five hours and 45 minutes of crappy sleep. For the last 20 years.
September 20, 2012 10:44 AM   Subscribe

Last night I slept for five hours and 45 minutes. For the last 20 years. I've tried many of the frequently recommended solutions such as melatonin and environmental changes, and am not sure what my next step should be.

I was looking through a journal and kept seeing references to how tired I was. I remember in 1994, prior to getting married, I fell asleep at work and was fired from a temp job. I’ve been manually tracking my sleep by setting a stop watch when I doze off, and then glancing at it when I wake up, and most of the time I am sleeping about five hours and 45 minutes.

I guess my first question is:
  1. What’s the best place to go online to ask for help with this? I went to a sleep forum years ago but it was a little too hard core. I’d had a sleep study conducted and the results were inconclusive, and the members were all “Scan it in and show us the numbers” and also spent a lot of time talking about tranquilizers that would kill a horse. I’m not there…yet.
  2. How do I find a good persistent sleep specialist? The last guy I saw seemed pretty smart, but he prescribed amiltryptiline, which left me groggy.
  3. Given the following context and history, what should my next step be?

Here is some background. I:
  • am 46 years old, 215 lbs., 6'6.
  • have been diagnosed with ADHD. My online Aspie scores are high
  • do not have trouble falling asleep
  • had a sleep study >five years ago, and it didn’t say much.
  • have allergies
  • have keratosis pilaris (sp?) and dandruff
  • have tried valerian/melatonin. Doesn’t seem to do much
  • Calcium/mag supplements made a difference once, then nothing.
  • Unisom and its ilk work ok if taken early in the evening, in that I don’t wake, but I often feel groggy throughout the day
  • When I go to sleep early, say 10 pm, I may awaken around 4pm but then fall back asleep. Often feel tired the next day
  • My exercise consists of riding the bicycle to work, three miles each way. Average speed: 9.8 mph, top speed: 19 mph on a slight downgrade.
  • am sleeping in a cold basement room on a mediocre, slightly short mattress with the windows blocked by cardboard.
  • wear earplugs and sometimes a sleep mask
  • use a sleep mask
  • my wife says I snore, but I don’t think it has been as bad lately
  • had nasal surgery a year ago and had my septum straightened and turbinates reduced.
  • Ambien puts me to sleep, but that’s not the problem.
  • After my nightly 5.45 of sleep, I often have a slight headache or develop one later in the day
  • After bad sleep I also experience more tendonitis and general achiness.
  • Having sex makes much of the headache and achiness go away. Surprise.
  • After a night of restless sleep I start feeling a little more energized around 6pm
  • I usually don’t sleep in the same room as my wife, because she goes to sleep around midnight, so if I go to sleep early I may wake up in two hours to see her bathed in the blue laptop glow of Downton Abbey
  • My work stress levels are moderate, but not worse than usual.
  • I have been skipping breakfast lately in case this is what Seth Roberts calls “Anticipatory Waking”
  • I don’t eat after 7pm, usually
  • My only electronics have been the iPad (with f.lux installed) but usually a Kindle with a nightlight.

In short, I feel like my sleep hygiene is a B/B+, and even on the nights when I am totally sleep-hygeinic, I don’t feel that rested. At this point I am inclined to get another sleep study and see my sleep doctor or another sleep doctor. I want to figure out if this is physical, psychological, or some murky combination of the two.

I’m just not sure what my next step should be. There are just too many variables for me to make a decision.
posted by mecran01 to Health & Fitness (35 answers total) 19 users marked this as a favorite
Your first step should be getting yourself a decent bed, one that's big enough for you! No electronic screens after 7 PM!

