CIAN TRAYNORhasn't had a full night's sleep in his life. Having spent years nodding off for only a few minutes a time and often struggling through the waking hours, he went in search of a reason – and a possible cure
MY HEART CAN be heard pounding through the dark. All I can see is the unblinking green light of a CCTV camera staring from across the room. There are 24 electrodes attached to my body. Three around the heart, four attached to the back of my head, two on each leg, one beside each eye. There’s a microphone taped to the side of my mouth to determine whether I snore, a clip on my finger to measure the level of oxygen in my blood, and a plastic device below my nose to monitor my breathing rate. The only thing that can’t be recorded is my frustration about why I’m not getting what most people take for granted: a good night’s sleep.
By taking an overnight analysis at the London Sleep Centre, the next eight hours could hold the key to understanding my lifelong inability to sleep solidly. I don’t know what it’s like to shut my eyes and wake up hours later, rested and refreshed. If I can fall asleep at all, it’s in small units of minutes strung together over several hours. If not, I invariably feel like an exasperated passenger on a pointless long-distance journey.
I have tried sleeping pills, exercise, herbal treatments, dietary adjustments, hypnotherapy, cranial massage, alternative medicine, exercise, counting sheep, hot baths and even lucky charms. Yet still my mind can’t enter shutdown mode. My mother insists it has been this way since I was born, when my insomnia became so demanding that my parents regarded a full day at work as welcome respite. With the family GP’s consent, I was regularly given a sedative until the age of three and a child psychologist insisted that I shouldn’t be allowed to leave my bedroom during the night, no matter how loud my protests grew. But nothing could force me into a normal sleep pattern.
Functioning as well as anyone else is manageable, but, after a particularly bad spell of sleeplessness, things become more difficult. At best, it’s like having a permanent cold. At worst, the strain of fatigue moves me close to tears. Everything intensifies, and things you wouldn’t normally notice become irritating: unnecessary sounds, bad manners and, quite hypocritically, other people’s neuroses. It can make a journey on public transport a test of resolve, forcing me to retread inward, convinced that I am not a good person. It’s this burden I want to be rid of.
The need for rest is so hard-wired that the average person spends about one-third of their life asleep. According to the European Journal of Psychiatry, more than 80 sleep disorders have been identified, affecting more than 200 million people worldwide, with almost one-third of Irish adults claiming to have trouble sleeping at night. Yet for such a solitary affliction, insomniacs are generally left to find a solution by themselves. GPs are given as little as five hours' training to deal with sleep disorders, and with no internet forums or help groups, there is no support network, let alone a community.
At the initial consultation at the London Sleep Centre, Dr Irshaad Ebrahim suggested my insomnia could be due to a neurological issue I was born with and, as such, is potentially treatable. After 29 years, the prospect of sleeping normally suddenly seemed possible. Yet all the results of the analysis reveal is that I have chronic primary insomnia: long-term sleeplessness that is not attributable to a medical, psychiatric or environmental cause. The conclusion that I just never learned how to sleep is disappointingly vague. However, the statistic that stands out the most in the report is that I woke up 108 times, which works out as an average of every three minutes and 51 seconds. Dr Ebrahim explains that my brain is secreting adrenaline throughout the night, preventing my body and mind having a chance for rest, which he claims is due to the way my brain chemistry has evolved since childhood.
There are two options. The centre offers to recruit me for a clinical research study that will test a new drug on people with my condition (previously tried only on rats and rabbits). Though I would be paid for parts of it, the trial would last at least three months (possibly on a placebo) and the only clear benefit I would gain is that the seven overnight sleep studies involved might turn up something unspotted in the previous analysis.
The other option is that I begin a sleep retraining programme based on Cognitive Behaviour Therapy (CBT) in conjunction with a medication that will block up the adrenaline, an antidepressant called Trazodone that is frequently used as a hypnotic. However, a reliance on drugs that could alter my personality means neither option appeals, as both seem to be solving an old problem with a new one.
Dr Neil Stanley, author of Making Time for Sleep, a review of 30 years of academic sleep research, is troubled by the lack of options available and has criticised such "one size fits all" solutions. "There are very few neurologists and psychiatrists involved in sleep, so doctors don't really know what they're doing," he says. "They don't like insomniacs because they are a challenge and there is no easy cure. CBT will work on some people but it is not the be-all and end-all. Doctors just say: 'we haven't got time, we don't understand'. Insomnia is not sexy. There is no patient group and you can't buy a ribbon for it. In mainland Europe and the US you would get much better help, support and information." My reservations are eventually allayed by sleep expert Dr Gregg D Jacobs, who spent 20 years developing CBT to treat insomnia as an assistant professor of psychiatry at Harvard Medical School, when he assures me that it is just as effective without medication and that major studies have shown that Trazodone does not add any extra effect.
After agreeing to undertake the three-month sleep retraining programme, I am given a seven-hour window of opportunity for rest each day. I cannot go to bed before 1.30am and cannot rise later than 8.30am, keeping to the schedule regardless of sleep.
There is to be no caffeine, no alcohol, no napping, no reading or watching films in bed, and no chocolate (after 2pm); phones must be switched off, all light must be blacked out, and I am not allowed in my bedroom outside the designated sleeping hours.
During the first session, the sleep counsellor warns that it is “going to get ugly” and advises me to cancel any upcoming social engagements. She also acknowledges that without the medication, and barring a miracle, it will not make me sleep normally – just better. The idea is that the rigorous schedule will gradually force me into a deeper, better quality of sleep for longer periods until it becomes automatic.
A sleep diary charts my progress and, sure enough, the first week is gruelling. But there are signs of encouragement: during one day, towards the end of the week, I feel a caffeinated-like rush without a coffee. Week two introduces an hour of winding-down time to “get in the zone” before bed through a long bath, breathing exercises and monotonous tasks such as extended flossing and stretching.
It’s another three weeks until the next assessment session, and by then all signs of promise have petered out. Although I am dreaming less, indicating a deeper state of sleep, I feel almost incapacitated during the daytime – at one point I couldn’t even find my house when returning from the supermarket.
I decide to discontinue the sleep retraining programme, six weeks after the analysis and more than €2,200 worth of healthcare later, far worse than I was before and worried what would happen if I kept going. The relapse is liberating, gifting me what feels like the most well-deserved lie-in I’ve ever had.
Since then, I have learned to appreciate that whatever snatches of sleep I can accumulate on my own terms feel far more refreshing. Coffee is there whenever I need a lift, and nothing helps lull me asleep like words on a page or the flickering images of a film with the volume down. And perhaps, for me, that has been the real merit of the sleep retraining programme: just experiencing how much worse it can be has helped me to sleep that little bit more soundly.
