Advice for sleeping with sudden insomnia?
August 11, 2014 6:55 PM   Subscribe

I haven't been able to sleep well for the past week; this is totally out of the blue, as I usually get around 7 hours of z's. I think it's due to stress. I'm averaging around 3 hours on a good night, which is taking its toll on my physical/emotional/cognitive health. I'm actually dreading getting into bed tonight, and would like some advice from MeFites who are struggling with/have overcome insomnia on how I can best rig my chances for possibly sleeping well.

I've already called my doc, but I'm fairly certain that I'm just super-stressed - I don't feel like I'm very stressed, but I'm getting a lot of physical manifestations of anxiety - tense muscles, shallow breathing, headaches, etc. - and think there is quite a bit bubbling beneath the surface that my subconscious is dealing with. I certainly have enough to be stressed about.

I'm not sure if there's anything the doctor can do, and wonder if it's something I should try and deal with on my own. But it's like I just can't shut my brain off when I'm in bed, even when I feel like I should be dead tired.

So far, I've tried: Belly breathing, Benadryl, white noise, reading, and listening to some "delta wave music" on Youtube (I've even tried counting sheep...). I have f.lux installed on my computer. These strategies have nabbed me a few hours of shut eye, but I wake up at least 3 times a night and only end up with 1-4 hours of sleep.

I'm planning on incorporating an exercise regimen into my day from this point on, but in the meantime I'd just love to get some decent shut eye tonight. Fellow insomniacs, please share with me your tips on how I might fall asleep as best as I can tonight.
posted by BuddyBoo to Health & Fitness (31 answers total) 7 users marked this as a favorite
Take a B-complex vitamin about an hour before bed (in my opinion this is a lot safer than melatonin, but everyone will tell you to take it, I'm just super skeeved by unregulated hormones being sold at 1,000 times the dose of the original OTC quantity/recommendation), take a dose of ibuprofen if that's not contraindicated by a pre-existing condition.

Make the room cool or cold if you can (I use a fan and a damp washcloth, moving it around every few minutes, to get my core temp down when A/C isn't available or good).

I have a little bit of tinnitus and it makes white and other color noises a little creepy for me - I hear voices in them. So I actually prefer voices - an episode of This American Life works for me, or a podcast or audiobook (Neil Gaiman reading his own stuff has a great cadence). But for whatever reason that stuff puts me straight out if i'm not sitting upright, just about any time. Your mileage may vary, it might be too interesting. But I kind of use it as a back-up: if I can't sleep at least I'm laying down comfortably and getting a bedtime story, which keeps me from rabbit-holing down my own issues.
posted by Lyn Never at 7:09 PM on August 11, 2014 [2 favorites]

Meditation could help you quite a bit. If you're not a meditator already, it might feel a bit weird to get into, but there are some fantastic guided meditations on youtube that I find helpful to listen to while I try to sleep. Type something like "guided meditation sleep" or "sleep talkdown" and see which sounds the most calming to you - then make sure you're in a dark room, totally comfortable, without audio interruptions, take some deep breaths, and give it a shot.
posted by AthenaPolias at 7:09 PM on August 11, 2014

Go get a massage. And ask your doctor for a few day's worth of Ambien XR tablets. The extended release will help prevent the middle of the night wakefulness.
posted by elizardbits at 7:16 PM on August 11, 2014

I would ask for Xanax if you think your doctor might be open to it. I'm the last person who'd ever suggest that, honestly, but a half dose is enough to make me sleep 8 hours with happy dreams and man, am I grateful for it now that I have recurring insomnia due to stress, too.

ASMR is also an option, if that works for you. Check out GentleWhispering's channel.
posted by Hermione Granger at 7:19 PM on August 11, 2014

Usually, I have trouble sleeping. I can initially get to sleep but then wake up several times during the night, usually for at least an hour.

I tried the Whole30 challenge, a food thing, for other reasons, and started having sweet potatoes with a bit of ghee and salt at dinner. Each time, I've slept like a log that night. Turns out sweet potatoes (and some other foods) are super for sleep!

