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January 11, 2014 4:11 AM   Subscribe

You aren't my doctor, psychologist or psychiatrist, but maybe you have something to share that will help me get onto a path toward curing a relentless, life-altering ( in the worst possible way( issue with sleep.

I've seen people ask about sleep before, but it seems that their problems were never as pervasive or complex as mine.
I'm a 24 year old post-college-kid who, about a year and a half into college, began experiencing some strange psycho- physiological symptoms, the most troubling of which was a constant mental and physical exhaustion. I wasn't just tired- I was the sort of tired that precluded all but the bare minimum, intellectually and socially.
Fast forward five years. I somehow finished college, albeit with a ruined GPA and an equally tarnished reputation amongst my professors.
I went through many different phases with my depression-like symptoms during this time, but the one that never left, only taking different forms, was my sleep issue.
Now it's been over half a year and what once was a problem of frequent, ill-advised, though manageable all nighters and missed school days has become a paralyzing ball-and chain.
My life is lived around sleep and my bed and energy levels that never quite get where they need to be for me to do so much as send an email- something that's caused me to missed out on the few opportunities for work and personal enrichment that have come my way.
To give you a sense of the problem, here's a break down of the two paths my day usually takes:

-Go to bed at 11pm
-Wake up a little before 2 am
-Stay up till 5/5:30am, not heavy-lidded but not really wanting to do much besides surf the net/watch TV.
-Go to bed, wake up between 11am and 2pm, groggy and almost physically craving my bed but not being able to fall back asleep. This being the case, I go downstairs, eat ( or overeat most days), and chug an energy shot, angry with myself for not feeling motivated enough to do anything productive. Heavy-headed but not sleepy, given the energy drink. Still don't do anything besides Hulu and Amazon and Youtube all day.
- Fall back asleep at some point between 2pm and 4:30-5 ( so two to three hours after my second wake-up)
- Wake up at about 5:30-8pm, feeling much better physically but still with a thin veil of fog and completely unmotivated to do anything that requires effort.
- Then EITHER fall back alseep at 11, OR stay up till 3 or 4 and start the cycle from there, depending on whether I have a second sip of my five hour energy shot.

As you can probably imagine, this is torture. I don't know what's going on. Why are the eight or nine hours after the first early morning wake up not enough for me to feel awake? Why do I take all these naps instead of sleeping the entire day through and at least being productive at night? Why am I waking up so early after going to bed at night in the first place?

What I do know is that I've almost doubled my weight in a year, become addicted to OTC stimulants and coffee, can binge eat carbs and sugar with scary enthusiasm and have to fight with myself to do things like brush my teeth or take a shower, just because I'm SO tired. I can't live life this way, much less hold down a job or a relationship.

So, what I want to know:
Is the time of day at which I sleep really that important? Is that why the first full 8 hours aren't doing anything?

Is there a sleep specialist in the NY metro area that has enough experience to deal with something like this?
I don't mean people you can find on Google. I mean the sort that make the news(papers). Mainly, I want them to know enough to look for the zebra in the field of horses and avoid jumping to apnea, prescription meds to solve my problems. I do have apnea, but this was an issue before that came onto the scene. Also, the energy drinks are only used to cope with this... the problem was there before they were too.

In the likely absence of a source of professional help, what should my sleep patterns look like and what's the quickest, most effective way to get there? I feel like my body has not only reversed day and night, but can't utilize the full pseudo-night for sleep.

What can I do to cope, emotionally and functionally, while I struggle with this?

I know this rambles and so if anyone needs clarification on anything, ask away. It's late and I know this is a lot, but I'm hoping someone has the answers because this is the furthest thing from a life well-lived. Thanks guys.

NOTE: I know that quitting the caffeine and seeing a therapist will probably make their appearances here. Those are good pieces of advice, but try and see if there's another way to look at this.
posted by marsbar77 to Health & Fitness (53 answers total) 8 users marked this as a favorite
 
One more thing to note- the depressive symptoms were not exactly comorbid with the sleep issue. They came later- about six months after my cycle began breaking down.
posted by marsbar77 at 4:12 AM on January 11


Have you been checked for diabetes? if your blood sugar spikes you can feel very lethargic and tired.
posted by thermonuclear.jive.turkey at 4:17 AM on January 11 [5 favorites]


I think your first step is to go to a medical doctor and get some tests done. Extreme fatigue can be a symptom of a number of illnesses, such as low thyroid, chronic fatigue syndrome, and many, many other things (some quite serious.)

Seriously, stop wracking your brain looking for emotional/lifestyle causes and go rule out physical causes first.
posted by Serene Empress Dork at 4:31 AM on January 11 [18 favorites]


Honestly, I think you might be lending too much snowflake-ness to this. Is it possible that you might need someone more talented than the average sleep specialist? Absolutely. Should you be narrowing yourself down to wanting to only see the best sleep specialist in the known world before you've actually have tried the others? At the very least, most doctors are going to be willing to run common blood tests and stuff before just handing you a prescription, if that's what you want. It's a place to start.

