Help me sleep deeply

July 7, 2017 8:49 AM

I frequently get phases of terrible sleep. I'm at my wits end. Do you have any other suggestions?

As mentioned, I've had some issues with sleep in the last few years. I know YANMD but have any of you gone through this?

Symptoms:
- Trouble falling asleep because can't turn off brain
- Unrestful sleep - tossing and turning, fighting sleep
- Can't get deep sleep - don't get much or any REM stage sleep
- wake up and can't fall back asleep - thinking too much

I've been to a sleep clinic but it was no help. Things tried in the past:
- Ambien/Lunesta only give me about 4 hours of sleep, then I'm wide awake.
- Over the counter: melatonin, misc sleep aids with a combination of ingredients. These don't help at all.
- NyQuil helps a little bit.
- The thing that helps the best for me is Xanex, but can leave dry mouth or groggy the next day.

Things I've tried that don't have to do with consuming anything:
- If I can't fall asleep within 30 minutes, get out of bed and do something else for a while. This has had some success.
- Also meditation can help.
- I also stay off devices in the evening.
- Therapy to get to the root of what I am thinking that keeps me up, but they are random thoughts, so not helpful

Thanks

posted by heavyp08 to Health & Fitness (42 answers total)

Do you get aerobic exercise?
posted by gregr at 9:03 AM on July 7, 2017 [6 favorites]

Do you consume caffeine or alcohol? They can disrupt sleep, especially depending on timing.

Is your room where you sleep dark and quiet, or is there light and/or noise pollution? Can you use earplugs and blackout curtains?
posted by cnidaria at 9:04 AM on July 7, 2017

There are many paths to the answer her, but you don't mention the root of your running mind and thoughts.

You are going to have to go there at some point.

Because Ambien and Lunesta only work for a short period of time, that is a clue that you might be under dosing for your the way your body processes drugs. Tell your doctor.

Nyquil is not a good way to go.

Our brains like routine when we are winding down, so create one and stick to it. Write down your thoughts/feelings every 15 minutes (just brief notes on how you feel, what's on your mind).

Commit to a 5 minute guided meditation every night... you have to stick with this for it to work, even if you hate it at first.

There are several body awareness meditations that are meant to calm us and reconnect us to our physical self which helps ground the mind.

We used to pay lots of money for this stuff and now it's all over Youtube for free.

If medical marijuana is available in your area, Look for an Indica variety edible. There are some gummy type edibles that are about half the size of a gummy bear that will take you to sleepy town on a magic cloud.

The pot collective by us is staffed and run like the Apple Store... it's not hard to get a pot card, your physician can help or you can go and pay $75 and talk to a Dr somewhere in your state and it's all done in 15 minutes. Annual renewal takes 1 minute.
posted by bobdow at 9:04 AM on July 7, 2017 [2 favorites]

It sounds like you may need to give your brain a boring focus. I use podcasts at night to fall asleep. As long as the sounds/voices are not too jarring, it gives my brain something to focus on. (There is a previous Ask listing some good ones) My trick is to turn it down low enough so that I actually have to focus to hear the words. It's helped tremendously.

I also take a Benadryl to help fall asleep and an aspirin, so subtle aches and pains don't keep me up.

I still haven't achieved sleep nirvana, but the above definitely helps.
posted by Vaike at 9:08 AM on July 7, 2017 [5 favorites]

If your problem is waking up in the middle of the night rather than falling asleep, there is a controlled-release form of Ambien you could ask your doctor about.

A few more sleep hygiene things you could try (they work for me): Less caffeine, especially after noon. Use a white noise machine. Wear an eye mask. Take a shower before bed. Sleep in a cold room, possibly with a fan pointed at you, under a heavy comforter or duvet.

