The torment is over but surely another is waiting in line.....your eyes, they suddenly feel strange, is it that they are not in place?
You center them, but it still does not feel right, you feel as though you are straining them constantly. This alone drives you mad.
Your eyelids suddenly feel light, as though their natural place is to be open, but in order for you to sleep you need them to be closed. Straining your eyelids you are taken by an even greater madness.
You think of the saliva in you mouth, do you need to swallow? why are you producing in such great quantities? why now? you need to sleep why is this happening???? you swallow it, only to replace it with a new load of fresh saliva - once more, the loop of horror.
The pillow is frustrating you, it is either too high or too hot. You turn it to its other side ,that in turn heats up as well. You remove the pillow but your neck lacks the support it requires....
And so strikes the horror, with you knowing you will sleep no more.

Insomnia affects approximately one quarter of the adult population. Insomnia sufferers typically report that they have trouble falling asleep, wake up frequently, tend to wake up earlier in the day, and that their sleep is unrefreshing.^{(1, 2)}

People with insomnia generally fit into a particular profile. They prefer to sleep at a certain time (e.g. at night or during the day, whatever, as long as they would have been sleeping at the same time each day), they take approximately 30-120 minutes to fall asleep, wake up 2-4 times per night, get a total of 4-6 hours of sleep per night, and experience symptoms of insomnia more than 4 or 5 nights per week. While people suffering from insomnia do report daytime fatigue, they would be unable to fall asleep during the day when given the opportunity (e.g. they are tired, but not sleepy). In fact, some researchers report that the daytime sleepiness of insomniacs is lower than that of normal sleepers, despite less total sleep time.⁽³⁾ Insomnia symptoms occur regardless of what day of the week it is (that is to say, insomnia happens regardless of whether it is a weekday or weekend).⁽²⁾ In general, insomnia has little to do with how much sleep the sufferer actually gets, but rather the subjective quality of that sleep.⁽¹⁾

Current research suggests that bouts of insomnia may be due to the experience of a state of metabolic hyperarousal by the insomniac.⁽⁴⁾ People with insomnia have difficulty falling asleep simply because they are more physiologically aroused; They have higher body temperatures, increased metabolic rates, and greater levels of anxiety than normal sleepers. Examination of EEG recordings from insomnia patients just prior to and during sleep reveals that insomniacs have more powerful alpha and beta activity, and attenuated delta activity.⁽⁵⁾ This pattern of aroused activity may explain the consistent underestimation of total sleep time and overestimation of sleep onset time that is often seen in people with insomnia, and may explain the secondary symptoms associated with insomnia (fatigue, inability to concentrate, moodiness). Interruption of sleep without hyperarousal does not produce these negative symptoms.⁽⁶⁾

Although insomnia can occur without any other apparent cause (primary insomnia), more often insomnia results from other preexisting conditions (secondary insomnia). In these cases, it is important to treat the underlying medical condition as well as the insomnia.⁽⁷⁾ The most common conditions associated with insomnia are:

• depression and/or anxiety
• excessive use of stimulants or sedatives
• restless legs syndrome

The particulars of secondary insomnia vary depending upon the cause. Insomnia resulting from depression and/or anxiety generally involves difficulty falling asleep, extended awakenings, and early awakening times. The sufferer will often report a sensation that their brain "will not let them sleep." In other words, the insomniac is too cognitively aroused for sleep to occur.⁽⁷⁾ Depression and anxiety appear to produce the same patterns of excited brain activity that have been associated with primary insomnia.⁽⁵⁾ Among adolescents, nightmares have been associated with anxiety.⁽⁹⁾ As a result, the experience of repeated nightmares can induce insomnia, eventually leading to the development of poor sleep hygiene

A subgroup of those who suffer insomnia because of anxiety and/or depression have what is called psychophysiologic insomnia.⁽⁷⁾ In these cases, the patient's concern about his or her inability to sleep result in the propagation of the sleep disruption. These patients will report feelings of sleep performance anxiety. Often, they have associated feelings of failure with the time and place in which sleep occurs. These feelings increase cognitive arousal when the person is in a sleep setting, making it more difficult for the person to sleep.

Use of stimulants and sedatives (particularly if no regard is given to the time at which they are taken) can create a dependence upon the presence or absence of an artificial substance in order to regulate your sleep cycle. That's bad, because a) if you miss your regular intake of whatever substance you are using, your cycle will get all thrown off, and b) as you develop a tolerance to whatever you are using, it will be more and more difficult for you to maintain your sleep cycle even using the artificial substance.