I don't think you should be trying here for "how do I sleep all day through", you sould be trying for "how do I manage to stay up all day so that I can actually sleep through the night". But, yeah, there's probably some underlying condition going on here, because you're talking about a very long pattern--five years and steadily worsening is definitely something you should seek professional help with, probably more than just "practice good sleep hygiene" and that kind of advice.
posted by Sequence at 4:33 AM on January 11 [4 favorites]


Not to threadsit, and I should have included this in the question but my thyroid, blood sugar and all my panels were normal last time I checked- about six months ago.
posted by marsbar77 at 4:33 AM on January 11


It may not be ideal, but have you tried ambien or something similar? It may allow you to get enough sleep to start to regulate your diet and start getting some exercise. I'm a huge believer that an unhealthy diet and lack of activity (say walking 30 minutes a day 4x/week) will make ANYONE feel physically and emotionally like crap - it does for me. Add in not sleeping and I can't imagine functioning. I have a friend who has been on sleeping medication for years. It's not perfect, but she functions much better with it than without. There may be a magic pill for your problem that can allow you to start to tackle the rest of your picture.
posted by Kalmya at 4:53 AM on January 11 [3 favorites]


1. Complete physical.
2. Manage the nightly lack of sleep, normalize that cycle (sleeping meds, Trazodone?)
3. Therapy, it really sounds like much of what you're dealing with is related to the depression.
4. Nutritionist to craft a diet for you and finding a motivation to stick to it.
posted by HuronBob at 4:55 AM on January 11 [3 favorites]


Is it possible you're a night person and just don't know it? My body really, really wants to stay up until about 7 in the goddamned morning, and my every attempt to make it do otherwise ends in tears and horror. I have a job that makes me sometimes alternate between staying up all night or waking up at like 5 AM, and when I have to wake up early it can mess me up for days. I feel sickly, weird, my stomach is off, I get headaches. It took me a while to figure out that I wasn't just chronically ill, I actually felt 9 thousand percent better when I could get back to staying up too late and waking up at a shameful hour.

All that being said, keep pressing ahead with therapy and doctors. You are going through hell, and it needs to be sorted out, whatever it takes.
posted by Ursula Hitler at 5:06 AM on January 11


Do not discount sleep apnoea as a cause of poor sleep quality, and the subsequent cycle. Severity can change quickly, and gets worse with age (usually).
posted by cromagnon at 5:07 AM on January 11 [5 favorites]


I know you're looking for an amazing specialist, but have you done a simple, preliminary sleep study, even at an average sleep study center?

They will definitely suggest quitting caffeine -- but even an average medical team will see that as an opportunity to remove caffeine as a variable on the way to solving your sleep problems, not as the end of the journey. (FYI. It sounds like the caffeine has made a side bet with the beast that is your sleep problem)

They will recommend good sleep hygiene to get you at an observable baseline, before bringing out creative solutions.

From my non medical perspective, I would concentrate on (as a first step) nutrition. Boost the nutritional value of what you're eating, even if you're still binging on sugary foods. Your body needs some honest energy.

The way you've narrated your problem, it sounds like you're not getting much done, so you can afford to give up the caffeine and sugar for a few weeks, even if it makes you super unproductive -- you're already unproductive. But you need medical supervision.

It's also completely possible to tell medical personnel that you're not interested in sleep medication -- but they may want you to use it for a limited time to give your body some restorative sleep and a "reset", again, to give see you at some sort of baseline. You should consider a short trial.

Another layperson suggestion -- quit tv and computers for a week and see what happens. Again -- what have you got to lose. Pick up a few books if you're antsy to read or distract yourself. Blue light of screens hurts sleep.

Make a commitment to meet up with a friend, out somewhere, even if you know you'll be sluggish. Your friend can then provide some testimony/observation to your medical team.

How are you earning a living/paying rent with this? If you're really not -- then you have nothing to lose to try even the smallest basic sleep hygiene steps while looking for a solution, but you really have to employ then for a few months (consecutively) before deciding that they have no role in a solution.

You've found ways to accommodate the beast-that-is-sleep-problems, you've created a number of life hacks to both accommodate and fight it. Someone's going to have to untangle all of that to free you. Good sleep hygiene is part of the untangling.

Caffeine, computer screens, tv and sugar are not allies to be trusted -- they're double agents. Routine, a CPAP machine, exercise, nutrition, and an engaged medical team are your friends here. They'll all pitch in.

