Please help me sleep again!
July 3, 2014 8:33 AM   Subscribe

I aggravated a lower back injury on June 3rd. This injury caused pretty bad nerve pain down my right leg that totally disrupted my sleep. Even though I am feeling much better now physically, my normal sleep has not returned. Note: I have read a bunch of AskMes about insomnia but I thought I would get some fresh responses here.

The nerve pain during that first week, when I was acute, was such that I could not sit or lie down. The only relief I had from the pain was when I was standing. And pain killers really didn't do much of anything to reduce the pain levels. As a result for about a week post injury I was on my feet 24/7, spending most days and nights leaning on the back of a high chair. On a few occasions I was able to find a sitting position that worked for a few hours-as long as I didn't move my leg. In those cases I was able to catch an hour or two of sleep. Also, I was on the 6-day prednisone pack to get the inflammation under control. That helped a lot but it made me jittery. Anyway, over the last few weeks my physical condition has markedly improved. I first regained the ability to sit comfortably, pain free. So I was able to catch more sleep sitting on a couch (in front of TV of course). Then I was able to lounge on the couch comfortably. And finally, I regained the ability to lie down horizontally. At that point, I returned to my bed and my ability to sleep vanished! I should emphasize that my pain levels now in bed are typically 0/10 or maybe 1/10. So I am totally comfortable. I've got the central AC running, I am wrapped in a comfortable blanket, etc. It feels great....but no sleep.

Things I have tried: Last week I tried taking unisom for a few days. Over time it seemed to have the opposite effect--making me feel a bit jittery and I was having frequent hypnic jerks. So I discontinued use. I also tried one 5 mg melotonin a few nights ago. Again, it didn't seem to make any difference but I felt even more groggy than usual the next day. So I discontinued use. Then I started to deal with sleep hygiene. I am doing all the recommended things, but I have only been doing it for 2 days. My routine (for the last 2 days) is to wind down after dinner--with very limited screen time. I take a short walk and sit by the pond for a bit. I then spend some time reading, or perhaps watching no more than 1 hour of TV. Then I go to bed. The last two nights I have gotten maybe a few hours of sleep--although it is remarkably hard to tell. I do recall a few dreams so I had to be sleeping some. Also, before this happened, my sleep hygiene wasn't great but I was always able to get maybe 5 hours of solid sleep, unless I fell asleep in the evening in front of the TV--in which case that night would often be sleepless until the very early morning hours. Also, there is no question that I have built up a lot of anxiety about sleep. So that isn't making things any easier. I have been taking a 30-45 minute walk each day. I know exercise helps and I was much more physically active before the injury. But I am still healing so I am cautious about trying to do more than a walk.

Anyway, here are my questions:

1) Should I try the melatonin again and maybe take it for a longer period of time to see if that helps? Is there a proper melatonin protocol (dosage, timing)?
2) I don't know much about OTC sleeping aids. But is there a type different from unisom that I could try? Or should I try Unisom for longer than just a few days/give it another chance?
3) Do I just need to be more patient and stick with the sleep hygiene routine and see what happens?
4) Regarding sleep hygiene, if I go to bed and can't fall asleep in say 30-60 minutes, should I get up? Is it OK to get up and read in a dimly lit room until the tired feeling comes back? Does this also apply if I do fall asleep for say 1 or 2 hours, then wake up and not feel tired? Or should I stay in bed and try to work through it?
5) yesterday at about 4 PM, I had an strong tired feeling wash over me. But given the time of day I resisted--it was torture. Should I just let myself go to sleep anytime given my sleep deprivation?
6) I am visiting my friends in NH on Monday. I visit them every few months and I have ALWAYS slept much better there--often through the night. They have no TV and go to bed much earlier than I usually do. Is this kind of change of venue typically helpful when dealing with insomnia? Would even going to a hotel for a few days be helpful as a way to get away from my bed?
7) Any other advice would be appreciated.
posted by Seymour Zamboni to Health & Fitness (7 answers total) 1 user marked this as a favorite
I drink a tea with Passionflower and Valerian root and I find it very helpful in getting to sleep. The one I have is Yogi Tea - Restful Sleep. For whatever reason I can't find it on any american websites but they do list a very similar one called Bedtime.

