How Long Does Insomnia Last?
Insomnia can be a debilitating condition that affects both the body and the mind. Anyone can suffer from insomnia and it can happen at any point in a person’s life. But what are the symptoms and effects of the condition? And how can people work at living with insomnia or recover from it?
In this podcast, Dr Pixie McKenna is joined by Matt Johnson, a broadcaster and ambassador for mental health charity Mind, who for many years has suffered sleepless nights as an insomniac. Kathryn Pinkham the founder of The Insomnia Clinic, one of the UK’s only specialist insomnia services also gives her thoughts on how you can still function while suffering from insomnia.
MattJohnson [00:00:32] Hello there.
Dr Pixie McKenna [00:00:33] Now during the day Matt, you’re a broadcaster, you’re also an ambassador for Mind. But by night you’re….
Matt Johnson [00:00:41] Batman [laughter]
Dr Pixie McKenna [00:00:41] An insomniac. Tell me about it.
Matt Johnson [00:00:45] Very much so! Do you have all day and night? So ten years ago, I went through a very difficult time with my mental health, quite chronic depression which went hand in hand with chronic sleep deprivation, severe insomnia. It was the most hellish period of my entire life. Into a time when I felt as if my only way out of this mess was to take my own life.
Dr Pixie McKenna [00:01:19] Oh gosh. Right.
Matt Johnson [00:01:20] Yeah. So it got to that point which was ten years ago this was November 2009. So I kind of know what it feels like to be in this empty void of emptiness. That’s exactly where I was, and helplessness. I’m not sure whether the sleep went first or the depression started or anything – what the cause of the problem was. And since then I’ve had issues with my sleep. Obviously, I didn’t take my own life, and since then it’s been a long process to work out why I got into that situation mentally. And it seems like, with every step that I took to try and improve my mental health and my physical well-being, my sleep got a little better. But then sometimes I would lose control of my sleep. And over the last ten years, it’s really fluctuated. So I’ve had really good periods, short periods of great sleep, almost too much sleep. And then another period two years ago when I was making a documentary about my period of depression. I was diagnosed with chronic sleep deprivation. And I had a sleep analysis test with the lovely University of Cardiff, and they really looked into it during my documentary and so I – more than most I think – would know a lot, know what it feels like to be knackered.
Dr Pixie McKenna [00:02:43] I was just going to say so are you knackered? I mean, are you tired all the time or do you just manage?
Matt Johnson [00:02:49] I manage at the moment. I have to say I’m going through a really difficult time with my sleep. Not with my mental health, now with physical health, I’m relatively healthy. My sleep patterns are all over the place, and I kind of know the reasons for that at the moment. Am I tired? Yes. Can I manage? 100 percent. The busier that I am the easier that life is. I need stuff to do – I need to keep my mind occupied. But yeah there was a period like I say 10 years ago when I was just constantly tired like in a different level type. And I know a lot of my friends recently are having babies and that you have no idea what time it is, and I’m like I kind of do, it must be different levels of tiredness that people go through, but at least you have a baby to look at and go ooh isn’t he or she amazing. You know when I go through my periods of just lack of sleep, and that would be everything between two and three hours sleep a night. It’s a different level of tiredness. It’s like jet lag but times ten.
Dr Pixie McKenna [00:03:54] Jet lag when you haven’t got the excuse or the sympathy from anyone because…
Matt Johnson [00:03:57] Yeah, absolutely.
Dr Pixie McKenna [00:03:59] So how do you manage that? I mean I can do a few days of not sleeping but then I’m really useless, and I’m cranky. I need to repay that sleep debt, otherwise, I just can’t go on. How do you manage?
Matt Johnson [00:04:24] There is no real formula. I try and get some routine in my life, yeah. One of the biggest things I learned from my entire experience with the documentary by speaking to experts was to reassess my relationship with sleep. So my relationship with sleep is a lot better. So I don’t punish myself by lying in bed if I’m tired, I get up, and I do stuff, and I don’t just lie in bed and think of worst case scenarios in my head anymore. I say ‘I’m not sleeping, I’m only going to go to bed if I am tired’. Yeah and that’s how I deal with it. And then if I only get to sleep at about 6:00 in the morning I make sure I’m still up at 8:00. So I try and get myself tired for the evening and have a routine. I rearrange my bedroom. I have the perfect bed for me that I’ve taken a while to try and find.
