Case Files: Adult Insomnia
Background
I never had much trouble getting to sleep at night (initial insomnia). My challenge was waking up in the middle of the night and looking at the clock to see if it was time to get up (not at 3:00 AM!) or else laying in bed until about 4:00 AM and finally getting up earlier than I wanted (terminal insomnia). I've always been one who does better with about 8 hours sleep at night. So when I'd get less sleep than that, or the quality of the sleep was less, I would suffer the next day.
My sleep hygiene was always pretty good. We live in a quiet neighborhood so we can leave windows open at night and keep the bedroom cool. We have some sources of white-noise going all night to soften any interrupting noises. We own a comfortable bed with a quality mattress. I go to be bed at the same time and usually get up at the same time (unless insomnia rules). No stimulants late in the day, no alcohol at night (can help you get to sleep but interfere with the quality of sleep). I routinely watch some TV and then go to bed and read for about an hour before getting sleepy while reading. Lights out, asleep within minutes. My biggest hygiene challenges are Rosie and Riley, our two miniature dachshunds who sleep with us. If they're restless at night and keep changing positions snuggling up next to me all night, that can be a problem. But ordinarily having them with us is a comfort, not a challenge.
Recent changes in our therapy practice had put a big challenge on my sleep. We were providing new services, there were enormous learning curves on the technology we were using, my billable hours had shot up from mid 20s each week to over 40 hours each week, and there were plenty of administrative tasks that screamed for attention. As a result, I was experiencing a ton of terminal insomnia. I was regularly awakening between 2:30-3:30 AM. I would try to shut off the mental ruminations with in-bed meditation. I began to take time-release melatonin in an effort to soothe my sleep, but it wasn't working. I knew I could do better by adding more exercise to my daily routine, but my schedule screamed "NO"!
I knew I could correct the situation using neurofeedback, but I wanted to take this opportunity to see how effective our new line of cranial electrotherapy stimulation (CES) devices worked for insomnia. We had arranged to become new distributors for Alpha-Stim® and purchased ten units for use by our patients who might benefit from this technology. I was excited when the first shipment arrived on a Thursday and decided to do one-person research (case study) on me and my insomnia and write about it so others could share the experience. The result is this article.
The First Use 
I opened the Alpha-Stim SCS box, removed the unit, inserted the battery, wet the felt electrodes on the ear clips, set the timer for 20 minutes, attached the ear clips to my earlobes, turned up the dial to "2" (200 µA), and sat down at my laptop to scan some documents. I didn't have the luxury of time to just watch TV or read while doing the treatment as the instructions has suggested. Almost immediately I noticed the tingling sensation on my earlobes, but I also noticed my stomach becoming slightly queasy. I decided to monitor that queasy feeling and adjust the dial down later if I needed (turns out I didn't need to adjust it down--my system got used to it). I continued with my scanning efforts but my computer software was not cooperating. Ordinarily this would be an issue. Ordinarily I would try to be calm, but cursing would ensue and my voice would get louder as I talked to the laptop and printer and asked them why the heck they weren't working, didn't they know I had a deadline and needed things to work right now?! I will admit to a bit of initial mumbling to my computer, but the Alpha-Stim was already producing an abundance of delta waves and I was starting to soften--my emotions were not so intense, my vision softened, and I became less perturbed by the difficulties of my computer scanning problem. Proof of the effectiveness of the Alpha-Stim was that I stayed with the computer problem for 40 minutes (!) and never cursed at it! When I had solved the problem, Sherri and I went out to lunch. I drove and was OK, but I had some lightheadedness. I noticed some difficulty finding the correct words I wanted to say. I knew this was probably the initial alpha wave surge that comes after treatment and just enjoyed the feeling. A few times I actually felt a bit giddy and just went with the flow. I knew the effect wouldn't last, so my afternoon patients had nothing to fear.
I realized that a single treatment would have little lasting effect, but that night I forgot to take melatonin at bedtime. It turned out that I didn't have too bad a night's sleep, but I wasn't sure the CES treatment had anything to do with that. I decided to discontinue any further use of melatonin at bedtime to see what the Alpha-Stim could do on it's own over time. I knew it would take 2-3 weeks to get significant relief, but I wanted this case study to be meaningful.
The First Weekend
The next day I used the Alpha-Stim at the office in the morning for 20 minutes before we began to see any patients. I noticed two things on the second use: there was no more queasy feeling at the 2 setting, and I didn't get the heavy softening effect during treatment--no giddiness, no trouble finding words, just simple relaxation. I knew this was probably the brain's way of responding to a now familiar stimulus--the response to treatment at the same intensity level would not be so immediately remarkable. I continued throughout the day seeing 8 of 9 scheduled patients and never felt overwhelmed by the demands of my practice. This was unusual for a Friday at the end of a busy week.
That night I awakened in the night and looked at the clock but remembered it was the weekend so the demand for sleep was less intense. I did sleep somewhat more relaxed. There was less ruminating in the middle of the night. I thought of job-related tasks that needed to be done but I was able to let go of those thoughts and drift back to dreaming. There was no need for in-bed meditation to go back to sleep.
I awakened Saturday morning feeling refreshed, and I had my regular backache that has plagued me for months on end. I knew that some stretching exercises and a warm shower would take care of the backache. Saturday was a productive day at home doing a lot of office work, but we also got out for a good walk with the puppies and enjoyed the Colorado weather. During Saturday I decided to ramp up the treatment efforts. I used the Alpha-Stim for 60 minutes in the morning at about a 2.5 setting while watching some TV. The slight increase in intensity created no side-effects. Just before supper I used it again for 20 minutes at a setting of 4, but backed it down to about 3.5 for the last 8 minutes to stop some mild queasiness the higher intensity level had created. By 8:00 PM that night I could not keep my eyes open in front of the TV so I went up to bed and read for an hour before falling asleep.
