In the Telegraph again :)

Ten days til publication, says Levy.

Can an insomniac ever learn to sleep again?

With lockdown condemning millions more to nightly wakefulness, Miranda Levy explains how she finally managed to get her shuteye again

ByCharlotte Lytton 31 May 2021 • 5:00am

'The longer you’ve had a sleep problem, the less likely it is that a few generic tips and tricks will hold the key to unlocking better sleep'
‘The longer you’ve had a sleep problem, the less likely it is that a few generic tips and tricks will hold the key to unlocking better sleep’

Everyone knows how rough a bad night’s sleep feels – all the more so over the past year, when disturbed rest has affected half of the nation. Rates of insomnia – defined as wakefulness for significant portions of the night, for months or years at a time – have also risen sharply, from one in six pre-pandemic to one in four. It can leave sufferers feeling “like a shadow of a person”, according to Miranda Levy. The sudden end of her marriage saw her tortured by an inability to sleep for eight years, eroding her work and home life in the process: in her new book, The Insomnia Diaries, she recounts the fractured moments of rest accrued over that near-decade, and how she learnt to sleep again.

A study published last year in the journal Nature Human Behaviorrevealed that women have far greater difficulty falling asleep at night than men, with insomnia typically affecting those in the 45-54 age bracket worst. Those afflicted in the short term are typically diagnosed with acute insomnia, caused by a particular ailment or trauma, an unfamiliar bed or excess noise, while the 10 per cent of the population who suffer from the chronic kind experience sleeplessness lasting at least three days a week for more than three months. For Levy, now 52, one gave way to the other: when her husband of nine years announced he wanted a divorce, what she assumed might be a few anguished nights turned into “eight years of hell”.Advertisement

“The problem is that the longer you’ve had a sleep problem, the less likely it is that a few generic tips and tricks will hold the key to unlocking better sleep,” Dr Sophie Bostock, founder of the Sleep Scientist, writes in the foreword to The Insomnia Diaries. Regularly struggling to get to sleep, lying awake for extended periods, feeling exhausted on waking and difficulty maintaining concentration, energy levels and even relationships are all telltale signs that trouble is afoot. “Sleep science is not rocket science but the sleep system does have quite a few moving parts. The longer it’s been broken, the harder it can be to twist the pieces back into shape.”

There is no magic number for how much shuteye a person should have, but most studies pitch it around the seven-hour mark: getting fewer than six hours each night is associated with a 12 per cent increased risk of premature death, while poor sleepers see their likelihood of future anxiety and depression double. “We are only scratching the surface” of insomnia’s real impact on brain and heart health, explains Guy Leschziner, professor of neurology and sleep science at King’s College London.Advertisement

The NHS advises that those experiencing periods of insomnia practise good sleep hygiene, achieved through regular bedtimes, a restful bedroom environment and a healthy lifestyle. It also suggests visiting the GP, should problems continue.Miranda Levy has chronicled her fight to get some sleep in The Insomnia Diaries CREDIT: Rii Schroer

In Levy’s case this led to a prescription of sleeping pills which, according to the Sleep Charity, are regularly being taken by one in 10 adults. But the drugs doled out each year in their millions – usually benzodiazepines and zopiclones (or “Z-drugs”) – are not an effective longterm cure: there was no difference in the quality or duration of sleep among those taking them compared with people who didn’t, researchers at Brigham and Women’s Hospital found this month. Worse still many – Levy included – find themselves in the throes of addiction as a result.

Why are we so reliant on treating a restless night by reaching for the medicine drawer? “People are used to getting a pill, aren’t they?” Levy mulls of her former reliance on clonazepam, and valium. “I needed a quick fix: go to sleep, wake up, look after my kids and carry on working. I think a lot of people feel like they need [that].”Advertisement

The debilitating effects of sleep loss cannot be overstated: it can fuel brain fog and weight gain, trigger type 2 diabetes, harm fertility and dent libido. If pills don’t work, though, what does? The Brigham study suggested cognitive behavioural therapy for insomnia (CBT-i) should be used in lieu of long term medication, as this “aims to essentially reprogramme your brain’s association between bed and sleep,” Prof Leschziner says. “It uses a variety of techniques, including relaxation therapies, good sleep hygiene, and sleep compression (making sure you do not spend prolonged periods of time in bed while awake and using your brain’s own mechanisms of sleepiness in the face of sleep deprivation).”

