help me sleep... PLEASE.
July 28, 2009 9:35 AM   Subscribe

Please help me sleep. Please :(

This is going to be VERY VERY VERY long because my sleeping problems have a 2-3 year history. Any replies I get beyond zero I will be very appreciative of.

I've posted questions/threads this in the past but the past has spanned a while hasn't it? As the months have progressed, each time I post this I'm increasingly frustrated and saddened that I will never have a normal sleeping life to get through college and get my degree. I started having sleeping problems when I started college. To this day, I cannot recall anything particularly horrific happening to me to traumatize my sleeping patterns. 4 years ago I switched from high school to college. That's what a good percentage of Americans do right and? Right.

I have a history of depression and a history of anxiety. Both I would say are not severe. The depression is moderate to slightly above moderate most of the time. I take 120 mg of Cymbalta for it and have done so for almost a year. I have anxiety, I used to take Xanax 3 times a day at .5 mg a clip and now I take it all at night to see if it helps me sleep any since I can cope with the anxiety in the day better now.

My depression/anxiety stems from lack of self-esteem and energy from a lack of sleep. So far it's all making sense right? Ok, let's keep going then.

I've always had a hard time winding down for sleep since I can remember and definitely before I started college. I'm sensitive to light before going to bed and I spend way too much time on the computer before bed (even though I've incorporated at least an hour to 2 hour cool down period before bed now after turning off the computer). I currently see an ENT doctor and a psychiatrist (and a psychologist for talk therapy sessions just to kinda vent really, I never have any big updates to give lol) . My ENT doctor is outstanding while I feel my psychiatrist is useless and I'm strictly on a seeing her every 2 month just because that's what you do I guess when you have all this shit going on. My psychologist/campus counselor is outstanding as well.

Roughly a year ago, I went in for a sleep study because as you'll see later on in this master thesis, I've tried every medication known to man for falling asleep and staying asleep. After an awful night in those horrendous laboratories they call sleep clinics, they said they had enough data despite my whopping 240 minutes of sleep. I was later diagnosed with sleep apnea and frequent arousals with my brain wave patterns. My options were CPAP, throat and uvula surgery (noooooooooo way. nooooooo way in hell), mandibular retainer, treating restless leg syndrome and jumping off a building. We tried a CPAP machine and I just got increasingly frustrating with the thing. At first the mask wasn't right, I got a new mask. Then I just detested all the maintenance you had to do to keep the piece of crap that didn't help me sleep all clean and functional. Later on, the sleep clinic and I tried to treat me for restless leg syndrome. Needless to say that didn't do a damn thing. I was on mirapex, although I don't remember the dosage. I just remember increasing it and then quitting the stuff. After I went back to them after all of that, I wrote them off as idiots and politely never scheduled another appointment with them again. I'm done with them. Best sleep clinic in Houston??? We fix the problems other clinics miss? Oh really???

So that led me to my ENT that I currently see. After a few months of trying nasal sprays (prescription), afrin, and useless saline rinses I decided to have sinus surgery on June 22, 2009. For the medical students out there... I had a balloon sinusplasty done combined with correcting a deviated septum (which doesn't cause problems in most peoples sleep) along with a right turbinate reduction. The surgery sucked balls but now I can breathe better, just no improvement in sleep. Hooray! :) The sinus surgery was my part one out of a two part plan for fixing my sleep. My ENT informed me that he could definitely get me breathing better but the surgery would not be primarily to fix my sleep. If it did so then that would be great, but if not then that was what we had understood going into the surgery so no big whoop. I secretly hoped it would though and had the surgery more so for that reason than fixing my day-time breathing. My second part would be using a mandibular retainer after my sinuses fully heal up. I think at this point, my ENT and I are "entertaining" the idea of when it's all healed I'll have great sleep. At this point, if I got a mandibular retainer it would be through a doctor that my ENT knows and not the useless sleep clinic that I previously went to. I don't even know what good that would do?

Now let us back track to what goes on once I manage to get relatively sleepy. I always eat before I go to bed because I've gotten so frustrated with every other method and medicine I've tried, so that's my first step. I then go to sleep and proceed to wake up anywhere from 3-4 times like god damn clockwork (for the past 4-5 years at least). I've consulted with other friends and they wake up too, but they fall asleep quickly. I usually eat before I go back to bed because in my mind I'm tiring my body out by using energy to digest food and thus it will help me get back to sleep. I know, but it's my theory, valid or not, lol. At this point when I post, I'm always asked well what do you think about when you wake up? Are you short of breath? What is your mood? How do you feel?

Well, I'm almost always irritated because I immediately think "great, it starts again. let's see how many times I wake up this night". Despite my severe sleep apnea diagnosis, I never wake up in a panic or short of breath. My mood of course is frustrated and irritated and I feel the same. Surprisingly, this is the point where I say there is nothing traumatic going on in my life that's causing me to wake up in the night like this. I've got the usual responsibilites such as being the man of the house since my dad passed away last year (again, sleep problems existed long before he passed away and I've discussed this with others at length), going to school trying to finish my degree through being tired as hell, helping my mom with daily house chores, running whatever errands I do, getting a good amount of exercise per week, getting together with friends, etc. It's not like I'm waking up every night 3-4 times because there's some lingering issue. If it's buried deep in my subconscious then that's where it must be and someone needs to Harry Potter my brain and extract whatever haunting fear or memory that is buried there with a magic wand because it sure as hell isn't anything out of the ordinary I can think of.

So now we're done with describing this. Have you fallen asleep yet? :). Within the last 3 months, we've replaced my bed and I have a brand new tempurpedic mattress and tempurpedic pillows - both of which I happen to like. However, the new bed and new pillows are not helping my waking up 3-4 times a night any. It's more comfortable to sleep on, but it's not helping the issue I bought it for.

Ok, aside from that paragraph I've stopped taking sleeping pills. They just don't work. Here is a list of what I have taken and I have been on each of these medications for at least 2 week periods (which in my mind is more than enough to see a difference, I've never believed that crap about give it more time...give it more time. 2 weeks is enough god damn time).

list (most are official sleeping pills, some are not):

Ambien CR

regular things I've tried:

all the sleep time teas in the world
valerian root capsules
different herbal cocktails (like those bottles that have valerian root, chamomile, etc in their capsules)
different indian teas.
hot baths for at least 30 mins, about an hour before I go to bed.
hot baths with epsom salt (yeah, it doesn't help sleep specifically, whatever right?)
hot baths with different "sleep" salts and other sleep mixtures.

what I haven't tried:

overdosing on drugs and getting permanent sleep. I'm kidding about this as I've entertained the idea, but you get the point of my situation.

