Teaching an old dog new tricks

It has been a good ten months since I stopped taking my sleeping pills. I have used sleeping pills to fall asleep on and off for a good 10 years – almost constantly really, except for the time I was pregnant with my son. I have tried to get off them several times over the last five years, but I was never successful. Now that it is almost a year since I stopped, I cautiously hope that I finally kicked the habit.

It has not been an easy journey. In the past, my only motivation to quit the sleeping pill was a vague belief of “chronic use of sleeping pills is bad for you.” But this time, I knew for sure that the pill was messing with my memory. My memory skills are very important to me. It is one of my strengths and something that I am proud of. The threat of losing my memory and my mind was a strong motivator in this quest to conquer sleep. Sometime ago, my doctor wrote me a prescription for a different sleeping pill assuring me that it was safe. I was hesitant about it and so she just shrugged and told me that I could use it if I want. I got the prescription filled but I have not used it at all. Every time I am tempted, I recall the feeling of intense embarrassment that I felt every time I couldn’t remember what happened the night before.

I have now come to see my chronic insomnia to be a disorder akin to alcoholism. I don’t think I will every be rid of it, but I can take steps to control it. I believe that using a sleeping pill even for one night will lure me back into the addiction. So, how do I control this beast that I have to live with? The answer lies in learning a few new tricks and following them diligently. Over the summer, I read a whole bunch of books on insomnia – from the helpful to the ridiculous. The first solution that is commonly recommended is the disciplined practice of sleep hygiene. Now, this is something that I have read so many times on various websites that I could probably recite it all in my sleep.

  1. Avoid or limit naps.
  2. Avoid stimulants like caffeine, especially after 3 PM.
  3. Do not eat too close to bedtime.
  4. Exercise regularly.
  5. Stop using screens with blue light for several hours before bedtime.
  6. Expose yourself to more natural light in the morning.
  7. Establish a regular sleep routine or ritual.
  8. Associate your bed with sleep – no watching tv or reading in bed.
  9. Ensure that the bed environment is ideal, not too hot or loud or bright.
  10. Go to sleep and wake up around the same time every day, including the weekends.

I have always shrugged off these suggestions because I believed that I was either already following most of them, or that some of them were impossible to follow. But after my research all summer, I wanted to give it a real try. Some things I was already doing – like no caffeine after 3pm, no screens for several hours before bedtime, somewhat regular exercise, morning sunlight exposure (as much as that is possible in the state of Washington!), and no tv in bed. I have always been against tv in bed. We have never had a tv in our bedroom. But I would always watch tv for an hour or so in the family room before bed,  (when kids are in bed and peace and quiet prevail) especially the shows that are not kid-friendly.

The first thing I did was start sleeping in a quieter room (aka no snoring from hubby). Then, I started turning down the lights at least two hours before bedtime. I stopped eating anything except for a small snack (to keep my blood sugars stable at night). Next, I started limiting or avoiding naps as much as possible. This was a bit of a challenge because I had to nap whenever I had a bad night’s sleep. I then tackled establishing a regular sleep routine. For this, I tried several things like a warm shower before bed, milk, or chamomile tea before bed and such. Nothing really caught on, so instead I settled for brushing my teeth, filling my water bottle, setting my phone to charge, and tucking the kids in bed. One change that made a huge difference was setting my phone on airplane mode during the night time. No more waking up because of notifications for every little thing! As my Fitbit vibrates for a silent alarm in the morning, I also made sure that I put the phone far away from the bed.

There were two suggestions on the list that were very hard for me. The biggest of them was sleeping and waking up at around the same time every day. As a night owl, this would be easier if I could go to sleep at 2 AM every night and wake up at 10 AM everyday. Alas, that is not possible in our world! So, I sacrificed the tv time that I used to enjoy after the kids went to bed and started going to bed pretty soon after the kids were asleep. This helped me establish a somewhat regular bedtime because I strictly enforce a regular bedtime on my children. Although it was difficult, I even managed to reduce the gap in bedtime on the weekends, to something more reasonable than four hours. But, even with all this, there was one more piece to the puzzle.

