Sleeping is giving in

August 25, 2010 2:15 PM

I can fall asleep, but it's not restful.

I would like to wake up rested, and not more tired than I started.

I had problems with insomnia a few years ago, but now, I can fall asleep pretty easily 6 out of 7 nights, because I am exhausted. However, during the night, I wake up 2-6 times. I often have real-life nightmares - things that I continue to think are real once I wake up, that relate to my job or personal life or fears. I wake up freaking out (even if I don't remember a specific dream). Then, it takes a while to calm down and fall back asleep. Repeat several times, and ultimately I wake up with my alarm and feel totally fried. It's like being in bed is more stressful than being awake.

Possibly relevant: I'm a 22-year-old, normal weight female. I don't exercise besides walking around (2-4 mi/day); I used to run, but I broke my foot a while back and am not supposed to run for another month or so. My thyroid has been tested recently, and I am borderline and being monitored. I drink on weekends and maybe once during the week. I don't take any medications. I don't have caffeine after about 3 or so. My job is pretty stressful, but I work reasonable hours, usually 9-630 or 7. I guess I am pretty Type A. I usually go to bed around 11, and wake up at 730 - that should be plenty of time, right?

The lack of sleep seems to be multiplying all my stress - things I could deal with rested, I can't now; things I can't deal with make it harder to sleep, and aughhhhhh if I don't get some good sleep soon I am going to go crazy. Any suggestions welcome.

posted by quadrilaterals to health & fitness (20 answers total)

Consider melatonin supplements. They're non-addictive and not sleeping pills. They just help you get into a state within which you can fall asleep easier.
posted by griphus at 2:17 PM on August 25, 2010

Melatonin can cause increases in vivid dreams. If you're already having nightmares, it may make them worse.
posted by logicpunk at 2:22 PM on August 25, 2010 [1 favorite]

I had a similar problem, and I saw a doctor about it. The doctor said it could be any number of issues, and wanted a sleep study. The sleep study sucked, but showed that I was experiencing moderate to severe sleep apnea. With treatment, I am now sleeping well again, and it has made a huge difference in my day-to-day life.

You may not have sleep apnea, but it could be any number of issues, and sleeping well is worth the suckiness of seeing a doctor and doing a sleep study.

Good luck!
posted by Lafe at 2:33 PM on August 25, 2010 [1 favorite]

Melatonin supplements make my partner sleep less restfully and with more dreams, so they may exacerbate your problems.

I hesitate to give sleep advice to anyone with insomnia problems, because I have experienced from my spouse that they've usually tried everything already, and are sick of getting advice :) But... waking up a lot in the night could be due to environmental factors like light (darker is better), temperature (we have a natural temperature cycle that cools us off as we fall asleep - fluctuations could wake you up), or noise (like an air conditioner turning on).

Another thought: if my partner has any caffeine after 12pm, it seems to disrupt his sleep. It may be confirmation bias, but it's something to try avoiding for a bit.

And there's the AskMe favorite: sleep apnea.
posted by muddgirl at 2:34 PM on August 25, 2010 [1 favorite]

Check out Gayle Greene's book Insomniac. She is a lifelong problem sleeper and covers the types and causes and treatments for insomnia in exhaustive, very interesting detail. It helped me a lot to realize that my own sleeping issues weren't my fault. Like most insomniacs, I had tried every suggestion everyone had ever thrown at me and nothing really made a difference, but I still felt like I must be doing something wrong. It turns out that I wasn't - I'm just a crappy sleeper. I went to the doctor and found a medication that works for me and my life is one thousand percent better.

Anyway, it's hard to say what is causing your sleeping issues just from what you have posted here, but maybe a quick read of that book will help you identify some potential issues you may not have considered.
posted by something something at 2:35 PM on August 25, 2010 [1 favorite]

P.S. Melatonin has never done anything for me at all.
posted by something something at 2:35 PM on August 25, 2010

I know this is going to sound weird, but my sleep improved drastically when I stopped eating wheat. I suspected I might have an allergy. And whatever wheat does to me - it screws up my sleep schedule and screws up my quality of sleep. Totally off the wall suggestion but possibly worth trying.
posted by greekphilosophy at 2:37 PM on August 25, 2010

I see Lafe beat me to it. Consider seeing a doctor and getting a sleep study done to test for sleep apnea. In addition to wrecking your quality of life, sleep apnea can potentially be dangerous if it isn't treated.
posted by phoenixy at 2:37 PM on August 25, 2010 [1 favorite]

Like somethingsomething and Gayle Greene, I'm a crappy sleeper and according to my parents have been a crappy sleeper my whole life long.

