Go The Fuck To Sleep: I'm My Own Worse Enemy Edition
September 30, 2015 3:41 PM Subscribe
I cannot get to sleep with any consistency. I have horrible sleep hygiene and I fail to sleep at reasonable times frequently. It's a life long issue, but as I get older, the lack of sleep is becoming more harmful. The problem is, I struggle to just stop and go to bed. There is always just one more thing I have to read or do. I can't seem to take control of this.
Some nights are better than others, but on a whole I just do poorly with making myself go to sleep. I always want to do a little more before I sleep, and that can be anything from internet browsing to eating, to cleaning, to reading a book. Logically, I know I need to go to sleep. I tell myself I need sleep to feel good ESPECIALLY now with a chronic pain. And yet, I frequently just . . . don't.
In a nutshell, if I can explain it, it's like system 1 becomes more in control the sleepier I get, while system 2 goes and fucks off someplace else. So I commit to sleeping, and I tell myself I need to sleep, and yet somehow there is just a little more I need to do before I got to sleep. I will even nod off, and then wake up and redouble my efforts to stay awake.
I'm driving myself crazy. I need to sleep full nights, and yet I can't seem to stop this. I'm under the care of a sleep specialist and I'm taking a bunch of medications for sleep and related conditions. As my tolerance grows though, I'm reverting to what is normal for me, this irrational, disconnected desire to stay awake just a little longer. Increasing the dose is not the answer.
I have been like this since childhood and it drove my parents nuts. In my 20s, I was not nearly affected by it like I am now, and indeed I embraced it as it tended to be a very creative time for me. If not creative, then just a little more time for enjoyment or learning or cleaning. In my early 30s, it clearly had a stronger negative impact.
One complicating factor is that I was recently diagnosed with lifelong adhd via neuropsych testing. I think that's playing a part here, both with trouble shutting my mind down, and with knowing I need to go to sleep and yet not following through. At the very least, some of the symptoms of adhd I've recently learned about sound a lot like my sleep problems in that I know what I need to do (go to sleep) and yet I can't implement that knowledge. As described here.
I plan to try medication to treat the adhd but can't get in to see a psychiatrist until December. And I don't *know* that's the problem with my sleep. It just seems like it might at least be complicating things.
I have a feeling that doctors could keep shoveling sleeping meds at me until I died of respiratory depression; as soon as I build any sort of tolerance, I'm back to this pattern of staying awake. When I was working, I had irregular sleep until I was so tired that I could not fight sleep anymore.
I do have a sleep doctor. I've had two sleep studies, and was found to have restless leg syndrome with periodic limb movement disorder. I take a sedative, and two muscle relaxers. One of them is an off-label treatment for the rls, which is now well controlled. Pain at night is moderately controlled, but I dare say it is better than during the day, probably from the muscle relaxers.
This does seem to be better and worse in cycles. I think what happens is that I do have a small amount of control, and I make myself go to bed and sleep while I'm still awake enough to let my rational brain / system two brain direct me. Usually I become diligent after a particularly rocky bout of sleep. But then as I'm getting better sleep (not great, still less than perfect compliance but at least moderately normal), I'll end up engrossed in something and can't let it go. Then I try to go to sleep, but I'm already too tired to be fully in control and the whole vicious cycle starts over again.
Complicating factor - chronically ill and much of my time is spent in my bed. As I've become more physically disabled, I've gathered things around my bed, in my bedroom. In an ideal world, I'd have two beds, one for day time activities, and one for sleep. But that's not an option right now. I know that's terrible sleep hygene.
However, I've always brought plenty of stuff with me to bed, and doubt that even under the best of circumstance I could be disciplined to stop doing that. I'm not saying this as a cop out, but as a human that's used this body for years and years, and I am my own worst enemy here. I have tried in the past and it doesn't take long for me to decide that I can bring a book to bed "just this once". And while I have my preferred activities that keep me a wake, in absence of them I will find something else to do, or get out of bed and go to where I can.
I feel like I'm absolutely insane because I cannot control this. The urge to stay awake and do more is dare I say compulsive, especially the more tired I get.
Any suggestions to help, even a little, would be greatly appreciated.
Some nights are better than others, but on a whole I just do poorly with making myself go to sleep. I always want to do a little more before I sleep, and that can be anything from internet browsing to eating, to cleaning, to reading a book. Logically, I know I need to go to sleep. I tell myself I need sleep to feel good ESPECIALLY now with a chronic pain. And yet, I frequently just . . . don't.
In a nutshell, if I can explain it, it's like system 1 becomes more in control the sleepier I get, while system 2 goes and fucks off someplace else. So I commit to sleeping, and I tell myself I need to sleep, and yet somehow there is just a little more I need to do before I got to sleep. I will even nod off, and then wake up and redouble my efforts to stay awake.
I'm driving myself crazy. I need to sleep full nights, and yet I can't seem to stop this. I'm under the care of a sleep specialist and I'm taking a bunch of medications for sleep and related conditions. As my tolerance grows though, I'm reverting to what is normal for me, this irrational, disconnected desire to stay awake just a little longer. Increasing the dose is not the answer.
I have been like this since childhood and it drove my parents nuts. In my 20s, I was not nearly affected by it like I am now, and indeed I embraced it as it tended to be a very creative time for me. If not creative, then just a little more time for enjoyment or learning or cleaning. In my early 30s, it clearly had a stronger negative impact.
One complicating factor is that I was recently diagnosed with lifelong adhd via neuropsych testing. I think that's playing a part here, both with trouble shutting my mind down, and with knowing I need to go to sleep and yet not following through. At the very least, some of the symptoms of adhd I've recently learned about sound a lot like my sleep problems in that I know what I need to do (go to sleep) and yet I can't implement that knowledge. As described here.