I resisted this last change the most because I never believed that not reading in bed would really make a difference . Reading in bed was my bedtime routine for years. In fact, that was how I realized that my sleeping pills were messing with my memory. I would have to go back and read the same section every night. My Kindle has a built-in light so I can read at night without disturbing others. Also, Kindles do not emit the blue night found in backlit screens, like phones and tablets. So, I believed reading in bed was okay and never made any effort to change that habit. However, over the past month or so, I have come to recognize my sleep window (that time just before falling asleep when your mind quiets and readies itself for sleep). I only learned to recognize this because of my regular bedtime. My sleep window is so small, such a light dip, that I would overcome it with the slightest stimulus (even reading). I never even realized that I had a sleep window before! But now that I knew I had one, I started waiting for it when I got into bed and give it a chance to develop before picking up my kindle to read. As weeks went by, I found myself avoiding the ritual of reading in bed and suddenly it all made sense. It was true – even reading in bed is disruptive to sleep (at least for someone like me). I really need to reserve my bed only for sleep. It just means that I will have to carve out some other time for reading. But, because reading is important to me so I am sure I will work that out.

Nowadays, I am falling asleep much faster than ever before. I picked out other small bits of advice, from books and websites, that have also helped. I keep a pad and pen near my bed to write down things that I want to remember the next day. That way I can let go of it in my mind. I surround my bed with everything I need. A full bottle of water, the pad and the pen, some headache meds and/or pain balm etc, all within a hand’s reach. To make my sleep “den” even more conducive to sleep, I set my thermostat a little lower than optimum. Did you know that one of the processes involved in falling asleep is a fall in your core body temperature? That’s why a warm shower before bed or a colder bedroom works. It makes your body temperature drop faster.

So, with all these lifestyle changes, I have made my insomnia bearable. I still wake up in the middle of the night sometimes and have trouble falling asleep again, but I am miles away from how bad it used to be. I still go to bed each day having no idea if I am going to get a good night’s sleep or not, but I am more hopeful. As each strategy brought me closer to my goal, I became more motivated to add more lifestyle changes to see if they will help. The downside of this type of management is the inherent fragility of it. Deviating from my sleep routine even for one day ripples into bad sleep for the next few days.

It helps to have a family that supports you. My family members, even my children,  know to never wake me up unless it is an emergency. My mother instilled in me a respect for sleep during my childhood. If I fell asleep before dinner (when I was a kid), she would rather let me sleep than wake me up to make sure I ate. She always said that missing that sleep would be more disruptive to my body than missing dinner. This is a unique attitude in an Indian mother (so many of them are obsessed with feeding their kids)! This family habit of “never wake a person who is sleeping” has even cost me a friendship. Just after college graduation, one of my best friend’s father arrived at my house to invite us all to his daughter’s wedding. I was out and my mother was napping and my 11-year-old brother refused to wake my mother and told him to come back some other time (as he was instructed to do with most people). He did not realize that it was an incredibly rude thing to do in this situation. Even after I apologized profusely on this behalf, my friend and her family took serious offense. Although I went to her wedding, she never spoke to me after that. Even after this incident, I stand by my “don’t wake up someone without a good reason” policy. I have heard it said in the Hindu culture that your soul communes with God when you are asleep. I believe that is the reason many of us wake up with a clearer head and more stable emotions after a good night’s sleep. Whenever a baby smiles in its sleep (and many babies do), my mother always said that the baby is smiling because God is playing with the child in his sleep!

Even after this incident, I stand by my “don’t wake up someone without a good reason” policy. I have heard it said, in the Hindu culture, that your soul communes with God when you are asleep. I believe that is the reason many of us wake up with a clearer head and more stable emotions after a good night’s sleep. My mother always says that whenever a baby smiles in its sleep (a lot of babies do), it is because God is playing with the child during sleep! I doubt most people think or write about sleep this much. But, for me, sleep is sacred. This morning, I tiptoed past the bird cage, because one of the birds was fast asleep! As I did that, it occurred to me that is an indication of how much I respect sleep. Its what prompted me to write this post.

So, please don’t wake a sleeping person unless you have a good reason. Here’s wishing everyone peaceful sleep.

-AB

 

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The pissing evil

Fifteen years ago, I was diagnosed with insulin resistance. Two weeks ago, I was diagnosed with diabetes.

The word “diabetes” has always struck terror in my heart. When I was growing up, my mother would always talk about how her grandfather died of it. To her, it was always a big demon. When I was 20, my mother was diagnosed with it. She was 42. Although, she always thought of it as a horrible disease, she didn’t really foresee that she would get it. Both her parents didn’t have it. For her it was a total shock, it just came out of the blue and knocked her off her feet. It took her more than a year to come to terms with the diagnosis. Witnessing her struggle with the diagnosis, it became this huge enemy in my mind. Since then I started to read and learn everything about the disease- knowledge is power after all.

