Sleep doesn't rule everything around me...
September 20, 2012 8:00 AM   Subscribe

(Chronic Insomniacs-filter) Sleep avoids me. Been doing so for years. Any tips or tricks to try and successfully sleep? Always special snow flakes....

First and foremost, I know the general things recommended for falling askeep. No tv or internet. Avoid caffeine. Don't exercise before bed....
On average I sleep about 4 to 5 hours every night. Never much more. I do have arthritis in my spine and I know this has something to do with it. I have tried damn near everything. Pills, melatonin, avoiding electronics, booze even cutting down on coffee in the afternoon. I am so tired of being tired. It affects my life in work, schook, and personal relatonships. Doctor isn't the answer. She isnt particularly good in this department (just take another pill...that doesn't help. It only increases my tolerance and makes me have to get early refills) I am going to try to get in to a sleep clinic, but money is an issue as my insurance totally sucks. I do smoke cannabis in the evenings which can help me get in the mood for sleep but again tolerance. I have an awesomely comfortable bed, which helps but not enough. I do use a heatpad which can trigger sleep but that is dangerous and not always a sure thing.
Looking for any tips or tricks I may not have tried or what you do to deal with poor sleep. That or coping mechanisms.
Thanks everyone in advance.
posted by handbanana to Health & Fitness (36 answers total) 11 users marked this as a favorite
Forgot to add. I avoid naps but may take one if I am particularly exhauted, perhaps pnce a week.
posted by handbanana at 8:02 AM on September 20, 2012

cutting down on coffee in the afternoon

Have you tried cutting OUT caffeine after noon? Sodas as well?
posted by Rock Steady at 8:04 AM on September 20, 2012 [2 favorites]

Its another pill but have you tried Lorazepam? I have really bad insomnia that comes in these cycles of maybe a couple weeks at a time. I take one of those pills and not only do I sleep, but the whole insomnia cycle is destroyed, so I end up taking maybe 5 or 6 of the pills per year.
posted by H. Roark at 8:04 AM on September 20, 2012 [1 favorite]

Also, it would probably help to know exactly what your average night of "sleep" looks like -- difficulty falling asleep, frequent waking and sleeping, waking early, etc.
posted by Rock Steady at 8:05 AM on September 20, 2012

Do you get any exercise?
posted by jaguar at 8:10 AM on September 20, 2012

I would save up for the sleep study. It will rule out or in sleep issues like apnea.

In the meantime, masturbation or sex before bed I hear makes a person tired enough to fall asleep.
posted by JohnnyGunn at 8:10 AM on September 20, 2012

I've talked to people for whom cannabis disrupts sleep. It may be worth experimenting with cutting that down or out.
posted by jaguar at 8:11 AM on September 20, 2012

Try change your habits & expectations.

It sounds like sleeping a solid 8 hours during the night doesnt work for you. It might make more sense to have a nap during the day. Listen to your body and work with it; sleep when you are tired, if possible and dont cause stress by trying to force yourself into a preconcieved pattern.

YMMV bit I find that having a busy brain just prevents sleep; so thinking about work, about money, about issues before bed is a disaster for me. As is smoking; my brain fires off and freewheels into the early hours.
posted by BadMiker at 8:15 AM on September 20, 2012 [1 favorite]

Yes I have cut out caffeine in the afternoon. No dice.
Can't take pain medication with benzodiazapams. Xanax, ativan, and ambien (not a benzo but close) dont work. Temazapam does but too good. I will be out 8 hours no matter what but wake up feeling worse than normal.

Thank you for the replies
posted by handbanana at 8:16 AM on September 20, 2012

For a month, cut out completely:
Highly spicy and acidic foods (onions, tomatoes, et. al.) past lunch.

Go to bed the exact same time every day, and wake up at the exact same time every day.
posted by A god with hooves, a god with horns at 8:19 AM on September 20, 2012 [1 favorite]

I absolutely agree with BadMiker - until you can get a sleep study done, in my experience with my sleep-struggling husband, the best thing to do is accept the fact that you're not going to get 8 hours of uninterrupted sleep.

Do you mind sharign what your schedule is like every day? My sleep-adverse partner finds that he sleeps better when he is on a very strict schedule.
posted by muddgirl at 8:20 AM on September 20, 2012

My average night of sleep is like this. Read/study until I can't pay attention anyymore to the words on the page. I will go for a walk usually to try to calm my mind and back which does help. I generally do these things until around 2 am. Doing them any earlier means staring at the ceiling longer. Fall asleep sometime between 2:30-4 am. Wake up with alarms at 7 or before the alarm if I went to sleep before 3am.
posted by handbanana at 8:22 AM on September 20, 2012

I've never been good at sleeping. One of the best things I ever did was count the number of hours resting in bed with my eyes closed rather than number of hours asleep. It's boring, but not difficult, to lay in the dark for hours. And it's a lot less stressful than the downward spiral of "If I fall asleep now, I get 4 hours of sleep .... 3 hours of sleep." Once I stopped worrying about the number of hours sleeping, I started sleeping more.

