Insomnia Recovery?

September 17, 2018 9:28 AM

I've had pretty severe insomnia for the last four years. I've tried medications, sleep restriction, intense exercise, meditation, and nothing has stopped the 2AM wake up. After I wake up, I generally can't fall back asleep.

I'm currently averaging about 4 hours sleep a night and feel. like. garbage. Mostly I'm dumber than I used to be, and I find it's harder to express myself. I also have daily, intense headaches with a nauseating and almost electric quality. I've seen multiple specialists, been checked for sleep apnea, and can't seem to improve. I've tried benzo's, Z-drugs, SSRI's, tricyclics- all have either made me feel like a zombie the next day or made my sleep worse. I just don't know how to get better, and I'm losing hope that it's possible. It feels like I might have brain damage at this point.

Has anyone been through a similar period? How did you get better? And did the physical symptoms improve? I'm struggling to keep going at the moment. I need a reason to hope again.

posted by Thesisaurus to Health & Fitness (28 answers total)

Some questions that could help us help you - have you tried going to sleep earlier, or later? If so, do you wake up x hours later, or at 2 anyway? Have you tried not using electronics for an hour or two before bed? Do you need to pee when you wake up? What do you do when you wake up - do you lay in bed and try to not think? I find once my brain's been "activated" I have more trouble falling back asleep, so I try to think of something really boring. Are you drinking caffeine after 12 PM - coffee or tea? Do you nap? How long does it take you to fall asleep when you go to bed initially?

I was waking up around 2 every night, and although I usually have no trouble going back to sleep, I didn't like it. Yeah, I felt foggy during the day, kind of like I wasn't operating on all cylinders. Not a good feeling. I ended up cutting added sugar 100% out of my diet (that includes cane, honey, maple syrup, agave, stevia, fake packet sugars like sweet 'n' low, glucose, fructose, etc etc etc ETC) and the waking up stopped. So what you're eating or drinking could be having an effect. That's a process of elimination game, but one which might be worth playing, one food/drink at a time. Give each thing you stop consuming a week to see if there's any difference.
posted by the webmistress at 10:09 AM on September 17, 2018

I could have written this a few years back, down to the decreased mental capacity and the 2 A.M. (or 1!) wakeup followed by 3-4 hours of uselessness, managing to fall asleep by 5 just in time for my 6 A.M. alarm, which I could never get up for. I went through all the OTC sleep aids; everything worked for a few days and then stopped, except for Benadryl which made me sleepy and anxious and fighty all at once. I felt my sanity leaving, like a physical thing. Eating or not eating, curating sleep atmosphere, exercising or not, nothing made a bit of difference.

I got lucky that Ambien worked so well for me, and within about three days I felt my clarity of thought coming back, and for the first time in literally years dared to hope that I was fixed. I take it generally for a maximum of three nights in a row; any more and my brain gets acclimated, and I can deal with a few nights of fractured sleep. I don't have any hangovers or any fun stories. My sister does not, because she does and has.

tl;dr, yes I've been there, I got better when I started getting sleep. Don't give up hope.
posted by disconnect at 10:11 AM on September 17, 2018

Response by poster: Sure. I have tried going to bed earlier and later. I usually wake up after 3-4 hours regardless of time. And I try to avoid electronics after 7PM. I try to limit non-sleeping time in my bedroom, keep it cool, don't nap, etc. I do all the sleep hygiene things.

I have not tried giving up sugar, although my only real intake is a packet in my coffee in the morning. On that note- no coffee after noon and only one cup daily.
posted by Thesisaurus at 10:13 AM on September 17, 2018

Trazodone is what eventually saved me. Some people do feel groggy the next morning, but after an adjustment period of a couple of days I never did. I take Ambien now instead, because Trazodone interfered with another med I had to start taking. I take it every night, without fail, and have for years. It does not have any weird side effects for me. I feel as though I sleep like a normal person now.

