It seemed like a small matter at first. Until it felt like a gorilla sitting on her chest.
That’s what chronic insomnia feels like, Kim Cattrall explained during a BBC Woman’s Hour broadcast.
“It was like a three-ton gorilla sitting on my chest. He was neither attacking me nor particularly demanding of my attention. He seemed self-absorbed, oblivious,” Cattrall said during the broadcast, reading entries from the diary she kept during the months after her insomnia began in late 2015. “But one can only take so much."
The "Sex and the City" star first opened up about her insomnia on the BBC in April, but her struggle made headlines again this week after she spoke about it to the Radio Times.
“I didn’t understand the debilitating consequences of having no sleep. It becomes a tsunami. I was in a void,” Cattrall told the Times.
Insomnia is the combination of disturbed sleep (trouble falling asleep, trouble staying asleep through the night or waking up too early in the morning) and having daytime symptoms like fatigue, trouble with concentration or moodiness, among others.
Studies show up to 50 percent of the adult population are affected by insomnia -- and about ten percent of people have chronic insomnia, which means they struggle to sleep at least three times a week for at least three months at a time.
The 59-year-old's struggle underscores the debilitating consequences of the sleep disorder. For Cattrall, the first step was admitting she needed help.
‘Is this what it feels like to be questioning your sanity?’
Cattrall said her insomnia led her to pull out of a leading role in the Royal Court Theater’s production of "Linda," which opened in London in November. She was disappointed to let down her fans, but knew she had to take care of herself.
“It was leaving me flat,” Cattrall said. “I didn’t know why. I always was able to sleep. All I needed was a blanket and a pillow. Now sleep was so precious.”
“The sleep I thought I would get on the weekend never happened.”
She said she rehearsed for ‘Linda’ six days a week and memorized lines on her day off. “The sleep I thought I would get on the weekend never happened.”
She said she remembered wondering if it were age or menopause or even unrequited love: “Is this what it feels like to be questioning your sanity? Your mental health? I’m not crazy.”
That kind of emotional response is typical of insomnia patients, Philip Gehrman, assistant professor of psychology in the Behavioral Sleep Medicine Program at University of Pennsylvania's Perelman School of Medicine, told The Huffington Post.
Difficulty concentrating, difficulty with memory, tiredness, fatigue, moodiness and depression are among the most common symptoms of insomnia, he said. Studies show people suffering from insomnia are less productive at work and the disorder can have big effects on their social lives.
“It’s almost hard to find a domain of functioning that can’t be affected by insomnia,” Gehrman said.
‘This is bigger than the play’
Cattrall sought help from a doctor in London while in rehearsals for ‘Linda.’ She was diagnosed with exhaustion due to insomnia, she said on the BBC broadcast.
“It felt frivolous that I couldn’t sleep. I understand it better now, but at the time I couldn’t,” Cattrall said.
The doctor prescribed medications, but Cattrall said it was a discussion with an old friend that convinced her to take a different approach: “I called an old school friend who said, ‘Stop. You have to stop. This is bigger than the play. This is bigger than your strength.’”
For people without insomnia, sleep is a natural process -- it’s easy, Gehrman explained. "People with insomnia get this reaction from other people, 'What’s wrong with you? Just go to sleep. Like they’re bringing this on themselves.'"
And those types of reactions can make it difficult to actually get help, he added.
Re-learn how to relax
Cattrall ended up back in New York and sought out another doctor who practiced cognitive behavioral therapy. Each night she listened to the doctor’s DVD that walked her through relaxation exercises. The DVD explained: “Every time you practice your relaxation exercises, the stronger the new habit of relaxation will become and you will weaken the old habit of worrying and your body’s muscles will relax.”
Cattrall’s doctor also gave her strict sleep rules that she was adamant about following, she told the BBC. “No naps. Banishment of electronics in the bedroom. No clocks. Only sleep or sex in bed -- not necessarily in that order.”
If she did wake up in the middle of the night she was instructed to wait in bed for what felt like 20 minutes trying to fall back asleep. If sleep didn’t come, she would get up, go to another room and read the Gettysburg Address by Abraham Lincoln. And then she would read it again. And again, until she felt sleepy and she would try going back to bed.
Cognitive behavioral therapy should be the first type of treatment a doctor prescribes to treat patients’ insomnia, before medications, according to recent guidelines from the American College of Physicians. The therapy includes a series of techniques intended to break the cycle of insomnia and retrain the body to develop a healthy sleep pattern again, Gehrman said.
“It doesn’t work as quickly as medications. It’s a more gradual approach. But the effects can be maintained over time,” he said.
"I choose myself"
Also on Cattrall’s agenda during her sleep re-training was a designated time to worry everyday, she said.
“If I started to worry about anything in the day, I would say to myself: ‘Wait. We’re going to do that at 2 p.m. We’re going to sit there and worry as long as you want. We’re going to sit there and make lists of things to worry about. But right now, let’s get on with the day.’”
One of the most common causes of insomnia is when someone goes through a stressful time and starts having trouble sleeping, Gehrman said. For most people when the stress passes, sleep improves. But other people continue to have sleep problems even after that stressful period resolves, he explained. “Their bodies get stuck in this cycle of not sleeping well -- which can last for decades if left untreated.”
“I had to come to terms with [the fact that] I might miss something.”
Cattrall said a big part of re-learning how to sleep during her therapy was realizing that it was okay when some things were outside of her control. “I realized I was missing an opportunity to experience life outside of my control. What I should be. What I could be. Experience life as someone else would do it -- and relax with that.
“I had to come to terms with, by me going to sleep, that I might miss something,” she said.
But she said realizing all of that helped her sleep. “I realized if I could play, not just on the stage, but in life -- I would sleep.”
But, the actress added, overcoming insomnia is still a work in progress.
“I’m still calibrating my sleep,” she told the BBC. “I choose not to ignore that I needed and still need to continue to reevaluate my priorities. I choose myself.”
Sarah DiGiulio is The Huffington Post’s sleep reporter. You can contact her at email@example.com.