Sleep, sleep, sleep.
March 11, 2010 7:24 AM   Subscribe

Help me figure out just what in the world is going on with my sleep (With updates from previous questions)

If you've read my past questions, then many of you know by now my history with trouble falling asleep and staying asleep.

I won't reference the other threads since not much in terms of things that have actually worked have come out of those.

I've had a history of sleeping problems pretty much since I left high school. Not that I never had sleeping problems in high school, but they seemed to get in the way of things much less. I guess I sort of could just auto-pilot through high school for the most part. Yet the past 4 years I've been in college, I've had trouble sleeping.

Name any sleeping pill you like (and I do mean ANY sleeping pill you like, lol) and I've been on it. No matter what I've tried really it's always the same story. It takes me 1-2 hours to fall asleep and that's with an armada of cocktails. Nothing too drastic but just cocktails like herbal valerian&chamolile relaxing pills (with your standard skullcap, passion flower, etc included) + a 3 mg melatonin supplement that also has a bit of what the relax&sleep valerian pills have in them + a prescription sleeping pill (currently temazepam of 15 mg).

With that being said, I'm not really looking for home remedies either. I've tried virtually all of them as well. Relaxing hot epsom salt bath with lavender mixed in, sleepy time drops on pillow casings, exercising fairly frequently 4-6 hours before bed (as opposed to right before bed which would naturally cause sleep issues). I've read conflicting reports on reading before bed as well. I do it anyway, but the evidence seems to be a bit mixed. I don't read thrillers right before bed, but I don't like to read just yawnfest books either. I try for something in between generally.

Now on to what I've tried with doctors. I had sinus surgery with my ENT to correct a deviated septum and removed part of my right turbinate reduced for just better general breathing as well as night time breathing (but not primarily for night time breathing). Breathing is mostly good,but I think I breathe well enough at night for it not to be a factor in waking up so much.

I've had two sleep studies to date. One determined I have sleep apnea and so we (I / sleep clinic) tried a CPAP machine at first. I lost patience with it after about a month. Too cumbersome, too irritating, and not helping. I really was opposed to it in the first place but when you sleep like I do, you learn to at least give it a try. While a month might have not been a fair shake, I didn't like it. The other sleep study was with the CPAP machine and its been so long I forgot what the results even were. I don't sleep well with all the bullshit that comes from 80 electrodes/wires being placed all over your body, so I don't see how they would even be able to tell anyway.

Fast forward to 4-5 months ago and I decided to try the TAP appliance (or mandibular retainer) route. I like it much better than CPAP but in terms of waking up at night, it's not faring any better. It's a great deal more comfortable, but in the end... it's still not working (I still use it for kicks, since it did cost $2000 +, lol). Now with the TAP appliance deal, there are certain levels you can adjust it to to move your lower jaw varying degrees forward at night (supposed to reduce any possible tongue in back of throat blockage, etc) and I'm already at a fair deal forward and about 25% away from maximum adjustment on the thing.

I just don't get it. What gives here? Now I know I talked mostly about waking up a lot at night, but falling asleep is at the crux of the issue too. Somehow, I think my extreme resistance to falling asleep and then my spotty sleep after falling asleep are related. Maybe not directly, but it's all part of something.

Who do I go to from here? Is there some sort of specialist aside from those at a sleep clinic that can help me? Do I need another sleep study?

If I need another sleep study (and I do hate them immensely), can I get a at-home sleep study? I notice those don't have the 80 electrodes and wires running all over you like the clinic sleep studies do. Does that mean they'll be less effective but perhaps effective enough to still help me?

I know I've written quite a bit, but I know this is asked quite a bit whenever someone posts about these kinds of questions. In terms of mentally and emotionally, I'm pretty stable at night. I'm not compulsively worrying about that much (just your usual life worries sometimes or class work for college) out of the ordinary. Of course, sleep is always towards the front of my thinking. Other than that, let me know if I left anything out for you guys. lol.