CBT-i usually attempts to reframe unhelpful thoughts about sleep, such as worrying how little you’re getting, as well examining the connection between the effects of our habits on our ability to rest. “It’s not for everyone,” he says. “It is quite challenging and difficult to do.” But over the course of the average four to six week treatment, “60-80 per cent respond very well to CBT-i alone” – the maximal benefit being reached at the 8-12-week point. “Many of the drugs doled out work for some people some of the time in the short term,” he adds, “but we know CBT-i is the treatment of choice”; one that, in the long term, is “more effective” than medication.Advertisement

CBT-i can be expensive to undertake, and NHS waiting lists mean an average of 6-18 weeks post-referral for a first session to take place: apps such as Sleepio (free to all through an NHS referral or on request) provide a virtual six-week programme to follow, which may at least be an interim solution. Resolving insomnia really comes down to one thing, says Prof Leschziner: understanding its root cause, be it physical or psychological. His patients share fears they’ll never sleep properly again “all the time,” which “actually fuels the insomnia” (made yet worse by the vogue for digital trackers, he points out, which encourage unnecessary micro-focus on total rest reached). Levy was struck by this message in her CBT-i treatment: “Don’t turn the insomnia into a worry that itself prevents you from sleeping. Some nights, as I lay there at 3am or 4am I’d say this aloud to myself: ‘Don’t turn the problem into a problem.’”

With CBT-i, a weighted blanket and a committed exercise regime, Levy finally began sleeping again two years ago – and has continued to do so, even in the face of a national coronasomnia crisis. “It didn’t happen overnight,” she says of her recovery, but now – after six or seven hours of rest – she wakes each morning with “a thanks to the gods of sleep”.Advertisement

Levy believes the abiding message for any insomniac distressed they may never recover is that their situation is temporary. “Be patient, give yourself some leeway, just power through it. Eat well, continue to exercise, socialise as much as you can, don’t catastrophise, try to keep perspective,” she advises.

The fear of returning to those dark, sleepless days will likely never dissipate entirely. “It certainly doesn’t preoccupy me,” Levy says. “I’m really happy I’m getting on with my day, getting on with my life, and looking ahead.”

The Insomnia Diaries by Miranda Levy (RRP £9.99). Buy now for £8.99 at books.telegraph.co.uk or call 0844 871 1514https://cf-particle-html.eip.telegraph.co.uk/e0bdcea5-1eeb-473b-9566-96e397a73c13.html?i=0&ref=www.telegraph.co.uk/health-fitness/body/can-insomniac-ever-learn-sleep/&channel=healthandfitness&id=e0bdcea5-1eeb-473b-9566-96e397a73c13&isapp=false&isregistered=true&issubscribed=true&truncated=false&lt=falseRelated Topics

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‘I didn’t sleep for eight years and my life fell apart’

Miranda Levy’s insomnia left her dependent on a cocktail of sleeping pills. It also wrecked her career and left her life in tattersByMiranda Levy28 May 2021 • 5:00am

Miranda Levy suffered with debilitating insomnia for years
Miranda Levy suffered with debilitating insomnia for years, as she discusses in her new book, The Insomnia Diaries CREDIT:  Felicity McCabe

May 2018. It’s my 50th birthday but instead of celebrating, I’m sitting in my childhood bed wearing a pair of tatty eight-year-old pyjamas, staring into space. I can’t remember the last time I left the house, which is just as well because I look a fright and I’m so exhausted, I can’t speak in full sentences, but babble in a mindlessly circular way.

For the best part of a decade, I suffered from insomnia so severe and disabling, it stole my career, my looks and ultimately my sanity.

The nightmare started in July 2010 – Friday 16th, to be precise. I was 42. I worked a four-day week as editor of a parenting magazine, and always enjoyed my ‘magic Fridays’, where I had the morning to myself to shop and exercise before picking the children up from school.

On that particular day, two heavy Sainsbury’s bags in hand – still in my gym gear from my Power Plate class – I navigated the front door and was surprised to see my husband standing in the living room.

