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Lately, I can't sleep. I do my work. I come home. I'm exhausted some days. I eat dinner. I watch TV. I play around on the internets. I go to bed. And I lie in bed for 2 hours. It is utterly frustrating.

I know all about sleep hygiene. I have given this talk a ridiculous number of times. It is advice so trite that most of my patients thumb through a magazine while I give the talk. You've undoubtedly heard it before: set a fixed bedtime and waking time, don't nap, avoid caffeine and alcohol, exercise regularly...

Most of the time I am giving advice to patients, I am being hypocritical, but except for the caffeine part, I actually follow this sleep hygiene stuff, and still! Insomnia! It is utterly frustrating and agonizing. It seems like there should be some way to sleep better, some way that I can relax and get a good night of sleep every time. I wish I knew how.

Insomnia

So, sometimes, I get terrible insomnia. And now it's 3AM and I can't sleep. I'm smoking cigarettes, thinking about a beer, wondering if I can get someone to write me some Ambien tomorrow. But it's not noise or pain or anything obvious causing my insomnia. It's that I can't stop thinking.

I'm thinking about this patient in his 90's who I intubated, and I was literally begging his son not to make me do this. Or the little old lady who I was doing CPR on, and I could hear each rib snapping under my hands. I was thinking about the 40 something mother of two who I've admitted for the fourth time for complications from chemotherapy. I'm thinking about a potassium of 2.7, and how I only gave 40mEq orally and added 20 mEq in the IV fluids, but maybe I needed to give more.

I can't let it go sometimes. I leave the hospital, and thinking about my own life is so unattractive that I'd rather think about whether I should've added a second antibiotic to cover anaerobes.