through the one that is now uncovered. iii) Repeat.

I find that I get bored with pranayama more quickly than progressive relaxation — usually after ten minutes or so — but a friend of mine insists that it works because (and I quote) it “floods the brain with oxygen and makes you sleepy.” Whether or not this is the case, the aim is breathe as slowly and deeply as possible.

c) Guided meditation

This is where a smartphone comes in handy, as you can lie on the floor/sofa/kitchen table in the dark and put your headphones on, or listen via the internal speakers with the volume turned down low (even though the following are videos, I only ever listen to the audio). It has to be said that most of the guided meditation videos on YouTube are rubbish and/or too long. Three that I have used a lot, though, are:

There are also apps: for example, Pzizz. You have to pay to get a proper Pzizz subscription, but even if you try their basic, free service, you can set up and keep one audio file to your own specifications. When I was using it a couple of years ago, my file was fifteen minutes long, with a male voiceover that faded out after 10 minutes, and much better than most of the stuff that was available free of charge.

d) Listening to relaxing music

The key here — at least for me — is not to listen to anything with lyrics or a catchy tune. For example, so-called “binaural beats” are good (search on YouTube and you’ll find hours and hours of them), as is Sleep Radio, an online radio station designed especially for insomniacs.

e) Reading, sewing, doing jigsaw puzzles etc.

As a rule I prefer not to switch on the light when I go downstairs or into another room, but I do sometimes read a book — which in itself is often a good way of making me sleepy — and similarly meditative (i.e. monotonous) activities like this do require at least some light.

f) As a last resort, I very occasionally (e.g. at about two or three in the morning when I am desperate and have been trying and failing to get to sleep for several hours) go for a walk or even a drive.

3) When you have relaxed for ten or fifteen minutes, or when you feel sleepy again, you can go back to bed. However, if you try to go to sleep for a further fifteen minutes or so and cannot, get up, go to another room and repeat Step 2.

4) The next thing you should be thinking about is what is known in the insomnia biz as “sleep hygiene.” That is, creating an environment and routine that is conducive to sleep.

a) If possible, do not drink caffeine or alcohol and if you do, do not have them after about lunchtime.

As the sleep expert Matthew Walker points out, the quarter-life of caffeine is around ten hours. In other words, if you drink a cup of coffee at midday, a quarter of the caffeine that it contains will still be in your system at ten o’clock that night, which is not exactly conducive to sleep. (Having said that, I did once rather comically take two Day Nurse tablets at about 7.30 p.m., which I realised upon reading the packet contained the equivalent of a strong cup of coffee. It was the evening before what was, for an insomniac, a high-pressure day — I was due to travel to Tokyo to meet a friend who was visiting from the U.K. — but incredibly, having tried and failed to make myself throw up, I did manage to get to sleep that night.)

Walker also points out that while alcohol can initially knock you out, it reduces the quality of your sleep, so that you are more likely to wake during the night, wake up early the next morning, and feel run down the next day.

b) Avoid eating late, eating rich or sugary food, and eating a large amount of food for dinner

I have dinner at around six o’clock, with no dessert, and try to make breakfast and lunch my main meals of the day. Also, I think it is a good idea to reduce the amount that you eat for dinner. When I stopped eating carbohydrates (rice, potatoes, bread, pasta, noodles, and so on) for dinner, my ability to get to sleep first time improved almost immediately, and more than three years later, I still avoid carbs in the afternoon and evening.

c) Do not drink too much in the evening, even water

This is to avoid having to go for a pee in the middle of the night. Even if you get to sleep first time, getting back to sleep after a nighttime trip to the toilet can be a tough job for an insomniac.

d) Do not watch too much TV or use smartphones and computers in the evening

Blue light from TV and computer screens is bad for sleep because it mimics daylight. I used to restrict myself to an hour of TV in the evening and nowadays do not watch at all. On both my iPhone and MacBook, I use the blue light reduction option called Night Shift. I also turn the brightness way down if I do have to use them. Apps like F:lux do a similar job, giving your screen an orange tint during the evening.

It is also important to have low lighting around the house. Most Japanese homes have harsh and powerful ceiling lights with flourescent bulbs, which are another source of undesirable blue light, so a couple of years ago I invested in a standard lamp and fitted it with low-power, tungsten-style LED bulbs.

e) Keep your bedroom dark and at a decent temperature

In other words, not too hot and not too cold. During the oppressive heat of Japanese summers, I often sleep downstairs in the living room, where it is marginally cooler than my bedroom. In winter, on the other hand, we have no central heating, but I have found that an electric blanket lessens the shock of climbing into an ice-cold bed, and makes me feel relaxed and cosy even if the room temperature is in single figures.