Also: stop using any stimulants and depressants for at least a month. These things are known to mess with sleep. Cold turkey might bring some much needed rest.
posted by eisenkr at 8:22 AM on September 20, 2012 [3 favorites]

Melatonin didn't help too well for me either, and I had hell-somnia for a year. If I'm not careful it still comes back.

What is helping me is a regular vitamin regimen of a calcium/magnesium/zinc supplement, which helps me both stay asleep when I need to and also helps improve the quality of the sleep I get (so even if I do just get 6 hours, it's actually okay), and 2 valerian supplements an hour before bed. My doctor warned me that these things aren't instant, though - you have to be taking them consistently for a couple weeks for them to "kick in".

And they really have helped. My doctor also prescribed me a sleep aid, but urged me to treat it as a sort of last-resort thing - I think maybe ONCE I took one when I was still trying to conquer my insomnia and I had a hell of a time getting to sleep the night before I knew I would have a big day. But since then, staying on the magnesium and the valerian really seem to be doing the trick.

Also - how anxious do you get about not being able to sleep? That was also part of my problem - I was getting so pessimistic about "well, I bet i'm not going to be able to get a good night's sleep AGAIN" was just turnng the whole thing into a self-fulfilling prophecy.
posted by EmpressCallipygos at 8:22 AM on September 20, 2012 [1 favorite]

If I have caffeine at 6am, my sleep cycle 15 hours later will be utterly ruined. You may be like me and your body may not metabolize caffeine the way others do.

Have you ever considered being screened for anxiety?
posted by These Birds of a Feather at 8:24 AM on September 20, 2012 [2 favorites]

Also, cut out the cannabis for at least two to three months. Your body may not be metabolizing it normally either.
posted by These Birds of a Feather at 8:26 AM on September 20, 2012

No I mean, do you have to be at work by a certain time every day? Do you get home in the evening at a certain time each day?

I/my spouse both find that if we try to go to sleep too late, we've missed the part in our cycle when we're both 'tired' and 'sleepy', if that makes any sense. So at 9pm I might be a bit sleepy, but I'm afraid I won't be able to fall asleep, so I stay up reading. By 10pm I'm no longer sleepy and I won't be able to fall asleep until 2. If I had gone to bed at 9, I might have been fine.
posted by muddgirl at 8:27 AM on September 20, 2012 [1 favorite]

If you don't set your alarm, what time do you generally wake up in the morning? If you don't have to wake up at a certain time, can you sleep past 7 or go back to sleep after waking up at 7, or is it that once you're up, you're up, and there's no way to sleep later?

Also, have you tried cutting out the walk? The advice not to exercise in the evenings can apply to something as non-taxing as a leisurely walk, if you're sensitive enough to sleep disturbance.
posted by decathecting at 8:29 AM on September 20, 2012

Why can't you take pain medications with benzodiazepines...?

I am a little bit in your shoes -- sleep hassles, exacerbated by physical pain -- and while I wouldn't get by without medications, the one thing I have control over that always helps is a good whack of daytime exercise.

Fortunately my doctor is down with my "I'll stuff in narcotics and go kayaking, okay?" plans; it leads to better overall health and reduced dependency on the pills, to use them to push my body into a better place.

In the past I drank a lot of booze with the idea that I was using it to help with sleep. Eventually somebody pointed out that it wasn't actually improving my sleep, and I stopped. Maybe you're in the same place with weed? If it was going to be a solution, it would've been a solution, kwim? That said, I tried Cesamet -- THC in a pill, sort of -- because even if I fell asleep fine, pain woke me, and that would have worked well if I had found a way to make the Cesamet effects not last fifteen hours. A pot brownie may be worth trying for you?

Advice to stick to a schedule is sound. I am pretty into little "routines" for sleep now; these can help, but be careful with that sort of thing if you have a lot of anxiety going on too.
posted by kmennie at 8:32 AM on September 20, 2012

You might try shifting the walk earlier in the evening. Exercising right before attempting to sleep is sometimes counterproductive.

If you need a way to clear your mind right before bed, you could try a writing down anything that's worrying you (even if it's just "Need to buy bread") as your last task every day. If you keep the list or journal by your bed, you could add to it as worries wake you during the night. Sometimes just shifting things out of one's head and out onto paper can reassure the brain that you're dealing with it and it can stop reminding you, now.
posted by jaguar at 8:32 AM on September 20, 2012

+1 eisenkr
Lying there, pretending to be asleep, can be very restful. Though it doesnt feel like it! Pairing this with a midday (lunchtime) lie down has helped me keep functioning sometimes.