Sunday morning I got up after nearly 10 hours of basically uninterrupted sleep. I did check the clock once or twice but I quickly drifted back to colorful dreams rather than any black and white ruminations. Even laying in bed in the morning with Rosie and Riley licking my face I could drift back to sleep. When I got up, I felt refreshed, comfortable and I had no backache! That's when I remembered that CES technology is used for the treatment of pain as well as anxiety, depression and insomnia. But this might be a coincidence, so I thought I'll just watch and see how this back thing develops. I completed one 60 minute treatment starting at level 4 but backed it down to about 300 µA as time went on. No lightheadedness, no ear tingling. Had a good productive day.
When I went to bed Sunday night, I did not slump into sleep as I usually did. I lay in bed with my mind feeling like it was revving at a new idle speed, as though my engine had been tuned up and I was no longer idling at a slumbering slow 400 RPMs, but now I was at about 800 RPMs. I was initially concerned, fearing I had done too much treatment and had pushed myself into the land of initial insomnia. It took me longer to fall asleep that night. I was awakened by Rosie barking downstairs sometime around 1:00 AM, got up to check, came back to bed and immediately went back to sleep for my weeknight 8-hour limit. Basically, it was a good night's sleep. I never looked at the clock that night, and when I woke up Monday morning I felt refreshed, and again I had no backache! There was stiffness to be sure, but not the throbbing pain I had become accustomed to having on awakening. I was beginning to believe the Alpha-Stim was truly helping my back pain as well as my sleep. I decided to restrict my treatments to 20 minutes a day during the week at around 200-300 µA.
The Next Week
By the time I got to the office Monday morning I was really revved up, like I had had several cups of coffee (and I only drink decaffeinated). I realized then that I had overdone it Sunday by treating at level 3-4 for 60 minutes. It showed up in my last night's sleep, and it showed in my over-activation at the office. By noon, the feeling of over-activation had warn off. I decided then to continue daily treatment for 20 minutes at 200 µA and not go above it. I was getting the benefits of the treatment, but by pushing the limits I was starting to get side-effects I didn't need or want. Higher intensity is not necessarily better with the Alpha-Stim. You need to find the intensity setting that gives you the results you want or need, and no more. Repeated use (time) and a lower setting were all that was needed to achieve the results I wanted.
I continued to treat myself at 200 µA for 20 minutes a day. I continued to sleep well, soundly, and if I awakened for a moment in the middle of the night it was without ruminations, gently returning to sleep. I continued to awaken refreshed. Sherri reported that by the 6th day I was no longer snoring when I lay asleep on my back! I basically achieved my goal of overcoming insomnia in one week, not three, but I would continue on. My real goal was to sleep like a teenager, not just overcome insomnia.
The Second Week
Our stress levels picked up even higher during the second week of my research for this article. A dear friend of ours and her son moved into our home because our friend's health was failing. We shared the responsibilities of feeding, providing medication and support for her. Long days at the office were followed by long nights providing care. We went to bed mentally, emotionally and physically exhausted. I slept without a problem. Sometimes circumstances like this can be so overwhelming that they force you to sleep. But our schedule was such that one or two nights went by when I hadn't used the Alpha-Stim because of our hectic schedule. My sleep began to slip on those nights. I realized early warning signs that I was heading back into a less restful sleep that would become insomnia if left untreated. Despite our hectic schedule, I recommitted to regular 20 minute sessions at 200 µA every day thereafter. I then continued to sleep rock solid for the rest of the second week, despite major challenges.
Around 1:00 AM one morning I was awakened by Rosie crying to get out of our bedroom. I thought she needed to go out in the yard for a bathroom break, but she just wanted to go downstairs and visit with our friend and her son. I was frustrated by Rosie's actions and took her back up to our bedroom to return to sleep. At 3:15 AM the same morning the phone awakened us. Our friend's alert system had gone off so we went downstairs to check it out. It was an accident so, again, we returned to bed. The next morning I knew I was over insomnia. I had been awakened twice in one night from a deep sleep and on both occasions I returned to sleep easily and woke up the next morning feeling refreshed. I can't remember that ever happening to me in my adult life.
The Third Week 
Week three began where week two left off. Still providing care for our friend whose health was failing fast, a springtime snowstorm to challenge our Hospice providers, and a growing weariness despite getting a decent night's sleep. Sometimes life can challenge our emotional resources even if we're sleeping well. There's nothing like a good night's sleep, but there's more to a good mental attitude than just sleep. I continued to be thankful for the quality sleep I was getting thanks to the Alpha-Stim. Life could be worse; it could get more mentally and emotionally stressful than what we were dealing with, but this test period for the Alpha-Stim was way beyond the normal curve. Part of the appeal to this device was knowing at the time that no matter what life dished out to me, I was going to be able to deal with it and still get a good night's sleep. By the end of the three weeks, I continued to sleep without disturbance, without early awakening and ruminating, and I continued to awaken feeling refreshed and without stabbing backache pain as a bonus. For the purposes of this research article my work was complete. I will continue to use the Alpha-Stim on an as-needed basis to keep my sleep stable and when life slows down a little I know I'll be sleeping like a teenager.
