I can't sleep. I like sleep.
June 28, 2013 6:56 AM   Subscribe

I usually sleep OK. Sometimes I have trouble falling asleep (mind racing, problems at work, etc, etc) but once I'm out, I'm out. I'll wake up once a night maybe to take a leak, but other than that, I'm good. Now, not so much.

About 90 days ago, my life got seriously high stress. I'm working on managing that. However, hand in hand (at least, in my head I've drawn a connection) my ability to sleep has gone totally to shit.

I can't fall asleep. When I do fall asleep, I wake up (usually around 3:00 / 3:30). Then if I manage to fall back asleep (which can take an hour in and of itself), I wake up again at around 6. Then, if I can manage to fall back asleep again, I wake up again around 7, then around 8, then it's time to get up anyway, and, fuck it.

Never in my life have I wanted so badly something that I have taken for granted for such a long time.

I went to the doctor and he prescribed me 30mg of Nortriptyline. I find that this helps me fall asleep, but it doesn't help me stay asleep.

Last night was probably the worst night of sleep I've ever had. I was so exhausted I went to bed at 8:30. I fell asleep promptly but woke up at 9:30, then 10:30, then 2:00, then 3:00, then 4:00, then 5:30, then 6:30, 7:30, and finally pulled myself out of bed at 8:30 to get ready for work.

I have strange, vivid dreams, even in these short periods of sleep.

This is starting to get really, really old.

I feel like Ralph Roberts from that Stephen King book, Insomnia - soliciting advice and home-spun remedies from anyone who will listen - but, please, tell me - have you got a cure for what ails me?

I have a cup of coffee once a day, in the morning. I used to have a cup in the evening, but I stopped that shortly after this problem developed. I don't drink soda (except maybe a Diet Coke if I'm eating lunch out). I drink water. My diet is pretty vanilla. I exercise regularly. I see a shrink to talk about my stress. I pop an Ativan when things get to be too much. I've tried different pillows. I've tried switching sides of the bed with my wife.

I'm tired.
posted by kbanas to Health & Fitness (36 answers total) 12 users marked this as a favorite
I have strange, vivid dreams, even in these short periods of sleep.

A doctor once prescribed me that same medication for migraines and I had 18h periods of on and off sleeping with crazyass dreams and what may have been waking hallucinations and all kinds of madness, interspersed with 14 hour solid sleeping some nights. If this is the first week or so that you are on the medication this last night of crazysleep may be related.

Have you tried stuff like Ambien/Lunesta/etc?

As painful as it may be, I would suggest completely cutting all caffeine.

Also iirc daytime Ativan use can cause nighttime restlessness.

White noise and blackout curtains in the bedroom may give you some relief.
posted by elizardbits at 7:05 AM on June 28, 2013 [1 favorite]

Stress does a NUMBER on my sleep too. Turns out I suffer from anxiety and I've been on a low dose of anti-anxiety drugs for years now.

Lately we've had SERIOUS ISSUES with repairs on the house and the $$$ that goes along with it. I am seriously stressed.

My insomnia involves waking up in the dead of night, usually with some horrific pop song running through my head, and having a panic attack. Good times.

Used to be I'd turn on scooby doo at a very low volume and that would allow me to tune out the racing brain stuff and at least rest in the dark with Velma and Shaggy and that gang.

Now I pop 25mg of dipenhydramine, aka, Benedryl, aka, Zzzzzquil. It works for me. I sleep very deeply, but wake up for the wee hour pee. I dream (stress dreams.) But I sleep.

YMMV, but give it a try.
posted by Ruthless Bunny at 7:09 AM on June 28, 2013 [1 favorite]

Headphones + boring podcasts worked for me...
posted by Pomo at 7:10 AM on June 28, 2013 [1 favorite]

It may also help to significantly step up the exercise. My insomnia has cut back a huge amount since I upped my exercise to 2h/day, 5d/wk of sweaty exhaustion.
posted by elizardbits at 7:13 AM on June 28, 2013 [2 favorites]

I was going to suggest exercise but you say you do that regularly. Do you, however, do it to the point where you're stupid tired, like I've-been-working-on-a-farm-all-day tired? Sometimes I find that to be necessary.

I also find my sleep suffers seasonally. If you live in a northern area, around now the sheer amount of daylight you're getting everyday is going to make you feel manic and sleep-deprived. I've found that I have to try to minimize sun input to my sleeping area and even start dimming lights, etc. earlier than I would like.

The constant waking up, though, makes me wonder if you have sleep apnea or some other respiratory issue.