After all of that and I really am sorry I had to put you through reading it, but there's just no way to sufficiently describe my situation. I wake up 4-5 days out of the week wanting to kill someone upon waking up or wanting to punch holes in my wall (which I haven't done yet).

What do you guys recommend? I am seriously convinced that certain pathways in my brain are screwed up and that I should almost see a neurologist to see what else could be going on with me. At this point, what would you do? I have tried so many things... so so many things and for what? What has it done for me besides nothing? Who should I take my problems to? Who should I see for this? What battery of tests can help me?

- Travis
posted by isoman2kx to Health & Fitness (51 answers total) 8 users marked this as a favorite
So you've:

- Been given a CPAP machine, but stopped using it
- Been prescribed medicine for Restless Leg Syndrome, but stopped taking it
- "Wrote off" the clinic that prescribed the above, because they were "idiots"

Look. I'm not trying to be harsh here, but you sound only loosely attached to reality. That's what happens when you don't get enough sleep - I know, because my dad had sleep apnea that got increasingly bad, and just before he finally gave in and used the CPAP consistently he was getting into regular fender-benders and was a danger to himself and others behind the wheel.

Use your damn CPAP, man. I know it's annoying and finicky and not really comfortable, but if it doesn't kill you directly, it'll do it indirectly.
posted by restless_nomad at 9:42 AM on July 28, 2009 [19 favorites]

i have had chronic insomnia that comes in waves for basically my entire life. I have not tried all the different rugs and treatments that you have, but have basically found two things that help me sleep.

1. alcohol. three ounces of hard liquor about half an hour before bed time usually does the trick.

2. exercise. a good hard run in the morning wakes me up for the rest of the day, and seems to make it so that i fall asleep better at bedtime as well. if that doesn't help, try a second run just before dinner (though you may find you start falling asleep EARLIER than you want to).

Of these two solutions, one is easier than the other. And one will make you healthier while the other will make you less healthy. But both work. Or at least they have for me.
posted by 256 at 9:47 AM on July 28, 2009

addendum: i obviously have no idea how alcohol may interact with sleep apnea or any medications you may be on so, obviously, do your own homework before you seriously consider that approach.
posted by 256 at 9:49 AM on July 28, 2009

I don't have much advice to offer here except for the RLS. Have you had your iron checked recently? Low iron levels (even those on the low end of normal) are associated with RLS. My GP didn't know this, and I was on Mirapex unnecessarily until I went to a neurologist. A few weeks of iron supplements completely eliminated my symptoms. You'll want to have a serum ferritin test. Anything less than 50 ng/mL is a red flag. I can tell when my iron's low now because the RLS starts to creep back.

Also, have you looked into biofeedback?
posted by lunalaguna at 9:53 AM on July 28, 2009

I've had insomnia for 26 years.

Things that work: when I wake up in the middle of the night, I pop two melatonin. They work like sleeping pills, to a degree, but are herbal.

I'm sure you already know to have zero caffeine if your goal is to sleep. I mean NONE.

I'm with you; sleeping pills can help me go to sleep, but cannot keep me asleep. Here's to hoping the sinus surgery helps, because that's probably what is waking you up. It can't hurt to try the melatonin; if it doesn't do anything for you, no big deal. Melatonin is available at any grocery/drug store in the US.
posted by Unicorn on the cob at 9:58 AM on July 28, 2009

What are you eating when you eat before you go to bed? That's pretty much the exact opposite of any advice I've ever been given regarding sleep quality -- I've always been told not to eat before I go to bed.
posted by jacquilynne at 10:00 AM on July 28, 2009 [2 favorites]

There's nothing traumatic going on, you say. Yet you are obsessing generally and all wound up. Obviously no sleep isn't helping, and as I've had lifelong insomnia issues, I really do sympathize. You need to gain some perspective and let go of all this stuff that doesn't matter at the end of the day when sleep is the priority. Choose to procrastinate on worrying about it all. You need some relaxation skills. I used to hate it when people said this to me, but in hindsight it's valid: "Lighten up." Maybe try skydiving and you will gain some perspective about what's worth worrying about. Then maybe you can let go of it all and get some sleep.

I do think some INTENSE exercise would help, as it's something you haven't mentioned, whether that is pushing yourself with weights or something involving endurance like a couple hours' brisk walk, paddle, or what have you.
posted by Listener at 10:02 AM on July 28, 2009

Exercise. Outdoors. Go wear yourself out in the sun. It might not help so much with the night wakings straight off, but it will make going to bed much more pleasant and sleep much more restful, and thus relieve some of the stress associated with sleep, and in turn make falling back asleep after waking easier.
posted by kmennie at 10:07 AM on July 28, 2009

I went through a five-year bout of chronic insomnia, and I tried many of the things that you've mentioned, but not the prescription drugs. These are some of the things that helped me:

There's a lot of info here about what drugs you've taken to help you sleep, but you haven't given any indication of your caffeine intake.

Cut out all your caffeine. Do this gradually so you don't get wicked headaches. You might also consider cutting down/eliminating white sugar, sugar can affect some people a lot more than they think.

Drink a lot of water during the day but really taper off after 5pm so you don't have to pee much overnight.

Exercise daily. Break a sweat, keep your heart rate up for 45 minutes or so. Stretch out afterwards.

Good work on getting a new bed, but look at other things that might be troubling your sleep. Drafts? Cold feet? Temperature changes in the night? Ambient noise?

To be honest, the above things just fine-tuned things. My chronic insomnia was caused by being profoundly unhappy in a relationship in a way I was unwilling to confront directly. No major trauma, but denial is a powerful coping mechanism, and your repeated insistence that there isn't anything traumatic makes me wonder if deep down you know what the chronic nagging issue is but don't want to deal with it. I may be projecting here so feel free to reject that theory.