Dr Pixie McKenna [00:05:14] Did that make a difference by the way because you know the way we say I don’t sleep well in a hotel and I don’t sleep here, and I don’t sit there. Actually I would sleep if I needed sleep, I’d get on the floor and sleep. Yeah, I have no issue, but has that made a difference to you?
Matt Johnson [00:05:26] It really has, much like I’m retraining my dog to kind of live in two different houses, my girlfriends or mine at the moment. He needs his own space in both, an area where he feels comfortable. His zone where he has his toys and my T-shirt so it smells like me and we get him used to it. I’m very similar, so I needed my cocoon, my nest. Yeah, and what that meant to me was I had my area that was just for sleep, my bedroom. So I had no TV in there no radio no electrics really. I tried not to use my phone an hour before bed. And if I did, I’d turn it on to night mode. But having the right bed for me and choosing it, owning it, spending a lot of money on it because I think for me it was the time and effort that I spent on it gave it value. If I valued it, I take care of it more, and I found the best bed for me and from then on I think that was the central point. And then I built outwards from it and from that. And when I have routine, when I have a good diet, and I have good exercise, and things are going okay with work I do tend to sleep well in that bed and sleep is the best thing in the entire world when you do it right. If it genuinely is and I really value, and I feel for people that don’t have it. And I understand that – I completely understand. But for me personally having that base creating your nest, that was the most important first that for me.
Dr Pixie McKenna [00:07:01] It’s probably a step that maybe a lot of people don’t think. I know seeing patients and they can’t sleep they’re lying in bed with their eyes open, but they’re not looking around and thinking, you know I could really have blackout blinds I could have ear plugs, I could take that stupid digital clock out of the room, I could sort the bed out from creaking.
Matt Johnson [00:07:24] It’s the same thing as we don’t take care of ourselves. Same with mental health. I’ve worked for ten years now within the mental health industry. And it’s the same thing in like oh I’ll just be fine. Margaret Thatcher lived on four hours sleep a night. I’ll be fine too. Those old tales stay within us subconsciously. We’re all like, it mustn’t be me. I’m just not aware, or I’m just a bit sketchy about something whereas we all know we should all know that there are certain things that we all can do to help ourselves. And that’s to help our mental health and our physical health and our sleep patter, and it’s drinking lots more water. It’s getting the right sleeping materials for yourself and not watching TV all night and then get into bed not exercising really late. Well for me all these things are really relevant and finding the right bed that’s right for me. It sounds like a bed advert, and I want it to be like this, but it can’t be. But the reality is, we have to put value on our sleep because we do need it and we don’t realise how much we do need it. And we spend so much time ideally six to eight hours a night I think; you’re the doctor.
Matt Johnson [00:08:40] That would be nice, a continual sleep. I’ve got a friend that doesn’t sleep in one block. He wakes up in the middle of the night. I think there must have been centuries ago and just like awake and hungry and then he goes back to sleep, and he wakes up, and there’s another nap in the afternoon. That sounds perfect. But he’s found the right patent for him. So for me, the most important thing is putting value on what’s important in life. And for me flipping from ‘I didn’t sleep, I hate my bedroom, I don’t ever need it I’m just going to drink to pass out’, things saying no you must love sleep you must care for it you must treat it with the respect that it deserves and then financially put your effort into that and put your physical and mental effort into it. And when I did that and when things are OK and not spinning too many plates with work, it does work for me.
Dr Pixie McKenna [00:09:32] And when you go somewhere else do you have anything that you take with you like your dog the T-shirt or whatever? Do you have some stuff that you might take if you’re sleeping in a different bed?
Matt Johnson [00:09:42] Very interesting. I don’t, and I’m away a lot with work. I tend to sleep okay in hotel rooms, weirdly enough. But I try and meditate, I try and have that one routine just before I go to bed. I’m terrible at meditating. I’m terrible. But I have to do something I have to stretch or do something that is just a little bit of a routine but I don’t. What I did I just take the ideology of self-care with me. I don’t have a comfort blanket unfortunately, I should – it’s a good idea. I wish I could take my dog everywhere. But Alan is not allowed in most hotels.
Dr Pixie McKenna [00:10:20] You’ve got a dog called Alan?
