Hello, welcome to my blog! I’m so glad you stopped by. I’m a new indie author that loves to read and write. I decided to create a blog to give my books more exposure and to write about my ideas and anything interesting that’s on my mind. I’m a regular person who loves to read and talk about it. I’ve been reading like crazy I was a kid and I haven’t stopped. Reading fiction and non-fiction got me through some very difficult times in my childhood and adult life. I was very into mystery books in my teen years devouring every Nancy Drew book out there. Someone recommended Sue Grafton mystery thriller books to me in my young adult years and now I’m a sucker for romance stories with some inspiration books thrown in there occasionally when I need some emotional uplifting. I recently started delving into the world of writing and self-publishing. It’s an exciting world full of ups and downs but I write because I enjoy it and its’ an emotional outlet for me. I’ll keep writing as long as I keep enjoying it. Check out my books and ramblings by following me. Thanks again for stopping by!
Skye Bailey is the pen name of an author who lives in the United States. She likes to write heart-wrenching, dark romance stories with characters that have gone through hardship and abuse and have survived and become thrivers. The author herself has gone through many struggles in her life and sometimes incorporates those struggles into her stories. Her stories will almost always have HEA endings because the author loves to give her characters hope and happiness in the end after much hardship. You may contact her through her email at firstname.lastname@example.org
The ability to focus seems to be increasingly endangered by our modern lives. What we hope will be a few hours spent in a creative flow taking care of important tasks at work, for example, is often interrupted by the pings and dings of a nearby cell phone.
But unlike the many who advocate for avoiding your smartphone altogether, engaging in a digital detox, or transitioning to a flip phone, Eyal doesn’t place the blame entirely on the technology that clamors for our attention. Each of us has a personal responsibility to resist temptation and to focus, he explains, no matter what gadget or gizmo enchants our minds next.
It makes sense that Eyal is measured in his approach to tech; after all, he also wrote Hooked: How to Build Habit-Forming Products, a guide for developing products that influence our behavior and keep us coming back again and again. But he also reminds us that before phones and the Internet, there was television and radio, both of which were seen as culprits of distraction by past generations. Furthermore, Eyal once attempted his own digital detox, purchasing a 1990s word processor without Internet so he wouldn’t be diverted while penning his book. He soon found himself flipping through books on his shelf instead of working. “Removing online technology didn’t work,” he remembers. “I’d just replaced one distraction with another.”
Eyal explains that all of our behaviors fall within a continuum: on one side there is traction, that is, actions that draw us toward what we want in life, and on the other, distraction, actions that pull us away from what we really want. Eyal argues that you can choose traction, that you can learn how to be “indistractable,” which he defines as “striving to do what you say you will do.”
Here are three key takeaways from his book.
We’re in charge (not our phones)
Our devices often “gain unauthorized access into our brains by prompting us to distraction,” Eyal writes, and, unfortunately, “the more we respond to external triggers, the more we train our brain in a never-ending stimulus response loop.” All behaviors require motivation, ability, and a trigger, he explains.
It’s up to us to “hack back” by getting rid of unwanted triggers. “By hacking back our phones, we can short-circuit the external triggers that spark harmful behaviors.” First, remove apps you don’t use that result in notifications and visual clutter. Second, remove the apps you do use and love and fit them into your schedule in a different way. For instance, instead of mindlessly checking Facebook notifications all day, set aside an hour to scroll through your news feed daily on your computer. Or if you really like a certain news app, spend time reading the articles on your web browser instead.
By rearranging your apps in a way that decreases clutter and reclaiming your time by changing your settings, you can put yourself back in control of interrupting alerts and triggers.
Rely on a plan, not your willpower
Mastering distractions takes foresight and planning more than willpower in the moment.
One of Eyal’s main strategies is to “timebox” your calendar, in other words, to start with a daily schedule instead of a to-do list. This means filling in all the white space in your schedule with everything you want to do so that you have a template for how to spend each day (in psychological terms, “setting an implementation intention”). While some may consider this limiting, Eyal argues that we are actually more successful with constraints. “Limitations give us a structure, while a blank schedule and a mile-long to-do list torments us with too many choices.”
Another one of Eyal’s techniques uses the “Ulysses pact,” or a commitment to your future self (think marriage or retirement accounts). One example he gives involves social pressure. For a period of time, Eyal asked a friend and fellow author to do 45-minute “work sprints” with him, in which both committed to working without stopping. Both found it helped keep them on track.
Mastering distractions helps us live according to our values
Mastering distractions doesn’t only aid our productivity; it helps us to be true to our values. Instead of simply reacting to external or internal triggers, we can craft our lives intentionally.
