Goodbye to Sleep Anxiety (and Fear of Dogs)

Meet Toby, our new dog. No, he doesn’t have a sleep problem. But Toby has a problem that seriously affects the quality of his and our lives: he’s terrified of dogs. We adopted him from a rescue shelter, unaware that the mere sight of a 5-pound Chihuahua would cause Toby to leap and bark as though he feared for his life. Toby’s fear of dogs reminds me of my own fear of sleeplessness, which I struggled with for decades. The problem seemed insurmountable . . . until I went through insomnia treatment and found a way out. If sleep anxiety is your problem too, read on.

Conquering sleep anxiety makes me think I can help Toby overcome his fear of dogs.Meet Toby, our new dog. No, he doesn’t have a sleep problem. But Toby has a problem that seriously affects the quality of his and our lives: he’s terrified of dogs. We adopted him from a rescue shelter, unaware that the mere sight of a 5-pound Chihuahua would cause Toby to leap and bark as though he feared for his life.

Toby’s fear of dogs reminds me of my own fear of sleeplessness, which I struggled with for decades. The problem seemed insurmountable . . . until I went through insomnia treatment and found a way out. If sleep anxiety is your problem too, read on.

Wondering Where the Fear Came From

How our muscular, 47-pound Labrador Retriever mix came to fear even dogs one-eighth his size is something we’ll never know. The shelter had little information about Toby other than that he may have spent some time on a farm.

We do speculate about his past. His fear of dogs might be a symptom of post-traumatic stress. Maybe he was once mauled by a pack of wild dogs (he has no visible marks of mistreatment). Or maybe he simply was not exposed to other dogs during that critical socialization period during puppyhood (the little bit of plaque on his teeth suggests he may now be approaching two years of age).

Regardless of what led to Toby’s fear of dogs, it’s now well entrenched. Yet our trainer says that with proper training we’ll be able to change Toby’s response to and behavior toward dogs.

How My Fear of Sleeplessness Developed

I know more about how my fear of sleeplessness developed (although, memory being as unreliable as it is, here, too, there’s speculation). I think my sleep anxiety must have started with the recognition that I was awake when others in the house/neighborhood/dorm were sleeping, that others seemed to fall asleep more easily and quickly than I did. In fact it was often when I felt exhausted and most craved sleep that I found myself tossing and turning in bed, awake till well after midnight even as a teenager (way before the advent of smart phones!).

Unpleasant symptoms followed those short nights: moodiness and unease during the daytime; at night, tension in the stomach, body warmth, and a racing feeling emanating from my chest down through my arms and legs. It’s no wonder I started worrying about sleeplessness at night: who likes those symptoms, anyway?

Sleep Onset Insomnia and Blaming Myself

Toby can’t see how useless and self-defeating his fear reaction toward dogs is or berate himself for his behavior.

But over the years my anxiety about sleep caused me to feel plenty of anger and disgust with myself. It was bad enough that I had sleep onset insomnia and could never predict when I’d finally fall asleep. But I knew the sensations accompanying my anxiety — the racing mind, the warmth, the tingling arms and legs — were only going to delay sleep further, yet I couldn’t stop myself from feeling them or worrying about how wasted I’d feel the next day.

I tried everything I knew of to solve the problem: relaxation exercises, yoga, tapes featuring sounds of nature, music purported to coax listeners into deep sleep. Those things might work for a week or two but soon I was back to the same old obsessive thinking about sleep. That I was unable to get a grip on the problem, unable to stop myself from prolonging my own wakefulness made me feel like I was engaging in willful self-sabotage. Just how ridiculous was I for doing that?

My fear of sleeplessness felt as entrenched as Toby’s fear of dogs. And it kept me feeling like an adolescent for many, many years. Why couldn’t I grow up and out of this phase and fall asleep like everyone else?

Changing Toby’s Behavior

Apparently changing dogs’ behavior can be accomplished through classical conditioning. Toby is very motivated by food, so we’re doing clicker training with him. Every time he looks at a dog, we click and give him a treat, click and treat, click and treat.

Eventually, the trainer says, Toby will come to associate seeing dogs with the pleasurable experience of eating something tasty rather than the disagreeable thing he experienced before. It’s slow going, but we’re starting to see some changes and we’re only two months into the training.

Overcoming Sleep Anxiety

I went for decades believing I could never turn my fear of sleeplessness around. But it finally happened, and I attribute the change mostly to sleep restriction therapy, an insomnia treatment offered as part of cognitive behavioral therapy for insomnia.

