Help! I can't stay asleep.
February 3, 2013 6:40 AM   Subscribe

Here's what a typical night looks like for me: 1. Go to bed between 10pm and midnight. Fall asleep easily. 2. 3-4 hours later, wake up for no apparent reason. Turn over and (usually) fall asleep again. 3. An hour or two later, wake up again. If lucky, fall asleep again; if unlucky, toss and turn for a while first. 4. Repeat step 3 several more times until morning. 5. Get out of bed at 9 or 10 feeling tired and unrefreshed. The awakenings happen for no discernible reason. I don't have nightmares, need to pee, etc., I just find myself awake. On an average night I wake up 4-5 times.

This has been going on for years, though it hasn't always been this bad. Things I've tried: 5-HTP, melatonin, GABA, magnesium supplements, herbal teas, kava kava, alcohol, meditation/progressive relaxation. Some of these things make me fall asleep faster, but my problem isn't falling asleep, it's staying asleep.

I consulted a sleep specialist, who ruled out sleep apnea, said the problem was psychological (nervous tension), and offered to prescribe sleeping pills. But I don't want to take a pill every night just to get a reasonable night's sleep.

Things I'm considering: cognitive-behavioral therapy, hypnotherapy. But my budget is tight and I can't afford prolonged therapy. Has anyone tried these for insomnia and if so, how many sessions before you saw results?
posted by zeri to Health & Fitness (32 answers total) 24 users marked this as a favorite
Oh, and exercise doesn't seem to affect it either: I do yoga 2-3 times a week but sleep equally badly on those nights, and I used to run regularly, also without any improvement in my sleep patterns.
posted by zeri at 6:42 AM on February 3, 2013

Recent studies have shown that behavioral modifications are more successful than pharmaceuticals in the treatment of insomnia, so you're on the right track!

Something I've tried with good effect on doctor's orders: limiting the amount of time that I spend in bed based on my sleep efficiency.

Here's how it works. Total up the number of hours you spend in bed trying to sleep and the number of hours that you actually are asleep. Divide the amount slept by the number of hours in bed (so if you are in bed for 11 hours, but only are asleep 7 hours of this time, your sleep efficiency score would be 63%) If the number you come up with is below 80% efficiency, you should start limiting the amount of time that you spend in bed, not dramatically, but being very consistent about it. As a result, you will get less sleep and be more tired in the short run, however it will have an almost immediate effect in terms of increasing your sleep efficiency (at least from my Doctor's practice and my personal experience).
posted by arnicae at 7:09 AM on February 3, 2013 [3 favorites]

That's pretty much how I sleep too, sometimes more than others, but never go a whole night, even with drugs, without waking up at least twice. I've decided that's just how I sleep. The suggestion of just trying to rest rather than sleep in answers to this question actually works better for me more than anything else. And I know you said you don't want sleeping pills, but you might try OTC Bonine. For some reason, that keeps me asleep more than anything except Xanax.
posted by still_wears_a_hat at 7:10 AM on February 3, 2013 [1 favorite]

1st try Alteril - a combo of all known natural sleep aids, essentially. Can be found at the health food store/GNC.
If that doesn't work try Ambien - it will work. Ask your doctor. Maybe ask your doctor about this whole thing in general.
If that doesn't work, you really, really should look into a sleep study.
posted by jitterbug perfume at 7:10 AM on February 3, 2013

I'm not sure why you're willing to consider "natural" sleep aids, which so far have not worked well for you, but not pharmaceutical ones. My quality of life improved by orders of magnitude when, out of desperation, I finally admitted that nothing else was working and put aside my concern with the stigma of taking a pill to sleep. I did have to try some different things - Ambien was awful for me but other things worked. Now, sometimes I take a pill, sometimes I don't, but it helps my stress level tremendously to know I have the option. And there is just no way to describe the difference between being exhausted all the time and being well-rested. Good luck - insomnia sucks.
posted by walla at 7:24 AM on February 3, 2013 [5 favorites]

IANAD and YMMV and all that, but I had the same situation a few years ago, and when I finally went to my GP (after trying the same things you mentioned), she said that sometimes our sleep patterns for whatever reason just get out of whack and my body basically needed a "reset" button to help rewire my sleeping pattern. So I got some Ambien, I took it for about a week, and found that after that I was able to sleep through the night without it.
posted by kinetic at 7:27 AM on February 3, 2013

