How I Started Sleeping Again
A Sleep Therapist helps me change the metaphors I use for sleep which changes how I treat sleep and then I sleep differently.
"When the cathedrals you build are invisible, made of perspectives and ideas, you forget you are inside them and that the ideas they consist of were, in fact, MADE, constructed by people who analyzed and argued and shifted our assumptions. They are the fruit of labor.”
Rebecca Solnit, Whose Story Is This?
I stopped sleeping in Italy.
I had gone to Tufo, a small village about an hour east of Naples. A wine town, a castle built into the hill. My host was a friend from a writing month in Prague; his family was from Tufo and he had come back to his aunt's house to host a writing retreat. I took two weeks of unpaid work to write in the sun drenched fields of Campania in June.
I came home early because I couldn’t sleep.
I tried and I tried. I would get up early, go on grueling walks up hills to get my body tired enough for sleep, stick my face in that burnished light. I tried to resist naps but one seemed to take me against my will each afternoon anyway.
One night, I slept two hours. I didn’t want to go to Capri but I did anyway. I spent the day in a small motorboat with seven people drifting around the towering island, face and skin whipped by wind and salt and the blue burning into the back of my eyes, my body tingling and heavy and adrift like I was in a dream. When we had to swim from our boats to shore for lunch (you cannot dock at Capri in a private boat, only the ferries are allowed that access), I thought my muscles would turn to liquid and float away in the tidal currents breaking on the rocky cliffs, leaving me for dead.
I stayed awake only dazed towards sleep as the sun set as we drove back to Tufo, Beyonce’s self titled album thumped through our rental car’s speakers.
That night I didn’t sleep again.
I tossed. I turned.
I’d try and try and try to get over the wall and just not be able to make it. My body would fill with something like bees and I’d be awake, quivering with the electricity of those internal stings, knowing the only resolution would be to sleep it off but unable to unwind enough to get that sleep, awake but too miserable to do anything with that experience of awakeness.
I had been awake almost two days and here I was shaking like a tissue paper kite shredding in the slightest breeze.
What I didn’t know was that I was still struggling with the time change. My circadian rhythm was thrown. This makes sense but I did not know how else to tend it.
And I was stressed. I wasn’t supposed to be stressed in the white-wine drenched afternoons snacking on sweet tomato and buffalo mozzarella bruschetta.
But I was stressed. I was lonely.
I couldn’t find my feet in the group dynamic. This had happened to me before; perhaps the memory of other trips with near strangers who couldn’t see me and I couldn’t see them, the chasms of relational desperation between us unable to cross, perhaps it set me off to the side.
The stress of social isolation stretched my nerves past their edges.
The next day was another adventure. Another drive to the coast. A ferry to Positano. A long, lurching, wave-crushed ride along the Amalfi coast, terraced citrus trees above us along steep drops under a gray sky. I stood in the doorway of the rocking boat and watched the unmoving hills and tried to feel okay. My body buzzed. My stomach turned. My vision blurred from dry eyes.
We reached Positano and it was beautiful. We swam in the water that glimmered clear and cool. We walked uphill and ate a lunch of pasta and seafood with wine. I then wandered off alone. I found a gelato place with wifi and used the internet to call home.
“I need to leave. I need to come home. I need my bed. Please find me a flight.”
I told the retreat organizer I needed someone to drive the rental car and me to the Naples airport the next morning. He tried to soften his questions against the flash of frustration that clenched his jaw.
But he helped me anyway; came up with a reason to take everyone on an excursion and drove me back to the airport.
I flew home. Robbie got me from JFK at 10pm. I saw my front door at 3am and it was the most beautiful door I had ever seen. I took a picture of it. I climbed in my bed and I slept.
I’ve had recurring insomnia ever since.
Here’s the story I told myself about sleep:
Sleep was a mystery.
I thought it could not be understood. I thought it came and went.
I thought it was like an angry muse who arrived and didn't arrive, who teased and tortured, loving and refusing in an eternal cycle of abuse.
