Sleep hygiene, *yawn*...

Needless to say, when your brain is filled with questions it can't find answers to, it often keeps you awake at night. Whilst I'm a worrier, I can't remember a time where I've suffered actual, clinical insomnia as a result of those worries. Sleep disturbances are pretty common amongst people who suffer depression, but mine have usually been on the opposite end of the spectrum. When I'm depressed I tend to sleep all the time. This summer, though, I have been unable to go to sleep at night. The result is not just that I'm tired and over-sensitive but that I'm spending a lot of time alone on the couch late at night or in the early hours of the morning doing things that are not so good for me, like searching for pregnancy disaster stories on the internet. I've come to discover that the whole internet, in fact, should be turned off after 10pm as nothing you read or see on there is likely to aid sleep or induce restful feelings. You're much better off reading a book, which I guess I've always known, but just haven't seemed to have the motivation for lately.

My psychiatrist, smart, reasonable person that she is, has given me a crash course in what the professionals call 'sleep hygiene'. I would give you an official definition of the term, except that Wikipedia is down today! Actually, it's pretty simple, common sense stuff - eliminate all of the habits/factors that might interfere with sleep, and develop routines that are likely to encourage it. I didn't really need to pay $180 to learn these techniques, as I'm pretty sure I already knew a lot of them. But I did need someone in a position of knowledge or authority to assure me that they were worth the initial bout of discomfort they cause. And, I guess, I am pretty desperate, so open to suggestions that I might otherwise dismiss as too hard!

Whilst I would like to discount most common sense strategies in life as being a load of bollocks (eg. if you eat healthier you will feel better), I actually know most of them to be true, sigh. Therefore, of course I have slept much better since I have actually given these strategies a go. Who would have thought? I only started this week, on Sunday, but already I have had a much better week of feeling more rested and less anxious and distressed just by doing the following things:

• Not napping during the day. I have always been an excellent napper, and there's nothing I like better than taking to the bed or couch about 2pm for some shut eye. Having to give this up is definitely the hardest aspect for me, particularly as I'm not working at the moment and have lots of available time to enjoy napping. I have not had a nap all week, and at times I have really struggled during the day with an almost physical compulsion to lay my head down. The fact that I have to get more tired than I already am in order to get less tired in the future seems a cruel strategy. But, whether it is this aspect on its own, or in combination with others, I have felt more 'ready' for bed at night as a result. It sounds stupid, but I don't think I ever realised before that you have to be genuinely tired at night before you can expect yourself to fall asleep; that the simple act of going to bed and expecting it to come is not enough.

• Set the alarm and get up at the same time everyday regardless of how much you slept. That last bit is the killer. I'm happy to get up at 7am everyday if I've had a decent night's sleep, but that's not what has been happening. By the time I've been getting to sleep it's often 2am or later, and therefore I've been sleeping in to try and get a decent amount of sleep. This, apparently, is not the way! This is also an extremely hard thing to do, and I'm still only in the 'trying' phase, not the more definite 'doing' phase. It doesn't feel fair to have to wake up at 7am after you've barely slept, especially when you have no practical reason to do so (such as work). Though I haven't been as strict as setting an alarm yet (one new strategy at a time!) I have gotten out of bed before 8am every day this week. This is something I will keep working on!

• If unable to go to sleep within 20 minutes at night, get up. This was also a mistake I'd been making. In an attempt to bully my body into sleeping, I'd stay in bed tossing and turning for hours. I wasn't going to get up as this would be 'permitting' my body to stay awake and rewarding it for its sleeplessness! Error in my framing of this experience, apparently! Staying in bed and expecting sleep to suddenly descend upon you is counter productive as you get more angry, emotional, anxious etc, all of which are feelings that ramp you up instead of turning you down. You're supposed to do a quiet activity that does not involve computers or TV. For me, this is normally reading, but lately it has also involved knitting and cross stitch as I've been getting a bit crafty. Often it might take another 60-90 minutes before you're tired again, which I've discovered from learning more about sleep cycles, but this is OK. You've got to catch the wave, so to speak.

• Have a little snack before bed, but not a banana! I often have a banana before bed. Not sure why, just habit! Apparently there is a chemical in bananas (I forget which) which affects serotonin levels, and as I take a medication that also affects my serotonin levels, this combination could be effectively boosting them before bed, and giving me an 'up' instead of a 'down'. At least, I think this is the way she explained it. Anyway, the gist is, don't eat the banana, but maybe try a biscuit!