Also, and If possible, consider sleeping in a separate bedroom from family members, as I have from Mrs. M and the children for the past few years.

f) Do not do strenuous exercise late in the day

However, light exercise — for example, walking or yoga — is OK. Going for a walk every evening after the children went to bed was one of the most effective anti-insomnia measures that I tried, as it was meditative, and had the added benefits of preventing me from falling asleep in front of the (or watching too much) TV, and allowing me to take photos and listen to music and podcasts.

g) Do not nap during the day or take a siesta

Like many insomnia treatment programmes, Sleepio recommends saving up your fatigue for when you go to bed at night, and I still find that if I nod off on the sofa during the evening, I am less likely to be able to get to sleep when I am in bed.

h) Go to bed and get up at the same time every night, even on weekends, and try and have the same routine every night before you go to bed

My own routine has changed and developed over the years and even now I am constantly tweaking it. At the time of writing, I fold up the laundry and dry the dishes after work, eat between 6 and 7 p.m., sometimes read a book to the children, take a shower at about 7.30, read an e-book on my iPhone (using Night Shift and with the brightness turned down, of course), help the children take a shower, clean their teeth, sometimes read to them in bed at about 9, go to my bedroom or the living room and read until I feel sleepy, and am usually in bed and asleep by about 9.30 p.m. (In years gone by and before I became an in-bed-before-ten/rise-at-four kind of guy, I would put the children to bed at 9 p.m., go for a walk, watch TV, read a book, do progressive relaxation, and get into bed at 11, all at the same time and in the same order, every night of the week.)

Unlike me, you may have a social life of some kind, but whatever your lifestyle, try and develop a pre-sleep routine and stick to it, even if it is only for the final hour or so before you go to bed.

i) Apart from sex, do not do anything in bed other than sleep

This includes reading (although as I said above, I do read in bed these days — after all, rules are made to be broken, right?), listening to music, watching TV, eating breakfast, building Lego sets, whatever. If you want to read, use a smartphone, or just relax, do not do these in your bedroom.

k) Finally, do not “clock-watch” during the night

I have a clock in my bedroom, but only look at it when I need to check if it really is time to get up in the morning.

5) If your insomnia is an ongoing problem and you are serious about curing it, you need to try what Sleepio calls “sleep restriction.”

The purpose of sleep restriction is to discover how much sleep you really need and to limit the time you spend in bed to that amount only.

To do this, keep a sleep diary for a few weeks. Record the time you spend asleep versus the time you spend in bed. (Because it is not a good idea to clock-watch, you will have to rely on your own rough estimates, but it is surprising how accurate these can be.) The average time that you spend asleep is your “sleep window.” So for example, when I signed up with Sleepio, my sleep window was 5 hours 45 minutes, while my “sleep efficiency” was poor, as I was spending about eight hours in bed every night.

Once you have calculated your sleep window, that becomes the set amount of time you spend in bed every night, although the difficult — and very important — thing is that even if you do not sleep well, you must not sleep late the following morning or go to bed early the following night. This may sound crazy, but it really works, as it forces you (and your body/body clock) into a strict, efficient routine.

For example, once I had calculated my sleep window, Sleepio rounded that up to allow me six hours in bed every night. Obviously going to bed at 11 p.m. and getting up at 5 a.m. was tough to start with, but I soon got to the point where I woke up naturally at that time most mornings, even if I had not set the alarm. The only times I allowed myself any extra time in bed were when I did not get to sleep until, say, 4 a.m., or when I had not slept at all the previous night. Other than that, I went to bed and got up at pretty much the same times every single day for a couple of years. Even now I hardly vary my routine, whether it is a work day, the weekend, the summer holidays, a birthday, Christmas, or New Year’s Eve. Also, and while I would like to be able to say that I now sleep for eight hours a night, I still average little more than six. The important thing, however, is that these days my sleep efficiency is much better, meaning that I spend a lot less time staring at the ceiling and frustrated at the fact that I cannot get to sleep.

6) In the long-term, it is also important to keep busy during the day and develop a positive attitude.

Make a list of goals that you want to achieve and things that you want to do. For example, maybe you want to run 10 km, write a book, start a new hobby, learn a new skill, get a new qualification, or travel.