I know this is just my coping strategy but if I'm not sleeping I have a wee routine; starting with consciously relaxing my body (and working hard on keeping attention focussed) then I imagine going for a walk. In great detail I'll get up, leave the house and walk a known route.

At worst this passes the time. At best it has led to some remarkeable lucid dreaming!
posted by BadMiker at 8:36 AM on September 20, 2012

Things that have helped me sleep (admittedly, I only have mild, intermittent sleep problems):
take around 7-9 pm to aim for bedtime of 10-11 PM:
Calcium citrate supplement
GABA amino acid supplement
Valerian - 1 or two doses worth

Referring to your comment "Temazapam does but too good. I will be out 8 hours no matter what but wake up feeling worse than normal.": For me, I have a foggy head and achy body if I sleep *too* long--I find that 15-10 minutes of vigorous aerobic exercise, like a short run, exercise bike, or elliptical -- elimates that foggy/achy "sleep hangover" right away.
posted by Ardea alba at 8:39 AM on September 20, 2012 [1 favorite]

The yoga pose Legs Up the Wall (which is just what it sounds like) is supposed to help with insomnia. I definitely find it restful. I would imagine it would either very much help or very much hurt your spine, so maybe check with your doctor first or at least ease into it.

Yoga Journal lists other poses that are supposed to help with insomnia, some of which look reasonably suitable for beginners.
posted by jaguar at 8:43 AM on September 20, 2012

Mixing benzos and opiates can cause resipatory depression...which can lead to death.

Cutting out caffiene will be hard. I am her bitch. Been drinking coffee since 12. I have cut it out in the pm and reduced intake to about 18 ounces a day.

Cutting out cannabis would increase my medications again increasing tolerance to opiates. My number one concern is managing pain which cannabis does very well with seemingly little side effects. Pain is a beast which needs to be contained. I have been bed ridden for over doing things like workouts and ignoring my body to work. I avoid over doing things now but I know I won't sleep if I dont contain the spasms and nerve issues.

Yes I work a 9 to 5.

If I dont set an alarm I still wake up on my own after 4 to 5 hours after falling asleep
I do exercise but do want to do more.

Perhaps being annoyed when I look at the clock and it says 2:30 and it feeds into it.
posted by handbanana at 8:44 AM on September 20, 2012

Have you tried meditation?
posted by Obscure Reference at 8:51 AM on September 20, 2012

Perhaps being annoyed when I look at the clock and it says 2:30 and it feeds into it.

It helped me a lot to angle my alarm so that I couldn't see the time while in bed, so I didn't have to try to ignore how late it was.

A bedtime routine that you like enough to stick to very consistently helps a lot. Doesn't matter much what the routine is, as long as it isn't too exciting.
posted by randomnity at 8:54 AM on September 20, 2012 [1 favorite]

Has your pdoc ever suggested hydroxyzine? It's an antihistamine and one of the side effects is drowsiness. Another side effect is making opiates work better. Not a benzo.
posted by Marie Mon Dieu at 9:02 AM on September 20, 2012

Try to exercise first thing in the morning instead.

Try music with headphones.

Try total darkness and make sure your clock doesn't have blue or green lights/digits/whatever.

Try one of those cheap fountains by your bed, the gurgling water kind of thing.

Try a sleep mask.

When you do wake up don't open your eyes and don't move. Think of boring things. sometimes I try creating crossword puzzles in my head and it puts me right back to sleep.
posted by mareli at 9:02 AM on September 20, 2012 [1 favorite]

As a fellow lifelong insomniac, my main annoyance with well meaning "how to get better sleep" advice is that long-term insomniacs have already tried basically everything there is to try. We aren't reading our iPads in bed for hours immediately following three cups of coffee!

I loved this book. The author is a lifelong insomniac who has tried everything. She explores all the potential causes and remedies of various sleep problems, and talks about where the research is going. If anything is going to give you some new ideas to try that just might work, it's that book.
posted by something something at 9:06 AM on September 20, 2012 [2 favorites]

If you're finding that your pain is the main issue (both pain during sleeping and being unable to take certain remedies due to drug interactions), have you considered seeing a pain doctor? It sounds like getting the pain more under control (it's difficult, I know) might be the main issue here? A specialist in pain might be able to help you deal with all these intersecting issues (pain, sleep, medications).
posted by jaguar at 9:21 AM on September 20, 2012 [2 favorites]

Even if you can't take benzos (I can't either; paradoxical reaction), there are a lot of other things to try for insomnia, most of them prescribed off-label. Here's my list of things I've tried. If pain/spasms are a problem, maybe ask your doc if you could take a stab at the muscle relaxants first, if you're not using any?

