PLEASE NOTE: This is a minimally-edited transcript that originates from a program that uses AI.
Anita Rao
This is Embodied, from PRX and WUNC. I’m Anita Rao. If you’ve ever struggled to fall asleep or stay asleep... you’re probably familiar with insomnia math.
Jennifer Senior
I would start thinking, oh my God, what if I never fall asleep? It's four o'clock, it's five o'clock, it's six o'clock. you know, that kind of thing where like, I'm only gonna get two hours of sleep.
Anita Rao
When journalist Jennifer Senior’s journey with chronic insomnia started in her late 20s... she was frantic to find a cure. But now, more than 25 years later...although insomnia is still a big part of her life, she’s more focused on reframing the sleep conversation. We’ll hear insights from both her reporting and personal life... Plus... we’ll meet a couple who share suggestions for navigating insomnia in a romantic partnership.
Jesse Rifkin
It's no longer a thing that's wrong with me or a thing that's wrong with, with Gabby. It's a, a problem that we share.
Anita Rao
Those conversations, just ahead on Embodied.
You know that kid at the slumber party, who was always the last to fall asleep, that was Jennifer Sr. Staring at her pink flowered wallpaper while others snoozed. But when she hit her teen years, something clicked into place and Jennifer became a self-described brilliant sleeper.
Jennifer Senior
I was like an atomic clock. I would fall asleep every night at one. I would wake up at nine when I lost my alarm clock, which you needed in those days. I didn't bother buying one until I needed an early morning flight to get out somewhere. I genuinely didn't need one.
Anita Rao
Then one night, a few months before her 29th birthday, something changed.
Jennifer Senior
I have no idea what happened and I would give half my life savings for someone to explain it to me. Okay? Maybe not that much particularly 'cause I'm older and I need it. But what happened was, Al, I closed my eyes and nothing happened until like five in the morning. And all I thought at the time was. How weird that was the first night.
Anita Rao
This is Embodied our show about sex, relationships, and your health. I'm Anita Rao. That one weird night in the late nineties became weeks, months, and years of struggling with sleep, putting Jennifer in the company of tens of millions of Americans diagnosed with chronic insomnia. Experts still aren't exactly sure why insomnia happens, but some contributing factors are genetics, mental health disorders, and stress. And when you consistently struggle to fall or stay asleep, it can lead to a whole host of problems for your health and quality of life. Jennifer has dealt with chronic insomnia and its many complications for more than two decades. She wrote about that experience in a piece for the Atlantic called Why Can't Americans Sleep? But in that article, Jennifer suggests that continuing to talk about how bad it is to not get sleep is not gonna help folks with insomnia. So we're gonna talk today about the reframes she wants to offer, but first, we'll hear stories of how insomnia has affected her own life and relationships. When it all started, Jennifer was experiencing intermittent sleeplessness.
Jennifer Senior
It was kind of like every fifth night I would have a, an off night where it would be like a four or five o'clock in the morning kind of deal. And I thought, Hmm, this is weird. And I saw my doctor and I said, this is happening. And he said, oh, have some ambien.
Anita Rao
Hmm.
Jennifer Senior
Um, there's no shame in it. Take it when you need it. It happens to people sometimes. And I said, okay. But I was so drug phobic in those days. I've been such a goodie goodie my whole life that I've taken like nothing, you know, other than I guess I smoked weed every once in a while in college, but like, who didn't? So, um, I refused to take it until I started having involuntary all-nighters. I mean, and that was bananas.
Anita Rao
As the weeks and the months went on, what did the inside of your brain, your internal chatter, start to sound like about not getting sleep?
Jennifer Senior
Oh yeah. So in the beginning I was annoyed by it, but there wasn't any kind of furious nighttime voice that was just, you know, that was emitting all sorts of distress signals. When I had an all-nighter, that almost instantly threw me into a panic where then I would start thinking, oh my God, what if I never fall asleep? What if I never fall asleep? It's four o'clock, it's five o'clock, it's six o'clock. It was insomnia math.
Anita Rao
I wanna ask about that insomnia math. 'cause as a creative, you were a, a writer, a journalist, and as a creative person myself, I know even just in like one night of bad sleep, part of what's happening in the insomnia brain is like, how am I gonna interview someone? My brain isn't gonna function. How am I gonna work tomorrow? Like, am I gonna be able to work tomorrow? What's gonna happen during the interview? Like that, like the stress about what you have to do in your day totally gets really loud. How did this lack of sleep affect your functioning in your day-to-day life?
Jennifer Senior
Totally, totally. So. Unlike you though, I don't think that I had the same kind of horrible deadlines. I was still doing the kind of job. 28 and three quarters, let's say that it was still kind of a beginner ish job where my salary was low. I compensated for it by writing other pieces, but I could still do them on a leisurely schedule. Magazine writing is absurdly luxurious in that way. It didn't matter. If I went a full night without sleep, when it started to make a difference was I went through a spell where I was only sleeping every other night.