I plan to try medication to treat the adhd but can't get in to see a psychiatrist until December. And I don't *know* that's the problem with my sleep. It just seems like it might at least be complicating things.
I have a feeling that doctors could keep shoveling sleeping meds at me until I died of respiratory depression; as soon as I build any sort of tolerance, I'm back to this pattern of staying awake. When I was working, I had irregular sleep until I was so tired that I could not fight sleep anymore.
I do have a sleep doctor. I've had two sleep studies, and was found to have restless leg syndrome with periodic limb movement disorder. I take a sedative, and two muscle relaxers. One of them is an off-label treatment for the rls, which is now well controlled. Pain at night is moderately controlled, but I dare say it is better than during the day, probably from the muscle relaxers.
This does seem to be better and worse in cycles. I think what happens is that I do have a small amount of control, and I make myself go to bed and sleep while I'm still awake enough to let my rational brain / system two brain direct me. Usually I become diligent after a particularly rocky bout of sleep. But then as I'm getting better sleep (not great, still less than perfect compliance but at least moderately normal), I'll end up engrossed in something and can't let it go. Then I try to go to sleep, but I'm already too tired to be fully in control and the whole vicious cycle starts over again.
Complicating factor - chronically ill and much of my time is spent in my bed. As I've become more physically disabled, I've gathered things around my bed, in my bedroom. In an ideal world, I'd have two beds, one for day time activities, and one for sleep. But that's not an option right now. I know that's terrible sleep hygene.
However, I've always brought plenty of stuff with me to bed, and doubt that even under the best of circumstance I could be disciplined to stop doing that. I'm not saying this as a cop out, but as a human that's used this body for years and years, and I am my own worst enemy here. I have tried in the past and it doesn't take long for me to decide that I can bring a book to bed "just this once". And while I have my preferred activities that keep me a wake, in absence of them I will find something else to do, or get out of bed and go to where I can.
I feel like I'm absolutely insane because I cannot control this. The urge to stay awake and do more is dare I say compulsive, especially the more tired I get.
Any suggestions to help, even a little, would be greatly appreciated.
Best answer: I sleep so much better when I'm taking my adderall daily. Otherwise my brain is just like WE HAVE THINGS TO THINK ABOUT RIGHT NOW MOTHERFUCKER REMEMBER THAT TIME IN 2ND GRADE WHEN YOU HAD TO BE DIRT IN THE CLASS PLAY THAT SUCKED LOL and suddenly it's 4am and I am the most angry.
posted by poffin boffin at 4:08 PM on September 30, 2015 [39 favorites]
posted by poffin boffin at 4:08 PM on September 30, 2015 [39 favorites]
I do this exact thing: "I will even nod off, and then wake up and redouble my efforts to stay awake." I'll be bingewatching some idiotic boring series, fall asleep, wake up, rewind to where I fell asleep, and start watching again--over and over and over again all the time thinking, why am I doing this why! I, too, feel insane, and it absolutely feels compulsive. Your two links and your idea that this is an offshoot of ADHD make beautiful sense.
posted by Don Pepino at 4:09 PM on September 30, 2015 [3 favorites]
posted by Don Pepino at 4:09 PM on September 30, 2015 [3 favorites]
Two small ideas:
1) Is there any chance you would respond to a withholding & reward system? Something basically like "If I put myself to bed at 11:30 pm for 3 or more nights this week, on the weekend I can have [thing I like]."
2) What if you put your bedroom lamp on a timer? I know that we can all continue to do stuff on our phones and whatever when the light is out, but would the light clicking off be a real reminder that now is time for sleep?
I have these tendencies as well, in that I do not tend to want to go to bed and love to be up later doing stuff. Having a partner who wants to keep a more regular schedule has helped a bit, in that I use his schedule to help regulate mine. I also came to terms with the idea that sleepiness was not a primary motivator for me to put myself to bed, so I needed to form other clues to make that happen and live with the fact that I would then lay awake for at least a little while and decided that that lay-down time was nearly as good for restfulness and health as actual sleep.
posted by vunder at 4:11 PM on September 30, 2015
1) Is there any chance you would respond to a withholding & reward system? Something basically like "If I put myself to bed at 11:30 pm for 3 or more nights this week, on the weekend I can have [thing I like]."
2) What if you put your bedroom lamp on a timer? I know that we can all continue to do stuff on our phones and whatever when the light is out, but would the light clicking off be a real reminder that now is time for sleep?
I have these tendencies as well, in that I do not tend to want to go to bed and love to be up later doing stuff. Having a partner who wants to keep a more regular schedule has helped a bit, in that I use his schedule to help regulate mine. I also came to terms with the idea that sleepiness was not a primary motivator for me to put myself to bed, so I needed to form other clues to make that happen and live with the fact that I would then lay awake for at least a little while and decided that that lay-down time was nearly as good for restfulness and health as actual sleep.
posted by vunder at 4:11 PM on September 30, 2015
Your behavior does sound like it's being caused by the ADHD but, having to spend so much time in your bed during the day would make anyone not sleep well at night, no matter what the medications or problems. Are you getting any sunlight? Do you have any sort of physical therapy? You need sunlight and movement for good sleep. Your behavior sounds a lot like what my ex-husband used to do. He has adult ADHD plus he is bipolar. Please have your doctor evaluate you for bipolar before putting you on ADHD medications because some of those meds can make a person with bipolar go off the deep end.