Finally, the worst sleep I ever got was when I took Claritin D, so if you are taking anything with pseudoephedrine, stop and find an alternative.
posted by capricorn at 9:12 AM on July 7, 2017 [1 favorite]

I've always been a horrible sleeper, although my problem is falling asleep rather than staying asleep (at least, most of the time). When I finally gave in and went to the doctor to get prescription meds, the first question he asked was, "Do you have trouble falling asleep or staying asleep?" - because the type of medication you need is different based upon your specific issue. It sounds like you've tried meds for the former but need something for the latter instead. So, go back to the doctor and tell them Ambien & Lunesta don't work. There are other options.
posted by something something at 9:13 AM on July 7, 2017

I've found that avoiding caffeine after mid-morning, going to bed a little before I'm actually tired (before my late-evening second wind hits), and/or a shot of whiskey work wonders. Edited to add: I think the late evening second-wind is related to meal times. If I eat earlier in the evening, I perk up earlier, then get tired earlier.

I've been trying to try the aerobic exercise thing for this and many other reasons, and will report back in a few years on that. Allegedly.
posted by tapir-whorf at 9:13 AM on July 7, 2017 [2 favorites]

Oh, and don't go to sleep directly after a hearty meal, or drunk.
posted by capricorn at 9:13 AM on July 7, 2017

Ambien has the same (non)effect on me. Try Lorasapam.

Do you suffer from sleep apnia? I do and I LOVE my CPAP. Single best improvement in my health. You might look into it. Usually covered by insurance.
posted by Lord Fancy Pants at 9:21 AM on July 7, 2017

Definitely zero caffeine or alcohol.

Have you tried taking a magnesium supplement? There's some evidence it helps a little bit.
posted by GuyZero at 9:24 AM on July 7, 2017 [4 favorites]

Seconding GuyZero on the magnesium - I'm going against everything I believe right now because one of the most annoying things about being a lifelong insomniac is listening to other people's over-the-counter recommendations for things that don't really work - but I'm pretty certain magnesium does increase the quality of my sleep.
posted by something something at 9:26 AM on July 7, 2017 [1 favorite]

A friend who uses melatonin at a doctor's instruction was recently advised to a) use the time-release kind, 10mg, when getting into bed, not to fall asleep but to stay asleep later on b) take 200mg of B2 90 minutes before getting into bed. This has worked tremendously well apparently, specifically in the area of quieting the rabbit-brain when she's trying to get to sleep, and boosting the performance of the melatonin for keeping her out.
posted by Lyn Never at 9:28 AM on July 7, 2017 [5 favorites]

A VERY hot bath or shower right before going to bed helps me.
posted by jeff-o-matic at 9:32 AM on July 7, 2017

I listen to quiet audio books and podcasts just to keep my brain off of the anxiety hamster wheel. For some unfathomable reason, this book Hole in One, has the record for putting me to sleep the fastest, several nights running. I don't think in an entire week I made it to the end of chapter two. (No insult intended to the author, I read several of her books when I was younger.)
posted by puddledork at 9:32 AM on July 7, 2017 [1 favorite]

I am similar to you in that I have no problem falling asleep but I can't STAY asleep.
I had tried everything from melatonin, magnesium, buying a new bed, acupuncture, massages, all of the regular suggestions - to no avail.

I recently purchased an air conditioner as it's been so hot here and I am having the BEST sleeps of my life because of it.

I'm now certain that my issue with sleep was my body temperature, which runs hot in general.

YMMV but for me, it's been a very simple fix for me and a life changer in all honesty.
posted by JenThePro at 9:40 AM on July 7, 2017 [2 favorites]

Some things that have been helping me are this pillow spray and CBD Oil. Both cost $ of course but this pillow spray has been amazing. I got a sample from Birchbox and immediately bought the full size. It really helps me to fall asleep. The brand ThisWorks has a whole range of sleep products but I've only used the aforementioned pillow spray.

And CBD Oil has been amazing. I use the drops under my tongue. I'm sure someone will fling themselves in and pronounce woo but I've gotta tell you it's been amazing. It's really helped me get off over the counter stuff, which as you know isn't that great, and I wake up refreshed and having slept all night. It has absolutely helped me to fall asleep too.

I also have a very dark, chilled room with white noise.

Also, this is an apple product thing, but I really like the bedtime portion of the clock on my ipad and iphone. It reminds me when to start winding down. I'm sure there are other apps that do this - but I've been using the ios one and it's helpful.
posted by rdnnyc at 9:50 AM on July 7, 2017

You sound exactly like me. I am now rested and tried all kinds of stuff including a sleep study.