Even if you do not sleep well, resolve to work towards these goals during the day. This will make you feel better about yourself and make you more tired, both of which should help you sleep better the following night.

Personally, I think that exercise — which is known to be one of the best ways of treating depression — can be a great help. After a break of more than a decade, I took up jogging again a couple of years ago and got a real buzz from it (more than I did when I was younger, for some reason).

It is also a good idea to guide yourself towards positive cultural stimuli, so try to read funny books or magazines, watch comedy shows on TV or YouTube, and listen to positive podcasts, radio shows, and so on. Watching or reading too much news and current affairs can have a negative effect, as they tend to revolve around problems, crises, disasters, crime, and the like.

Another thing I would recommend is to have some kind of counselling or therapy. Insomnia is often a sign of underlying stress or psychological issues, and having a sympathetic (and neutral) ear can not only help you to realise what those stresses and issues are, it can also help you develop a more relaxed attitude, and to look at things from a more objective standpoint. I am by no means in a state of blissful happiness these days, but thanks to therapy and the various things I have learned about myself through suffering from insomnia, I am now a lot better at separating my worries in life (whatever happened to me on a particular day and whatever I am supposed to be doing the next) from the short-term, practical worry of whether or not I will be able to get to sleep that night. Even if you cannot solve a psychological problem or resolve an issue that is bothering you, becoming aware of it — and of how it is affecting your behaviour — is the first step along the way to inner peace, well-being, and overcoming insomnia.

So this is me recommending a book that I haven’t actually read yet, but that sounds like it will be of interest to anyone out there who — like me — is an insomniac, either recovering or suffering.

The book is Why We Sleep by Matthew Walker, and is discussed by him and Dr. Rangan Chatterjee in two episodes of the Feel Better, Live More podcast, and by him and Rich Roll (a vegan ultramarathon runner, no less) in one episode of the latter’s eponymous podcast:

https://podcasts.apple.com/gb/podcast/feel-better-live-more-with-dr-rangan-chatterjee/id1333552422?i=1000444124353

https://podcasts.apple.com/gb/podcast/feel-better-live-more-with-dr-rangan-chatterjee/id1333552422?i=1000505147890

https://www.richroll.com/podcast/matthew-walker-600/

If you suffer from insomnia, being told by Walker that you should be getting between seven and nine hours of sleep a night (even as a mostly recovered insomniac, I still average less than six and a half) may feel like pressure that you don’t need, but do keep listening if you can. Walker’s heart is in the right place — as is his brain — and you will discover all kinds of interesting things. For example, that the tennis player Roger Federer sleeps not for six, seven, or even nine hours a night, but twelve, and that teenagers should be getting as many as eleven (Walker thinks that schools should start their lessons at about 10 a.m. to take this into account).

This was originally written as a guest post for my good friend James at ALT Insider, and is re-posted here with his permission.

A while ago, Gaijin Pot ran a very honest and revealing article called Dealing With Depression In Japan, and while moving here may seem more like a holiday than real life, in fact – and for reasons I shall explain later – I would argue that you’re probably more likely to fall victim to mental illness while living abroad than in your home country. What follows, then, is an account of my own experience of depression, and while some of it relates directly to living in Japan and some of it doesn’t, either way, I thought that my story might be of interest to readers of Muzuhashi.

***

Until the spring of 2016 I was, on the face of it at least, enjoying life in my semi-rural corner of Ibaraki, working as an ALT and bringing up two young children with Mrs Muzuhashi, aka Mrs M. Then, all of a sudden, I was plunged into what I can state with some certainty were the worst twelve months of my life.

For the Muzuhashi family, 31^st May 2016 was to be our last night in the ‘mansion’ – i.e. concrete apartment block – which had been our home for the previous four years. The next day, we were moving to a detached house that was slightly more expensive and slightly further away from civilisation, but significantly more spacious.

One of the students in my English class at the local community centre had told me about the property, and since it wasn’t listed with an estate agent, this was a classic case of my contacts in Japan paying dividends. Despite one or two drawbacks – for example, the commute to our children’s nursery school would now take thirty instead of ten minutes by car – it was too good an offer to refuse, and the kind of place in which Mrs M and I could envisage ourselves living for many years to come.