You sleep in a basement, does it have any mold problems? Is it adequately ventilated?
posted by mareli at 10:53 AM on September 20, 2012 [3 favorites]

am sleeping in a cold basement room on a mediocre, slightly short mattress with the windows blocked by cardboard.
I usually don’t sleep in the same room as my wife, because she goes to sleep around midnight, so if I go to sleep early I may wake up in two hours to see her bathed in the blue laptop glow of Downton Abbey

Is there not a room in the house she can relocate to for purposes other than sleeping? Surely in the bedroom sleep is a priority! You shouldn't have to sleep in the basement on a crappy mattress, man

If you're having headaches and bike that much, maybe drink more water
posted by MangyCarface at 10:54 AM on September 20, 2012 [9 favorites]

I wonder if you are just worrying too much about it. Maybe drop the journals, get rid of the stopwatch, do something to relax for 15 minutes before you go to bed, and then go to bed. Just laying there awake is reasonably effective as rest. Worrying about sleep, which it sounds like you do every waking moment, is not conducive to actually sleeping.
posted by COD at 10:57 AM on September 20, 2012 [3 favorites]

Increase your exercise - try at least 30 min a day in one session for a week and see how you feel - take the long way to work.

Try taking a vitamin B complex.

Increase your water intake.

Listen to music before you go to sleep.
posted by NoDef at 11:07 AM on September 20, 2012 [1 favorite]

Are you medicating the ADHD? That's had the greatest effect on my sleep happiness out of everything else I have ever tried.
posted by elizardbits at 11:12 AM on September 20, 2012 [1 favorite]

It doesn't sound like it, but it might be worth investigating whether you have a circadian rhythm disorder, such as DSPD. If this is the case, light therapy done properly is extraordinarily effective (I'm 35 years old and have had DSPD as long as I can remember and only recently learned what it was. Within 10 days of therapy my cycle has shifted by 3 and a half hours. I highly recommend this very readable paper: A practical approach to circadian rhythm sleep disorders.

As for finding a specialist, the way I did it was to look up sleep clinics in my area, and contact them directly. They pointed me to a referral form and then got a doctor to fill it out and fax it to them. I'm in Canada so I'm not sure if the same process applies in your area.

As for melatonin, I've read that smaller doses are more effective. Unfortunately, here in Toronto I couldn't find a single vendor that sold melatonin in anything less than a 2.5 mg dose. I was able to find an online vendor that sold 300 microgram time released doses (life extension brand) and they shipped it within 3 days.

If your diagnosis is one for which melatonin and/or light therapy is appropriate, it is extremely important to understand that the timing of these treatments is of paramount importance. A lot of people have found treatment to have no effect (or the opposite effect as desired) because they do not understand how to properly time it. The pdf I have linked above goes into detail about this.
posted by spacediver at 11:12 AM on September 20, 2012 [4 favorites]

It sounds like, from a pharmacological perspective, the issue is that you really don't need the type of sleep aid that most other people with insomnia do. Most of them like drugs like Ambien (or Sonata, etc) because they just help you fall asleep and they quickly wear off. It sounds like you may want to try other more traditional sleep medications, which have a longer duration of action so that you can stay asleep. Trazodone would be an example.

If your wife doesn't have issues with sleep like you do, why can't she use the computer in a different room until she is ready for bed? One of the rules of sleep hygiene (as you probably know) is no screens in the bedroom. And it sounds like your compromise is working out poorly because you're ending up sleeping on an uncomfortable bed. (if your wife does have problems with sleep too, she shouldn't be watching Downton Abbey in bed in the middle of the night, either...)
posted by treehorn+bunny at 11:12 AM on September 20, 2012

Response by poster: Thanks for this advice so far.

1. I usually sleep in the basement away from my wife.
2. I've been obsessing over the sleep lately because it dawned on my that I never feel rested. For years.
3. I take sustained-release Methylphenidate (Concerta) in the morning, and it wears off before I go to sleep (18mg). I don't take it all the time, but can take a week off.
4. I actually have a light box so can try using it.

Please keep the advice coming, thank you.
posted by mecran01 at 11:19 AM on September 20, 2012

Yeah, crappy mattress + why can't I sleep well = "Doctor, why does it hurt when I hit myself?"
posted by sageleaf at 11:23 AM on September 20, 2012

I have a similar problem, and my doctor recently recommended this book to me. It's supposed to be very helpful. It's a non-medical program that apparently has had a lot of success. I
posted by SpacemanStix at 11:23 AM on September 20, 2012

Response by poster: Oh, and DPSD sounds exactly like my teen son!
posted by mecran01 at 11:25 AM on September 20, 2012 [1 favorite]

I noticed that you put "often feel tired/groggy the next day" after almost every example where you happened to get more than 6 hours of sleep. The first thing that comes to my mind is: does this persist if you get that much sleep day after day? Feeling crappy the day after sleeping in is very common, even (especially?) when you need the sleep -- it's whether you still feel groggy after two or three weeks on the same sleep schedule that matters. Could it be that you're mistaking temporary grogginess (a la the "in bed at 10, feel tired the next day" example) for something more permanent?

