By Malika Noor Mehta
Artwork by Devika Menon
She lay in her bed awake, her eyes closing and opening. It was 1:00 am and she had been huddled under her covers for over an hour. The blanket felt too warm at first. She removed it, only to find her toes freezing after ten minutes. Perhaps it was not the temperature that was so bothersome. Perhaps it was her mind. Thinking about her day. Thinking about the presentation she had made for her boss, about the food she ate, about the chats she’d had with her family. The past was not the past, and the future was worrisome. She had so much work. So many errands to run. Goodness, she thought, should she write down her To-Do’s before she forgets them? She pulls out her planner and begins scribbling. And as she writes, the hours' pass. Her eyes strain. Her mind races from one thought to the next. She can’t find a moment of peace. This is her night. Every night.
Insomnia. The silent yet debilitating disorder that disrupts lives so often.
What is insomnia?
Insomnia is a disorder that makes it extremely difficult to fall asleep or to stay asleep. Insomniacs may wake up too early or fall asleep too late, leading to fitful slumbers and a feeling of fatigue the next day. Insomnia invariably impacts the person’s quality of life as sleep affects our moods, our ability to concentrate, and our physical well being. Holding a steady job or sustaining meaningful relationships might become difficult when the mind is simply working on overdrive and entirely unrested.
Insomnia can occur in different forms and at varying levels of severity. Acute insomnia is short-term. It lasts a few days or a few weeks. It is likely instigated by a stressful period or a sudden traumatic event.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) explains acute insomnia as “a manifestation of the ‘fight or flight’ response to danger,” one of the many ways in which the body prepares to tackle an incoming attack (always alert and on-guard).
Chronic insomnia, however, could last for a month or longer. It might have similar triggers as the short-term condition but is potentially more difficult to tackle as the reasons for it may be ongoing. While insomnia itself incapacitates an individual and must be tackled head-on, the underlying question remains: is insomnia the main issue or it is simply a symptom of something else that is disrupting the person’s mental stability? In order to combat this disorder, getting to the root of the problem is critical.
Insomnia in the pandemic
Anxiety and depression are common causes of insomnia, and if that is the case, understanding the reasons why we are experiencing these lows is important. For instance, many people noted insomnia as one of the symptoms of the anxiety caused by the COVID-19 crisis. As the pandemic brought the external world to a standstill, it made our internal worlds churn. We have been separated from our families and friends. We have had to isolate in small, cramped spaces. We have had to navigate complicated medical systems and worry about our loved ones falling sick. We have been prevented from partaking in most regular recreational activities and have found our lives permanently and unexpectedly altered. If this just doesn’t cause anxiety, what does?
Donn Posner, the president of Sleepwell Associates and an adjunct professor at Stanford University School of Medicine explains that the pandemic has caused the “perfect storm of sleep problems.” Even before the COVID-19 crisis hit, 30-35% of the global population dealt with acute insomnia. While approximately 72% of acute cases of insomnia resolve themselves, recovery is not always permanent. At least 6.8% of these cases develop into chronic insomnia, which is defined as experiencing sleep problems at least three nights of the week for at least three months.
Developing chronic insomnia at any time is quite serious, but dealing with it in the midst of a global health crisis is particularly problematic. Chronic insomnia is associated with a series of severe health conditions such as cardiovascular disease, diabetes, hypertension and an increased risk of Alzheimer’s. Developing any one of these conditions in non-pandemic times would be serious. Having to deal with these issues during a pandemic would just be overwhelming.
So what should one do to combat insomnia?
Ok. We know this sounds rather dire but don’t fret - it is not all bad news! Insomnia is absolutely curable. To kick insomnia’s ass, we must start with certain behavioural changes
Do not nap! After a sleepless night, it may seem counterintuitive to skip the afternoon nap. Professor Posner, however, explains that naps are to sleep what snacks are to a healthy meal. If we nap for more than 20 minutes in a day, we essentially “ruin our appetite for sleep.”
Do not sleep in! After a big night out, sleeping till 1:00 pm on a Saturday will disrupt your sleep patterns indefinitely rather than compensate for the lost sleep from the night before. Wake up early. Embrace that sense of sleepiness throughout the day, and then go to bed early.
Create a rhythm! In order to combat insomnia, we need to get comfortable with a regular sleep rhythm. That means setting a time to sleep and a time to wake up and really trying to stick to these times. During the day, try to set specific times to eat and exercise too. As the body naturally forms habits and falls into certain rhythms, sleeping slowly becomes easier to come by.
Do not worry! If falling asleep seems truly impossible, get up. Do not lie in bed and worry about your inability to fall asleep. Instead, read a relaxing book. Go for a short walk. Do a quick puzzle. Decide on an activity (no television or smartphones) that will calm your mind and do it.
Therapy is always a good idea! While implementing certain new behaviours may seem fairly simple and easily done without the help of an external party, asking for a little help never hurts anyone. Therapy is always a tool that we can use to relieve our anxieties. This is something that will help us get to the root cause of insomnia and tackle it head-on so that the condition does not reoccur. A therapist may also help us track our behavioural changes and encourage us to keep going.
All in all, insomnia is a serious but manageable condition. Many people experience it in their lifetimes. In fact, the likelihood of you coming across people in your network who have lived through and tackled insomnia is fairly high. Therefore, do not be afraid to talk about what you are going through. Telling your friends and family about what you are experiencing and asking for help is one of the first steps in healing. Just remember – you are not alone.
About the author:
Malika Noor Mehta is a mental health entrepreneur. Before the pandemic, she was engaged in creating a fellowship program that placed mental health counsellors in low-cost schools in Mumbai. Her interest in mental health stems from her teaching experience at Teach for India and her time in Jordan and Greece, creating trauma-sensitive education programs for Syrian refugees. She holds a Master in Public Policy from the Harvard Kennedy School of Government. In her free time, she loves to write and take photographs.