At the time, though, the move wasn’t the only thing on my mind. I was tired of being a middle school ALT, a job that was too easy and too boring, and in which I simultaneously felt superfluous to requirements, and on the rare occasions when I was asked to contribute to a JTE’s lessons, underappreciated. To that end – and following the advice of your main man James – for just over a year I had been doing translating and proofreading work on the side. Not least in the financial sense, I found this to be highly rewarding, but because I couldn’t do translating work at home, I was doing it instead in the school staff room, right under the noses of my teaching colleagues. In an effort to further improve my Japanese, I was due to sit level four of the Kanji Kentei (漢字検定 / a kanji test aimed at native speakers) at the end of June, and spent the remainder of my spare time on practice problems and past papers.

At home all was apparently well, but it has to be said that my social life had shrunk back to being practically non-existent, as I devoted almost every available moment outside work to my family. Having children was without doubt the most fulfilling thing I had ever done, and I progressed from being the kind of thirty-something bloke who is typically reluctant to start a family, to a hands-on dad and born-again baby hugger. My enthusiasm was, I now realise, all-consuming, and I had become a little too eager to sacrifice the kind of things that might have allowed me to let off steam, like going to a gaijin pub for an over-priced pint, channelling my inner Frank Sinatra at a karaoke box, or cycling off into the wilderness. As it happened, in the summer of 2016 the Muzuhashis were to embark on one of our occasional visits to the UK, and this gave rise to a whole new set of stresses. If, for example, we woke up on the morning of our flight to find that either Muzuhashi Junior or Muzuhashi Junior II was too ill to travel, we may have to cancel the entire trip, and because we couldn’t get insurance to cover such an eventuality, lose a quite eye-wateringly large amount of money in the process.

So having completed some last-minute preparations for the move, there was enough on my mind on 31st May that I was still awake at about midnight, when our daughter began to stir in her futon (like a lot of families in Japan, at the time the Muzuhashis were in the habit of all sleeping in the same room). When I say ‘stir’, what I really mean is ‘throw up’, and because there had been no sign of M Jr being ill that evening, my wife and I were unprepared for the veritable tsunami of vomit that engulfed M Jr’s face, hair, clothes, bedding, and even the floor.

About half an hour later the clothes and bedding were in the washing machine, and M Jr was showered and back in bed. By now, though, I was even more wide awake than before, and when, at around two a.m., she awoke for a further round of vomiting, poised to spring into action and limit the collateral damage.

After yet more mopping, changing and washing we were back in bed again, and this time M Jr went to sleep and stayed that way. Try as I might, however, I remained resolutely conscious. This was fine for another hour or so, but by three in the morning and then four, I began to contemplate the – as Al Gore might have put it – inconvenient truth that everyone else would wake up at six. I tried lying on my back, my front and on my side. I went for a pee, had a glass of milk, and listened as early morning commuters sped past on the road outside and scooter-borne newspapers were delivered to the neighbours.

For some reason, my mind had also become host to an unwanted intruder. A few bars from the chorus of one particular song – in this case, a J-pop number that was broadcast during cleaning time at the school where I worked – played over and over in my head, a phenomenon that is referred to as an ‘earworm’. Every time I turned over or adjusted my position on the pillow, every time I noticed a noise from outside, every time I had a new thought about how exhausted I might be the next day, every time I breathed, it seemed, the same phrase popped into my head, and try as I might I could not dislodge it from its needle-stuck-on-a-scratched-record, repeat-playback loop.

Finally, inevitably, the end came, and at six a.m. my wife and children woke up. Many was the time in my younger days that I would stay out all night, arrive home when the sun had already risen and sleep until lunchtime or later, and conversely, the earliest I had ever set my alarm to get up and go to work was 1.30 in the morning. But this was the first time in my life that I had quite literally not slept for a single second since getting into bed, and particularly on this occasion, there was no option but to get up and confront the day ahead.

Thankfully the move itself was taken care of by a combination of Mrs M, some friends of ours with a keitora (軽トラ / little white flatbed vans beloved of farmers and ubiquitous in the Japanese countryside), and a removals company. All I had to do, therefore, was go to work, zombie my way through a couple of English lessons with my JTE, and spend the remainder of the day sitting in the staff room, pretending to study kanji.

When I arrived at our new home that evening, the furniture and white goods were in place, and M Jr had been diagnosed with strep throat (溶連菌 / yohrenkin), throwing up several more times during the day. The crunch came that night, when the four of us retired together to our second-floor bedroom. Given the fact that by that point I had been awake for about forty hours straight, I assumed that I would drift off as soon as my head hit the pillow. But something had clicked in my brain the previous night, and once again I found myself tossing, turning, and looking on in envy at M Jr II: angelic, contented and fast asleep in the futon next to me.