I found out that my deepest sleep was earlier in the evening - aka, before midnight. 4am on is restless sleep often and after 6am it's more or less catnaps.

So knowing that - I have no caffeine past 9am, took a lower stress job to have fewer things to ruminate over, earplugs to avoid noise in the night waking me up, dropping the bedroom temperature 10 degrees and a consistent bedtime (9:30pm) every night. Works like a charm now.
posted by notorious medium at 10:31 AM on July 7, 2017

I've done progressive relaxation, behavior modification therapy, light therapy, seen a sleep doctor, had an overnight study, and taken a pile of drugs (but not all at once). My advice to you is: see a doctor, again. My sleep doctor went AWOL on me (quit renewing prescriptions, wouldn't return calls, never did send me the results of the overnight analysis – but then I never saw a bill for it either, so ¯\_(ツ)_/¯) but my GP actually turned out to be great.

From experience: Lunesta is pretty much only for sleep onset issues and isn't going to be effective for sleep maintenance. Ambien has a longer half-life and is slightly more useful for sleep maintenance, but if you take it in a high enough dose the hangover from it can be as bad as what you're describing with Xanax. Ambien also comes with tolerance issues so I think doctors are trying to get away from using it as a daily medication (mine did, anyway). Before he went AWOL my sleep doc also sent me home with some samples of Rozerem (which I think might be better for sleep maintenance) but I still had such difficulty getting to sleep with it that I couldn't ever get to the point it could help.

When I saw a new GP and told him about the issues I had both with Ambien and the doctor who wasn't returning my calls, the GP put me on a low dose of trazodone that has been great. At my first followup after prescribing trazodone, my GP had me try amitriptyline instead, and that absolutely did not work for me, so I went back to trazodone (and I'm still on it, three GPs later). I'm not your doctor and I'm not suggesting you shop for a prescription, but I do think you need to talk to a doctor (or another doctor) and see if they can work with you to figure out a treatment that works. Note that treatment of insomnia is an off-label use for both trazodone and amitriptyline so your doctors may vary. My subsequent GPs have all asked me about usage and side effects, but none of them have suggested I need to do something else.

In addition to seeing a doctor there are things you can do to improve your sleep hygiene but having had to go off Ambien and having had a few years now on trazodone I'm a big believer in using all the tools you have available to you. Sleep is a health issue. If your doctor isn't helping you manage it, find a new doctor.
posted by fedward at 10:37 AM on July 7, 2017 [1 favorite]

I have been a chronic insomniac since 1989. Took a long time, and meds and whatever to find a routine that works for me.

1. If I wanna sleep, no sharing a bedroom/bed.

2. Dark, cool, setting a bedtime and sticking to it. Making sure I have enough time for wind-down plus eight hours of bed. No caffeine past 3pm.

3. Take: 5HTP, 10 mg melatonin and a benadryl before bed. (The benadryl is for allergies which give me breathing trouble.)

4. For the ruminating mind, both at bedtime and when I wake up like clockwork circa 3am: A boring fairly quiet podcast or audio book set to turn off in 15 minutes or 30 minutes. If I'm still awake, I'll set it for another 15, but this almost never happens these days unless I've really got something bothering me. Set the volume as low as you can still hear.
posted by RedEmma at 10:37 AM on July 7, 2017 [1 favorite]

Oh, and make sure to use something like f.lux for blue light on laptops or other screens. I turn my phone to nighttime light as well.
posted by RedEmma at 10:38 AM on July 7, 2017 [1 favorite]

Cognitive behavioral therapy for insomnia (CBT-I) will start with a full assessment of what's interfering with your sleep and help you change those things or refer you to get treatment if it's something like sleep apnea (although if you went to a sleep clinic they probably ruled out those kinds of medical problems). It's not just about exploring feelings and thoughts or getting to the root of stuff, even though it's called "therapy." It's a structured, manualized treatment focused on creating a sleep schedule specific to your needs that's designed to retrain your brain to sleep when it needs to, involving predetermined periods of sleep of a shorter duration than you may be attempting to get now. It works really well and should only take about 6 sessions.
posted by quiet coyote at 10:44 AM on July 7, 2017 [1 favorite]

The best usual suggestions that have worked for me are 1) no screen within an hour of bedtime (implemented by reading an actual book for an hour before turning off the light); 2) dark room and 3) no caffeine, for me after 2 pm.

