Sleep scheduling hacks
September 15, 2015 8:37 AM Subscribe
I need to go to bed and get up (much) earlier, and be moderately functional in between, asap. What are your tips? (Difficulty level: chronic night owl)
Ideally, I'd ramp up to it over a few weeks, but I need to just get it done, now. It's a significant time shift. I've been trying to make a change these past few weeks by waking up at the same time as often as possible, but my sleep onset time isn't shifting backward along with it.
Net result is that I'm on 4-5 hours' sleep for several days in a row (usually feeling unwell and nauseous for the first half of the day, I think because I'm getting up at a weird time in my sleep cycle), accumulating sleep debt, and then sleeping through (i.e. not even remotely hearing) my three very loud alarms, which sets me back to my starting point.
I live on my own, so can't ask anyone to throw a brick at my head at my target wake time.
I am not really cool with hypnotics. OTC stuff is ok, I guess; am supposed to stay away from anything with antihistamines, due to possible interactions.
I'm familiar with sleep hygiene, but find it difficult to regularly enforce. Any tips on being better about this?
Any ideas on making it through the day like a normal person (i.e. not being nauseous)?
I recently tried a full-on assault - took 0.5 mg melatonin 8 hours before target sleep time, got light exposure immediately (30 mins walking outside), reduced blue light sources in the evening - it was all I did for a couple of weeks - found it exhausting and was easily thrown the second I let up my vigilance (by going out and doing a normal evening thing like normal people do).
TIA.
Ideally, I'd ramp up to it over a few weeks, but I need to just get it done, now. It's a significant time shift. I've been trying to make a change these past few weeks by waking up at the same time as often as possible, but my sleep onset time isn't shifting backward along with it.
Net result is that I'm on 4-5 hours' sleep for several days in a row (usually feeling unwell and nauseous for the first half of the day, I think because I'm getting up at a weird time in my sleep cycle), accumulating sleep debt, and then sleeping through (i.e. not even remotely hearing) my three very loud alarms, which sets me back to my starting point.
I live on my own, so can't ask anyone to throw a brick at my head at my target wake time.
I am not really cool with hypnotics. OTC stuff is ok, I guess; am supposed to stay away from anything with antihistamines, due to possible interactions.
I'm familiar with sleep hygiene, but find it difficult to regularly enforce. Any tips on being better about this?
Any ideas on making it through the day like a normal person (i.e. not being nauseous)?
I recently tried a full-on assault - took 0.5 mg melatonin 8 hours before target sleep time, got light exposure immediately (30 mins walking outside), reduced blue light sources in the evening - it was all I did for a couple of weeks - found it exhausting and was easily thrown the second I let up my vigilance (by going out and doing a normal evening thing like normal people do).
TIA.
easily thrown the second I let up my vigilance (by going out and doing a normal evening thing like normal people do).
I'm an early riser and I consider myself fully adapted, but going out late in the evening still has the ability to throw me off for several days thereafter. I think you need to expand your definition of "normal people." Normal for me is being home no later than 8:30 so that I can be in bed by 9:30. I don't live with the mole people or have no social life whatsoever, but I make sure to go home in time to go to bed.
Do you drink coffee or soda? Drinking coffee early in the morning (upon waking) and then having absolutely no caffeine for the rest of the day helps me reinforce an earlier bed time.
posted by telegraph at 8:45 AM on September 15, 2015 [3 favorites]
I'm an early riser and I consider myself fully adapted, but going out late in the evening still has the ability to throw me off for several days thereafter. I think you need to expand your definition of "normal people." Normal for me is being home no later than 8:30 so that I can be in bed by 9:30. I don't live with the mole people or have no social life whatsoever, but I make sure to go home in time to go to bed.
Do you drink coffee or soda? Drinking coffee early in the morning (upon waking) and then having absolutely no caffeine for the rest of the day helps me reinforce an earlier bed time.
posted by telegraph at 8:45 AM on September 15, 2015 [3 favorites]
Keep a bottle of water by your bed and drink it (all) upon waking. You say you have trouble even hearing your alarm go off so this is a step beyond that, I realize, but once you're actually up it'll help tremendously. A lot of morning-zombie fogginess is simple dehydration.
posted by phunniemee at 8:46 AM on September 15, 2015 [7 favorites]
posted by phunniemee at 8:46 AM on September 15, 2015 [7 favorites]
Drink water before bed. Will make you get up in the am to pee. Then, the real hardship is staying up.
I'm a chronic night owl and my only solution is not putting myself in morning situations. I have left jobs for jobs with more flexible hours because of this.
posted by slateyness at 8:48 AM on September 15, 2015 [3 favorites]
I'm a chronic night owl and my only solution is not putting myself in morning situations. I have left jobs for jobs with more flexible hours because of this.
posted by slateyness at 8:48 AM on September 15, 2015 [3 favorites]
Wake up at the same time every day. Don't sleep in on weekends, or on days off. Get up at whatever time you usually get up - even if that is 7am on a Sunday.
I also use an app called Sleep Cycle to track my sleep. It also has a feature where it will wake you up at your lightest point in a sleep cycle. I set it to wake me up between 6:15 and 6:45am every single day and the alarm goes off when I'm easiest to wake - a nice way to start the day.
posted by schroedingersgirl at 8:54 AM on September 15, 2015 [6 favorites]
I also use an app called Sleep Cycle to track my sleep. It also has a feature where it will wake you up at your lightest point in a sleep cycle. I set it to wake me up between 6:15 and 6:45am every single day and the alarm goes off when I'm easiest to wake - a nice way to start the day.
posted by schroedingersgirl at 8:54 AM on September 15, 2015 [6 favorites]
I find that sucking on a peppermint Altoid helps with the "got up too early" nausea.