It’s critical to first reflect on your values, Eyal says, and the qualities of the person you wish to be. Then, the way you spend your time will fall in line. For instance, one of his poignant stories in the book is his regret over missing a magical moment with his daughter when he was lured away by his phone. As a remedy, he blocked off time in his schedule every Friday afternoon to fully engage in an activity with her (pulling a note out of a “fun jar” to determine the outing or special occasion). “Having this time in my schedule allows me to be the dad that I envision myself to be.” He writes:
If we chronically neglect our values, we become something we’re not proud of—our lives feel out of balance and diminished. Ironically, this ugly feeling makes us more likely to seek distractions to escape our dissatisfaction without actually solving the problem.
You can be proactive in setting yourself up to focus on what matters most while minimizing distraction. And Eyal writes that you can even influence others to also strive to do what they say they will do.
“In the workplace, we can use these tactics to transform our organizations and create a ripple effect both in and beyond our industries,” Eyal says. “At home, we can inspire our families to test these methods for themselves and live out the lives they envision.”
Hannah Belcher and her mom walked into an assessment meeting with a young doctor. Together, they answered the physician’s probing questions: was Hannah good at making friends? What about the little oddities in her behavior—her dislike for particular colors and textures, especially things that were moist? Then they talked about her preoccupation with certain books and movies and her trouble understanding other people’s emotions.
After three hours, the doctor said, “Usually I need some time to go through the evidence or talk it through with my supervisor, but I think the evidence is pretty conclusive.” Hannah had Asperger’s Syndrome. What may surprise you is that Hannah and her mom weren’t at the assessment because of a referral from a pediatrician or concerns from an alert elementary school teacher. As a matter of fact, Hannah was a 23-year-old woman with a psychology degree when she found out she was on the autism spectrum.
The reason for this is partly rooted in the story of how scientists 75 years ago took the first steps to find answers for families struggling to help their children. But ultimately, it’s because men and women are different, and often, so is how they experience autism spectrum disorder, or ASD.
In the beginning: all about the boys
When psychiatrist Leo Kanner produced a small study in 1943 that described autism for the first time, there were almost three times as many boys represented in his research as there were girls. Hans Asperger, for whom the so-called “high functioning” version of autism is named, published his own study in 1944, which looked only at boys. It makes sense, then, that as experts developed tools for diagnosis, they’d mostly be looking at characteristics of the males who were so heavily featured in the early research. Given that boy-influenced profile of autism, it’s not surprising that today four times more boys than girls have been diagnosed as having ASD.
Initially, some people believed girls couldn’t be on the spectrum at all; later, a consensus formed that ASD was just more rare in women, and when it did occur, was more severe. But as time goes on, experts are realizing that autism in women is not necessarily either of those things. It’s just different from autism in men.
Those differences often allow a woman to “pass” as neurotypical. For example, she may not be involved in the stereotyped “special interests” associated with ASD, such as trains or computer games. Instead, a woman’s interests may center on the arts or media with fantasy elements, like Disney movies or Lord of the Rings. Women on the spectrum bring an intensity to their hobbies that distinguishes them from their typical peers, but if those hobbies are acceptably “girly,” their wider community may not recognize how unusual they are.
What’s more, studies have also shown that women with autism are more motivated to socialize than men with autism. On their own, they can pick up skills to help them navigate the neurotypical world, though it may cost them an exhausting level of effort. Dr. Cynthia Martin, a clinical psychologist at the Child Mind Institute’s Autism Center, told me about one such example from her practice.
“A young girl I recently evaluated walked into my office with a big smile. She made eye contact, responded to my greeting, and then proceeded to ask if I like puppies, before telling me about a time that she helped watch her neighbor’s puppy. Had I not known better, I would have thought this little girl had excellent social skills!” Dr. Martin said. “I knew though, from her mother, that she always does well with greetings and that she tells everyone the exact same story. The story was not of her own personal experience, but instead from an episode of a cartoon.”
Boys with a developmental disorder may express their frustration with anger, which attracts immediate concern and attention. But girls are trained by society to appease, not get mad—and that includes girls with autism. “When girls are more cooperative and less disruptive, they are less likely to be referred for an evaluation even if they are struggling with social communication and social relationships. In other words, their vulnerabilities are masked by their strengths,” Dr. Martin notes.
In her book,Autism in Heels: The Untold Story of a Female Life on the Spectrum, Jennifer Cook O’Toole describes how women do their best to blend in with their neurotypical peers, using an arsenal of strategies to camouflage their social struggles. To avoid eye contact without bothering her conversational partners, O’Toole looks into the middle distance and angles her head just-so to convey a sense that she’s listening. She learned to do this through her involvement in the theater world—and indeed, being a woman with ASD often means living life as a sort of actress, memorizing social rules almost as though they are stage directions, or copying the dialogue from movies or TV shows. O’Toole, by the way, was diagnosed at 34.