It worked like breath, like a metabolic system, like hunger. Our body knows how to want sleep, to ask for it, to enter it.
It was a door with no door, a slip through time and space that requires nothing from us at all. It was a ghost that either loved me or hated me, came and went at its whims.
But also sleep was something I had to make.
I had to lure it in. I had to hunt it down through the highway and byways.
I had to exhaust myself. I had to outsmart it.
I had to run fast enough to leap its walls and into its land.
I had to bribe it to my bed with pills and concoctions.
But sleep will not be bribed.
Instead, I had to look to the side like one does at the stars, letting go focus to peripheral vision, catching the glimmers of ancient explosions in our retina.
Instead, I had to make a room Sleep wanted to be in, the room being my body, being the pressure of the water behind the dam.
Sleep never hated me. Sleep wanted to be with me, wanted to run through my body like water in an irrigation system. It was always a skill my body had–but I needed to relearn its ease. My body had to be reminded how to sleep.
I’m not the only one who isn’t sleeping. Most of America doesn’t seem to be getting enough. And sleep quality is a pre-indicator of disease.
CDC had this to share: almost a third of adults in the United States are not getting enough sleep.
And lets all just pretend we are shocked when we find out that wealthy white people are getting more sleep than anyone else.
Missing (at least from this data set anyway) is the cross analysis of autoimmune issues with sleep-disruptions. Early parenting with sleep (and is divide in gender for those early years). Neurodivergence and sleep pattern alteration and its affect of health outcomes. I’d love this data. Anyone know where to get it?
These numbers aren’t changing much with a social awareness of sleep importance. Enough books have been written about why we need sleep and why we should prioritize it. I used to marvel when I heard these numbers, as if people were intentionally living life in a way that avoided sleep.
And then I became an insomniac. Turns out, we all want all the sleep we need. We are just blocked by something. Employment available in our area. Care work. Illness. Fear. A quiet home. A million things we don’t control.
As the year tipped towards the winter solstice, I started waking up at 2am in addition to struggling to fall asleep.
One night, I was up from 2am-sunrise, writing letters and asking my friends in those letters how I was supposed to live a life like this. The cold that was Covid kept me up two nights in a row. I was already on weeks of inconsistent sleep after months of wild sleep and an undiagnosed autoimmune flair.
I’d lost the flow of my life; I’d lost the flow of my family’s life. Months went by without me taking Pippin to daycare in the morning. Never mind that it was three minutes from door to door. Never mind that she was easy to get up. Never mind that this was a thing mothers do and a thing I wanted to do because I wanted to be a good mother.
Instead, Robbie carried her into her classroom and made breakfast and left it on the counter for me to wake up when I would wake up. He would answer Pippin’s calls in the night too, letting me continue drifting in shallow dreams rather than stepping into her demands and waking up and maybe not going back to sleep.
We’d learned the hard way that if I lost hours of sleep for more than two nights in a row, I would catch whatever germ cocktail traveled home from daycare. I’d start with a scratch in my throat. Two weeks later, I’d emerge via a drug trail of steroids and antibiotics.
Any picture of me from this time period is me laying down. I was never upright, never holding Pippin, never playing. (Though as I went to look for a picture of this, I found I only took photos when I felt better so it was “NEVER” it was… lots of moments I didn’t want to capture. I think there are more examples in the photos Robbie and my sister took).
I’d started taking sleep aids. Melatonin and hemp gummies. Ativan pills a friend had slipped me when I’d cried to her about being unable to sleep. Chamomile tea. Magnesium glycinate. Acupuncture. I’d started piling them onto each other.
I’d take more than I should when I’d hit 1am and not be able to drift off. I was scared of the next day. I wanted to run screaming from my body. Instead, I took the pills.
On one of the December nights, I took three pills at 4am. It was too much. I woke up hungover after noon. I knew that I’d been crazy, literally to the side of my mind. Being sleepy is worse than being drunk behind the wheel of a car and I was sleep drunk facing a cabinet of sleep meds.
