awake at 3 am

Awake. Again. Still.
Overwhelmed with heat: tossing off covers, sticking out one arm, one leg, unbuttoning pyjama top, flinging it off, groping on the floor for it an hour later, repelled by the dampness. Vowing not to check the time.
Checking the time.
Feeling the need to pee but not wanting to get up. Knowing that now that I’ve noticed my bladder, no sleep will come. Getting up to pee, tripping on the jeans discarded on the floor, the ones that I knew I should put away because I’d trip on them in the dark.
One more attempt in bed: stomach sleeping, fan directly on me, neck too tight on the right, switch face to the left, nothing is working, now calf muscles feel tight and twitchy.
Giving up: retreat to the guest room with a book. Vowing not to check the time.
Checking the time.
Thinking, always, of the irony: how many people over the course of my career did I counsel regarding insomnia? All those handouts on sleep rituals, stimulus control, tests for sleep apnea, screens for depression and anxiety, discussions about pain and caffeine and exercise and naps.
And here I am, at 3 am again, wide awake. Well, to be specific, lately it’s 2:20 am and 4:40 am. Which at least has a nice mathematical symmetry.

I joke with my menopausal and perimenopausal friends that we should FaceTime at 3 am, since that seems to be when we’re all awake. Circadian rhythms? Hormone fluctuations? It feels unfair, that after years of period cramps and pregnancies and crying infants, now in menopause we cannot get some blessed rest. All the male partners seem to sleep whenever they want, which can lead to some anger, frustration, and mildly murderous thoughts. But it would be even more difficult to sleep in jail, most likely. (Don’t worry, I’m almost completely kidding).
 
Many patients have requested sleep aids and I’ve always tried to deter them. Habituation, falls, fractures, car accidents, all of these things are proven consequences. Instead, here are all the things I’ve tried over time:
-half-caf coffee, only before noon, no other caffeine
-exercise at least one hour daily, including yoga, never after 9 pm
-meditation (including guided sleep meditation)
-no TV before bed, no screens for an hour before bed, reading until sleepy
-journaling before bed or in the evening
-hot milk before bed, lavender candles, sleepytime tea
-fan for coolness and white noise, ear plugs
-sex before sleep, sleeping in a separate room, sleep restriction (getting up if not asleep)
-removing the clock and phone from the room
-removing the dog from the room, cancelling the newspaper since 4 am delivery wakes the dog
-avoiding naps or limiting to 30 min (setting alarm), bamboo sheets for breathability
-melatonin, magnesium, imovane, trazodone (yes, I gave in for a bit…didn’t work)
 
I feel this is a pretty comprehensive list. I think my efforts should be rewarded with some really great sleep, don't you? So far, the awakenings continue. My overall sleep duration has improved, and I don’t feel exhausted all the time, so I guess this is just me, for now.
See you at 3 am?