Sleep and the lack of it

I have been a dreadful sleeper since I can remember. So many adolescent nights hearing the Westminster chimes of the dining room clock every 15 minutes, grinding up to 4 a.m. before I lost consciousness of it. Since adulthood it has generally been the other way round - going to sleep OK, then waking up in the small hours and staying awake. For most of my life it has been unusual if I sleep for more than 4 or 5 hours.

In normal times I have been able to be laid-back about this, just get myself a cup of tea, read, do relaxation breathing until it's time to get up. But when I have major stresses to deal with (a constant theme of work for past 5 years or so) I will sometimes not get to sleep at all, and spend the whole night without losing consciousness. This got to be a common occurrence during the year before diagnosis, when I knew there was something badly wrong with me and was sure it was worse than the menopause or post-viral something.

I have a very strong impression that my cancer has grown in spurts rather than at a steady rate - over the year or so before diagnosis, I was feeling badly ill for short periods (not more than a few days) against a background of feeling "below par" constantly. And I'm sure that the times it has gone into spurt mode have been the times when I have let stress get the better of me, and then completely lost it on the sleep front.

If I don't get enough sleep I'm too weary to keep up the focus, the treating pain and stress as an intellectual challenge, which meditation-based relaxation and pain management techniques require. More than two or three nights without losing consciousness and I become a nervous wreck. After this happened following diagnosis I was most relieved to be prescribed Zopiclone, which sends me to sleep in a gentle and pleasant way and leaves me with absolutely no "hangover" effects in the morning. This is very different from the experiences I have had on the occasions when I have been prescribed diazepam/valium type drugs to combat sleeplessness - these take hours to send me to sleep, make me feel anxious, and thoroughly bad-tempered in the morning.

Indeed, one of the greatest pleasures of the past few months has been that scarcely a night has gone by when I have had less than 4 hours sleep. (The main exception to this being the first part of each round of chemo, which involved megadoses of steroids.) At first, the Zopiclone was keeping me under for 6/7 hours, then after a while, I began to wake up after 4 hours. I tried a different type of sleeping pill - Zolpidem - to see if this would keep me asleep for longer. This was a complete failure, even though it's meant to be one of the same family as Zoplicone. As with diazepam-type things it made me feel anxious and unable to get to sleep. So, I decided to follow a proverb which I'm more usually inclined to regard as reactionary claptrap designed to keep the Victorian working classes in their place: "Striving to better, oft we mar what's well". I promptly returned to Zopiclone. That four hours, combined with how quickly and pleasantly and reliably Zopiclone has continued to send me off to sleep, is enough to keep me sane. And six months after diagnosis, I'm sleeping for longer again - usually five or six hours.

I have been taking Zopiclone solidly, give or take the odd experimentation with not doing so, for the six months since diagnosis. After being told (June 2005) that I'm likely to live longer than originally anticipated, I have become more inclined to experiment with alternatives - in particular, I really do think I ought to be able to get to sleep using meditation techniques.

But I'm not setting myself any goals or targets in this respect. As far as going to sleep is concerned, "trying hard" is a recipe for failure. I can't switch off my consciousness if I'm making a conscious effort to sleep. And having found something which works reliably, I can see no point at all in suffering the torments of sleeplessness. Once you're regularly taking drugs like morphine, it seems a bit silly to worry about being addicted to sleeping pills!

Zopiclone does have very definite limitations. To me what it seems to do is, for quite a short period of time - perhaps just half an hour or so - eliminate the knot of anxiety which normally settles into my stomach when I go to bed, and send my breathing onto a very gentle, even plane. If you take one and then get distracted from going to bed and relaxing as completely as you can, you can easily miss the window of time within which it works. Exactly how long after you've taken a pill this "window" of readiness to sleep opens up, seems variable and unpredictable. On occasion I have tried to be analytical about what it does which sends you to sleep, but not surprisingly maintaining consciousness on this analytical level is something which itself prevents Zopiclone from working.

Zopiclone probably wouldn't send you to sleep unless you're in a sufficiently good mental state to create the right preconditions for it to work - ensuring that you're as relaxed and comfortable as possible in bed. For me, two key things were investing in an expensive moulded "Putnam's pillow" which provides proper support for my neck and shoulders, and learning to maintain a good posture instead of sleeping in a hunched-up position. I always go to sleep and take my rests with a lavender bag under my nose. And I relax by using meditation techniques, encouraging my mind as far as I can to just follow my breathing and to gently come back to this whenever it gets distracted.

The doctors have been slightly unwilling to go along with my regular use of Zopiclone. They maintain a strong dislike on principle of people taking sleeping pills for more than brief periods, even when you're "a terminal". When I asked my consultant why, she replied that extended periods on sleeping pills "can destroy your sleeping pattern". "What sleeping pattern?", said I. My point was aceepted only with reluctance - they seem to be much happier with the idea of taking extra morphine to send you to sleep, or prescribing anti-depressants. Past experience makes me very wary indeed of anti-depressants, and I think I would have to take a very large dose of morphine - much more than I would want to take - to actually send me to sleep. The very silly thoughts which morphine induces in my head make me irritated, and this in itself keeps me awake.

For reasons I don't understand, doctors appear much more inclined to see insomnia as invariably the result of depression or anxiety, than to entertain the possibility of a more complex relationship between cause and effect. In my case, I would say that specific stresses bring on insomnia, and that this results in losing my normal capacity to deal with depression and anxiety. It's time that sleep was recognised as an issue which is of central importance to all aspects of health, and which needs to be much better addressed by the medical profession.

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