While you wait for your appointment, get as much sunlight as you can and move around as much as possible. Avoid sugar and caffeine. Eat fruits and vegetables. A change in diet can help so much.
posted by myselfasme at 4:12 PM on September 30, 2015
While you wait for your appointment, get as much sunlight as you can and move around as much as possible. Avoid sugar and caffeine. Eat fruits and vegetables. A change in diet can help so much.
posted by myselfasme at 4:12 PM on September 30, 2015
Meds actually helped with this, just by helping me get a little bit of control over my life. It's true that stimulants can make it hard to sleep, but I take mine first thing in the morning, and they've worn off by bedtime. When I'm not taking adderall, everything feels like chaos, which is not conducive to setting up and sticking to a schedule.
My basic rule is that if something is hard, I need an inflexible routine. I have a bedtime, and it is not negotiable. I start winding down at 9:00. I need to be in bed with the lights off at 10:00. I don't know if that would work for you, but that's what I do. I don't play the "just one more..." game, because there is no negotiating. It's 10:00, so lights out.
My main problem now is that I wake up in the middle of the night and have trouble getting back to sleep. I have no solution to that, other than to listen to podcasts featuring people with very soothing voices.
posted by ArbitraryAndCapricious at 4:13 PM on September 30, 2015 [2 favorites]
My basic rule is that if something is hard, I need an inflexible routine. I have a bedtime, and it is not negotiable. I start winding down at 9:00. I need to be in bed with the lights off at 10:00. I don't know if that would work for you, but that's what I do. I don't play the "just one more..." game, because there is no negotiating. It's 10:00, so lights out.
My main problem now is that I wake up in the middle of the night and have trouble getting back to sleep. I have no solution to that, other than to listen to podcasts featuring people with very soothing voices.
posted by ArbitraryAndCapricious at 4:13 PM on September 30, 2015 [2 favorites]
hello! I am sorry you are struggling like this, consistent sleep patterns are an amazing sort of therapy all on their own, let's try to get you there.
when you are slipping in your sleep patterns or things have gone a bit off the rails... you have to take a step back and make a simple plan that you know you can stick to. behavioral psychology is more powerful than drugs in some cases and it doesn't complicate your already complicated medical situation.
some free stuff you can try:
change the sheets before bed every night. yep. teach your brain that sliding into cool clean sheets is sleepy time.
pick a winding down ritual for yourself and stick with it for a month. it can be as simple as a 15 minute guided meditation check out youtube for some free examples or breathing exercises followed by some good old fashioned journaling with pen and paper. writing is a form of psychological exorcism... the bonus is being able to look back when you are well.
if you can drink some herbal tea, Chamomile or similar without caffeine during your personal ritual... great. warm beverage + clean sheets and quiet time are not magic, but powerful suggestions for your brain to follow.
when you close your eyes every night, try a simple systems check... think about your toes, wiggle them, try to imagine sunlight or moonlight touching just your toes and making them tingle. then move up your body, section by section. remain aware of when it gets hard to concentrate, what hurts or is getting in the way. When you get stuck, take 5 deep breaths and let them out... continue your systems check until you have reached the top of your skull.
take 5 more deep breaths and just try to be still in the quiet.
The first 2 weeks you try this, it's going to be awkward, weird feel dumb and then like all things of this nature... you start to look forward to it.
if you consistently write down what the barriers are during your ritual, patterns emerge.
being stuck in bed a lot is an additional physical drain on you, so we have to get a little pep back into you to get your brain chemistry on board with your wellness plan. There are lots of exercise options for people stuck in bed with chronic pain, just start really small and do 10 to 15 minutes of exercise a day. work up to 30 minutes a day.
the routines of some exercise on a schedule and a systems check to wind down are going to help put you onto the path to becoming a sleep ninja.
There are also non-drug alternatives to altering your brain chemistry and making it more amenable to sleep... one of the alternatives is called CES. It's basically delivering low voltage electrical stimulation to your head. It sounds like crackpot medicine but it's been clinically tested on insomnia patients with decent results.
posted by bobdow at 4:24 PM on September 30, 2015 [3 favorites]
when you are slipping in your sleep patterns or things have gone a bit off the rails... you have to take a step back and make a simple plan that you know you can stick to. behavioral psychology is more powerful than drugs in some cases and it doesn't complicate your already complicated medical situation.
some free stuff you can try:
change the sheets before bed every night. yep. teach your brain that sliding into cool clean sheets is sleepy time.
pick a winding down ritual for yourself and stick with it for a month. it can be as simple as a 15 minute guided meditation check out youtube for some free examples or breathing exercises followed by some good old fashioned journaling with pen and paper. writing is a form of psychological exorcism... the bonus is being able to look back when you are well.
if you can drink some herbal tea, Chamomile or similar without caffeine during your personal ritual... great. warm beverage + clean sheets and quiet time are not magic, but powerful suggestions for your brain to follow.
when you close your eyes every night, try a simple systems check... think about your toes, wiggle them, try to imagine sunlight or moonlight touching just your toes and making them tingle. then move up your body, section by section. remain aware of when it gets hard to concentrate, what hurts or is getting in the way. When you get stuck, take 5 deep breaths and let them out... continue your systems check until you have reached the top of your skull.
take 5 more deep breaths and just try to be still in the quiet.
The first 2 weeks you try this, it's going to be awkward, weird feel dumb and then like all things of this nature... you start to look forward to it.
if you consistently write down what the barriers are during your ritual, patterns emerge.
being stuck in bed a lot is an additional physical drain on you, so we have to get a little pep back into you to get your brain chemistry on board with your wellness plan. There are lots of exercise options for people stuck in bed with chronic pain, just start really small and do 10 to 15 minutes of exercise a day. work up to 30 minutes a day.
the routines of some exercise on a schedule and a systems check to wind down are going to help put you onto the path to becoming a sleep ninja.