And there's always melatonin.
posted by seemoreglass at 7:14 AM on June 28, 2013 [1 favorite]

Some "natural" remedies include pumpkin seeds (L-tryptophan, you can get powder in any health food store) which has worked for me, and valerian root which I personally have never tried.

Cut the caffeine. No TV before bed (read a book for 1/2 hour instead).
posted by St. Peepsburg at 7:15 AM on June 28, 2013

No caffeine after lunch (including tea and coke) and try some hard exercise after dinner.
posted by 445supermag at 7:16 AM on June 28, 2013

try some hard exercise after dinner.

Yea people are different. This would guaranteed keep me up. I have sleep issues too and exercise does help, but I need to have it done before 8 or so.
posted by sweetkid at 7:20 AM on June 28, 2013 [1 favorite]

I thought my husband was writing this post when I started reading it! His situation is very similar. I'm a lifelong insomniac but this kind of anxiety-induced sleeplessness seems to be a different beast. Things that have helped him:
- 20 minutes of yoga before bed
- earbuds with a podcast or audiobook, turned down to a barely audible level
- cutting back on sugar in the evenings
- melatonin
- ear plugs
posted by something something at 7:23 AM on June 28, 2013

Response by poster: "My insomnia involves waking up in the dead of night, usually with some horrific pop song running through my head, and having a panic attack. Good times."

I don't know about the panic attack part (although the dreams I'm having are usually pretty awful) but the pop song part really resonates with me. When I wake up in the middle of the night there's always some stupid song stuck in my head on a loop that makes me feel like I'm going crazy. I can't turn it off.
posted by kbanas at 7:24 AM on June 28, 2013 [2 favorites]

My doc suggested walking 2-3 miles early in the day.

I use ear plugs and am eye mask.

I take skullcap tincture which puts me to sleep but does not keep me asleep (my sleep issues are stress-triggered, too). Just recently I started to do some meditation in the evening, which seems to calm that stress response more than anything.
posted by Riverine at 7:26 AM on June 28, 2013 [1 favorite]

yea I also am an early morning panic attack waker. It's definitely due to stress in my case. I dunno, medication has helped the most. Antidepressants though, not just the Ambien.
posted by sweetkid at 7:29 AM on June 28, 2013 [1 favorite]

Actually the more that I think about it, the more your descriptions of sleeplessness remind me of how my insomnia acted when my ADHD was unmedicated, especially the racing thoughts and the intrusive repetitive song thing. I had Polly Wolly Doodle (idefk) stuck in my head for about 8 months and I thought it would finally be The Thing That Made Me Snap.

If this and the work concentration issues have been going on for a while, you might want to explore the possibility of an AD(H)D diagnosis.
posted by elizardbits at 7:29 AM on June 28, 2013 [6 favorites]

Is your bedroom too warm? I find that when I'm stressed and having trouble sleeping, if I turn the AC up so it's as cold as I can stand it, I actually fall and stay asleep much better.
posted by mchorn at 7:31 AM on June 28, 2013 [1 favorite]

This is super obvious, but have you tried Tylenol PM or Phenergan (over the counter antihistamine sleeping med)?
posted by dontjumplarry at 7:32 AM on June 28, 2013

Response by poster: "Is your bedroom too warm? I find that when I'm stressed and having trouble sleeping, if I turn the AC up so it's as cold as I can stand it, I actually fall and stay asleep much better."

No, but it might be too cold!

I usually have the window wide open and the fan on me, and during the night as the temperature falls it may be getting too chilly. That's something to consider, for sure.

"If this and the work concentration issues have been going on for a while, you might want to explore the possibility of an AD(H)D diagnosis."

Certainly possible! Although I don't really have work concentration issues (at least, as far as I know!). I've seen a couple psychiatrists in my life and have been on anti-anxiety medication like Cymbalta at various points, but no one has ever suggested AD(H)D. Certainly something to look into it.

As I read through all your suggestions a couple things jump out at me (and thanks for all of them).

- Our curtains our total shit and it starts to get bright so terribly early. Also, the dogs sleep at the foot of the bed and occasionally whine and fight and walk around. I think maybe a sleep mask and some ear plugs are in order.

- Anxiety certainly seems to play a role in this. Some of your comments on meditation and other solutions to combat anxiety seem very helpful.

posted by kbanas at 7:35 AM on June 28, 2013

Don't try to go to sleep too early because your body will reject it. Maybe hold off until 10ish or so. Read until you get drowsy and then put your book down and turn off the light. (Emphasising book here; avoid backlit media). If you wake up, don't get up unless you need to go to the loo. Keep your eyes closed, even if it takes an hour or more to go back to sleep. If you need to go to the toilet, do it. Don't put it off. Get straight back into bed after doing so and don't pick your book up. Close your eyes. Keep them closed.
posted by h00py at 7:36 AM on June 28, 2013

I am you -- but I've been you for awhile. What I've learned is:

1. As far as Rx meds -- I've preferred the stress relievers (Xanax, etc) to the knock-you-the-hell-out drugs (Ambien) when I've gone that route.

