Sleep No More
September 19, 2013 5:17 AM Subscribe
I've been struggling with two sleep-related issues: anxiety over going to bed and waking up early feeling overheated. Tips on how to manage either problem?
I've had a sleep disorder since I was 13, although some of the symptoms I've experienced date back to early childhood. I started seeing a sleep doctor again at the beginning of the year and for the first time in my life was properly diagnosed with Upper Airway Resistance Syndrome and Periodic Limb Movement Disorder. Which symptoms are prominent is always changing but consists of some combination of difficulty falling asleep, difficulty staying asleep in the early morning, chronic fatigue, and violently thrashing around while asleep. Recently the only symptom that has been bothering me has been waking up early (usually ~30 minutes before my alarm clock goes off) feeling extremely overheated. I previously brought this symptom to the attention of my sleep doctor when it was happening earlier this year; they did bloodwork and did not find anything medically off, and it went away on its own after a month or two.
This, combined with the fact that I need to go to bed much earlier than my body prefers to (11PM vs 12:30-1) for work is leading to a huge amount of anxiety over going to bed every night. Sleep is so stressful and fraught with angst and my go-to way of dealing with it is to just put off going to bed. This is obviously not working out too well, and between these two issues I'm losing an extra hour of sleep each night. I wake up every morning vowing to go to bed an hour earlier, but by the time 10PM rolls around I have a dozen rationalizations that keep me from getting into bed - the best I've managed is 15 minutes past the time I need to be in bed. I've tried techniques like setting a bedtime alarm but when push comes to shove I tend to ignore them. I've never been good about holding myself to my own promises, and I am much more likely to self-sabotage when the thing I'm trying to accomplish is unpleasant in some way.
Relevant info:
- I see a therapist and psychiatrist for chronic anxiety. Currently I do not have health insurance so I can't afford to see any of my doctors until my new insurance kicks in November 1st. At any rate, they are aware of these issues but we haven't made much headway in managing them.
- I have done two diagnostic sleep studies and am due for another so I can be fitted for a CPAP machine once I have insurance again.
- I take Ambien to fall asleep and Neurontin for PLMD and anxiety.
- I practice good sleep hygiene-- not great, but good. Regular bed time and wake up time on weekdays, no hanging out in bed, avoiding coffee/tea after noon, etc.
- My usual strategies for dealing with early awakenings don't work once it's light out.
- I keep my bedroom cool and wear minimal clothing at night. The temperature I need to stay cool in the AM would be too cold for me to fall asleep. I have tried removing clothing and turning my fan on when I wake up but both usually wind making me feeling chilly and therefore waking up even more instead.
- I've been experiencing issues with fluctuating body temperature while awake as well.
I'm looking for any tips or tricks that could help me manage either of these issues, particularly anything that will help me conquer the anxiety/avoidance cycle that fuels my difficulty getting into bed. Any and all assistance is greatly appreciated.
I've had a sleep disorder since I was 13, although some of the symptoms I've experienced date back to early childhood. I started seeing a sleep doctor again at the beginning of the year and for the first time in my life was properly diagnosed with Upper Airway Resistance Syndrome and Periodic Limb Movement Disorder. Which symptoms are prominent is always changing but consists of some combination of difficulty falling asleep, difficulty staying asleep in the early morning, chronic fatigue, and violently thrashing around while asleep. Recently the only symptom that has been bothering me has been waking up early (usually ~30 minutes before my alarm clock goes off) feeling extremely overheated. I previously brought this symptom to the attention of my sleep doctor when it was happening earlier this year; they did bloodwork and did not find anything medically off, and it went away on its own after a month or two.
This, combined with the fact that I need to go to bed much earlier than my body prefers to (11PM vs 12:30-1) for work is leading to a huge amount of anxiety over going to bed every night. Sleep is so stressful and fraught with angst and my go-to way of dealing with it is to just put off going to bed. This is obviously not working out too well, and between these two issues I'm losing an extra hour of sleep each night. I wake up every morning vowing to go to bed an hour earlier, but by the time 10PM rolls around I have a dozen rationalizations that keep me from getting into bed - the best I've managed is 15 minutes past the time I need to be in bed. I've tried techniques like setting a bedtime alarm but when push comes to shove I tend to ignore them. I've never been good about holding myself to my own promises, and I am much more likely to self-sabotage when the thing I'm trying to accomplish is unpleasant in some way.
Relevant info:
- I see a therapist and psychiatrist for chronic anxiety. Currently I do not have health insurance so I can't afford to see any of my doctors until my new insurance kicks in November 1st. At any rate, they are aware of these issues but we haven't made much headway in managing them.
- I have done two diagnostic sleep studies and am due for another so I can be fitted for a CPAP machine once I have insurance again.
- I take Ambien to fall asleep and Neurontin for PLMD and anxiety.