You deserve to be free.
posted by vitabellosi at 5:08 AM on January 11 [15 favorites]


Have you been allergy tested? Food allergies can make me incredibly sleepy, even if I've just woken up. And there's not always any other symptoms, just an overwhelming desire to go back to bed.
Another possibility, I believe, is Vagus nerve issues. I'm on my phone so it's hard to link, but Google it - something you wouldn't even think of, like a bowel movement, can cause overwhelming tiredness if you have Vagus nerve issues.
posted by MexicanYenta at 5:15 AM on January 11


Your schedule that you articulate so well is almost exactly reflective of me when I'm on a sharp downward shift in my lifelong battle with depression. The only thing that pulls me out of it is to kick my depression's ass (for the time-being). There is no magical reset and there is no seeming logic to when it's going to start, but it always stops when I also stop wanting to not exist. So I mean, that's one data point for you.

I started doing this when I was in my later years of college, but I've had serious depressive episodes since I was 11, with occasional (about once every three years, each lasting a month or two) suicidal ideation. I'm also just extremely a night owl and always had poor sleep hygiene, and now I work from home on a schedule that makes me quite nocturnal, but nearly all my work gets done in that 5pm-10pm sweet spot. That helps in some ways but not in others, like socializing. When I'm in one of those downward turns though, it's harder and harder to do anything ever, including check my email, which is how I do all of my work. So that's crappy, and I'm working on that.

Depression is really different for everybody and there's no one right way to arm yourself against it. But I think you need to consider it seriously. Whether it's something that's happening because of the sleep problem, or has caused it, it's evident in your question that at the very least, you would benefit from trying some of the coping techniques (therapy, nutrition, medication, lifestyle changes) that we have to combat it.
posted by Mizu at 5:21 AM on January 11 [2 favorites]


Find a friend or someone who will take you on a week-long hiking/camping trip with no junk or screens around, and not let you quit and make sure you're safe.
posted by michaelh at 5:29 AM on January 11 [7 favorites]


If your recent doctor's visit and blood panel didn't include autoimmune disorders in the blood tests, you might want to consider that. My husband was diagnosed with rheumatoid arthritis without having joint mobility/pain symptoms. His symptom were overall tiredness (including an inability to focus on intellectual things), headaches, and sleeping and napping a lot. Some of what you're describing sounds like how he was feeling before he was diagnosed and treated. His treatment essentially eliminated the symptoms with the exception of a few relapses a handful of times a year.

In terms of depression, if you're uninterested in therapy, I've heard in the past that regular exercise is almost as helpful as regular therapy - there are free running groups in Manhattan and a few years ago I enjoyed the Nike Running Group which despite being linked to the corporate giant is full of nice and not offensively perky people - they have routes for all levels of runners including beginning (2 min running, 2 min walking, repeat); the runners are friendly and not snobby or obnoxious. This time of year is really hard on people in the northern hemisphere - the lack of sunlight is literally depressing. Some say that vitamin D supplements can help with this, others recommend using a SAD sunlamp.
posted by sciencegeek at 6:01 AM on January 11 [1 favorite]


What is your Vitamin D level? Your B12 level? Those aren't included in routine blood work, so either ask for those tests or read your lab report to see if they are listed.

Have you been allergy tested? You never know if this is an odd allergy of some sort.

Ditto on the autoimmune testing. Some can cause extreme fatigue, along with generalized inflammation in the body that can wear you down. Couple that with an allergy (to food dye, wheat, soy, etc) and you are giving yourself a triple whammy.
posted by MultiFaceted at 6:12 AM on January 11 [5 favorites]


Get a sleep study first.

Husbunny's depression and chronic fatigue started in his twenties. They were intertwined, feeding off of each other for decades. He never felt rested, even after hours and hours of sleep.

I diagnosed it in one night. Sleep Apnea. Snoring like a fiend, heart wrenching dead stops for up to 15 seconds, then catching of breath and snoring again.

A CPAP machine has made a WORLD of difference in his sleep, fatigue and his depression.

I now have a happy, well-rested husband who gets up in the morning and goes to work every day.

Before you start looking for zebras, get a sleep study. Any specialist will ask for one anyway, and how much better to do it without the expense of dealing with an emanate specialist.
posted by Ruthless Bunny at 6:19 AM on January 11 [3 favorites]


Echoing everyone else: Make an appointment with a doctor, any doctor, and go. Your resistance toward prescription meds seems to be avoidance of the issue - I have sleep issues that are very minor compared with yours, and it took only a few nights of crying with frustration before I sought medical help. You have got to start somewhere, and if that means taking Ambien for a few nights in order to start getting your head on straight enough to deal with the larger problem, well, that's what you need to do.
posted by something something at 6:41 AM on January 11 [1 favorite]


Yes, go to a medical doctor. You might wind up with an activating antidepressant (Eg wellbutrin) or prescription stimulants combined with a sleep aid. Or you could get a mega dose of vitamin D. Or you could get a referral to a sleep clinic. Who knows. Start with a GP and go from there. The goal is to get you functioning in daily life, not just solving a sleep problem. Good luck.
posted by crazycanuck at 7:17 AM on January 11