Seconding the recommendation to be in bed more or less only when sleeping. It may be that you're just a natural multiphasic sleeper; in any case being in bed for 11-12 hours seems like an awful lot absent some other health issue. Maybe set a limit on it - the second time you awaken, get up: read a book, have some herbal tea, (hand) write in your journal (no screens). When you're tired, pack it in. This is pretty much the only way I can beat episodic insomnia. Eventually I get back to something that feels both productive (in that it's restful) and normal (in that it fits with the life I choose to live).

It may not work for you - you may need to use a sleep aid. If you think that better living through chemistry is worth a try, by all means speak to a physician.
posted by Emperor SnooKloze at 7:29 AM on February 3, 2013

Tried switching beds? Your body might be telling you it doesn't like your present mattress.
posted by flabdablet at 7:32 AM on February 3, 2013

Have you tried earplugs? I'm an insomniac and do a much better job of sleeping through the night when I wear earplugs.

It also occurred to me a couple of years ago that I sleep much better if I am slightly too cold, so it might be worth experimenting with the temperature in your room and combination of blankets, etc.

Above all, though, do talk to your doctor. I resisted for a long, long time, but taking a low dose of Trazodone has changed my life. I don't care if I have to take it for the rest of my life - the quality of my sleep is finally normal almost all of the time, and I don't have any side effects from the medication whatsoever.
posted by something something at 7:39 AM on February 3, 2013

You said you saw a sleep specialist - did you have a proper sleep study done? My own sleep problems came from periodic limb movements waking me up every 7-15 seconds. Most of the time they were micro arousals I wasn't aware of, but a few of them would always fully wake me up.

Hypnosis might still be helpful. Find a therapist that records the session and you listen to at home.

For myself, I'm on a lovely cocktail of drugs and self hypnosis (recording) but at least I'm sleeping through most nights now.
posted by [insert clever name here] at 7:47 AM on February 3, 2013

Not meaning to trivialise your problem but you appear to spend something like 10-12 hrs in bed. Perhaps you're simply aiming for too much sleep? Have you tried getting up after 6-8hrs? That seems to be how much you can get in, if your estimates about time before and between waking up are correct, before you cannot fall asleep again with ease?

If you feel you do need 10-12 hrs and don't go to bed before 10pm the last few hrs of sleep would be during daylight hrs. So perhaps you need blackout curtains?
posted by koahiatamadl at 7:49 AM on February 3, 2013 [2 favorites]

I sleep like this a lot of the time. One of the things that I found was that when I was certain that I was wide awake in the middle of the night, I often wasn't. That there was some fakeyness to the certaintude and if I just lay there quietly and didn't poison my mind with I AM AWAKE thoughts, I'd drift back off. Other things that helped me were more serious cardio exercise (I don't know if yoga does this for you or not, when I did yoga it was more a lot of stretching and wouldn't tire me out) and taking benadryl before bed which made me a little muzzyheaded without feeling doped up or tired in the morning and without something addictive. I also often sleep in earplugs because I am a light sleeper. It gets worse when I'm stressed or anxious and I do have a prescription for lorazepam if I need it, which I rarely do (a few times a year?) but it's nice to know there is a knockout drop option if I really need to sleep and can't.
posted by jessamyn at 8:07 AM on February 3, 2013

I've gone through periods like this, and the best thing was to get proper sleep hygeine. There's a whole list of things that shouldn't be done/taken within a couple hours (or more, for some things) of going to bed: caffeine, exercise, sugar, for starters. Do you have caffeine after noon? For some people, this is enough to keep them wired.

Also, what are the light levels like? I often wake up if there's any light coming in the window, or if I get too warm.