Most of all though it seems you need a bit of an attitude adjustment. I understand that you are frustrated after trying for years to fix your problems, but it seems to me that you are blaming a lot of other people for not fixing your problem. It's your problem. If the maintenance on the CPAP machine is too much trouble for you to bother then no one else can help you. ( I know a half dozen people who use CPAP machines, and they've never complained about the maintenance on it. After all, it is the thing that helps them breathe!)
posted by ambrosia at 10:09 AM on July 28, 2009

i've heard several anecdotes about the marijuana's ability to medicate insomnia and RLS.

i can't seem to find any reliable literature on the topic. if you happen to live in California, its quite likely you could obtain a medical license if you want to go the legal route.

on this forum, it has a rating of 9/10 for "perceived effectiveness" among insomniacs.
posted by breadfruit at 10:14 AM on July 28, 2009

Your only mention of exercise is that you are "getting a good amount of exercise per week." Step 1 for breaking insomnia is to get a couple hours of heavy exercise or work related physical activity a day. Being physically tired from deep muscular fatigue powerfully resets your body's rest cycle, as your muscles and organs need more sleep time to repair themselves, refuel with ATP, and eliminate excess lactic acid. People who burn lots of energy in muscular effort also seem to have lower levels of stress hormones like cortisol, and to respond better to daily stress situations, in the long run. For most people, this means that their brains seem to generate more of the hormones that enforce the normal disconnection between our nervous systems and our voluntary muscles, that permit the safe unconscious sleep state. And the improvement in cardiovascular fitness and perhaps concomitant loss of weight that generally accompanies such activity seems to help those with sleep apnea, too.

Seriously, man, if your sanity and well being are at stake, get physical to the point of deep muscular fatigue daily for a while, and you will sleep.
posted by paulsc at 10:16 AM on July 28, 2009 [3 favorites]

If you have OSA then all the sleep in the world wont help. You tried CPAP, but did you try a dental appliance? In my case, it turns out my OSA was almost non-existant while sleeping on my side, so I tried that and eventually got in the habit of sleeping on my side. Now I feel more awake and without the CPAP or appliance.

As far as insomnia goes, I have succcess with relaxation techniques, especially meditation, along with some melatonon and/or tryptophan. I read somewhere that insomnia was a 24 hour problem of arousal. So people like us get spurts of energy or mental arousal randomly. The trick is to learn to be relaxed all day and not let stressors keep you aroused all day and then wonder why you cant sleep at night.

I suggest going back to the sleep doctor or trying to sleep on your side. Cut all stimulants or at least switch to green tea instead of cola/coffee.
posted by damn dirty ape at 10:18 AM on July 28, 2009

My 52 year old dad died the night he didn't use his CPAP machine. is a really helpful site. They helped me with my adjustment period, they helped me find a good mask that I could tolerate, they helped me to understand what the data from the machine meant, and best of all, they don't coddle people.
posted by elsietheeel at 10:21 AM on July 28, 2009 [2 favorites]

Criminally bad advice: Drinking booze before bed for your insomnia.

That'll just make the apneas worse.
posted by elsietheeel at 10:22 AM on July 28, 2009

elsietheeel: I tried to include quite a hearty IANAD and YMMV. I'm not offering medical advice. I'm offering an anecdote of what worked for me.
posted by 256 at 10:24 AM on July 28, 2009

I've has insomnia for about the last thirteen years of my life, and I've tried a heck of a lot of things for it, with most of them not seeming to work. For my birthday almost a month ago, my mom bought me one of these. Admittedly, I was kind of skeptical, because, well, nothing has ever really worked for me. When I remember to use the dang thing, though, I sleep, and it's wonderful. It produces a noise not unlike that of a hair dryer -- a steady, windy noise -- and it does a great job of masking any 'outside' noises. [I can usually hear the television in the living room through my closed bedroom door, but with this on, that distraction is gone.] For the first week or so of using it I had some wickedly intense dreams, but the little brochure included with the machine does state that your body might go through a period of adjustment of a few days to a couple of weeks. In my case, the week of crazy nightmares was a small price to pay for actual sleep for the last three weeks.
posted by alynnk at 10:26 AM on July 28, 2009

We tried a CPAP machine and I just got increasingly frustrating with the thing. At first the mask wasn't right, I got a new mask. Then I just detested all the maintenance you had to do to keep the piece of crap that didn't help me sleep all clean and functional.

Look, I know the CPAP machines are a pain and the only other real option is surgery, but sleep apnea is no joke. Regardless of whether or not it helps you sleep, you should get treatment for it. If you leave your sleep apnea untreated, especially if you are taking certain kinds of prescription medications, you might die. From Wikipedia:

Similarly, in any person who has some form of sleep apnea (including obstructive sleep apnea), breathing irregularities during sleep can be dangerously aggravated by taking [respiratory depressants]. Quantities that are normally considered safe may cause the person with chronic sleep apnea to stop breathing altogether.
posted by burnmp3s at 10:32 AM on July 28, 2009 [2 favorites]

First of all, stop eating right before going to bed. Second, if your problem is an obstructed airway, all the sleeping pills in the entire universe are not going to un-obstruct your airway.

I personally don't cycle through REM sleep properly and after having tried all the sleeping pills available, settled on 2mg of ativan at night several years ago and sleep much better now. This may not work for you as you take benzos during the day and may have a tolerance for them.

My mother has apnea, and while the CPAP is annoying to maintain, it also allows her to sleep like a semi-normal human being. I understand it's a pain in the ass, but how long did you try it?
posted by crankylex at 10:34 AM on July 28, 2009

I used to suffer from insomnia and found it very anxiety provoking. I found myself calculating how many hours of sleep I would get if I fell asleep at this point or that point and then imagining how the next day would be ruined due to lack of sleep. The thoughts of my day being ruined caused even more anxiety, which made it even more difficult to sleep.

My solution was to find a medication that helped me sleep. I don't take it on a regular basis, but knowing it's there has brought me immense relief. This brings me to my first suggestion - Keep trying medications in various doses until you find one that works and then just have it available in case you can't sleep.

Next, try some behavioral changes - use your bedroom for bedroom related activities - sleep, sex, getting dressed, etc... Don't watch tv, use your computer, or talk on the phone in your bedroom.