I would hurt myself, perhaps seriously, if I was left with only pills to solve my sleep.
I called Dr. Yamasaki.1
I’d known Dr. Yamasaki when I lived in State College, PA. We were both part of a women in business group. She’d been one of my favorites to be around, a gentle and quiet presence who seemed to exude wisdom and kindness without saying a word. I knew she did sleep therapy. I couldn’t imagine what that looked like. And I’d recommended her to other friends who struggled but no one took me up on it; why would they when I had no idea what it even meant?
I’d already tried everything I knew how to do. So I called her.
I wasn’t sure my sleep even counted as bad enough to get help. Or if I even wanted a CBT approach. Would she just tell me to try harder at being consistent? Would I get told the same info I read in every article that existed on sleep: no naps, no phone, get up at dawn even on weekends? Would I find out it was all my fault (I suspected it was all my fault)? Or what if I was permanently broken and nothing could fix my sleep? What if I would just be like this forever and not have a way out?
Our first meeting was in January 2024. We did some surveys to establish how bad my insomnia was. She asked me a long list of questions.
When did I go to bed? How many times did I wake up? Did I have trouble falling asleep or staying asleep? How long did it take me to fall asleep? Did I feel comfortable on my mattress? How long has this been going on?
She assured me that she asked these questions not to say that the solution to my sleep was obvious; a better mattress was unlikely to fix the whole thing. But she needed a comprehensive picture of what my sleep world looked like.
“Most people have tried everything by the time they get to me.”
Ah. Well then.
I thought we were going to start with strict rules. Instead, we started by tracking my sleep for two weeks. It was simple to start this way.
When did I fall asleep? When did I wake up? When did I get in bed? When did I get out of bed? How many wake ups? How long? How many hours of cumulative sleep? Was there a nap? How long and when in the day?
I started to see patterns. The length of time it took me to fall asleep. The days I napped and the days I had espresso and the days I was sick and the days I felt fine. It felt unchangeable but more visible.
The first change she made was a question. “I think we need to move your bedtime later so we can increase your sleep efficiency. I’m thinking 11:45pm.” She asked it so gracefully, like a suggestion, an invitation for consent. She wasn’t going to tell me what must be done. She was going to say what she saw and she would invite me to express everything I wanted to express.
I was not a fan. 11:45? How was I supposed to ever get up in the morning if it took me two hours to fall asleep?
The idea was this: we need sleep pressure to fall asleep. Crudely, it is like a spring that builds tension throughout the day. With enough tension in the spring, when we lay down in bed, it will release and carry us through the night. Without enough sleep pressure, we will have trouble falling asleep or have middle of the night wakeups. By pushing my bedtime back, I would be increasing my sleep pressure.
While staying up that late sounded impossible (I was often tired by 8pm), and resisting my sleepiness sounded like a recipe for not sleeping at all (why wouldn’t I just fall asleep when I felt sleepiest?), I said I’d try it. I also reluctantly gave up reading before bed (lies: I just switched to poetry instead of prose with long chapters. But shhhhh it all works out in the end and I confessed to this lie later).
But the biggest change was the metaphor.
The way we describe something informs how we treat it. The way I spoke about sleep changed how I acted which changed my sleep. My sleep then changed which altered my experience of the world. When I changed the metaphors around sleep, my sleep itself changed.
The most important conversations we had were the ones that started by me saying “So I’ve always described my sleep like this…” or “I’ve thought about sleep like this…”
It gave her a direct look at the way my world was built around sleep, its elusiveness, my desperate attempt to catch it with a rainbow parachute, making as big a surface as possible for it to land and me catch it.
Instead, I came to find out, it didn’t need a parachute of time, just a committed bedtime and wake up time. It needed 7.5 hrs-8 hrs, not nearly 12 of tossing and turning and waiting and hoping.
It needed a bed-sized landing space, not me running back and forth with a butterfly net.
I needed gravity to turn the earth on its axis. I just needed to be tired.
I needed to do less, not more.
Language constructs the world. That the world then constructs our ideas. And back and forth and back and forth.