One consequence of camouflage that’s perhaps too successful is that women with autism struggle not just to get a diagnosis but to have others accept that their condition exists. They can receive a string of misdiagnoses—being labeled with depression, borderline personality disorder, or anxiety disorders—and spend years treating those conditions, only to discover later on that all those were secondary sufferings influenced by the real obstacle: ASD.
Sarah Hendrickx was inspired to write her book, Women and Girls with Autism Spectrum Disorder, after she brought her son in for his own assessment appointment. She mentioned to the psychiatrist the family’s extensive history of autism, including her own position on the spectrum, which she learned of at age 43. She wrote about what happened next.
The psychiatrist questioned my diagnosis, asking who had diagnosed me. He asked how I could have autism because I didn’t look like I had autism and I was having a two-way conversation with him. I replied that maybe it’s because I’m an adult and a woman. He looked at me incredulously and said, with obvious contempt, “Are you trying to tell me that being a woman makes a difference?” . . .
I knew there was nothing I could say. I shut up and hoped that we could just continue what we had come for. I waited until we had left the room before I cried and exploded with frustration. I wish this was the only occasion where I have had to justify my diagnosis because I don’t look autistic enough, but it isn’t and it won’t be.
Besides the struggle to wrest a diagnosis from a world that too often sees autism as a men’s issue, the intersection of womanhood and autism presents its own unique puzzles. Perhaps the most potent struggle: relationships.
“I’ve found in my experience that I’m a lot more trusting than my neurotypical peers, and this leads me to not always see when someone has duplicitous intentions,” Amy Gravino told me. She’s a certified autism specialist, writer, and consultant who’s been diagnosed since age 11. “I believe what people say up front, because I’m very up front. That leads to a lot of women on the spectrum being taken advantage of. When people can see your heart so clearly, it’s so much more vulnerable to being broken and being abused.”
Research has repeatedly found that people with autism are sexually victimized at stunningly high rates, sometimes two to three times the rate of the general population. It’s not just an inability to read social cues that poses a threat: the social isolation women on the spectrum often experience puts them at risk, too.
“Because we often don’t have a lot of the same learning experiences we can end up in abusive relationships not even realizing they’re abusive,” Gravino says. “We don’t always realize what abusive behavior even looks like. We think, ‘If a guy wants to always know where I am and whom I’m with, that must mean he really cares about me!’ Or, ‘I don’t know what I’m doing, therefore I have to listen to him.’”
In Autism in Heels, for example, Jennifer O’Toole describes a gift her then-boyfriend once gave her before she went on a beach vacation: a white undershirt with “Hands off, I have a boyfriend” hand-painted on the chest and the word “Taken” on the back. “God help me, but I thought it was the cutest, most romantic thing ever,” she writes. She had a friend take a picture of her wearing it as a souvenir.
“Often times women on the spectrum are made to feel they aren’t allowed to have standards,” Amy Gravino says. “That makes us vulnerable, because we’re accepting any crumbs that are thrown at us, at the same time not realizing how much danger we could wind up in.”
Friendship, fraught with peril
From an evolutionary perspective, friendship for women is a survival strategy. By forming alliances with each other, we can protect ourselves and our families even though we usually aren’t as physically powerful as our guy counterparts. But for women with ASD, navigating those relationships with female peers is not easy.
For one thing, the same vulnerability that can make women on the spectrum easy prey for sexual abusers also puts them at risk for bullying and exploitation from “friends.” They can be manipulated by “mean girls” into humiliating themselves or even taking part in bad behavior, and then be convinced to take the rap when their friends get caught. Liane Holliday Willey, who was diagnosed at age 35, devotes an entire chapter in Safety Skills for Asperger Women: How to Save a Perfectly Good Female Life to dispensing advice on how to socialize safely, admitting that “it took me decades before I could openly admit how many times others had victimized me.”
“My best friend is a woman and is a wonderful person, but it’s not been easy,” Amy Gravino told me. “One of my biggest fears is that I’ll eventually drive away all of my friends, just by virtue of being the way that I am . . . the other thing that I’ve had to learn is that sometimes a friendship might end, and it’s not my fault. Many autistic people operate from a place that if something goes wrong, it’s automatically my fault—I’m the broken one, the autistic one. It took me a very long time to get out of that head space and realize it’s not necessarily my fault if a friendship goes belly-up.”
Gravino has struggled with friendships that ended abruptly and without explanation, being ghosted by a former close confidante who dropped her cold. “For me, that’s absolutely the most devastating thing, to not know why,” she says. “Because how on earth can I know what I did wrong if nobody says, ‘This is what happened?’ ‘I don’t deserve to have friends, I’m too difficult to love’—that’s what I believed about myself for a very long time.” With hindsight, she gained the perspective that she is not responsible for carrying the burden of toxic friendships.
