An insomniac's monologue

Twenty-one-year-old Anoushka Metrani tells the story of her nightly struggles to fall asleep. How and when do sleep problems turn into insomnia? And how do doctors treat it?

It is Sunday, 11 pm. I am tired but I can’t sleep. I haven’t slept in three days. And I haven’t felt rested all week. I have struggled to focus on work, and everything from talking to friends to cleaning my room feels overwhelming.

When I stayed up all night, staring at the ceiling for no apparent reason for the first time in 2021, I didn’t know what it meant. I had spent hours trying to fall asleep on many nights but my brain refused to calm down. I have a hyperactive mind and with nothing to keep me distracted at night, it had a free run.

The sleepless nights, overthinking and anxiety — Google called it insomnia. And then my psychiatrist confirmed it. It took me about a year to see a doctor and only because my mother made me do it.

Getting help is not as easy as it sounds, even for a ‘woke’ Gen Z girl like me. Don’t we fear judgement? Insomnia is a teen-youth thing. Your generation is too sensitive. You are overreacting. It’s all in your head. Just keep busy, and sleep will follow. I have heard it all. But I don’t react and defend myself anymore.

I also understand why people don’t ‘believe’ me. Unlike many who develop red eyes and dark circles from one night of sleep deprivation, I look fine and functional on most days. Playing a sport or running is tough because internally, I am bone-tired. But commuting, working in the office, socialising, and sketching are easy to do.

When stress hit me

For the longest time, I had been an excellent sleeper. In my early teens, my friends made fun of me for sleeping at 10 pm or even early. While they were up till midnight bingeing on Netflix or studying, I hit the bed by 10 pm.

That changed when I entered Class 11 and then 12. A psychologist attributed it to anxiety about impending changes in academics and my body. Sleeping by 12 am became the norm. It was normal in my friend circle, so I didn’t make much of it. Initially, I was sleepless for two to three days every month. That became longer and more frequent last year.

It was when a close friend of mine opened up about her diagnosis of anxiety and insomnia that I decided to talk to my mother and we landed up at the doctor’s clinic.

Categorised as a sleep disorder, insomnia can make it hard to fall asleep or stay asleep, cause disturbed sleep, and impact health, productivity, and quality of life negatively, my psychiatrist explained to me on the first visit.

“I know. Just make it stop. Help me sleep,” I said curtly. He advised me to stay away from electronic devices before bedtime, exercise every day, meditate, and drink chamomile tea. It wasn’t very different from what I had been trying — doing yoga, listening to white noise, lo-fi, and brown noise, avoiding caffeine, lighting scented candles in my room, downloading wellness apps, and dancing.

I tried what my doctor advised, except for keeping the phone away for it was my source of comfort, a companion on lonely nights. Eventually, I tried the phone thing for a week. Not much changed. I averaged three hours of sleep every night that week. There must be something wrong with my brain, a manufacturing defect, I blamed myself. It made me irritable and increased my anxiety.

One day, to my surprise, sleep was a friend again. Then it wasn’t. A back-and-forth of sleep, no sleep, and inadequate sleep ensued.

Insomnia doesn’t mean one can’t sleep ever, something I get to hear a lot. In fact, one of the longest sleep-deprivation records is held by Randy Gardner from California. As a 17-year-old in the early 1960s, he stayed awake for 11 days and 25 minutes. Reportedly, he had exhibited tiredness, lack of concentration and hallucinations during the voluntary experiment, and developed insomnia later.

I sometimes ‘feel’ I have stayed up longer than that simply because I don’t feel rested. But there are genuine cases where people sleep but feel they haven’t slept at all. Dr Ravi Yadav, professor of neurology, Nimhans, explains: “A 50-year-old woman said she could not sleep during day or night despite medication but was able to perform daily tasks. After a sleep test, we found she was getting adequate sleep. This is called paradoxical insomnia or sleep state misperception.”

Doc prescribes a pill

The lack of restful sleep doesn’t help the many problems my body is riddled with — Gastroesophageal reflux disease, migraine, and backache. I also had two bouts of Covid.

Seven to nine hours of sleep is ideal but public mental health educator Dr Sharmitha Krishnamurthy says “the quality of sleep is also important”. Non-restorative sleep, she says, can lead to increased heart attacks, mood deregulation, hypertension, diabetes, depression, hormonal imbalances, irregular menstruation, and chronic inflammation. You become immunocompromised and susceptible to cold, flu and infections.

“Suicidal tendencies also increase. We see a lot of suicide cases late in the night or early in the morning because of sleep deprivation,” she informs.

I went back to my psychiatrist 10 months later. My sleep wasn’t getting better, I told him. He prescribed one sleeping pill a day.

After the first dose, I felt uneasy, unusually alert. I felt there was someone outside the door and texted my friend that I was afraid. A few days later, I was feeling better and I stopped the medication. My mother found out and I got a dressing down. She was right. Doing this without the doctor’s advice was not and is not a good decision (See box). I have stopped the medication, and practice sleep hygiene instead. But sometimes, I lack the motivation to keep up with that.

Other cases

When I set out to write this story, I found many who claimed to have insomnia but only a few who had been clinically diagnosed.

Dr Sujit Kumar spoke about a 50-year-old homemaker whose life was in “a bad condition”. She was healthy but poor sleep left her constantly irritable. She would struggle to do household chores, and bicker with her family. With medication, she started clocking 6-7 hours of sleep against 3-4 hours earlier, shared the neurologist and epileptologist from Bengaluru.