There are also non-drug alternatives to altering your brain chemistry and making it more amenable to sleep... one of the alternatives is called CES. It's basically delivering low voltage electrical stimulation to your head. It sounds like crackpot medicine but it's been clinically tested on insomnia patients with decent results.
posted by bobdow at 4:24 PM on September 30, 2015 [3 favorites]
You know, this reminds me of how I used to be chronically late to everything. I knew I should get going, but there was always one more thing . . . and it didn't matter how much I wanted to see the person who was waiting for me, or do the thing that was scheduled, or would get in trouble for being late.
Two things have helped me become (mostly) punctual. First, I saw a psychiatrist for general depression, and she asked me directly why I was late for our sessions. Why, she asked, would I deprive myself of time that was strictly for me, for which I was paying? I found that a very zingy question. There wasn't any really good answer.
Second, it helps so much to build structure for yourself. For me, I plan in advance how much time I will need to get somewhere, add a little cushion of 5 minutes to a half hour, and then that time is when I leave. It's immutable. I have to go then. No exceptions.
So, for you, I'd suggest you think about why you are depriving yourself of the sleep you need to function and think and develop memories . . . don't beat yourself up, just ask yourself why, in a curious compassionate way.
And I really think you need to build your own structure. You know what it needs to look like -- everything around a comfortable seat well away from your bed, nothing but sleep stuff where your bed is. A fixed bedtime and a bedtime ritual that starts itself at a fixed time . No exceptions. Not ever. Bobdow has other great ideas to add into your bedtime ritual.
You will get better and better at this as your rational brain is more convinced there isn't a good reason not to do what you need to get enough sleep, and as you nail down your bedtime ritual and take everything that isn't sleep related away from your sleep space.
posted by bearwife at 4:51 PM on September 30, 2015 [6 favorites]
Two things have helped me become (mostly) punctual. First, I saw a psychiatrist for general depression, and she asked me directly why I was late for our sessions. Why, she asked, would I deprive myself of time that was strictly for me, for which I was paying? I found that a very zingy question. There wasn't any really good answer.
Second, it helps so much to build structure for yourself. For me, I plan in advance how much time I will need to get somewhere, add a little cushion of 5 minutes to a half hour, and then that time is when I leave. It's immutable. I have to go then. No exceptions.
So, for you, I'd suggest you think about why you are depriving yourself of the sleep you need to function and think and develop memories . . . don't beat yourself up, just ask yourself why, in a curious compassionate way.
And I really think you need to build your own structure. You know what it needs to look like -- everything around a comfortable seat well away from your bed, nothing but sleep stuff where your bed is. A fixed bedtime and a bedtime ritual that starts itself at a fixed time . No exceptions. Not ever. Bobdow has other great ideas to add into your bedtime ritual.
You will get better and better at this as your rational brain is more convinced there isn't a good reason not to do what you need to get enough sleep, and as you nail down your bedtime ritual and take everything that isn't sleep related away from your sleep space.
posted by bearwife at 4:51 PM on September 30, 2015 [6 favorites]
Response by poster: Your behavior does sound like it's being caused by the ADHD but, having to spend so much time in your bed during the day would make anyone not sleep well at night, no matter what the medications or problems. Are you getting any sunlight? Do you have any sort of physical therapy? You need sunlight and movement for good sleep. Your behavior sounds a lot like what my ex-husband used to do.
Yes, I do spend time out side in a chair when I can. Specifically to get sun. Winter is coming so that will change, but I've used metal halide lamps in the past to sort of emulate the sun. I'm not in physical therapy right now; it hasn't helped when I have. I was doing regular light exercise and daily stretching, though the last two weeks have not because I've had a pretty significant flare. But I will start again as soon as I'm over this hump.
With that in mind, the sleep problems go back to childhood, whereas my partial bed-bound state is only in the past 3-4 years. I'm sure it's not helping matters, but I am sleeping better now than I was pre-chronic pain. Largely because of an effort on my part because the pain is worse on little sleep. Which is the sad part - I am trying in earnest to get better sleep and it's still just not working.
He has adult ADHD plus he is bipolar. Please have your doctor evaluate you for bipolar before putting you on ADHD medications because some of those meds can make a person with bipolar go off the deep end.
The adhd testing I did also including testing for comorbid disorders precisely because my therapist had the same concern. No bipolar. Mild depression because being in pain all the time is depressing. (in other worse, it's really not my normal state.)
There are lots of exercise options for people stuck in bed with chronic pain, just start really small and do 10 to 15 minutes of exercise a day. work up to 30 minutes a day.
I hadn't considered this, usually I wait until I am able to be mobile to resume, but bed based activities might be perfect (and possibly regardless of sleep, so thank you for this).
posted by [insert clever name here] at 5:00 PM on September 30, 2015 [1 favorite]
Yes, I do spend time out side in a chair when I can. Specifically to get sun. Winter is coming so that will change, but I've used metal halide lamps in the past to sort of emulate the sun. I'm not in physical therapy right now; it hasn't helped when I have. I was doing regular light exercise and daily stretching, though the last two weeks have not because I've had a pretty significant flare. But I will start again as soon as I'm over this hump.
With that in mind, the sleep problems go back to childhood, whereas my partial bed-bound state is only in the past 3-4 years. I'm sure it's not helping matters, but I am sleeping better now than I was pre-chronic pain. Largely because of an effort on my part because the pain is worse on little sleep. Which is the sad part - I am trying in earnest to get better sleep and it's still just not working.
He has adult ADHD plus he is bipolar. Please have your doctor evaluate you for bipolar before putting you on ADHD medications because some of those meds can make a person with bipolar go off the deep end.