Gravino has leveraged her insights on the ASD experience in her busy life as a TEDx speaker, coach, consultant, and writer. She’s authoring a memoir about her experiences navigating the landscape of relationships and dating as a woman on the spectrum. Addressing women who may be seeing an image of themselves emerging in this description of autism, she says, “I know it’s scary. But if this is a part of who you are, you’re still the same person you’ve always been. This just helps to fill in those missing pieces. And know that the journey is different for everyone. There’s no one way to be a person with autism.”
Though I come from a line of excellent gardeners (both my grandmother and my mother can make anything grow) I can’t make a claim to a green thumb of my own. I’m an amateur in the original sense of the word—I love plants and gardening, and often pore over seed catalogues and tiny seedlings. I don’t make my selections with real skill, though, and enthusiasm for plants often leads me into unrealistic purchases; my new green friends sometimes meet early graves.
But my eyes still stray to the colorful displays in front of grocery stores and nurseries—petunias and fuschias, roses and marigolds. And now that plants can be outside (thank goodness!) I’ve put some thought into the form of gardening that fits into almost any lifestyle: planting in outdoor pots. Pots are versatile, interesting, and can even be multi-season (I’ve seen a potted tree brought indoors for the winter), and they can go with you for minor moves. Plus, outdoor pots are pretty low-maintenance: put them outside and, at least occasionally, they’ll be watered for you.
Here’s a beginner’s guide to starting a potted patio garden, complete with the advice of the green thumbs who are helping this little brown thumb along:
First things first, supplies. Avoid my fatal flaw as an amateur gardener: your pot needs to have a hole in the bottom. If the pot doesn’t have a hole, the water can’t drain out, and your plants can become waterlogged. I like the classic terracotta pots because they’re inexpensive and pretty. But some experienced gardeners don’t recommend them because they break easily; they can also get moldy because the water seeps into the walls of a terracotta pot. If you’re worried about that, choose something with a glaze that waterproofs the pot. And don’t be embarrassed to just get a plastic pot: they come in pretty styles and colors that can blend into the rest of your decor. Then you’ll need potting soil—potting soil is different from gardening soil because it has fewer potentially harmful bacteria. For this reason, potted plants are less likely to get the bacterial diseases you can run into with plants in the ground. While you’re at it, I’d recommend picking up a cute watering can or two to make watering a fun experience!
If you don’t have a dedicated nursery or garden store near you, both Home Depot and Lowe’s have extensive and reasonably priced garden sections where you can buy pots, plants, and other supplies. You can also try ordering online: Burpee and Gurney’s are well-established seed companies that also stock plants and gardening supplies. What I like about these two websites is their awareness of your geographical location (they tell you what gardening “zone” you are in based on your location). So much about gardening depends on where you are in the world that ordering random plants from a more generic retailer like Amazon could go wrong fast. For that reason the best way to go, if it’s available to you, is to duck into a small local store where a real gardener can give you plant advice!
Picking your plants
This is where the real magic happens. The plants that are right for you will vary widely based on region, but here are a few that can thrive in places as widely different as southern California and the northern Midwest. Traditionally, for a big (say, knee-high) pot, you want three different kinds of plants: a “thriller” to be the center of attention, a “filler” to fill the bulk of the pot, and a “spiller” that will cascade dramatically down the side of the pot. Here are some easy-care options:
Dahlia: These lovely star-like flowers come in a wide variety of colors and will happily steal the show in any pot.
Fuschia: These little blooms look like elegantly-clad ballerinas! They will elevate any pot.
Geranium: Geraniums are sturdy container-gardening classics that come in a wide variety of types and colors.
Coleus: I’m always fascinated by the kaleidoscope of coleus colors at the garden store. Low-profile and easy to care for, these leafy plants come in a variety of colors and patterns and will happily fill the empty space in a pot.
Dusty Miller: This silvery, dusty-looking plant is a very happy filler for zones 7-10 (that means you want to be in a warm climate for this one). I love the unusual color of Dusty Miller plants and their intricately-sized leaves.
Lamb’s Ear: Another silvery plant, this one is fun because it feels fuzzy and soft (like a lamb’s ear!) It’s a nice alternative to Dusty Miller for slightly cooler climates (zones 4-8).
Sweet Alyssum: I love alyssum because one little plant bursting with tiny white-or-purple flowers can turn into a huge frothy waterfall before the summer is over. It’s an easy-to-please plant with a fresh scent.
Million Bells: These are lovely if you want a more traditional flower shape to your spiller plant; it has pretty little petunia-like blooms.