I also found that tracking my sleep with a Fitbit helped me be a little more responsible about when I went to bed -- I knew that I'd be looking at the data over the next week and regretting staying up later.
posted by pie ninja at 8:57 AM on September 15, 2015 [1 favorite]
I also found that tracking my sleep with a Fitbit helped me be a little more responsible about when I went to bed -- I knew that I'd be looking at the data over the next week and regretting staying up later.
posted by pie ninja at 8:57 AM on September 15, 2015 [1 favorite]
Best answer: You may have already tried some of these things, but I had a decent amount of success by really focusing on light control. I know you mention morning light and reduced blue light, but I found I had to really go all out to get any effect.
Here's a recent answer I posted where I included Amazon links for everything, since I don't have time to re-write everything. The general idea is that a couple hours before bed, I put on my blue light blocking goggles, and I keep them on until I am in bed, about to go to sleep. I use an orange light in my room at this same time. I switched the night lights in the house to red lights. I covered up any appliances that gave off bright/blue light with some kind of translucent orange paper. It's not full proof, but it makes a huge difference.
I also replaced my overhead light with daylight bulbs like these. I also use a sun lamp for at least 30 minutes in the morning. (I would link to it but for some reason Amazon gave me an error when I tried to find it in my recent orders.
This stuff has been really helpful, but none of it is perfect. I am an extreme night owl, and I have had the same experience as you, in that as soon as I let myself slip for one night, I get completely thrown off again. Still, this regimen has been the best set up for me so far.
Also, I can't take any hypnotics or anything like that for sleep, but I do take clonidine nightly. It's kind of like a beta blocker, although it acts on different receptors. It is used as a blood pressure medication, but it has a lot of off label uses for things like anxiety, alcohol withdrawal, ADHD, etc. I take it each night, .2 or .3 mg, and I've done it for years now. Not addicting, never had to increase my dose. It stops having any effect after about 6 hours or so, which means it doesn't make me hungover the next day.
It doesn't knock me out the way something like seroquel does (which is a good thing as far as I'm concerned) but it seems to help my brain and body chill out. It's the kind of thing where if I'm not good about sleep hygiene, I could easily stay awake, but if I do work with the medication rather than against it, it helps make it possible for me to go to sleep.
I also use it very occasionally at a lower dose (.1 mg) for anxiety (like when I'm on a plane). Since I can't take benzos or anything like that, it's nice to have for those occasions as well.
One thing is if you have low blood pressure, it may not work for you. Of course, IANAD, IANYD, this is just something to consider and maybe talk to your doctor about.
posted by litera scripta manet at 8:57 AM on September 15, 2015 [7 favorites]
Here's a recent answer I posted where I included Amazon links for everything, since I don't have time to re-write everything. The general idea is that a couple hours before bed, I put on my blue light blocking goggles, and I keep them on until I am in bed, about to go to sleep. I use an orange light in my room at this same time. I switched the night lights in the house to red lights. I covered up any appliances that gave off bright/blue light with some kind of translucent orange paper. It's not full proof, but it makes a huge difference.
I also replaced my overhead light with daylight bulbs like these. I also use a sun lamp for at least 30 minutes in the morning. (I would link to it but for some reason Amazon gave me an error when I tried to find it in my recent orders.
This stuff has been really helpful, but none of it is perfect. I am an extreme night owl, and I have had the same experience as you, in that as soon as I let myself slip for one night, I get completely thrown off again. Still, this regimen has been the best set up for me so far.
Also, I can't take any hypnotics or anything like that for sleep, but I do take clonidine nightly. It's kind of like a beta blocker, although it acts on different receptors. It is used as a blood pressure medication, but it has a lot of off label uses for things like anxiety, alcohol withdrawal, ADHD, etc. I take it each night, .2 or .3 mg, and I've done it for years now. Not addicting, never had to increase my dose. It stops having any effect after about 6 hours or so, which means it doesn't make me hungover the next day.
It doesn't knock me out the way something like seroquel does (which is a good thing as far as I'm concerned) but it seems to help my brain and body chill out. It's the kind of thing where if I'm not good about sleep hygiene, I could easily stay awake, but if I do work with the medication rather than against it, it helps make it possible for me to go to sleep.
I also use it very occasionally at a lower dose (.1 mg) for anxiety (like when I'm on a plane). Since I can't take benzos or anything like that, it's nice to have for those occasions as well.
One thing is if you have low blood pressure, it may not work for you. Of course, IANAD, IANYD, this is just something to consider and maybe talk to your doctor about.
posted by litera scripta manet at 8:57 AM on September 15, 2015 [7 favorites]
I suggest you try melatonin again, but differently. First of all, melatonin has an extremely short half-life (something like 30–60 mins), so I think if you want to get a full night's sleep, you should take an extended-release version. I used to take the immediate-release version and wake up extremely alert around 2:00–3:00a, which was counterproductive to a good night's sleep.
Next, I think you should try at least 3 mg of melatonin XR for a full night's sleep. If that doesn't work, try 6 mg. (I take 12 mg per night, but that's probably more than most people should take.)