You might think, since my problem involved anxious thinking about sleep, that cognitive therapy would be the way to go. In fact, as I underwent insomnia treatment, I was guided through “cognitive restructuring,” a cognitive approach to extinguishing negative thoughts and feelings about sleep through careful examination and reappraisal. Were my fears about sleeplessness realistic or distorted? If distortion was occurring, what might be an alternative, more balanced way of looking at the situation?

Apparently, this approach to decreasing sleep anxiety works for some people with insomnia. It did nothing for me. My fear of sleeplessness felt far too deeply rooted to be eradicated by simply reasoning with myself.

A Behavioral Approach to Fear Extinction

What it took to finally root out my fear was a behavioral approach similar to the one we’re using with Toby. By restricting my time in bed, sleep restriction therapy created the sleep pressure my brain apparently needed to fall asleep a lot more quickly. I started falling asleep pretty much on cue — a fabulous development! And when I began to see I could count on falling asleep with regularity, my fear of sleeplessness started to fade away.

The process took time, though, just as the process with Toby is going to take time. There were nights when the old anxieties returned to hijack my sleep. But with time the nights when fear ambushed me on the way to the bedroom were fewer and fewer.

Now my fear of sleeplessness is a thing of the past. With persistence and the right kind of insomnia treatment, yours can be made to disappear, too.

If you’ve struggled with sleep anxiety, what have you tried to decrease your anxiety, and has it worked?

Q&A: Anxious About Sleep? Get Relief

Anxiety about sleep is a problem for some insomnia sufferers. Fear of sleeplessness is the main thing keeping them awake at night.

Here’s how sleep anxiety develops and how to tone it down.

Relieve fear of sleeplessness with cognitive and behavioral therapies.This week a woman (I’ll call her Gina) wrote to Ask The Savvy Insomniac with questions about sleep anxiety and sleep restriction.

 

 

 

 

I have had chronic insomnia since September. I honestly didn’t have any major life event that caused it. Just a few bad nights of sleep—and the anxiety started setting in. The worst part of it for me is that as soon as it nears “bedtime” my heart starts racing and I feel extremely anxious.

I am doing sleep restriction therapy (I’ve been averaging 5 hours per night) but I’ve had a few “slips” along the way. I tend to drift off to sleep on the couch (for about 5 or 10 minutes). How long does this take? I’ve been doing it for over a week and I haven’t seen any great improvements. I’m losing hope.

Anxiety About Sleep: How It Develops

Anxiety about sleep can develop during a stressful life event when sleep is difficult. It can also develop following several nights of bad sleep, regardless of what triggered them.

Being unable to sleep when you want to sleep is frustrating. Frustration may give rise to symptoms of physiological arousal: increased heart rate, blood pressure, respiratory rate, and body temperature. If you’re prone to developing chronic insomnia you may be particularly sensitive to what’s going on inside your body. Merely noticing signs of arousal at a time when the brain and body are supposed to be shutting down can cause anxiety.

It’s important to note when and where these unpleasant sensations are occurring. They’re not happening as you drive your 3-year-old to daycare or participate in a staff meeting. They’re happening at night when you’re in bed in the bedroom—where you’re supposed to be asleep.

After a few bad nights you may also begin to notice unpleasant symptoms during the daytime: lethargy, low mood, trouble thinking. Consciously or unconsciously, you might start to connect these these symptoms to your struggle for sleep at night. This, too, can give rise to anxiety or exacerbate existing anxiety.

Activities and projects may claim your attention during the daytime. But when nighttime rolls around and your physical and mental stamina are at low ebb, boom! The mere thought of going to bed makes you anxious, ramping up physiological arousal and increasing your anxiety still further.

Forget about sleep when you finally go to bed. Your odds of an easy send-off are nil.

If You’re Anxious About Sleep

Keep these things in mind. Sleep-related anxiety:

  • Is learned. It doesn’t just materialize out of nowhere but is rather conditioned through a process similar to the one described above (and likely predisposed by constitutional factors as yet unknown).
  • Is not your fault. Conditioned learning takes place at an unconscious level; you are not aware that it is occurring. So don’t play the blame game—it hurts rather than helps.
  • Can be unlearned. That’s where we’re heading now.