Seconding a sleep study. Before popping pills, you want to be sure you don't have apnea or restless leg syndrome waking you up.

I take Ambien, it's the only thing that works. I also avoid coffee and tea past noon. My doc tried giving me Trazodone, which many people swear by, but I had honest-to-God night terrors (bolting up in bed screaming - NO FUN) and felt hung over the next day. Melatonin works, but it gives me those crazy dreams.

Talk to your doctor and get checked out, but if you need Ambien or something like it, then you need it and there's nothing to be ashamed of.
posted by Rosie M. Banks at 3:21 PM on August 25, 2010

I used to have a similar type of sleeping problem, I could fall asleep easily but woke up about 4-6 times per night and wasn't rested in the morning. I would be tired all day.

For me, sleep meds solved the problem. I started out on trazedone which worked well for me for several months -- i would sleep soundly and wake up feeling rested and alert. Eventually Trazedone stopped working for me (I would sleep too long and wake up groggy), so I switched to Neurontin, which I like even better - I sleep deeply, I dream normally, and I wake up rested and alert. It's great.

I did try a couple other meds along the way that didn't work for me, and I know some people for whom meds don't work; still -might be worth a try.
posted by insectosaurus at 3:29 PM on August 25, 2010

Nthing the sleep study. It's amazing how much difference a CPAP can make.
posted by BZArcher at 3:45 PM on August 25, 2010

When I talked to my doctor about persistent middle-of-the-night insomnia (with stressful thought interludes just like yours), she prescribed amitryptyline. It has done wonders for me (also I find it very inexpensive in generic but YMMV). It's not a knockout drop, though you do get a little drowsy after taking it. It just keeps you asleep. There's no morning hangover or anything, either.
posted by Countess Elena at 4:01 PM on August 25, 2010

There are already lots of good suggestions here, but be sure not to overlook the most easily overlooked one: room temperature. When I was a child, I loved to sleep in a warm room under lots of blankets, but these days being even a little too warm at night gives me nightmares and causes me to wake up every couple of hours in a sweaty panic, just like in your OP. So be sure to at least try turning the thermostat down even if that seems like a silly suggestion, because if that is the problem it's the easiest one to fix.
posted by Marla Singer at 4:11 PM on August 25, 2010

Breatheright strips, ear plugs (the big waxy kind), making sure all those little red power lights are covered, and melatonin.
posted by Ideefixe at 5:06 PM on August 25, 2010

Too many potential factors here. It could just be stress - like you say, it's a negative feedback loop. Check your sleep hygiene, try to take a few consecutive days off work, and maybe try some meditation or other relaxation techniques over the next few weeks while you wait for the appointment with your doctor. This is a "depression or thyroid or you aren't breathing" kind of problem, and that's what doctors are for.

For what it's worth, I've had intermittent insomnia and such since I was six years old (that's when I remember sitting up all night wondering why everyone else liked to sleep all the time and why I couldn't manage it.) Most recently (a month ago, ish) the wacky nightmares and multiple wake-ups were fixed with a vacation and a move to a place with A/C and a brand-new bed, all on the same day.
posted by SMPA at 5:13 PM on August 25, 2010

Thanks, everyone. I guess this is kind of a wait-and-see thing, as well as trying things out and seeing a doctor if this continues.

I have been falling asleep with the light on, and my window a/c has been making loud noises recently; I'm also not sure I'm practicing good "sleep hygiene" (I've never heard that term before, but it makes sense).