Sleep is also the fruit of an idea. We’ve been talking about it since before Shakespeare’s Hamlet tied sleep to death, perchance to dream. Sleep is pinned in scientific terms like “insomnia” or “hypersomnia” and stages like “REM”. Dreams are messages from the divine, warnings or love notes. Sleep is visiting the dead. Sleep is waking up in the otherland. Sleep is restoration. Sleep is mechanical. Sleep is organic. Sleep is drifted through us after we make love. Sleep is reward for labor. Sleep is avoidance. Sleep is the fabric of existence.
I did not trust my sleep because my language did not trust sleep.
My language constructed language as a ghost I needed to catch. Where language might be, instead, the hum of my body ready for me at any moment. Trust that my body can do it. Trust that I can do it. Trust in my ability to be awake even while sleep. Trust that I’ll get the sleep I need in the time I give myself to have it. I panic that lack of sleep will send me into illness again and again. I feel the urge inside me like a small body fighting any restriction, even the restriction of a hug that might soothe.
To change my trust with sleep, I had to change the words I used to describe what it was.
“Sleep pressure” was not just a new term; it was the image of a river pressed against the mill’s wheel, pushing pushing pushing till enough water molecules tipped it into rotation. I had to let the pressure build for sleep to unfurl itself in me. If I took the water away too soon, I’d be trying to push the wheel myself all night. I needed to see sleep as reliable, something I needed to caretake less and let stand more.
With fewer interventions, undirected by metaphors I was leaving behind, sleep could do what it needed in my life. Sleep was, indeed, like a river, better left to its own course through the landscape rather than me trying to constantly adjust its course, however well intentioned.
I even changed the common terms used in sleep therapy. “Sleep restriction”--even when said as “therapeutic sleep restriction”--felt like dietary language. “Stop this necessary thing so you can become the person you want to be, no matter how painful or opposed to the behaviors necessary for survival.”
But that isn’t how it felt or how we approached it.
I proposed a new term. “Adjusting sleep edges.”
The edge of falling asleep, the edge of waking up, these fluctuating locations, the line between the points growing and shrinking with intentional intervention. By decreasing the space between my sleep edges (going to bed later, getting up earlier), I was building the gradual pressure that would result in vivid days and deep nights.
I couldn’t sleep much last night. It was everything to do with the nap I took late in the day to account for moving boxes in direct sunlight and the sleepiness that comes over me in that space. So I laid down and set an alarm. Then I didn't get up when the alarm sounded. It was too late to rescue my sleep pressure. I knew I would be up late. And I was. Then Toddler screeched a bunch. That wired me up. So there were maybe 4 hours of sleep and then she woke us at 5:45 insisting on getting up. We didn’t fight because that seemed too tricky with the move chaos. I tried to sleep more but couldn’t.
Was up at 6: 45 to start prep for my dr appointment at 8:15. I made it to the appointment no problem and just a smidge of caffeine.
The above feels like a miracle to me. I know exactly what happened to my sleep. I know how to support it back in a good direction. I believe sleep will give me what I need when I lay down in bed again; I don’t have to add hours via a nap or an early bed time or sleeping in. That at worst, it’s a three day battle of sleepiness before my sleep clicks into place like a smooth swiss gear. And when I miss sleep, when there aren’t enough hours to feel like the sun shines out of my ass, well then, it’s still going to be fine. I might not feel great but my life moves on. I make it to early morning drs appointments. I schedule them on purpose knowing it won’t cause me anxiety the night before, that I’ll sleep as much as I can, and I will still safely arrive the next morning.
Dr. Yamasaki’s practice.
She offers telehealth in many states.
Legal clarification! This was written without the input or review of Dr. Yamasaki. Consistent with therapeutic ethics, she declined the format of an interview and the opportunity to edit this piece. Any mistakes or misrepresentations of her work, her therapeutic methods, and sleep science are mine and mine alone. Nothing in this piece should be taken as medical advice and I am not responsible for any decisions made by a reader of this piece.