:(
posted by isoman2kx to Health & Fitness (20 answers total) 8 users marked this as a favorite
 
I have trouble sleeping myself, and spent a lot of time trying to figure out what I was doing wrong or what I could change to remedy the problem. Then I read Insomniac by Gayle Greene and it completely changed my thinking. The author is a lifelong insomniac as well, and has tried every possible treatment and drug and homeopathic remedy, and describes it all in detail, as well as the physiology of the brain and emerging theories in the field. I cannot recommend it highly enough. It removed the burden of "what's wrong with me??" from my thinking. It may be that I'm just a bad sleeper, and that's the way it is and I have to learn to live with it. I know that doesn't offer you a solution, but it did bring me some peace of mind, at least.
posted by something something at 7:38 AM on March 11, 2010


You could get another sleep study, but frankly, you've tried and rejected (or else they just haven't worked) the full arsenal that most sleep specialists have to offer to address sleep-disordered breathing: CPAP, ENT surgery, and high-end dental devices. How severe was the actual apnea? Did anything else physical show up on your records, like alpha intrusions, lack of restorative sleep, etc.?

Did you try an insomnia clinic? This is a program of cognitive behavior therapy and modification designed to teach basic "sleep hygiene" to those who have trouble falling asleep, or staying asleep. Based on the considerable # of questions you've asked about mental health issues, you might want to consider that this could be a side effect of depression and/or anxiety, or even a side effect of anti-depressant medication. Talk to your doctor before ruling out any possible physical causes, etc., but it sounds like you've had the best care money can buy down that route and it hasn't worked.
posted by availablelight at 7:39 AM on March 11, 2010


have you been evaluated for any mood disorders or ADD?
i had numerous sleep problems for as long as i can remember.

my psychiatrist tried 5 different sleep aids on me and none of them worked. (ambien, lunesta, and 3 others - i forget which). all the other stuff like valerian root, relaxing bath, etc no go either. sometimes taking some muscle relaxers and a glass of wine would at least get me to pass out for a good stretch.

then i started adderall. i get to sleep fairly easily. i feel rested in the morning. i still may not always sleep for 8 hours, but i actually stay asleep now and don't have such crazy dreams (or if i do, i don't remember them because i am staying sound asleep).

just putting that out there. not that you have ADD but that maybe there is something else going on than a physical thing requiring a CPAP machine. (as odd as this souinds, i no longer snore in my sleep since starting adderall. i had the big crazy snoring most nights, but no longer, according to my boyfriend.)
posted by sio42 at 7:40 AM on March 11, 2010 [1 favorite]


sounds like you need a cartoon character and a large mallet.
seriously tho, do you set your sleep schedule or does work/school?...if so do you sleep better on the weekends? if i dont get to bed late (2am+) and get my 8hrs, then i dont sleep well...maybe its a matter of figuring out what your body's schedule is and working your life around that.
posted by sexyrobot at 7:42 AM on March 11, 2010 [1 favorite]


That book sounds fascinating, something something. It looks like the author keeps an updated blog here.
posted by muddgirl at 7:49 AM on March 11, 2010


Think outside the box here. If you aren't a good sleeper during normal sleep hours, when are you a good sleeper? Can you switch your hours at work/school to accommodate?

Some people have different circadian rythms.
posted by TheBones at 7:50 AM on March 11, 2010


At-home sleep study: I don't know if this is what you're talking about but you can buy your own pulse oximeter which can monitor the oxygen levels of your blood overnight to see if you're having serious apnea episodes (you definitely want to address serious apnea if you have it, it's a potentially lethal condition and can cause all kinds of serious health problems.) Doing it yourself doesn't have the same diagnostic capabilities of a real sleep study, of course, so you ought to be working with medical professionals as well.

I had good luck with the CMS-P meter from Contec Medical Systems which I bought on eBay directly from China where it's manufactured for about a hundred bucks. But there are zillions of different meters available, that's just one of the cheaper ones. Also, I've heard of people simply borrowing a meter from their physician.

