Chronic insomnia recovery journey of a once fearless sleeper

Chronic insomnia. 

Definition: A long-term insomnia characterised by difficulty falling asleep, staying asleep, or experiencing poor sleep quality that lasts for three months or more. 

Clinically, chronic insomnia is often categorised into three types: sleep onset (difficulty falling asleep), sleep maintenance (difficulty staying asleep), and non-restorative sleep (poor sleep quality despite adequate time in bed). Many chronic cases, including mine, involve a combination of or progression across these types. Severity can vary widely - while some may manage intermittent bad nights, others, like myself, may go several consecutive days with little to no sleep.

Below, I share personal insights of an oftentimes gruelling journey that's plagued me since late 2020 and continues to make progress little by little. 

The reasons I've chosen to do so are: 

1. Chronic insomnia is rarely covered in depth by mainstream literature or ex-sufferers (potentially to avoid re-traumatisation). 

2. The few articles available often promote expensive or troublesome treatments with uncertain effectiveness. 

2. Sufferers can often feel stigmatised, isolated, and helpless, because of how poorly it's understood. 

3. Curative treatment beyond sleeping aids are abysmal in Singapore or generally, around the world. 

4. Though often described as idiopathic (no clear cause) and triggers vary, the mechanisms perpetuating chronic insomnia often share common roots.

5. Co-morbidities with other mental health issues and anxieties can amplify the turmoil or reinforce a vicious cycle, as I found out later into my journey (in my case, Body Dysmorphic Disorder (BDD) which I was diagnosed with as a teenager). As literature on such overlaps are scant, I hope my personal insights provide some value.

Finally, as I discovered years into my journey, education is really the beginning of the end for many. <3 

How it Began

Early 2020 was a period of great flurry and anxiety as Covid-19 hit home. There was also a bigger inner storm brewing as I freshly got out of a few-year-long and difficult relationship. 

The descent to poor sleep was subtle and blurry. 

It started with slowly sleeping later as I endeavored on multiple online courses during Covid across philosophy and American politics, as a way to sharpen my mental faculties and compensate for that feeling of lack from deep heartbreak. I would listen to webinars, read long reading materials, and translate them into AI voiceovers when I couldn't read further. The grind lasted 2 to 3 months across post-work weekday evenings and weekends. 

Sometimes, I slept late on volition. Other times, my mind was just too wired to sleep. I remember being kept awake one night with thoughts of the Big Bang theory which I'd just read about that evening. 

Sleep onset was slowly dragging to 4 to 5am, with next day awakenings around 9am. This was atypical, as I was someone who usually slept by midnight and awoke by 8 to 9am the next day. I tried keeping fit by diligently jogging 4 - 5 times per week, mostly in the evenings after work and before study time. 

The period of late 2020 went by in a blur of busy-ness as I tried to cope the best way I knew how. 

Spiralling Downwards 

A few months in, I started seeing the physical signs of lethargy: constantly oily and dull skin, tired eyes, moodiness. The internal reinforcement was when acquaintances I met over a Turkish dinner in late 2020 commented on my dark eye circles and poor complexion. 

It was the external alarm to a warning already blaring inside. 

Early 2021 was a time of career opportunity and major change. I took the challenge of switching into another role and industry, facing a steep learning curve and little accessible help due to pandemic work-from-home restrictions in Singapore. The stress and isolation were immense.

I remember continuing to sleep only 4 to 5 hours per night, constantly feeling tired but wired. I was constantly burdened by the elusiveness of sleep. That was accompanied by ample desk research and 'remedying': Traditional Chinese Medicine (TCM) visits, Homeopathy, generous and experimental consumption of herbal sleep aids and anti-inflammatory supplements like melatonin, ashwagandha, valerian root, and turmeric. 

In April 2022, my sleep rapidly declined into daily one-hour episodes for three excruciating weeks. I was lying down up to 10 hours but with only 10% sleep efficiency (time spent asleep vs time in bed). By that time, I had transitioned to sleeping on the floor, then yoga mat, due to an extremely negative association with the bed. It had become a representation of hours of tossing and turning and any combination of nocturia, night sweating, restless legs, constant awakening, nightmares, and poor quality sleep (all of which are commonly seen in chronic insomnia). 