Restless legs syndrome is characterized by an intense and irresistible urge to move the legs. The symptoms tend to get worse at night. This condition usually results from a dysfunction of the central nervous system involving the dopaminergic pathways, although it sometimes can result from an iron deficiency. This syndrome seems to effect somewhere between 5% and 15% of the population, with symptoms appearing before the age of 20 in nearly half of all patients.⁽¹⁰⁾ Within the population of people suffering from this syndrome, 94% report sleep onset insomnia.

So, what can you do if you have insomnia?

First of all, change the way you think about sleep. Studies of human sleep patterns indicate that there is a lot of variability in the amount of sleep each person requires, the time it takes to fall asleep, and the conditions under which the best sleep occurs.⁽⁷⁾ Depending on the way you are, you might be fine with as little as 4 hours of sleep per 24 hour period, or require as much as 11 hours. Don't think that you absolutely need 8 hours of sleep in order to get enough sleep. Thinking that way about sleep is likely to increase your anxiety about the situation, and therefore decrease your ability to actually fall asleep.

Don't do a lot of things in bed.⁽¹⁾ Hanging out in bed reading, watching t.v., playing cards, noding, whatever you do that isn't sleeping when you are in bed will dissociate the sleep setting from the act of sleeping. If you go to bed and find that you are not falling asleep, get up and do something else, then return to bed when you start to feel sleepy again. Eventually, you'll condition yourself to associate sleep with being in bed, and it will be easier for you to fall asleep there. Hey, if nothing else, it's a good excuse to have sex on the kitchen floor. (:

Don't use drugs to help you sleep at night or stay awake during the day. Don't drink alcohol before bed. Yes, alcohol is a sedative, so it will help you fall asleep. However, after the initial sedative effect, alcohol prevents you from achieving deep sleep, and increases the likelihood that you will wake up in the middle of the night.⁽¹¹⁾ Don't consume excessive amounts of caffeine to stay up through the day. The introduction of the stimulant into your system will make it difficult to reestablish a natural sleep cycle. Don't use sleeping pills, especially benzodiazepines.⁽¹²⁾ They have ridiculous side effects, are addictive, and only help in the short term, and withdrawal often results in a worsening of insomnia symptoms. Don't take melatonin for any extended period of time. It causes gonadal atrophy!⁽²⁾ Researchers are actually developing birth control with melatonin as the active ingredient! In fact, about the only substance I read about that had any net positive (i.e. positive effects better than negative side effects) effect on sleep was valerian extract.⁽¹²⁾ It doesn't seem to alter how much sleep a person gets (although it may increase the amount of time spent in slow-wave sleep), but it does seem to make insomniacs more accurate when reporting how much sleep they have gotten. In other words, it doesn't really help you sleep more, but you at least feel like you've been sleeping.

If you think that your insomnia is being caused by some other problem, treat that as well as the insomnia. I said that before, but I think it's an important point. Treatment of both problems (and notice that I am not saying that only the underlying cause should be treated) leads to the most improvement in both problems. Lichstein et al ⁽⁷⁾ even reported improvement in the primary disorder when secondary insomnia was treated.

Take a bath.⁽¹¹⁾ Seriously, it heats up the brain, changing brain activity in a way so that you end up sleepy. Drink a glass of warm milk. The redirection of blood flow from your brain, and some of the stuff you digest out of the milk will help you get to sleep. There is something to be said for all of those things that your mother told you.

Don't worry about it. This one is much easier said than done. Yes, it is hard when you can't sleep. The idea of getting enough sleep can become all-consuming, as if all your other problems would be solved if you could just get a little rest. You are better off if you can manage not to think about it. Instead, try to just live. If you find that you are getting sleepy, go to bed. If you can't sleep once you get there, go do something else. Don't wonder about when you will start to feel tired, don't think about all the nights before that you haven't been able to sleep, don't try to come up with all the things you can do to alleviate the problem (note that this last suggestion is the exact opposite of what I am doing now). Just sleep if you get tired, and don't sleep if you don't, and other than that, try not to think about it.

I hope you all have better luck with these than I do. Sleep well.