We had been together for 13 years, married for nine, but busy careers and the competitive tiredness caused by two children born 20 months apart meant things had started to fracture. He started speaking. I only heard part of what he was saying – such was my discombobulation – but the upshot was this: he wanted to call time on our marriage.

I had heard people talking about Sliding Doors moments, about rugs being pulled from under them. Now I knew what they meant. Nothing would ever be the same again. At some point, I called my best friend and burst into tears. Then I finished the day on autopilot, making a birthday cake in the shape of a football pitch for my son, who was about to turn six. I went through the usual family evening routine and took myself to bed at around 11pm.

But I didn’t fall asleep until after 2am and was awake at around 4.30am. I was devastated at what had happened – my whole life had been thrown off balance. I was also distraught about what might happen to my sleep. I’d had a bout of insomnia years earlier, which had taken me many months to overcome.Levy with her father in 2014, during her time in rehab. She moved in with him two years later CREDIT: Courtesy of Miranda Levy

I didn’t know it at the time, but I was already slipping back. This time around, it would last the best part of a decade. My Insomnia Crash, as I later called it (though it was really more like a train wreck in slow motion), hurled me headlong into a cycle of dependency on sleeping pills and tranquillisers, resulting in a stint in rehab, two psychiatric hospitals and a sleep clinic.

Today, I’ve recovered and I sleep six or seven hours most nights – I even slept well in the pandemic. But I still live under a slight shadow that this might all happen again.

A growing modern-day problem

Insomnia is a growing, modern-day problem – and Covid has made things worse. The number of people experiencing it shot up from one in six pre-pandemic to one in four in the middle of it, according to research from the University of Southampton. Even those without full insomnia are affected: half of Britons say their sleep has been more disturbed than usual during the pandemic, with two in five saying they have slept fewer hours a night.

I first experienced insomnia at 16, the night before my O level maths exam; I remember feeling horrified that a person could have the lonely and disorientating experience of being awake all night. In the years after that, my sleep was a bit fragile, particularly just before starting a new job or the first night in a hotel. But mostly, I slept well – eight, nine, even 10 hours a night – until 15 years ago when I was given a taster of how disabling prolonged insomnia could be.With her two children, Christmas 2004. After some difficult years, their relationship is stronger than ever CREDIT: Courtesy of Miranda Levy

A few days before Christmas 2005, my appendix burst and the two weeks I spent on a bright, noisy NHS ward seriously interfered with my sleep. When I got home to my dark, quiet bedroom, things surprisingly did not improve. By this time, I was married, and working as a freelance journalist. We had two wonderful children, then 18 months and three years old. Life was good. But suddenly, for several months I was incapacitated by insomnia, unable to work or properly engage with my children.

This was bewildering. Sleeping pills helped, but only for a couple of hours a night. I’d spend the whole day gearing myself up to put the kids in the bath and read them a bedtime story. But my concentration was shot and the words in those storybooks could have been Mandarin. I felt guilty that I couldn’t properly ‘be there’ for my children.

Eventually, with the support of my husband and an empathic psychiatrist who prescribed a sedative antidepressant, I got back on my feet. For the next four years, my sleep was great: I slept for England.

Until that day in July 2010.

My descent back into insomnia

That night, after my husband said he wanted out, I slept for two and a half hours. The next night, 35 minutes. Then, not at all. I was terrified, praying that my sleeplessness was just an initial shock reaction. On my way to work on Monday, dazed with tiredness, I stopped at the walk-in GP service and asked the doctor for some sleeping pills, explaining I’d had bad personal news. When he wrote me a two-week prescription, I felt a rush of relief – but that night the pill didn’t work. The next night, I took two. Didn’t work either.In search of a night’s sleep: the candles, weighted blanket, books and pills  CREDIT: Still-life: Felicity McCabe

Those early weeks were a panicky blur as I tried everything I could think of to sleep – exercise, hypnotherapy, reiki. I banned myself from looking at my phone before bedtime. Someone even bought me a purple crystal, which apparently emits a ‘serene frequency’. I was desperate.