Sweet potatoes have stayed on my dinner menu.
posted by LOLAttorney2009 at 7:19 PM on August 11, 2014 [1 favorite]

I've had intermittent severe insomnia since I was a kid (ask me about being awake for 96 hours! and paranoid hallucinations!). Once it gets going, it really feeds on itself, and I think it's worth trying to cut it off at the knees with some short-term pharmaceutical assistance like Ambien or Xanax. IME, if I can get back to a normal-ish schedule for a few days, it tends to resolve for a while.

Also, if you're like me, you might be inclined to think that if a little benadryl didn't work, more benadryl might work better. This is sadly false, unless you like hangovers. B vitamins make me super-wired, but mileage varies here.
posted by dorque at 7:25 PM on August 11, 2014 [2 favorites]

You mentioned exercise, which helps me sleep better. Try to get the exercise in the day -- if I exercise in the evening it makes it harder for me to sleep.
posted by duoshao at 7:26 PM on August 11, 2014

I second meditation/relaxation. It's very individual what works, and for me, some recordings work for a while, and then don't. My recent favorite is one track of deep relaxation , Exploration # 3, 15 minutes

It ends telling you come back and be relaxed and awake, so I edited that out with audacity. Oops, You can't buy that track separately from the album. I'd still recommend it, though.

Also, darkened room (heavy curtains, shades, whatever) helps.
posted by judybxxx at 7:27 PM on August 11, 2014

The Mayo Clinic has some good information on melatonin. It's been helpful for me in the very short term for initially falling asleep; I've been having stress issues, too, and falling asleep has been difficult. With the melatonin (3 mg), I actually fall asleep and then I'm fine. My doctor advised me to use it for a week and then we'd reassess. It's been about 5 days now and I'm already feeling sleepier earlier than I had been, which I think is a good sign.
posted by cooker girl at 7:39 PM on August 11, 2014

I once had trouble sleeping due to anxious depression - like no sleep for 6 days. The doc gave me xanax, I layed in bed very f'd up not sleeping for several more.
Xanax works different on different people.

Depression doesn't always look like what you think.

Prozac made me saner, but trazadone lets me sleep. I have concurrent scripts for both with my Doc's blessing. I've found the trazadone is the thing that helps, even my sleep-nazi doctor said it was the one thing he would permit - after saying no alcohol for four hours before bed and lots of other fun stuff.
Oddly, while it sends me off to pleasant dreams/clear head in the morning, some folks find the opposite effect.

And yup, I know about the hallucinations, it starts with me after about 6 days.... rats in the corners of my vision.. I can never turn my head fast enough to see where they went. Fun times....
posted by rudd135 at 7:41 PM on August 11, 2014

Are you on any medications that may be causing insomnia? Or have you recently come off a medication?

As a temporary fix, I would suggest 1 MG of melatonin or valerian root tea (yes, it is supposed to smell that bad!)
posted by girl flaneur at 7:41 PM on August 11, 2014

I have suffered from insomnia since I was a wee tot, like four or so years old. I have tried every trick in the book over the years and a few things have worked.

Exercise. Not just a half-hour walk either, but like 45-60 minutes of intense aerobic exercise coupled with another 45-60 minutes of weight lifting with free weights.

A sleep mask or blindfold that blocks out all light.

A documentary or re-run of a show I've seen several times before, playing on headphones at a volume so low that I have to strain to hear it. My brain will follow the familiarity of it down into sleep, letting go of the crazy concerns that it would normally have cycled through over and over and over and over and over....

Melatonin works in tiny doses, like, a 1mg tablet snapped into eight pieces. I take one of the pieces. (If I take a 1mg or 3mg tablet, it's like taking speed.)

What doesn't work or works only sometimes:

Benadryl sometimes works but it gives me a hangover.

Calcium-magnesium supplements work on my SO but give me the worst headaches I've ever had in my life.

Valerian gives me nightmares; I'd rather not sleep than sleep via valerian.

Turning around in my bed so that I am sleeping with my head where my feet normally are. (Don't know why this works, but it sometimes does.)

What I think you should do:

Hit up your doctor for some short term sleeping meds and make a pact with yourself that they are short term.
posted by GoLikeHellMachine at 7:44 PM on August 11, 2014 [2 favorites]

Good sleep hygiene will help improve your sleep, although it won't resolve any underlying issues. There's a lot of stuff you can do but I think the three biggest to do are:

Only spend time in bed when you're sleeping.