Develop a relaxing bedtime routine - What types of things help you relax? Try to set up a night time routine involving those things. Keep a journal of thoughts/feelings and write in it before bed. This will help you sift through any thoughts that might be floating in your head before bedtime.

During the day, get lots of exercise - walk instead of drive, take the stairs instead of the elevator, etc.

Calculate how much sleep you need. Some people need 10 hours and others need just 5. Where do you fall? If you need less sleep to feel well than the average person, try not to fret. Not everyone needs the same amount of sleep.

I also recommend eating for the last time at least 1 hour before bedtime and avoiding caffeine for 6 hours before bedtime.

Finally, the tips below other people have suggested to me when I had insomnia:

1. Look at the clock and challenge yourself to stay up as late as possible without getting out of bed
2. If you're in bed for more than 30 minutes before sleeping, get up and clean the house (provides negative reinforcement)
3. While in bed, concentrate on relaxing different areas of your body
posted by parakeetdog at 10:36 AM on July 28, 2009 [1 favorite]

While I didn't read everything word-for-word, I want to point out two things:

a) Most sleep apnea sufferers are fat. Losing weight makes the sleep apnea lessen or go away. Try losing some weight. This is a two-fold thing, as a good diet and more activity should help you sleep better as well.

b) In mentioning using the computer at night, you said "even though I've incorporated at least an hour to 2 hour cool down period before bed now after turning off the computer". I recommend you take this even farther. Shut off ALL lights, the TV, whatnot. If you like to read, get a very low light, or a booklight, or candles. Don't turn on overhead lights. Let your body produce all the fun little chemicals it does when the sun sets.
posted by phrakture at 10:41 AM on July 28, 2009

Yes, use your CPAP machine, stop eating a few hours before bed, and give your RLS medicine another shot, ditch any caffeine or other stimulants, find a place for vigorous exercise in your day. I also think changes in your routine may be helpful. Try maintaining a very rigorous sleep schedule, going to bed and getting up at the same time every day, even weekends or when you don't have to get up for class. If this works for your living situation only use your bedroom for sleeping. Reading, watching TV, and using the computer should all be done outside your bedroom.

Re: alcohol. Aside from potentially being criminally bad advice my own findings is that alcohol increasingly interferes with sleep as I age, waking me me up more and not feeling rested in the morning.

If you live an a noisier place try the white noise machine or soft foam earplugs. I like my bedroom cool, dark, and quiet.

And really, use your CPAP machine.
posted by 6550 at 10:46 AM on July 28, 2009 [2 favorites]

I have a similar problem to yours. In my case, my dental arches are too small so orthodontics combined with MMA (orthognathic surgery) to move my jaw forward 10mm is on my agenda. You can read up on MMA surgery online and there are some good blogs posted by people that have had it done. Apart from that, I like ambrosia's post.

Oh and yes, exercise. Won't fix your apnea but it will wear you out. Just don't exercise right before bed.
posted by jmmpangaea at 10:49 AM on July 28, 2009

Actually, a lot of thin people have sleep apnea. It's a misconception that it primarily affects the overweight and obese.

In addition, losing weight doesn't always help. My neurologist said that maybe 20% of his sleep apnea patients who've lost weight have been able to stop using their CPAP machine. Sadly I am not in that 20%. I've lost 80lbs since January and still have to use my APAP every night.

The OP needs to make friends with his CPAP machine.
posted by elsietheeel at 10:49 AM on July 28, 2009

I went through a period of acute anxiety a couple years back due to a slowly failing small business -- as business got worse, so did my anxiety and sleep pattern. After consulting a psychiatrist, he initially tried me on some sort of serotonin re-uptake inhibitor, I forget the name. It made me feel WEIRD. I did not like it one bit, and quit taking it after two days of what I can only describe as "the wobbles." He thereafter prescribed Klonopin, and I've generally been able to sleep, since. Well, 4 out of 5 nights, anyway.

The last 6 months, I've been tapering off the Klonopin, and so far, it's going well. First, a reduction in my stress level at work (I'm now a regular old manager for somebody else, and I'm somehow surviving on exactly half the income I thought it took to survive. Funny, that.) has been the main factor, but other than that, things that are helping are

1. regular exercise (I work hard most days -- on days when I'm desk-bound, its noticeable)
2. meditation, though not nearly enough -- I have a very restless mind and get frustrated sometimes. Mornings seem best for this.
3. I read at night until my eyelids slam shut. I don't try to go to sleep before I'm utterly unable to stay awake. Some nights, it's 15 minutes, some nights, it's 2 hours.
4. Easy on the internet in the PM hours. Really. This is a serious cause of insomnia for me. A good 2-hour Metafilter session between 8 & 10 PM = I'm wide awake at 4:00 AM. When your brain says to look away from the screen, LISTEN. My new habit is when I catch myself refreshing a site I've looked at in the same sitting, I hit command+q next. It's hard, but it's made a real difference when I've obeyed this rule.

Earlier in life, I self-medicated with alcohol. I cannot recommend this for the long-term whatsoever.
posted by Devils Rancher at 11:10 AM on July 28, 2009 [1 favorite]

The Xanax is such a bad idea I can't stand it. It is habit forming and will NOT help you sleep after your body gets used to it. It is NOT a good idea for you to be taking it. Your shrink should be telling you this. It can cause depression. Don't quit cold turkey but talk to you shrink and tell him you want to quit.

Do what the sleep clinic tells you to and go back for another appointment. How are they supposed to help you if you don't go?
posted by kathrineg at 11:49 AM on July 28, 2009 [1 favorite]

Have you tried YOGA?
posted by 3dd at 11:51 AM on July 28, 2009 [1 favorite]

I should clarify my above advice. I am not a psychiatrist, therapist, or mental health professional. I used to have insomnia and was told this by an excellent Harvard- and Columbia-trained psychiatrist after I was prescribed Xanax for sleep problems by a shitty GP (also Ivy league trained, ha).
posted by kathrineg at 11:51 AM on July 28, 2009

You've gotten good advice. Now for a few random things: Outgassing, especially in TempurPedic mattresses is surely not helping you sleep. I sleep on Latex, super comfy, much healthier.
Also, same thing for what your sheets, clothes, etc are washed in. Some people have chemical sensitivities, you may be one of them, and breathing in Tide all night could be keeping you up. Try Seventh Generation or whatever.
Things like cologne may have formaldehyde in them, which would also mess with your brain. Go natural.
And yes on the Melatonin!!! Although it doesn't seem to work as well in men, I hear. I prefer drops under the tongue to pills.
Naps. If you don't have the time, make it. Even for 30 minutes in the afternoon.
It seems that with your surgery your Sleep Apnea should be better, so why the CPAP? Seems like it wouldn't help anyhow.
And finally, be positive. Stress leads to less sleep, worse sleep, no sleep. Be happy about the sleep you do get, and not frantic about the sleep you don't.
posted by anniek at 11:56 AM on July 28, 2009

over the counter: melatonin worked like magic for my 16 year old daughter, who was till she began this, up all hours, every night.
posted by Postroad at 12:00 PM on July 28, 2009

Have you tried setting up a routine?