2. OTC/herbal stuff -- melatonin (5mg or less....less is more in this case) has helped, as has Valerian root.

3. I've cut down on caffeine, but I never have given it up entirely. The thought of that first cup of coffee in the am was too precious at times.

4. IT WILL GET BETTER. If you are able make peace with the insomnia for awhile, realize it won't kill you, and take advantage of the little "bonus" middle of the night time to do what pleases you, it helps. It will eventually get better -- my insomnia comes and goes. I don't say this lightly (we're wired to NEED SLEEP) but having been through a new baby x2 and the resultant mess it made of my sleeping habits, I've learned that I'm pretty damn resilient and that a sense of humor is invaluable. I'm pretty sure all worthwhile superheroes suffer from insomnia from time to time. Hang in there!
posted by pantarei70 at 7:40 AM on June 28, 2013 [1 favorite]

I find Nyquil really works. Not sure about taking it long term but in the short term it really helps with the 3:57am "oh shit" wake ups.
posted by bquarters at 7:41 AM on June 28, 2013

Oh, right! I misread the "problems at work" as "problems concentrating at work" not as "I have trouble falling asleep because I'm worried about problems at work", oops.
posted by elizardbits at 7:51 AM on June 28, 2013

Response by poster: "Oh, right! I misread the "problems at work" as "problems concentrating at work" not as "I have trouble falling asleep because I'm worried about problems at work", oops."

I still appreciate the suggestion. It's just as possible as anything else, and certainly something I'll ask my doctor about!
posted by kbanas at 7:57 AM on June 28, 2013

For me, the looping song (or phrase or, god this is the worst for some reason, a name) is my red flag that this isn't caffeine or an undercooked potato or too much screen time. That sort of thing makes me sleep bad and wake a lot, but the rabbit-brain is either other chemicals (alcohol won't do that to me, but too many cigarettes will, and in fact I quit smoking two weeks ago and also stopped waking up at 3am, which I have done for over 10 years and sort of come to enjoy) or bad neurochemicals, which could be a depressive dip for me or something frustratingly difficult like sleep deprivation. I am very peaceful about my insomnia, even kind of fond of it, but the nights with the repetitive thoughts are really different.

You should probably read through the other insomnia threads from the past couple of weeks, but I think exercise and hydration are significant factors in stress insomnia and "chain" insomnia (where you're sleeping badly because you've been sleeping badly). I do not think that taking amnesia-inducing drugs like Ambien or Lunesta are the best choice for this kind of insomnia when you're at that "diminishing returns" phase, because you'll just not remember that you didn't sleep. My drug of choice is doxylamine succinate (Unisom), a half to start with, but try whatever you want to start with. Get through a few nights (especially Friday and Saturdays, assuming you're not working weekends, so there's not too much of a problem if you end up stoned or hungover all day from whatever you take) so you're not so disadvantaged by lack of sleep in the first place.

Also, as has been noted in all the insomnia threads in the last couple of weeks, the days are really long right now in the Northern hemisphere and that jacks a lot of people up. It'll pass.
posted by Lyn Never at 8:49 AM on June 28, 2013

Blackout curtains. Today, if not, then tomorrow.
posted by oceanjesse at 9:02 AM on June 28, 2013

I downloaded THIS program to my android phone, and let me tell you... worth it. I just put some headphones on, lay back, and go through the program. Asleep in minutes.
posted by PuppetMcSockerson at 9:12 AM on June 28, 2013 [1 favorite]

Curtains, eye patch, earplugs, light or moderate exercise, maybe melatonin and some white noise. It is the season for early waking. Temperature is important too. I really don't like a fan on, but having on on low helps in the heat.

Avoid overeating, drinking too much or too little water, alcohol, too much artificial light and stimulation right before bed (ie. not too much TV/videogames/web browsing/etc). Take a short nap during the day if that tends to help you.

Maybe write in a journal before bed to try to let go of the stress a little?