Trailing Lobelia: Lobelia’s quirky little blossoms range from a beautiful blue to purple and make a lovely spiller plant. Make sure you get the “trailing” version.
Or, do it the easy way
If the thriller/filler/spiller combo is just feeling like too much, there’s always the easy way out: a one-plant showstopper. The easiest way to do this is to buy a Supertunia or other petunia. Petunias are virtually indestructible and give you a lot of bang for your buck. Colorful and vivacious, they’ll brighten up any patio garden in full sun and will gladly take over a huge amount of pot real estate. Or try a smaller pot with any of the “thrillers” above for an easy-maintenance, simple pot.
If you want to be practical, there are various vegetables that can be grown in pots: try tomatoes, spinach, lettuce, carrots, or even some versions of zucchini and cucumber. A variation on that theme is companion planting: two complementary vegetables planted in the same container can help one another thrive. A small potted herb garden can thrive on your windowsill even as summer eases into fall.
Don’t be afraid to do what works for you. A friend of my grandma’s plants her vegetables directly in the bag of soil. There are plenty of herb gardening kits that give you everything you need but water. And you’re still a real gardener if you pick up one of those pre-planted hanging pots at the grocery store! The health and psychological benefits of gardening can be reaped by everyone—green thumb or brown.
Feeling emotionally stuck but not sure who to reach out to? Maybe you’re finding it difficult to connect socially with others; maybe you’re struggling in your relationship or with drug or alcohol abuse. You may be experiencing anxiety or depression. Or maybe you simply want to be proactive about your upcoming wedding and hope that premarital work will help you start the next chapter off strong.
Wherever you are, there is help. In fact, there is a world of professional helpers out there so you don’t have to go it alone. But as some clients have shared with me, it can be hard to know what all the letters behind someone’s name mean and whether they can really help. There are psychologists, psychiatrists, counselors, social workers, marriage and family therapists, career coaches, executive coaches … the list goes on!
First, let’s get a bit more clarity on the types of helping professional out there.
A licensed counselor (LCPC), social worker (LCSW), marriage and family therapist (LMFT), or psychologist (PsyD) are all qualified to provide talk therapy. Talk therapy is also synonymous with psychotherapy or counseling, where the client expresses their thoughts and feelings to a therapist who can guide them in gaining more insight, self-awareness, and coping strategies to reach the client’s goals around well-being. (The American Psychological Association has helpful information in this article about some of the basic differences between these professions.)
A psychologist has a masters degree as well as a doctoral degree. You may see M.A., PhD, PsyD, or EdD behind their name. A psychologist is able to prescribe medication in certain states but primarily does talk therapy.
A social worker will have a two-year masters degree focused on human behavior, psychotherapy, and community resources, plus two to three years of supervised clinical work. You will see the letters MSW or LCSW behind their name (or something similar, depending on the state). Social workers do not prescribe medication.
A licensed clinical professional counselor is similar to a social worker in that they also have a two-year masters degree focused on human behavior, psychotherapy, and community resources. You will see the letters LCPC behind their name, depending on the state. Licensed mental health counselors do not prescribe medication.
Marriage and family therapist
A licensed marriage and family therapist is also similar to a social worker and licensed counselor in education with a two-year masters degree. You will see the letters MFT behind their name, and they too provide talk therapy. They do not prescribe medication.
All of these licensures fall under the umbrella of therapy, and each may have a subspecialty. You will want to check a provider’s background, education, and training to determine what they treat and what client populations they serve. Some therapists only work with individuals, some only work with couples, and some work with families and groups. Some therapists may have a specialty in trauma, grief and loss, eating disorders, mood disorders, or other areas. Most providers offer a free consultation call to determine if working together is a good fit, so this may be a first step in your research.
To find a therapist, you can ask for a referral from your doctor, family, and friends, or you can go through your insurance company’s website for providers for whose services you can get reimbursement. (If you decide to use an out-of-network provider, you can usually submit a statement for partial reimbursement. Check with your insurance company to see what they cover.) Psychology Today is another great resource for providers in your area.
When talk therapy isn’t enough, medication may be necessary as part of your treatment plan. Medication coupled with psychotherapy can make for very effective care. For a medication evaluation, you can ask your therapist for a referral to a psychiatrist or look through your insurance company to find a list of names.
A psychiatrist goes to medical school and focuses on biological functioning, mental illness, and medications. A psychiatrist primarily prescribes medications. A primary care doctor or nurse practitioner can also prescribe medication for mental health. When possible, it is best to have an evaluation by a psychiatrist who can do a thorough evaluation of mental health and guide medication management.
If what you have read so far doesn’t feel like what you need, or you are looking for more specific guidance related to your career, leadership, or life skills, consider working with a coach.
