When do manageable fears become terrifying obsessions? For me, it is when I am sleep-deprived. When we don't get enough sleep, the emotional centre of the brain becomes more active. This is particularly unfortunate if you suffer from anxiety and depression.
In one study a set of increasingly disturbing images were shown to people who had slept normally, and to others who had been deprived of sleep for thirty-five hours. It found that the emotional centre of the brain, the amygdala, was about 60 per cent more active in people who had been sleep-deprived. The study also found that the connection between the amygdala and the frontal lobe of the brain had been disrupted by lack of sleep. The frontal lobe slows down the brain's emotional centre. When you are sleep-deprived, you lose control over your emotions. (1)
My experience of depression began with insomnia. I found it hard to get to sleep, hard to stay asleep, and had a tendency to wake up early - feeling sick with exhaustion. My insomnia needed to be dealt with if the illness was to end.
The reassuring news is that learning to sleep is a skill like any other. But it's a skill you can probably only acquire as you start to get better. When I was in the grip of acute depression, there was nothing for it but to take tranquilisers. But as this enabled my body to get more sleep and start to recover, my psychiatrist advised that I should start trying to understand the situation for myself in more biological terms.
Our bodies are cleverer than our minds. When we are truly tired, we will fall asleep. Sleeping is a natural action. You don't have to do anything to get to sleep. It is not humanly possible to stay awake forever. The one topic that mustn't be on one's list of worries is sleep itself. That is what can stop you from sleeping and make you ill, both physically and psychologically.
Lying awake in the dark, we are robbed of normal cues. We may not be able to see reassuring prompts of our familiar surroundings, and we may experience time differently. We may be fearful as we feel we are alone, even if we share a bed with someone. When they are asleep, we are alone with our insomnia.
In order to stop being anxious about sleep, I had to start believing that in due course I would get the sleep I needed. I had to accept that this might not always happen conveniently at night, so I had to arrange my life as far as I could to make this possible. If I was awake at night, I needed to make it feel normal as opposed to frightening. One obvious resource for me was to remind myself that I wasn't alone.
I now try to enjoy lying awake in the dark with my feelings, even going a step further and contemplating that I am awake for a reason and it is safe to be so. I practise breathing techniques. I try to meet my own needs for reassurance and calm, and have a conversation with the scared person who is sweating at four o'clock in the morning.
Being compassionate to myself is sometimes enough. When I am sufficiently calm, I can then try to change the narrative of my thoughts. Every time the worries return, with steady willpower I guide my excitable mind elsewhere, as if I am on a train and have to move along the carriages until I find a comfortable berth. I then try to anchor my thoughts to something more positive and pleasant, something complex enough to hold them for a long time.
Sometimes I get up, put the light on and try to learn a new poem by heart. When I was first ill William Butler Yeats's 'The Lake Isle of Innisfree' and its evocations of quiet helped me relax, my unconscious mind eventually ceasing to distinguishing between real or imagined experience as I listened to the shimmer of lake water.
I recall being young in my grandparents' house as a relaxation technique, retracing my old steps, remembering the hall table upon which were invariably a few small envelopes addressed in my grandmother's purple ink and bearing a second-class stamp. I taste the thinly sliced and buttered bread for tea and hear the heavy tread of my grandfather winding up the clocks. Room by room, I travel back in time and recollect the peace of a happy childhood.
As you recover, you can take further steps and practise what doctors now call good 'sleep hygiene'. All the clichés apply: a completely dark room (I put up blinds); a milky drink (dairy products are rich in tryptophan, an amino acid that also acts as a hypnotic); doing nothing too stimulating before bed (a wind down routine); and going to bed at roughly the same time every night. It wasn't as though I didn't know about such approaches. The difference was that now I rigorously put them into action.
In Macbeth, one of Shakespeare's most anxious plays (in all senses), the leading man believes he has killed sleep itself. He introduces a wonderful string of comparisons about the value of sleep which are possibly the most beautiful ever written: sleep is, variously, 'The death of each day's life, sore labour's bath/ Balm of hurt minds! Great nature's second course/ Chief nourisher in life's feast.' It also - possibly the most ingenious yet - 'knits up the ravell'd sleeve of care.' Maybe some of the approaches above will help you knit up that unravelled sleeve of care, and terrifying obsessions will once again become manageable fears.
1)'The Human Emotional Brain Without Sleep: A Prefrontal-Amygdala Disconnect,' Current Biology, 2007.
Rachel Kelly's memoir Black Rainbow: How words healed me - my journey through depression is published by Hodder & Stoughton, £16.99. Its accompanying app, also called Black Rainbow, is available for download on the Apple App Store. All author proceeds of the book and app are being given to the charities SANE and United Response. Follow Rachel @rache_Kelly or go towww.blackrainbow.org.uk