Anita Rao
Wow.
Jennifer Senior
It was, I mean, that's a recipe for psychosis. Yeah. It didn't last long because. On the in-between nights when I did sleep, I wasn't sleeping 11 hours, I was sleeping like five, and very quickly that becomes a disaster. So I rushed to a sleep clinic that, by the way, I found in a phone book, but it was associated with Columbia Presbyterian, which I knew was a major hospital in New York. So I figured, well, this has to be pretty good. And you'll notice that. C is really early in the phone book. I like, that's how I found it, and I was taking Ambien at that point, but I had a terrible reaction to Ambien, and so not only was I highly reactive and squirrelly, people would tap me on the shoulder and I would jump up and be like, yeah, yeah. I also would run into the bathroom. And start to cry.
Anita Rao
Hmm.
Jennifer Senior
And I knew it was the Ambien and not the fatigue because before I took it, this was not happening to me. So I reported back to this sleep clinic. Look, my GP gave me this. It is so not working.
Anita Rao
Hmm. So you were having difficulty with medication and you went to the sleep clinic, and one of the things that you tried there was a treatment called Cognitive Behavioral therapy for Insomnia or CBTI, and this is a first line treatment for insomnia intended to help people change both their thinking and their behaviors around sleep. It sounds like a really intense process. Tell me a bit about what it was like for you to go through that.
Jennifer Senior
When I went to Columbia Presbyterian, what they said was, look, we're gonna consolidate your sleep. You're gonna do this by taking a drug called Restoril, which is a benzodiazepine. It's in the same family as Valium, which I always thought was kind of. Shameful and valley of the dolls like and yuck. I took it one night. It didn't put me to sleep. There was nothing worse than being groggy the next day, having not fallen asleep on a sleep medication. So I decided to try cognitive behavioral therapy without it. I begged them and what I had to do, the main tent pole in this therapy is you consolidate your sleep. Okay? What does that mean? It is the craziest way possible. You keep a sleep diary. And you see how many hours you are sleeping. Obviously some nights I was sleeping zero, but on the nights that I was sleeping, as I said, it was only about five. And for other people who let's say get into bed at nine and then sleep from 12 to four are up, and then they sleep one more hour, you know you have to add up all those hours and you can press them into one block. That means you choose a time you wanna wake up. So let's say for me it was nine o'clock. That's my usual wake up time. I would have to say until four o'clock and only allow myself to sleep from four to nine. That was so hard and I didn't fall asleep at four. That's not exactly how your body works. And without medication, because I was so afraid of Restal, it didn't occur to me that there could be other drugs that I could use in any way. I was afraid of them. I went a haywire, and almost immediately, I, I, I couldn't sustain it. It was a nightmare. I would do more allnighters. I got hideously depressed. It was totally counterintuitive, but the idea is you compress it and if it works for those five hours, if you sleep the majority of them for three nights in a row, then you can add 15 minutes. Then if you do that for the majority of three nights where you fall asleep, you know, then you get to add 15 minutes more and you build up this, what they call sleep pressure and you've reset yourself. I couldn't even get, I think I got two weeks in and cried, uncle.
Anita Rao
So what did you know at this point about what causes insomnia and what was causing yours in particular?
Jennifer Senior
I mean, at that point, people's working hypotheses were, you must be depressed,
Anita Rao
Uhhuh.
Jennifer Senior
And I kept looking at them and being like, really? I mean, I've always had kind of low level. Melancholy slash depression, but I had energy. I was sunshiny. Whatever low hum of sadness I have had did not interfere with anything. They ultimately decided that I must have been depressed, and I just thought, and to this day, think now that I do understand what clinical depression is. It set one off. All I can think is, well, that was wrong. Like to this day I push back.
Anita Rao
So you had tried cognitive behavioral therapy for insomnia and you weren't able to stick with it. You were struggling to find a medication that worked for you. How were you mentally processing all of this at that point? Kind of acknowledging that this might be your new reality.
Jennifer Senior
I was frantic. Mm-hmm. And I didn't yet think it would be my new reality, Uhhuh. It had not occurred to me that this would be a 25 year problem, and that's just 25 years and counting. What happened was I only tried a sleep medication for one night. Mm-hmm. Because it didn't work. I said, I'm trying this without it, assuming that all sleep meds would be the same. And I became so hideously depressed that they said, we're putting you on an antidepressant. Paxil solved a problem. It made me so sleepy during the day even, and so sleepy at night that it solved the problem. But number one. I felt shame over taking an antidepressant. This was 1999, I guess, and I just, it made me dumb, I dunno how else to explain it. My head became this kind of whistling prairie and it was harder for me to write and that was terrible too. So I, I just had this kind of altered self-conception, like what am I just, this now kind of compromised and depressed. Per it. It was pretty radical what happened to me then.