Go to bed and wake up at the same time every day.

When you wake up in the middle of the night and can't fall back asleep, get out of bed. I personally hate this and it feels totally counterintuitive, but lying awake in bed and feeling miserable fuels sleep anxiety. Turn on a dim light and do something dull-- read a boring book or work on easy crossword puzzles. NO electronics. As soon as you start to feel sleepy, get back into bed. Repeat as necessary.

OTC sleep meds and melatonin are worth considering but YMMV.
posted by fox problems at 7:54 PM on August 11, 2014 [1 favorite]

Avoid alcohol, if you're not already. It keeps you from falling into and staying in deep sleep patterns.
posted by jaguar at 7:57 PM on August 11, 2014 [1 favorite]

I struggled with anxiety-induced insomnia during a period of intense stress. With the help of my therapist I managed to greatly improve things. All of these are non-pharmaceutical and fairly easy to implement, but getting a prescription to help you sleep in the short term might be a good thing to add to the arsenal. Here goes:

- Make the room very dark, and slightly cold, with warm blankets.
- If the bed is too hard, get a foam pad underneath to make it more comfy.
- Use the bed only for sleeping and sex; no reading or lounging.
- Exercise during the day if you can.
- Cut back on caffeine. Especially, no caffeine in the afternoon, preferable after noon, definitely after 4pm.
- Go to bed when tired, but aim for regularity in sleep and wake times. (Don't try any drastic shifts)
- Make sure there is not a digital clock visible in your room; it will just stress you out if you can see the time.
- Block off a decompression period thirty minutes before bed with no computers or phones; do something relaxing.
- A relaxation technique called "Progressive Muscle Relaxation" (video) was very helpful. This is a good thing to do before bed as it helps you shake off tension and stress.
- When lying in bed, techniques like counting sheep are actually a really good way to keep the mind from getting worked up. It's important not to start thinking about things which might make you more alert and stressed.

Now -- the key thing is what happens when you can't fall asleep, or when you wake up and can't get back to sleep. This is where the stress or anxiety can really start to spiral, because you start to stress about the fact that you're awake, and that makes you more alert. Here are some strategies:

- If you have been in bed trying to sleep for more than about 30 minutes, stop, and get out of bed.
- Go to the living room. Have the lights turned dim.
- Make a cup of herbal tea (non-caffeinated!) or a similar relaxing drink.
- Consider doing some stretches or the relaxation technique above.
- Read a boring book. You should find such a book while awake, and place it in the living room in an obvious spot, so you don't have to think about what to read or where it is. The point of this is to give your mind something to focus on without giving it an opportunity to get active and wake up. If the book is too interesting, it will wake you up. If you have nothing to focus on, you might stay stuck in the anxiety loops that were keeping you up. My personal choice is a bicycle repair manual.
- When you feel tired, go to bed again and try to sleep. Don't go back to bed until you're tired.
- If you go back to bed and can't sleep after 30 minutes, get up again. Repeat.

Getting out of bed when sleeping isn't working proved to be a really valuable weapon. After some experience I came to agree with my therapist that once the mind is stuck in an anxiety cycle that is keeping me awake, it is very hard to get out of it while lying in bed. But physically leaving the bedroom and focusing on something else makes a big difference. It may feel wrong to be up and reading at 3am, but it is actually far more effective than lying awake and trying to force sleep.
posted by PercussivePaul at 8:12 PM on August 11, 2014 [1 favorite]

I'm actually dreading getting into bed tonight

This is huge. It is now "in your head" and you are anxious about sleep. This happened to me recently. I had a 4 week bout of severe insomnia (like 0-1 hour of sleep per night) that started because of a lower back injury with bad pain, but then morphed into an anxiety-driven problem after my back pain went away and I was physically fine. The anxiety was about sleep. I became obsessed with sleep and like you I would dread bed time. I tried everything: sleeping pills, vicodin, melatonin, sleepy time tea, white noise, ocean wave CD's, all the usual sleep hygiene rules. But I was freaking out. And I know the sleep hygiene rules work for some people, but they fueled my anxiety because it became ritualistic and with the rules came expectations and with unmet expectations came more anxiety.