Some insomniacs who are anxious about their sleep respond to treatment with cognitive therapies. Cognitive restructuring, offered as part of cognitive behavioral therapy for insomnia (CBT-I), may help by dismantling some of the attitudes and beliefs that keep sleep anxiety alive. Other insomniacs have found that mindfulness meditation helps to alleviate sleep anxiety. Acceptance and commitment therapy is worth checking into as well.

Stimulus Control Therapy

For me personally, the two behavioral strategies I learned during CBT-I had the biggest impact on my sleep anxiety. By regularizing and solidifying my sleep, they helped to make fear of sleeplessness a thing of the past.

You’ve heard advice to the sleepless that counsels avoiding the bed except for sleep and sex? Well, this rather parsimonious view of how to use the bed has grown out of studies showing that stimulus control therapy (SCT) for insomnia works. The protocol is simple:

  1. Go to bed only when sleepy.
  2. Use the bed only for sleeping (and sex). Do not read, watch TV, eat, or do anything else in bed.
  3. If within 15 minutes you’re unable to sleep (estimate the 15 minutes; do not watch the clock), move to another room. Do a quiet activity—reading, knitting, watching TV—until you feel really sleepy. Then return to bed. The goal is to break the association between the bed and wakefulness and instead learn to associate the bed with falling asleep quickly.
  4. Repeat the above instruction as often as necessary.
  5. Get up at the same time every morning regardless of how much or how little you’ve slept.
  6. Do not take naps.

Sleep Restriction Therapy

The aim of sleep restriction therapy (SRT)—the treatment Gina is undergoing—is to restrict your time in bed so that most of your time there is spent sleeping rather than lying awake and worrying about sleep. The SRT process is somewhat involved and I’ve blogged about it elsewhere. Find out more by typing “sleep restriction” in the site search box above.

In response to Gina’s concerns about sleep restriction: avoid drifting off too early by engaging in evening activities that are not completely sedentary. And don’t lose hope because you’re failing to see improvements right away. It may take two or even three weeks before you notice appreciable benefits.

Take it from one who’s been there and done that: it’s worth the wait.

2017: Resolve to Improve Your Sleep

Do you have a persistent sleep problem? Make cognitive behavioral therapy for insomnia your No. 1 New Year’s resolution for 2017.

Here’s what you stand to gain, what may stand in the way, and where to find help.

CBT for insomnia should be your no. 1 resolution for the new yearDo you have a persistent sleep problem? Make cognitive behavioral therapy for insomnia your No. 1 New Year’s resolution for 2017.

Here’s what you stand to gain, what may stand in the way, and where to find help.

A Treatment That Improves Sleep

Cognitive behavioral therapy for insomnia is focused on boosting sleep drive and removing psychological barriers to sleep. It’s become the front-line treatment for chronic insomnia because it gets results. Most people who undergo therapy can expect to:

  • Improve sleep efficiency. In other words, you’ll cut the time it takes to fall asleep in half, and cut the number of nighttime awakenings—and their duration—in half.
  • Improve sleep quality. You’re likely to sleep more soundly and wake up feeling more refreshed in the morning.
  • Sleep moderately longer, especially if you’re young or middle aged.

So why hesitate?

The First (and Maybe Biggest) Barrier to “Yes”

If you’re like I was, the biggest barrier to trying cognitive behavioral therapy (CBT) for insomnia may be the belief that nothing can improve your sleep. This is actually a logical way of thinking if you’ve had insomnia for a long time. After years of trying to improve your sleep by means you’ve read about elsewhere—chamomile tea, talk therapy, relaxation exercises—and getting poor results, why would your expectations for CBT for insomnia be anything but low? Hope is hard to come by after years of insomnia and failed attempts to improve sleep.

Gearing up to try yet another insomnia treatment can reawaken hope. But it also opens up the possibility of failing again. Just how comfortable is that? Besides, undertaking CBT for insomnia involves going through a process—and that process may not sound particularly quick or easy. It can be hard to silence these objections and commit yourself to another insomnia treatment.

A Second Possible Barrier: Fear of Sleeplessness

The prospect going through sleep restriction (the part of CBT for insomnia that involves curtailing your time in bed and observing prescribed bed and rise times) may make you uneasy. Sleep restriction was a red flag for me.

What if, during my allotted time in bed, I never fell asleep at all? This was scary to contemplate. As described in Chapter 8 of The Savvy Insomniac, my sleep anxiety was sky high when I went through treatment and drove me to do some pretty strange things.