Anita Rao
Just ahead, how the upheaval of insomnia affected Jennifer's social life in dating and what helped her find new equilibrium? You're listening to Embodied from North Carolina Public Radio, a broadcast service of the University of North Carolina at Chapel Hill. You can also hear embodied as a podcast. Follow and subscribe on your platform of choice. We'll be right back.
This is Embodied. I am Anita Rao. Why Can't Americans Sleep? That's a question journalist Jennifer Sr. Took on in a recent piece for The Atlantic. Her search for answers stemmed from her own life experience. Jennifer has been dealing with chronic insomnia for more than 25 years. The sleeplessness came out of nowhere and Jennifer tried everything to stop it. From acupuncture and meditation to rigorous exercise. She then tried cognitive behavioral therapy for insomnia, or CBTI. It's an intervention that includes restricting your sleep, but it was too challenging for her to stick to insomnia, also made her depressed. All of this took a big toll on every facet of her life, including relationships.
Jennifer Senior
During that period of struggle, I guess it was longer. I, I couldn't predictably make plans.
Anita Rao
Mm-hmm.
Jennifer Senior
Because I'd be so dead the next day. So I was constantly canceling on people. And some people were very understanding and particularly friends who had struggled with depression and were already on antidepressant meds because although it wasn't the same, they understood what it was for, you know, bodies to be uncooperative. However, I had some friends who. We're not particularly kind about it and would say things like, all of us have bad nights.
Anita Rao
Mm.
Jennifer Senior
And all of us can't sleep. And I, I would explain to them the difference, and one in particular who knew the contours of this thing still said something that was so hurtful. A friend had an, a friend of hers had invited me to spend the weekend at this fabulous thing that I wouldn't have had to pay a nickel for, and I said yes, and then was so run down that I canceled last minute. She was horrified. And I understand that. You know it, it must have. Looked flaky and like I was taking for granted a really spectacular invite. So I understand why she got upset, but she just let me have it. All of us have trouble sleeping. This is ridiculous. You can power through this. We all power through it when we can't sleep.
Anita Rao
Hmm.
Jennifer Senior
Only years later did I say to her, I really could have used your friendship. I love you so much, and it's my fault too, because I should have then in there said, whoa. Is that hurtful? Hmm. Like, let's back up here. You know what? She totally would've been nice about it.
Anita Rao
How about in dating? Were you able to have open conversations about what you were going through? How did it affect your romantic life?
Jennifer Senior
Oh God. So I was dating a guy at the time who we're friends now, and I'm usually friends with all my exes, but this was rough. I mean, he'd say things to me like. Well, why don't you just close your eyes when I would say I'm having trouble sleeping. Geez. Yeah. It was just, oh God, it was so bad. And I went on an antidepressant while we were together, and he kind of awkwardly said, well, I once dated a woman who was on that, but I, I just, I knew instantly what he thought, which was. She must be a banana boat. It was too early, you know, it was before a lot of people were on this. He once actually also must have furtively looked in my medicine cabinet because he looked at me and said, what's acetaminophen? And I said, Tylenol. But he was clearly casting around to see if there were any other drugs in there that should give him pause. And of course, the only thing I had in there. Was Tylenol. So, but I, I knew just what he had done, right? He was casually saying, oh, you know, I recently saw acetaminophen, and I was like, yeah, in my medicine cabinet. So from that point on, I was very careful to find people who were gonna be different.
Anita Rao
So you're describing this, these early years of chronic insomnia where you're really struggling, you are, it's affecting your social life, your relationships. You're trying to figure out what kind of medication you feel comfortable taking, if at all. Was there a turning point when things started to stabilize and you found a more consistent rhythm with sleep?
Jennifer Senior
Uh, yeah, and no. I mean of course eventually, but in that first year, eventually I went off Paxil 'cause I could not stand what it was doing to my writing and instantly there was a difference. And also I was able to sleep again for a stretch. And I went back to nine to one and thought, well, thank God that's over. Then it started all over again. And I'll never forget, I went into my editor in chief's office started bawling, and Caroline Miller said to me, you know, don't be ashamed. Go on something else. You know, if this wasn't working for you, there are other things, or there are other sleep medications. You know, I know about other people who've taken other sleep medications. And let me ask around for you and. I started taking Klonopin and she was so nice de-stigmatizing, saying, you know, don't let this ruin your life. There is nothing to be ashamed of. And Klonopin did the trick and has remained the thing I did eventually have to go on other antidepressants. It really did set off a chain that from that point onward. I was in a much more depressed zone. I was clinically depressed. And by the way, the conventional wisdom now is that the causality, they are of course intertwined, but that insomnia is more likely to cause depression than the other way around.