The most important information we need to know is if you've had a sleep study. They give so much information that can't be learned any other way. You say you had apnea before. It could have worsened, causing troubles for you. You really need to figure out if something is going on that isn't going to be obvious to you, but that a sleep study will pinpoint on.
posted by Aranquis at 7:25 AM on January 11


You could try NYMag's best doctors in NY list. There's a search box at the bottom where you can select location and type in "sleep" as the expertise. It's limited to doctors who made the best doctors list this year.
posted by donut_princess at 7:28 AM on January 11 [1 favorite]


I believe routine might help you a lot. Break the bad habbits and repeat your days as similar as possible to both each other and "normal" people's. To do so, you might need help from a therapist.
posted by oxit at 7:29 AM on January 11


N-thing go to a GP for a complete physical, and tell them everything. In the meantime, cut back on caffeine (limit to 1 or 2 cups before 1200), walk for 30 mins per day, and stop watching TV or looking at any kind of screens when you wake up in the middle of the night.
posted by rpfields at 7:32 AM on January 11 [1 favorite]


To my layperson's eye, this isn't necessarily some Dr. House, MD situation: you're exhausted because you are in fact not going through the mechanics (not even the complexity of not going through the stages of) sleeping (instead of logging 8-9 hours of continuous yet non-refreshing sleep like is the hallmark of apneas, underlying "zebra" medical conditions, etc.).

My bet is that you've got the "horse" of insomnia, and no matter what you think you've tried with regards to sleep hygiene on your own, the new hot thing (which has actually been studied for years) is a specialized form of CBT. (And yes, depressive symptoms secondary to insomnia respond to insomnia treatment as well--your instinct is right on that.)

Find a sleep center/specialist that has a CBT program, or refers out to one....and also treats people with different sleep rhythm/work shift/delay issues (also not a zebra).
Bonus points if it's an academically affiliated clinic/doctor.

Still start with a great GP for preliminary blood workups. But when I've had fatigue resolve with vitamin help, thyroid supplementation, etc.....I wasn't tired because I was waking up at 2am and staying up until 5am every morning like clockwork.
posted by blue suede stockings at 7:38 AM on January 11


Try liquid iron supplement. I am dead to the world without my iron.

Do you drink coffee / caffeine? Quit it.

Stop all the screen time and read a book.

I wonder how this all started. What were the beginnings of this cycle? You weren't always this way.

I wonder if you are now over tired. When I sleep too much, I get even more exhausted. So can you force yourself into a more normal schedule? And exercise. Leave the house and go for a walk or a light jog. I find when I force myself to exercise, even when I'm tired, my sleep gets reset and I wake up the following day feeling better.
posted by St. Peepsburg at 7:54 AM on January 11 [1 favorite]


Post history reveals that OP has a physical disability...maybe ease up on the exercise suggestions.
posted by skbw at 7:57 AM on January 11


You mention that you have sleep apnea but not whether or not you are using a CPAP or BiPAP. From what you describe I am guessing you aren't. Maybe I'm wrong, in which case feel free to skip over what I'm about to write. No sleep doctor worth his or her salt is going to start looking for the zebras you want them to until they are positive they aren't dealing with a horse. That means until you have been compliantly using your PAP machine (at least 70-80% of nights and for at least 6-7 hours or so) it just muddles things too much. Your logic about the timing between learning about sleep apnea and your symptoms is flawed as well. Unless you've had two definitive sleep studies with the first showing that when you began the symptoms you absolutely didn't have any apnea. And I don't mean a home sleep test because those are not used to rule out apnea. They're good at confirming it but they cannot say a thing about subtle airway obstruction (UARS). So unless you've had two in lab sleep studies, you need to chuck that idea right there.

Medicine isn't a matter of finding a doctor who has the magic ability to pull an obscure diagnosis out of thin air. It's about doctors (or PAs or NPs) making differential diagnoses and systematically excluding them from causality. They need to be able exclude diagnoses before moving on to the next on the list.

It's very possible you have more than one sleep disorder going on. It is very common. Sleep medicine is hard because night time sleep and daytime fatigue/sleepiness are so nebulous. Delayed sleep phase or narcolepsy or idiopathic hypersomnia can overlap sleep apnea. Can endocrine issues play a part? Sure. Depression? Oh, absolutely.

So, I'd start by finding treatment for your apnea. I'd find a sleep doctor (try the ones affiliated with universities if you want one who is in the newspapers because those are the ones who do research) who you feel confident as it sounds like you are not confident in the one(s) you've seen previously. Then, once you've ruled in or out your sleep apnea start looking at other causes. See a mental health provider.