No doubt my fear of sleeplessness made the first few days of treatment harder. But the gains I made were quick in coming. By the fourth night of treatment, I was falling asleep at my designated bedtime and sleeping right through the night—a pattern that was touch and go for a while but has held up very well over time. My sleep anxiety is now a thing of the past.

Take some advice from a lifelong insomnia sufferer who dithered around for 11 years longer than she should have before finally taking the plunge: just do it.

Finding a Sleep Coach

CBT for insomnia is typically administered by a trained sleep therapist over the course of 6 to 8 weeks. This is still the preferred form of treatment for the many insomniacs who like the idea of face-to-face coaching (and have insurance covering treatment or can afford to pay for it themselves).

Here’s how to find a sleep therapist certified in behavioral sleep medicine:

Some behavioral sleep medicine professionals offer a condensed form of CBT-I called brief behavioral treatment for insomnia (BBTI). Therapy takes place over 4 weeks (rather than 6 to 8) and involves two face-to-face meetings with the therapist and two follow-up phone calls. Read more about it in this blog post about BBTI.

CBT for Insomnia Online

What if you live in the hinterlands and there are no behavioral sleep medicine therapists nearby? With access to the internet, you’re still in business. Three interactive online programs—SHUTi, Sleepio, and CBT for Insomnia—are excellent resources for insomniacs in far-flung locales and those on a limited budget:

  • The SHUTi program ($135 for 16 weeks of access and $156 for 20 weeks of access) was recently shown in a clinical trial to get results equivalent to those obtained in standard face-to-face CBT-I.
  • A clinical trial of the Sleepio program ($300 for 12 months of access) is under way right now.
  • The CBT for Insomnia program is a 5-session program created by Dr. Gregg Jacobs, author of Say Goodnight to Insomnia, for the nominal cost of $44.95.

Insomnia sufferers, suspend your disbelief and try this out. I can’t promise it will relieve your insomnia—but the odds are greatly in your favor.

Good night, and good luck.

What doubts do/did you have about CBT for insomnia?

Q&A: Panic About Insomnia Relapse

Lately I’ve been hearing from people who improved their sleep using sleep restriction or full-blown CBT for insomnia (CBT-I) and then experience a relapse. They have a few bad nights and fear they’ve lost all the gains they made. Here’s how one reader recently described her plight:

“I realize that sometimes I will get scared when I have one or two bad nights once in a while. I’m afraid that insomnia will haunt me once again. Is this normal? What can I do?”

Insomnia sufferers should do something quiet at night until they're sleepyLately I’ve been hearing from people who improved their sleep using sleep restriction or full-blown CBT for insomnia (CBT-I) and then experience a relapse. They have a few bad nights and fear they’ll never sleep well again. Here’s how one reader recently described her plight:

 

 

I realize that sometimes I will get scared when I have one or two bad nights once in a while. I’m afraid that insomnia will haunt me once again. Is this normal? What can I do?

Normal or Abnormal?

When cognitive behavioral therapies for chronic insomnia work—and they do improve sleep for 70 to 80 percent of the insomniacs who try them—it can feel like such an achievement. “At last,” you think, “I’ve got this monkey off my back!”

In reality, though, only a minority of the people who undergo CBT-I report that their insomnia is “cured.” The rest of us experience occasional insomnia relapses.

As anyone who’s read The Savvy Insomniac knows, I went through CBT-I with a group of 4 other insomnia sufferers. At the final group meeting, the therapist gave us a handout on how to maintain the gains made during treatment and what to do in case of relapse. Not only are occasional relapses not abnormal; for many of us, they’re probably inevitable.

All Is Not Lost

The first relapse can feel like such a downer and provoke lots of anxiety. “What? I restricted my sleep only to end up right back where I started, and maybe even worse?” It’s easy to appraise the situation this way: you’re short on sleep, fatigued, and out of sorts. Everything about it feels depressingly déjà vu.

But all is not lost. What occurs during CBT-I is a process some scientists liken to a rewiring of the brain. Neural pathways related to new thoughts and behaviors are established as sleep becomes more regular and the bed and the bedroom come to be associated with sleep.

Older pathways active during insomnia do not disappear. Rather, the new pathways—to continue speaking figuratively—are superimposed on the old. With every good night of sleep, neural connections along the new pathways are strengthened. You expect to sleep well at night and you do.