The fear of sleeplessness had infiltrated my sleep, presenting me with nightmares whenever I got to sleep fitfully. In one nightmare, I was faced with the choice of waking (and facing sleeplessness) or confront the scariness of it - I chose to stay in it. 

I cried many nights, lost to exhaustion and the fight between easing anxiety with music or social media or forcing sleep. 

I was still turning up to work daily (by which time we had transitioned back to hybrid work arrangements), due to the uncertainty of when the situation would alleviate. Towards the end of those three weeks, I finally saw a General Practitioner (GP) and pleaded for sleeping pills. In Singapore, doctors can only prescribe sleeping aids for five days without referring to psychological medicine. The GP seemed apologetic as he prescribed me a few days’ supply, explaining that he could not dispense more. The medication didn’t restore healthy sleep but helped break the one-hour cycles.

Pivotal Moments

Mid-2022 was the time of my division's mid-year review meeting. We sat in a circle sharing in turn how our half year had been. When it was my turn, I inadvertently broke down and shared my sleepless ordeal. It was a pivotal moment when I acknowledged I was not okay. 

Then, in August 2022, I experienced what I consider to be my first (and thankfully only) panic attack while holidaying with my then-boyfriend (now-husband) in Da Nang, Vietnam.  My sleeping aids weren't helping, so we decided to visit a Pharmacy in Vietnam to procure some sleeping pills. Despite my partner's pharmaceutical background, the pharmacist was only able to offer pills not available for distribution in Singapore and with uncertain side effects. I remember taking the recommended dose before turning in, then again a few hours later when they didn't work. 

Something felt greatly amiss shortly after - I entered a state of bodily immobilisation and extreme weakness while my mind and heart raced. I felt trapped in my own body whilst experiencing extreme adrenaline and terror of dying. I also felt extremely dizzy. I weakly dragged myself into the bathroom and tried vomiting out whatever I had downed. As my partner was a deep sleeper and I didn't intentionally wake him, he didn't notice till much later. When he finally awoke, I wept uncontrollably in his arms as we figured out next steps. We finally visited a hospital when morning came around. The attending doctor prescribed a generic drowsiness drug to tide me over until I returned to Singapore. We contemplated whether to cut our trip short but eventually stayed the course. 

Other Worst Points and Recovery Efforts

Throughout my few-year long journey, the worst periods were from 2022 to 2023, where I averaged 3-5 hours of broken sleep. 

It was marked by great chaos, panic, and exhausting every avenue to find an answer. Sometimes, this led to scary hypotheses like Fatal Familial Insomnia (FFI) - something many chronic insomnia sufferers have googled but is rarely the cause. 

Sleep was getting profoundly stressful, so I recounted the hours I had slept or talked about it vaguely in references. 'Sleep' was replaced with synonyms and the number of hours I'd slept was referenced in colour codes so I didn't need to utter them. In that time period, I probably achieved the healthy 7 hours or more of sleep only once when I succumbed to fever.

As chronic sleep deprivation dragged on, there were physical strains I had to manage through diet and exercise. I more frequently felt the signs of bodily inflammation and aches, until one day, they did not subside despite undergoing massages and various lifestyle measures. It was debilitating to feel like a young person caged in an old person's body. In order to cope and not worsen my condition, I gave up inflammatory and stimulating food items I liked to consume entirely - chilli, cold drinks, caffeine - for at least a year. 

Nonetheless, my western lab tests and medical reports were coming back normal. There was nothing particularly concerning detected with my thyroid, cancer markers, hormones, blood, or even urine. I was staring into what seemed like an infinite abyss, a possibility of living with the condition and sleeplessness for an indefinite period of time and with no reprieve. 

What made this journey particularly challenging was battling an unknown, with unknown solutions and cures. As surely as earth's rhythm of dusk and dawn, night came everyday. The prospect of sleeplessness showed up every 24 hours. The fear of sleeplessness showed up even earlier - from the moment I opened my eyes to another exhausting and dreary morning. It was a crippling type of fear that I feel I cannot accurately represent in words. 