The adhd testing I did also including testing for comorbid disorders precisely because my therapist had the same concern. No bipolar. Mild depression because being in pain all the time is depressing. (in other worse, it's really not my normal state.)
There are lots of exercise options for people stuck in bed with chronic pain, just start really small and do 10 to 15 minutes of exercise a day. work up to 30 minutes a day.
I hadn't considered this, usually I wait until I am able to be mobile to resume, but bed based activities might be perfect (and possibly regardless of sleep, so thank you for this).
posted by [insert clever name here] at 5:00 PM on September 30, 2015 [1 favorite]
In order to get to sleep and stop his whirling thoughts, my partner lies in bed in the dark with earbuds and listens to podcasts that he has already listened to before. Because he already knows the content, it makes it easier for his brain to relax into sleep.
posted by foxfirefey at 5:06 PM on September 30, 2015 [1 favorite]
posted by foxfirefey at 5:06 PM on September 30, 2015 [1 favorite]
I get it that your issue is giving up the ghost and going to bed, not tossing and turning when you try to sleep. Still, if you get to the point of trying to wind down, listen to these . For many years, nighttime was was a lonely, torturous war. I'd get up and work just to stop tossing and turning. I've tried many sleep podcasts, but the track_to_relax series knocks me out within five minutes. I can't say that I know the content of any given episode, even though I've probably "listened" to it several times over. Magic.
posted by GeorgieYeats at 5:15 PM on September 30, 2015 [1 favorite]
posted by GeorgieYeats at 5:15 PM on September 30, 2015 [1 favorite]
I also listen to podcasts - Backstory, the history podcast, specifically. It is interesting and engaging enough for me to pay attention to and distract my brain, and soothing enough to fall asleep to - thug the next day I listen to the whole thing because it's that's good.
posted by It's a Parasox at 9:02 PM on September 30, 2015
posted by It's a Parasox at 9:02 PM on September 30, 2015
Part of training for sleep hygiene is developing a strong association that says bed = sleep (+/- bed = sex, still hopefully a positive association). It sounds like, because of your chronic illness, you may have developed an association that says bed = pain, or bed = boredom, or bed = frustration and disappointment. I wonder if staying up when you are well enough to eat, clean, or read a book actually feels like you are winning because you are not confined to bed? If so, I'm not sure what the answer to that would be, but I can see how the pattern would be hard to break.
Having said that, I'm embarrassed to acknowledge how late I tend to stay up when my partner isn't around to chivvy me into going to bed at a reasonable time. I often just don't feel tired at night, and it feels like a luxury to stay up for a little longer. Of course, this is Nighttime Cheese Monster doing a huge disservice to Morning Cheese Monster, who feels like death after only a couple of hours sleep. Times when I've been able to conquer this behaviour have involved making it feel luxurious to go to bed at a reasonable hour, so that I'm less tempted to stay up.
posted by Cheese Monster at 9:35 PM on September 30, 2015
Having said that, I'm embarrassed to acknowledge how late I tend to stay up when my partner isn't around to chivvy me into going to bed at a reasonable time. I often just don't feel tired at night, and it feels like a luxury to stay up for a little longer. Of course, this is Nighttime Cheese Monster doing a huge disservice to Morning Cheese Monster, who feels like death after only a couple of hours sleep. Times when I've been able to conquer this behaviour have involved making it feel luxurious to go to bed at a reasonable hour, so that I'm less tempted to stay up.
posted by Cheese Monster at 9:35 PM on September 30, 2015
There is such a thing as CBT for insomnia, or CBTI. I'm not sure if you could find a practitioner in your area. The crux of it is sleep restriction to consolidate the sleep period and improve sleep hygeine, then gradually increasing the amount of time you spend in bed in 15 minute intervals. I mention this because you say a lot of the problem is behavioral--becoming engrossed in something and keeping yourself up--and that meds have not been helpful. Therapy seems like a logical next step, along with the psych assessment for other confounding factors.
posted by chemgirl at 9:36 PM on September 30, 2015
posted by chemgirl at 9:36 PM on September 30, 2015
Light can help set your rhythm - I don't know if getting a true light therapy box is a possibility for you, but if it is, having a "dawn" and a "dusk" session could help nudge your body into feeling sleepier at night and more awake in the morning. For this to work properly, it has to be a light that's 10,000 lux or over - there's plenty of good information out there, but it might be helpful to talk to your doctors and see if they have any recommendations?
Another thing that might be helpful is to set up some reward to look forward to in the morning - something you can't have at night, but will get as soon as you wake up. A new episode of your favorite show or podcast, an interesting MeFi link - anything you can bring yourself to save, or have other people provide you with. Is there someone whose writing you like who lives in a timezone where they'd update their work in your morning? If it's too much fun excitement can make it hard to sleep, but trying to hit that reward center of knowing a good thing will happen once you wake up - something you can't wait for all night, because it really isn't going to happen until you've had sleep.
posted by harujion at 5:21 AM on October 1, 2015
Another thing that might be helpful is to set up some reward to look forward to in the morning - something you can't have at night, but will get as soon as you wake up. A new episode of your favorite show or podcast, an interesting MeFi link - anything you can bring yourself to save, or have other people provide you with. Is there someone whose writing you like who lives in a timezone where they'd update their work in your morning? If it's too much fun excitement can make it hard to sleep, but trying to hit that reward center of knowing a good thing will happen once you wake up - something you can't wait for all night, because it really isn't going to happen until you've had sleep.
posted by harujion at 5:21 AM on October 1, 2015
Best answer: Do consider trying the ADHD meds. For some of us the chemistry is so fun that amphetamines make us sleepy. I got nowhere with more than 5 years of treatment for anxiety and depression and insomnia until a therapist suggested ADHD and I tried Adderall. It really does make the brain shut the hell up. Ritalin doesn't work as well for me. Don't bother with Intuniv as a first line treatment (I do take it as an adjunct to Adderall because it smooths everything out, but it is shatteringly expensive. Twice the price of Adderall XR, even when both are generics. If Adderall works but makes you jittery, get generic for Tenex guanfacine as it is much cheaper. I only take Intuniv guanfacine because my insurance covers all of it and won't cover the cheap stuff.) Haven't tried Straterra because it wasn't worth it when I have no problems taking stimulants.