Worth a shot, maybe.
posted by aclevername at 9:04 AM on July 3, 2014

For the next two weeks, continue with consistent sleep hygiene techniques, and try to mellow out your anxiety about not sleeping. I managed to do the latter by reminding myself that I'd be able to find ways to get through the next day even if I didn't get much sleep, and that not sleeping wasn't the end of the world. (If you can reduce your responsibilities/ increase your schedule flexibility for a bit while you get this settled out, that would likely help with the anxiety.)

Opinions differ about getting up if you don't fall asleep quickly. I don't, unless I'm wide awake, because otherwise it would make me be more attentive to the clock and less likely to fall asleep. (Removing clocks from the room helps some people.)

Most people say not to nap if you're having insomnia, but there isn't a lot of evidence to support that. If you do though, I would recommend doing it no later than 2 or 3.

No caffeine.
posted by metasarah at 9:06 AM on July 3, 2014 [1 favorite]

I'm in the middle of a similar episode (sciatica) and have dealt with it before, too. I think it's just a matter of keeping at it with all you're doing right. I think you're correct in pinpointing the anxiety as the current culprit. I predict that at some point your brain is going to get bored with worrying about sleep and will revert to its normal patterns.

As for your specific questions
1) Try a timed release does of melatonin. I think I take a 3mg timed release dose by Source Naturals that helps me more than larger doses.
2) I would personally stay away from other OTC sleep aids unless your pain increases again. I think they compound the problem.
3) My opinion is yes.
4) Getting up never works for me, I'm naturally alert if I'm up. For me the work is in training my brain to shut down when I'm tired, not to give in and stay awake another 3 hours. YMMV.
5) Naps of up to 20 min can be very restorative and not interfere with nighttime sleep. I'd go for it and set a timer if you're worried about sleeping long. As with babies, "sleep begets sleep" so build up some easy wins in the sleep departments by taking advantage of short naps if you can. At least it may lessen your anxiety about getting enough sleep.
6) No idea. Seems like a lot of work for an unsustainable results (i.e., it won't necessarily help you sleep at home)
7) Try a few hypnosis or ambient tracks. Some of them help me, some don't. For me it's obvious when I find one that helps my mind check out. It's noticeable. I don't know if it's the same for you, but if you luck on something that feels like that, you could try it. Also, rewriting the anxiety chatter with stuff like, "My body knows what it's doing. When I absolutely need to sleep, my body will fall asleep." etc.
posted by cocoagirl at 9:15 AM on July 3, 2014

Your sleep hygiene sounds great, but you need to give it more time.

Instead of that last hour of TV, try switching out to an audio book/podcast. I get a paradoxical reaction of falling asleep when I'm paying close attention, so I listen to French-language news (low B back in 8th grade). Librivox (public domain audio) has audio files of trigonometry tables which are the dullest thing ever.

I found pill-form melatonin did zip. Stumbled on a liquid form and 0.25 brings deep sleep plus strange dreams.
posted by Jesse the K at 12:08 PM on July 3, 2014

Try hot milk and honey.

Also when I get into an occasional pattern of insomnia I swap myself around! ie My feet go where my head normally is or I sleep in a different room.. it just seems to shake things up a bit and help break the pattern
posted by tanktop at 1:35 PM on July 3, 2014

Can you go to the doctor and get a tranquilizer? When I hurt my hip my doctor gave me a choice of painkillers or valium to help me sleep. I choose valium and it worked like a charm. I slept 10 hours a night for a week and healed up faster than I'd any right to.
posted by fshgrl at 5:53 PM on July 3, 2014

And pain killers really didn't do much of anything to reduce the pain levels

suggests to me that your endorphins were very active.

But since β-endorphin is synthesized from a precursor molecule (POMC), the complementary cleavage product of which goes on to produce the adrenal cortex stimulating hormone ACTH, high β-endorphin levels can be accompanied by high adrenalin levels that promote sleeplessness.

You are not experiencing much pain now, but that could merely mean that your endorphins have it under control yet are still at relatively high levels, and that you still have a lot of adrenalin circulating around.

You could try trazodone, which blocks adrenergic receptors associated with sleeplessness, and helps insomnia associated with hot flashes, which can also be attributed to too much adrenalin.

Or, if you happen to have some of the painkillers that were ineffective left and they include opioids, you could try taking some of those now in hopes that they would cause down regulation of your endorphins, and that would lead to lower levels of adrenalin.
posted by jamjam at 2:34 PM on July 4, 2014 [1 favorite]

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