I do work in sleep medicine but I am not your PA and this is not medical advice. Good luck.
posted by teamnap at 8:08 AM on January 11 [3 favorites]


A friend of mine had Hashimoto's (inadequate thyroid) that was similar this. For years it looked like she had unmanageable sleep patterns (that manifested in poor school attendance, terrible grades etc despite her obvious brilliance) and then one day she fell over in the shower and they figured out her thyroid was pretty much not functioning. Thyroid pills were all it took to fix it.
posted by fingersandtoes at 8:18 AM on January 11


A friend of mine had Hashimoto's (inadequate thyroid) that was similar this.

OP, you mentioned you've had your thyroid checked, but note that what you need to detect Hashimoto's is the antibody test(s), which aren't done automatically when someone "checks your thyroid" (most doctors just tick off the boxes for TSH, T3 and T4 levels, etc.).

Note that Hashimoto's can cause "inadequate thyroid" (hypothryoidism), but is actually an autoimmune condition (that can also cause periods of hyperthyroidism, or have no seeming affect on TSH or T3/T4 during some periods).
posted by blue suede stockings at 8:30 AM on January 11 [1 favorite]


What HuronBob said.

After you have had a complete physical workup to make sure there's nothing else going on, you want to ask your doctor for Trazodone.

It is a mild antidepressant with soporific side effects. At therapeutic levels for depression, you basically turn into a zombie. At much lower levels, it is extremely effective as a sleep aid, and is so well tolerated that it's one of the most common sleep aids used in geriatric populations. It has essentially no side effects, is non-narcotic, and non-addictive.

25mg is enough to make sure I have a solid and restful 7-9 hours of sleep. Take it about 40 minutes before you want to be asleep. Spend most of those 40 minutes relaxing, then go lay down. You'll be asleep ten minutes later. The first few days there will be some grogginess but after, you'll be fine.

This pill is, for me, magical.

But! Full physical workup first.
posted by feckless fecal fear mongering at 8:38 AM on January 11 [2 favorites]


PLEASE get tested for Vitamin D as someone else has said. I experienced extreme fatigue, depression, and anxiety during the time my vitamin D was low.
posted by Ms. Moonlight at 9:22 AM on January 11


Unfortunately, there's no good, solid answer to this. You'll definitely run into a lot of hammers diagnosing you as a nail.

I'm an old lady with near lifelong, intermittent sleep problems, and I empathize entirely with the perpetual level one tech support answers, insisting you just turn it off and on again one more time. Definitely give advice a try at least a few times before you dismiss it, but if something really hasn't worked for you at all, don't listen to the people who tell you you must be doing it wrong. They don't know what they're talking about. (Edit: Not talking about anyone here. That's a general observation from real life.)

The cold, cruel reality of insomnia is that, unless it's attributable to one of a few readily diagnosable causes--really, mostly just apnea and a few underlying medical conditions--you're pretty much on your own. Definitely consider those possibilities, of course, and if you haven't had really thorough workups for a variety of different conditions, pursue that with as much energy as you can muster. Autoimmune disorders in particular seem to take a million years to get diagnosed, based on my observations of people I know who have them, and they almost always seem to involve some sort of sleep weirdness.

I haven't found a formula-type answer to insomnia myself, so I can't give you a recipe. What did help me understand the issue better, and I think approach it more productively, was reading Gayle Greene's Insomniac. It's not a self help book, but a memoir/layperson's survey of the state of the art. She pretty much just documents her research into her own severe and persistent insomnia, describing various research methods, treatments, etc.. The moral of the book, ultimately, is that there really are no one-size-fits-all solutions, and that, like I said, you're probably on your own. But she does cover a lot of things you could try and ways to look at the problem, and just reading about that helped me to better observe and articulate my specific sleep patterns so I can better address them on my own.

So I have things I do that can kinda sorta sometimes work for me, but not for everyone. It's really more of a management thing than it is a cure thing for me.

To give you an idea, though: My big thing is that there is a point in a bout of sleeplessness where I have to make sure I sleep at least 4-5 hours, or the insomnia will catch hold and get a lot worse. Another is that sleep aids seem to have a lifetime maximum efficacy for me. When I find something that does work, I need to be very careful to not take it too often, because after some number of times, they start to actively keep me awake, so I use them very infrequently, only when I need to pull out the really big guns to prevent a massive sleeplessness cycle. I also do a number of the common 'sleep hygiene' things that you can easily find on the internet, but I completely reject some others simply because they don't work for me.