The lack of general awareness, understanding, and empathy towards this condition made it extremely isolating. I remember having conversations with (then) colleagues and friends who couldn't understand, who shared basics of sleep I had already known/tried/tested, or who offered words meant to empathise but which only added salt to wound. 'What a pity", "You're supposed to be at the prime of your life", or people who kept yawning indiscreetly after saying they had slept through the night. 

It was extremely daunting to make any social plans in this period, notwithstanding the social anxieties that BDD already brings. In the lowest valleys, I was terrified to make any social plans even a day ahead of schedule, for fear of having to postpone or cancel without a 'reasonable' excuse. I was terrified of being seen, and when I did finally show up to a group gathering after months of isolation, felt overwhelmed.

The pressure to keep working while treating my condition was huge, as I didn’t know how long this would last and invested heavily in treatments - expensive TCM and weekly acupuncture, mild hyperbaric oxygen therapy (m-HBOT), grounding mats, foot bath salts, breathing apps and exercises, and so on. Like many others, I first tried improving my sleep hygiene - widely considered the first line of defence against insomnia - by adjusting my bedtime habits, screen use, and evening routines. Unfortunately, that alone wasn’t enough. I also lowered my jogging frequency and shifted them from evenings to mornings to avoid depleting my 'Yin/Life' forces or over-stimulating my mind, as per TCM advice. None of these worked.

I further tried Cognitive Behavioural Therapy for Insomnia (CBT-I), considered the gold standard for chronic insomnia treatment in the western medical community. However, based on online comments, the results seem to vary greatly - showing great efficacy in improving the sleep duration, quality and ratio for some (i.e. time spent asleep to lying down), while also having a negative impact for others. It involves shortening the lying down window to build up one's sleep drive and conditioning our minds to associate lying down with sleep. That personally meant nights of torture - not lying down despite feeling extremely drained and forcing myself to do other things, while also diligently checking and counting sleep and wake times for my progress log. I summoned my courage to do this for 12 weeks before realising it wasn't working out.

Since late 2023, I began visiting a psychological medicine clinic to receive prescriptions for sleeping pills - a step I was extremely reluctant to take. Relying on medication felt like relinquishing control and only deepened my sense of helplessness. The initial options were short-term sedative-hypnotics like Zolpidem and anti-anxiety medications such as Xanax - both of which are widely used but carry risks of dependency with prolonged use. Occasionally, I also took Chlorpheniramine, an over-the-counter antihistamine that is sometimes used off-label as a mild sleep aid. As none of these worked particularly well for me, I eventually transitioned to Lemborexant (Dayvigo), a newer class of sleep aids designed specifically for insomnia and generally considered safe for long-term use. Still, I took it sparingly, typically halving the dosage or skipping it entirely whenever I was feeling more courageous to confront a sleepless night. My doctor even remarked that I was her patient who took the least medication! 

Co-morbidity with Body Dysmorphic Disorder (BDD)

It was much later into my insomnia journey that I noted a strong connection between how I was sleeping and feeling, beyond the simple explanation of deathly tiredness coursing through my veins. 

I realised that the lack of 'beauty' sleep was affecting my physical appearance and/or perception of it.  

The very prevalent advices from beauticians, online literature, and such were not helping. I was distraught and helpless. I felt completely powerless to alleviate the BDD symptoms that were heightening and straining my ability to perform at work, in video conferences, or in any situation or setting where being "visible" was required. The challenge was that I'd always been in and enjoyed stakeholder-facing roles. 

This was when I felt my condition slowly but surely wearing away at my ability to work, my core identify and esteem. 

I sought concurrent counselling/therapy for chronic insomnia and BDD, but it didn't alleviate the suffering entirely. It was as much physiological as it was psychological, and they were locked in a vicious cycle of feeding the other. 

Education and Turning Point

Many times, my condition felt like a downward spiral of abyss I could not emerge from. 

The silver lining in the storms? I found my current partner/spouse in the storm of 2021. He lived through the eye of the storm with me and proposed in 2023, the same year we got married. If anything solidified that he was a guy worth marrying - it was his equanimity through it all, and his acceptance of me at my 'worst'. 