I'll also mention, it took me an entire year of trying with the CPAP machine, with constant adjustments of the pressure level, before I became comfortable enough to sleep through the night with it. Good luck...
posted by XMLicious at 7:51 AM on March 11, 2010


There are many different kinds of masks for the CPAP machine. My husband went through (this is NOT an exaggeration) 12 of them over the period of 5 months before he found one that was actually comfortable and didn't leak. He worked with someone from the sleep group and they just kept trying until they found something that worked.
posted by Kimberly at 7:52 AM on March 11, 2010 [1 favorite]


Oh, and I should mention that the software which comes with that particular meter, the CMS-P, seems to be Windows-only.
posted by XMLicious at 7:53 AM on March 11, 2010


I've always had a very hard time getting to sleep, as does my father. For as long as I can remember it has taken me at least 30-60 minute. Longer when I am more stressed.

My dad told me a guy he knew taught him how to self hypnotize himself, which worked wonders for him when he was in the military. He has lost that ability through the years, but that may be an avenue for you to try.

I've recently been using a technique based on something I read in a book on Zen Buddism (The Way of Zen), where a have an avatar in my head that helps me clean everything out by picking things up and putting them in another 'room'. Once everything is picked up and my head is 'empty' (with my avatar in a chair reading the paper), I'll do one of two things:

1. I focus on a single part of my body (I use the inside of my left nostril). If I catch my mind wondering away from that, I imagine a butterfly flying back to that point on my body.

2. Count backwards from 100 and restart the count if I miss a number or say a number wrong. (I've been doing it in German lately for the extra challenge.)

This keeps my falling asleep, even when I am very stressed, to the 30 minute time-frame, which is very good for me. What helped me get to this point is related to what availablelight notes: I've made peace with the fact that I suck at getting to sleep and just roll with it now. That, I think has enabled these techniques to work as well as they have, as I am no longer worried about getting to sleep.
posted by chiefthe at 8:13 AM on March 11, 2010 [3 favorites]


OP, I am not entirely clear ... is your current problem limited to falling asleep only at this point, or do you still have trouble staying asleep once you fall asleep? If you weren't trying to go to bed at a certain time, do you eventually get tired and fall asleep and sleep ok? Do you tend to catch up on sleep on weekends? Or is this constant and daily, regardless of your bedtime and wake-up time?

I think a lot of people are going to pile on you about the CPAP. I had a similar experience as you with regards to the CPAP...I was diagnosed with mild-to-moderate sleep apnea, tried the CPAP for several weeks, but it made my sleep worse. I got a lot of shrill responses from all over the place about how it takes months to get used to it, but no one could really explain how the fuck you are supposed to cope with getting even LESS sleep than normal for MONTHS when you have a life and responsibilities to deal with. People get psychotic about sleep apnea, and I just wanted to encourage you to not take it too personally (which I used to do) ... it's between you and your doctor. Plenty of us choose not to use a CPAP and are doing just fine. IANAD, but my personal opinion has been that if your overall health (blood pressure especially) isn't suffering, you're probably not at major risk of dropping dead in your sleep. Also, I found that the companies dealing with durable medical equipment and CPAP machines are total scumbags, and it seems really convenient for them to get people to become permanently dependent on a machine to help them breathe overnight. A lot of people who get on a CPAP find that despite making changes that are supposed to help their apnea (losing weight, etc) NEVER get off of it. Me, I stopped using the CPAP after a few weeks, lost weight, and improved my sleep hygiene. I no longer snore and now sleep much better.