Matt Johnson [00:10:21] Yes, good, isn’t it.
Dr Pixie McKenna [00:10:25] First dog I’ve heard of called Alan.
Matt Johnson [00:10:25] All dogs should be called white van drivers names I think – Tony, Alan, Steve.
Dr Pixie McKenna [00:10:32] Brilliant! When you have to recover from your insomnia, so if you’ve had a bad run, what are your recovery tricks? What do you try and do during the day?
Matt Johnson [00:10:44] I try and nap as much as I can. I’m just in a really busy period at the moment, which is why I’m not sleeping, and my eczema is bad because of it. I’m a little bit ratty; I was ratty yesterday working. I’m just covering a lot of bases with work.
Dr Pixie McKenna [00:10:57] And I guess, do as you have done, if you’re in trouble ask for help. You need to get help; you need to talk about it.
Matt Johnson [00:11:02] You need to, 100 percent. Yeah. And the stigma attached to lack of sleep is silly. You know I remember when I used to have my sleep problem and go ‘I’m gonna go for a nap’. ‘What do you mean you’re going for a nap you wuss?’. You know I just said I need it. You know in Spain they go for siestas all the time, it’s part of their culture. Our culture is ‘snap out of it, you’ll be fine’ in any sort of illness. You know mental illness especially, lack of sleep especially. So yeah it’s just that nap element of the UK should be implemented. We should take time.
Dr Pixie McKenna [00:11:38] Yeah. It’s seen as laziness isn’t it really.
Matt Johnson [00:11:41] Yeah it’s seen as lazy ‘Oh I had a lie in today, I’m sorry!’ You know what I mean. It’s because I didn’t get to sleep till 3:00 in the morning. I wasn’t playing computer games or watching the telly, I just couldn’t sleep so my sleep pattern is different to yours and it’s the acceptance of that stigma because there’s a huge stigma attached to not sleeping.
Dr Pixie McKenna [00:11:58] It’s like a badge of honour isn’t it? You know I was working all night, and I only had two hours sleep, but I’m fine, I’ll keep going
Matt Johnson [00:12:04] Yeah. Yeah well done, great stuff, you’ll pass out soon.
Dr Pixie McKenna [00:12:10] Thank you so much because it’s really good to hear someone who’s lived through it and still you know dips in and out of the insomnia. It’s very, very important. And good tip by the band because I think certainly from my experience it’s true with people, they don’t think about their sleep surroundings, and that’s really really important as well.
Dr Pixie McKenna [00:12:29] So wishing you lots of nice sleep-full nights over the coming months.
Matt Johnson [00:12:33] Thank you, I appreciate it. Could you actually do like lots of records for me because your voice is calming. This is why she was chosen I reckon…
Dr Pixie McKenna [00:12:42] It’s because I’m so boring.
Matt Johnson [00:12:45] No no, it’s not that, your voice is very calming. Can you do my Tom-Tom? Can you be Siri on my phone?
Dr Pixie McKenna [00:12:54] I’m not sure they’d understand if I had to say 33 and things like that.
Matt Johnson [00:13:00] That’s perfect. Thank you. It’s lovely to meet you. I think this is a really important issue that we should all really look at.
Kathryn Pinkham [00:13:28] Well I actually had a late night last night, so I had less sleep than I probably should have last night actually.
Dr Pixie McKenna [00:13:33] Well, it’s great to have you here because if anyone’s going to know it has to be the founder of the Insomnia Clinic. So I’m going to ask the first question which I’m dying to know is what brought you to finding and deciding that this was what was needed?
Kathryn Pinkham [00:13:48] So my background was in mental health, so I worked in psychological services and as part of the work we were doing, we were trained in working with people with sleep problems. And what I found was that so many people had sleep problems and they were really easily treated. And I had this sort of epiphany that actually, case by case, every patient I saw, this light bulb would go on when I explained to them about sleep and how they could fix it and they were coming back saying that actually their mental health problems and their anxiety and their mood were all improved positively by fixing their sleep. And I think historically sleep has sort of been seen as a secondary problem. So the mental health problem was the biggest problem, then the sleep was just a side effect of that. But now more so it’s been seen that actually sleep can be the main problem. And that actually if someone suffers with poor sleep it’s pretty unlikely that they won’t, if they suffer with it for long enough, and severely enough it’s unlikely that they wouldn’t then develop some anxiety, some stress and some mood problems because when we’re tired all the time it’s really hard not to feel that way. So I was made redundant from the NHS, and I thought I wonder if I could just pick this one niche market and just work only with these people. And I started offering my own sessions. They filled up really quickly, and then I had inquiries from other places in the country, and it grew from there. So I trained up other people and kind of us as a team were trying to work as many people as we can because it is such a huge area.