Lastly, take it 30–45 mins before you get in bed (preferably the same time every night); that will allow you time to get in bed and wind down for 10–15 mins before falling asleep. When you start to feel sleepy, put your phone up and try to fall asleep, otherwise you might miss your window of opportunity.
This is my favorite brand/formulation of melatonin (Douglas Labs melatonin P.R. 3 mg), mostly because it's based on an 8-hr release. Most of the other brands I've tried have been based on a 6-hr release, which is great if you only want six hours of sleep, but I prefer a full 7–8 hrs.
posted by rbw at 8:58 AM on September 15, 2015 [5 favorites]
Next, I think you should try at least 3 mg of melatonin XR for a full night's sleep. If that doesn't work, try 6 mg. (I take 12 mg per night, but that's probably more than most people should take.)
Lastly, take it 30–45 mins before you get in bed (preferably the same time every night); that will allow you time to get in bed and wind down for 10–15 mins before falling asleep. When you start to feel sleepy, put your phone up and try to fall asleep, otherwise you might miss your window of opportunity.
This is my favorite brand/formulation of melatonin (Douglas Labs melatonin P.R. 3 mg), mostly because it's based on an 8-hr release. Most of the other brands I've tried have been based on a 6-hr release, which is great if you only want six hours of sleep, but I prefer a full 7–8 hrs.
posted by rbw at 8:58 AM on September 15, 2015 [5 favorites]
We got one of those gradual-awakening lamps that slowly turns up over 30 minutes, then turns the radio up over 2 minutes at the appointed awakening time. (It also has a couple of other alarm options, but I'm a light sleeper and don't need them.)
I also have a set of boring podcasts that I listen to only at bedtime, to condition my brain to think "this podcast=sleepytime."
posted by telophase at 9:05 AM on September 15, 2015 [2 favorites]
I also have a set of boring podcasts that I listen to only at bedtime, to condition my brain to think "this podcast=sleepytime."
posted by telophase at 9:05 AM on September 15, 2015 [2 favorites]
Best answer: i'm pretty certain i have DSPD - i'm a lifelong night-owl - i really get clear-headed and productive between 10PM and 3AM naturally. there is no way i am ever going to be in any office anywhere by 7AM. but i have battled to get to 8:30 pretty consistently. The critical elements for me are:
- 45 minute brisk walk after supper
- in bed by midnight, asleep by 1AM
- an alarm by the shower, so when i hit it, i step right in
it's maddening to be burdened with this 'not-normal' body-clock - and to be judged for it as if it were a matter of character...self-acceptance, etc.
posted by j_curiouser at 9:06 AM on September 15, 2015 [11 favorites]
- 45 minute brisk walk after supper
- in bed by midnight, asleep by 1AM
- an alarm by the shower, so when i hit it, i step right in
it's maddening to be burdened with this 'not-normal' body-clock - and to be judged for it as if it were a matter of character...self-acceptance, etc.
posted by j_curiouser at 9:06 AM on September 15, 2015 [11 favorites]
Do you have the sort of life, or is your shift early enough, that you could go to bed after work in addition to or instead of before? My dad has worked third shift my whole life; he takes a 2 hr nap at dinnertime, goes to work, and gets 5-6 hours after he comes home. If it's something like a 3-11am bakery shift, you might be able to do that.
posted by tchemgrrl at 9:13 AM on September 15, 2015 [1 favorite]
posted by tchemgrrl at 9:13 AM on September 15, 2015 [1 favorite]
When I've had to do a sudden switch, I force myself to stay up for 24 hours (or whatever number fits; skip sleeping one night is the thing). Instant reset.
posted by feckless fecal fear mongering at 9:33 AM on September 15, 2015 [2 favorites]
posted by feckless fecal fear mongering at 9:33 AM on September 15, 2015 [2 favorites]
Best answer: Until you get it locked in and habitual, you really have to spend your whole evening in service of bedtime. Get yourself some paper books or an e-ink reader, or use your phone ONLY for listening to podcasts/books and do not look at the screen for more than the necessary 20 seconds or so that requires. Spend screen/socialization time on self-care instead. Have a small carby pre-bed snack, and make it something you really enjoy like half a really good bagel or the EasyMac you'd normally never admit to eating or a scoop of your favorite restaurant's fried rice.
Only you can apply the self-discipline to do this, but treat yourself to good books/podcasts so you enjoy that time, accept that it will not be forever and there will be a point where you can (judiciously!) have screen time or be social in the evenings, but for now you can't and you have to do other things, and then you have to go to bed at bedtime.
Secret a lot of people don't know: lots of people who have a sleep routine go to bed at bedtime, not when they feel like it, and it's much like cleaning when it's time to clean instead of waiting until you feel like doing it (never). The other secret is that most people have several windows of time in the evening when getting in bed and laying down results in sleep, and you have to figure out when yours are. Mine are about 9-9:30 and 10:15-10:45 (which is bedtime), and then one I rarely use at about 12:15, but the early window is really only a 3-season window since the sun's barely down in the summer (though if I'm not feeling well, it works).
I don't go out on weeknights, it fucks everything up. I sleep in a tiny bit on weekends (like 8, 8:30 at the latest) but the older I get the more I'm likely to still go to bed at 10.