A life coach is different from a therapist as they may coach on more specific topics like business or career and act more as a cheerleader as you move forward. Coaching is regulated by the International Coaching Federation, and coaches have varying levels of education. Life coaches do not guide emotional processing of past experiences or mental health issues, so when in doubt, consult a therapist first.
A career coach is trained to collaborate with you in reaching your career goals. You may want to pivot to a new career and work with a career coach around self-exploration, job search strategy, and interview preparation. A career coach may have training from various programs that are aligned with the National Career Development Association.
An executive coach works with leaders and emerging leaders to help them gain new leadership insights and strategies. While therapy may be beneficial in gaining new insight and enhancing emotional intelligence in the process, coaches focus on solutions and help to empower the client towards action. Executive coaches will also have training from various programs, so check into their background before working with them.
Now that you know what kind of helpers are out there, you can begin looking for the right person to help you move forward with more confidence. While there are many options, it’s important to reach out to a few people for a consultation call to see if they’re a good fit. Consider on your call a few questions:
Do they treat your issue?
Do you feel heard on the call?
Does the therapist or coach ask you questions to understand if it’s a good fit?
Does the therapist or coach seem present without distractions?
Once you have chosen a helping professional, consider how you feel in the first few sessions. It can take time to build trust with someone you don’t know, so ask yourself if you feel you are in a warm and inviting space. If it’s not a fit, then find someone else and don’t give up. Keep going until you find someone with whom you feel heard and understood.
Therapy or coaching is an investment of resources and energy. You don’t have all the answers when you start. But if you stay open to the process and show up over time, you will begin to feel differently and see transformation over time. You’re worth investing in, so start reaching out to a couple of professionals, ask questions, and get the support that will help you reach your goals.
Caitlin Magidson is a Certified Career Coach and Licensed Clinical Professional Counselor who empowers clients as they strive to find clarity, purpose, and wellbeing, in their personal and professional lives
I jerked awake to the sound of blood pounding like a drum between my ears. I felt part of my face go numb as I struggled to breathe, the prickles spreading from my chin to my cheeks. My bedroom was dark except for the dim red light leaking from the digital alarm clock on the bookshelf. It claimed it was 2:30 a.m. A dull wave of despair hit my chest. If that was true, I’d only been asleep for two hours. And surely after such a terrifying awakening I wouldn’t be getting any more rest that night.
I know now that this awful experience was the result of waking up in the middle of a panic attack, my first and hopefully last such misfortune. But at the time, I thought I’d simply found a new low in my weeks-long battle with insomnia … a battle I was definitely losing, one night at a time. It was several years before I learned that my sleeplessness was likely tied to changes in my fertility hormones, as my 20-something body shifted into a mysterious early menopause.
The truth that a woman’s sleep is affected by her reproductive cycle was never a topic in my high school health classes. Nor did anyone mention that girls are at a higher risk of insomnia than guys, with one out of four women suffering at this very moment. Still less did we learn that medicines, even natural options like melatonin or Valerian, aren’t the right first-line treatment for people who aren’t getting enough rest. These facts are critical information for any woman who sleeps, or who longs to one day sleep again.
Why can’t she sleep?
It’s actually in adolescence, around the same time when boys and girls are being herded through those health classes, that sleep differences emerge. Up until then, children of both sexes get about the same amount of rest.
Puberty, and the onset of menstruation, is what changes the sleep game for a young woman. Estrogen, the quintessential female hormone that builds a lining in her uterus, also happens to play a role in helping her fall asleep. Progesterone, the ying to estrogen’s yang, works to keep her uterus a healthy environment should it be occupied by a tiny guest. It also has a sedating effect. Without enough progesterone, women are susceptible to mood issues and anxiety.
Both of these hormones are present at low levels on the first day of a woman’s cycle, when her period begins. As the weeks pass and her body prepares for ovulation, her estrogen and progesterone levels soar, making it easier to fall asleep.
If the ovulation doesn’t result in a pregnancy, a young woman’s hormones then plummet, triggering menstruation and starting the cycle over again. If she does conceive, a new hormone joins the party: Human chorionic gonadotropin, or hCG. It’s generated by the baby’s placenta, and peak levels are associated with morning sickness (or more accurately, “all day and all night” sickness). When the baby is born, mom’s body once again enters a hurricane of hormonal changes.
These cycles normally last for decades, until peri-menopause, a time when hormones once again lurch around unpredictably. It’s hard to sleep on a roller coaster, even if it’s your own body running the ride.
The odd thing is, in the midst of all the chaos, women are actually capable of getting better quality sleep than men. Studies have shown that females get more deep, stage-three sleep, even as babies, and our circadian rhythms are less susceptible to age-related disruption. But millions of women may be sabotaging this evolutionary advantage with their choice of contraception: researchers have found that hormonal birth control, with its artificial smoothing of the fertility cycle, correlates with a reduction in the amount of slow wave, stage-three sleep women enjoy.