Anita Rao
How old were you when you found Klonopin and that transition began to happen?
Jennifer Senior
Maybe late 30. Late 30, you know, like maybe, yeah, about a year. A half into the process or something. Okay. Process. I call it a process. Process of trying to fix it. The process of life. Yeah. Yeah. Devolution in terms of my own body, you know? Yeah.
Anita Rao
So you mentioned that the, there is a changing understanding of how depression and insomnia are connected. Can you explain that a little bit more?
Jennifer Senior
Yeah. I mean, of course. Depression can cause insomnia. It, it's certainly a manifestation of depression. It it, no one, they're very complexly related, and once you're an insomniac, you become more depressed, blah, blah, blah. But when they have tried to tease this out in recent years, what they have found is that. If you have insomnia, boy oh boy, are you teed up to experience depression. Whereas if you have depression, it is not necessarily nearly as likely that you are going to become an insomniac.
Anita Rao
So I wanna understand more about the evolution of your relationships. We talked about these early days of dating and, and needing to make sure the person you were with. Understood what you were going through. You did meet your now husband when you were in your mid thirties. How was it to navigate insomnia in that relationship?
Jennifer Senior
Well, I was lucky in that I had known him since. I guess I was like 28 Uhhuh, and he was very married and I was dating age appropriate men. He was older than me, he was 14 years older. And let me just reemphasize highly, like one of the things I liked about him was what a loyal and devoted husband that he indeed was. And so when I heard that he was single. I thought, well, number one, he sort of watched me go through my insomnia stage so he knew. Remained a dear friend, and number two, he was one of my editors in New York Magazine and never ever, ever, ever, ever once came close to hitting on me. And so it sounds a little like, oh my God. Well there must have been something between you there weirdly wasn't and at all. In part 'cause he never gave off that vibe in part because I was so, my head was so in these other relationships and I was fretting so much once I'd become an insomniac. But he knew about it and seemed to be, and he was so understanding and already knew, like the ways that I was kind of a banana boat, you know? So like, it didn't, so it was easier with him. Just in terms of like, he already knew, you know, once you're in your mid thirties, you're so tired of going on dates that you just kind of wanna say, here's my videotape. Get back to me at month six. You know, let's just, yeah. Here's all the baggage. Yeah, yeah, yeah. You're right. Exactly. But he knew all of it, you know, and I said I knew a lot about his life 'cause I just knew him, you know, so it, it was easier. But of course somebody then has to tolerate. When you're still awake at night. Yeah. And what it's like to be despairing and crying. 'cause you can't fall asleep. 'cause Klonopin was still an imperfect fix. I would still sometimes just not fall asleep.
Anita Rao
Hmm.
Jennifer Senior
And he had to deal with that and that was hard.
Anita Rao
How did he deal with that?
Jennifer Senior
Well, some nights he would really hold me and other, but when it became kind of a regularized thing, he was sort of powerless to figure it out. You know? I think eventually. I couldn't keep him up. He needed to sleep too.
Anita Rao
Yeah.
Jennifer Senior
Right. And so, I mean, he needed his sleep. So when I'd go through spells, he would be sympathetic the next day. You know, sometimes he would still hold me in the middle of the night. I would get up and go to another room and read, or if it was particularly bad and unyielding cry, you know, he stuck with me.
Anita Rao
Yeah.
Jennifer Senior
And that's just a hard thing to do. I think if I had to be realistic, it's so disruptive. I mean, I'd go through stretches where it wouldn't be at all disruptive and he would of course be very understanding what I would talk about him, about it with him the next day and it would, it was like, and. But it's a lot to soldiers through as a spouse when someone is really in the thick of it, in spite of everything they're doing to not be in the thick of it.
Anita Rao
So the two of you got married, you then became parents. I'm so curious about how your preexisting challenges with sleep affected that transition into parenthood. A time known for being filled with sleep deprivation.
Jennifer Senior
Yeah, actually it's funny, we didn't. Get married until our son was three, because we were two. Oh, okay. Yeah, we were just way too cool. Okay. Well, you became parents, right? It was also a second marriage, so who cared? And you know, I was already a stepmom, so I mean, the, we were already in the soup together, but the transition to parenthood in some ways was easier. First of all, I needed no medication. Once I was pregnant to fall asleep, I, I slept. It was a miraculous reprieve and. Also afterwards I needed an antidepressant 'cause I had terrible postpartum depression, but I did not need anything else. And I also should say I, you know, I had gone through many spells where I hadn't needed more than an antidepressant. I mean, it wasn't like I had many, many spells of intractable sleeplessness for those years. Anyway, I had the baby and I was so used to being up that it was fine. But I mean, I took on all the nighttime stuff, which moms do anyway, because they're trying to breastfeed blah, blah, blah, you know? But, um. Or they are breastfeeding. Um, so in some senses it wasn't that bad, although it did to some degree awaken all the PTSD a person would have about that. Yeah. But at least I was staring at this beautiful cooing baby, you know, it was for a purpose. And I was falling asleep, like the dead between, so it was fine.