When it's critical or I've had a bad schedule, I take about a third of a doxylamine succinate (Unisom, Drugstorebrand-som, but make sure it's the doxy and not diphenhydramine). Any more than that knocks me out too hard, but a third (it's really hard to cut in thirds, but it's really cheap too so it doesn't matter if you shatter a few) will get me to sleep and keep me there until my natural cycle kicks in.
Also, on more difficult nights I put on the Sleep With Me podcast, with the sleep timer set to 30 or 45 minutes. I like some of their storyline(ish thing)s better than others, which seems like a dumb thing to say about a podcast you are meant to not hear and which knocks me out in 10 minutes, but some of them have a cadence I like better, I guess.
I use the iHandy Alarm Clock Pro app with 3 alarms set to a non-jarring song (plus one "you have overslept GET UP NOW" alarm that plays Van Halen's Panama if I'm not up and turned off the app already), so at bedtime I put my phone on the charge cable, start the podcast in Overcast, set the sleep timer, button out of Overcast and open Alarm Clock Pro (it has to be the most-recently opened app to work in the morning), lock the screen, put it face down on the dresser, and turn out the light.
(On preview, I also agree with fffm: stay up 24 hours. It sucks, but it gets me to reset and then renews my reverence for The Schedule.)
posted by Lyn Never at 9:38 AM on September 15, 2015 [10 favorites]
Only you can apply the self-discipline to do this, but treat yourself to good books/podcasts so you enjoy that time, accept that it will not be forever and there will be a point where you can (judiciously!) have screen time or be social in the evenings, but for now you can't and you have to do other things, and then you have to go to bed at bedtime.
Secret a lot of people don't know: lots of people who have a sleep routine go to bed at bedtime, not when they feel like it, and it's much like cleaning when it's time to clean instead of waiting until you feel like doing it (never). The other secret is that most people have several windows of time in the evening when getting in bed and laying down results in sleep, and you have to figure out when yours are. Mine are about 9-9:30 and 10:15-10:45 (which is bedtime), and then one I rarely use at about 12:15, but the early window is really only a 3-season window since the sun's barely down in the summer (though if I'm not feeling well, it works).
I don't go out on weeknights, it fucks everything up. I sleep in a tiny bit on weekends (like 8, 8:30 at the latest) but the older I get the more I'm likely to still go to bed at 10.
When it's critical or I've had a bad schedule, I take about a third of a doxylamine succinate (Unisom, Drugstorebrand-som, but make sure it's the doxy and not diphenhydramine). Any more than that knocks me out too hard, but a third (it's really hard to cut in thirds, but it's really cheap too so it doesn't matter if you shatter a few) will get me to sleep and keep me there until my natural cycle kicks in.
Also, on more difficult nights I put on the Sleep With Me podcast, with the sleep timer set to 30 or 45 minutes. I like some of their storyline(ish thing)s better than others, which seems like a dumb thing to say about a podcast you are meant to not hear and which knocks me out in 10 minutes, but some of them have a cadence I like better, I guess.
I use the iHandy Alarm Clock Pro app with 3 alarms set to a non-jarring song (plus one "you have overslept GET UP NOW" alarm that plays Van Halen's Panama if I'm not up and turned off the app already), so at bedtime I put my phone on the charge cable, start the podcast in Overcast, set the sleep timer, button out of Overcast and open Alarm Clock Pro (it has to be the most-recently opened app to work in the morning), lock the screen, put it face down on the dresser, and turn out the light.
(On preview, I also agree with fffm: stay up 24 hours. It sucks, but it gets me to reset and then renews my reverence for The Schedule.)
posted by Lyn Never at 9:38 AM on September 15, 2015 [10 favorites]
+1 for same bedtime / wake-up time 7 days/wk if you're not already doing that. Also you don't say what your issue is with the drugs (and your link has a login wall), but even a week or two of Ambien and never again would make a big difference in resetting your internal clock.
posted by neat graffitist at 9:44 AM on September 15, 2015 [2 favorites]
posted by neat graffitist at 9:44 AM on September 15, 2015 [2 favorites]
Best answer: I've struggled with this my whole life. Like slateyness, I have literally foregone jobs that would've required me to be in the office at 9AM. Weirdly what "fixed" me was visiting Australia a few years ago: ever since, I've woken naturally every day at 7AM. I don't know why, but I am glad. Life is much easier now.
When I was a night owl, I tried everything to shift my schedule, both for one-off events and sustained periods. Here's what I found:
-- Focusing on getting to sleep when I wasn't sleepy was annoying and unsuccessful. I was more successful when I focused on getting up early, and let falling asleep be a byproduct of getting up early, rather than the reverse.
-- That said, trying to trick myself into falling asleep early, once I had already been getting up early for a few days, did help.
-- I found that taking too much melatonin didn't work. My sweet spot was taking a tiny amount of melatonin, like, IIRC, 1mg. 3mg made me feel crappy the next day, plus it did not actually work to help me fall asleep. Too much seemed worse than none, to me.
-- Late evening walks, exercise, baths, books, blue-light-blocking goggles and filters -- all that did nothing for me. YMMV.
-- Eating breakfast, exercise in the morning, getting sunlight in the morning, loud music in the morning, lamps that simulate sun in the morning, sleep apps designed to wake me at a particular point in the REM cycle and similar, also didn't work for me. Again YMMV.
-- To trick myself into falling asleep early (once I was already a little sleep-deprived), these things worked: boring podcasts, Benadryl, or one glass of wine drunk very quickly. I found it just as easy to fall asleep under those circumstances at 8PM as I did 10PM or midnight, and that helped me to shift my whole schedule earlier, rather than just making it through one day of a time-shifted schedule. Also drinking a full glass of water before bed would help me get up when I needed to.