Other than that, things that might help are:
-a better bed. Seriously, this makes a huge difference. A nice latex or memory foam mattress is only a couple hundred bucks from
-don't do other things in bed. If you want to use the iPad or Kindle, get up and sit in a chair.
-Before-bed rituals. Mine is a warm candle-lit bath. I thought this was stupid before I tried it, but it turns out that spending some time in the near-dark right before bed really improves the quality of my sleep.
-are you open to trying medical marijuana? Small doses (especially those taken via edibles) have a good reputation as a long-lasting sleep aid (as opposed to Ambien and the like, which induce sleep but don't do much for sleep quality).
posted by vorfeed at 11:27 AM on September 20, 2012 [3 favorites]

Is there any place or time when you do sleep well? For example, if you're staying a hotel do you sleep better or worse?

What happens if you take a nap? Maybe you are just a short-time sleeper but you need to sleep more frequently. Can you take a nap after work? Does that affect your ability to sleep later on?

Second the mattress. I really got into sleep hygiene in a big way a couple of years back and a new mattress is last on my list. Even with the terrible one I have now I sleep a ton better following the normal suggestions (very dark room, cold temps, white noise, no screens, etc.).
posted by marylynn at 11:29 AM on September 20, 2012 [1 favorite]

Response by poster: Regarding grogginess:

I sleep about six hours a night. If I fall back asleep, I sleep another 90 minutes. I can't imagine sleeping in until 10 a.m.
posted by mecran01 at 11:30 AM on September 20, 2012

Response by poster: If I nap, I feel a little better but then don't fall asleep until later the same evening.
posted by mecran01 at 11:31 AM on September 20, 2012

What about caffeine? Have you tried cutting that out?
posted by Busmick at 11:37 AM on September 20, 2012

Response by poster: I don't use any caffeine. I will drop the methylphenidate use for a week and see what happens.
posted by mecran01 at 11:40 AM on September 20, 2012

YMMV - My wife said i snored. And on occasion "stopped breathing" and then snorted and started again, which freaked her out. (I was more freaked out that she was observing me sleeping, this was back in dating days)

Anyway, long story short, she talked me into breathe right nasal strips. I broke my nose as a teen and the strips seem to open me up enough to promote breathing through my nose when i sleep. I didn't notice much of anything honestly, but she said I snored less and seemed more regular, so we made it part of our usual shopping routine to pick some up.

Then we moved, and I couldn't find them for about a week. I was tired all day, couldn't focus, and was sore and irritable. I put it down to the aches of moving lots of boxes, but then realized hey, it's a week later and I still feel like crap. Then we found my strips and two days later I was back to my usual energetically grumpy self.

Oh, and nthing the bed. Get a good quality futon mattress at the very least and you'll thank yourself later.

Hope you find something that works for you. Nothing worse than sleeping and not feeling rested.
posted by envygreen at 11:42 AM on September 20, 2012 [1 favorite]

Best answer: YMMV - I was tired for 5 years, even when getting a consistent amount of sleep I always felt groggy and tired. I finally broke down and tried a CPAP (that's the apnea machine...) It's been 3 months and the results were practically instantaneous. 2 months ago we had a weekend long power outage, so I didn't have access to my machine - by Sunday I was exhausted and cranky again, exactly like I had felt before I got on the machine.
posted by dadici at 11:48 AM on September 20, 2012 [3 favorites]

Have you tried changing your sleep schedule to get more sleep (adding a nap during the day or going to bed earlier) and stuck to the same schedule for a week or so?
posted by bq at 11:51 AM on September 20, 2012