Aakanksha Singh said her grandmother had insomnia for over two decades. “At night, my grandma would double-check the door locks and go around the home anxiously, reciting prayers. She would sleep for four hours during the day. After grandfather’s passing, she began having panic attacks. An ENT specialist referred her to a psychiatrist and we were told the lack of sleep, paranoia and age had resulted in delusion and mild dementia. She was taking 20 pills a day to keep herself sane,” the engineer from Mumbai recalled.

Lalitha Mondreti, 49, said she had trouble sleeping for many years but she always focused on getting help for her physical health — asthma, fibromyalgia, and immunity issues. Stress related to work and her father’s battle with cancer kept the Bengalurean awake.

“Five years ago, I decided to seek help. My doctor told me whether I could fall asleep or not, I should turn off the light and sit in the dark for an hour. My sleep cycle improved in a month and I was able to sleep for three to four hours,” the former waste management professional shared. Yoga, naturopathy, and meditation has helped her since, she said.

Seela’s insomnia came as a surprise to her in 2014. A policy researcher in Delhi, she had visited a doctor complaining of mood swings. She was diagnosed with both bipolar disorder and insomnia. “Some days, I could not sleep. Other days, just four hours,” the 39-year-old looked back on the ‘signs’.

Dr Ravi shared a case study of mild insomnia: “A 32-year-old businessman would sleep within 10 minutes at night but stay awake from 1 am to 5 am. The lab study found he had insomnia with obstructive sleep apnea, in which breathing stops momentarily. This was because of his obesity.”

Coping with bad days

Everyone has nights when they can’t sleep but I have them often. I call them ‘bad days’. They strike me when I am feeling low. Over time, I have learnt to avoid forcing myself to go to sleep. Instead, I watch Netflix. I write ‘dark’ poetry and post them on Instagram. Poor sleepers see vivid dreams, I have gathered from anecdotes. I see guns and zombies. I have penned down these dreams in my diary. I hope to reel out a storyline for a book one day.

In recent times, one particular week in September was the most difficult. I remember walking around in a daze, swaying, staring at the ceiling. I have no memory of two days from that week. I am reminded of what Dr Sharmitha said: “Sleep ensures that the memory goes from short-term to long-term.”

I am writing this story in the middle of these ‘bad days’. It is 12.04 am. I close my eyes and remind myself that I need to be productive. Some days I feel like doing too much at once, and it overwhelms me. In the end, I do nothing and I feel worse. My mind is caught in the vicious loop of overthinking.

It is 1 am. My eyes start drooping. Finally, sleep is here. At 1.08 am, I open my eyes. I feel heaviness in my chest, a weight I can’t quite seem to place. I sit up and take a couple of deep breaths. I try to meditate but tonight the thoughts are too loud inside my head.

At 2 am, I start writing poems. I scroll through reels. At 3 am, I walk out of my room and pace up and down the hall. The frustration builds. I want to slam my head against the wall. Maybe that will knock me out.

By 4 am, I am on the floor in my bedroom. I can’t stop crying. I am so tired. The carpet feels soft and comforting. I dwell over my past failures but also imagine impossible scenarios, about being the only survivor in a plane crash or being late to an important event. The rational voice in my head counteracts every intrusive thought with logic.

Now I am tempted to chat with fellow insomniacs — I see many of them ‘online’. But I don’t want to be a bother.

I hear the birds chirping, and the clock glows faintly to show 5.26 am. I crawl back in my bed and get under the blanket. I clutch my stuffed elephant like it is the only thing keeping me from floating.

I don’t know when I fall asleep, or if I slept at all, but I am up again at 7 am. I refuse to get out of my bed though.

(With inputs by Mariya S Mattathil)

Experts speak

‘Not a youth problem’

Dr Harish Shetty, a psychiatrist based in Mumbai, says it is wrong to dismiss insomnia as “a teen-youth problem”. “If one is showing symptoms of insomnia, it’s a sign that the mind-body orchestra is out of sync and needs to be reset. Most insomnias are a sign of other illnesses. Anxiety regarding jobs, finances or health is the most common cause.” Chronic insomnia is also seen in those who work in night shifts, are addicted to alcohol and drugs, and have nutritional deficiencies.

FAQ with Ravi Yadav, professor of neurology, in charge of Sleep Disorders Clinic, Nimhans

Short-term insomnia is always co-conditional, caused by grief, acute stressors, fever, body pain, traumatic events like hospital admissions, etc. It is reversible but can predispose a person to chronic insomnia.

Chronic insomnia is insomnia that lasts for more than three months, when the brain goes into hyperarousal, a state of being alert most times, and the circadian rhythm is disturbed. Hyperarousal can be attributed to three Ps: Predisposing factors — genetic, physiological and psychological. Precipitating factors can be anxiety, stress, bereavement. Perpetuating factors include overthinking.

Insomnia can be cured with therapy or medication or by treating the primary cause (like anxiety or obesity). Chronic hyperarousal needs long treatment — a mix of sleep hygiene, Cognitive Behavioral Therapy-Insomnia (CBTI) or medication. A good 50% of insomniacs improve with behavioural therapy and lifestyle changes. Most don’t prefer medication.

If insomnia is co-conditional with some psychiatric condition, people may experience unease and paranoia after taking sleeping pills in the initial days. This calls for further assessment.