I strongly recommend Gayle Greene's book Insomniac. She's a lifelong insomniac herself and goes into great detail about the gamut of potential causes and treatments. It helped me so much to see in print that there is something real causing this problem for me, that it isn't an emotional defect or something I can think my way out of. Reading that book made me finally go to the doctor, again and again, until they listened to me and found something that worked.

Another thing that could help is the Sleep with Me podcast. He tells progressively more boring stories in a soft, soothing voice. It doesn't always put me to sleep but it does seem to have a relaxing affect, distracting your brain for a while from freaking out over not being able to sleep.
posted by something something at 10:20 AM on September 17, 2018 [4 favorites]

Have you been tested for autoimmune disease? I went through a period of intense insomnia and it turned out it was a symptom of a larger issue.
posted by BooneTheCowboyToy at 10:40 AM on September 17, 2018

Have you tried cognitive behavioral therapy? I haven't, but https://www.theguardian.com/news/2018/sep/14/finally-a-cure-for-insomnia makes it seem like it might help
posted by kbuxton at 10:50 AM on September 17, 2018

Have you thought about Polyphasic Sleep? It would mean going to bed at 8 PM for you, but it could work with your insomnia.

You could also try CBD, or a joint every night before bed.
posted by DarlingBri at 11:36 AM on September 17, 2018 [1 favorite]

Have you tried addressing a possible magnesium deficiency? It appears to have a pretty strong possible relationship to insomnia.

I've gone on one of those irritating trendy diets that most people find requires supplemental electrolytes, and I got a recommendation for this supplement that I use in my evening drinks/water (my cocktail recipe involves Fresca and flavored seltzer and this stuff), and I've been sleeping like a champ compared to my average and I haven't taken a doxylamine succinate (the only sleep aid I can remotely stand, and I can only do a half or a third) in a couple months now. The diet's not hurting, along with giving up red wine that was definitely jacking up my sleep some, but the drastic change in my sleep came when I started drinking that stuff every day.
posted by Lyn Never at 11:50 AM on September 17, 2018 [2 favorites]

Response by poster: I have tried CBT and I read that same article this week and found it infuriating. The headlines promises so much but then it's just about basic CBT for insomnia. Which may be the answer I guess? It just hasn't worked at all for me.

Yeah, I've had some basic labs done and nothing came up. Thyroid was normal. Other panels normal.
posted by Thesisaurus at 11:50 AM on September 17, 2018

Response by poster: I have a big jug of magnesium in the pantry which I have taken on occasion. Never seemed to help, but I haven't taken it for more than a few days at a time. I could try to be more consistent with it I suppose.
posted by Thesisaurus at 11:52 AM on September 17, 2018

This is not a fun suggestion, but: quit caffeine. Try cutting out the coffee for at least a week. I don't have any scientific studies to back this up, but anecdotally, I've seen that caffeine sensitivity increases with age. What was fine for you five years ago might be way too much now.
posted by prewar lemonade at 12:03 PM on September 17, 2018 [1 favorite]

Response by poster: I can give it a shot. But... man, coffee is the only thing I look forward to these days.
posted by Thesisaurus at 12:39 PM on September 17, 2018

Following closely because I've tried everything mentioned so far with little to no success.
posted by The Underpants Monster at 1:16 PM on September 17, 2018

Sorry but my solution was also quitting caffeine completely. I also had to avoid chocolate in the evenings. And it still took a few months and determined sleep hygeine. I also had to work hard on better strategies for dealing with rumination and anxiety.

The plus side for me is that I had always had trouble sleeping even as a child. Now I am a pretty reliable sleeper. Totally a learned skill. I can even have occasional caffeine now as long as it is before 9am.
posted by kadia_a at 2:38 PM on September 17, 2018

If you're pretty sure you're not going to get a second sleep because you feel completely wide awake, use the time. I've been waking up at 4:00 or 4:30 or 5:00 for no good reason for months. I brew up a buttload of coffee and clean the kitchen and do laundry and frolic around like I'm on speed until NPR takes over for the BBC, and then I turn it off and do deskwork. If I wake up at 3:30 or earlier, I try to go back to sleep and then get up at 5 or so if it didn't work. I'll feel awful all day if I get up that early, but 4:00, it turns out, is great. I've become what I've always reviled: one of those assholes who goes on about the joys of being up before everyone else "watching the sun come up."