Anita Rao
So yeah. I'm curious, like how, how would you compare those periods? Were you almost sleep? It sounds like you were maybe sleeping better even though I was, yeah,
Jennifer Senior
Yeah. Be, I mean, I was being sleep deprived because I'd have to wake up, I'd have to feed, it was disruptive, but I would fall right back asleep and I, as soon as I was getting like six hours, which was fairly quickly, I mean, if you added it. Up. It was fine. It was fine. I was accustomed to six.
Anita Rao
So when your son was seven years old, you were in your forties, you decided to try CBT therapy for insomnia for the second time. What motivated you to try it again?
Jennifer Senior
I what became one of the three daily book critics for the New York Times uhhuh. Um, and in those days you had to review three books. Every two weeks. So do the math. It's a lot of reading. One work every four and a half days. Yeah, and I was the nonfiction person, so those books tended to be longer and. It wasn't just that you had to read a book, you had to read it really carefully. I never skimmed, I never skipped any parts. Um, I, everything was very dogeared. I also, you had to metabolize it, then you had to figure out something to say that was pretty smart. Otherwise, people were gonna say, why is this person the book? Um, and then it had to go through the snake, right? There was the editor, the copy editor, the proof. Person, you know, it was so much, and so I was working around the clock. It was the wrong job every night of sleep counted. Mm. It was highly stressful. I was working all the time. I was working in bed, you know, because I would wake up, stand up, and then lie back down and read and so that was bad. You shouldn't do that. It means you associate work with sleep and that's not good. So. I thought, okay, I'll do CBTI without the sleep deprivation component. I will do the cognitive component, which is challenging your thoughts. Is it really so bad if you get one? If you lose a night's sleep? And I would go to the worst place thinking, well then I'll get fired. And then the next question is, okay. Let's say you do. Mm-hmm. Is that the worst thing in the world? And I would think, not really. I don't like this job. And I, I was probably the shortest serving book critic, like at the New York Times. 'cause eventually I just quit anyway. I was like, terrible. I tried quitting after a year and three months and they were like, we're gonna make it easier. Just do one more year and see. And I still, it was still too much for me. So, um. I, I left after two years and one quarter, but that was why.
Anita Rao
Did you do the sleep restriction part again?
Jennifer Senior
I eventually did later uhhuh, um, when I had an easier thing and it still didn't work like it. It's just, it's brutal. If you're depressed and contending with bad sleep, it, it's just you, you have to really be willing to tough out more depression. And my initial sleep episode triggered what became a lifelong, uh. Issue with depression too. So, uh, no, I couldn't hack it one day. I would love to make a third run at it, but the truth is I am sleeping better these days because I have long COVID and it makes me sleep. Mm-hmm. So, um, and I'm sure that being sleep deprived teed me up. I also came in being hideously immunocompromised and had had all kinds of terrifying infections before this COVID came along. So now I'm sleeping better. Paradoxically. So there's no need now to do it.
Anita Rao
So you mentioned in the early years, uh, there was the thought that depression was causing insomnia, that you had depression and it was causing insomnia. Even though you hadn't experienced depression before, your bout of chronic insomnia. How has the understanding of the causes of insomnia shifted? What do we know now?
Jennifer Senior
You know. I wasn't impressed by what we knew.
Anita Rao
Mm-hmm.
Jennifer Senior
I mean, they will still test you for things like sleep apnea, which was not my problem 'cause I couldn't fall asleep. They know that people who are prone to anxiety, obviously there, I guess there's a greater likelihood that you could be teed up. Um, that was certainly true of. Me, I mean, I've always been anxious and I've always been perseverative. I, I, I have loops in my head. So, um, I, I guess that in hindsight is something, but I, I, I'm not, I, there's one thought. I think they're pretty convinced now that narcolepsy is an autoimmune phenomenon, which makes me wonder whether they, they will one day discover that what I have is two, or that autoimmune, you know, people who have autoimmune issues. Which I do are teed up for this sort of thing, but I'm to tell you the truth, pretty underwhelmed by what they know.
Anita Rao
Well, there is one model you talk about called the three Ps. Uh, it's used to describe what might cause and maintain insomnia. So that's predisposing factors, precipitating factors, and then perpetuating factors. What did you learn about each of those and does that shed any light on the mysteries?
