I can’t sleep.
In and of itself, this isn’t really surprising. Insomnia is a side effect of chemo, along with night sweats, for which my oncologist prescribed Gabapentin. The Gabapentin is supposed to make me sleepy, too, but it doesn’t.
Honestly, sleeping has never been my strong suit. The first time someone commented on my lack of sleeping was a professor during my summer abroad in college who noticed I was always prowling around the dorms where we stayed in England. He theorized that I had something on my mind. Well, yeah. I always do. I remember lying awake as a kid in Detroit wondering how we’d all get out of our second story bedrooms if there was a fire. After a while of thinking about this, I’d inevitably conclude that my dad would figure it out (hypothetical thanks to my Dad!). Other times, I’d get annoyed that I could never remember falling asleep and try to stay awake so I could see what it felt like to fall asleep (I don’t know how to explain that one. I was a weird kid.)
In law school and for most of my 20s, I slept 4 hours every night. It worked well with studying and then big-firm associate hours combined with keeping up an active social life. It probably wasn’t until 10 or 12 years ago that I started reading things about how important it was to sleep, how lack of sleep led to obesity and other health issues. I started trying to sleep more to help me lose weight, honestly, but it was easier said than done. Then I hit 40, and I think there’s a hormone shift somewhere around there, because I noticed a lot of my female friends started complaining about not being able to sleep, either.
Over the years I’ve tried various things. I don’t like to rely on pills but I’ve tried warm baths, warm milk, melatonin, tryptophan, and yes the occasional Advil PM, muscle relaxer or anti-anxiety med when it’s really bad and the other option is staying awake all night. I have great sleep hygiene (if I do say so myself). I’m plenty tired. I just…don’t sleep. This problem has escalated again since my diagnosis.
The reason this is bothering me now is because of the things I think about at night. It used to be random thoughts about the world, or something I read, or how far I needed to run the next day, or whether or not I missed a deadline in a case. Since I was diagnosed, my thoughts are more emotional and a lot of nights I find myself wide awake with tears streaming down my face. Some of these thoughts are as you’d expect – is the cancer really gone, will it come back, will the side effects of treatment cause problems down the road, is this going to kill me? Some of them are about the kindness of other people, my doctors, my family, my friends. The other night I found myself mourning Grim and Milo, my cats that died nine years ago. There’s no one to talk to at night and even if there was, I wouldn’t know what to say or how to explain it, or how they could help.
The insomnia seems to be worse the night before chemo. I’m no longer anxious about the chemo itself, it doesn’t hurt (other than the cold caps) and it’s actually kind of a pleasant environment. Plus, I get to spend time with Tony and usually a friend too. But going to chemo reminds me that this is serious, that even after they cut the cancer out they’re so worried about it coming back one day that I need 16 rounds of really strong chemotherapy and then 28 rounds of radiation. The other week at chemo I met a woman who is going through treatment for breast cancer for the third time. It’s anecdotal, I know. But it strikes me that no one can promise me this is going to work or that if it does work, it will work forever. And what’s worse is that I can’t control any of it (most people who know me would agree that control is probably my biggest issue here).
Last week the PA at my oncologist’s office suggested I try a Lorazepam with the Gabapentin, “unless you think that would be too much?” she asked. I looked at her blankly and explained, “last night I took a Gabapentin and 10 mg of Valium, and I was awake until 1 a.m. and woke up at 5.” “Oh,” she said.
I think the best thing about running (or working out with my trainer) in the morning, including the mornings of chemo, is that it clears away the night. Even if it’s dark when I set out, by the time I come home the sun is up and the cobwebs of the night are swept away by the light and by the pounding of my heart and the sweat dripping from my forehead. Like the monsters under the bed of a child, during the day my fear is gone and my thoughts are mostly positive.
It’s only knowing the morning is coming that gets me through the longest nights.