I usually sleep well. But occasionally didn't/don't. At one point in my life lack of sleep due to waking up during sleep time stressed me out (which made it harder to fall back asleep). Somehow I became more philosophic about it. Now if I wake up I don't let it get to me. That's probably not really helpful, but my attitude towards waking up has made a difference to me. Easier said than done, I guess, but I know losing a some sleep is something I can manage even if unpleasant.
posted by jclarkin at 9:50 AM on June 28, 2013

I'm a new insomniac as well, but when I feel like I'm actually able to fall asleep fairly easily, I take either Unisom or melatonin to ensure that I stay asleep. They don't work very well if I'm feeling wide awake before bedtime though.
posted by peripathetic at 10:01 AM on June 28, 2013

For me, the TIMING of exercise is key when I was having trouble falling asleep. I work long, stressful hours, so if I have at least a short workout after work (at least 30 minutes til I'm sweaty), a light dinner, an hour or two of TV, some reading… I'm lights out for the rest of the night. If I do my gym workout first thing in the morning, it doesn't help my insomnia AT ALL because I fall asleep with the annoying thought of OMG only 6 more hours til I have to wake up and have to go to the gym and THEN go to work and I better not forget to do X and Y and then SQUIRREL! oh, did I remember to add Z to my list?!
posted by HeyAllie at 10:42 AM on June 28, 2013

I've been you for an unfortunately long number of years. I'm basically used to it now but I do have a couple of suggestions, some of which have been mentioned above.

- absolute dark. Blackout curtains aren't an option for me, so I use a tempur pedic sleep mask. It is remarkable. Not only that, but my body is now trained to think it's time to fall asleep when I put the sleep mask on, so it's win/win.

- quiet. If you can't get quiet, get a white noise machine. I can't stand hearing the sound of actual surf when I'm visiting the beach, it stresses me out (I'm weird like that). But the recorded surf sound is the one thing that will for sure put me to sleep. I think it somehow replicates the in/out of breathing in a way.

- do not use the bedroom for anything but sleep and sex. No tv. No reading. No ANYTHING. Eventually your body gets trained to sleep.

- mantra practice. Any mantra will do. If you're a Catholic, the Hail Mary is just about the right length. You can also use the lovingkindness phrases from the popular insight meditation practice. You can also simply count your breath -- just count from one to five. Don't *do* anything to your breath, just count. When you reach "five", start over at "one." When you lose track of where you are, start over. And you will lose track. When your mind starts to rattle around in shit that (a) doesn't matter and (b) you can't do anything about now anyway, turn to the mantra. Every time you notice that you are off mantra, turn back. Gently and with no judgment. All you're doing is gently training the mind to turn to a phrase with no charge on it as something for your mind to chew on when it's in the mood to chew.

- eat protein before bed. A hard boiled egg. A little cottage cheese. A glass of milk.

- no screens for 45 minutes before sleep. No tv, no computer, no email, no ask.metafilter, no tablet, even an e-reader. Read a book or a magazine, not a screen. When you awaken, NO SCREENS. That will keep you awaker than a mosquito in your bedroom.

- consider a warm shower before bed. As your body cools down, you naturally fall asleep.

- I do use drugs. Amitriptyline for me. But they don't help as much as you'd like or in the way that you'd like. But they are out there.

- the first time I got a full, uninterrupted night's sleep in about 5 years was the first time I went to a local spa for a particular treatment. I wonder if you can replicate this: It's a long soak in a Japanese bath followed by a massage. I was more relaxed than I had been in years and years. I awoke the next morning and practically started crying, I felt so good.

Finally, when you awaken, remind yourself gently that you're still getting rest. You can lie in a relaxed mode, using your mantra practice, and that's almost as good as sleep. But if you stress out about it, you'll become awaker and awaker, and that *will* have negative effects the next day. Think about my grandmother, who slept like a cat, all day, all night, but she woke periodically and every time she awoke she would freak the fuck out and be like oh my god I never sleep. Just hush the grandmother in your mind. That helps a surprising amount.
posted by janey47 at 10:46 AM on June 28, 2013 [9 favorites]

I have ADHD and anxiety and there is a radio station in my head. I'm also a terrible insomniac. Summer is a miserable time of not enough darkness. Xanax is awesome for this. No other sleep or anxiety med has helped me. The other thing that helps is to have an audiobook, one I'm familiar with, playing all night. Seems to shut off the music fairly well. Stuff narrated by Scott Brick is like SleepyDreamyNightySnoozySnooze. Especially Asimov's Foundation, which isn't very exciting to begin with. Getting a Kindle Paperwhite has helped too, because I can read in the dark with such minimal light that it doesn't keep me awake.
posted by monopas at 11:08 AM on June 28, 2013 [1 favorite]

i find that if i cannot get my brain to shut off (which is a lot), what usually works for me is counting my breaths backwards from 100. for some reason this is soothing to me. and since i'm already counting, i take deep breaths - as deep as i possibly can. in through your nose and out through your mouth works best for me, but anything is fine. i usually drop off somewhere in the 70s or 60s. sounds really silly, but it works.
posted by koroshiya at 11:16 AM on June 28, 2013

Lots of great advice here...unpack and re-pack the chemistry, from caffeine ( not always obvious, read the label for Excedrin:) )

Consider a sleep study, or ask your wife to record you while you sleep.

