Why can't I sleep and what can I do to sleep?
September 24, 2015 7:57 AM   Subscribe

Starting when I was a teenager I have had trouble sleeping, but this has only become worse as I have become an adult. Now, without the use of medication and even with them, I feel chronically fatigued.

I didn't sleep much as a teenager but I slept enough to not have to worry about it. After my dad committed suicide around my 18th birthday, the amount of sleep I got each night nosedived until I eventually started to take sleeping medication. I stopped taking sleeping medication once I noticed a substantial weight gain (and corresponding weight loss after I quit those pills) when I was on them, eventually returning back to my manageable issues with sleep.

To support my mother and myself I started work as a commercial truck driver, which, due to the erratic scheduling, exacerbated my difficulties sleeping even further. The final straw that broke the camel's back it seems was the major highway accident I had with a truck last winter, rolling a tractor-trailer unit off a highway and nearly killing myself.

Now it seems sleep just doesn't happen for me. Without the use of medication, the best sleep I can manage can best be describe as intense meditation, where I am in bed with my eyes closed, not feeling anxious, not thinking about anything that makes me stressed, completely zoned out, but still not able to fall asleep. With the use of medication, I usually wake up every 2 hours, wander around the apartment, before going back to bed and repeating this ritual approximately 2 hours later.

If it is any help I do not nor have I ever consumed coffee and most other beverages with a high caffeine or sugar content (i.e., energy drinks, Coke, Pepsi), either as a teenager or as an adult.

I don't know what is wrong with me?
posted by 8LeggedFriend to Health & Fitness (12 answers total)
Have you had an overnight sleep test done? Or just gone with prescription meds from your GP? Sleep testing can discover a whole lot of problems that can be relatively easily solved.
posted by markslack at 7:59 AM on September 24, 2015

Have you considered a sleep study? That will help you figure out what's going on.

Are you using proper sleep techniques? Going to bed at the same time every night? Cutting back on food & drink several hours before bed? Turning off screens and harsh lights an hour before bed? Etc.?

It's really hard to tell what could be wrong just by what you've described.
posted by xingcat at 7:59 AM on September 24, 2015 [1 favorite]

What kind(s) of sleep medication have you tried?
posted by Juffo-Wup at 8:02 AM on September 24, 2015

Most of your questions are about your depression, anxiety, and low self-esteem. Are you, or have you been, in treatment for any or all of these? Because they can all fuck up your sleep.
posted by rtha at 8:18 AM on September 24, 2015 [7 favorites]

I feel your pain, I have had a variety of sleep issues. You don't state whether the medication you are taking is Rx or OTC, so I can't determine if you have contact with a primary care physician.

You should see your/a PCP, describe your sleep problems and see if you can get a referral for a polysomnography (sleep study). The tech running your sleep study will ask a variety of questions and use a variety of sensors attached to your body to determine many metrics about your sleep. I've had a couple down, and they were really worthwhile. I'm assuming you have some type of health insurance? If you do, check to make sure a polysomnography is covered.
posted by Rob Rockets at 8:20 AM on September 24, 2015

It sounds like you've been through a lot. I'm sorry you've had to deal with all of that. And not getting enough sleep just makes things worse.

This might not be the answer you want to hear, but it sounds like your psychological state is a big factor here (I think you know this, since you mentioned all that stuff that happened to you). You say you don't feel anxious/stressed, but you're still carrying that trauma around inside you, somewhere, whether consciously or not. My therapist told me that one way of coping with psychic pain is to 'zone out' or 'switch off' - in other words, to push your feelings aside so they can't overwhelm you and stop you carrying on with life (work, family responsibilities, etc.). Everyone does this to some extent. But there's always a payoff for not regarding your mental health.

Have you ever been to therapy? That'd be my suggestion if it's within your means.

As for 'quick fixes' - I know a few people who have had success with melatonin supplements. I personally have found that phenibut (a nootropic) helps with anxiety, sleep and satiety. It does have a fairly high abuse potential though, and I've developed a pretty big tolerance for it, even though I take it in small doses.

I wouldn't recommend sleeping pills or benzodiazepines or anything of that ilk because they can make you feel even worse, and the withdrawal can be a bitch.

In any case I think you should go see your GP and ask them what they think. Good luck to you!
posted by sweetshine at 8:20 AM on September 24, 2015 [1 favorite]

I've had insomnia lately which is directly tied to anxiety and depression, so that's definitely a thing, but what happened for me, and what I understand what commonly happens with chronic insomniacs, is that after a long period of difficulty sleeping it becomes self-perpetuating. When there is pressure to fall asleep and a belief that sleep will not come, it is almost impossible for me to relax, and if sleep does come it will be light. No matter how tired I am, as soon as I hit the bed, I am wired with tension.