Jennifer Senior
So predisposing, you could argue I was predisposed with, let's say a very early childhood history that I thought had been completely obliterated. And anyway, in childhood it was more like I was the last kid to fall asleep, right? And then, sure, I was an anxious person. Was I more anxious than any other journalist? I don't know. I think the precipitating factor is what is still mysterious. Often, I didn't have any major life event. You know, sometimes people do they divorce, they lose their job, someone dies. That, that had not happened to me. So, uh, I don't know, I, I just don't know what started it. The perpetuating factors you can sort of identify, because once you are. Unable to sleep. There's a ton of anxiety associated with not sleeping. Then an anxiety process takes over, and that's what co the cognitive piece of cognitive behavioral therapy and the behavioral part is designed to alleviate, you know, because once you're anxious about not sleeping, you fear sleeping, and you fear not falling asleep. So the idea is to de catastrophize and alleviate that. Anxiety, but that can really perpetuate it.
Anita Rao
Just ahead, we'll hear what assumptions about insomnia. Jennifer is still working to push back on, and we're gonna meet a couple who will share advice about handling insomnia in a relationship. As always, you can hear the podcast version of the show by following embodied on your platform of choice. We'll be right back.
This is Embodied. I am Anita Rao. Today we're talking with writer and journalist Jennifer Sr. About her decades long experience with chronic insomnia throughout her life, insomnia has affected how Jennifer approached friendships, romance, and work. She's tried various treatment methods over the years, including cognitive behavioral therapy for insomnia twice, but both times she couldn't get through the part that involves grueling sleep restriction. Jennifer details all of this in her recent piece for the Atlantic. Why can't Americans sleep? The article tackles how the booming sleep industry is affecting how we talk about sleep, including the conversation around sleep medication. Jennifer, herself was once resistant to taking a sleep aid. She feared addiction and also wrestled with the notion that sleep medication doesn't give you real sleep. So she interrogated all of that through research and reporting.
Jennifer Senior
There's some evidence that it alters your sleep architecture. But tons of meds. Alter your sleep architecture. So to isolate these alone infuriates me. I mean, no one tells people to go off their antidepressants if they're struggling with depression and they interfere with your sleep architecture and so do others that. I can't remember which ones now, but that are just non-negotiables. Mm-hmm. People's lives. Also like, look, I wear a whoop. I've got a wearable, and like my sleep architecture looks pretty good. I seem to get enough deep sleep. I seem to get enough REM sleep, and it's possible that if I went to a proper sleep lab, they would show me that the spindles were still wrong, that still the way this was induced was not optimal. Okay. But it's better than getting no sleep. Mm-hmm. I mean, what, what are our alternatives here? I take a very low dose. I do it under the supervision of a doctor. There is a very good Danish study out there. They looked at a cohort of people who take these meds and out of a million people, they looked at the people who were, who took these meds for more than three years. Only 7% of them increased their dosage beyond the recommended dose.
Anita Rao
Hmm.
Jennifer Senior
Now, that's still a lot at the population level, but if you look at your individual risk, so there's a 7% chance that maybe you'll exceed the dose you were prescribed. I mean, I, I never have ever. I've been taking the lowest dose of Klonopin for over two decades or whatever. I mean, I, I've managed to do really well in my life.
Anita Rao
I mean, it sounds like you still feel, you, you have an emotional reaction still to this question about sleep aids and for a long time in your life, it seems like you were fighting it internally, like you didn't wanna take them because you had internalized a lot of that stigma. You are in a different place. Now, but there is still a lot of stigma. Like I watch White Lotus and, you know, oh, we all see that character, you know, downing her, her Lorazepam and it's, it's culturally very much a thing that like, oh, people are abusing sleep medication.
Jennifer Senior
Totally.
Anita Rao
So talk to me about that and like reconciling kind of the way that our perception of the use of sleep aids has evolved culturally alongside this kind of research of how important sleep is.
Jennifer Senior
Totally, and I loved that character. I think Parker Posey is a genius, but there she was, you know, right. Downing these pills and then suddenly her husband was sneaking them. But part of me really pushes back against that. You can have a doctor who is responsibly monitoring that. There's Jimmy Hendrix and Judy Garland and overdosing, and kind of the way one thinks about it in the popular culture. It is of course much better to sleep a natural sleep. And I would encourage. Everyone to try CPTI first. There aren't enough practitioners out there. A lot of gps don't even know it exists. It's easier for them to just prescribe a pill. More people should know about it, and it's the first line of defense and it should be, but anyone, for people for whom it doesn't work. I, I just was desperate to make it clear that you are not pathetic. I just really wanted to emphasize that it is so much better to keep trying CBTI and I really will make another run at it at some point in my life. I've tried it two and a half times and for me it didn't work and it's really hard to suspend your life and dedicated time to be able to do it properly and it's worth it if you can. And it's worth even doing a modified form without this sleep compression. But I just was desperate to make clear that not everyone is Parker Posey.