Response by poster: @envygreen: my wife has also noted me snoring, stopping, and snoring, but I thought it had cleared up after the surgery. I may record myself sleeping at night and look at the mp3 on Audacity.
posted by mecran01 at 11:54 AM on September 20, 2012

How long have you been on the Concerta? I ask because I was taking Ritalin, which is similar, for about 3.5 years and recently had to stop because it was having a bunch of diverse and bizarre side effects, including constant (4-5x a night) wakefulness and insomnia. Switching back to Adderall has reengaged my good sleep patterns. I switched to the Ritalin because I'd had similar problems with the Adderal, which I was on because of similar problems with the original Ritalin, etc etc, sometimes you need to update your software, basically.
posted by elizardbits at 12:32 PM on September 20, 2012

Response by poster: Concerta: I was taking it once or twice a week, then went overseas for a month and took it every day (about two months ago) and then have been taking it three times a week for the past month. So it could be making Things Worse. I will stop taking it.
posted by mecran01 at 1:56 PM on September 20, 2012

Surgery is on the horizon for me to undeviate the septum, but even if your nose is straight, it could be worth a shot. I have allergies too, so keeping things open helps. You can get a box of the knock offs for cheap at your local drug store, but if you're gonna try it, I recommend getting the new X shaped name brand ones to try first. It's 10 bucks and will either make a difference in two days or not.
posted by envygreen at 2:12 PM on September 20, 2012 [1 favorite]

I sleep about six hours a night. If I fall back asleep, I sleep another 90 minutes. I can't imagine sleeping in until 10 a.m.

I meant going to bed at 10 PM (as in your example: When I go to sleep early, say 10 pm, I may awaken around 4pm but then fall back asleep. Often feel tired the next day.) I didn't mean sleeping in until 10 AM. Sorry for the ambiguous phrasing!
posted by vorfeed at 2:13 PM on September 20, 2012 [1 favorite]

If you have (or could borrow) a smartphone for awhile, there are some good apps to analyze or record sleep patterns. Sleep cycle is one I used for awhile, but in trying to find it, I found a few that will detect and record noises.
posted by salvia at 2:35 PM on September 20, 2012 [1 favorite]

Best answer: If it been more than five years since your last sleep study and you're still always feeling tired then maybe it's time to find a new sleep doc. We can give you 703 suggestions in regards to what it might be, but a doctor can help you really get this figured out.

My husband finally heeded my advice (got tired of me nagging) and had a sleep study done. He had 120 disturbances per HOUR and an blood O2 level of 78% (seventy-freaking-eight!)- yet he would have told you he slept 'OK' and was just tired. Two weeks into a CPAP and he's a new man. You may not need a CPAP, but wouldn't you rather know for sure?
posted by PorcineWithMe at 3:10 PM on September 20, 2012 [2 favorites]

There's an extended release ambien for people who have trouble maintaining sleep (as opposed to just having trouble falling asleep).
posted by selfmedicating at 7:37 PM on September 20, 2012 [1 favorite]

Have you tried a white noise machine? It's not 100% helpful for me, but does help.

I'm on a lot of meds, which is part of my problem, but similarly I fall asleep fine, and then wake up about 6 hours later and can't go back to sleep. I saw a sleep therapist who said that in such circumstances, get up and go somewhere else-- read or something until you feel sleepy again. That works sometimes.
posted by miss tea at 3:24 AM on September 21, 2012 [1 favorite]

Best answer: Following ProcineWithMe's advice, you really need another sleep study. As you probably know, sleep apnea doesn't just affect your sleep. It lowers your blood oxygen levels, thus lowering the oxygen getting to your brain and heart. Over time, like say 20 years, severe cases can contribute to congestive heart failure.

My ex-husband got this very lecture from my doctor father and nurse stepmother, after laughing off a sleep study as unnecessary for several years of snoring and crankiness. After his sleep study, his nightly use of a CPAP gave him, within one week, a more rested feeling and an overall better mood from getting higher quality sleep. And for the first time in years, I was able to get quality sleep as well, because I didn't have to listen to that snorting all night long.