And Ambien is a terrible recommendation. It might help you sleep, but it will most likely also induce functional sleepwalking. I knew someone who crashed his car into a mailbox and woke up with no memory of it -- he'd talked to people as well, they thought he was fine.
posted by DoubleLune at 8:09 AM on February 3, 2013

Oh, and the other thing -- do you have a high stress level from something in life? I started getting much better sleep when my stress level was drastically reduced.
posted by DoubleLune at 8:11 AM on February 3, 2013

There's a very interesting study that links insomnia to sleep-breathing disorders. Did you have a sleep test? Did it show any sleep-disordered breathing? Do you snore, make other funny mouth noises, stop breathing at night, wake up gasping for breath or feeling hot and sweaty, or do you have to get up to pee all the time? Any of those can indicate sleep apnea - but a sleep test is the only way to find out for sure.

I wear Breathe Right strips (the ugly beige ones adhere much better than the clear), use Flonase nasal spray, and have an air purifier in my bedroom (bonus: it emits a soothing white noise). These have all helped me to sleep better - I still have trouble getting to sleep but I no longer keep waking up unless one of the cats decides I must be awake. (I was never diagnosed with a sleep breathing disorder - I was tested and everything came back normal - but I decided that it couldn't hurt to make sure I was breathing as well as I could, just in case.)
posted by Rosie M. Banks at 8:18 AM on February 3, 2013 [1 favorite]

i had success with alteril (otc) for a problem similar to this, though not as bad.
try to reduce stress levels in your life in general.
if you're in bed at 5am wide awake and you have to be up at 7 or 8 just get up, that way when you're in bed you're sleeping. you'll be tired after a few days of this but it might help reset your sleep-clock.
posted by zdravo at 8:23 AM on February 3, 2013

it will most likely also induce functional sleepwalking

This is a rare adverse effect, not "most likely." I have taken Ambien occasionally for over 10 years, and have NEVER had such an effect, nor has anyone of my acquaintance. It is currently recommended to take the lowest dose possible; I take only 5 mg, though 10 is the most commonly prescribed dose.

The main point with Ambien and other such sleep aids is to NOT take them every night, as sleep becomes even more difficult without them, and they eventually lose their effectiveness. Occasional use can be very helpful, coupled with relaxation techniques and attention to sleep hygiene.
posted by RRgal at 8:25 AM on February 3, 2013 [1 favorite]

Do you smoke? If you do, this could be nightly withdrawal.
posted by gjc at 8:34 AM on February 3, 2013 [1 favorite]

I agree with koahiatamadl and others, twelve hours is a lot of time to be in bed. It could be that you're trying to get too much sleep. Try 8 hours or less. Nearly everything I've read on sleep and sleep problems and I've read a lot, because I've had sleep problems in the past and it's messed with my bipolar. Though all that reading doesn't make me an expert by any means, I know that. Anyway a lot of what I've read suggests that most adults only need 8 hours at the most. Now, if you're a teenager, you might need 12 hours, but anyone outside of their teens should be getting 8 hours or less, 6-7 hours a night is what most experts on the subject recommend.

So if you find yourself lying awake, even if it's 5 am, then you should get out of bed and do something else until you're tired again. It's your body telling you that you're done sleeping for a time. By forcing yourself to go back to sleep until 9 or 10 am, you're interrupting your Circadian rhythm and that's what's causing you to be tired most of the time. If you don't want to wake up at 5 am or 3 am, then there are ways to reset your sleep cycle. They're all over the web. It takes time, but it can be done.
posted by patheral at 9:09 AM on February 3, 2013

I believe that difficulty staying asleep can be a symptom of perimenopause or other hormonal changes. I don't know if there are good remedies based on that, but (if you're female and the right age) it might be worth exploring that angle.
posted by LobsterMitten at 9:35 AM on February 3, 2013 [1 favorite]

And Ambien is a terrible recommendation. It might help you sleep, but it will most likely also induce functional sleepwalking.

Bogus. Ambien has in some circumstances had odd side effects (including sleep walking), but the statement that it will "most likely induce functional sleepwalking" is NOT correct. As with everything on metafilter, consultation with someone with actual medical experience is advised before taking medical advice from internet strangers at face value.
posted by arnicae at 9:36 AM on February 3, 2013 [2 favorites]

I've taken Ambien, and I find it works very well, although it tends to lose its effectiveness the longer you take it.