At any rate, I know you say that you are feeling emotionally/mentally stable, but I have a hard time imagining that. Insomnia is one of the most stressful things a person can deal with, and simply being sleep deprived causes a lot of stress both on the mind and body. My main suggestions are to find a primary care doctor who is going to work with you on this in a very supportive way -- by referring you to specialists who can help and by constantly monitoring your overall health. Additionally, I think you should meet with a counselor and maybe even a psychiatrist. For me, antidepressants have helped me greatly. Even if that's not the answer for you, perhaps working with a mental health professional can help you better look at your self-care routines and help you determine whether you are giving up on treatments because they really aren't working for you or because you're anxious/frustrated/irritable/etc and don't even really see that about yourself.
posted by tastybrains at 8:23 AM on March 11, 2010 [3 favorites]


HOW TO SLEEP WELL
a.k.a. “Sleep Hygiene”
adapted from William Dement (http://www.stanford.edu/~dement/howto.html)

General

Get up and go to bed at the same time every day. Even on weekends! When your sleep cycle has a regular rhythm, you will feel better.

Daytime

Use sunlight to set your biological clock. As soon as you get up in the morning, go outside and turn your face to the sun for at least 15 minutes; more is better. This is the best time to get your exercise. Even if it’s cloudy, the brighter light outdoors will help.

Stay away from caffeine, nicotine and alcohol at least 4-6 hours before bed. Caffeine and nicotine are stimulants that interfere with your ability to fall asleep. Coffee, tea, cola, cocoa, dark chocolate and some prescription and non-prescription drugs contain caffeine. Cigarettes and some drugs contain nicotine. Alcohol may seem to help you sleep in the beginning, but will disrupt sleep later in the night.

Don’t take naps (if you have trouble sleeping at night). This will ensure you are tired at bedtime. If you just can’t make it through the day without a nap, sleep less than one hour, before 3 pm.

Evening

Refrain from exercise at least 4 hours before bedtime. Regular exercise is recommended to help you sleep well, but the timing of the workout is important. Exercising in the morning or early afternoon will help sleep; evening exercise will disrupt sleep.

Write out your problems. If you’re a worrier, schedule some time in the early evening to work on your problems: write out what the problem is, and what you're going to do about it tomorrow. This can unburden your mind.

Getting ready for bed

Develop sleep rituals. It is important to give your brain cues that it is time to slow down and sleep. An hour before bedtime: turn off the TV and the computer, reduce lighting to the least amount necessary. Listen to relaxing music, read something soothing, have a cup of caffeine-free tea, do relaxation exercises.

Take a hot bath 90 minutes before bedtime. A hot bath will raise your body temperature, and the following drop in body temperature can make you sleepy.

Have a light snack before bed. If your stomach is too empty, that can interfere with sleep. However, if you eat a heavy meal before bedtime, that can interfere as well. Dairy products and turkey contain tryptophan, which acts as a natural sleep inducer.

Your bedroom

Only use your bed for sleeping (and sex). Refrain from using your bed to watch TV, pay bills, do work or reading. TV’s bright lights give your brain the wrong message. Condition your mind to associate being in bed with only one thing: sleep. (Sex is the only exception.)

Make sure your bed and bedroom are quiet and comfortable. A hot room can be uncomfortable. A cooler room along with enough blankets to stay warm is better. If light in the early morning bothers you, get a blackout shade or wear a sleep mask. If noise bothers you, wear earplugs or get a “white noise” machine or a fan.

Don't have a clock where you can see it. Nothing is more frustrating than seeing how long you've been not sleeping.

In bed

Sleep only when sleepy. This reduces the time you are awake in bed.

If you can’t fall asleep within 20 minutes, get up and do something boring until you feel sleepy. Sit quietly in the dark or read the warranty on your refrigerator. Don’t expose yourself to bright light (no television) while you are up. The light gives cues to your
brain that it is time to wake up.
posted by neuron at 9:00 AM on March 11, 2010 [4 favorites]


I gave you a hard time about your CPAP the last time you asked this question and I'd like to apologise for that.

About six months ago I started having difficulties with CPAP myself. Even though I'd been using it successfully for a year or so, I began to take it off after a couple hours and throw it across the room. I've been through about 10 different masks of various styles and I couldn't tolerate any of them. So I'm getting a TAP appliance this month.