-- If I was only time-shifting for a few days, it helped to be super-prepared on those mornings -- I would lay out clothes and stuff the night before, and carry around energy bars, etc. When I was time-shifting for a longer period, I found that rather than focusing on making mornings as efficient as possible, it helped to build in leisure time in the mornings by getting up earlier, so I didn't feel so resentful and unhappy about the whole thing.
It was annoying and required constant attention. I feel your pain and wish you luck :)
posted by Susan PG at 9:48 AM on September 15, 2015 [6 favorites]
When I was a night owl, I tried everything to shift my schedule, both for one-off events and sustained periods. Here's what I found:
-- Focusing on getting to sleep when I wasn't sleepy was annoying and unsuccessful. I was more successful when I focused on getting up early, and let falling asleep be a byproduct of getting up early, rather than the reverse.
-- That said, trying to trick myself into falling asleep early, once I had already been getting up early for a few days, did help.
-- I found that taking too much melatonin didn't work. My sweet spot was taking a tiny amount of melatonin, like, IIRC, 1mg. 3mg made me feel crappy the next day, plus it did not actually work to help me fall asleep. Too much seemed worse than none, to me.
-- Late evening walks, exercise, baths, books, blue-light-blocking goggles and filters -- all that did nothing for me. YMMV.
-- Eating breakfast, exercise in the morning, getting sunlight in the morning, loud music in the morning, lamps that simulate sun in the morning, sleep apps designed to wake me at a particular point in the REM cycle and similar, also didn't work for me. Again YMMV.
-- To trick myself into falling asleep early (once I was already a little sleep-deprived), these things worked: boring podcasts, Benadryl, or one glass of wine drunk very quickly. I found it just as easy to fall asleep under those circumstances at 8PM as I did 10PM or midnight, and that helped me to shift my whole schedule earlier, rather than just making it through one day of a time-shifted schedule. Also drinking a full glass of water before bed would help me get up when I needed to.
-- If I was only time-shifting for a few days, it helped to be super-prepared on those mornings -- I would lay out clothes and stuff the night before, and carry around energy bars, etc. When I was time-shifting for a longer period, I found that rather than focusing on making mornings as efficient as possible, it helped to build in leisure time in the mornings by getting up earlier, so I didn't feel so resentful and unhappy about the whole thing.
It was annoying and required constant attention. I feel your pain and wish you luck :)
posted by Susan PG at 9:48 AM on September 15, 2015 [6 favorites]
Response by poster: Thanks so much, everyone. Really appreciate my fellow night owls offering strategies and commiseration.
(The reset has worked for me in the past, but only very temporarily - it's also made things worse in the medium term.)
Sorry, neat graffitist, didn't realize. Original study:
Abstract
Objective To test the hypothesis that people taking anxiolytic and hypnotic drugs are at increased risk of premature mortality, using primary care prescription records and after adjusting for a wide range of potential confounders.
Design Retrospective cohort study.
Setting 273 UK primary care practices contributing data to the General Practice Research Database.
Participants 34 727 patients aged 16 years and older first prescribed anxiolytic or hypnotic drugs, or both, between 1998 and 2001, and 69 418 patients with no prescriptions for such drugs (controls) matched by age, sex, and practice. Patients were followed-up for a mean of 7.6 years (range 0.1-13.4 years).
Main outcome All cause mortality ascertained from practice records.
Results Physical and psychiatric comorbidities and prescribing of non-study drugs were significantly more prevalent among those prescribed study drugs than among controls. The age adjusted hazard ratio for mortality during the whole follow-up period for use of any study drug in the first year after recruitment was 3.46 (95% confidence interval 3.34 to 3.59) and 3.32 (3.19 to 3.45) after adjusting for other potential confounders. Dose-response associations were found for all three classes of study drugs (benzodiazepines, Z drugs (zaleplon, zolpidem, and zopiclone), and other drugs). After excluding deaths in the first year, there were approximately four excess deaths linked to drug use per 100 people followed for an average of 7.6 years after their first prescription.
Conclusions In this large cohort of patients attending UK primary care, anxiolytic and hypnotic drugs were associated with significantly increased risk of mortality over a seven year period, after adjusting for a range of potential confounders. As with all observational findings, however, these results are prone to bias arising from unmeasured and residual confounding.
I.e.: "those who used anxiolytics and/or hypnotics were 3 times more likely to die prematurely during the 7 -year follow-up period"
posted by cotton dress sock at 9:56 AM on September 15, 2015
(The reset has worked for me in the past, but only very temporarily - it's also made things worse in the medium term.)
Sorry, neat graffitist, didn't realize. Original study:
Abstract
Objective To test the hypothesis that people taking anxiolytic and hypnotic drugs are at increased risk of premature mortality, using primary care prescription records and after adjusting for a wide range of potential confounders.
Design Retrospective cohort study.
Setting 273 UK primary care practices contributing data to the General Practice Research Database.
Participants 34 727 patients aged 16 years and older first prescribed anxiolytic or hypnotic drugs, or both, between 1998 and 2001, and 69 418 patients with no prescriptions for such drugs (controls) matched by age, sex, and practice. Patients were followed-up for a mean of 7.6 years (range 0.1-13.4 years).