Even with good control, my mother became insulin-dependent after several years. Ten years ago, at the age of 60, my dad became a diabetic. He took his diagnosis in stride, with his never die attitude. Still, as years marched on, the disease wore down his body as well as his optimism and sometimes overpowered him. He is not insulin-dependent, although he had to take insulin for a couple of months when some medication had the side effect of high blood sugar. Currently, both my parents have their blood sugars under control and continue to battle this demon.

When I was pregnant with my first child, the doctors worried that I would get gestational diabetes because I was already insulin resistant. I followed a very strict diet and checked my sugars seven times a day. I managed to deliver my daughter without succumbing to gestational diabetes.  When I became pregnant with my son, I went on a similar diet. In the last trimester, even with the strict diet, I saw the sugars climb up. It got to a point where I just couldn’t eat any differently to get it under control. I had to take insulin injections during the last three weeks of my pregnancy. Research shows that those who get gestational diabetes almost always develop type II diabetes within five years of the pregnancy. I was determined that I would not become part of that statistic. I lasted six and a half years.

The trouble with such research statistics is that numbers are black and white, while biology isn’t. Those numbers are not hard facts; they are just estimates. Like the estimate that if both your parents are diabetic, you have a one in two chance of becoming one yourself. But when they say a one in two chance, it isn’t like a flip of a coin. It is not mean that if my parents had eight kids, four of them will become diabetic. In reality all eight kids probably get various amounts of susceptibility, some more than others. With the decks stacked against me genetically, I could only exercise control over my lifestyle to delay the inevitable onset.

Every other Indian is diabetic these days. Chennai is the diabetic capital of the world. With all this background, there must have been some part of me that KNEW that I too will be a diabetic some day. I just hoped it will be after 60 like my dad. It is incredibly upsetting to me that even with monitoring my health for so many years, the demon caught up to be even before he caught my mother. I never expected to be diagnosed at 39. My mother’s parents were both diagnosed last year. My grandmother is 78 and my grandfather was 84. I am the youngest in my family to be diagnosed with this disease.

Coming to terms with a diagnosis that changes your lifestyle completely is very much like grief. I grieve for the life I lived before when I didn’t have to worry overly about what I ate and when. That life is now gone. The five stages of grief are denial/isolation, anger, bargaining, depression and acceptance. My mother went through a lot of denial because she was had no inkling of her health status. I thought that I didn’t waste much time in denial, but it must have been there because I did not want to admit to anyone that I was now diabetic. I was overwhelmed with isolation and depression. It didn’t help that I already felt isolated because of my move to the US. But mostly I felt guilty. So much guilt that I had let this happen. So much shame and anger, mostly directed inward. Then I wallowed in self-pity. One night, I was overwhelmed with fear; fear of eating. I felt panicky that no matter what I ate, I would not be able to control this. I wanted to release my emotions by writing a post about it, but I was not ready then. I did not want anyone to know my failure to prevent this. At this stage, I started reading more about emotional responses to the diagnosis. Website after website told me to let go of the guilt and the fear. I prayed for help to do just that.

Yesterday, I forgot to put my protein bar in my purse on my way out. When I started feeling hypoglycemic and searched for the bar, it wasn’t there. I know the dangers of hypoglycemia. Besides, the danger, it leaves me tired, makes me binge eat and sometimes leaves behind a headache. Thankfully, I had emergency glucose tablets. I have never had those before but they did an incredible job of rescuing me. I then bought a box of peanuts and couldn’t stop myself from eating three servings instead of one. Later, when I was waiting to pick up my kids at the bus stop, I admitted to a new friend that I am a diabetic. I didn’t plan on it. It just happened. I guess I was starting to come to terms with it.

Today, something happened that pushed me over the line into acceptance. I found out that my daughter’s new best friend, a fellow fifth-grader, is a type I diabetic. It shocked me when the child chose a single slice of brown bread as an after-school snack because “it was the only thing in the house that was below 5 carbs.” Now I feel ashamed again, but this time for all the drama, the self-pity and the depression. How incredibly blessed I am that I got to live till 39 years without this disease! That child is only ten.

I know that this epiphany does not mean that the struggle is over or that I will always be fine with it. I have seen how my parents still have days when they just want to surrender to it all. I know I will have my down days. But for now, I have made my peace with it. And I write this to remind me on those black days to count my blessings and be grateful.

By the way if you are wondering about the title of this post, it refers to the etymology of the word “diabetes”. It is an old common name for diabetes, derived from the symptom of excessive urination.

-AB