I've periodically had insomnia brought on by bad bedtime habits (though the insomnia did not carry on as long as yours), and a week of following this routine to the letter helped a lot:

(1) Living healthy in general--regular exercise, eating healthy, etc.

(2) Taking a high-quality magesium supplement, like magnesium citrate. NOT a magnesium oxide.

(3) Ending exercise a few hours before bed


(4) One to two hours before bed, turn off the computer and television.

(5) One hour before bed, do bedtime preparations and dim the lights. Turn off all lights in the area, close shades, leave only one or two dim lights on.

(6) Do something relaxing, like reading light fiction or knitting, talking with your partner, etc. Do NOT do this in the bedroom or in bed. The bed is for sleeping. You must train your body to remember this.

(7) A half-hour before bed, take melatonin.

A note about melatonin: Most melatonin supplements I've seen come in 3mg capsules. With melatonin, less is more and too much can actually make sleep issues worse. You actually want a dose that's ideally 0.25-0.5mg, at most 1mg, but good luck finding it in a drugstore. Melatonin is not a sleep drug. It's a hormone that regulates your circadian rhythms. By taking it, you're basically telling your body "This is when it is time to go to sleep." If you go crazy on it, or take it at 8pm one night and 11pm the other night, you're just going to fuck up your circadian rhythms even more.

(8) Enter sleeping area. Sleeping area should be dark and quiet and as free of electronics as possible. Plug in the cellphone and alarm clock outside your room and set the volume on high if you have to, but even get them out of there. Black out the windows as best as possible. Wear a sleep mask and earplugs.

(9) Lie down, breathe deeply, and think about the fiction book you were reading or whatever. Don't think about sleeping.

If you are still awake after a half-hour or so (you won't have the lighted clock on there, so use your best estimate), then get up, return to the dimmed area and the calming activity. Repeat the cycle, minus taking the melatonin over and over again.

Try this for a week or two weeks. You are overriding years of bad habits so it is going to take time and you will have to be patient. It is a pain in the ass. Deal.

Furthermore, all of this advice is moot if you have sleep apnea that is bad enough that you need surgery and require a CPAP. Good, regimented sleep habits will help anyone, but medical conditions that potentially kill you can override even the best habits.
posted by schroedinger at 12:32 PM on July 28, 2009 [6 favorites]

Oh yeah: I generally buy whatever melatonin is at the drug store, and break the tablet into fourths.
posted by schroedinger at 12:33 PM on July 28, 2009

Yes, the CPAP is a pain in the neck. But, if you have a severe apnea diagnosis, there's nothing else you can do. It takes anywhere from 1-3 months to fully get used to using the thing, once you find the right mask. If you haven't given it that long, then you haven't really tried it. It's the only treatment that works 100% (as long as you have the correct pressure set).

Some clarifications: The sinus surgery will do zilch for your apnea. The problem is deeper in your throat. And, frankly, if you can handle recovering from the sinus surgery, you can handle recovering from the soft palette/uvula removal. The recovery for both sucks, but only the deeper throat surgery will help with the apnea. Ironically, the worse your apnea is, the better chance that you will benefit from the surgery, most of the time. I don't know why that is, but my ENT gave me that stat.

The retainer may work for you, it may not. Usually, you have one fitted by a dentist. It's supposed to hold your jaw forward, so that your palette doesn't touch the front of your esophagus or your tongue while you sleep. It's another thing that feels annoying, and requires an adjustment period to get used to.

Also, you can not tell how your apnea is affecting you while you sleep. Once you wake up, it stops. There's no way for you to accurately tell what's working for it and what isn't, because you'll never be awake and aware enough to observe it. It doesn't matter if you don't feel short of breath or panicky, that's no indicator of anything. The only thing you can do for yourself is to buy some medical gear (basically, a breathing detector, an oximeter, and a monitor to record the data) and test yourself. Or, of course, you can go the sleep study route again, but you really didn't seem to like that.

I'm also going to second elisetheeel: DON'T take any sleeping pills or alcohol if you have a problem with sleep apnea! If you can't wake up when you have an apnea, you very well can suffocate. Don't risk that.

Good luck with this. If you want to ask me any specific questions about my own experience or about CPAP, you can PM me.
posted by Citrus at 12:42 PM on July 28, 2009 [1 favorite]

Why do you say nooooooooooooo way in hell to the surgery? It's a couple of weeks of a sore throat and feeling miserable vs a lifetime of tiredness and crabbiness (if you live long enough.) My mom had sleep apnea for years and she finally listened to me the day I was riding with her (I was a teenager so probably 10-12 years ago) and she almost ran off the road because she fell asleep at the wheel. For a couple of years she'd been having to stop halfway to work to get out of the car and walk around to wake herself up.

Her CPAP made her have nightmares that she was drowning (she has an aversion to having things on her face) and so she had the surgery. She sleeps fine now, isn't tired all day anymore, and as a bonus to the rest of us, she no longer snores loud enough to wake the entire neighborhood.

You sound like you feel pretty awful right now. What you have to ask yourself is how bad you want it to get before you suck it up and have the surgery. I know surgery is scary and not fun and expensive, but it can greatly improve the quality of your life. You might feel like a new person if you start getting regular, good sleep.
posted by IndigoRain at 12:49 PM on July 28, 2009

Most psychiatrists don't think of this, and I don't know why, but it's worked wonders for me: Remeron (mirtazapine) is an anti-depressant that is often used in low doses (15 mg) to help patients sleep. In high doses, it has the opposite effect.