Dr Pixie McKenna [00:15:11] Huge problem. And I guess many of us will say ‘oh I’ve got insomnia I can’t sleep’. Give me your definition or if someone’s listening how might they, by definition, be an insomniac?
Kathryn Pinkham [00:15:25] So yeah I think I think it’s interesting because insomnia sounds quite scary. I think a lot of people who have insomnia probably think they don’t because insomnia sounds like you’re awake all night every night and you never get any sleep at all. But actually insomnia is defined as trouble falling asleep, staying asleep, waking and not feeling refreshed, more than three times a week and having lasted longer than three months. So actually if you’re somebody who goes to bed and it takes you a couple of hours to fall asleep, or you wake up at 4:00 a.m. and you’re awake for a couple of hours every night actually that is classed as insomnia and therefore treatable in the way that we treat her.
Dr Pixie McKenna [00:15:56] So we shouldn’t be walking around saying or just accepting the fact that, and you know loads of people say it ‘oh I’m a poor sleeper, or I’m tired all the time’.
Kathryn Pinkham [00:16:04] Yeah. I think that a lot of people do accept it. I mean, I meet people all the time and when I tell them what I do. Everybody knows somebody who doesn’t sleep. And I think people do accept it and it’s you know in some ways kind of having not enough sleep is seen as a badge of honour that you know you’re working so hard you only get five hours a night. So yes you’re kind of quite proud of it. And I think lots of people don’t really realise that they’re not getting enough – the impact that it’s possibly having on them.
Dr Pixie McKenna [00:16:29] And if somebody is listening and they think well you know my sleep might be problematic. What are the signs, what are the cues for them in terms of their physical and mental well-being that might make you actually think you need to sort your sleep?
Kathryn Pinkham [00:16:47] So I think the first sort of signs would be if you’re aware that you’re just starting to spend more time in bed awake so a good sleeper spends very little time awake staring at the ceiling wondering what time it is or looking at the clock. I think when you start to notice those kinds of things it’s becoming a habit and you go to bed thinking about how well you’re going to sleep and whether or not you going to fall asleep. That for me is a great point to actually get help then. That can be nipped in the bud really early.
Dr Pixie McKenna [00:17:13] So ultimately actually sleep diaries is good isn’t it and in someone who’s worried about their sleep if you’re going to go into your doctor it’s good to be able to talk about the quantity and quality of your sleep and also all those lifestyle things around it that are going to be affecting your sleep which we sometimes don’t disclose or don’t think about.
Kathryn Pinkham [00:17:29] Yeah and we say to people during treatment it’s useful to keep sleep diaries to see how they’re getting on. But at the end of it, I say to people you know let’s just behave like a normal sleeper and normal sleepers aren’t recording all of this. They don’t know any of this information so actually just rip it up and forget about it after that you know we don’t need to pay so much attention to the in’s and out’s of it.
Dr Pixie McKenna [00:17:48] I see a lot of patients that can’t sleep and you know they’re very often telling me what impact that has in terms of their work their assumed productivity, arguments, concentration accidents etc.. Do you see that for someone who can’t sleep?
Kathryn Pinkham [00:18:11] Yeah I think when somebody can’t sleep well what they tend to do is mis-attribute everything that’s going wrong to the lack of sleep, so people get really worried about work and ability to perform at work and driving. Everything can kind of become dangerous because of sleep. You know if people are sleep deprived we know that there are lots of reports about how dangerous it can be. And so I guess part of the work that I’m doing with people is empathising with how stressful it can be but also saying OK, we’re going to do what we can do with the sleep but what else could you be doing to manage some of those things and, you know, what are the support you could be getting for those things? Because, as I say, it does turn into that when someone is as stressed as how you’re describing there, possibly just fixing their sleep is not going to be everything. But I say yeah for a typical person it typically ends on it would say it affects every area of their lives. Absolutely. You know as I said, in the beginning, people find it really difficult to remain upbeat, happy not stressed, if you’re not sleeping well, it really is a pillar of mental health that we can’t we can’t ignore. We can’t fix the other things if someone isn’t sleeping well.