How to:
the night before: don't eat dinner, or eat a very tiny dinner. Don't drink alcohol or too much of anything. A little hot tea is fine, but obviously no caffeine. Go to sleep when you feel sleepy.

The crack of predawn: Get up in the gloom and stagger in the dark to the clock. (I have a clock radio that's dark until you push a button and then the clock part lights up, but I don't like it. I like to try to figure out what time it is while I make my way to the kitchen to look at the clock on the stove and see if I guessed right. Don't ask me. It's part of Morning Mystery Time.) Don't turn on any lights. If the clock says it's too early, go back to bed, still in the dark, and offer yourself up to sleep until it's not too early or until, having fallen back asleep, you get woken by your alarm. If the clock says it's not too early, turn on all the lights and make coffee and turn on music and go outside and get the paper or turn on the sprinklers, greet the cat, sing, make breakfast--basically celebrate wakefulness. You might need to make "not too early" an hour earlier than my "not too early," since your habitual waketime is 2. Try to push it gradually up to 4, and then join me in the frolic!
posted by Don Pepino at 3:47 PM on September 17, 2018 [2 favorites]

I wake up at 2 every day too; I just go to bed at 7 or 8. When I wake up at 2, I start working or watch movies or answer emails and sometimes I even drink coffee. I can fall back asleep for a couple hours before the regular day starts and I've just sort accepted that's my sleep schedule.

My mom does the same thing but she refuses to get up and do anything and usually takes an ambien. I only recently discovered the segmented or polyphasic sleep that DarlingBri mentions and I was surprised to find out that people try to have this schedule on purpose.
posted by katinka-katinka at 4:02 PM on September 17, 2018 [1 favorite]

I think my accute insomnia was triggered by a parasite. After antiparisitics it did slowly improve. I did all the sleep hygiene stuff, and tried melatonin which did nothing for me, but does work for some. Z drugs work for only a few nights before they stop working, Benadryl worked for 2 before it switched to the paradoxical side effect of being wired.

What worked: benzos sometimes, and now I take noratryptaline nightly. I got treatment for anxiety, which is a factor.

I also lucked out and found a GP who worked with me, reviewed my sleep journal every week or 2, and sent me around to specialists. Good luck and keep trying, I slept almost 7 hours last night! It can get better.
posted by Valancy Rachel at 5:50 PM on September 17, 2018

This is what happens to me if I'm under-hydrated (among other things). Drink more water than you can stand in the morning, a lot in the afternoon, and very little after dinner. Easy to try, hope it helps.
posted by kate4914 at 6:24 PM on September 17, 2018 [1 favorite]

Ambien doesn't last long in the body, when I wake up stupid early like this I will take one up to about 2 maybe 2:30 am. What I've found useful recently is CBD oil, which seems to be available in a growing number of places. It has the effect of quieting the voices in my head so that I can relax and sleep, which is impossible if I'm fixated on some argument late at night by myself. I think it takes a long time between swallowing a pill and feeling the effects, you might find it faster to take drops, or to take a pill before you go to bed. (hm... I should take one now).
There's a product out there called Neurosleep which helps me get to sleep. I drink half a bottle at a time. It works better than plain melatonin for me. I've also had occasional good luck with audio books or soothing podcasts. Oh and earplugs. Evey night.

