by Katrina Woznicki
Insomnia affects millions of people worldwide. I am one of these people.
Some people are productive with their insomnia, using periods of sleeplessness to write, knit, study, read, work, somehow get ahead in life.
I am not one of these people.
I couldn’t tell you exactly when my insomnia began, sometime in my early 40s, and I think around the time I weaned myself off antidepressants, specifically selective-serotonin reuptake inhibitors (SSRIs). Whether my insomnia is from being female, residual anxiety, hormones, or genetics, I couldn’t say.
But let me back up.
For most of my life, I never had a problem sleeping. Not during my turbulent teens, not during my parents’ divorce, not during the financial stress and academic pressures of college, not during those early years of career, marriage, parenthood. My head touched the pillow, and about eight to nine hours later, it was time to get up and do things all over again. Whatever stressed me out at the time, I slept through it. In the morning, fully-rested, I went jogging along the Hudson River before getting ready for work and taking the kid to daycare. By the time I ate breakfast at my desk, sometime around 7:45 or so, I already felt like I had accomplished a great deal.
That was all before insomnia, antidepressants, and benzodiazepines.
Panic attacks, depression, anxiety, and bipolar disorder run in my family. All of those things are associated with sleeplessness. Thankfully, I don’t have bipolar disorder or any other mood disorder.
After having my first panic attack at age 38, I was put on SSRIs, first Effexor then Celexa then Lexapro (with a brief stint with Zoloft, which was terrible and actually made the insomnia worse). Medication helped, initially, but I experienced a myriad of side effects over the course of trying different dosages of different pills: paresthesia, constant dry mouth, urinary retention, heart palpitations, chest tightness, hunger. But I slept (except for the six weeks of trying Zoloft).
After three and a half years of side effects, I tried three times to wean myself off SSRIs. Depriving your body of the chemical compounds it became accustomed to triggers side effects. I tried to do this gradually, cut my pills carefully so as to not disrupt my body too much, but perhaps I didn’t cut my pills carefully enough. During the first time, I cried constantly as I reduced my dose, gave up, and went back on the full dose. Nonstop crying is exhausting, and I had stuff to do, like work and parent.
During the second time, I had what psychologists call a “dissociative experience,” where I was watching TV in my living room on a sunny September afternoon, not really thinking about anything too serious or sad, when I suddenly felt like my head was separating from my body. I gripped the sofa pillow, absolutely terrified, and the feeling passed in under a minute (though I wasn’t timing it, but it was thankfully short). I never abused recreational drugs and have never even smoked pot. I was so freaked out by what had just happened, I returned to the full dose of SSRIs. Square one, again.
About eight months after thinking my head was floating away from my body like some balloon, I felt brave enough to attempt reducing my SSRIs again. This time, I took things even more slowly. It took five weeks of cutting pills down smaller and smaller, until they were bits of dust on my kitchen countertop. I have successfully remained off SSRIs since May 2015. No panic attacks. No chest tightness. No dry mouth. No more head floating off my shoulders. No more urinary retention, though I have experienced some bladder nerve damage likely due to SSRI use, said to be an under-reported problem, especially among women.
The psychiatrist I saw at the time was an older man who was very dismissive towards my complaints about SSRI side effects. I got the sense keeping people on SSRIs was his bread and butter. So I found a different psychiatrist, and with her support, was eventually able to get off antidepressants for good.
SSRIs help many people struggling with mood disorders, panic attacks, depression, and anxiety, and I’m not here to persuade or dissuade. But I’ll never go on these drugs again. They are given out like candy, and the side effects tend to get glossed over. Locusts could pelt me in the face; the Rapture could come; something awful could happen anytime, anywhere—I won’t take SSRIs. I’ll suffer through whatever’s thrown at me.
But I would like to fall asleep every night and wake up functional the next day. Who doesn’t?
To sleep, I tried melatonin supplements, but those might as well have been M&Ms. I tried listening to guided meditation apps, and I would fall asleep but not stay asleep. I dabbed lavender around my face, which smelled great, but didn’t help me sleep. I see an acupuncturist for a variety of things, including insomnia, and while I get drowsy lying on the table looking like a pincushion, I need to be awake enough to drive home.
To help me sleep in my bed, at home, through the night, my new psychiatrist recommended other types of SSRIs with different chemical compounds that may or may not cause the same side effects I had struggled with earlier. I declined, and she understood, never once pressuring me into taking anything.
She had prescribed Klonopin at the lowest dose so I could sleep when flying, since I hate to fly, and eventually on my own I started taking Klonopin to, well, sleep. It worked great. I would wake up refreshed. I told her about this, because I knew Klonopin and other benzodiazepines were highly addictive. She knew my history with SSRIs and knew I wasn’t a pill-popper. She trusted my judgment, that I don’t take Klonopin lightly, that I take it because it causes minimal side effects for me and is the only thing that shuts my body down eight consecutive hours so I can get some rest.
Hormonal changes during a woman’s 40s can send sleep patterns into a spiral. I don’t know any woman over age 40 who’s standing at some backyard barbecue telling her neighbors and friends “Oh, yeah, I got a great night’s sleep last night!”
What I hear all too often is women drinking wine to fall asleep or they’re not falling asleep at all. Maybe they’re taking a pill, like me, but they’re not talking about this at backyard barbecues because pills sound too street, like we should be smarter than this, whereas drinking wine somehow sounds more sophisticated. Pounding a vintage Malbec before bedtime does indeed sound better than popping benzos.
It’s been nearly a year and a half of nightly Klonopin use, not something I’m proud of, though I’m not ashamed of it either. I’m somewhere in between, annoyed that this is what works. I’m here to tell you that despite all my green juice, yoga, jogging, meditation classes, dance classes, acupuncture, and positive thinking, I can’t sleep without Klonopin. It stinks. Wine keeps me awake. Exercise during the day sets me up for a decent night’s sleep at night (still need the Klonopin), but if I exercise too late at night, even a late-night dance class, I can’t fall asleep (even with Klonopin). I can’t have caffeine in the afternoon otherwise I’m awake.
I take the lowest dose of Klonopin (thankfully, I’ve never had to increase dosages of anything, and feel lucky there), and have been trying to gradually wean off it. We’ll see where this goes. I admit here, to you, I’m not feeling as confident as I did with the antidepressants. It’s proving to be much harder, and I’m not sure if there’s a good night’s sleep should I ever become benzo-free.
Before bedtime, I lay a pill on the kitchen countertop, grab a steak knife, and chop off a small corner because you have to reduce Klonopin use so carefully and gradually otherwise there’s a risk of seizures and other complications, and, obviously, I don’t want those. When I stand in the kitchen chopping up Klonopin like I’m Julienning some carrots, I feel like a suburban hausfrau cliché.
I worry I won’t be able to get off Klonopin without help—and there are benzodiazepine rehabilitation centers. What are those group meetings like, I wonder? Will I meet other women in their 40s struggling with whacky hormones, life’s many transitions, and insomnia? Do I bring a dish to pass? Do we bring a bottle of wine? Is there a rehab book club or Facebook group?
These are the things I think about lately. That, and how my experience has made me far more sympathetic to people with bigger problems trying to recover from far more complicated drug addictions.
When I walk around, my bag rattles with the sounds of pills. It almost sounds like a baby rattle. This annoys me, that Klonopin has a sound. Should I ever get off this damn drug, I won’t ever forget its sound. I’ll likely hear it in my sleep, if I’m lucky enough to enjoy an unmedicated night’s sleep.