Just pay really, really close attention to any patterns you can discern, and try to figure out as many things--big and little--that make things better or worse for you.
posted by ernielundquist at 9:45 AM on January 11 [2 favorites]


Along with Vitamin D, Magnesium may also be a factor.
posted by jbenben at 9:49 AM on January 11


Don't reject meds and quit all energy drinks caffine. At best you are keeping yourself only minimally functional with stimulants. At worst you are exhausting your body out more and depriving it of the sleep in needs which feeds the cycle. I ignored lots of peoples advice for a long time regarding caffine because I was so tired I had to have it. Finally I decided I'd try for two weeks and go back to all the energy goodness if nothing changed. And in those two weeks I felt so much better I haven't gone back except for the occasional treat and some teas.
I echo many others people advice about seeking medical help and not ignoring the sleep apena.
posted by AlexiaSky at 10:10 AM on January 11


angry with myself for not feeling motivated enough to do anything productive

That's exactly how I used to feel before finding out that Delayed Sleep Phase Syndrome was a thing. Now I'm happily productive all night, and tend to wake up regular as clockwork and ready to start my day at around 1:30pm - unless I couldn't be arsed putting on the CPAP mask, in which case I wake up groggy as hell around 2:30pm.
posted by flabdablet at 10:11 AM on January 11


Also, I've recently been experimenting with regular fasting, and I've been finding that after four or five days of not eating, my sleep phase starts to shift earlier by about 20 minutes per day; by the end of a two week fast I'm typically down by 2am and up by 10:30am.
posted by flabdablet at 10:13 AM on January 11


Wow. You guys are amazing. No sleep study yet. It was recommended to me but I always thought there would only ever be two possible outcomes- normal results or apnea which would necessitate a CPAP. Sigh. Anyway, keep em coming!
posted by marsbar77 at 11:08 AM on January 11 [1 favorite]


"It was recommended to me but I always thought there would only ever be two possible outcomes- normal results or apnea which would necessitate a CPAP."

Would you refuse to use a CPAP machine if it was recommended? I'm just a bit confused as to why that was one of two outcomes that led to you avoid getting a sleep study. One of the strongest symptoms of sleep apnea is exhaustion even with sufficient sleep. If a CPAP machine would fix that, wouldn't you be knocking down doors to get one?
posted by Dynex at 11:46 AM on January 11 [7 favorites]


Also, if you completely rule out any physical or chemical problems, I can answer these questions:

"Why do I take all these naps instead of sleeping the entire day through and at least being productive at night? Why am I waking up so early after going to bed at night in the first place?"

If I took 2 long naps in the day I would never be able to sleep through the night. I would absolutely wake up around 2am and not be able to get back to sleep. If I woke up at 2am and wasn't able to fall back asleep, I'd be exhausted all day, and would feel the urge to take a nap - which I would resist!! Because I know if I nap during the day I can't sleep at night.

Every time my sleep at night has been so badly disrupted, the following day is pretty much a right off. I just have to stay awake until at least 10 so I don't keep the cycle going.

As well, when I do wake up at 2am, if I turn on a computer or TV screen, the light and motion gets my brain into high gear, which is the opposite of what you want. Of course I feel the urge to do those things, as they help distract me from the anxiety of not being able to sleep. Making a warm cup of tea and practising some slow gentle counting exercises (counting backwards from 100 while visualizing the numbers) before crawling back into bed is much more helpful.

But not nearly as helpful has taking benedryl. I take half a pill a few nights a week around 10pm. If I wake up at 2am on a night I took a benedryl, I barely have time to acknowledge I woke up before passing out again.

If you have untreated sleep apnea, or any physical or chemical reason, none of this is going to help you. Get a sleep study as soon as possible, as you rule out problems you'll get closer and closer to the answer.
posted by Dynex at 11:58 AM on January 11 [4 favorites]


Won't cure your insomnia but might help with the general lifestyle and productivity - when I wake up between 2-4 a.m. and can't get back to sleep, after a while I get up and start work, whether that means going to the office or getting out the laptop. I'm fortunate(?) in that I have a job where lots of it can (in fact, some of it must) be done at off hours. If that isn't a possibility (and assuming you can do so without waking the neighbors/family/roommates), there's also housework, drawers to straighten out, exercise, etc.

To the extent I can do this, I feel less lazy, crappy, etc. when I inevitably fold up in the early afternoon. It greatly helps my mood, which helps me eventually get back to a normal sleep schedule.
posted by randomkeystrike at 12:43 PM on January 11


It was recommended to me but I always thought there would only ever be two possible outcomes- normal results or apnea which would necessitate a CPAP

Man, if the outcome is that you have apnea and need a CPAP, then you have apnea and need a CPAP, whether you get the study or not. But if you do need a CPAP, and then you get a CPAP, it has a pretty high likelihood of both improving your quality of life a lot and saving you from brain damage or an unpleasant early death. They're a a little bit of a pain in the ass for sure, some people tolerate them better than others, but even you don't like using it, I think you'll find that you would like having a stroke a lot less.
posted by strangely stunted trees at 1:19 PM on January 11 [1 favorite]


CPAPs are not as bad as you are probably thinking. Depending on the severity of your (possible) sleep apnea there are other treatments. You are putting the cart before the horse. Get a sleep study.
posted by teamnap at 1:37 PM on January 11


Lifelong insomniac here. Four things that have really helped immensely.