Finally, I realized that I was my own worse enemy. So I stopped caring. I really just decided to not care about sleep anymore. I dropped the rules and went back to my familiar routines. I went to bed, and just said to myself "if I sleep, great, and if I don't I will just rest here, whatever, it doesn't matter". And my sleep started to improve. And once it started to improve, I became less anxious about sleep which helped even more, and I got myself into a positive feedback loop which fixed the problem.
posted by Seymour Zamboni at 8:14 PM on August 11, 2014 [7 favorites]

Oh, one more thing that helps me. Sometimes when I get up after not being able to sleep, I am able to fall asleep on the couch in the living room. Just being away from the bed is enough. Worth a shot, if you have such a setup.
posted by PercussivePaul at 8:20 PM on August 11, 2014

50mg of Benadryl.

I'm actually dreading getting into bed tonight

Perhaps it would be easier to fall asleep somewhere you're not "supposed" to, like the couch? Or when you're not "supposed" to, like while you're reading a book? A lot of people find it easier to fall asleep when they're not stressing over trying to fall asleep.
posted by Jacqueline at 8:25 PM on August 11, 2014 [1 favorite]

Beware of advice that says "X totally helped me to sleep" - insomnia can have many causes, and a treatment that worked for someone else won't work for you if the underlying cause is different. See my previous answer on this topic: Sleep-sleep-sleep
posted by HiroProtagonist at 8:25 PM on August 11, 2014

Melatonin works for me. I take it about half an hour before I want to go to sleep, I read in bed like I usually do, I get really drowsy, and I fall asleep.

I have had cycles where I lose sleep and stress/anxiety/fatigue causes me to lose sleep the next night, continuing for a week or 10 days. Melatonin breaks that cycle. I don't use it routinely--only if I'm expecting a bad night.

I think I've had one time where it just didn't work, out of 20 or 30 uses.

It doesn't take much. I started taking 2.5 mg but that's way more than I need. I take part of a pill now, maybe 0.8 mg (n.b. less than 1 mg). I would advise not taking more than 2 mg to start. It's sold in much higher doses, but more is not better here.

Melatonin doesn't stop me from waking up early in the morning and having trouble falling back asleep, but that, while imperfect, is more restful and less stressful than not falling asleep in the first place.

Note that this is not a sleeping pill, it's a hormone that works with your normal sleep cycle. Don't take it except as a nudge at your usual bed time. If you take it at weird hours you'll only confuse your body.
posted by mattu at 8:42 PM on August 11, 2014

There is a lot that doctors can do about insomnia. In addition to the other drugs that have been mentioned, trazodone is another option for sleep that has the distinction of not being physically addicting. Ambien and benzodiazepines like Xanax can work well for people, and many people don't have a problem using them for short term purposes, but they do both cause tolerance, dependence, and withdrawal. After talking with your doctor they can discuss more about what's best for you and whether medications for sleep are necessary. They will likely ask you about sleep hygiene first - i.e. no caffeine, no daytime naps, no screen time in bed, so I would definitely recommend you ensure that your sleep hygiene is top notch prior to seeing them.
posted by treehorn+bunny at 8:58 PM on August 11, 2014 [1 favorite]

Super dark room.
No LCDs etc. an hour before bedtime.
No caffeine after 2 or 3 (this changed really suddenly for me).
No work/TV/etc. in bed.
Get out into the sun in the morning soon after you wake up, if you can.
Hot bath before bed. (This is essential for me because it relaxes my muscles, but I know it has the opposite effect on some people.)
Appreciation: I list off to myself 5 good things from the day and why they were good. Today was a terrible day, but the 5 things can be little, like "I actually had salad for dinner, which is good because I got my vegetables." If I lose track because stressy thoughts distract me or whatever, I start over. If I get through all 5 and I'm not asleep yet, I try to do it one more time. Last night I drifted off before I got through the first one!