Main outcome All cause mortality ascertained from practice records.
Results Physical and psychiatric comorbidities and prescribing of non-study drugs were significantly more prevalent among those prescribed study drugs than among controls. The age adjusted hazard ratio for mortality during the whole follow-up period for use of any study drug in the first year after recruitment was 3.46 (95% confidence interval 3.34 to 3.59) and 3.32 (3.19 to 3.45) after adjusting for other potential confounders. Dose-response associations were found for all three classes of study drugs (benzodiazepines, Z drugs (zaleplon, zolpidem, and zopiclone), and other drugs). After excluding deaths in the first year, there were approximately four excess deaths linked to drug use per 100 people followed for an average of 7.6 years after their first prescription.
Conclusions In this large cohort of patients attending UK primary care, anxiolytic and hypnotic drugs were associated with significantly increased risk of mortality over a seven year period, after adjusting for a range of potential confounders. As with all observational findings, however, these results are prone to bias arising from unmeasured and residual confounding.
I.e.: "those who used anxiolytics and/or hypnotics were 3 times more likely to die prematurely during the 7 -year follow-up period"
posted by cotton dress sock at 9:56 AM on September 15, 2015
Best answer: I have done this in as little as three days when changing shifts at work (from evening shift to morning shift) using co-q-10 and melatonin. I was a night owl, sick, etc. It took a few weeks to fully adjust to day shift, but I was getting up and functional from the get go. There are multiple comments by me talking about this already.
posted by Michele in California at 9:57 AM on September 15, 2015 [2 favorites]
posted by Michele in California at 9:57 AM on September 15, 2015 [2 favorites]
Best answer: I am a night owl. I lived on the West Coast but on Eastern time (to sync with the markets). I had to get up and leave the house between 3:30 and 4:00 AM. As my father said to me, the only time you saw 3:30 was coming in not going out. I was successful at it for the year I did it.
First, I shifted all my clocks to eastern time. The data on my screens had it already so not a huge change. Second, I set a time to go to bed (9:00 PM). I then took two tylenol PMs at 8:45. I also tried to work out daily on the way home from work at 2:00PM
Within two weeks, I had cut back to 1 Tylenol PM. Then to none shortly thereafter. I avoided all caffeine too for that year too. No coffee, no soda, no nothing with caffeine.
I got used to it and well after a week it was ok. There were some benefits in terms of Bay area traffic that I avoided because of the time shift although you would be surprised how many people are on the road at 4:00 AM heading to the city from Marin.
I think critical to being successful will be adhering to an early schedule on the weekends too. Sleep and extra hour (or two) but get up close to your work day time.
To me, the bottom line was some OTC help the first few weeks, I knew it would suck the first week as I would be sleep deprived and that as a human, eventually I would get used to it. (Although, one of the factors we considered when moving back to the east coast was my sleep schedule. As soon as I got back, within a day or two, I had shifted right back to being a night owl.
posted by AugustWest at 11:15 AM on September 15, 2015 [1 favorite]
First, I shifted all my clocks to eastern time. The data on my screens had it already so not a huge change. Second, I set a time to go to bed (9:00 PM). I then took two tylenol PMs at 8:45. I also tried to work out daily on the way home from work at 2:00PM
Within two weeks, I had cut back to 1 Tylenol PM. Then to none shortly thereafter. I avoided all caffeine too for that year too. No coffee, no soda, no nothing with caffeine.
I got used to it and well after a week it was ok. There were some benefits in terms of Bay area traffic that I avoided because of the time shift although you would be surprised how many people are on the road at 4:00 AM heading to the city from Marin.
I think critical to being successful will be adhering to an early schedule on the weekends too. Sleep and extra hour (or two) but get up close to your work day time.
To me, the bottom line was some OTC help the first few weeks, I knew it would suck the first week as I would be sleep deprived and that as a human, eventually I would get used to it. (Although, one of the factors we considered when moving back to the east coast was my sleep schedule. As soon as I got back, within a day or two, I had shifted right back to being a night owl.
posted by AugustWest at 11:15 AM on September 15, 2015 [1 favorite]
I gradually realized that although I lost the buzz from caffeine within a normal timeframe, it was still active to some degree in my system for ~12 hours. It's really, really hard for me to fall asleep if I've had caffeine within the last 12 hours.
Cutting down on screens at night also helped me, but the crowning touch was buying a bunch of very easy crossword puzzle books. Large print is even better. They're perfect for giving my mind something to focus on that doesn't demand real attention - my brain starts relaxing immediately. When I started using them, I'd open one of the books an hour or so before I wanted to go to bed, and was nice and wound down and ready to sleep when the time came. These days, I'm slacking off on that, but I keep a few books near my bed, and I do 5-20 minutes of filling in squares as I'm getting into bed. It gets me past that spinning-brain point and makes it much easier to fall asleep.
posted by current resident at 2:43 PM on September 15, 2015 [1 favorite]
Cutting down on screens at night also helped me, but the crowning touch was buying a bunch of very easy crossword puzzle books. Large print is even better. They're perfect for giving my mind something to focus on that doesn't demand real attention - my brain starts relaxing immediately. When I started using them, I'd open one of the books an hour or so before I wanted to go to bed, and was nice and wound down and ready to sleep when the time came. These days, I'm slacking off on that, but I keep a few books near my bed, and I do 5-20 minutes of filling in squares as I'm getting into bed. It gets me past that spinning-brain point and makes it much easier to fall asleep.
posted by current resident at 2:43 PM on September 15, 2015 [1 favorite]
Best answer: I just had this discussion with my therapist because I need to get 8-9 hours of sleep and I have to wake up at 6 am with my schedule, but I can sabotage it by waking up at 7.30am, so I end up sleeping at midnight and crashing.