However, in January I started taking Adderall for ADHD. I can't believe how much stimulants have changed my sleep. I'm able to fall asleep within 10 minutes, and I stay asleep through the night. I still don't feel entirely rested, so I'm pretty sure I'm continuing to have events, but it's nice to be able to fall asleep instead of lying there staring at the ceiling, and not wake up in the middle of the night over and over.

Is there a possibility you may have ADHD?
posted by elsietheeel at 9:19 AM on March 11, 2010 [1 favorite]


@tastybrains

thank you, thank you, thank you. more so for the encouraging reply than the information you provided (although both were nice :) ). that's what I'm talking about with the sleep apnea and CPAP. if it's going to take more than a few months, then how is that benefiting me while I do other things and go to school and/or work? it doesn't, lol.

as for my original post. my problem is with both falling asleep and staying asleep. well... it's most prominent on days before I have class. I have class at 9:30 the next morning on tues/thurs, which doesn't seem like something I'd have to get up absurdly early for , but I commute to a university 70 miles away (for this semester). so that puts my wake-up time at about 6:30 and my go to sleep target for about... 11 to 11:30. I start to get ready for bed around 9 on mon/wed nights - doing the whole teeth brushing deal, taking my dog out to pee, turning off my computer, then usually heading to my room around 9:30 and fruitlessly selecting a book to read until I think I'm sleepy. on the nights where I don't have to get up for anything in particular the next morning, I still get up the 4-5 times a night... but the falling asleep itself I feel like there's less pressure to do so. even that being said, it still takes a bit because I ideally try to go to sleep by no later than midnight even on days where I don't have class. that used to not be the case but I've pretty much adjusted my biological clock to start punching in around 9/9:30 to go to bed at 11:30-midnight on non-school nights too. (except for the occasional late outing with friends going to a bar, movie, whatever)

Fwiw also, I do take anti-depressants to the tune of 120 mg of Cymbalta (on it for about a year now) and see a psychiatrist every few months. Fairly stable with it. What I meant by the mood is that oh yeah, it definitely wears on me during the day at times but at night I'm not breaking into a sweat or a panic attack about sleep, I just get frustrated at night. I'm sorry that reply was so long! lol.

@elsietheeel (and sio42 also)

no worries elsie, it happens. at the time I didn't really want to give it a try and even though I didn't give it long of a try, it's not as though I'd completely stopped trying. very interesting that you and sio42 both mentioned adderall as a factor for better sleep (and the obvious of course with the help with ADD). hmm.

this will be a slightly long winded reply as well, but it's important to give all the details I think (further messages can be on email if you like :p). I've never pinned down for sure whether I've had ADD or not elsie. When I was a kid in junior high, I started ritalin around the 4th grade and was on it until about my junior year of high school. Then I decided to just get off it because I felt like I could do the work on my own and the original ADHD diagnosis had been from my pediatrician which was like 10-11 years ago and even then I think they guess half the time with kids using a philosophy along the lines of "oh this kid's bouncing off the walls, he surely has ADHD!", lol. Then, about 2 years in to my college life I started having doubts about why math and physics were so hard for me. I felt stupid and wondered if there was an answer to me feeling that way. I went to a psychologist and filled out various ADD questionnaires, 1-5 scales, etc and she did say she felt I have ADD. So we tried a few things. We tried Ritalin at first (which was ok) and then we tried strattera which made me feel like I was about to have a heart attack and then I pretty much just gave it up and resumed my college life without it (I might have "possibly" tried Adderall too, but maybe it wasn't for very long).

To sum up, maybe I do have ADD, maybe I don't. It's difficult to tell sometimes because a lack of focus can very very much be from sleep as well. So what do you think about all of that?


really really appreciate everyone's replies so far. thank you very much!
posted by isoman2kx at 1:22 PM on March 11, 2010


Honestly, I think you sound a lot like my spouse, sleep-wise. You're probably just naturally a night owl, and it's hard to get yourself to fall asleep until you're really REALLY tired.