Also really effective for me and less usual: I use a comfy lightweight but very effective sleep mask, put in ear plugs if there is any ambient noise, and do a breathing exercise for about 10 breaths after I have my mask/plugs installed and am in sleep position. I count four as I breathe in through my nose, hold the breath for a count of 4, open my mouth and exhale to a count of four, count four more, and then begin the process again. And I really recommend linen sheets. They are incredibly soft once washed repeatedly, and very breathable right from the get go.

If meditation has worked for you, I also recommend trying a flotation tank. Do 3 visits and see if that helps. I find that thinking about being in the tank when in bed is very sleep inducing.
posted by bearwife at 10:53 AM on July 7, 2017

Magnesium supplements. All of us have trouble getting enough magnesium these days, and there is evidence that it works for sleep. I recently started taking these and they work great. Calcium helps me fall asleep fast and magnesium keeps me asleep through the night. They say magnesium is better absorbed topically, but I have not had as much success as with tablets.
posted by aabbbiee at 11:32 AM on July 7, 2017

A weighted blanket has helped me a lot. Still need to remember to not drink caffeinated beverages after about 2pm.
posted by meijusa at 11:37 AM on July 7, 2017

If you are a woman you should have your iron levels checked. Per the NIH, Anemia decreases sleep quality.
posted by mrmurbles at 11:48 AM on July 7, 2017

Here is what helped me:

- No caffeine after breakfast time. My dad could drink coffee after dinner and sleep like a baby. I do not take after him in that respect. Limiting my caffeine to early in the day - and switching from coffee to tea - has helped with my sleep.

- Magnesium, as others have said. It's a miracle supplement! If you want to get your magnesium from a food rather than a pill, pumpkin seeds, aka pepitas, are a great source.

- Melatonin. Many over the counter melatonin supplements contain more than you need; liquid melatonin supplements like Sundown Naturals can be titrated so you don't give yourself more than you need.

- Soothing podcasts/music. I like various Midori new-age stuff, nature sounds, and drone-y podcasts that have soothing voices.

- Most important of all: I got a sleep test and a CPAP for my apnea! Without this, I'd still be on mega-doses of all kinds of sleep meds that, in one case (Seroquel) wound up giving me insulin resistance. It turns out I didn't need all that stuff once I got the machine that helps me breathe in my sleep. I had insomnia because my body was suffocating every night! Insist upon a sleep test, the in-lab kind, not the chintzy at-home-oximeter-clip kind. Sleep apnea is very underdiagnosed, especially in women and thin people. It's not just for old, fat guys! CPAP gave me my life back.
posted by Rosie M. Banks at 11:51 AM on July 7, 2017

For me, a low dose of Remeron has been amazing for sleep. It may be overkill for you, or hard to convince a doctor on -- I already take other antidepressants, so adding one more was easy for my doctor to swallow -- but it's something to think about.
posted by nebulawindphone at 12:09 PM on July 7, 2017 [1 favorite]

Stay off devices is what everybody says, and I wouldn't contradict it if you hadn't already given it a long trial, and the thing about types of light and the brain is probably true, I don't know anything about that. however, I think you should rethink this, especially if you have an electronic reader and count it as a "device." because:

being unable to settle or put away your thoughts will not happen if your thought-box is kept full right up until you are so sleepy you just have to fumble the device off and close your eyes. if at the time you close your eyes, your thoughts already have a direction and a focus, and one that is not anxiety-born, you can follow them all the way to sleep without having to accomplish the task of stopping thinking first, which I find frankly impossible. so going to bed means reading for a while, or watching a bunch of videos, and continuing to think about either the story you are involved in or a pre-decided autohypnotic kind of thought chain. the idea is to fill your mind with a non-random stream of thought leading to sleep, so that random thoughts never get the chance to take hold and start flipping around, which is nearly impossible to calm down without drugs or getting up and waking up and starting all over again. engage your brain in something soothing but compelling so that when random thoughts would normally start entering, you are not at home to them.