1.http://www.nhlbi.nih.gov/health/public/sleep/insomnia.txt
2.Perlis and Youngstedt (2000) The diagnosis of primary insomnia and treatment alternatives. Comprehensive Therapy, 26(4), 298-306
3.Stepanski, Zorick, Roehrs, and Roth (2000) Effects of sleep deprivation on daytime sleepiness in primary insomnia. Sleep, 23(2), 215-219.
4.Bonnet and Aarand (1995) 24-hour metabolic rate in insomniacs and matched normal sleepers. Sleep, 19, 453-461.
5.Hall, Buysse, Nowell, Nofzinger, Houck, Reynolds, and Kupfer (2000) Symptoms of stress and depression as correlates of sleep in primary insomnia. Psychosomatic Medicine, 62(2), 227-230.
6.Rosa and Bonnet (2000) Reported chronic insomnia is independent of poor sleep as measured by electroencephalography. Psychosomatic Medicine, 62(4), 474-482.
7.Lichstein, Wilson, and Johnson (2000) Psychological treatment of secondary insomnia. Psychology and Aging, 15(2), 232-240.
8.Jones and Czajkowski (2000) Evaluation and management of insomnia in menopause. Clinical Obstetrics and Gynecology, 43(1), 184-197.
9.Nielsen, Laberge, Paquet, Tremblay, Vitaro, and Montplaisir (2000) Development of disturbing dreams during adolescence and their relation to anxiety symptoms. Sleep, 23(6), 727-736.
10.Hickey (2000) Restless legs syndrome. Canadian Family Physician, 46, 1762-1763.
11.Hryshko-Mullen (2000) Behavioral treatment of insomnia: the Wilford Hall Insomnia Program. Military Medicine, 165(3), 200-207.
12.Donath, Quispe Diefenbach, Maurer, Fietze, and Roots (2000) Critical evaluation of the effect of valerian extract on sleep structure and sleep quality. Pharmacopsychiatry, 33(2), 47-53.

Last night I lay in bed and dreamed I couldn't sleep,
tossed and turned my subconscious inside out,
muttered muffled frustration at imagination's irony.
Grumbling feverish complaints, growled murmurs that my mattress couldn't hear,
my words were downed in the fine goose feather pillow, stifled by its stuffing.
Around me choked wild wide-eyed dreams,
endless alarm clocks bared lethal neon numbers like glinting razor fangs,
murderous grinning monsters of a jungle I couldn't see.
Terror bloated my mind to immobility, straining, swelling in the vast, strangling darkness.
Closed eyes shut one world out, locked another in
its blind images projected onto the screen of my eyelids.
My room was warped in a cinematic nightmare, no longer a haven of rest.
I drowned in the waterbed's cruel, slavering maw
as fiendish wallpaper cackled wickedly,
and a smirking spider's web of sheets snickered at my entangled helplessness.
The whitefaced ceiling stood mute, but its giveaway guilty glare
gloated of how they'd all plotted against me, stolen my rest,
battered my brain till my teeth rattled with betrayal
down my throat to eat me from the inside out,
beating my breast as I died of exhaustion...!
I awoke, screamed as a knotted string of static burst forth from the radio, tripped over its tangled self,
clattered into my ears with one eager clumsy fall,
snarled angrily to itself and the horror movie fled,
reeled off in defeat, fluttering between my lashes one last time
then over and out at last.

---Spring 1995

This really happened, or at least the part about dreaming sleeplessness did. From there I mixed metaphors and wordplayed my way to a pome that made its way into my high school's literary magazine above a print of a truly awesome painting of a skeleton innocently asleep in bed with a teddy bear, face and hair hanging from her bedpost, skin over a chair next to the bed, eyes in a glass on the bedside table. I was thrilled.

I'm tired, like all of the time. Constantly, bone grindingly tired. And still I don't sleep. Well, I do, but these days it seems I can make about four hours maximum of unbroken but nightmare filled unconsciousness that can take forty eight or more hours of constant mental activity to achieve. Hardly worth it really.

I remember having this problem back when I was too young to drink coffee, smoke, or have any of the vices 'they' recommend one abstains from in order to regain sleeping patterns, (so I know it's not that). Sure, I drink too much coffee, but when one's mind is half asleep but won't go all the way one may as well try to make being awake a worthwhile and productive experience with stimulants.