The key to taking Ambien is to pop that pill and then go straight to bed. It's when you do not go straight to bed that Ambien can cause problems. I have never known anyone to sleep-drive while on it, though I have known people to text or email some ridiculous things and then be unaware they did it the next day. But this won't happen if you take your Ambien and then go right to bed afterwards - no staying up to browse the Internet or whatever.
posted by Rosie M. Banks at 10:08 AM on February 3, 2013

I came in here to say what LobsterMitten said-if you are a female of a certain age, hormonal changes will cause sleep patterns like this. I have them and I am going through menopause.

Also, if you are in the habit of drinking alcoholic beverages in the evening, you might want to try stopping for a bit. I find that sometimes a glass or two of wine will mess up my sleep patterns. Ymmv on that one.
posted by St. Alia of the Bunnies at 11:18 AM on February 3, 2013

I had a sleep study done and was diagnosed with Alpha Wave Intrusion. Basically the alpha waves intrude into the rem sleep cycle and I never get enough restorative sleep. I take Lunesta and it works very well. I have go off it every six months due to tolerance issues but only for a month. They also recommended changing my sleeping routine: bed is for sleeping only, no eating right before bed, no falling asleep with TV on, turn off lights and any other distractions, and no coffee after 5 pm. If I am not asleep in 45 minutes, which is rare and a sign my tolerance is building, I get up and have a glass of water. And then go back to bed. I aim for 6-7 hours of sleep a night.

Sleeping 10-12 hours a day is for preschoolers not healthy adults.
posted by cairnoflore at 11:58 AM on February 3, 2013

If you are interested in CBT but don't have the big bucks, there are several books like this with CBT programs for dealing with sleeplessness.
posted by Obscure Reference at 12:02 PM on February 3, 2013

Me too. I find melatonin to be marginally helpful. Usually during the 2-3 AM wakeup, I trundle into the living room and pick up my guitar. I'll do a hour or so, sometimes with very satisfying improvisations. I've actually nodded off during a riff. Then back to bed.

A cup of warm milk at the start of this wakeup period sometimes seems to help. I've heard that a fresh apple works in a similar way. I believe that anything that points you in the direction of sleepytime is valid. Sometimes it takes only a nudge to get there.

Some of my issues revolves around ambient pain. I can take only so much medication for this: if I don't stay ahead of the pain curve, I have to take enough morphine to go catatonic before it helps, and I don't like it. I was surprised to discover that heat helps. A long, hot shower, or half an hour in the hot tub seems cause bone pain to evaporate for a few hours, then fatigue takes over and I can fall asleep. If I get about two hours per sleep session, then I wake up feeling refreshed.

I used to read--this was to break out of the feedback loop in the running dialogue in my head--then the last thing before sleep was the sound of the book hitting the floor as I nodded off. But I haven't had the running-dialogue problem in years. For a while, meditation work in this respect, but I grew bored with it. I still read at night, but that's because it's a pleasing habit. It helps me to fall asleep, but it doesn't stop me from waking up in an hour. I once thought this problem with sleeping was a result of PTSD. I don't know if it used to be that way, but I'm pretty sure it's not the case now.

Good luck.
posted by mule98J at 12:56 PM on February 3, 2013

I have this problem sometimes and hate sleeping pills because they all make me feel worse the next day than if I had taken nothing. My issues are also related to nerves/anxiety and any pills I've ever tried for that have just made me feel loopy/drunk, which I don't like either. So instead I've looked into dietary changes.

Aside from improving the diet overall, I've found that there are a couple of things I've been able to do to improve my sleep.

I have to eat something within a couple hours of wanting to go to bed or else I will wake up. Not a lot, but I have to eat something and I could never be one of those people who "doesn't eat after 4pm" or whatever. I've found that filling things like beans or lentils(something carb-y with fiber) are usually good for this. I also sometimes make a smoothie with bananas, yogurt, etc, because both of those are supposed to be good sleep-inducing foods with tryptophan, magnesium, etc in them. Magnesium is supposed to be helpful in staying asleep, so I try to make sure that I eat more magnesium-rich foods.