• No caffeine after 4 or 5pm. Egad! Torture! Of course, I could have figured this one out by myself. It's not a good idea to take a cup of tea to bed with you, as I so often do because I am a self-punishing sadist who wants to feel miserable from lack of sleep! I've switched to decaf tea at night, or no tea at all. *sniff sniff*

• Sleep rituals. Develop some routines that remind your body that it is time to sleep. For me, the things that work are a warm shower at night and reading for a little while. This is something I am also working on. Another thing I think will help, but which I haven't implemented yet, is preparing for the next day before I go to bed (get clothes out, write things to do etc) so that I don't go to bed worrying about them.

• Daylight. Did you know your body actually needs to be exposed to sunlight in order to set its internal clocks? Neither did I! That thought had never crossed my mind, and I do spend an awful lot of time indoors, as my low Vitamin D levels will attest. Apparently, I need to spend at least an hour outside everyday, which will actually be hard for me to be honest! I have enjoyed my attempts at sunshine this week, though, even if it has just been sitting on the front porch and relaxing.

• Exercise. This is another one that makes perfect sense, yet which I don't like to think is actually true! It also ties in with the daylight thing. So, about the best thing I can do is to go for a walk or bike ride outside during the day, and I'll be able to kill two birds with one stone. Today Leslie is working from home and we went for a 45 minute walk and covered 4km, including lots of hills! I do feel pretty tired now - if only it were bed time!

Anyway, I'm sure there are lots of other things I am yet to learn, but implementing some of these has actually worked this week. I've also been prescribed Ativan, for when the sleep situation becomes desperate, and I've only had to take it once this week. It was pretty damn nice, too, so no wonder it gets a good price on the black market! 

No sleep is normal. Sigh.

I saw my GP this morning for a check up. I told her I haven't been sleeping. She told me I had every reason not to be able to sleep and that sleeplessness is a normal part of the grieving process. I know that is probably true, but I'm not sure how to handle the practical problem of being perpetually awake while I wait for this symptom to pass. For one, being over tired and feeling under the weather makes me even more sensitive than usual so I can't tell how I'm actually feeling - upset or tired, depressed or tired etc. Then again, the daytime feeling of tiredness is much more preferable than the night time feeling of sleeplessness. It's so lonely at 1 or 2am. Even Peppy is fast asleep during those witching hours. Our house is too small for me to be watching TV without keeping Leslie awake. Nothing seems worth reading when I'm sitting in the dark and can only think about death and the pointlessness of everyone's existence.

I showed my doctor the results of all of the tests that were done in hospital and she agreed that they were somewhat inconclusive on whether the apparent infection they found in fact caused me to go into preterm labour, or whether I went into preterm labour and as a result acquired a bacterial infection. It's the old chicken vs egg scenario, and there's no way of getting any conclusive evidence either way. She said that it might put my mind at rest to be tested for evidence of any remaining bacteria or infection so I consented to  what I guess what a pap smear where they would look for evidence of pretty much anything - chlamydia and bacterial vaginosis, particularly, which are very common. She's pretty sure it'll all come back negative, but at least I will then know for sure that I've got a clean slate, so to speak! The good news is that my uterus is looking in good shape and has gone back to where it belongs.

I'll bring up the sleeping thing again tomorrow with yet another of my health professionals, my friendly neighbourhood psychiatrist. I'm sure she has many more solutions to knock me out!

On another note, I can't believe that it is Thursday again. Thursdays feel very poignant for me because that is the day that my pregnancy ticked over to the next week of gestation. It's also the day of the week that Max was born. As each Thursday passes I can't help but think of what week of pregnancy I would be up to now if this accursed nightmare had not occurred. I think this week would be Week 30 - the homeward stretch. If Max had been born at 30 weeks the outcome would most likely have been very good. I would not have got to take him home straight away, but he would have come eventually. I keep wondering what it feels like to be 30 weeks pregnant. Would I have heartburn? Braxton hicks contractions? A waddle when I walked? How much bigger would my tummy have been? It is so weird to have had the experience of giving birth to a baby but having missed out on so much of what usually comes before.

As each Thursday passes I'm shocked by how quickly the time is passing, even though each individual day often feels like a marathon to get through. Time has lost all sense of meaning for me and I wonder how I'll manage over the next few weeks when I have to get back into work and other worldly responsibilities.