- I practice good sleep hygiene-- not great, but good. Regular bed time and wake up time on weekdays, no hanging out in bed, avoiding coffee/tea after noon, etc.
- My usual strategies for dealing with early awakenings don't work once it's light out.
- I keep my bedroom cool and wear minimal clothing at night. The temperature I need to stay cool in the AM would be too cold for me to fall asleep. I have tried removing clothing and turning my fan on when I wake up but both usually wind making me feeling chilly and therefore waking up even more instead.
- I've been experiencing issues with fluctuating body temperature while awake as well.
I'm looking for any tips or tricks that could help me manage either of these issues, particularly anything that will help me conquer the anxiety/avoidance cycle that fuels my difficulty getting into bed. Any and all assistance is greatly appreciated.
I would encourage you to keep a food/sleep diary too. You might be sensitive to carbs. caffeine, sugar, or other things that can exacerbate the issues you've already identified.
posted by thinkpiece at 10:16 AM on September 19, 2013
posted by thinkpiece at 10:16 AM on September 19, 2013
Are you able to install a programmable thermostat? I have to be cool to sleep, otherwise I get nightmares, so we've got a Nest and set it to slowly warm up starting about 6AM on weekdays and 7AM on weekends.
I've also got a Chillow, which is a cooling gel pad to put inside your pillow case. I use it when I have migraines, as coolness on my head helps a bit, and my mother-in-law reports that it helps her hot flashes..
posted by telophase at 10:36 AM on September 19, 2013
I've also got a Chillow, which is a cooling gel pad to put inside your pillow case. I use it when I have migraines, as coolness on my head helps a bit, and my mother-in-law reports that it helps her hot flashes..
posted by telophase at 10:36 AM on September 19, 2013
When I'm feeling anxious I often put off bedtime even though I'm really tired. The thing that works for me is going to bed an hour *earlier* than needed, promising myself I'll read in bed until bedtime. Very frequently I'm asleep half an hour before I need to be.
And honestly, getting up and going to bed at approximately the same time every single day including weekends is the second biggest help for me, the first biggest being avoiding caffeine entirely.
posted by kadia_a at 10:43 AM on September 19, 2013
And honestly, getting up and going to bed at approximately the same time every single day including weekends is the second biggest help for me, the first biggest being avoiding caffeine entirely.
posted by kadia_a at 10:43 AM on September 19, 2013
The thing that helps me fall asleep is to have something to listen to that focuses my mind (displacing the anxious thoughts). I use podcasts (music doesn't engage my mind enough to keep me from worrying) that are light-weight (so the content doesn't trigger any anxiety) and easy to tune in and out as I start to drift off to sleep. My personal favorite is Wait, Wait, Don't Tell Me. A friend gave me a pair of bedphones - headphones with soft, flat ear pieces and very long cords made to wear while falling asleep. I also set the timer to turn off the podcast eventually (longer than I think i will need) which helps in a different way, since as long as the podcast is still going, I know I haven't been awake that long.
posted by metahawk at 5:04 PM on September 19, 2013 [1 favorite]
posted by metahawk at 5:04 PM on September 19, 2013 [1 favorite]
I have an electric blanket (I think in the US it is called something different, and underlay or something?), on a powerswitch timer.
So my bed is warm when I go to bed, and while I'm falling asleep, but it switches off soon after that. This would allow you to keep the room cooler, while still falling asleep easily.
***
Bedtime:
After 6 months of an early start, I still haven't adjusted my bedtime significantly.
It is very hard for me to go to bed before midnight. Ironically, what is easier, is going to sleep before 8pm.
Apparently for 2 hours before your 'standard' bedtime, is the period in which your body most tries to fight its level physiological tiredness. Think of it as a battle between your body clock, and your tiredness level, just like how if you stay up all night you often 'wake up' a bit more once it's daytime again.
Anyway, for me, this means if I get home, and just crawl in bed before 8pm, I guess my body thinks I'm having an afternoon nap or something, and voila, I sleep through til morning, and fix up a bit of my sleep debt.
If I do this on a Wednesday night, I can cope for the next couple of days of work.
So yeah, I'm getting 5-6 hours several nights in a row, then 9-10 hours on my catch up night. Screw it, it seems to work.
***
Sleep - have a hot shower before bed and an antihistamine if you have *any* hayfever/allergies. The shower makes me fall asleep so much quicker and deeper, that it kind of pays for itself in terms of sleep debt, even if I've gotten home really late. It chills my body out quite a bit.
Antihistamine - Being able to breath at night means I was more rested. I don't have to do this anymore, see next point.
***
For me, since I realised I have a wheat allergy (probably not gluten, just a plain old, sets off my hayfever, food allergy), my need for sleep has gone down from at least 9 hours a night to 7. Anxiety has gone way down too. I also just don't have any caffeine at all.