all the "yous" above mean "me," obviously this will not work for everyone and probably not for most people, or else the standard recommendations wouldn't be the opposite of this. but if the standard protocol doesn't work. also, maybe you already tried this before giving it up. but if not --?

you can also achieve this effect through podcasts and audiobooks and whatnot, but having to wake up enough to turn them off when you're almost asleep can ruin everything.
posted by queenofbithynia at 12:25 PM on July 7, 2017 [1 favorite]

The most helpful thing for me (besides the herb Valerian) when I am going through a period of insomnia, is listening to guided sleep meditation. There are several podcasts dedicated to this. There is also a podcast called Sleep With Me, that tells stories for listeners to fall asleep to. I have not tried that podcast yet, but its on my list.
posted by WalkerWestridge at 12:42 PM on July 7, 2017 [2 favorites]

The only thing that worked for my terrible pregnancy insomnia is doxylamine succinate, better known as Unisom. It appears to be non-addictive, and pretty magically effective.
posted by tatiana131 at 12:57 PM on July 7, 2017

Note that there is more than one formulation of Unisom, it's not all doxylamine so check the labels. Doxylamine = best OTC sleep aid IMHO.
posted by aramaic at 2:16 PM on July 7, 2017

Trying to quiet your mind down before going to sleep would probably be helpful. I usually do this by reading a book* for about half an hour before getting in bed. It helps me immensely. I'd rather do something constructive/interesting for that half hour than toss and turn and worry about stuff.

* Yes, an actual book with pages made out of paper.
posted by number9dream at 2:41 PM on July 7, 2017

Paradoxically, I find that sleep restriction helps me break out of these kinds of jags. I keep good sleep hygiene, don't increase my caffeine intake, and limit the amount of time I'm in bed to the time I'm actually asleep. I go to bed later than usual (by an hour or two), get out of bed and do something if I wake at night and am unable to fall back asleep, and get up at my usual time or a little earlier if I happen to wake up before the alarm. Yes, it is deeply unpleasant. Sometimes I get 3-4 hours of broken sleep and that's it. But I'm not lying in bed fretting about it (so my brain doesn't learn that the bed is a place where that is allowed). And I get exhausted enough that after 2-3 nights of this, I finally crash and sleep through the night without waking. It's usually enough to sleep through the night consistently again until a period of travel or high work stress or something else, when I repeat the process.

It's illogical, but it definitely works.
posted by peanut_mcgillicuty at 6:14 PM on July 7, 2017

I've gone through these periods and at some point it feels like a self-fulfilling prophecy. My brain/body even fights prescription sleep aids.

But I'll nth the suggestion of a "boring focus." Books or music with words are too distracting for me, but I created an Amazon playlist of soothing, mostly solo piano music (think "Sheep May Safely Graze" here). If I concentrate on the melodic line (even sometimes imagining I'm playing it myself), it gives my mind something to focus on and follow along to. After a while, as others mentioned, it becomes a cue to sleep and I don't get much past the first or second song (I usually play it on shuffle). I've also had luck with "singing bowls" type music.

I've also had some success with my own form of "guided meditation" when the random or anxious thoughts hit. I'll imagine a big locked box (like a treasure chest - the vivider the imagery, the better). Whenever an anxious thought occurs to me, I picture grabbing it, placing it in the box, and locking it. If it tries to come back , I tell myself firmly "that's in the box" until morning. I keep doing it with each random thought or anxiety and eventually my brain is emptied out and I fall asleep. Sometimes I'll pair it with other imagery like replacing the empty space of those thoughts with cotton, or clouds, or painting the inside of my skull white. Sounds weird, but hey, if it works!
posted by Preserver at 7:08 PM on July 7, 2017

Check out a podcast called "Sleep With Me". Give it more than one try. Has worked miracles for many people, including me.
posted by ChristineSings at 7:11 PM on July 7, 2017 [2 favorites]

Have you been checked for sleep apnea?---waking up a lot can be a symptom.
posted by Napoleonic Terrier at 7:40 PM on July 7, 2017

Hi there heavyp08, as someone who works in the field of insomnia treatment and research, I have to say I'm impressed with all the good recommendations from fellow Mefites in this thread so far. I'd like to add one to them and talk a little about some of the recommendations that have been made.

