What A Sleep Physician Learned From Her Own Experience With Insomnia

Dr. Carol Yuan is a board-certified physician in pulmonary, critical care and sleep medicine and founder of B. Hai Sleep Health, a telehealth sleep service that helps women get better sleep. Learn more about Dr. Yuan and her sleep work at www.bhaisleephealth.com.

Recently, sleep seems to be slipping through my fingers. As a sleep physician with a special interest in women’s sleep health, I know all too well the possible causes. Since I just celebrated my 42nd birthday, I’m turning the corner where perimenopause is now within sight. Factors like swinging hormones, caregiving, carrying a high mental load, and multi-tasking at home and work result in increased anxiety and stress. No wonder women experience insomnia at a higher rate than men — almost 40%! One in four women have difficulty falling asleep, staying asleep, or waking up too early and can’t go back to sleep.  

I also know from the thousands of women I have talked to and had a glimpse of into their busy lives that insomnia treatments don’t fit on a prescription pad or in a pill bottle. Solutions to help busy, tired women get more quality sleep require equal doses of science, creativity and  practicality.   

In 2020 the whole world turned upside down, and birthed the new term “COVID-somnia.” I found myself searching for better sleep as well. After almost ten years of full-time employment in hospitals and private practices, I traded off job security for entrepreneurship. I decided to create my own path and build a telehealth sleep practice for women. The process is exhilarating but unprecedentedly stressful.  

My lifestyle changed overnight. As a newly minted physician entrepreneur, there are rolling deadlines for events, meetings, applications. I also took up locum assignments that span across time zones. In one month, I slept in four different Airbnbs and hotels. Stress plus uprooted routines equals sleep loss (in case you didn’t already know from the year 2020). As I was forced to pay more attention to my own sleep that was slipping away, I had to step up my game.  

Little things matter

Traveling is the antithesis to rest. Routine, familiarity and sense of security weave together the fabric of a good night’s rest. On-the-road sleep can easily disintegrate into fragments. I was sleeping only 4 to 5 hours a night. In the middle of the night, I wake up disoriented staring at the unfamiliar paintings hanging on the starch white walls in hotel rooms.  The next morning my brain feels like soup and eyelids heavy like lead.  

Green tea matcha lattes are my favorite pick-me-ups. But the caffeine in it was causing me to feel wide awake at night time. I became more aware of its impact on my sleep and cut out the afternoon Starbucks run.  

I started paying more attention to the lighting and temperature in the room. As I dim the lights and dial down the temperature at night, I visualize melatonin flowing from the hypothalamus and drop in my own core body temperature. It became a relaxing bedtime ritual.  

Just say no — to electronics 

This was the hardest for me: saying no to electronics. I wasn’t able to do it immediately, even though I know all the reasons doom scrolling and checking emails is supposed to be bad for sleep. Breaking up with my phone was a slow and gradual process..  

First, it was just remembering to put it on silent, so it doesn’t go off every hour with the message alerts. Then, the self-restraint to keep my hands in the bed, not reaching across in the dark, feeling for that familiar case everytime I wake up. This means I had to set an alarm for wake up, even though most of the time I don’t need it. Since I was a child I always woke up before the alarm. Now that security of knowing I won’t oversleep helps me stay asleep.  

Then came the physical separation. I began by intentionally leaving my phone the last place I was before going to bed. It was the couch, bathroom, or kitchen. Gradually I became used to the distance and appreciated it. I like going to bed and waking up in the morning with my own thoughts, appreciation and praises to God.  

It took a few months. Now most of the time, when I’m not on call, I sleep with my phone on silent, lying somewhere that requires me getting up on my feet if I want it.   

Fake it (till you make it)

Being sleep deprived feels horrible. You feel like you’re dragging through the day in motion without consent. I especially despise the delayed reaction time. An arterial blood gas report usually takes me no time to interpret. When I’m sleep deprived, I need to go over it a few times before my brain agrees to start crunching the numbers and tell me what to do next.  

The tendency when we feel tired is to slow down, which is normal and natural. But there’s something called “sleep pressure” or “sleep homeostasis” that argues for us to fight that urge and act like we’re full of energy, even when we might be running on fumes. High sleep pressure, built up by physical and mental exertion while we’re awake, increases the chances of a better night sleep. Just like how you might skip a meal sometimes to whip up an appetite for later, the more we’re starved for sleep by engaging in challenging mental tasks and physical activities, the more efficient our bodies will sleep at night.  

For me, that means resisting the urge to nap when I’m dealing with insomnia. Saying yes to hanging out with friends, networking events and exercises that I have committed to. To not back out of them because I feel tired. The trade-off I’m hoping to achieve from pushing myself (faking it) is my body will be more efficient at refueling overnight and reset my energy balance (making it) in less time.  

Sleep can become elusive for us women in healthcare as we juggle the demands of work and family while navigating the changes in our own bodies. In my personal dealing with a recent bout of acute insomnia, I tried paying more attention to the small habits that have big impacts, like saying no to electronics, and staying active physically and mentally. Your strategies for getting consistent, adequate sleep may look different, as they should be personalized to your specific situation, lifestyle and goals. I’m glad you’ve come this far to the end of the blog post. It means sleep is your top-of-mind. Keep sleep a priority and you will reap the benefits of the health and energy to carry on.