By then, my husband had moved to the spare room – a situation that was to continue for financial reasons until I eventually moved out six years later. I knew if I could just get some proper rest, it would help me cope with everything that was going on.

Friends tried to help, dishing out advice. Some suggested I put lavender oil on my pillow, others that I drink camomile tea, burn a Jo Malone candle, spray magnesium on my arm. Though well-meaning, I found the advice frustrating. Meanwhile, the nights were endless and lonely. I tossed and turned, staring at the red numbers on my alarm clock.

When morning broke, I’d feel defeated, furious, and too drained to consider how I’d survive another endless day.

‘Out of control sleeplessness’

Soon my sleeplessness felt out of control – no longer a temporary state but a ‘stand-alone’ problem. I felt sad about the end of my marriage and uncertain about the future, mixed with a large dollop of fear, but the horror of being awake 24 hours a day – and the exhaustion that accompanied it – defied description.

I’ll always be grateful for the way my ex took great care of the kids during this time, supported by their grandparents. Meanwhile, my life fell apart, piece by piece.

I was put on sick leave from work and my GP referred me to a consultant psychiatrist for more specialist advice. At that first appointment, I begged the psychiatrist to give me something that would ‘buy’ me some rest, practically hugging him round the knees. He prescribed clonazepam, a drug with tranquillising qualities, often prescribed for panic disorder.

At first this bought me a few minutes’ sleep here and there, and a pleasant fuzziness in between. But the relief didn’t last. I found myself needing more to get the same effect. The psychiatrist doubled the dose, later increasing it further. Soon I was dependent, and would ‘hide’ the pills from myself – usually in a pair of boots in the wardrobe – to deter myself from taking more than the prescribed dose.https://cf-particle-html.eip.telegraph.co.uk/ef4da3df-8789-4258-a129-5e4df36d7ae8.html?i=0&ref=www.telegraph.co.uk/women/life/didnt-sleep-eight-years-life-fell-apart/&channel=women&id=ef4da3df-8789-4258-a129-5e4df36d7ae8&isapp=false&isregistered=true&issubscribed=true&truncated=true&lt=false

By September I existed in a spaced-out state of utter exhaustion, probably best described as ‘numb terror’. I dreaded seeing the other mothers when the children returned to school. It was a friendly community, but it was also a hive of gossip. I hadn’t seen the gang since early July and in that time I’d gone from cheerful working mum to a fidgety ghost, who found it difficult to make eye contact.

On the first day back, I dropped the kids at the school gate, planning to dash back to the car. But – too late – I was spotted by several of the Mummy Corps. I knew I didn’t look great but they stopped chatting when they saw me. One woman actually did a double take. I gave a falsely bright smile, saying, ‘How was your summer?’ Then I hurried home, retreated to bed.

As the weeks passed by, things didn’t improve. Every morning, I thought this hell was simply unsurvivable, that I couldn’t possibly manage another hour.

That autumn, tortured with sleeplessness, I took an overdose. I didn’t want to die. I just wanted to sleep and hoped there might be some hazy benefit from emptying the blister pack. There wasn’t. The world tilted alarmingly and I was violently sick. Frightened, I called an ambulance. I don’t recall a great deal about what happened at the hospital, except that I was given an antiemetic (a medicine that treats vomiting), plugged into a saline drip and made to feel like a moronic time-waster.

The search for a solution

Over the next 16 months, I made several abortive attempts to return to work. Then, in January 2012, I was made redundant. I started spending even longer in bed, stopped answering the phone to my friends and withdrew entirely from the world. Gradually, I convinced myself that the only way to end this horror was to switch myself off, permanently. I contemplated suicide for a long time, researching methods online.

Yet the irony is that at the same time, I was still desperately scrabbling around for solutions: I saw numerous psychiatrists who gave me yet more pills – from sleeping pills to drugs used to treat psychosis – which had terrible side effects, including weight gain. My body weight doubled in the space of a few years. My hair became dry and straw-like, my skin flaky.

Staring in the mirror one day, I didn’t recognise the spectre looking back. Everything I’d worked hard for had gone: from my career to – temporarily – the love and trust of my family.