Dr Pixie McKenna [00:19:18] And I suppose many people will think if they start not sleeping well they’ll all know someone who doesn’t sleep well or an auntie or whatever that she never slept she was on sleeping tablets for 40 years etc. etc. and they think they will become that person.
Kathryn Pinkham [00:19:34] Yeah, yeah, definitely. And I think that you know especially for somebody who’s perhaps suffered with depression in the past and as part of that depression that people didn’t sleep. One bad night’s sleep is terrifying for them because they think they’re gonna go back to that place again. You know maybe at that time they had to be off work sick because they weren’t sleeping and they were so unhappy so you know I suppose it is a little bit like the cycle of depression that actually if you have depression in the past then you have a bad day it’s very hard to not panic because you desperately want to go back to where you used to be.
Dr Pixie McKenna [00:20:01] And so your premise of going back to basics is having a bedtime and awake time?
Kathryn Pinkham [00:20:10] Yes. So the first step that I would get people to take would be to reduce this window of time in bed. So if you’re in bed for eight hours, nine hours every night but you’re only asleep for six, and that’s a broken six somewhere in there. I would say let’s reduce that window down to six hours because what we can do is then teach your body. You no longer have this opportunity to be in bed for eight hours and pick and choose when you want to sleep in that window. You just have one six-hour window. So what happens now is when you wake up nice and early, and you go to bed later your appetite for sleep is much higher. Your drive is much higher. So we’re kind of going right back to basics and saying that actually if you were tired enough and we can create a bit of mild sleep deprivation your chances of falling asleep quicker and staying asleep longer are suddenly much higher.
Whereas what our initial reaction to do is to always go to bed earlier. We’ve lost that drive. You know if it’s been darker for longer we’re getting sort of towards 11 o’clock and midnight even half-past twelve it’s been darker for longer. Your body recognises that your melatonin is higher and we will fall asleep quicker get up nice and early the next day and stop repeating this pattern and what people will see is that pretty quickly their sleep sort of condenses into a better quality in that window because they’re a little bit sleep deprived. And we’re kind of creating that; we’re managing the sleep deprivation and then when that starts to work we just slowly open out that window. Bit by bit and get something that feels better for them. So the biggest question that people would probably ask is how to fall asleep quicker. And it’s a really simple one for me, I can just go to bed later. If it takes you an hour and a half to fall asleep, you should just go to bed an hour and a half later. You’re not losing anything because you’re awake anyway. And now you can be downstairs, you can watch TV, you can do something. When you’re lying in bed all you’re doing is creating this bond with your bed that is about being awake, and our minds always stray, we always worry, and we always turn to sort of negative thinking if we’ve been lying in bed for long enough. So my advice is actually just cut that piece of the puzzle out take it downstairs go to bed later, get up early and that drive will look after itself.
Dr Pixie McKenna [00:22:09] And what about weekends? If you’re normally up at a certain time or have to get up at a certain time are you allowed to hit the snooze button?
Dr Pixie McKenna [00:23:30] And what are your tips and your advice in terms of things if you’re a bad sleeper or what do you do that you have to get rid of?
Kathryn Pinkham [00:23:40] So of the sleep hygiene things I suppose when people come see me, the sleep hygiene is probably in the way rather than helping. I would say I advise people to use caffeine, so I go actually if you’re doing this restricted sleep window and you’re trying to fix your sleep. Have a cup of tea in the morning, good sleepers are having a cup of tea or a cup of coffee. Have one mid-morning or you know just after lunch if you want it, that’s not going to affect this new bedtime but what it is going to do is give you a helping hand that as I say all the good sleepers are doing well the good sleepers are still having a cup of tea in the afternoon because they’re tired, it’s the poor sleepers who are suffering trying to get through caffeine free even if they didn’t sleep very well. So my advice to them is as you know wake up in the morning you know have a cup of tea keep a nice routine and be healthy during the day stop your caffeine after lunch, don’t have anything too close to bedtime. TV is fine, reading a book is fine, screen time minimising. I mean, I think the advice is two hours before. I kind of say well if you know you’re not going to do it two hours before then do an hour before. I try to make it what do you’re actually going to stick with.