Dr. Harris points out that there is more at play than just the constant changes in our bodies. Women cope with higher rates of depression and anxiety, both of which are associated with sleep problems. We still do the bulk of the housework and childcare, even as we hold down jobs meaning our brains are constantly multi-tasking. And many of us live in a culture that regards sleeplessness as a sign of genius, selflessness, or passion for our work.
“Whenever I hear someone say to me ‘I’ll sleep when I’m dead,’ I get so frustrated,” she said. “We are getting better at prioritizing diet and exercise when possible, and don’t glorify our poor diets and lack of exercise—so why do we glorify lack of sleep? It needs to be considered a pillar of wellness just as we treat diet and exercise, and I might argue it is the backbone that’s the most important of them all.”
Searching for solutions
I agreed with that perspective when I made an appointment with my primary care physician for help with insomnia. I’d been to visit him recently for odd symptoms—numbness and painful electrical shocks in my hands (diagnosis: carpal tunnel syndrome, treatment: wrist braces). He was an incredibly compassionate doctor who had been treating me since childhood, sometimes for free when I didn’t have insurance, writing “N/C” on a little slip of paper for me to hand to the ladies at the billing desk. This happened a few times before it dawned on me that it stood for No Charge, simultaneously solving the mystery of why the ladies were always so unhappy when they saw me coming.
On this visit, however, he had few answers for me, although he was concerned when I told him I was going for days at a time without any shut-eye. I couldn’t stop my brain from flipping through my to-do list like a stack of cards; songs didn’t just get stuck in my head as I lay awake on my pillow—they somehow seemed to play at full volume, with my brain shouting the lyrics. Making sympathetic noises, he printed out a fact sheet on “sleep hygiene” for me.
Sleep hygiene is an unfortunate phrase that suggests to the insomniac that they are not just desperately exhausted, but also grimy, in the manner of an under-showered teenage hockey player. A better term would perhaps be “good sleep habits.” Certain practices, like avoiding caffeine late in the day, turning off screens to wind down for bed, or keeping the bedroom dark and cool like a cave, can help with sleep. The opposite behaviors—drinking coffee with dinner, playing on the phone in bed, or piling on warm blankets, can lead to delayed or broken rest.
The problem is that these are all common-sense suggestions. As someone who couldn’t sleep, I’d already known to try such simple lifestyle changes prior to calling my doctor. It wasn’t long before I found myself back in the doctor’s office, more desperate than ever.
Now the real journey began: we tried melatonin (didn’t work) and Remeron, an antidepressant sometimes prescribed off-label for its drowsy side effects. It made me sleep, but also gave me vivid, Freddy Krueger-level nightmares. Next, I took a swing at the over-the-counter medication Unisom. The first dose gave me glorious sleep. Alas, subsequent nights I spent awake in bed with what I can only describe as Restless Legs Syndrome, but in my hands. “This is weird and unacceptable,” I thought to myself as I compulsively clawed the air like a fatigued, pajama-clad T-Rex.
I can laugh about that now, but it is impossible to adequately describe the sense of loneliness and confusion that can accompany an eruption of insomnia. It’s not just the physical pain, the permanent headache that settles above your tired eyes. Nor is it just the solitary hours spent awake, when you’re alone with the sound of the heater turning on and off and the occasional momentary glow from a stray car headlight. It’s also the sensation of weakness; that everyone else in the world is better rested, better equipped, and not a mess.
At my next appointment, my doctor wasn’t available, and I saw his partner in the practice, who was not impressed by my suffering. He couldn’t sleep during medical school, he told me. “But my hands,” I said forlornly, holding up the wrist that was still clad in a brace. By this time I’d convinced myself that I might have a rare nerve disease, instead of carpal tunnel syndrome. “In medical school,” he replied, “we learn that when you hear hoof beats, you look for horses, not zebras.”
As I sat on the examining table, I felt tired of hearing about his medical school and tired of trying to get better.
As Dr. Harris later told me, this is not an unusual experience for insomniacs, especially women. “I’ve had plenty of patients who have told me that their male—and female—doctors have said something along the lines of ‘Oh, I don’t sleep either, it’s totally common,’ and they’re left feeling as if it is shameful to ask for help,” she says. “Other times, it is thought of as a quick medication fix which isn’t the right way to approach it in most circumstances either—the idea of ‘don’t worry, this pill will fix it all.’” Harris points out in her book that most doctors receive only a few hours of training in sleep disorder diagnosis and treatment.
I decided it was time to find an expert.