I can't use meds, and my toddler won't sleep before 9 pm, so I have to go to bed with her at 9 pm.what I'm trialling now is taking all the stuff I do at night instead of sleeping in one or two short breaks during the day and tracking it with a financial deal (beeminder) that if I watch my trashy tv show during lunch and read metafilter before dinner, no guilt and fully relaxed like I would at bedtime, then I have to go straight to bed before 9.30.
You can have great sleep hygiene but if you are in bed and it's the one time if the day when you get to do whatever you want, all cozy and relaxed - you need incentives in that moment to make it worthwhile to close your devices and turn off the lights. Putting an inspirational quote or a pretty landscape with the time you want to sleep each night written on it and a note from yourself that you promise future you to sleep early. Get really nice treats for breakfast that you only get when you've slept early the night before.
And please do update this ask if you find something that works! I got to sleep early last night, but I'm going to try some of the thread suggestions too.
posted by dorothyisunderwood at 4:10 PM on September 15, 2015 [3 favorites]
I can't use meds, and my toddler won't sleep before 9 pm, so I have to go to bed with her at 9 pm.what I'm trialling now is taking all the stuff I do at night instead of sleeping in one or two short breaks during the day and tracking it with a financial deal (beeminder) that if I watch my trashy tv show during lunch and read metafilter before dinner, no guilt and fully relaxed like I would at bedtime, then I have to go straight to bed before 9.30.
You can have great sleep hygiene but if you are in bed and it's the one time if the day when you get to do whatever you want, all cozy and relaxed - you need incentives in that moment to make it worthwhile to close your devices and turn off the lights. Putting an inspirational quote or a pretty landscape with the time you want to sleep each night written on it and a note from yourself that you promise future you to sleep early. Get really nice treats for breakfast that you only get when you've slept early the night before.
And please do update this ask if you find something that works! I got to sleep early last night, but I'm going to try some of the thread suggestions too.
posted by dorothyisunderwood at 4:10 PM on September 15, 2015 [3 favorites]
Where do you live? If you live somewhere warm enough, go camping. Your own backyard is ideal unless there are flood lights that point into it. Use a tent only if there is precipitation. Otherwise just sleep outdoors with nothing but the sky or a tree above you.
Basically, if you avoid all artificial light and any significant light emitting appliances and use the sun you will be unable to do anything after dark, so you will start sleeping, and soon be unable to stay asleep once the sun comes up.
People used to consider it reasonable to get up before five a.m. and go to bed shortly after five p.m. because they weren't using artificial lights. It's not that the cows put them on that schedule. They put the cows on that schedule because it was the one they were already on.
If you can't go camping set up your home so that the light level indoors matches the light level outdoors. Gradually move into darkness through the evening.
The first couple of evenings find an activity that you can do while awake in the dark, such as sitting and talking with someone, or listening to a talking book.
posted by Jane the Brown at 4:40 PM on September 15, 2015 [1 favorite]
Basically, if you avoid all artificial light and any significant light emitting appliances and use the sun you will be unable to do anything after dark, so you will start sleeping, and soon be unable to stay asleep once the sun comes up.
People used to consider it reasonable to get up before five a.m. and go to bed shortly after five p.m. because they weren't using artificial lights. It's not that the cows put them on that schedule. They put the cows on that schedule because it was the one they were already on.
If you can't go camping set up your home so that the light level indoors matches the light level outdoors. Gradually move into darkness through the evening.
The first couple of evenings find an activity that you can do while awake in the dark, such as sitting and talking with someone, or listening to a talking book.
posted by Jane the Brown at 4:40 PM on September 15, 2015 [1 favorite]
After a year of getting up at or after 9am, I'm spending mid August through mid-December dealing with an alarm clock that's going off at 6am daily. For me it's helped knowing that this is a transient thing, but for you it might not be? Anyway, I'm actually counting days, which helps me think about the problem in the way Lyn Never suggests - for right now, my evenings are in service of the bedtime. I also have a dawn alarm clock, and even though it sucks, I set it to go off a full hour before I actually have to leave the house. Which means that commute included, I spend four weeknight hours at home and awake. One of those is for food. One is for getting ready for bed and getting in bed and getting ready to actually sleep. The remaining two are for decompressing and studying.
It sucks, but I've managed the whole first month without any of that full body and brain exhaustion I remember from other, less stringent attempts to shift my schedule, which is pretty amazing considering I made a trip across two time zones over labor day and caught a nasty cold somewhere in week two.
I am a begrudging convert to strict and consistent bedtimes, given the results.
posted by deludingmyself at 6:57 PM on September 15, 2015 [1 favorite]
It sucks, but I've managed the whole first month without any of that full body and brain exhaustion I remember from other, less stringent attempts to shift my schedule, which is pretty amazing considering I made a trip across two time zones over labor day and caught a nasty cold somewhere in week two.
I am a begrudging convert to strict and consistent bedtimes, given the results.
posted by deludingmyself at 6:57 PM on September 15, 2015 [1 favorite]
Along with dorothyisunderwood, I'm eager to know which tactics you find helpful.
