Sleep Hygiene For the Sleep-Filthy?

July 25, 2012 10:48 AM

What is the best, quickest way to recover from unavoidable weeklong periods of awful sleep?

Here's the deal: approximately every 1.5 or 2 months, Mr. Julthumbscrew is on-call for a week for work. It's a brutal experience... basically, for that entire period, he doesn't get more than two hours of contiguous sleep (and on some nights gets NO sleep). This is unavoidable. What I'm hoping IS avoidable are the post-on-call issues.

While you'd think that after a week of no sleep, he'd just collapse into bed, sleep for 18 hours and wake up fresh as a daisy, this isn't the case. On-call weeks seem to "break" his ability to sleep, somehow, and for several weeks afterwards, his sleep is awful: he can't fall asleep, he can't STAY asleep, he winds up napping semi-involuntarily and then isn't tired at bedtime, etc.

What can we do to snap him back to relatively-normal sleep as quickly as possible? Some possibly-relevant data:

- He's a smoker and a coffee drinker (but doesn't drink it after mid-afternoon).
- Apparently, it's easier for him to fall asleep while watching/listening to something because it slows down the chatter in his brain.
- We've heard the "only use the bedroom for sleep and sex!" advice, but as our bedroom is ALSO his office, that ain't gonna work for us.
- We are open to any and all other suggestions, though.
- He's an otherwise pretty-healthy, pretty-normal early-30s dude.

Thanks, HiveMind!

posted by julthumbscrew to health & fitness (19 answers total)

Have you tried light-blocking curtains for not-on-call days? What about a white noise machine or a loud fan?
posted by manicure12 at 10:53 AM on July 25, 2012

Would you be open to melatonin tablets?
posted by Hakaisha at 10:55 AM on July 25, 2012

Melatonin. Works amazingly well when I have trouble sleeping and makes my sleep feel a lot more natural than Ambien, Restoril or any of the prescription drugs.
posted by mikesch at 10:56 AM on July 25, 2012 [3 favorites]

I really recommend a Bucky sleep mask. If he can stand them, I'd add earplugs, but failing that true silence or soothing sounds are advisable. And no TV or screen time within 2 hours or more of bedtime.

It is surprising how effective a mask, sound control and absence of "blue light" exposure can be in getting someone into a sound sleep.
posted by bearwife at 10:57 AM on July 25, 2012 [2 favorites]

I know that people have started to recommend fasting for jetlag. Would something like the Argonne diet help him re-adjust?
posted by punchtothehead at 10:58 AM on July 25, 2012

Another option might be light therapy.

I have a light box for SAD, and it works really well for me.
posted by Ruthless Bunny at 11:03 AM on July 25, 2012

I love taking a single Advil PM (or Excedrin PM, or generic PM -- Big Lots sells my favorite, 100 tablets for two bucks) on nights when I want to get at least 8 hours of uninterrupted sleep. Sometimes I'm a bit groggy the next morning but a shower usually kicks it. If he's going to go the medication route, I'd suggest trying it first on a non-work night so he can see how he feels & functions the next day.
posted by jabes at 11:14 AM on July 25, 2012

I go through this at work sometimes. I find that the worst of it isn't so much to do with sleep debt and how tired I am, but a shift in work hours. I often have to work up to 16 hours a day for weeks at a stretch. And then it's over, and I scale down to twelve, and then after that down to eight or ten.

You'd think that after scaling back down to a more normal schedule, life would get easier. But my body doesn't know what to do with the extreme shifts in the work/leisure/sleep ratio.

For example two weeks ago I did the downshift from twelve hour days to ~8 hour days. My body still does not know what to do in the evenings. I'd developed a routine where I got home from work, drank a beer and maybe ate something while watching an hour or so of mindless TV, then sleep. But now my evenings have expanded from a couple free hours to six or seven! My body has no context for what to do with all this free time. I have boundless energy and am never tired when it's time for sleep. I'm hungry at odd hours. I'm actually more out of whack now than I was when I was working around the clock.

The key to getting back into a normal schedule is that free time is not to be spent zoning out and drinking, it's to be spent in some kind of pursuit that will burn energy. Preparing meals and doing basic household tasks. Writing. Seeing friends. Movies. Exercise. Tasks can be fun, but they have to burn energy (even just mental energy). I try to structure my free time very intensely in order to make sense of how my day works and what I'm supposed to be feeling at any given time. Hungry at lunch time. Sleep at bedtime. Etc.

Maybe this would work for Mr. Julthumbscrew?
posted by Sara C. at 11:28 AM on July 25, 2012

I've seen a couple of articles this week about fasting to reset your body clock. Here's another account. The gist is that you simply don't eat for 12-16 hours, then eat a large meal at your new desired breakfast-time. Not eating after 8pm is also recommended.
posted by ourobouros at 11:30 AM on July 25, 2012

* pulls up chair, sits down *

Melatonin gets recommended a lot, but it didn't do jack-daddy-shit for me. It is possible, though, that it's the kind of thing where the effect is cumulative (i.e., it won't do anything the first time you take it, but if you keep taking it regularly anyway for a week or so then you'll start noticing an impact). What helped me instead was a valerian supplement (which was also cumulative), taken an hour before bed; and a calcium/magnesium supplement. Magnesium is supposed to be good for helping you stay asleep. I've fallen off the sleep wagon myself a couple times, and getting back on the vitamin/valerian regimen always helps. The magnesium also seems to help fastest in improving the quality of sleep -- there's always a couple days where I'm still not getting the amount of sleep I want, but the sleep I do get seems to be better somehow.