When I was doing some research on Xanax, I found the same thing kathrineg said: it is contraindicated for sleep apnea. At least according to the internets. But -- and you should obviously discuss this with your doctor, because I'm certainly not one -- my understanding is that Xanax is a short-acting benzo, which is double bad. With a longer-acting benzo like clonazepam (Klonopin), you may experience less rebound anxiety and more intense sleepiness. Xanax, like Ativan, wears off relatively quickly so that if you take it at night but not in the morning, you may experience some discomfort around midday.

A lot of the above advice is great: do get some intense exercise in the early morning (rowing!); do turn off the computer, TV and video games at about 9 p.m.; don't drink any caffeine after noon; don't eat before bed; don't hang out on your bed ("Bed is for sex and sleeping."); do get out of bed if you can't fall asleep after half an hour -- and don't use this as an excuse to turn on the computer or television; do try meditation and yoga; don't stop using devices that have been prescribed to you just because they're annoying.

Your talk therapist should be able to give you a much longer list of sleep hygiene rules. And she/he probably already has. You're probably tired of hearing the same thing over and over again. Don't despair. Maybe someone here has suggested something you haven't tried before. Or, you know, reminded you of stuff you've left off doing.

Good luck.
posted by brina at 12:55 PM on July 28, 2009

Just a small addition. When 'settling down' before bedtime, you might have to give yourself even longer. I need about 3 hours of mindlessness.

If I am on the computer, I turn down the screen brightness to the bare minimum, bit by bit, until it is as low as it can go. With the t.v., I turn the sound down more and more until I prefer the choice of sleep over t.v.
posted by Vaike at 2:27 PM on July 28, 2009

I always look back with first anxiety, then some frustration, and then intrigue. Then I look back over the replies before I post back on a started metafilter thread. Some people completely misunderstand you, some people think you want to do certain things for a lifetime (because I "want" to use caffeine every day and I certainly "want" to eat forever at night), and then some people actually understand and empathize/help you. Thank you for those that successfully did the last one and have been highlighted.

Look... there are certain things I don't want to do right now and unless I fail out of school because of sleep I won't do (ex: throat surgery). I didn't like the CPAP machine and that's my personal preference. How are some people on here going to tell me that my personal preference is wrong? It works for you? That's great. I didn't like it and it didn't work for me.

I'm not going to die (hopefully not for a few many years since I'm 23). If I was going to die, the sleep clinic and my ENT would have both likely warned me that "hey, getting off this CPAP is a bad idea man. I'd give it a real good try before you croak". More or less, lol.

Also, it's hard to stop eating at night. Some people here don't seem to understand that. It's like I'll just magically decide to not do it one day and then poof I won't struggle at all. No worries mate! I won't even address the tempurpedic bed remark.

I do get exercise but sometimes I'm too tired to feel like exercising. I get easily 30+ mins about 4 times a week. For those of you that suggest intense exercise, what about when the school year starts though? I can't go "INTENSE" exercising if I'm barely getting sleep as is can I?

All I'm asking from the non-helpful crowd is to understand. I wrote the original thread this morning with my usual morning frustration and this time it was boiled over. I do feel the same about much of my comments even though now I am calmer 8 hours later.
posted by isoman2kx at 2:37 PM on July 28, 2009

melatonin also is a no go. I tried 3-5 mg of that stuff for months. it's a relatively useless device with not much medical backing other than to help jet lag.
posted by isoman2kx at 2:41 PM on July 28, 2009

Sometimes adults have to do things we don't like to improve our health and well-being.
posted by elsietheeel at 2:43 PM on July 28, 2009 [7 favorites]

Your call, but I was a lot like you and managed to change my life over the span of a few years. I dont sleep great, but Im much better where I was. No caffeine past 1, addressing my anxiety/insomnia, addressing my OSA, not eating at night, etc all works. It wasnt easy, but you sound like you cant be bothered. Oh well, youre an adult now. You'll reap the consequences. Calling people who are giving you some straight talk unhelpful is how you cope. Thats fine, but it doesnt make it right.
posted by damn dirty ape at 2:49 PM on July 28, 2009

Certainly you can have your preferences, but there's a point where it seems like your question is "How can I stop tripping and falling on my ass? I walk backwards everywhere, and I fully intend to keep doing that. Also, I don't want to look behind me. Help me!" and really... there's not much anyone can say to that.

Two of your three "best answers" were pretty firm in their support of CPAP. I'm not sure if you're not seeing that, or what - I can't tell after reading your response.
posted by restless_nomad at 3:00 PM on July 28, 2009 [3 favorites]

"... I do get exercise but sometimes I'm too tired to feel like exercising. I get easily 30+ mins about 4 times a week. For those of you that suggest intense exercise, what about when the school year starts though? I can't go "INTENSE" exercising if I'm barely getting sleep as is can I? ..."

Yes, you can. Ask any Marine, Army, Navy or Air Force* boot camp recruit :-) Ask any scholarship athlete doing "2-a-day" football training camp. Those guys, tens of thousands of them, are all sleeping like logs, in barracks, dorms, and camp facilities, this week. The benefits of improved sleep from heavy exercise are so immediate and universally applicable, that I feel certain in saying that, absent any medical conditions you may have that prevent normal function, the fatigue you may feel from heavy exercise would be offset, within weeks, by your improved concentration and capability while alert. You may actually get "back" more time in productivity gained, than you spend in a continuing exercise program, which is why most people who exercise continue to do so. If you started a full on exercise program now, by the time you started school again, most of your initial training lag (training pain, schedule change, initial rapid weight loss, oxygen capacity improvement, etc.) would be behind you by the time you started school again.

*Well, maybe not those Air Force guys. They generally get air-conditioned barracks, even in basic.

"All I'm asking from the non-helpful crowd is to understand."

We do. You think you've tried it all, and that nothing can work for you. But we (the non-helpful crowd), think you haven't tried most common remedies enough, and that many things that have provably worked for others will work for you, too. And many of us have personal experience that is in direct opposition to your assertions. Good luck.
posted by paulsc at 3:21 PM on July 28, 2009 [2 favorites]

Well, this is what worked for me to overcome almost two years of increasingly worsening insomnia, so I'll throw it out there on the off-chance you find it useful: Say Good Night to Insomnia.