The only three solutions that seem to work for him are:

(a) rigorous sleep hygiene - this really REALLY isn't fun - when he's trying this, he can't stay up late on weekends or sleep in, and it's still not guaranteed to work. There are sleep clinics that specialize in this sort of thing - pointing out light sources, heat sources, and energy sources that could be keeping someone awake.
(b) Melatonin. I'm honestly surprised you haven't tried this yet?
(c) Adopting his schedule to his preferred sleeping habits. In college, this meant never scheduling class before noon. That's pretty hard to accomplish, but it's doable.
posted by muddgirl at 1:31 PM on March 11, 2010


Oh I have muddgirl, I have. If it exists and it's not illegal, I've tried it :p. I currently use it with my sleep regime now. It seems like melatonin is hit or miss for people. It either works pretty well or doesn't do a thing. I am still out on the verdict with my 3 mg supplement. I do try my best for a sleep schedule though during the week so I suppose that is at least going my way for that.
posted by isoman2kx at 3:08 PM on March 11, 2010


Yeah, I was pretty sure you'd probably already tried it :)

I do try my best for a sleep schedule though during the week so I suppose that is at least going my way for that.

See, this is what I mean by "a rigourous sleep hygiene isn't fun" - my spouse, can easily maintain a "normal" sleep schedule if he does it every day. But it's unreasonably hard to do this. I'm a normal sleeper, so if I stay up late one night on the weekend and sleep in the next morning, I get back on track very easily. But if my spouse stays up late one night, his sleep is shot for for weeks and weeks. He literally cannot deviate. However, he does respond well to melatonin, and he does not have the same ancillary issues that you have.
posted by muddgirl at 3:14 PM on March 11, 2010


It seems like melatonin is hit or miss for people. It either works pretty well or doesn't do a thing.

Melatonin works if you have problems with your melatonin cycle or are otherwise melatonin-deficient. If this is not your problem, it won't do a thing for you.

There are several causes of insomnia, briefly:

1) Melatonin deficiency. Supplements can help.

2) Failure to relax / stress. Various routines and herbal supplements can help you to calm down and relax.

3) Internal Stimulants. Stuff you ingest [caffeine is an obvious example] can act or be metabolised to stimulants that can keep you awake. The only solution is to stop ingesting them, or don't ingest them late in the day when they'll affect your sleep.

4) Medical conditions such as sleep apnea or chronic pain. Get treatment.

5) External stimulus. Noise, too hot/cold, uncomfortable bed etc. Stimulus needs to be eliminated.

The thing to keep in mind is that each remedy works for a specific cause - it's useless applying a remedy when the cause of your insomnia is something else, so identifying the cause [or at least eliminating what ISN'T the cause] is very useful. If you're already relaxed and mellow, taking herbal relaxants isn't going to do you any good.

I had problems with very bad insomnia for a long time, my problem turned out to be #3 - I was taking glucosamine for joint problems, and it helped with my joint pain, but it turned out it was really messing up my ability to sleep. Stopped taking it, and my sleep problems vanished. I had done the sleep hygiene thing, and taken relaxants and melatonin, but none of that helped, because they were treating the wrong problem.
posted by HiroProtagonist at 8:11 PM on March 11, 2010 [2 favorites]


I just read an article that made me think of this thread. Since it sounds like you are a classic super-night-owl, have you ever looked into delayed sleep phase syndrome and/or light therapy?

It also reminds me that one thing that helped my major insomnia in 2008 was going to a tanning booth once a week. I didn't do it to get tan, I simply used it for about 5 minutes (less than half the max time) and it really seemed to help. Of course, it's not without its own health risks, but it could be worth a try to see if you can "reset" your sleep cycle. It's certainly cheap and easy enough to try, right?
posted by tastybrains at 1:51 PM on March 12, 2010


Hmm. That's interesting tastybrains. I like to call them the cancer beds for fun, but I don't think I'd have a problem doing it for 5 mins or so if it would help the sleep out. I'll do some research on it. Thanks!
posted by isoman2kx at 7:46 PM on March 13, 2010


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