Doxepin/Sinequan (tricyclic antidepressant)
Neurontin/Gabapentin (anticonvulsant, analgesic) - I see from your history you're already on this.
Seroquel/Quetiapine (atypical antipsychotic) - I've had success with the brand of this but not the generic.
Lioresal/Baclofen (muscle relaxant)
Remeron/Mirtazapine (tetracyclic antidepressant)
Soma/Carisprodol (muscle relaxant)
Desyrel/Trazodone (tricyclic antidepressant)
Elavil/Amytrptyline (tricyclic antidepressant)
Flexiril/Cyclobensaprine (muscle relaxant)
Norflex/Orphenadrine (muscle relaxant)
Rozerem/Ramelteon (melatonergic)
Vistaril/Hydroxyzine (antihistamine)
Xyrem/Gamma-Hydroxbuytyric acid (GHB and GABA-b receptor agonist for narcolepsy)
Zyprexa/Olanzapine (atypical antipsychotic)

I currently take a cocktail of the first half-dozen things on that list for sleep (with my doctor's blessing - he prefers a variety of things at lower doses to a blast of one), in combination with magnesium and calcium. You might have to try a few kinds of magnesium and calcium to find one that really works for you - I have good success with magnesium chloride tablets and a magnesium gluconate spray by Vinco that I spritz under my tongue when I wake up during the night (which gets into your system faster than a pill). For calcium, I take plain old Tums.

I also take low dose naltrexone for both sleep and pain, but I know that's not on every doctor's radar. You can read about my sleep cocktail here and here if you're interested. I have real problems with insomnia due to chronic illness.
posted by jocelmeow at 10:46 AM on September 20, 2012 [1 favorite]

My major thing with getting better sleep was cutting out caffeine completely and no chocolate after about 3pm. If I have a coca cola at 8am then it definitely affects my ability to sleep at 10pm.

When I was having very bad insomnia, using certain thougth techniques helped me. I used to use visualisations to encourage blankness - I wasn't able to 'stop thinking' so instead I tried thinking about blank things. For me this was thinking about being in a very thick white mist, or lying with a thin shimmery white cloth over my whole body or having a really big glass cloche over me (but not in a scary way!) Sounds weird but stopped my mind from whirring with some practice. I'm guessing meditation would have a similar effect.

I also find that going to bed before I'm dead tired works much better. For me this is about 10pm, getting up at 6am. In an ideal world I think I'd get about 8:15 hours per night but this varies between people.
posted by kadia_a at 10:49 AM on September 20, 2012

It helped me a lot to angle my alarm so that I couldn't see the time while in bed, so I didn't have to try to ignore how late it was.

I came in here to post randomnity's advice, but he/she beat me to it. I even turn the television/clock thingy around in hotel rooms so that I don't see what time it is when I inevitably wake up in the middle of the night.
posted by tallmiddleagedgeek at 1:34 PM on September 20, 2012

Super strict scheduling weakens the cycle for me. The lamps in my living areas are on timers.when the one in the living room turns off, it cues me to get ready for bed. Similarly, the bedroom one enforces or at least encourages eyes shut.

When i have a hard time staying asleep, I get up, relax somewhere other than the bedroom, and return to bed in a half hour or so.

When i'm in a late night waking phase, it means I have to set aside a stupid amount of time to get enough rest across two sessions. And grit my teeth around folks who boast of needing very little sleep. But it beats the mind/body fallout of not doing it.

I really feel for ya--pain on too of sleeplessness is horrid.

awake now due to neighbr noise. Sigh
posted by nita at 10:33 PM on September 20, 2012

Naproxen (Aleve) might be worth a try, if your arthritis pain is part of what's keeping you from sleeping well. I find them better than other pain pills just because they last 8 hours instead of 4. And definitely try a hot-water bottle instead of the heating pad. They get hotter, and are much safer. (The ones made in the U.K. are a lot better than the ones from the U.S. - send me a MeFi mail if you decide you want one and maybe I can help.)
posted by still_wears_a_hat at 5:54 AM on September 21, 2012

I would second the advice to re-examine your caffeine intake. I got my heavy consumption down to one caffinated drink per day (in the morning) but it wasn't until I cut it out completely that I noticed a transformative effect on my ability to get to sleep at night. I found it bizarre that my system would be so sensitive to caffiene having consumed it in large quantities, all the time, for decades, but there you go.

Don't forget that all of the usual sleep hygiene advice has routine as a success factor, so stick with any changes for a while before ruling them out as unhelpful.

Good luck!
posted by bimbam at 12:26 AM on September 22, 2012

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