Dr Pixie McKenna [00:24:39] Yeah, realistic.
Kathryn Pinkham [00:24:39] It’s all very well saying two hours, but I check my phone right before I go to bed so I don’t practice what I preach, but I still sleep okay. So I guess sleep hygiene is definitely good advice and it’s something, it’s sensible advice but it doesn’t need to be bang on 21:30 I have to turn this off and then I’ve got to give this enough to sit quietly for an hour and wind down before bed. For me that’s putting too much pressure on sleeping so my absolute no no’s would be don’t be on laptops and iPads all evening. That’s going to inhibit your development of melatonin. Try not to go to bed with loads of things on your mind, I encourage you to write stuff down, you know even if you’re aware that the thing that was on your mind last night in the middle of the night isn’t on your mind now. Still, write it down in the daytime, pre-empt it. Write it down, spend 20 minutes, write down everything that’s on your mind and at the end of 20 minutes just close the book and then distract yourself, do something else. But going to bed later stops this racing mind, you know if you’re tired enough you will sleep whatever’s on your mind. You can sleep, it’s going to be too early and kind of keeping that habit going and that cycle going, that increases that negative thinking in bed.
Dr Pixie McKenna [00:25:44] And how long if you can’t sleep should you stay in bed. Do you get out after 20 minutes, half an hour?
Kathryn Pinkham [00:25:53] So we would kind of advise the 20-minute rule. 20 minutes is the maximum time. If you’ve been away for two minutes and you’re already wound up, and you’ve already checked the clock three times and counted how many hours then just leave the bedroom. People will say I have less chance of sleeping. For me, it’s no different. You can either be in bed having all that kind of negative associations being built up within your bed, or you can just go downstairs totally change your mindset turn the TV on for 10 minutes and then go back to bed when you feel sleepy, and you’re far more likely to fall asleep by doing that.
Kathryn Pinkham [00:26:30] I think it comes from you know our mum’s always said to us, well at least you’re resting.
Dr Pixie McKenna [00:26:35] Resting your eyes.
Kathryn Pinkham [00:26:35] And I suppose what I’m saying to people is, but it’s not restful. Describe to me how restful is that experience? And it’s actually awful as it’s really stressful, you know your partner’s lying in bed next to you fast asleep, and you hate them for it. You’re worrying about loads of different things, so she is not resting. There’s nothing restful about it so leave the bedroom get back downstairs do something else and then get back to bed.
Dr Pixie McKenna [00:26:56] So you sleep well?
Kathryn Pinkham [00:26:57] Yeah I do sleep well yeah. I think it’s interesting because I do sleep well, I mean if I do have problems even I don’t take my own advice I would lie in bed just like everybody else. You know I’d have to have bad sleep for a good week before I’ll start taking this advice because it’s not natural. You don’t want to give up and get out of bed. Nobody wants to leave the bedroom. So I am a good sleeper, but I think what I can always say to patients is I am a good sleeper, but what you need to know is that doesn’t mean that everything else is rosy. I don’t wake up and jump out of bed every morning. I still would be irritable. I still look tired sometimes and I think that when someone’s been a poor sleeper for a long time they kind of put sleep on this pedestal that actually their concentration will be better, they would be happier, they would be less irritable. And you know I’m not saying that good sleep isn’t important, of course it is, but it isn’t necessarily going to fix all of these things. Okay, let’s be realistic expectations here you’re looking for a perfect eight hours every night to equal this new life. Let’s kind of look at that and make sure the goals are rational and realistic.
Dr Pixie McKenna [00:27:57] But ultimately I think we can all improve probably.
Kathryn Pinkham [00:27:58] Yeah I think it’s hard now to sleep with 24-hour phones and lights, there’s so much to do you know at any point I can do a job on my phone in the middle of the night when it pops into my head. That’s definitely affecting people sleep so you know it’s a 24-hour society, loads of stress, everybody’s too busy, not enough hours in the day. So yeah it is a problem. It is definitely a problem for lots of people.
Dr Pixie McKenna [00:28:23] I mean it’s good for people to hear about CBT for insomnia. Because I don’t think many people although you’ve said it’s around for the last 20-25 years I don’t think many people know what’s involved in it. So I think that’s brilliant. Thank you so much. That’s been really, really helpful.