Also - the green helped me put together a "go to sleep" playlist that worked unusually well for letting me mentally switch off and chill out. The circumstances that were keeping me awake late have long since ended, but I still use it now and then if I'm just too restless at bedtime.
posted by EmpressCallipygos at 11:37 AM on July 25, 2012

This is classic Shift Worker Sleep Disorder. I would think your primary care doctor would be happy to prescribe Ambien by night and/or Modafinil by day, which would be really helpful to kick him back into a normal schedule.
posted by roofus at 11:53 AM on July 25, 2012

I'm a lifelong poor sleeper. As in, wake up many times per night, sometimes lie awake an hour or two, and on any night when something exciting happens or is about to happen or might someday happen, I don't sleep. And then I spend days afterward also not sleeping.

Diphenhydramine (the generic for Benadryl) works like a charm for me, and it's perfectly safe, non-addictive, and cheap. Multiple doctors have recommended this method to me over the years, especially the ones who use it themselves.

Diphenhydramine is the ingredient in all the Excedrin PM/Tylenol PM style medications, only it doesn't have any pain reliever. I take two (the recommended dose) about an hour before I want to be asleep. I'm rarely groggy in the morning, but I'm also a morning person.

Also, quitting smoking helps everything. I say this as a former smoker.
posted by ImproviseOrDie at 12:32 PM on July 25, 2012 [1 favorite]

Does Mr. Julthumbscrew have any tendency towards anxiety? Sometimes minor anxiety that is normally not a problem can be sent spinning out of control by work stress. That can subsequently destroy sleep. If this sounds possible, your husband may want to get treated for general anxiety in addition to sleeplessness. Treating the sleeplessness alone may not be very effective if anxiety is also involved, even if the anxiety is not a problem outside of his on-call week and current recovery period.
posted by rocketpup at 12:46 PM on July 25, 2012

Instead of melatonin, try co-q-10 in the morning or take it in the morning plus melatonin at night. Co-q-10 is the co-enzyme for melatonin. It wakes the brain up and also causes a melatonin spike about 12 hours later. In contrast, taking melatonin does not cause increased production of co-q-10. He might need a lot of co-q-10. I took 400mg to 600mg for a few years to straighten out my brain chemistry after coming off large amounts of prescription medication. I also used co-q-10 in the morning plus melatonin at night to rapidly adjust my sleep schedule over a three day weekend when I moved from evening shift to day shift.
posted by Michele in California at 12:53 PM on July 25, 2012 [2 favorites]

I work a mixed 4/10s-3/12s graveyard schedule, with the odd full week on days thrown in. Unless I want no social life whatsoever, I have to switch my 'weekends' back to a normal sleep at night/up all day schedule, then flip it back when I go to work. I used to really suck at sleeping (insomnia, waking up every couple of hours, trouble waking up, went though a sleep study and nothing seemed to help), regardless of my sleep hygiene practices. I started sleeping with earplugs after my schedule got really erratic and it totally changed my life - when I wear them I can sleep 8-9 hours in a stretch (rather than the ~4 average I managed before). I don't use melatonin or ambien or anything, but I'll occasionally take an antihistimine to speed up the sleep process if I had too much coffee the night before. I occasionally take modafinil but try to avoid it because it makes me cranky for days afterwards.

quitting smoking appears to have made a difference in my overall sleep patterns as well, but it took several months to really show an effect. The earplugs took a few days.
posted by par court at 1:11 PM on July 25, 2012

Oh god, i went through this when I had a totally brutal on-call schedule. I was on-call 24x7 for some things, and one out of every three weeks for ANY after hours issue... Those periods of time, I simply did not sleep.

I told all of my friends at the time that I had exactly three states: Being on call, recovering from being on call, and dreading being on call.

I was seeking any answer - from herbal teas and melatonin, exercise, healthy eating, blocking the light in my room, and white noise, to more questionable things - I reached a point to where ANY answer would have been good.

What helped me was something I didn't expect... I had started seeing a psych because of the sleep issues, and because I felt like I was losing my mind. He saw signs of depression, whereas I saw signs of exhaustion from not sleeping. He prescribed wellbutrin, based on family history and family experience, but advised that it likely wouldn't help with the sleep, as it had stimulating effects.

After a few days, I started sleeping normally.

YMMV.
posted by MysticMCJ at 1:47 PM on July 25, 2012

Melatonin sounds like the way to start, but if you can get a doctor to prescribe 1-2 Ambiens, they are masterful at deleting jet-lag by enforcing a relatively uninterrupted sleep period in time with local night. I would think this is similar.
posted by Sunburnt at 1:50 PM on July 25, 2012

When I started self-hypnosis, I was told never to do it in bed lest I inadvertently create a sleep cue instead of a relax cue. Apparently for people susceptible to self-hypnosis, it can be hugely effective. The Relaxation Response, which actually focuses on controlling high blood pressure through meditation not sleep at all, was the book recommended to me.
posted by mchorn at 1:57 PM on July 25, 2012

If it's just roughly 6x/year, there is really no reason not to take one Ambien each time to knock him out at the desired time.
posted by elizardbits at 3:23 PM on July 25, 2012 [1 favorite]