But seriously, the stimulants help me sleep because I am way more functional during the day so my brain actually lets me sleep at night. More or less. It is a vast improvement over the Non-24 hour sleep-wake syndrome that my Delayed Sleep Phase became after a while. There were no sleep meds that helped (not that my meds manager was willing to give me, because she doesn't prescribe barbiturates). I tried so many. Wake meds were the beginning of the answer for me.
I also had Restless Leg. Really really bad. It is the worst kind of insult to injury when you actually do feel tired and sleepy and you lay down to sleep and just as you drift off... LEGS ON FIRE!!! Well, feet on fire in my case. The sense memory hurts even thinking about it. It was a problem off and on before I started psych meds, but SSRIs made it exponentially worse. So I don't take an SSRI, I take Wellbutrin. A bit of muscle tension is worth not having burning feet all the time and it does help me not be so depressed. Supplementing with Magnesium glycinate and iron has made the RLS go away completely. Here's an iron supplement that even my mom can take, and every other one has made her nauseated. Label says two, I take one.
I've tried all the sleep hygiene, too. Can you tell I've been at this for 15 years? A lot of it is geared for normally functioning people. I think it is all about finding what works and some actual science. So I reduce blue light by avoiding backlit screens and have an orange bedside lamp. I can't sleep in silence, so I have an audiobook playing all night long. Adequate but not overwhelming darkness. I don't read in bed before sleep because I get hyperfocused. Once I figured out how to sleep, I started work on my schedule. This is always going to be a battle because my internal clock very much wants me to sleep from about 4 am to noon. The best practice I've found is to take my morning meds at exactly the same time every single day. No matter what time I went to bed, I take the morning meds (Adderall, Allegra, and a few supplements) at 7:30. It is easy because I keep them on the nightstand, with water and 1/2 ounce of cheese. Then I go back to sleep for the hour it takes the Adderall to kick in. I'm still not very functional before noon, but I feel better about myself. Last few days I've been staying up too late at night and really need to cut that out. It is hard not to be my own worst enemy. Damn wikipedia clickholes.
Otherwise, it is all about baby steps. I try to do one thing every day. One task. Some days it is a great achievement that I took a shower, other days I get half the garage cleared out because I started with get all the recycling into the bin and got on a roll. But the one task is always something I can do, whatever it is that day even if it wasn't what I planned to do. On my worst days the one task is that I forgive myself for not doing what I planned and just take care of myself instead.
Anyway, you sound like you're better at this than I am. (Exercise, what?!?! someday. I'm working on it. Planning stages. Setbacks. Budget Cuts.) So at least, if nothing else, you know that despite your chronic pain, you are still more active and motivated than some Random Crazy Internet Lady. And if you ever want to express some thoughts or talk about meds, PM me.
posted by monopas at 12:12 PM on October 1, 2015 [2 favorites]
But seriously, the stimulants help me sleep because I am way more functional during the day so my brain actually lets me sleep at night. More or less. It is a vast improvement over the Non-24 hour sleep-wake syndrome that my Delayed Sleep Phase became after a while. There were no sleep meds that helped (not that my meds manager was willing to give me, because she doesn't prescribe barbiturates). I tried so many. Wake meds were the beginning of the answer for me.
I also had Restless Leg. Really really bad. It is the worst kind of insult to injury when you actually do feel tired and sleepy and you lay down to sleep and just as you drift off... LEGS ON FIRE!!! Well, feet on fire in my case. The sense memory hurts even thinking about it. It was a problem off and on before I started psych meds, but SSRIs made it exponentially worse. So I don't take an SSRI, I take Wellbutrin. A bit of muscle tension is worth not having burning feet all the time and it does help me not be so depressed. Supplementing with Magnesium glycinate and iron has made the RLS go away completely. Here's an iron supplement that even my mom can take, and every other one has made her nauseated. Label says two, I take one.
I've tried all the sleep hygiene, too. Can you tell I've been at this for 15 years? A lot of it is geared for normally functioning people. I think it is all about finding what works and some actual science. So I reduce blue light by avoiding backlit screens and have an orange bedside lamp. I can't sleep in silence, so I have an audiobook playing all night long. Adequate but not overwhelming darkness. I don't read in bed before sleep because I get hyperfocused. Once I figured out how to sleep, I started work on my schedule. This is always going to be a battle because my internal clock very much wants me to sleep from about 4 am to noon. The best practice I've found is to take my morning meds at exactly the same time every single day. No matter what time I went to bed, I take the morning meds (Adderall, Allegra, and a few supplements) at 7:30. It is easy because I keep them on the nightstand, with water and 1/2 ounce of cheese. Then I go back to sleep for the hour it takes the Adderall to kick in. I'm still not very functional before noon, but I feel better about myself. Last few days I've been staying up too late at night and really need to cut that out. It is hard not to be my own worst enemy. Damn wikipedia clickholes.
Otherwise, it is all about baby steps. I try to do one thing every day. One task. Some days it is a great achievement that I took a shower, other days I get half the garage cleared out because I started with get all the recycling into the bin and got on a roll. But the one task is always something I can do, whatever it is that day even if it wasn't what I planned to do. On my worst days the one task is that I forgive myself for not doing what I planned and just take care of myself instead.