Does apnea hit my population (young, female, "normal" (whatever that means - the CDC considers my BMI healthy, I guess) weight)? I don't snore often, though I do have severe allergies during certain seasons and to certain allergens; exposure makes my breathing weird at night, I'm told.
posted by quadrilaterals at 7:07 PM on August 25, 2010

Obstructive apnea is the most common form of sleep apnea. It's not just BMI that makes you likely to have it. Things like the structure of your throat and the weakness of the supporting tissues can determine whether you're a candidate for it. Central and complex apneas have more to do with the brain-lung connection and only account for about 12% of all apneas, if I'm recalling correctly.

Men do get sleep apnea more than women, but it's not uncommon for women to get it. It affects older people more than younger, but again it's not unheard of in young adults.
posted by Hardcore Poser at 7:17 PM on August 25, 2010

My first thought was "sleep apnea," and Hardcore Poser points out accurately that it can affect young, relatively fit adults of both genders. Obesity certainly can be a contributing factor, but you don't need to be obese to have it.

Definitely get that sleep study done. Even if you don't have sleep apnea, your doctor should be able to figure out what's going on.
posted by valkyryn at 5:46 AM on August 26, 2010

Yes, you can have sleep apnea even if you are skinny and don't snore. My cousin has it and is beanpole thin; the person I know best (female) who has it didn't snore noticeably, and although overweight, will not stop having it if she loses weight. In both cases, it was down to the structures of their noses, throats, tongues, etc. (If you think you might have it, it can be life-threatening unless fully--not just superficially--treated, so do NOT try to self-treat it with special pillows, breathe-right strips, or anything else hawked on TV or radio.)

Good sleep hygiene includes turning the light off before you get ready to go to sleep, not reading or using a laptop or watching TV where you sleep, going to bed at around the same time every night, etc.

If you are getting more than eight hours of sleep, are waking up often, and don't feel rested and have daytime sleepiness, that's exactly what you should tell your doctor--don't be vague and say "I'm tired" or "I'm not sleeping well." Say "I don't feel rested when I wake up. I'm sleeping more than eight hours a night, but I fall asleep easily 6 nights out of 7 because I'm exhausted. I'm sleepy during the day." (or whatever exactly describes your issues.)

A sleep study may help figure out what's going on, regardless of whether it's sleep apnea or any of many other irritating sleep disorders. I know it feels like you should just be able to take care of it yourself--everyone else knows how to sleep, right?--but no, these things are pernicious and hard to figure out, and even ones that aren't as bad as severe sleep apnea can still have a horrible effect on your job performance, depress your immune system, cause car accidents, etc.

Good luck!
posted by wintersweet at 8:50 AM on August 26, 2010

If "sleep hygiene" is a new term for you, I'd definitely suggest learning more about it and practicing good sleep habits.

Here's a starting point: How to Sleep Well, from the website of William Dement, a well-known Stanford sleep researcher.

A sleep study would probably be a really good idea, but while you're waiting to do that, there are all kinds of things you can do to help your body realize it's time for restful, relaxing, restorative sleep.

One thing that's helped me: I used to experience lots of mind racing when falling asleep - while waiting for sleep to come, I'd frantically go over all the things I had to do that week, or go over situations that were stressing me out, or have annoying imaginary conversations with people I was disagreeing with in my waking hours. None of that is helpful. So, I got into the habit of thinking about a relaxing, comfortable, restful place when I turn out the light. Light goes out, and I imagine a quiet, relaxing, beautiful place where I'm lying down, focusing on every detail. It's much more conducive to restful sleep than worrying about stuff.

Also, this:

"I usually go to bed around 11, and wake up at 730 - that should be plenty of time, right?"

Well ... maybe. Maybe not. If you're falling asleep right when you go to bed, that's 8 1/2 hours of not-at-all-restful sleep. If you're not falling asleep right at 11, it's even less. I would suggest implementing as many of the sleep hygiene suggestions as you can (especially getting more exercise, increasing the darkness in your room, and doing only relaxing things before bed), and see what happens when you get NINE hours of actually restful sleep. If you feel good there, then maybe you need more than 8 1/2 hours.

Good luck!
posted by kristi at 10:30 AM on August 26, 2010