I did eventually manage to get to sleep on the night of 1st June, but from that point onwards, each bedtime became a trial-by-insomnia, and while I didn’t have another all-nighter, on average I was getting no more than two or three hours’ sleep a night. Looking back, I’m amazed that I could still stand up straight, let alone ride a bicycle, drive a car, or explain the finer points of the present perfect tense to a room-full of fourteen year olds.

Perhaps inevitably, as well as physical tiredness and psychological stress, the insomnia soon took its toll on my immune system, and after more than a fortnight of next-to-no sleep, I fell ill on the day of the Kanji Kentei. The exam itself took place at four in the afternoon (members of staff are allowed to sit the Kanji Kentei alongside their students), and during the day I felt so dreadful that I contemplated going for a lie down in the nurse’s room. In the end I settled for dozing at my desk – which incidentally is a perfectly acceptable thing to do in Japan – but once I had sat the exam, gone home, not eaten dinner because my appetite had deserted me, taught the aforementioned community centre English class and returned home once more, I had a fever of 38 degrees (that’s 100°F for the more metrically challenged among you).

Even that night I hardly slept, and over the next few days went to see a doctor on three separate occasions. At one point my throat infection was so bad that I was on the verge of being admitted as an in-patient, but having twice been put on a drip and prescribed two different varieties of antibiotic, by the middle of the following week (with all of my paid holiday already allocated to our imminent trip to the UK, I was obliged to take two days off unpaid) things had finally started to improve.

The antibiotics also helped me sleep properly for the first time in nearly three weeks, but once I had finished taking them, while the throat infection had cleared up the insomnia had not, and on my last visit to the hospital I was handed a prescription for zolpidem, a sedative that is widely used to aid sleep. The doctor assured me that zolpidem was mild and would not cause any problems, but having taken my first dose at the end of June 2016, there began a year-long battle not just with insomnia, but with the medication I used to combat it, and with the side effects of both.

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.

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?

This was originally written as a guest post for my good friend James at ALT Insider, and is re-posted here with his permission.

While my insomnia and subsequent depression were triggered by a combination of factors – moving house, my daughter throwing up in the middle of the night, the kanji test, our upcoming trip to the UK, dissatisfaction with my job as an ALT, the conflict of interest that arose from trying to work my way into translating while still holding down a full-time job – the underlying causes were perhaps different.

No matter how much I studied, my Japanese stubbornly refused (and still does refuse) to become fluent, which left me isolated, and even when I was communicating with the people around me, stuck in a rut of superficial small talk. Furthermore, my desire to raise bilingual children by only speaking to them in English, pretending not to understand should they speak Japanese to me, and not speaking Japanese to other people when they are present, has isolated me to an even greater extent than the average foreign parent in Japan. (The mere fact of becoming a father was, I believe, another contributing factor to my psychological instability: having children carries with it a great deal of responsibility, and has reminded me of incidents and emotions from my own childhood that I might prefer to forget.)

On a more mundane level, I found myself irritated by certain aspects of life here. For example, I had a long list of gripes about Japanese drivers, who jump red lights, overtake parked cars when there is traffic approaching on the opposite side of the road, fail to indicate before making a turn, crawl along in the middle or outside lane, leave their engines running in car parks, or leave their air conditioning on with the windows wound down. This kind of thing may seem trivial, but I spent a disproportionate amount of time complaining to Mrs M, or honking my horn and hurling abuse at other motorists if they did something that I viewed as being particularly idiotic.

I’m sure readers of this blog have similar pet hates – the endless form-filling and waiting in line required to get a visa or a gaijin card, for example, or the poorly heated apartments with paper-thin walls and single-glazed windows – and while I don’t claim to have a secret formula for dealing with them, something that changed my attitude was the realisation that culture shock isn’t a hatred of the country in which you live, but rather, a love of the country where you grew up.

Also, I am far from being the first expat to have difficulty coping with life in Japan. An acquaintance of mine couldn’t handle the pressures of fatherhood, and disappeared back to America never to be seen again, leaving his partner to bring up their young son by herself. Having broken up with his girlfriend, an ALT in my wife’s hometown let his personal life unravel to the point where he hardly left his apartment, which was in a state of complete squalor. And a friend of mine who works in recruitment has dealt with ALTs who have become alcoholics, suffered from paranoid delusions, thrown furniture from their balconies and bricks through shop windows, or simply stopped going to work – gaijin hikikomori, if you will. But if for whatever reason you find that life in Japan is overwhelming you, what should you do about it?