As I said, this has been a life-long trouble. My parents recall what a sleepless baby I was (and yet still manage to blame my lifestyle in the same breath, unable to understand that my lifestyle has formed around my insomnia rather than vice versa). I used to go to bed as an older child and just lie there, waiting for the next day's worth of school to happen. In the end I gave up trying and read under the covers till I passed out. I probably got more education as a result of that than ever turning up to class, all bleary eyed and useless.

As the years rolled by I adapted, I became known as a night owl even though I was awake during most of the day too. I got into the cliché geek all night computer programming sessions, writing music on the PC, all that fun stuff. I found myself inspired more during the night, as do most artistic types. I didn't enjoy the sleeplessness but I started looking at it as more of a gift, a way to access my artsy side during the hours when everyone else slept.

But now it's getting silly. I hallucinate regularly, (nothing wild, just things wobbling that shouldn't, like concrete pillars), my thought processes are, frankly, fucked up and my mood gets more bitter by the day. And the nightmares, unless I get thoroughly stoned before I crash out, I get the most incredibly dark nightmares which really don't help at all. (I admit though, I've picked them up in more recent years.)

Maybe I should see a doctor, but I get the feeling I'll get the same old advice, (no caffeine, no smoking, no this, no that, all of which I've tried at some points before) or I'll get an expensive prescription for pills that'll leave me feeling shittier that before. Perhaps I'm better off ranting in here, hour on end until the wee smalls instead.

I'm off to bed to stare at the ceiling for a while. Wish me luck...

In Albuquerque, New Mexico Insomnia is a coffee bar at 4013 Silver Ave. It is a little hard to find if you've never been there before. The best way I've found to reach it is to travel west on Central and then take a left in front of The Pulse. This will take you onto a street that will gradually lead you into a left turn onto another street running parallel to Central, and this is Silver Ave. If you continue down Silver, the second building on your right will be Insomnia. Insomnia is locally owned and operated by Suzanne and Heath. The trademarked symbol of Insomnia is a crescent moon with an open eye resting on the tip of the moon. That is the sign you'll see above the front door

Insomnia is open from 9 PM to 3 AM every night of the week, except Monday. There is a cover charge to get in on Fri. and Sat. nights. The cover charge is usually $3.00 unless there is a band playing that night, in which case the charge can be up to $5.00. The nice thing about being charged cover is that you get a ticket good for one free drink at the bar. Most of the drinks are about $2.00 to $3.00, so it sort of balances out.

One of the nice things about Insomnia is the building design. When you walk through the front door you're in the main room, and the drink window (where you order and such) is in the back. There are usually three or four coffee tables in the main room, all decked out with games like Chinese Checkers, Risk, Chess, Sorry, Candy Land, and Clue. To the right of the main room is a smaller room where people go to think, write, or just talk in a quieter and calmer location. Next to the drink window on the right is a doorway that leads to a room half the size of the main room. At the back of this room is a stage that the bands use to play on, and where a local poetry reading is held on Wens. nights. To the left of the stage is a doorway that leads to the bathrooms, a backdoor out of Insomnia, and the entrance to the kitchen. To the right of the stage is another, smaller room, that is home to the original Frogger and Centipede Arcade Games] (I've lost more quarters to Frogge than I care to remember).

Insomnia is comfortably furnished in old, beat-up, plush couches and chairs. They are dangerously comfortable, (dangerous only because they are easy to fall asleep on, and if this happens Heath will take the liberty of gently waking you from you peaceful slumber by shouting through a megaphone next to your ear. There is also the danger of sinking in the upholstery and becoming lost in the nether regions of the couch or chair) and look like something you'd drag out of a high school drama furniture loft.

Insomnia also offers you an interesting cross-section of social groups and classes. Just about any stereotype of person you could think up eventually seems to walk, stumble, or be drug in through the doors at some point. There was once an ugly incident of someone running through the doors while aflame, but that's another story.

The usual cast of characters to expect at Insomnia are as follows - Angel, Athena, Balls, Bones, Casper, Charles, Dark Heart (not the villain from the Care Bears), Dee, Derrick (he'll be the one talking to people that aren't really there), Dice, Emma Rose, Erin, Foxy (when she's not in jail), Froggy, Ghost, Irish Mike, Legend, Liz, Mel, Opal Anne, Phoenix, Roman, Samantha, Sin, Sparky, Stephen, Sway, Tony Santiago, Trip, and Ug (short for Ugly). I'm really not sure as to how many of these people came to have their nicknames. In the case of Dark Heart he liked the name, and just started to demand the everyone at Insomnia call him by it, which is