I worked evenings (3-11 or 4-12) and nights (6-2) for about 15 years. Then in early 2013, I was promoted to a 9-5 job. My sympathetic boss has let me push it to a 10-6 shift, but I still start each day feeling like some poor creature that's been flushed out of its burrow.
posted by virago at 7:51 PM on September 15, 2015 [3 favorites]
I worked evenings (3-11 or 4-12) and nights (6-2) for about 15 years. Then in early 2013, I was promoted to a 9-5 job. My sympathetic boss has let me push it to a 10-6 shift, but I still start each day feeling like some poor creature that's been flushed out of its burrow.
posted by virago at 7:51 PM on September 15, 2015 [3 favorites]
Best answer: I found one of the studies I was thinking of which examined the effect that blue light blocking goggles have on sleep/melatonin. Here's the full text. In case you want some more data aside from n=1 anecdote above. Here is another article that has some discussions of circadian rhythms in humans that may be of interest.
posted by litera scripta manet at 2:16 PM on September 16, 2015 [1 favorite]
posted by litera scripta manet at 2:16 PM on September 16, 2015 [1 favorite]
Response by poster: Update. After taking drastic measures to get somewhere close to a normal wake time, at least, I've been doing the following, and things have been roughly ok:
- Even though I am still not really tired until past midnight, the big lights go out at 10 pm, consistently, because it does help me wind down.
- I keep red bulbs (couldn't find orange ones on amazon.ca, or anywhere else for that matter) next to two lamps, and swap the bulbs (and get ready for bed) at about 11 pm. The first few nights I tried this, the red glow left me feeling panicky, for unknown reasons (well - anything green obviously looks black in that light, I have a bunch of plants - found it creepy :/), so I did leave off this tactic for a bit. However, I tried again after the linked question above (moved the plants to a less agitating location, see below), and it seems to help. Thanks to litera scripta manet for sharing the knowledge :)
- If I'm on the computer past 11, f.lux is on. Not sure it completely blocks blue light, but it does contribute to a "winding down" sort of feeling.
- I set things up so I can have my curtains open all the time, exposing only the top half of the window. (Plants and a screen.) This way, I get the morning light. Absolutely helps. Three alarm clocks are going, and I am not needing the two backups, so far.
- I'm just not allowing myself to think about anything serious (or inspiring, or intense in any way) after 11pm. Doesn't matter what it is, it can wait until the next day. (Well, there have been a couple of exceptions, but they are truly exceptions. Only work, and only if it's absolutely necessary, and if I'm actually being productive. No handwringing etc. allowed.)
- I did wind up trying a benzodiazepine a few times. I am still super cagey about that, so I switched back to a valerian root mix (has hops and something else, I think). If I'm really wired, I take an OTC sleep med. With the other measures, this does seem to help. If I ever find myself in a total panic, I guess the BZs are there, but I'm aiming to avoid that when poss.
- Part of this most recent bout was, I think, related to not being able to exercise due to an injury. Once that healed up, I got back to activity. It's just walking or easy elliptical, and light band workouts - not as demanding/tiring as what I used to be able to do - but doing something is always better than nothing. So glad and grateful I can move again.
Thanks so much again to everyone who took the time to share their tips and experiences.
posted by cotton dress sock at 2:56 PM on February 2, 2016 [3 favorites]
- Even though I am still not really tired until past midnight, the big lights go out at 10 pm, consistently, because it does help me wind down.
- I keep red bulbs (couldn't find orange ones on amazon.ca, or anywhere else for that matter) next to two lamps, and swap the bulbs (and get ready for bed) at about 11 pm. The first few nights I tried this, the red glow left me feeling panicky, for unknown reasons (well - anything green obviously looks black in that light, I have a bunch of plants - found it creepy :/), so I did leave off this tactic for a bit. However, I tried again after the linked question above (moved the plants to a less agitating location, see below), and it seems to help. Thanks to litera scripta manet for sharing the knowledge :)
- If I'm on the computer past 11, f.lux is on. Not sure it completely blocks blue light, but it does contribute to a "winding down" sort of feeling.
- I set things up so I can have my curtains open all the time, exposing only the top half of the window. (Plants and a screen.) This way, I get the morning light. Absolutely helps. Three alarm clocks are going, and I am not needing the two backups, so far.
- I'm just not allowing myself to think about anything serious (or inspiring, or intense in any way) after 11pm. Doesn't matter what it is, it can wait until the next day. (Well, there have been a couple of exceptions, but they are truly exceptions. Only work, and only if it's absolutely necessary, and if I'm actually being productive. No handwringing etc. allowed.)
- I did wind up trying a benzodiazepine a few times. I am still super cagey about that, so I switched back to a valerian root mix (has hops and something else, I think). If I'm really wired, I take an OTC sleep med. With the other measures, this does seem to help. If I ever find myself in a total panic, I guess the BZs are there, but I'm aiming to avoid that when poss.
- Part of this most recent bout was, I think, related to not being able to exercise due to an injury. Once that healed up, I got back to activity. It's just walking or easy elliptical, and light band workouts - not as demanding/tiring as what I used to be able to do - but doing something is always better than nothing. So glad and grateful I can move again.
Thanks so much again to everyone who took the time to share their tips and experiences.
posted by cotton dress sock at 2:56 PM on February 2, 2016 [3 favorites]
This thread is closed to new comments.
posted by cotton dress sock at 8:42 AM on September 15, 2015