Good sleep hygeine: Go to bed and get up at the same time every day, weekends included. No naps. No screens an hour before bedtime. No caffeine eight hours before bedtime. Lots of morning light. Dim lights three hours before bedtime. If you wake up during the night and can't fall back asleep quickly, get out of bed and do something dull but engaging in dim light (read a boring book, do crossword puzzles, etc.)

Stop micromanaging your sleep: I know you feel tired, but try not to catastrophize feeling tired. You are tired and it sucks, but it's not the end of the world. Breaking your fear of being tired will go a long way toward helping you cope with your sleep issues. You may want to see a therapist about it, but a book that is actually really helpful is Say Goodnight to Insomnia.

Sleep meds: It is not at all inappropriate to use medication to help you adjust to a new routine. Ambien works, so does trazodone. If you're really doctor-averse, try melatonin and/or Benadryl an hour before bed.

Sleep restriction: If setting a regular bedtime/wake time isn't enough to get back on track, you very well may have to retrain your body to consolidate sleep. What's the longest you ever sleep at a time? If it's five hours, go to bed five hours before your wakeup time. ONLY sleep during that time. Continue to practice good sleep hygeine--do not nap, no caffeine eight hours before bedtime, dim lights before bedtime, morning light. THIS IS REALLY HARD AND WILL SUCK, but stick with it. If you find yourself drifting off during the day, get up and walk around, drink ice water, do whatever you can to keep from falling asleep. Stick to this schedule for a week. You may still wake during the night (this is normal, actually) but as long as you are falling back asleep quickly, it's OK. Then you can start increasing your time in bed by fifteen minutes every few days, as long as you are actually sleeping that long. If you find yourself waking early or waking for long periods during the night, dial it back fifteen minutes or half an hour until you are sleeping consistently. Keep doing this until you can work yourself back up to seven or eight or nine hours.
posted by elizeh at 2:49 PM on January 11 [1 favorite]


Another thing to consider is that weight gain can greatly exacerbate the symptoms of apnea.
posted by smoke at 2:57 PM on January 11


You can't possibly come up with anything that's going to help yourself significantly in the sleep-deprived condition you're in. You need a sleep study. When I had mine, they hooked up 30-some leads to my body - EEG on the scalp, heart and lung leads, arms, legs, eyelids - everywhere. They gave me an Ambien and watched me all night long, recording every neurological impulse, every breath and heartbeat, every eye blink, every leg twitch, every episode of sleep apnea, REM sleep, etc. They then went over my results and decided that I may have some sleep apnea but what I really was experiencing that was interrupting my sleep so badly was restless legs - an average of 39 times an hour. I knew I had restless legs and foot cramps, and restlessness, period - but didn't know whether my case was really bad or not. The doctor said it was a miracle that I was getting any sleep at all. After going through all kinds of debate - he wanted to put me on Ambien and I declined due to the bizarre and dangerous side effects - he finally put me on generic Requip - at my pharmacist's suggestion. That was 3 weeks ago and I have not had ONE episode of restless legs since! I sleep 8 to 9 hours a night and wake up rested and ready to go - I haven't rested like this in 20 years.

Get a sleep study done. Then get the results - in detail - for your own records. Try to stay away from Ambien if you can, but go over beat by beat every detail of your study and talk with the doctor about what will help. You may need CPAP for sleep apnea - lots of people do and most have no idea they have it.

You can't function reliably without thorough sleep. I firmly believe that sleep deprivation is at the root of more mental and personality disorders, more road rage, domestic violence, and Heaven knows what else, than we have any awareness of.

Good luck to you.
posted by aryma at 4:51 PM on January 11


I'm not sure if this is helpful or not. You seem to have suffered quite a bit so it's probably you're quite familiar with this road but maybe there's something useful. I was taking Ambien regularly for a long time. There was always an excuse about how I absolutely had to go to sleep, so I had to take it, so I could go to a meeting in the morning or whatever--it was like a required tool.

Anyway, Ambien has returned some ghastly study results and I decided to stop taking it. I went cold turkey. It was horrible. I didn't sleep for what felt like forever. I was a zombie. Sleep deprivation makes you eat like an animal, too. I think I ate some UPS guy trying to deliver a package.

I would be up all night for days and days, and because I was just like 'this shit has got to stop' I was getting up at 5 AM. So I'd be up all night and pass out around 4 and then the alarm would go off.

Good times.

Anyway, I powered through, added daily cardio, kept with the 5 AM wake up call, and I'm fine now. I'm reading Master and Commander -- I fall asleep in three pages every night.

I think this was doable because I really really wanted to white knuckle through it -- I didn't want to take drugs to sleep every night. It sucked, but it sucked in a way that made me feel like I was doing something positive and productive. I think the entire thing took a couple of not fun weeks, but like I said, I was very motivated and I felt good that I was doing it.

