How Hyperarousal Impacts My Insomnia
I’m aroused all the time. And not in a way that excites my husband.
In November 2018, I took myself off for a sleep study – I was about 30 years overdue. I knew I had restless legs syndrome (RLS) but wanted to know if anything else was happening. I’d been taking two RLS medications and participating in every cure I could discover on Dr. Google, but still – I was treading the boards night in, night out.
If I got two hours sleep in 24 hours it was a great night. I’d like to say, I wonder how I functioned, but I know for a fact, I wasn’t functioning. Not only was I utterly fatigued but my mental health was plummeting at dizzying speeds.
Going for my sleep study
I flew to Melbourne (back when we were allowed to fly on airplanes in Australia). The rather good looking young man hooked me up to all the gidgets and gadgets before I took a photo of myself looking the antithesis of sexy.
Then I was told to sleep. I stared at the ceiling thinking, No chance in hell, but with a couple of sleeping tablets on board, I managed some recorded shut-eye. I don’t recall sleeping – but the recorded results would suggest otherwise.
Discovering my hyperarousal
When I visited the nice sleep specialist the next day, he confirmed my diagnosis of RLS and said I also have Periodic Limb Movements (PLM) – which is evidently a common comorbidity with RLS. But – and this was news to me – I was also in a state of hyperarousal1 for the entire evening.
I knew I was hyper-aroused all day long. My startle reflex is truly startling. Some lovely waitresses have been alarmed at my response to the innocuous question, Can I help you? But having a printed readout saying I was in that same state all night long was a little bit startling. It did, however, explain why any time I managed to fall asleep, I’d wake with clenched fists and a clenched jaw – every part of my body tensed and ready for action.
Anxiety, hyperarousal, and insomnia
Anxiety is a component of hyperarousal – not the other way around (so I’ve been told – I’m not a doctor or a researcher). It’s often associated with post-traumatic stress disorder (PTSD). The readout from my night of non-sexy sleep showed my brain never rested – not for a moment. Not even when I slept. Which to be perfectly honest was more often than anticipated, all things considered. But my brain was unaware of the requirement to switch off.
My RLS medications work tremendously well. Since first prescribed, my legs finally rest. But even with restful legs, my insomnia was deteriorating badly – most significantly since 2012 when my life first started becoming unbearably stressful. Over eight years there’s been an acceleration of anxiety, hyperarousal, and insomnia. All wrapped up in one neat little bundle.
'How can I fix this?'
Next came the extremely important question for my extremely expensive specialist, How can I fix this? He said I needed psychological support – not pharmacological. Taking sleeping pills (the handful that don’t exacerbate RLS) feels good in the short term, but over a period of time, the chances of developing tolerance and dependence are extremely high. The advice was to go back to my psychologist and work at reducing anxiety.
As anxiety is a component of hyperarousal (I’ve been informed), working on reducing anxiety remains my primary goal for improving sleep. There are dialectical behaviour therapies that help.2 Including, distress tolerance tools like TIPP (temperature, intense exercise, paired relaxation, and paced breathing). Or emotion regulation tools to Let go of emotional suffering.
Things like, observe emotions by stepping back from the experience; practice mindfulness of body sensations; remember you’re not your emotion; practice emotional acceptance and willingness. Perhaps this sounds like jargon. Perhaps it sounds terrific. It doesn’t matter. If it works, that’s what’s important.
Mindfulness is living in the here and now
The overarching thing that helps me – if I actually practice it – is mindfulness. I’ve heard the oversimplification that depression is living in the past and anxiety is living in the future. This isn’t entirely accurate but it’s a rough summary. Mindfulness is living in the here and now and has demonstrably taught me how to reduce hyperarousal. I’m still jumpy but the clenched teeth do ease a little.
There are bucketloads of apps that walk and talk you through mindfulness. But there are simple exercises to do right here, right now.
- Grounding – identifying something with the five senses (what can I see, what can I hear etc...)
- Noticing every sight and sound while walking
- Focus on now – not yesterday’s sorrow or fear for tomorrow
- Recorded meditations with pretty babbling brooks
- Deep breathing exercises and conscious relaxation
I’ve done it all. Sometimes very badly but there are no gold medals for practicing mindfulness. There’s just giving it a go.
Letting go of the past and the future
When you live with chronic anxiety and reside in the land of hyperarousal it’s not easy to let the clenched fists go. It’s impossible not to jump like a kangaroo at every surprise. And sleep feels like an absurdity. But it’s possible to make a deliberate, conscious decision to let go of the past and the future, just for a tiny moment, and hope a few moments of shuteye waft your way.
How often does someone offer you unsolicited advice on your condition?