It may sound obvious, but your first option is of course to quit and go home. When I first lived in Japan I worked for an English conversation school in Tokyo, and due to a combination of factors – culture shock, a relationship break-up, noisy neighbours, overwork and disreputable employers – I became so unhappy that I seriously considered hopping on a cheap flight and heading back to the UK. Partly out of pride, and partly because something told me that I shouldn’t give up just yet, I stuck it out, began trawling the small ads, and within a few months had a better job, better employers, quieter neighbours and, most important of all, had met Mrs M. I’m not necessarily saying that you should force yourself to stay on no matter what, but it is quite likely that even if you are having a tough time, you feel the same way that I did, namely that deep down, you don’t want to give up on your dream of living and working in Japan. Also, it may be the case that even if you wanted to, returning home is not an option – for example, if you have work commitments, a wife and kids, or a husband and kids.

Men in particular – and I would freely admit to being guilty of this myself – have a tendency to keep things bottled up, but the first thing you should always do if you’re feeling depressed is to talk to someone. Your new mates in the nearest gaijin pub aren’t a bad place to start, but as well as the fact that you may not want to confess all to them, they probably haven’t known you for very long. The next best thing to going home, therefore, is to talk to the people you left behind.

Like a lot of expats, particularly during the first couple of years I lived here, I almost made a point of ignoring my friends and relatives. This was partly because I thought it would help me integrate into Japanese society, and partly because I felt obliged to make new friends. When I was in the UK, I would typically see or talk to at least one friend or relative a week, but in Japan this plummeted to more like once every couple of months. Emails and Facebook are all very well, but much like the difference between reading a Japanese textbook and talking to a real-life Japanese person, there really is no substitute for a proper conversation. So particularly following our visit to the UK in the summer of 2016, I vowed to have more direct contact with my friends and relatives there, and have since talked to people I had been out of touch with for years at a time, in places as far flung as Sweden, Spain, Canada and New Zealand. Way back in the mists of time, this would have necessitated an expensive and / or logistically inconvenient phone call (as anyone who remembers Smart Pit and the Brastel card will tell you). But as well as being able to talk to pretty much anyone in the world for free (or rather, for the price of a broadband / mobile connection) via Skype, FaceTime or Messenger, nowadays even calling real-life telephones via the internet is cheap. At the time of writing, for example, I can call a UK mobile phone for just 6p a minute from Skype, something which has enabled me to reach even my more technophobic friends.

As such, if you need someone to talk to, you could call the Suicide Prevention Lifeline in the US or the Samaritans in the UK, organisations which are, I assume, unlikely to discriminate against someone merely because they live abroad. Even if your Japanese isn’t up to the task of describing the finer points of your mental state, there are some English-speaking counsellors and therapists in Japan – for example, at Tokyo Mental Health and Tokyo Counseling Services. A word of warning, however: their services don’t come cheap, and nor will counsellors and therapists in your home country – for instance, my Skype sessions with a therapist in the UK cost 50 GBP a time. Fortunately, if you either cannot or do not want to spend large sums of money, there is the TELL Lifeline, a free telephone service from an organisation that also offers face-to-face counselling.

As Liam Carrigan points out in his Gaijin Pot article, the question of whether or not you should talk to your employer is a tricky one. The cowboy conversation school I worked for in Tokyo was unlikely to have helped if I told them I was depressed, but the school managers I saw on a daily basis were some of my closest friends at the time, and would, I suspect, have proven both sympathetic and trustworthy. I felt much the same way about my colleagues at the dispatch company through which I first worked as an ALT, and now that I’ve moved on to being direct hire, it so happens that my supervisor at the board of education is an English teacher with whom I already had a good working relationship. On condition that she keep it to herself, I told her about my problems, and as well as a sympathetic ear, received some useful advice (a friend of hers had recently recovered from a similar brush with insomnia, medication and psychiatric treatment).

Whatever you do, though, the most important thing is to not bottle up your feelings. Communicating the fact that you are depressed to another human being is the first step along the way to overcoming it, and it is important to emphasise the fact that no matter how hopeless you may feel, if you seek help and work hard at trying to find a solution, things will get better. Not only that, but in my experience, you may emerge on the other side as a better person. Having found myself in a place that felt like rock bottom, I have learned to appreciate the good things in life, to be more considerate to the people around me, and to be more positive about my job, Japan, my family and the future.