Anyway, you sound like you're better at this than I am. (Exercise, what?!?! someday. I'm working on it. Planning stages. Setbacks. Budget Cuts.) So at least, if nothing else, you know that despite your chronic pain, you are still more active and motivated than some Random Crazy Internet Lady. And if you ever want to express some thoughts or talk about meds, PM me.
posted by monopas at 12:12 PM on October 1, 2015 [2 favorites]
Best answer: I used to have a similar problem. I would often procrastinate until 3 or 4 in the morning instead of going to bed at 11PM or midnight as I intended because I knew I wasn't likely to fall asleep anyway. First light was when I could sleep, and that was that. (Well, I could fall asleep fine if I went to bed in a 15 minute window around 10PM, but there's no way I'm going to sleep that early on a regular basis. My life simply isn't compatible with that) A couple of months ago I read about a specific deep breathing exercise that has completely changed that for me. I can fall asleep whenever I want!
Specifically, breathe in for 3 seconds, hold your breath for 4 seconds, then breathe out slowly for 5 seconds and repeat. Something about that specific level of oxygenation and the ritual knocks me right out. The first night I think it took 10 repeats or so. Lately I'm asleep on the second or third breath. It really is amazing compared to laying in bed for literally 3 or 4 hours without falling asleep.
It's also great for knocking down the physical symptoms of anxiety when used in other contexts.
posted by wierdo at 12:54 PM on October 1, 2015 [1 favorite]
Specifically, breathe in for 3 seconds, hold your breath for 4 seconds, then breathe out slowly for 5 seconds and repeat. Something about that specific level of oxygenation and the ritual knocks me right out. The first night I think it took 10 repeats or so. Lately I'm asleep on the second or third breath. It really is amazing compared to laying in bed for literally 3 or 4 hours without falling asleep.
It's also great for knocking down the physical symptoms of anxiety when used in other contexts.
posted by wierdo at 12:54 PM on October 1, 2015 [1 favorite]
Ok, duplicate information (but it took til about 10 posts down!). but...
I'm ADHD, and I hate being bored. Haaaate it, and I don't really hate things, but it feels like my brain is dying, or shutting down, and it's a not-good thing, and it's not even necessarily because I'm doing nothing, because I can entertain myself happily for an indefinite amount of time just day-dreaming, but I do associate doing nothing with fear of boredom.
Anyway, it means that I suceed better at sleeping if it involves... doing things?
Crucial thing, is to go have a hot shower. Several reasons, it is an interrupt to whatever I'm doing and yet it isn't 'going to bed', so it's easier to partake in. It really helps warm and relax my body, so I sleep a lot better when I do sleep. I then return to bed (and not to my book or computer or whatever), and then I close my eyes and listen to a thing.
A guided relaxation, or, the favourite answer, a podcast! Or a story!
Search sleep hypnosis on app stores for guided meditations. I still listen to Savage Love pretty often. There is an audiobook of Ursula Le Guin short stories called Changing Planes which is good.
My brain can be entertained while my eyes are closed and I am resting, and then, hey, if I fall asleep, win-win, if I don't, then at least I wasn't bored.
I also have to have a snack before the shower, but that's some weird hypoglycemic can't-sleep otherwise thing.
So the pattern goes, snack, hot shower, then listening to podcasts with the lights off, and it's pretty close to a routine (hah, that mystery word for those things I DON'T fall into) and it works because it disrupts the perseverating on whatever task it is that I am doing, and it's pleasant enough that I get carried from one activity to the next, to bed.
If you can get away from TV or computer or book to having a snack or a shower, that's pretty much the kicker.
So, we're saying podcasts, but it feels like it actually means 'Storytime!'.
Oh, and definitely put bluelight blockers on your computer-type devices, like f.lux, and switch all bright lights off and put really mellow red/orange tinted lamps or fairy lights on at sunset.
posted by Elysum at 2:25 PM on October 1, 2015 [3 favorites]
I'm ADHD, and I hate being bored. Haaaate it, and I don't really hate things, but it feels like my brain is dying, or shutting down, and it's a not-good thing, and it's not even necessarily because I'm doing nothing, because I can entertain myself happily for an indefinite amount of time just day-dreaming, but I do associate doing nothing with fear of boredom.
Anyway, it means that I suceed better at sleeping if it involves... doing things?
Crucial thing, is to go have a hot shower. Several reasons, it is an interrupt to whatever I'm doing and yet it isn't 'going to bed', so it's easier to partake in. It really helps warm and relax my body, so I sleep a lot better when I do sleep. I then return to bed (and not to my book or computer or whatever), and then I close my eyes and listen to a thing.
A guided relaxation, or, the favourite answer, a podcast! Or a story!
Search sleep hypnosis on app stores for guided meditations. I still listen to Savage Love pretty often. There is an audiobook of Ursula Le Guin short stories called Changing Planes which is good.
My brain can be entertained while my eyes are closed and I am resting, and then, hey, if I fall asleep, win-win, if I don't, then at least I wasn't bored.
I also have to have a snack before the shower, but that's some weird hypoglycemic can't-sleep otherwise thing.
So the pattern goes, snack, hot shower, then listening to podcasts with the lights off, and it's pretty close to a routine (hah, that mystery word for those things I DON'T fall into) and it works because it disrupts the perseverating on whatever task it is that I am doing, and it's pleasant enough that I get carried from one activity to the next, to bed.
If you can get away from TV or computer or book to having a snack or a shower, that's pretty much the kicker.