Hang in there!
posted by wintersweet at 9:20 PM on August 11, 2014 [1 favorite]

A lot of people have already provided some great sleep hygiene suggestions for you, so all I can really add is some input about vitamins/supplements that may be helpful to try. YMMV, but I've found these fairly effective for my insomnia: Theanine, GABA, Melatonin (1-3 mg; used infrequently) and Magnesium (start in small doses to avoid GI upset).

When I worked in a vitamin store, many customers found benefit from Valerian as well. It smells pretty awful though.

If you want to go the pharmaceutical route, perhaps inquire about an anti-anxiety med rather than a sleep one.
posted by stubbehtail at 10:02 PM on August 11, 2014

Melatonin and Valerian helped me immensely when I had to get up for school at 5:30 am, but was kept up until 3am by anxiety. I started taking it on the weekend when I didn't need to be up at any time, just to begin with a clean slate, so to speak. I washed all the sheets and comforter as well. (Somehow my brain finds a really clean bed more soothing, senseless as that may be.) I think I would have failed all my classes that semester if those things hadn't helped.
posted by oneirodynia at 11:03 PM on August 11, 2014

Valerian root tea has worked for me rather well as long as it's concentrated enough, though it tastes unpleasant. I used to take Ambien extended release, which I would not recommend at all in general (unless it's an emergency situation) but especially if you need to be peppy in the morning. Non-extended ambian worked better for waking up. The problem I found with both, however, was that it did nothing to reset my sleep schedule on nights that I didn't take it, I had the same level of insomnia.

Perhaps surprisingly, what is working for me right now better than anything has been daily exercise and magnesium glycinate supplements. They have less of a knockout punch than Ambien of course, but keep me asleep deeply all night.

As with all sleep issue solutions, YMMV. Wish you the best of luck!
posted by equestrian at 1:34 AM on August 12, 2014

I had some sleep issues for a while and a routine of aggressive sleep hygiene helped. Basically, I did everything PercussivePaul suggests. It took about five weeks to work, but it eventually did the trick. YMMV -- just adding an anecdotal data point (if "anecdotal data point" isn't totally oxymoronic).

I would also add a few extra tips:

• Get up in the morning and get outside and see some morning sunlight. Throughout your waking hours, cut down on your use of artificial lights and glowing screens as much as you can, especially at nighttime.

• Avoid naps during the day, if you can get by without them.

• Everybody knows to avoid caffeine, but people often forget about theobromine, the stimulant in chocolate. Theobromine is more gentle but stays in your body longer. Personally, I've found that if I have too much chocolate too close to bedtime, it doesn't effect my initial sleep -- but I am much more likely to wake up in the middle of the night.

• I noticed that processed sugar strongly affects my energy levels and wakefulness, so I gave it up entirely during my battle against insomnia. This might be overkill for you, but if you have as much of a sweet tooth as I do, it might be worth monitoring how it affects your own wakefulness and adjusting accordingly.

• If you are going to medicate your insomnia with anything stronger than herbal tea, I hope you will have a conversation with your doctor about the specific substances you are considering and what the long-term health and addiction concerns might be in your specific case. I always get a little nervous when I see people recommending medications or powerful herbal supplements to each other on the Internet. I know it's offered in the spirit of "This worked for me, but ask your doctor about it before you try it" but I figure it's worth making that explicit.
posted by yankeefog at 2:09 AM on August 12, 2014

Benadryl wires me. I would not do that. I say: Cut caffeine. Clean/organize your bedroom so it's a sanctuary. No screens in bed or right before bad. And pop two Tylenol PMs and go to sleep when your body is feeling super sleepy from the pills. You might feel a little groggy in the morning from the pills if you don't go to bed early. I normally take one but if you're struggling, take two. Obviously, don't take them every night, but once every so often is totally fine. It definitely works. Funny story: I accidentally took a Tylenol PM instead of a regular PM in the middle of the day. I thought I had come Ha.
posted by AppleTurnover at 3:55 AM on August 12, 2014

Seconding Seymour Zamboni that by worrying about sleep, you can prevent yourself from ever acheiving it. I know from experience. I also read somewhere that worrying about something causes your brain to periodically check up on that thing, and (so helpfully!) when it checks to see if you're sleeping, it wakes you up.