Why I think it might help you:

I'm almost always irritated because I immediately think "great, it starts again. let's see how many times I wake up this night"...My mood of course is frustrated and irritated and I feel the same.

This. The author can be a little long-winded and a bit condescending at times, but if you can get past those parts, he offers several incredibly helpful tips for defusing and eliminating the anxiety, anger, and frustration around bedtime that prevents you from falling asleep easily, both when you first go to bed and when you wake in the middle of the night. I used to absolutely dread going to bed because I knew that yet another terrible night lay ahead. And of course it was terrible because I was all wound up with tension, which prevented me from sleeping, which meant that I was exhausted and angry the next day, which meant that I would dread bedtime again that night--it's a vicious cycle. I couldn't believe that some people actually looked forward to going to bed and found it enjoyable--that was a completely foreign concept to me.

I didn't believe for a second that it would help me, but I would have read anything by that point if I thought it would help me get even a couple minutes more than the 3-4 hours a night I was logging, and it worked unbelievably quickly. I read it over a year ago, and since then I can count the number of truly bad nights I've had on one hand. I encourage you to give it a shot. I can't speak to the CPAP, exercise, sleeping pills, etc., but you sound incredibly pissed off about everything, and learning to manage your emotions around bedtime is one of the first steps on the road to recovery.
posted by anderjen at 3:22 PM on July 28, 2009 [1 favorite]

Maybe I'm not the best at posting when frustrated and then replying, lol. I'm pissed off about everything the first few hours I'm up everyday naturally because of my sleep.


alright paul. i'll try my best to kick my own ass over the next couple of weeks. sometimes i need a post like that to get me going until I can get myself going.


thank you for the book suggestion. i'm certainly not opposed to a book on getting rid of insomnia for sure.

@ dirty ape

It shouldn't come across like that. I felt some of the posts were rather strong though and acting like it was some easy deal. If I truly could have stopped eating in 5 seconds flat, I would have done it for the past 3 years a lot sooner.
posted by isoman2kx at 5:50 PM on July 28, 2009

If you must eat before bed, try having something that you think of as comfort food, like toast or a small bowl of chicken soup. Toast and a cup of tea works when I'm having problems with insomnia.

I also heartily recommend thick blackout curtains like these.

Information overload tends to stress me out and can lead to insomnia if I'm overdoing it on the computer. When that happens, I'll just unplug for a few weeks -- no emailing, no surfing, no news -- only the bare minimum of time is spent on the computer (i.e. bill paying). After I'm done, I turn it off and leave it off. I also take a vacation from tv, especially news, which really seems to agitate me when I'm already tired and stressed out.

If you have a tv in your bedroom, move it. Or at least unplug it and don't watch tv in your bedroom.

Someone upthread suggested naps, which also work, if you can manage it. I went for almost two years on just four hours at night and a one hour nap in the afternoon. Amazingly, I felt energetic and happy because the sleep I was getting was quality.

An air purifier can help block out distracting sounds with white noise and reduce dust and pollen in your room if you have allergies.

If you can't sleep, don't just lie there getting frustrated. Sometimes I'll take my pillow and blanket and try to sleep in another room. Surprisingly, this works more often than not. Perhaps your bedroom is getting uncomfortably warm or cold and you don't notice because you're fitfully trying to sleep.

The last resort is my Sleepytime Mix. It's a group of songs that I've got on my iPod that I've noticed make me feel extremely relaxed or contemplative. I never, ever play these particular songs at any other time than bedtime, when I have extreme insomnia, lest I dilute their effect. I play these songs in a neverending loop and I'm out like a light within twenty minutes. If I wake up, I don't turn off the music. I'll just listen to the songs again until I drift off. Works like a charm.

Good luck.
posted by LuckySeven~ at 6:58 PM on July 28, 2009 [1 favorite]

Over the course of the last year, I've gone from a messed up insomniac to a normal sleeper. Here's what I did:

This is the big one: Progressive Muscle Relaxation. I play this mp3 every single night as I'm going to sleep. It is deceptively simple - it guides you through contracting and relaxing various muscles. This releasess the tension and anxiety that I carry in my body, and it gives me something to focus on rather than the "OMG I'VE NEVER GETTING TO SLEEP" thoughts in my head. I rarely make it all the way through before I'm asleep. It used to take me at least an hour to fall asleep. If I wake up in the middle of the night and don't just roll over and fall back to sleep, I put it on again.

No caffeine after noon. I was prepared to go down to no caffeine whatsoever if limiting didn't work.

No food within 1-2 hours of bedtime. I see that you think that it is helping you to eat before bed, and maybe it is. But if I eat close to bedtime, I have much more trouble falling asleep, and I have horrible nightmares.

Maintain a sleep routine. I go to bed every night at 10pm, and I wake up every morning at 6:30. Even on the weekend, even on vacation, even while visiting family, even when I haven't been sleeping well and just want to hit the snooze. Also, I use a sunrise clock in the morning so I wake up gradually instead of being jarred awake by an alarm.

No napping during the day
. All that did was keep me up later that night.

No reading before bed
. This was key for me. I've always read in bed before I go to sleep, but I finally realized that I was using the reading to fight sleep.

Make my bed as inviting as possible. I change the sheets frequently, because I like nice clean sheets. I have lots of blankets so I can add or subtract depending on the weather. The more comfortable I am, the better I sleep. This extends to travel as well - I always bring my body pillow with me. I may be the crazy middle-aged lady who brings her own pillow with her to a hotel, but one weekend without it messed up my sleep for two weeks. Never again, so I bring it.

Exercise. As everyone above mentioned, I tire myself out with exercise.

I'm not going to kid you: this wasn't easy. I miss reading before bed. I want a damn coffee in the afternoon. It would be nice to not have to schedule social events so that I'm home by 10pm. But in the end, it comes down to this: I can choose to do the things I need to do to get sleep, or else I choose the consequences. My life is better when I'm sleeping, so I choose to do the things that get me sleep, even when it is hard. I've slipped - I've had the coffee, traveled without my pillow, read before bed. And then I deal with the consequences - days of trying to get my sleep back on track.
posted by xsquared-1 at 5:38 AM on July 29, 2009 [2 favorites]

Have you been tested for hypoglycemia, hyperglycemia, or any digestive problems or food intolerances? A shot in the dark. If you haven't had a full physical in a while you need one.