First and foremost, I would urge you to consider seeing a Behavioral Sleep Medicine practitioner. You can use the Society for Behavioral Sleep Medicine's find a provider web site to see if there is a provider in your area. A good BSM specialist will be licensed in your state, trained in Cognitive Behavioral Therapy for Insonmia (CBT-I) and have some background in medicine and/or therapy. One good reason this would be useful is that a BSM specialist can screen you for sleep apnea and other sleep disorders, which as Napoleonic Terrier pointed out would be valuable information. If a BSM professional isn't available you might consider an app like Sleepio. Colin Espee, the sleep researcher who worked on it's development is one of the top people in the field and many of the insomniacs I've recommended it to have told me it helped them.

That being said, you mentioned that "If I can't fall asleep within 30 minutes, get out of bed and do something else for a while. This has had some success." I use this technique with my patients as part of a set of general recommendations called stimulus control. A good friend of mine who teaches insomnia treatment at UPenn, suggested that often 30 minutes is too long to wait before getting out of bed. Try 5 or 10 minutes, or as he suggested, as soon as you realize that you're not falling asleep right away. Good stimulus control practices also include removing other stimuli from the bedroom by limiting behaviors in bed to sleep and sex, do everything else elsewhere if possible.

The person (peanut_mcgillicut) who said, "sleep restriction helps me break out of these kinds of jags" is also on the right track, but I would add that sleep restriction is best done while under the care of a BSM specialist and that you should never restrict your time in bed less than 5 hours for the sake of safety..

I'd include the caveat that none of these recommendations will fix your sleep instantly if you have chronic insomnia. I typically work with patients for 6 - 8 weeks and then they continue to do this stuff on their own. Almost all of them report that it gets worse before it gets better and that the first 3 - 5 days treatment are challenging. The good news is that, 9 times out of 10 when I follow up with them in 3 months they tell me they are cured. I'm not alone in having a lot of success with it.

I hope this is helpful and if you have any more questions your welcome to ask here or PM me if you prefer.
posted by Jernau at 9:41 PM on July 7, 2017 [6 favorites]

For an over-the-counter option, you might want to give Unisom Sleep Tabs a try. They are doxylamine succinate, not the diphenhydramine HCI you'll find in Benedryl. If you want to try a different prescription drug, ask your doctor about trazodone; it's an older antidepressant prescribed off-label for insomnia, and it's not habit-forming like Ambien can be. Though you might get a stuffed nose from it after taking it, which can interfere with the actual getting to sleep part.
posted by old_growler at 11:22 PM on July 7, 2017

Marijuana?
posted by Jacqueline at 5:02 AM on July 8, 2017

nthing the podcast Sleep with Me. This has been a game changer for me.
posted by RaeVaughn1958 at 8:43 AM on July 8, 2017

Response by poster: Do you get aerobic exercise? - No, but that is a goal.

Do you consume caffeine or alcohol? = Caffeine - yes, but not usually after 3 pm. Even if I don't have any after 10 am, it doesn't make a difference. Alcohol - not very often

Is your room where you sleep dark and quiet, or is there light and/or noise pollution? = Yes, room is quiet and dark, and I sleep with a box fan on.

I tried magnesium years ago when my insomnia was really bad, but have not tried it lately. I will give it another go.

Melatonin does not help at all.
posted by heavyp08 at 5:51 PM on July 8, 2017

Maybe stop caffeine earlier in the day? I have found that I cannot have caffeine after 11 a.m. to ensure a good night's sleep. Even if I try and push it to 1 a.m., I feel it that evening.
posted by answergrape at 8:47 AM on July 10, 2017