Ask if anything is going on with her. My partner has restless leg syndrome. We put one of those mattress toppers on to mitigate giggling. Well he's had a couple "lift large legs & drop" episodes that are awakening....

Best wishes. Sorting this out.
posted by childofTethys at 11:23 AM on June 28, 2013

Ativan is a sort of mid-duration benzo. So, if you're taking that at night to help you fall asleep, it wouldn't be surprising to wake up at 3 am. Xanax is actually even shorter acting. Xanax works well for people who just need help falling asleep. If you want to stick with a benzo to help you sleep (as opposed to Ambien), ask your doctor about Klonopin, which is more or less the same drug, but it lasts for 8 hours instead of 5. Of course, benzos are not good long-term solutions, so ymmv with that. But, when I needed it, it helped me quite a bit.
posted by Lutoslawski at 11:57 AM on June 28, 2013

+1 to protein before bed, and a sleep study if this keeps up.

Sometimes low blood sugar during sleep manifests itself as jolting awake with a panic attack. You don't want to eat a heavy dinner within 2 hours of sleep but a light, protein-intensive snack like yogurt or a piece of chicken before bedtime can help fuel your body through the night. (Naturally, if you suspect blood sugar issues from other symptoms, go to your doctor.)

And I have to tell you that one manifestation of my severe sleep apnea was vivid, unpleasant dreams; another was waking up with my heart pounding. If standard sleep hygiene, soothing music, melatonin, exercise, etc. don't help, then get a sleep test to rule out any physical causes for your insomnia.

Re melatonin: It works very well for me. But the doses sold in most tablet forms are way too large. I take 1 mg max, less if I can help it (like 0.5 mg). I get a brand called Sundown Naturals Liquid Melatonin, which has a measured dropper with which to titrate your dose. The standard 3 or 5 mg. melatonin tablets are much too much for most people and can cause nightmares and morning headaches and grogginess.
posted by Rosie M. Banks at 12:26 PM on June 28, 2013

2 months ago the exact same thing started happening to me. I broke down from the combined anxiety & sleep deprivation.

I'm trying a combination of things, and still have my good nights & bad nights, but what's helped so far is this:

- DO NOT LOOK AT THE CLOCK WHEN YOU WAKE UP. I have a hard time following this one, but if I look at the clock I'm continually thinking "oh crap, only three more hours till I have to get up....oh crap, now only two more hours." If I can restrain from checking the time, I lose the "OMG MUST SLEEP" anxiety and fall back to sleep faster.

- Lexapro / anti-depressant to taper off the anxiety

- I've noticed a difference with 2mg Lunesta - it's not foolproof, but noticeably helped. No side effects for me. I'm just hoping I don't build up a tolerance too quickly.
posted by wheek wheek wheek at 3:43 PM on June 28, 2013

Has your alcohol intake changed at all? Anything that interferes with serotonin production or intake can lead to waking up early. An old friend of mine's shrink told him: Can't fall asleep? Anxiety. Can't stay asleep? Depression.

Also jumping in to say that using Tylenol PM or Nyquil as a sleep aid is a really BAD idea-- acetaminophen is not easy on the liver, and shouldn't be taken unless absolutely necessary.

I find dogs to be very distracting and disruptive of my sleep, so I use a white noise machine whenever I dog sit.

Diphenhydramine (Benadryll/Sominex) for one or maybe two nights in a row might help get you back on track while you adjust your sleep hygiene routine (earplugs, etc., as you mentioned.)

Good luck. I feel all of your pain.
posted by Schielisque at 4:18 PM on June 28, 2013

Oh I can SO relate! I have had the same troubles you describe. I downloaded a meditation podcast to drown out the repetitive songs. I also started taking Valerian (it stinks but I got used to it and now love the smell and the taste because it instantly relaxes my body and mind). Valerian usually takes a week or so to start affecting you so be patient at first. Once it does start working you can go months without taking it and it still works right away the next time you need it. Also I dont excersise past 5 PM. I think everone is slightly different. There are a lot of good suggestions here, you'll probably just have to do a bit of trial and error before you find the best things to help you sleep. Good luck and take really good care of yourself otherwise. Lack of sleep triggered depressive episodes for me, so just beware that is a possibility. Hope you get things worked out soon!
posted by WalkerWestridge at 6:12 PM on June 28, 2013

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