5 hours and 45 minutes is enough for some people. But when it's a shitty quality 5 hours and 45 minutes, it's not enough for anyone. You need someone to study what's going on when you're sleeping. And not just a self-recorded audio file. That won't tell you how long/often you're in REM, what your blood oxygen is, etc.
posted by ImproviseOrDie at 4:58 AM on September 21, 2012 [2 favorites]

Response by poster: My only question at this point is why my sleep study from five years ago didn't find anything, but I'll definitely set up an appointment. Took some amiltryptiline last night and slept for eight hours straight but still felt groggy and tired all day. Thanks all for the advice and help.
posted by mecran01 at 3:04 PM on September 21, 2012

When I just tried melatonin, it would work for a short time and then stop working altogether. You need to take selenium+melatonin and maybe b6, as well. Although, since you don't have trouble falling asleep, you can just take selenium. I know this might sound like "take megadoses of vitamin d!", but it really worked for me and I was getting less sleep than you.

And since you're adhd, try drinking coffee before bed.
posted by stavrogin at 4:16 AM on September 22, 2012

Your last sleep study could have been inconclusive for a variety of reasons- the tech doing the set up may not have placed the electrodes correctly or the doc may not have interpreted correctly - who knows?! Medical knowledge expands so rapidly that there may even be new diagnoses since your last study. Do some research and find the best sleep doc your insurance will cover. Good ones won't just hook you up overnight, but will run a full physical including blood work and cardiac screenings.
posted by PorcineWithMe at 1:27 PM on September 22, 2012

you mentioned you have keratosis pilaris - one of the theories abounding for the last decade or so is that it is a sign of a vitamin deficiency (vitamins a and K2). synthetic vitamin a in high doses can be dangerous - accutane is just ultra-high vitamin a - and eating enough naturally-occurring can be difficult if you eat a standard western diet lacking organ meats. I spent years and probably a couple of thousand dollars on various scrubs/acidic lotions/creams in an attempt to get mine under control and it just made it worse. but when I went gluten-free and started taking vitamin supplements in the form of fermented cod liver oil and butterfat oil, it cleared up in a few weeks. the supplements aren't cheap, but the cool thing is they have lots of magnesium as well. there is a lot of 'woo' around these two supplements in the primal/paleo community, but I don't think it's entirely unjustified - the changes I notice when I take them vs. not are that significant.

I had 15+ years of shitty sleep, which appears to have cleared up in the last year. I don't think it was just related to dietary changes - I cut out a lot of things that I used to imbibe a lot of, like smoking and booze, removed many significant sources of stress from my life, amped up my exercise regime, and went from sleeping whenever I wanted/felt like to working a weird off-shift, constantly on-call schedule. But the biggest shift I think was realizing that my natural sleep cycle is about 4.5 hours long - my body just wants to wake up then. If I wake up in the middle of a cycle, like two hours in, I feel like total shit and exhausted. If I wake up naturally after one cycle, putter around for half an hour, then go back to bed, I can sleep through another 4.5 hours with no issues. Maybe you have a similar issue and would benefit from 'chunking' your sleep out into 5:45 segments throughout the day, rather than trying to force yourself into a 9 hour block out of every 24 hours - I found that the stress of 'not sleeping enough' when I tried to do that made me way more anxious about lack of sleep and miserable in the morning than I was when I just tried to fit in one or two 4.5 hour blocks throughout the course of a day or so (my 'day' is usually about 36 hours).
posted by par court at 10:18 PM on September 22, 2012 [1 favorite]

Response by poster: Some followup:

1. Saw a sleep nurse practitioner, who had me try Trazodone. It made my hands tremor, but otherwise sorta helped. He kinda gave up after that and told me to work on sleep hygiene.

2. Had an oximeter test and my oxygen levels are fine throughout the night.

3. Took all the electronics out of my bedroom and put them in the other part of the house. This keeps me from going online when I wake up at night. I also take off my watch.

4. @par court: I've been reading about segmented sleep. Definitely something going on there.

5. The last few nights I have been taking four valerian around 9:30, and conking out around 10:40. This has helped me to sleep about seven hours at a stretch, which is awesome. I'm also not teaching right now and don't have to get my son up at 6:00 a.m. for school, which helps.
posted by mecran01 at 8:29 PM on June 1, 2013

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