Importantly, I discovered 'Fearless Sleep' and 'The Sleep Coach School' (both YouTube channels on sleep coaching), along with the principles/teachings of Dr Daniel Erichsen, a former sleep doctor-turned-coach, who left sleep medicine to advocate his now increasingly established theory of Chronic Insomnia as a problem of a phobia around sleep and sleeplessness, rather than a sleep issue itself. He also published a book on the accounts of chronic insomnia cases he had helped support, titled 'Tales of Courage: Twenty-Six Firsthand Accounts of How Insomnia Ends'. This was revolutionary to me as society and western medicine have often portrayed insomnia to be a physiological condition that should be treated with sleep hygiene and discipline. 

Some general principles this school of thought/theory espouses as extracted below: 

- Effort undermines sleep (i.e. the more effort and thought you give it, the harder it becomes) 

- Sleeplessness is primarily a result of hyperarousal. The fear of sleeplessness drives up this hyperarousal and thus paradoxically perpetuates sleeplessness. 

- The initial trigger for insomnia are many times circumstantial (e.g. work transitions, navigating uncertainty, stress) and can happen to anybody, but the perpetuation of it is commonly due to learned phobia. 

- Phobia is learned from the initial periods of short-term insomnia, when the brain realises something amiss and tries to 'problem solve' (which is a natural survival instinct to perceived threat). 

- What kickstarts the journey of recovery is, firstly education. The brain finds comfort in understanding. Then, exposure. It is important that we cycle through the periods of sleeplessness and do not give weight to it. 

- The path to recovery is about accepting or embracing sleeplessness rather than fearing it, because the idea is that in so doing, hyperarousal goes down. This is why the advice for Chronic Insomnia sufferers may look drastically different than for transitory insomnia. (E.g. Instead of giving them the standard wind-down/no-blue-light-before-bedtime advice, sufferers of this condition may actually benefit from not paying heed, because it benefits them to dissociate sleep from effort or needing to do something). 

- Exposure should accompany indifference - i.e. being willing to cycle through fluctuations in sleep. Not celebrating 'wins' when sleep gets better, not giving too much attention to it when it gets worse. It is this indifference that (very) slowly and eventually informs the brain that sleeplessness is NOT a threat (nevermind the standard sleep advice, because it really isn't helpful in this condition). 

Conclusion 

There is still so much to be said for this condition, and if I wanted to, can go on for hours. But here are my personal key learnings and takeaways which may not have come out so strongly in the above writeup.

1. Silent conditions are real and equally important to be addressed and treated. By coming out about my personal ordeal/situation today, I hope to give light to an experience that many others may share or benefit from.

2. The gaps in the medical system and literature are still prevalent. It sometimes does take a whole community to support one person. Any information that one can contribute to cut through the fog would be useful.

3. I think of Chronic Insomnia as a condition that exists in the intersection of physiology and psychology - where both physical manifestations and mental processes feed off each other. It's a condition that deserves to be treated from a whole-person perspective rather than invalidating either. (Although it was the findings of Dr Daniel Erichsen that proved most comforting/groundbreaking for me, it was also the therapeutic effects of TCM acupuncture etc that alleviated the physical signs of strain and manifestations like night sweats and nocturia for me)

4. One is not weak just because they suffer from these conditions, though they are understandably very debilitating. It can trouble even the most resilient of people (and in this case hardcore 'problem solvers'). Overcoming this becomes your weapon and strength.

Currently, after close to 5 years into the journey, I still encounter nights where sleep eludes me before and during mid-sleep awakenings, and I frankly haven't adjusted back to sleeping on the bed. Instead of forcing sleep, though, I give myself the permission to daydream about the day or listen to YouTube videos for education or entertainment, which mostly result in me inadvertently sleeping at some point. Other times, I take a half tablet of Dayvigo to ease me into a state of not trying. I accept that crappy days and nights occur, and I choose to take the path to continued recovery gently - choosing courage most days but being able to accept that I'm human and also choosing medicine on others. 

I hope this blogpost helps and supports someone in your journey for yourself or a loved one.

I'd separately love to hear if you enjoyed this post or would like to learn more about BDD - which is another condition which is severely lacking in understanding and literature around the world.

Till next time, 

Meng Yee <3