Anita Rao
We are in a moment where the discourse around how much sleep people get, how good that sleep is, what they should do about it is, is just bigger and bigger and bigger. Uh, but you argue in your piece that this hasn't equated to people getting more sleep. So how do you think the sleep industry has affected. People with insomnia in particular?
Jennifer Senior
That's a great question. I, I don't know if the sleep industry has made it worse, although it's a gazillion dollar industry at this point and growing. I think that it has profited off of the fact that we now know that, that there are tons of deleterious effects from not sleeping. But yes, public awareness of how bad it can be to not sleep, does not seem to have made us. Sleep better. I think one thing that's very interesting is that wearables having an Aura ring or a Fitbit or an Apple watch or what I wear a whoop can sometimes make people very neurotic about their sleep. This woman named Kelly Baron at the University of um. Utah even coined this very funny term called Ortho somnia. It basically describes the neuroticism of not sleeping. You know, it's, it's for people who have been made nuts by not sleeping and being too fretful about what your Apple Watch says it, it can backfire.
Anita Rao
Hmm.
Jennifer Senior
For sure.
Anita Rao
What do you better understand now about your own sleeping brain? From talking with neurobiologists and, and understanding the brain science of folks with insomnia.
Jennifer Senior
Uh, a couple of things. Well, first of all, one thing that I, that all these people told me is that there's a lot of data out there saying that eight hours isn't really the right number for people. It's somewhere between 6.5 and 7.4 that's associated with the best health outcomes. It's a correlation, not necessarily causation, right? It might be that. It's not that that amount of sleep causes good health, it's that people who are healthy get that amount of sleep, right? Hard to know. But I think that's very important for people who worry, um, that they're not getting enough sleep. If their Apple Watch says that they've gotten 6.5 to 7.4, that might be just dandy. So I feel better when I look at my watch. In terms of what I've learned, well, you know, unfortunately your body can unlearn sleep. What happened back then, I think a default kind of country road in my brain, like, oh, this is weird. I'm not sleeping. This is not my brain's habit. I, I think it eventually became a super highway and it became my brain's habit. There are ways to unlearn it. That's what the cognitive behavioral part of CBTI. Four, changing your thoughts about it. 'cause those anxious thoughts really become grooves. They're deeply etched in your brain and you can unlearn them. And I've tried to unlearn them and I've gotten better at unlearning them, by the way, I mean, I do tell myself more soothing stories at night and I read and I don't get so freaked out and I'm better about it, you know, I am, I, I stress less and it probably diminishes the spells that I have of not sleeping.
Anita Rao
Do you have a like a mantra or maybe it's just a story that you tell yourself now at night when those thoughts begin to get loud? When you can't fall asleep.
Jennifer Senior
One night is not a big deal. One night is not a big deal. Another mantra. Let's see. I can still be a good mom. I will apologize if I'm snappish. I will apologize if I'm irritable. I will explain. Probably not that day 'cause I'm too in it. Those are some.
Anita Rao
I love those. Jennifer, thank you so much for the conversation. This was really fun. It was great. Jennifer Sr. Is a staff writer at The Atlantic. You can find the link to her recent piece. Why Can't American Sleep at our website Embodiedwunc.org. As Jennifer shared, insomnia affects every single part of your life, and we wanted to dig a little deeper into the relationship piece. So our producer, Kaya Finlay, called a couple who has been working through sleep problems for 15 years.
Gabrielle Moss
We met in 2010, the old fashioned way, by which I mean at a bar. We started talking 'cause we were some of the only people there. And, uh, a few months later we started dating and we got married in 2016.
Anita Rao
That's Gabrielle Moss. She and her husband, Jesse Rifkin are both writers in New York City. Jesse is also a lifelong insomniac, which almost immediately began to affect their relationship.
Jesse Rifkin
At the time that Gabby and I started dating, I was living in an apartment that was literally underneath a highway overpass that was having nighttime construction. And so we started spending a lot of nights together at Gabby's apartment, and she had a very, uh, like touch sensitive mattress. And so even the slightest shift. As I tried to get comfortable to fall asleep or whatever, or as I could sleep, I would wake her up instantly.
Gabrielle Moss
I think it, it might have even been less the mattress and more me, you know, I think sharing a bed to that extent was kind of a new experience for me, and it turned out to be one that my body did not love. So then I started, uh, experiencing insomnia as well.