I can't help but feel that if seroquel can't keep you asleep, there is a really significant medical condition going on, not something like anxiety or not enough exercise. My experience with it is that it takes a LOT to wake someone up who is on seroquel. That medical condition might be your sleep apnea.

I am not a doctor!
posted by kathrineg at 6:44 AM on July 29, 2009

Look... there are certain things I don't want to do right now and unless I fail out of school because of sleep I won't do (ex: throat surgery). I didn't like the CPAP machine and that's my personal preference. How are some people on here going to tell me that my personal preference is wrong? It works for you? That's great. I didn't like it and it didn't work for me.

I'm not going to die (hopefully not for a few many years since I'm 23). If I was going to die, the sleep clinic and my ENT would have both likely warned me that "hey, getting off this CPAP is a bad idea man. I'd give it a real good try before you croak". More or less, lol.

Sleep apnea might not kill you, and there are certainly more dangerous things that you could be doing to your body. But if you don't believe me that leaving apnea untreated is dangerous, read this, this or this. Reggie White, a hall of fame NFL player, died at the age 43 of heart arrhythmia, which may have been due at least in part to the fact that he had been diagnosed with sleep apnea but refused to use his CPAP machine (his wife has since created an organization to raise awareness of the risks of sleep disorders). My dad has sleep apnea and left it untreated for most of his life, and at one point he had heart palpitations that put him in the hospital, where he lost consciousness and had to be defibrillated. People may not force you to get your sleep apnea treated, just like people won't knock a cigarette out of your hand if you decide to smoke, but the consequences of ignoring the advice to get treatment for a serious medical condition may be severe.
posted by burnmp3s at 7:29 AM on July 29, 2009 [3 favorites]

I had chronic insomnia from about age 12 to age 22 or so. The worst years for me were college. What helped me was getting out of college (and my insanely stressful approach to college) and having a more regular job-and-apartment adult life. Even when I went back to law school, my sleeping was okay. (I had a much less intense approach to law school, which I know sounds weird.) Anyway, you may find that your problem improves at a later stage in life.
posted by ClaudiaCenter at 11:48 PM on July 29, 2009

The only thing that helped my insomnia (after trying many sleep aids, inc. Ambien, Rozerem, and Trazodone, and being unable to adjust to using a CPAP) was hard & long cardio workouts at the gym after work, tanning booths twice a week, and yoga twice a week in addition to my antidepressants.
posted by tastybrains at 12:31 PM on August 3, 2009 [1 favorite]

Exercise every day... the routine will get your body "up" into an active, regular cycle that will aid you in falling asleep and staying asleep, because your body will want to sleep.

Secondly, the simple act of staring at a screen before you go to bed will keep you awake, because you're staring at a light and then trying to go to sleep. Doesn't work.

Set a time to get up every morning, and seriously just get up at that time. Then stay up until you your body tells you to to go sleep. It'll suck for 3-7 days, then you'll probably be reset, because your body will be telling you when to go to sleep, not the other way around.

Finally, there is a drug out there - Xyrem - that is incredibly expensive (c. $1600/mo) and dangerous (it's just GHB, but legalized as a super-regulated med) and very effective. If you have sleep apnea, then you definitely cannot take it, because it seriously keeps you down, and you'll probably suffocate.

Try paragraphs 1-3, then if that doesn't work, do the CPAP for 3 months, then your uvular surgery. If none of that works, you're probably psyching yourself out, and should return to paragraph 3. If life really sucks and there's just no other way, then Xyrem *might* be an option.

Setting a time to get up and sticking to it come hell or high water will probably go a long way, though.
posted by stewiethegreat at 11:07 PM on August 3, 2009

I'm coming to the party a bit late. I just stumbled upon your thread, but I thought I would mention a couple of things in case you check back.

First, please, please, please think carefully about using melatonin. A doctor told me years ago that it was perfectly safe to take indefinitely and I took it every night for over 10 years. My current doctor said that studies with ER doctors have shown that it doesn't really work and that I was just having a placebo effect. She said it was probably causing my nightmares. So, I just stopped taking it. A week later the worst 6 months of my life began. I felt like I was going to faint for a month straight. I had panic attacks and terrorizing anxiety between them. Every doctor I went to said it couldn't be the melatonin. This just terrified me more. I was sure I had a brain tumor or something. Finally I wrote to a researcher at Penn State who does melatonin research. He said that he gets countless emails like mine from people like me and their doctors. He assured me that it was most likely the melatonin, but that my body would eventually adjust and right itself. Eventually it did, but the problem with anxiety is that once you get severe anxiety, according to psychiatrists and psychologists, you cannot heal it. You can only put it in remission. I will spend the rest of my life fending it off.

In the midst of my terror, I did a lot of research on the internet, looking at medical journals and the like through a university. I realized that they know very, very little about all the ways melatonin affects the body. It is a hormone and it affects every system in your body. It is NOT a harmless "herb" that simply regulates your sleep cycle. Today it makes me crazy that there are cancer patients who cannot have weed, but any 10 year old can walk into a pharmacy and buy this hormone that doctors know so little about. There are many countries where it is illegal to sell melatonin. Perhaps you can get it with a prescription. I do not know, but you cannot walk into a store and buy it.

If anyone sees my post and is persuaded to stop taking melatonin, I think the key is to taper off of it very, very slowly. I read a case study of a woman with a severe developmental disability. When they took her off of melatonin she developed tardive dyskenisa (sp?). When they put her back on it, the td went away. When they took her back off, it came back. Eventually they tapered her off of it extremely slowly over a 2 month period and she was fine.

Secondly, I would like to recommend a book that was just highly recommended to me. It is called Saying Goodnight to Insomnia. The author recommends cognitive behavior techniques (among others) for dealing with this problem. Based on your post, I would guess this would be ideal for you.
posted by Original 1928 Flavor at 2:51 PM on December 11, 2009

« Older How would you show a french girl US culture in a...   |   Assaulted on a bicycle, what should I have done? Newer »
This thread is closed to new comments.