The older pathways and ways of thinking are still there, though, and due to stress or anything else disruptive to sleep, they may regain some influence. Insomnia returns, and you’re as anxious about it as you ever were. But there’s good news, too: once the newer pathways are established, they’re easier to return to.

I’ll attest to this from personal experience. Before I went through CBT-I (and sleep restriction therapy), my bouts of insomnia could drag on for weeks. Now when I experience insomnia and (in rare cases) my fear of sleeplessness returns, I’m able to return to better sleep and dispense with the anxiety in a few days. I do it pretty much by following instructions I received during CBT-I. Here’s how:

What To Do in Case of Relapse

  • Don’t go to bed unless you’re sleepy. If after 15 to 20 minutes you’re not asleep, get up, go to another room, and do something quiet until you’re sleepy again. Then return to bed. If this doesn’t help after a few days, try the next suggestion.
  • Restrict your sleep by an hour or more for a few days. Be strict about getting out of bed at a consistent wake time—even on weekends.
  • Once your sleep is solid again, extend your time in bed by half-hour increments every 2 nights until you return to your desired bedtime.
  • Be sure to get daily aerobic exercise throughout the process.

If you’ve experienced a relapse of insomnia, please take a minute to share how you got your sleep back on track.

Laying Fear of Sleeplessness to Rest

Once fear of sleeplessness moves into your bedroom, it can feel like a permanent feature of the night, making insomnia worse. But does it have to be this way?

Therapy with a sleep specialist, or measures you can take on your own with instruction from a book or the web, can help set fears to rest.

night-demonOnce fear of sleeplessness moves into your bedroom, it can feel like a permanent feature of the night, making insomnia worse. But does it have to be this way? Therapy with a sleep specialist, or measures you can take on your own with instruction from a book or the web, can help set fears to rest.

Cognitive Restructuring

Many insomnia sufferers have sleep-related attitudes that interfere with sleep. Beliefs like these—“My ability to sleep is out of my control,” or “When I sleep badly I can’t function the next day.”—can contribute to the development of anxiety about sleep.

“Cognitive restructuring” may help. It’s a part of cognitive-behavioral therapy (CBT) for insomnia. As part of this program, a therapist tries to convince you that your catastrophic thinking is distorted, and persuade you to adopt a more realistic mindset. The claim is that changes in attitude—“I can control my sleep by adopting a better sleep schedule,” and “If I sleep badly one night, I’ll sleep better the next.”—can help to decrease sleep-related fears and improve sleep.

Sleep Restriction Therapy

Cognitive restructuring may be useful for some insomniacs, but I had better luck with sleep restriction, a therapy I blogged about on June 27 and July 1. The main goal of sleep restriction, another part of CBT, is to help insomniacs fall asleep more quickly and sleep through the night.

Sleep restriction helped me do just that. But it had another benefit as well: it helped me get rid of my fear of sleeplessness to a large extent. How? By functioning as an exposure therapy.

What Is Exposure Therapy?

Say you have a spider phobia. During exposure therapy, you might start by looking at a picture of a spider and eventually progress to sitting near a real spider outdoors. The goal would be to reduce your physiological response to spiders—the pounding heart, the urge to flee—and get more comfortable in places where spiders are likely to be.

Sleep restriction, which brought me face to face with my fear of sleeplessness, accomplished a similar thing. The first few nights were scary. It took every bit of resolve I had to stick to the program when my anxiety level was sky high.

But gradually things changed. As the nights went by, I found myself sleepier and sleepier at bedtime and began falling asleep within minutes of lying down. With improved sleep, I was less fatigued and my thoughts were clearer during the day. As bedtime approached, I began to expect that I would sleep. Within a few weeks, my fear of sleeplessness had all but faded away: an incredible boon for someone who lived with this fear off and on for years.

Occasionally my fear of sleeplessness will return in times of stress. When it does, it feels much more manageable. It’s not the demon it used to be.

My advice? If fear of sleeplessness is part of your problem, cognitive and behavioral therapies are worth checking out.

Do these therapies sound like they might help you?

Fear of Sleeplessness: How and Why

I spent years in denial about my fear of sleeplessness. Just how mixed up would I look if I admitted to an anxiety that undoubtedly made my insomnia worse?