Jesse Rifkin
I think the way that our insomnias were sort of like the opposite of complimentary with each other is that my trouble is falling asleep and Gabby's insomnia is that she wakes up very, very easily and then stays up. And so my inability to sleep would then wake her up and then her being up would perpetuate my inability to sleep and, and it was just like a constant. Tension between those two things.
Gabrielle Moss
My peak, extreme insomnia years were 2013 to 2015 where I, and in that time I think we had all sorts of, you know, conflicts where I would be on, you know, two hours of sleep and like screaming and crying. You did this to me, you did this to me.
Jesse Rifkin
Mm-hmm.
Gabrielle Moss
And. We were, we were still sharing a single bed at that time. And I would just think, how is everyone, every other couple on earth navigating this? Like this has been the standard for couples for centuries. You know, what is wrong with us? That we can't figure this one out? And sometimes I would get very mad and blame Jesse, and sometimes I would get very mad at myself and blame myself. I saw a bunch of doctors, most of whom were kind of. Not that clued in, not that knowledgeable about insomnia. I wondered if insomnia was going to like, literally destroy my brain and my relationship.
Jesse Rifkin
I think the first solution that, uh, really jumped out at us almost came by accident. Uh, we were on a trip to Reykjavik, just by sheer coincidence, the hotel that we were staying at, what we thought was going to be. One bed, as per usual, was two twin mattresses pushed next to each other, and it was like this, you know, extraordinary revelation that, oh, if we just sleep in separate mattresses, that that motion transfer that's constantly keeping us awake is just not gonna be an issue. And we started doing that on vacations. You know, other places we would go, other hotels, we'd, we'd just get like rooms with two beds and that was just, that felt groundbreaking.
Gabrielle Moss
And then we carried that on back in our home. Uh, for a while I was sleeping on the couch. And then in 2017. We bit the bullet and got two beds, just like an old time sitcom. We have the, the Lucy and Ricky. I love Lucy Beds, just right next to each other in the bedroom. And you know, at first I was kind of very upset about it. I thought, you know, God, this is so. Abnormal or we're not close, it's gonna end our intimacy. But that has not been how it's turned out at all. Um, it turns out it's much easier to have a loving adult relationship when you are getting more than two hours of sleep at night.
Jesse Rifkin
I think finding a solution to a shared problem that works for everybody is intimacy. I think fixing this issue has brought us closer together. Unquestionably and lying together in a, a bed that just like makes everybody unhappy and keeps everybody awake was pushing us further apart. So intimacy, you know, it, it doesn't look like any one thing.
Gabrielle Moss
I think usually if one of us has a bad night of sleep, the other one. And is very willing to pick up all the slack that following day and really empathize with them. You know, try to take things off their plate and kind of really, really help them because we both know how much of a struggle it is to go through a day without any sleep. So, you know, the other one will kick the caregiving into overload when we know that the other one has had a a really bad night of sleep.
Jesse Rifkin
We can also, I think, sometimes tell when a bad night of sleep might be on the horizon. You know, if there's something that's, that's bothering the other person, that we make a point of having a conversation and talking through all of that stuff before it's time to go to bed. Sometimes it helps, sometimes it doesn't, but it, it helps enough I think that we can kind of do that for each other.
Gabrielle Moss
I think when we got together, I was in that boat of like, oh, you have insomnia. Well, why don't you just go to sleep? So I am the person who kind of learned to have a little more empathy and understanding on that end, especially as it also came for me. So I think probably. We support each other in this way by both, just knowing that insomnia is is not a choice. You know, there are certainly things you can do to make it better or worse, but at the end of the day, it is not your decision. It is a problem with your brain and body and like any other chronic issue of the brain and body. To some degree, it's outside of your control, and so you can't. Blame someone or hold them responsible for experiencing it.
Jesse Rifkin
I think also because of the way that it's developed in our relationship, insomnia, you know, it's no longer a thing that's wrong with me or a thing that's wrong with, with Gabby. It's a, a problem that we share and I think that makes approaching it a lot less scary. It's just, it's like we're redecorating the apartment or something. It's a practical problem with a practical solution.
Anita Rao
Thanks so much to Gabrielle and Jesse for sharing their story with us and to Atlantic staff writer Jennifer Senior. You can find out more about all of these folks at our website, embodiedwunc.org. Find behind the scenes and bonus content for our show by following us on Instagram. Our handle is @embodiedWUNC. Today's episode was produced by Kaia Findlay and edited by Amanda Magnus. Nina Scott is our intern. Jenni Lawson, our technical director, and Quilla wrote our theme music. Wilson Sayre also provided editorial support. This program is recorded at the American Tobacco Historic District. North Carolina Public Radio is a broadcast service of the University of North Carolina at Chapel Hill. I am Anita Rao.