Anyway if nothing else helps "doubling down on misery" helped me.
posted by A Terrible Llama at 4:58 PM on January 11


Oh and yeah, I agree with everyone else -- GP + sleep study as a first order of business.
posted by A Terrible Llama at 4:59 PM on January 11


Check your memail.
posted by suedehead at 6:13 PM on January 11


You should know that not only can getting fatter make sleep apnoea worse: sleep apnoea can make you get fatter more easily. You should also know that sleeping with a face-sucking squid attached to your head is a much worse thing to contemplate than to experience, especially given the immediate and dramatic improvement it will make to the way you feel on waking.
posted by flabdablet at 8:27 PM on January 11


Maybe instead of hopping on the internet when you wake up in the night you could light a candle and read a little bit. Or, just enjoy looking at it, or listen to a little music. I say this because last winter I did an experiment for a few months where I stopped using all forms of electric light (i.e. I just used candles at night, and didn't watch television or use the internet during the day or night, except for about an hour once a week), and I found that it helped resolve some of my sleep issues. I slept almost constantly for the first couple weeks, and then I found myself naturally shifting to a very normal sleep schedule, which is not something that I had ever had before. That's a little extreme, but it did convince me that electric lights can be very stimulating, and therefore disruptive to proper sleep. So, maybe avoiding electric lights at night could help. I doubt if it would solve the problem entirely, but it might lessen the symptoms a little.
posted by sam_harms at 1:41 AM on January 12


Nthing that a CPAP is not the only possible treatment for apnea, and that apnea is not the only possible issue here. I had a vitamin D deficiency at one point that turned me into a zombie regardless of the amount of sleep I got, and that on top of a sleep disorder would've been utterly brutal (my mom and brother have apnea, so I've got some familiarity with its effects). If you haven't discussed this with a GP in very specific terms, start there to make sure there aren't physiological factors you need testing for, and then get a sleep study.
posted by EvaDestruction at 6:54 AM on January 12


Scheduled myself for a sleep study and going from there with any possible med routes/cpap. Also planning on starting Magnesium and Vitamin D in the interim, just in case. Thanks everyone...hopefully this nightmare ends before my 20s do.
posted by marsbar77 at 7:48 AM on January 12 [3 favorites]


I'd be interested to know what you find out.

Best of luck.
posted by flabdablet at 8:06 AM on January 12


It looks like you are on the right track, but I'll add my observations. We humans were designed to operate on a 24 hour cycle. Our activity is somewhat regulated by our metabolisms, which regulates a lot of our functions, like how fast to process the food we eat, when we should sleep, and when we are likely to be active. Your body uses clues like daylight and activity to keep your metabolism on track. Through some combination of apnea and your lifestyle, your metabolism has jumped the tracks. You are no longer on a 24-hour day and trying to force your body to conform is turning you into a zombie. The apnea is not helping, either. I'm guessing that if you left it up to your body you would stay up 20-24 hours, then sleep 10-12 hours, instead of the 16/8 split we are "supposed" to get.

So, like others have suggested, you need to get back on track by addressing the apnea, then convincing your body to get back on track through lifestyle changes or sleeping meds.

One of the aspects of apnea that a lot of people do not realize is what it does to your heart. When you sleep your body and mind are supposed to be resting, but with apnea, neither really gets any reast. When your breathing stops or slows, it doesn't take long before your blood oxygen drops to a point where your heart kicks in to overdrive to increase the amount of oxygen your blood can absorb from your lungs. This also wakes your brain up, even though you may not realize you are awake, or maybe that you were even sleeping. Eventually the heart rate drops, you fall back to sleep and the cycle is ready to repeat. Maybe every 2 minutes, or 4, or 10.

The result is that in that 11pm-2am sleep, your mind thinks you were sleeping or in twilight, but your heart thinks you've been at the gym for the last 3 hours. So you are tired but at the same time a bit pumped up from that monster cardio session you just had. Eventually the tiredness wins out and you get need to sleep again, when the 24-hour world says you should be waking up, so you sleep in and nap. You are so tired that your heart doesn't work as hard when you have these naps, and as a result you wake up groggy from the prolonged reduced blood oxygen. Light probably bothers you, so you live in a cave. Your metabolism is so out of whack that you probably aren't eating when your body expects new fuel, so when it gets it it tries to process as quickly as it can, drawing a lot of blood to your stomach and making you lightheaded and tired.

Any of this sound familiar? Fix the sleep apnea. Then give your body the clues it needs to get you back in the 24-hour cycle. That includes light and exercise in the morning, food at traditional times (breakfast, lunch, light supper - no food after 6 or 7 pm - split lunch up to smaller meals at 10-11 and 2-3 if it is making you tired after eating), darkness at night. Discuss with your doctor sleep aides to help you sleep on schedule.
posted by Yorrick at 9:43 AM on January 12


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