I didn’t know anything about emotion then, or how people come to fear things like dogs or water or sleeplessness. I’ve come a long way since.

fearI spent years in denial about my fear of sleeplessness. Just how mixed up would I look if I admitted to an anxiety that undoubtedly made my insomnia worse? The thought that I could be afraid of sleeplessness made me feel small and weak. It suggested that part of my sleep problem was learned, and that I was at fault for not being able to unlearn it.

I didn’t know anything about emotion then, or how people come to fear things like dogs or water or sleeplessness. I’ve come a long way since.

What Is Emotion?

When we talk about emotion, we’re usually referring to the visible expression of private feelings: grief following the death of a loved one, excitement at winning a trip to Hawaii, anger at mistreatment by a boss.

But for scientists, emotion has a different meaning. It refers not to feelings we’re aware of—or to the expression of these feelings—but rather to biological systems that evolved to detect and help us respond to important changes in the environment. Neuroscientist Antonio Damasio explains it this way: “For certain classes of clearly dangerous or clearly valuable stimuli in the internal or external environment, evolution has assembled a matching answer in the form of emotion.”

The Fear System

Each emotion is a separate system unto itself, involving different neural pathways in different parts of the brain. The fear system is among the most ancient, fundamental to human survival in a world full of predators.

The fear system is part of our make-up today. If we catch sight of a man waving a gun, that information engages the fear system, traveling rapidly to the brain and triggering the physical impulse to run or hide.

The fear system works with lightening speed; no thinking is required. “This system does its job unconsciously,” writes neuroscientist Joseph LeDoux, “literally before we actually know we are in danger.” Only after the fear system has done its work are we conscious of being afraid.

Some Fears Are Acquired

Some fears develop as the result of a single negative experience. After getting bitten by a pit bull, you fear dogs. After a car accident, you’re afraid to drive on the highway.

Other fears develop following several unpleasant incidents. A series of low test scores results in the development of test anxiety. A series of concerts in which you play badly gives rise to performance anxiety.

Fear of Sleeplessness

Fear of sleeplessness may develop in a similar way. Persistent nocturnal wakefulness and anticipation of fatigue the next day, coupled with the bodily arousal this unpleasant thought gives rise to, might be just the right ingredients to create a fabulous fear-of-sleeplessness stew. Over time, darkness and the bed—or merely thoughts about the darkness and the bed—come to trigger anxiety. We’re as conditioned to fear sleeplessness at night as Pavlov’s dogs were to salivate at the ringing of a bell.

We have no say in the development of such fears, and once they form, they’re hard to get rid of. But there are therapies aimed, among other things, at decreasing the fear of sleeplessness. I’ll write about them in Monday’s blog.

What fears do you have relating to insomnia?

1001 Sleepless Nights

Before I decided to take the bull by the horns and actually do something about my insomnia, I was convinced there was little TO do. I believed my fate was sealed from birth: on top of being short and stubborn, I was destined to be on shaky terms with the night. I could curse the gods, or I could settle down and make the best of it.

sleepless-nightsBefore I decided to take the bull by the horns and actually do something about my insomnia, I was convinced there was little TO do. I believed my fate was sealed from birth: on top of being short and stubborn, I was destined to be on shaky terms with the night. I could curse the gods, or I could settle down and make the best of it.

At the same time, the dreamer in me hoped that insomnia was something I would outgrow, like acne or my crush on Paul McCartney. By process of osmosis, I would absorb enough wisdom to slough off my sleep problem and one day be able to drop off with ease.

My Sleep Pattern

For years my insomnia was episodic, occurring in periods of stress and excitement, so there were times when this dream seemed close to attainment. For as many bouts of sleeplessness as I had (three or four a month? two dozen a year?), I also experienced periods of smooth sailing. I would find myself dropping off the minute my head touched the pillow and notice I couldn’t remember the last time I’d taken a sleeping pill. Then this thought would occur: I have achieved it! The luxury of steady work followed by sound sleep at night. Finally my body is working as nature intended.

Disturbing Questions

In this new state of enlightenment, I could look back at my former self and wonder: why had sleep once been so undependable? And why had fear of sleeplessness taken hold of me at the sight of the afternoon fading into twilight or the sound of evening birdsong? What malicious force had the power to turn things of such beauty into things of dread?

But surely it was better not to probe too deeply. A sleeper doesn’t need to trouble herself with why the restless lie awake.

At some point, though, the jig was always up. The next day or the next week, some blip or wrinkle would interrupt my day, news of misfortune fallen on a family member, or signs of a clash brewing at work, and I was off and crawling through another slew of sleepless nights.