If I wake up in the middle of the night, I've found that having a banana with some water helps me get right back to sleep - so far I've tried that about 5 times and it has worked every time. Avocados are supposed to be good too, so I've been trying to eat more of those but the banana is easy to grab and eat in the middle of the night if I realize that I will otherwise be laying awake for awhile.
posted by fromageball at 1:48 PM on February 3, 2013

Some answers to assorted questions: I'm male; I've never had a sleep study done; I don't smoke; my caffeine intake is limited to a cup of tea in the morning; I love my mattress and have had the same problem sleeping in other beds. Earplugs: I use them in the morning when the upstairs neighbors are up and about; if I try going to sleep with them they make me uncomfortable after a while and wake me up (even the Howard Leight ones people rave about), but in any case noise isn't usually the problem. Neither is light: most of my awakenings happen in the middle of the night when there's no light coming in.

People are right that 10-12 hours is a long time to be in bed. This doesn't happen every night, only when the insomnia is bad enough that I feel I need those extra couple of hours in the morning, but in any case I'm going to try limiting my total time in bed to, say, 9 hours max, and see what happens.
posted by zeri at 5:12 PM on February 3, 2013

I have this same general problem and would suggest a limit of 7-8 hours.

Also, I think stress is probably the main cause. I find that to take my mind off daytime issues, I can get back to sleep most easily if I think about positive non-verbal things. Stuff I like to do with my hands, for example - gardening, carpentry, etc. For other people it might be cooking , knitting, painting, walking. It's the verbal stuff that is keeping you awake.
posted by beagle at 5:52 PM on February 3, 2013

I'm always surprised in these insomnia threads that no one ever mentions Remeron (mirtazapine). It is the only thing that has ever really worked for my insomnia. There are some real downsides to it though: 1) it has at times put me out for 12 hours, 2) after you wake up, you will be very groggy for the rest of the day and maybe even the following day, 3) when you finally wake up you will want to eat every carb in the house. I haven't used it in several years since I more or less just live with not sleeping very well these days, but I used to use it when I needed to "reboot".
posted by jenh526 at 8:12 PM on February 3, 2013

If your sleep specialist didn't do a sleep study, on what basis was apnoea ruled out? Because what you're describing sure as hell sounds like the difference between me pre- and post-CPAP.
posted by flabdablet at 12:17 AM on February 4, 2013

Other posters have suggested limiting the number of hours you sleep/stay in bed. I would add that you should should try waking up at the *exact* time every morning, and going to sleep at the *exact* time every night.

That said, have you considered the possibility that you are trying to sleep during the wrong hours altogether? Your description could indicate a variety of sleep issues, but one of them could be a circadian rhythm disorder such as "Delayed Sleep Phase Syndrome." Approx. 10% of patients who go to the doctor complaining of insomnia are actually living with DSPS in a time-rigid society. Basically, people with DSPS cannot enter into their sleep phases at socially accepted times, even if they try. While your description does not, at first glance, sound like a typical description of DSPS - since you ARE able to fall asleep between 10pm and 12am - it does remind me of nights I have tried to adjust my sleep schedule to "normal" times.

I have DSPS. (Or as I like to see it: a different circadian rhythm that would allow me to stay up and help protect the rest of y'all from the wolves.) I go to sleep around 3am most nights and wake up around 11am most mornings. When I do this, I sleep like a rock, and I wake up feeling rested. BEFORE I knew that I had DSPS (which was before I had a schedule that allowed me to wake up so late and discover that I could actually sleep a full night if I just went to sleep later), I experienced all sorts of other symptoms of insomnia - some of them similar to yours. If I ever try to go to sleep around 10pm, *sometimes* I can fall asleep then, but if I do, there is no way I will sleep through the entire night. My body just does not want to sleep during those hours. What does your sleep pattern look like on the weekends or during vacations, when you do not need to wake up at a specific time? If you go to sleep later and get a better night's rest, that could indicate DSPS.

IF that is the case, you have a couple options: 1) Attempt to adjust your circadian rhythm using chronotherapy, phototherapy, meds, etc OR 2) Adjust your life around your circadian rhythm.

Although DSPS itself may be a rare condition, I suspect that many people try to force themselves to sleep at socially acceptable times when their bodies don't really want to cooperate...hence the need for sleeping pills, intense sleep hygiene methods, "sleeping in", staying in bed for 10-12 hours, alarm clocks, etc.
posted by emoemu at 8:19 PM on February 4, 2013

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