Most of my friends hung in there with me. But when my closest friend said she would ‘come and sit with me for an hour’ – I suddenly felt like an elderly person in an old people’s home. It hit me that she felt sorry for me and it was only then that I realised just how much the dynamic of our friendship had shifted; I felt utter despair.’Just four hours’ sleep was enough to restore me to a basic level of sanity’ CREDIT:  Getty Images/EyeEm

By mid 2014 – four years into my insomnia battle – I had tried roughly eight different drugs in total (none of which worked at all) and was hopelessly dependent on the clonazepam, which I’d been taking for the longest. Convinced it wasn’t helping, I decided to wean myself off it, with the help of an online reduction chart but the side effects proved too much – I felt sweaty, dizzy and sick – so I booked into a private rehab clinic. This was possibly the worst decision I was to make, as it was geared towards alcohol and recreational drug addiction, not people coming off prescription pills.

I didn’t respond well to the therapists’ ‘tough love’. On one occasion, the group leader made me stand on a chair and sing God Save the Queen to ‘bring me out of myself’. Mortified, I burst into tears. I also withdrew too fast from my drugs while there, and became agitated, incoherent, and entirely lost the plot. In the end, I was sent briefly to an NHS psychiatric unit, before later being moved to another private facility.

The long road to recovery

Things finally changed in summer 2016. My father retired from his dental practice, and we all decided I should move into his Essex home to properly recover. I felt numb as I sat in the back of a taxi, clutching a small overnight bag containing pyjamas and a toothbrush. We’d decided that the children should stay with my ex. There wasn’t a day that passed where I didn’t miss them, or that this didn’t break my heart.

I mostly spent those days in my childhood bed, watching Netflix, still not sleeping and struggling with the drug-withdrawal side effects. I remember having a stuttering inability to get my words out. I even started hitting myself in the face at one point.

It would take two and a half more years to improve but as 2019 dawned, something odd, and not-altogether-unwelcome, was starting to happen. There were a couple of hours on the occasional night that I couldn’t account for: I’d look at the clock, and it would say 2.45am. The next time I looked, it might say 4.06am. My ‘sleep hours’ slowly crept up. It wasn’t a steady increase – some nights I’d sleep three hours; the next, two hours – but the trend was generally upwards, and it filled me with incredible joy.

Just four hours’ sleep was enough to restore me to a basic level of sanity. I began exercising on a treadmill in my dad’s spare room. I even went out for short walks; before then I only ever left the house for medical appointments.

For the previous eight and a half years I felt like I’d been chained to the bottom of a pond – I could just about make out a distorted version of the world above though I couldn’t see or touch it – but slowly, gradually I started to feel better. Much better.

Placeholder image for youtube video: kS_IG6VbTXs

I still can’t put my finger on exactly why. It wasn’t simply a change of scenery, as my insomnia continued for two years after moving in with Dad. But my surroundings there were less stressful, which helped, as did eventually withdrawing from the pills and overcoming the side effects. Being able to exercise a bit, eat healthily and engage my brain by reading and watching the news, was all a virtuous cycle, and my sleep improved further.

Other things helped too: I bought a weighted blanket, designed to mimic the feeling of being held or hugged. And after my sleep had already started improving, I came across a brilliant therapy called Cognitive Behavioural Therapy for Insomnia (CBTi), a structured programme that helps people identify thoughts and behaviours that cause or worsen sleep problems, then replace them with ‘healthy’ thoughts and behaviours. One of the things that stuck was when a psychiatrist told me ‘you mustn’t turn the problem into the problem – in other words, don’t turn the insomnia into a worry that itself prevents you from sleeping. Some nights, as I lay there at 3am or 4am, I’d say this aloud to myself: ‘Don’t turn the problem into the problem.’ What I learnt from CBTi helped turn my three or four hours’ a night into five, or even six.

‘Like waking from a coma’

One day in March 2019, I felt well enough to go to the supermarket with my sister-in-law. As she paid for the groceries by tapping her debit card against a machine, without having to enter her PIN, I was astonished. ‘Don’t you know about contactless?’ she laughed. ‘You have missed so much. You are like Sleeping Beauty, waking up after a hundred years.’