I've made some progress on this. Mostly it has been about de-emphasizing sleep as a goal, and instead trying to focus on relaxing behaviors. I only go to bed when I'm yawning. If I am wired, I get up immediately. Same goes for if I wake up and am wired, even if I would rather sleep more. The point is to remove the long periods of lying in bed, which reinforces the association of bed and pressure/tension. I go for walks, I take baths, I do some stretching, I drink herbal tea, and if I start yawning I try again. And if I don't, I stay up, maybe all night. It's shitty to have to do that, but the same thing would happen if I was in bed and it is better to be up when I'm not sleepy. Also, I try to give myself processing time in the evenings to sort through my thoughts (solo walks are good for this), so that there is not a queue of stuff to think about waiting to hit me when I hit the bed.

I also had some success sleeping on the living room couch. Because the couch did not have the stressful associations that the bed had. I even moved my bed into the living room for a while and that actually helped too.

Definitely see a doctor for tips and I highly recommend seeing a therapist as well. Good luck.
posted by PercussivePaul at 8:48 AM on September 24, 2015 [1 favorite]

I find one hour of outdoor aerobic exercise is a must every day. I have to get rid of tension and that and a hot bath and a glass of wine does the trick but I still need a little "tip in" to go to sleep and stay there.
I count my breaths (mouth closed) slow and easy - inhalations and exhalations allowing a nice long pause in between each (the pause will get longer as you become sleepier) - i aim to get up to a 300 breath count and almost never get there.
posted by Tullyogallaghan at 10:23 AM on September 24, 2015

Have your thyroid checked. Hyper thyroid activity can mess a lot of things up, including sleep. A lot of people have horrific lives and still sleep, so it might be metabolic.
posted by Oyéah at 8:48 PM on September 24, 2015

I have had terrible sleep since my pre-teens. Even when I could get to sleep easily, my sleep was of very poor quality. In May of this year, my psychiatrist prescribed me a medicine that is used to reduce nightmares in people with PTSD, despite the fact that I didn't report any nightmares. (It's prazosin, an old blood pressure medicine and alpha blocker, not a benzodiazapene or neuropsych med.) That shit has worked absolute wonders for me. Given that your own sleep plummeted after a traumatic event, it might be worth looking into.

Other things I do to manage my historically poor sleep include a low-carb diet and daily exercise, with as much of the exercise as possible being outside. But seriously, look into the prazosin.
posted by KathrynT at 9:52 PM on September 24, 2015 [1 favorite]

A lot of what others are saying upthread are great things to look into, but one really interesting and possible "simple" thing to look at is: how good is your bed?

I say this after years of crap sleep because of being kinda broke most of my life and only being able to afford a cheap mattress. Then I had a few traumatic injuries. Blown out back. Slipping disk in my neck. Sleep became something that only happened after total exhaustion, and even then, it was only a few hours a night. Finally, I bought a "good" mattress. Like expensively good. I had to after I went to a mattress store and got to test out some of the mattresses they have. I initially was thinking "oh, I just want to get something like what I have, but you know, not worn out." Then I made the mistake of lying on a good mattress. You mean my back isn't supposed to hurt when I lie down? I am supposed to be able to lie on my side and not feel like my hips are being torqued into a corkscrew? Wait, I can lie flat and have my whole body be able to relax and not have to use some weird combination of muscles to hold myself in place? 3 weeks later the new mattress arrived at my apartment. That first night sleeping on it? I actually slept. Not just the usual "body is shutting down now, deal with it" and waking up achy and feeling unrested. I woke up not in pain. And I had slept for 9 hours straight. I cannot stress how much a good mattress will do.

But also all the other things. It is never one thing. It is the accumulation of everything. As a teenager I used to be able to sleep anywhere, on anything. Now I know I definitely cannot. A good bed is one thing you can easily do. It won't fix everything (I still have nights where sleep just does not happen). But it will at least offer you something your body and mind might accept as a safe place to actually relax and rest.
posted by daq at 12:25 AM on September 25, 2015 [2 favorites]

A regimen of strict sleep hygiene. It's very likely a customized schedule of sleep restriction to retrain your body will help to some degree. The genetic component seems clearly present; hard to say how much of a role the cognitive/psychological component is playing, so some talk therapy may be helpful as well.

PS: Nthing the suggestion for a sleep study by a reputable provider (sleep medicine is not as advanced as it could actually be, nor do most providers practice it as well as it should be).
posted by dancing leaves at 5:24 AM on September 25, 2015

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