So, we're saying podcasts, but it feels like it actually means 'Storytime!'.
Oh, and definitely put bluelight blockers on your computer-type devices, like f.lux, and switch all bright lights off and put really mellow red/orange tinted lamps or fairy lights on at sunset.
posted by Elysum at 2:25 PM on October 1, 2015 [3 favorites]
Yes, those podcasts really work. I like Judge John Hodgman because of course he's a judge, so he knows all the right answers. It's very comforting to listen to him making everything right for the desperate people who call with terrible problems (like they don't know how to handle it when they encounter inside-out T-shirts in the laundry or they want to fly their sports team flags but their spouse does not want them to fly their sports team flags). For some reason the whackwhackwhack gavel sound is totally soporific if the lights are off and I'm lying down. And I get twice the use out of each podcast because I fall asleep almost immediately and miss most of it, so I can listen to it again while getting ready to go in the morning! I don't want to listen to an on-purpose "wind-down" tape because that's all healthy and hygienic. Elysum has it exactly, it's storytime! Podcasts work because I actually want to hear them, and I feel like I'm playing, not doing a chore.
posted by Don Pepino at 3:00 PM on October 1, 2015 [1 favorite]
posted by Don Pepino at 3:00 PM on October 1, 2015 [1 favorite]
In describing your sleep hygiene, or lack thereof, you could easily be describing me. I hate going to sleep and will, left to my own devices, stay awake as long as I possibly can, then wake up after a couple hours and stay up longer.
My prescriber recently put me on 200mg of Seroquel (quetiapine) at night (for depression management in addition to sleep issues), and it's been helping me a lot. I can stay awake for about an hour or so after taking my dose, so it doesn't feel like an immediate knock-out drug (which I tend to put off taking, because it's equivalent to wanting to go to sleep very soon and I never do), but it is basically impossible to stay awake on after that. It's been a couple months and the effects haven't diminished. Enforced sleepytime is, right now, the only way I have any chance of maintaining a regular sleep schedule, because I'll break it as soon as I can otherwise. The other benefit is that I get to play a new game called "how much stuff can I fit in before my body shuts down", which appeals to my mind's desire for busyness.
Drawbacks: it is very, very expensive without insurance (but very affordable with, at least in my case, and it is available in generic form). The first few nights, I had terrible restless leg syndrome, but that went away pretty quickly; I don't know if it would persist with you, seeing as how you already suffer from it more frequently. It may be contraindicated for you due to other issues. I'm loathe to recommend yet another course of medication, because ugh more pills, but it's really making a difference for me when other sleeping aids and attempts at patterns have not worked or been too difficult for me to adhere to / easy for me to break. It may be worth asking your doctor about. Good luck.
posted by Errant at 3:15 PM on October 1, 2015 [1 favorite]
My prescriber recently put me on 200mg of Seroquel (quetiapine) at night (for depression management in addition to sleep issues), and it's been helping me a lot. I can stay awake for about an hour or so after taking my dose, so it doesn't feel like an immediate knock-out drug (which I tend to put off taking, because it's equivalent to wanting to go to sleep very soon and I never do), but it is basically impossible to stay awake on after that. It's been a couple months and the effects haven't diminished. Enforced sleepytime is, right now, the only way I have any chance of maintaining a regular sleep schedule, because I'll break it as soon as I can otherwise. The other benefit is that I get to play a new game called "how much stuff can I fit in before my body shuts down", which appeals to my mind's desire for busyness.
Drawbacks: it is very, very expensive without insurance (but very affordable with, at least in my case, and it is available in generic form). The first few nights, I had terrible restless leg syndrome, but that went away pretty quickly; I don't know if it would persist with you, seeing as how you already suffer from it more frequently. It may be contraindicated for you due to other issues. I'm loathe to recommend yet another course of medication, because ugh more pills, but it's really making a difference for me when other sleeping aids and attempts at patterns have not worked or been too difficult for me to adhere to / easy for me to break. It may be worth asking your doctor about. Good luck.
posted by Errant at 3:15 PM on October 1, 2015 [1 favorite]
I just heard something fascinating on the radio. It turns out that prey species (like giraffes) sleep less than predator species (like rhinos). Giraffes get by fine on five minutes of deep sleep in a 24-hr period. Elephants get three hours. Rhinos sleep eight hours. Because they can. Because nobody is trying to kill them. Because they're rhinos. The radio failed to mention the fact that bipeds are nowadays killing rhinos in droves, but that's a relatively recent development and they haven't adapted new sleep patterns to fit their actual situation. Maybe the trouble with us is, we've adapted to the real world the way rhinos have not. So we're all hypervigilant because we feel threatened by the world, so we goad ourselves to stay awake like the tender, long-lashed giraffe instead of going to sleep like the armored tank rhino. Anyway, I don't care if that's the problem: that's what I'm going to tell myself as I turn off Netflix at 9 pm sharp every single goddamn night no matter what from now on: enough of this weak hamster shizz, time for me to go to sleep like a boss.
posted by Don Pepino at 7:03 AM on October 3, 2015 [1 favorite]
posted by Don Pepino at 7:03 AM on October 3, 2015 [1 favorite]
This thread is closed to new comments.
I wrestle with sleep problems myself, and don't really have any good answers, but I can say don't get too invested in the idea that ADHD meds will solve this. Most ADHD meds are stimulants so if they're still in effect around bedtime, they're more likely to make the issue worse than improve it.
The only exception I know of is strattera, which is a selective norepinephrine reuptake inhibiter. It's not very widely used for ADHD though, because it doesn't work for a lot of people, it takes a while to get started with, and it tends to have a lot of side effects.
posted by aubilenon at 3:53 PM on September 30, 2015