It was true. I felt as if I’d woken up from a coma after seven years: I’d missed Brexit, Tinder and Leicester City winning the Premier League. I didn’t know who on earth Alexa was. And why were £10 notes made of plastic?

That year, I finally started doing things I was sure I’d never do again, like reading the news. I opened my emails and finally deleted the 60,000 spam messages that had accumulated. My father bought me an online course in creative writing, which I hugely enjoyed. I even took my first tentative steps back into journalism, writing an online column for this newspaper called The Insomnia Diaries, which would later lead to a book deal. Gradually my career gathered momentum.

As my life fell back into place, I began considering my lost decade. What on earth had happened to me? But everyone I asked – from sleep professionals to close friends – had a different theory. Some believed the end of my marriage triggered post-traumatic stress disorder (PTSD), or that I was depressed. My own verdict is that I was given too many drugs, too easily, and for too long, and whipped off them too quickly, which exacerbated, rather than solved, my sleep issues.

When Boris Johnson announced the first lockdown last March, I went cold, terrified my insomnia would return. I hadn’t coped well with a domestic crisis, how would I manage with a global emergency? But, miraculously, over the last year my sleep didn’t suffer. I applied the CBTi rules, I exercised, I reminded myself to relax – and it worked.

These days, I sleep from midnight to 6am. I’m often still tired but it’s enough to enjoy life – and I’m excited for the future. I’m living in my Dad’s place as the sale of my marital home goes through, then the plan is to buy a place back in north London. I’m waiting for my divorce to be rubber-stamped by the courts too. I have a new boyfriend, I’m rebuilding a stronger relationship with my kids, plus I’ve lost half of the weight I put on (by healthy eating and taking up boxing).

Yes, things could go wrong again, but I’m told I’m a different person since my Insomnia Crash; more empathetic, cheerful, plus, as a result of all I’ve been through, I don’t dwell as much on what people think about me. One therapist told me I had ‘post-traumatic growth’. I rather like the sound of that.

In the depths of my insomnia, the mere thought of going to a party filled me with horror. But when ‘unlockdown’ began, I found myself craving restaurant dinners, shopping trips and holidays. And two weeks ago, I finally celebrated my 50th (OK, my 53rd) with a garden party attended by my nearest and dearest.

We drank many toasts to the end of lockdown – and the restart of my life post Insomnia Crash. How I loved the canapés and the prosecco. And the beautiful night’s sleep that awaited me, when the laughter had died away.

The Insomnia Diaries: How I Learned To Sleep Again, by Miranda Levy, is out on 10 June (Aster, £9.99); pre-order a copy at books.telegraph.co.uk

Read expert advice on how insomniacs can learn to sleep again in the health pages of Monday’s Daily Telegraph

Have you struggled with insomnia? Share your story in the comments section below and Miranda Levy will reply to your comments later today. 

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16 days to go – and a weeny update

So, just over two weeks – and I’m thrilled to say there’s quite a lot of interest in The Insomnia Diaries.

I have a big piece in the Telegraph Magazine (out this Saturday, 29th – and a follow up in Monday’s health section of the paper). Possibly a biggie in the Daily Mail a few days later. Extracts in GLAMOUR, Reader’s Digest, and bits and pieces for other mags including Top Santé and the Jewish Chronicle.

Podcasts too – Gabby Logan, Outspoken Beauty and Andrew Pierce on the Daily Mail.

Perhaps most exciting at all – I’m speaking at the Stylist Literary Festival on 14th June, and just recorded the LoveReading one this morning. Maybe some national broadcast lined up week of publication.

I’m very grateful.

But most of all, I want to hear from people who’ve read it -so please pre-order your copy, which should arrive on June 10th. And let me know what you think!

talesofaninsomniac.com
Blog for people who like:

The Insomnia Diaries: How I Learned to Sleep Again

She’s so….. heavy

There were three main things that helped me come out of my eight-and-a-half-year Insomnia Crash.

If I had to name a ‘product’, it would be a weighted blanket. I had a fantastic winter one from @melacomfort. And the lovely people there have just sent me their newest summer model. Look how silky it is!

For the other two things that really helped… well, you’ll just have to buy the book when it’s out on 10th June (pre-order it now, to have it fresh on your doorstep – or in your ears). 🙂