Health

For the one in 10 people suffering from insomnia, each night is a battle. The author shares her arsenal. By Jackie Bos.

The realities of living with insomnia

Bed becomes a source of anxiety for many insomniacs.

Credit: WPixz / Shutterstock

Last night, I dreamt Cillian Murphy was my boyfriend. The dream was disappointingly chaste. On waking, I realised it arose from the audiobook I was listening to overnight: a cosy village romance set in Ireland. Like Inception, my dreams have been coopted by my narrative sleep aids.

This was, however, at least a gentle experience.

Since I turned 48 and the beginning of menopause, my sleep has become disordered, including, but not limited to, insomnia. I often call a night of trying to sleep fighting the bear; what Dr David Joffe of Sydney’s Royal North Shore Hospital describes as “war not rest”. As if the tossing and turning and legs like electric eels aren’t enough, there are hallucinations, when the ceiling descends like Luna Park’s Rotor and the curtains wrap my body in a shroud. As I wake in fright, I feel as if I’ve just eluded death. Other times I simply wake, bolt upright, gasping for air.

Insomnia affects 10-15 per cent of adults, and impairments can range from memory to mood, with comorbidities from heart disease to diabetes. There are a few types, according to Joffe: primary sleep-onset, wakefulness after sleep onset and early morning wakers. If these symptoms occur at least three nights a week for three months, you’re a member of the club you’d rather not be.

I score 100 per cent on Joffe’s test, unlike my home sleep test, which earnt me a paltry 56 per cent in sleep efficiency. A good night for me is cobbling together six hours. Often it takes 10-plus hours in bed to achieve that. Most nights I sleep only four, non-consecutively. I wake up half an hour after falling asleep, multiple times a night.

When I do, I put on an audiobook – what Joffe calls effective “distraction and redirection”. These aids mustn’t be too interesting, so it’s Jeanette Winterson for day reading but aforementioned village romances overnight. Most mornings, I’m awake for hours from 3am to 7am. Sometimes I’ll do some bed yoga. If I’m lucky, I might fall back asleep, on and off, until mid morning.

Call me at 8am and I’ll kill you.

My older siblings – two sisters and a brother – all have insomnia, as does my mother. Dad, unfortunately, surrendered to the big sleep decades ago. I wish he could join us in our 3am WhatsApp commiserations over our wakefulness. Our family profile supports the premise that insomnia is genetic. Or it might indicate we’re all equally screwed up.

We all have different sleep strategies, however. My brother, a mathematician, scoffs sleeping pills like candy, works on maths problems and compensates with a day nap and an ocean swim when he can. One sister, an artist, opts for slow-release melatonin and reads ebooks overnight, drinking tureens of tea in the morning to kickstart the day. The other, a counsellor, gives up and goes for a jog on the Bondi to Bronte coastal trail. My mother, retired for just over a decade at 94, and a contrarian, drinks coffee.

What are we doing wrong, and right? In the “bad” column: sleeping pills, caffeine, naps; in the “good”: melatonin, books, yoga, exercise. In the middling column: ebooks, since print or audio is preferable to screens.

Caffeine is widely considered the enemy, though when I was hit with the one-two punch of insomnia and long Covid, I, too, turned to caffeine and sugar to get through the day. The World Health Network Long Covid Expert Advisory Group notes that 44 per cent of people develop insomnia after contracting Covid.

So, what should an insomniac do? Most experts recommend melatonin, though they stress that timing and quality are crucial, and less is more. “It’s the Wild West out there, with gummies being given to kids,” says sleep psychologist Dr Frank Cahill.

While experts also agree sleep hygiene includes sleeping at a regular time, no naps, avoiding stimulation as bedtime approaches and engaging in regular exercise, it’s a razor’s edge. “If you get too fixated on hygiene, there can be more pressure that you must sleep,” Cahill warns.

“What feeds insomnia is the underlying fear. The harder the insomniac works, the more they feel like a failure,” he says.

The gold standard treatment is cognitive behavioural therapy. That’s because a ruminatory tendency is common to insomniacs, and people with PTSD and various traumas are particularly susceptible. “Trauma steals deep sleep,” says hypnotherapist Danielle Leikvold. “It’s not only big T Trauma but little t trauma too.”

Indeed, anxiety, along with age (over 40), alcohol and apnoea, are the four As that comprise Joffe’s profile of the insomniac. I tick one and two on this list – tests revealed no apnoea, a condition where breathing temporarily stops. Men are more prone to it but, Joffe says, “as women lose oestrogen, it’s no surprise the incidence of apnoea accelerates for them”. Many experts recommend hormone replacement therapy for menopausal insomnia.

Insomnia can coexist with a grab bag of sleep disorders, including restless leg syndrome and hypnagogic hallucinations. The latter, like my vision of the Luna Park Rotor, is when “the brain doesn’t wake up as fast as the body does,” explains Sean P.A. Drummond, professor of clinical neuroscience at Monash University. There are much worse types: husbands have been known to pummel their wives to death.

Joffe says these are a type of REM sleep behaviour disorder (RBD), that is, they affect the rapid eye movement stage in which most dreams occur. Often experienced by people with narcolepsy, RBDs can be an early predictor of Parkinson’s and Alzheimer’s. Drummond distinguishes these disorders from those connected to the deep slow-wave stage of sleep, such as sleepwalking and sleep-talking.

No wonder, then, that many of us sleep-disordered start to experience what Drummond describes as “conditioned arousal”, where bed becomes a source of anxiety. He advocates sleep restriction therapy – restricting time in bed, which builds up a “sleep debt”, that is, a cumulative sleep deficit.

He’s also a proponent of stimulus control: where you do nothing but sleep when in bed. For me, that second directive is the stuff of nightmares: I do everything from bed. It is my palace, my island. I’m not like the reclusive ladies of Grey Gardens, where Big Edie cooks corn on the Sterno on her mattress. I’m more, as Truman Capote put it, “a completely horizontal author”.

The good news is that seemingly small things can, apparently, be cumulatively curative. Leikvold attests that she has treated insomnia with hypnotherapy and eye movement desensitisation and reprocessing (EMDR) techniques in as few as four sessions. She suggests pre-sleep practices, too, such as visualising a sequence of colours behind the eyelids and linking this with conscious breathing: in through the nose, out like a sigh.

I’ve added these techniques to my sleep preparation arsenal. I know that ignoring sleep disorders can snowball. As Joffe warns, “By the time you’re 70, you’ve been asleep for 28 years. Mess with that and it hurts you.”

This article was first published in the print edition of The Saturday Paper on October 18, 2025 as "Fighting the bear".

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