CBT-I, the real MVP
There is, in fact, an entire field of healthcare called sleep medicine. I located a doctor at a nearby hospital who specialized in something called “cognitive behavioral therapy for insomnia,” also known as CBT-I. The Google reviews were promising, and at least I looked forward to talking to someone who did nothing but help people get rest. In the waiting room, I found myself studying the other patients, trying to detect in their faces any sign that they were as tired as I was.
I was surprised when the sleep therapist told me that my mind, far from being weak, was actually powerful enough to create my symptoms, from the scary nighttime awakening, to the numb hands, to the insomnia itself. “It’s not all in your head, in that your symptoms aren’t imaginary. They’re very real. It’s all in your head, meaning that these experiences are being mediated by your brain,” she said. The theory is that insomniacs have developed negative thought and behavior patterns about sleep. By changing my thoughts, I could change my behavior, and then, my world.
For example, one common thought distortion is catastrophizing. I definitely recognized this tendency in myself. The evening after a rough night of sleep, I’d have an automatic negative thought and engage in a little fortune-telling too: “I’ve got to start getting some sleep. If I don’t, tomorrow is going to be a disaster. I’ll never make it.” Feeling anxious, I’d get into bed earlier to try to force sleep. Not surprisingly, this backfired.
CBT-I involves challenging those negative statements, recognizing that thoughts aren’t always logical and sometimes are based more in emotion than reality. My sleep therapist suggested I identify my thoughts and predictions, write them down, and then ask myself whether they were accurate.
If I don’t sleep, will tomorrow really be a disaster? Well, possibly, but I’ve also gotten through days just fine without much rest. I have, in fact, made it through every single day when this happened, without losing my job or napping at my desk. And what if it is a “disaster”? What’s the worst that could happen? Perhaps I would have a bad day at work? It’s not quite the sinking of the Titanic.
It’s important to note that CBT-I is not the same as forcing positive thoughts. It’s an attempt to help our brains get re-centered in realistic expectations. Sometimes, a specific negative thought may be completely accurate, and in that case there is no benefit to trying (and probably failing) to convince yourself it’s not.
CBTI-I techniques address behavior as well, harnessing those much-maligned “sleep hygiene” rules and enhancing them for effectiveness. One approach involves sleep restriction therapy. The bottom line of this method is that in order to sleep better, one should spend less time in bed. Gradually, an insomniac can train her body to have adequate “sleep hunger” again.
Sound a little too good to be true? CBT-I is evidence-based, with mountains of research showing that it works spectacularly well for curing sleeplessness. It has no negative side effects, does not require spending big bucks at a pharmacy or natural nutrition store, and data even suggests treatment can be effective when done over the phone or with the aid of a self-help book like The Women’s Guide.
“CBT-I is the gold standard,” Dr. Harris told me. “Many people still don’t appreciate that it is a very effective—and typically, fast—treatment that needs to have more word out about it.”
The best part is that unlike a pill bottle that runs empty, CBT-I gives you tools you can use going forward for lasting sleep success. CBT-I therapists don’t claim that you’ll sleep like a baby every night for the rest of your life—but if you do experience a hard time going to bed, you can use the simple thought exercises and behavioral changes of CBT-I right away to prevent one bad night from spiraling into a painful bout of insomnia.
Rest … at last
So what happened to me after I tried CBT-I? I got better—mostly. As my anxiety around sleep faded, the electric shocks in my hands vanished, too. I don’t think I ever had carpal tunnel syndrome. I didn’t recover completely, however, until after I got on hormone replacement therapy following my early onset of peri-menopause. The solution for my insomnia turned out to involve gathering a constellation of treatments, all of which worked with my mind and body, instead of against them.
“Progesterone is an incredible help for women and sleep,” says Teresa Kenney, a womans health nurse practitioner who has been in practice for 20 years. Currently, Kenney works with women struggling with sleep at the St. Paul VI Institute’s National Center for Women’s Health, and her work includes evaluating whether patients are experiencing hormonal sleep disturbances common in the fertility life cycle.
“When taken orally, progesterone is quickly broken down into allopregnanolone … It affects [neurotransmitter] receptors in our brain, promoting relaxation and sleep. I rarely meet a patient who doesn’t love the way progesterone improves their sleep,” she told me. Kenney recommends natural or bio-identical hormones. “The progesterone that is found in birth control pills—progestin—is synthetic and not natural to a woman’s body,” she explains. By sticking with the real deal, women may be able to avoid disruption to the deep, Stage 3 sleep we all long for. Happily, that’s been the case for me.
“When we sleep we are literally detoxifying and resetting our bodies to live joyful, energetic, and healthy lives,” Kenney adds. If you are a woman who can’t sleep, don’t just power through your days, feeling like the only other choice is to depend on medication. Today, that’s no longer true.
“There’s no need to suffer in silence, and we all need to support one another,” says Dr. Harris.