I've favorited this post, I'm also keen to read what other people are suggesting. Insomnia is a bitch. One of the sleep books I read suggested that most GPs don't know much about sleep, and if you have problems, you should ask for a referral to a sleep specialist. I completely agree with this advice and am passing it along to you but I have myself not done it yet. Some days it's as much as I can do just to get dressed and leave the house without punching anyone if I haven't slept. The amount and quality of my sleep really has an amazing affect on my mental health.
posted by Vatnesine at 6:33 PM on September 17, 2018

My new GP didn't like that I was on ambien long term, and her preferred alternative was gabapentin. It had a longer half life and didn't work for me for that reason, but maybe worth a try.
posted by Dashy at 6:41 PM on September 17, 2018

This didn’t turn out to be the solution for me but I haven’t seen it mentioned yet: my doctor suggested a high-protein/high-fat snack before bed because apparently sometimes waking up can be caused by a drop in blood sugar.

There’s also some research about using exposure to bright lights (like a light box) at night to help with early-waking insomnia: “The treatment of early-morning awakening insomnia with 2 evenings of bright light.”
posted by needs more cowbell at 7:11 PM on September 17, 2018 [1 favorite]

My GP sent me to a specialist; he did a sleep study, shrugged, and said, "Well, you don't have apnea. What exactly IS it you think *I* can do for you? Have you considered seeing a psychiatrist?"
posted by The Underpants Monster at 7:29 PM on September 17, 2018

I had similar problems in the past and what worked for me was getting off sugar. I stopped eating anything with sugar in it - cereal, donuts, cookies, ice cream - and within a week was sleeping better. Now I occasionally eat something with sugar in it and do so knowing I will pay a price that night. I have heard that flour affects some people the same way. Try researching "diet and sleep" and see if something helps. You can pretty easily modify your diet, see how it affects your sleep for the next week then move on to the next modification.
posted by eleslie at 8:34 PM on September 17, 2018

Response by poster: Alright, thanks all. I'll stop the sugar and caffeine and see if that helps anything. I have tried light therapy, which honestly is maybe the only thing that's improved my sleep a tiny bit. I'll try to be more consistent with it.

The Underwear Monster - I'll keep you posted. But before I sign off this thread entirely, what have you tried? Sleep restriction? Daylight therapy? When you wake up are you uncomfortable? Anxious? Physical pain?
posted by Thesisaurus at 5:38 AM on September 18, 2018

Can you change your day schedule so that you can sleep when you need to during the day? Insomnia often involves anxiety, and being short of sleep worsens it. Presumably you can't easily change your day schedule as you have a job, that requires you to be present and functional nine to five. But you might find that making your bedtime 5:30 PM and your waking up time 2:30 AM would result in more sleep.
posted by Jane the Brown at 6:32 AM on September 18, 2018

I had this problem when there was a lot of stress in my life. Now it only happens occasionally (like last night, whee).

Things that made it better: 1. no booze before bed and 2. a medication called Tizanidine. It's a muscle relaxant, but for me it was two+ hours of guaranteed sleep and no grogginess when I woke up for the day. I could wake up at 2 or 3am, pop a Tizanidine, and fall back to sleep in about 15 minutes -- sleeping through until my alarm went off at 5.
posted by elsietheeel at 7:26 AM on September 18, 2018

I'm on year 12 of this. I tried a million different things but the only things that significantly helped were:

Gabapentin, which lets me average 6 instead of 3-4 hours of sleep per night now, which is a big improvement even though it's still pathetic

Modafinil, which makes life without sleep a little less crappy. I can't afford it so now use adrafinil, which is harder on the liver but worth it to me. (I only use it a couple times a week to go easy on my body and avoid building tolerance.)

Becoming more matter-of-fact about it: instead of thinking about and being upset by how much it's sucking, recognizing that it is what it is and working within that.

Good luck. I know how much it sucks.
posted by metasarah at 10:54 AM on September 26, 2018

Yeah, my insurance company looked at my doctor's Modafinil prescription and said unless you have X result on Y bloodwork, which is incredibly rare, GFY.
posted by The Underpants Monster at 12:36 PM on September 26, 2018