After struggling for years with insomnia, and subsequently an ambien dependence, I got the best advice from my father (a doctor who frequently gets called in to work at all hours of the night): Just get used to going without sleep!

Not because sleep isn't important, but because worrying about it will actively prevent you from sleeping. Spend your late nights preparing for the next day. Clean the kitchen, lay out your clothes, pack a lunch, get the coffee maker ready with extra strong beans, floss. That way even if, worst case scenario, you don't get a single moment of shut eye, you are as prepared as you can possibly be to face the day.
posted by BusyBusyBusy at 4:08 AM on August 12, 2014 [4 favorites]

I just went through this! I had a person going through my backyard at night just after my dad died. I ended up having anxiety every time I went to bed. And then it turned into having anxiety about having anxiety. I tried Lunesta and then Ambien to get me through it. 3 months later and I was still having problems. And then I remembered that I am a Christian and I'm pretty comfortable with prayer so I gave it all over to God and haven't had any problems since.
posted by myselfasme at 6:28 AM on August 12, 2014

I would second almost all of the above regarding sleep hygiene, abstention from caffeine and chocolate, relaxation/meditation/prayer, reducing stress factors, vitamins, and so on. Self-hypnosis works for some - often by thinking about a hypothetical scenario you can relate to or are interested in; this helped me when I had about a decade of difficulty going to sleep in my late teens/early twenties.

Melatonin is worth a try (dosage recommendations vary), as is Valerian. Benadryl has been mentioned - this contains a sedating first generation antihistamine (diphenhydramine) in North American preparations, but a different non-sedating second generation antihistamine in other geographical markets (this may explain why it doesn't work for some, although some people are also prone to "paradoxical alertness" with certain sedatives). Other sedating first generation antihistamines include Promethazine (sold as Phenergan in the UK) and Clorpheniramine (Piriton). Other miscellaneous medications with potentially useful sedative side effects include Amitriptylene (an old-fashioned antidepressant that is experiencing a renaissance as a cheap second-line drug for chronic pain syndromes and night-time urinary incontinence; 20mg taken before bed can be helpful but will give you a dry mouth) and Clonidine (an old-fashioned centrally-acting antihypertensive that is nowadays widely used in critical care for sedation and analgesia; 100mcg in the evening should help). Watch out for morning hangover effects as these are not exactly short-acting drugs, and for god's sake don't combine them unless in very low doses (Clonidine is also available in 25mg tablets).

Whatever you do, make sure to view your "treatment" regimen as temporary and get back to "normal" as soon as possible. Having supportive partner/friend-with-benefits/friends-without-benefits/family members/coworkers helps a lot ... don't hide your problems away or they are bound to become chronic.
posted by kairab at 7:15 AM on August 12, 2014

I can sympathize, I've dealt with sleep issues for the past 15-20 years, tried most of the above....

What ended up working best for me is to listen to podcasts/audiobooks. I started out with a science fiction podcast called the Drabblecast, he has the most soothing voice... I listen to it, sometimes my brain kicks back in and I do my worrying.... but I continued to listen. At first I would hear an hour or two of the story/podcast but after a few weeks, I found I woke up about 2 am and realized I hadn't heard but about 30 minutes of the podcast. So I reset it, then would wake up again and reset back to where I remembered and found it was about 15 minutes in.

Now having done this for over 2 years, when I go to sleep with a book or podcast (I save up a few and let them go from one to another) I find I wake up only occasionally. When I reset the audio it often is just a 5 to 15 minute piece of the story that I heard. Just knowing that my awake periods actually totaled less than an hour instead of the several hours it felt like gave me some peace of mind and made me feel more rested than when I thought it was half the night I was awake.

A very important piece of this for me is the earphones. I use either earbuds or a sleep mask that has speakers built in. I'm fortunate in being able to sleep with the buds in and not get tangled up in the wire. The sleep mask isn't as successful for me, the earbuds focus the sound and covers the external noises that used to bother me.

Now I listen to audio books (Game of Thrones comes in 30-40 hour volumes, takes forever to listen to one if I don't also listen in the car....) I just wish I had done this years earlier!
posted by IpsoFacto at 12:38 PM on August 12, 2014 [1 favorite]

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