It is 12:27 a.m., and I should be asleep.
I have just finished a 12-day stretch of working every day, mostly in the clinic where I spend my days on Shelter Island, but also a few days in the hospital. I am exhausted, a heavy feeling in my bones and muscles and a persistent sort of fog that weighs down my brain, and I know that sleep is what I need.
For most of my life, I fell asleep easier than anyone I knew who didn't suffer from narcolepsy. Not until I started my residency in family medicine did I start to lie awake at night, replaying clinical decisions, wondering if I'd missed some crucial bit of evidence in a patient's history, or if I'd succumbed to the stress of an 80-hour workweek and snapped too loudly at my kids.
It wasn't much, just a hint of insomnia now and then. If I tuned up my sleep hygiene and engaged in acts of self-care, if I turned my phone off an hour or two before bed, exercised in the morning instead of at night, ate lots of greens and not much sugar, and meditated regularly to help adjust my responses to anxiety and worry, it settled down.
Those things work for me, although I know they don't always work for everyone. Sometimes people need extra steps beyond these. For some, cognitive behavioral therapy with a therapist or something like the CBT-I Coach mobile app developed by the Department of Veterans Affairs can be very effective. Some even need prescription medicine, although there are no magic bullets in that regard.
I know I'm lucky that it usually doesn't take much to get me back on track.
Until Covid-19. Then there weren't enough moments in the day to eat and go to the bathroom, much less for "self-care." I spent my nights replaying my days — had I made the right decision in choosing one antibiotic over the other? Did I remember to wipe down my phone with alcohol after I stripped my scrubs off and washed my hands? Was I endangering my children by hugging them after a day on the Covid-19 unit, even though I'd stripped in the basement and streaked naked through the house to the steaming hot shower and scrubbed every surface of my body with soap until even my eyelids were raw?
I know I wasn't the only one having a hard time sleeping. Between a constant barrage of information from the news media, so often slanted beyond usefulness by both sides of a polarized aisle, and a world seemingly out of a late night special on the Sci-Fi channel, many were struggling with the same thing.
And losing sleep leads to increased irritability, decreased mood, and impaired memory, among so many other detriments.
Which leads to more and more worry.
Which leads to lying awake at night, praying for sleep as a farmer prays for rain.
Now, months later, as numbers have dropped and things don't seem quite so bad locally, I'm able to sleep better. I'm back in the clinic, mostly dealing with the day-to-day of a family practice. I'm slowly restarting my self-care routines, starting with meditating for 10 minutes first thing in the morning. It helps. I'll start running again soon, hopefully, and that will help, too.
That's how chronic conditions work. There are moments of exacerbation and times of recovery and, hopefully, periods of remission. For insomnia, and so many other conditions, a pandemic is nothing if not exacerbating.
But if you too are lying awake at night, wondering when things are going to get better, let me reassure you: It may be a process, but there are steps you can take. You can start with some of the ones I mention here, or you can ask your doctor for other options. You can take it one day at a time, knowing that the little things will add up.
And I'll be right there with you, doing what it takes to get back on track.
Joshua Potter, D.O., is a physician with Stony Brook Southampton Hospital's Meeting House Lane Medical Practice who specializes in family and neuromusculoskeletal medicine. He oversees the practice's Shelter Island office. Opinions expressed in this column are his personal and professional views and not necessarily those of his employer.