I don't want to say it was a silver bullet, but it was at least a brass bullet, and I feel kinda dumb that I spent years wishing for a magic fix, when there was one. I just didn't realise that I cannot have any wheat, at all, and if I do, my allergies will play up from the next day onwards for at least half a week.
Excessive sleep is often a symptom of an unknown/recognised health condition. Its what helps our body cope when we are a bit sick. Fingers crossed you're lucky and figure out what it is, and that it's fixable.
posted by Elysum at 9:40 PM on September 19, 2013
So my bed is warm when I go to bed, and while I'm falling asleep, but it switches off soon after that. This would allow you to keep the room cooler, while still falling asleep easily.
***
Bedtime:
After 6 months of an early start, I still haven't adjusted my bedtime significantly.
It is very hard for me to go to bed before midnight. Ironically, what is easier, is going to sleep before 8pm.
Apparently for 2 hours before your 'standard' bedtime, is the period in which your body most tries to fight its level physiological tiredness. Think of it as a battle between your body clock, and your tiredness level, just like how if you stay up all night you often 'wake up' a bit more once it's daytime again.
Anyway, for me, this means if I get home, and just crawl in bed before 8pm, I guess my body thinks I'm having an afternoon nap or something, and voila, I sleep through til morning, and fix up a bit of my sleep debt.
If I do this on a Wednesday night, I can cope for the next couple of days of work.
So yeah, I'm getting 5-6 hours several nights in a row, then 9-10 hours on my catch up night. Screw it, it seems to work.
***
Sleep - have a hot shower before bed and an antihistamine if you have *any* hayfever/allergies. The shower makes me fall asleep so much quicker and deeper, that it kind of pays for itself in terms of sleep debt, even if I've gotten home really late. It chills my body out quite a bit.
Antihistamine - Being able to breath at night means I was more rested. I don't have to do this anymore, see next point.
***
For me, since I realised I have a wheat allergy (probably not gluten, just a plain old, sets off my hayfever, food allergy), my need for sleep has gone down from at least 9 hours a night to 7. Anxiety has gone way down too. I also just don't have any caffeine at all.
I don't want to say it was a silver bullet, but it was at least a brass bullet, and I feel kinda dumb that I spent years wishing for a magic fix, when there was one. I just didn't realise that I cannot have any wheat, at all, and if I do, my allergies will play up from the next day onwards for at least half a week.
Excessive sleep is often a symptom of an unknown/recognised health condition. Its what helps our body cope when we are a bit sick. Fingers crossed you're lucky and figure out what it is, and that it's fixable.
posted by Elysum at 9:40 PM on September 19, 2013
The opposite of what Elysum suggested might also work, e.g. an air conditioner (something that won't blow cold air right on you) on a timer to go on an hour before your alarm.
With the PMLD and the temperature fluctuations, I would also consider increasing your iron intake and maybe supplements. Low iron can cause just about every annoying symptom there is, either directly or by chain reaction. I have also done sleep studies and have PLMD, and I was advised that although my iron levels were within the normal range, I should try to keep it in the top half of normal (e.g. using made up numbers, if normal was 100-200 units, mine was 110 but I should aim for 180 units). Seems to have made a difference.
Also, I get sleep disturbances and temperature fluctuations because of hormonal changes, which can apparently be a normal side effect for some women, but obviously YMMV (especially for men). It might be worth getting that tested.
posted by sarahkeebs at 10:12 PM on September 20, 2013
With the PMLD and the temperature fluctuations, I would also consider increasing your iron intake and maybe supplements. Low iron can cause just about every annoying symptom there is, either directly or by chain reaction. I have also done sleep studies and have PLMD, and I was advised that although my iron levels were within the normal range, I should try to keep it in the top half of normal (e.g. using made up numbers, if normal was 100-200 units, mine was 110 but I should aim for 180 units). Seems to have made a difference.
Also, I get sleep disturbances and temperature fluctuations because of hormonal changes, which can apparently be a normal side effect for some women, but obviously YMMV (especially for men). It might be worth getting that tested.
posted by sarahkeebs at 10:12 PM on September 20, 2013
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As far as the overheating, I got a bamboo blanket, I wear cotton pajamas, and using the CPAP helps a lot.
As far as the anxiety, I take a lot of deep breaths and try to remember that lying there quietly is, while not as good as actual sleep, still pretty beneficial. If I don't have to get up early, I don't go to bed until I'm really tired (like falling asleep in front of the TV/in my book). For awhile, Lunesta helped me get to sleep (maybe try something other than the Ambien?) and after a few weeks I stopped taking it. Klonopin also helps with Restless Leg Syndrome and that can be taken only as needed.
My usual strategies for dealing with early awakenings don't work once it's light out.
This one is easy - get blackout shades.
posted by desjardins at 6:37 AM on September 19, 2013 [1 favorite]