Help me get more sleep
March 19, 2016 4:10 AM   Subscribe

I've had insomnia for years. Decades. I've talked to doctors, tried prescription meds, tried over the counter meds, changed my diet, changed my exercise, worked on sleep hygiene, and had a sleep study. I still need more sleep.

My insomnia is actually much better now. These days, instead of not being able to fall asleep for hours at bedtime, or waking up at 2am, I'm waking up pretty regularly about 4-4:30AM. For a total of 5.5-6 hours of sleep a night. I know some people thrive on that little sleep, but I would be happiest with 8 hours a night. I very very rarely am able to make up the deficit by taking a nap or sleeping later on some mornings-- once I am up, I'm up.

When I wake up, I can't really leave my bed, or I'll wake up the entire house. (This was lots easier before we had a dog and kittens who raise a ruckus and wake the kids if they see me downstairs.) I could go sit on the floor in the bathroom, I guess. That's pretty much my only option other than lying in bed trying not to wake my spouse.

I think this is genetic-- my grandmother and my mother both had this same sleep issue, and my 10 year old seems to as well.

I feel like I've tried everything, so I kind of feel like "what's the use of even wasting an Ask" but OMG I am So. Tired. Please help?

Things I have tried:
- doctor
- psychiatrist
- therapist
- Trazedone (as a prescription sleep aid)
- Xanax (which probably worked best, but it's scary for more than a handful of times a year)
- benedryl and melatonin (taking this regularly now, on consultation with my doctor; I've tried weaning off the benedryl within the past few months, but within 5 days I was at an unsafe sleep deficit, and unable to drive or manage daily life so I started again)
- exercising more. Exercising less. Exercising at different times of day.
- Whole 30 (it gives amazing sleep for everyone ELSE apparently; not me)
- more carbs in the evening. Less carbs. More fat or protein, and less. (Going to bed hungry guarantees a poor night sleep, nothing else seems to make a difference)
- calcium/magnesium supplement: this is one of the few things that actually seems to help, but not reliably. I think maybe stiff muscles are waking me up? In that vein, I sometimes take an Aleve at bedtime, but in decades past I'd do that with ibuprofen and eventually developed an anaphylactic reaction to it, so I don't want to take Aleve more than very occasionally.
- stretching or yoga in the morning or before bed
- SSRIs (not currently, and none but the trazedone made a difference. Trazedone made me so exhausted it was counterproductive)
- meditation tapes, progressive relaxation, and yoga nidra
- sleep study revealed no apnea or other useful info
- sleep hygiene program helped, in that I can now fall asleep easily at night and I am not currently bi-phase in my sleep patterns, but it's less useful at 4am when I can't get out of bed

These days I'm fairly easily falling asleep sometime between 10 and 11 (and appreciating my good fortune!). I am sleeping through the 2 or 3 am wake up that used to plague me (yay!). But I just can't seem to sleep past 4 or 4:30 am. And I am just. So. Tired. Help?
posted by instamatic to Health & Fitness (33 answers total) 28 users marked this as a favorite
Three orgasms. Srsly.

Or/and just lying still with your eyes closed is an excellent option. It's 80 % as restorative as actual sleep and almost meditative. Stressing and tossing and turning is what's making you tired. Not the lack of sleep sleep, at those levels.

Hugs. I'm in the same boat (bed?) as you. But less scientific in my methodology.
posted by taff at 4:26 AM on March 19, 2016 [7 favorites]

I haven't tried it yet myself, but Kevin Kelly's Cool Tools blog just had a review for MySleepButton, an iOS/Android app designed using a cognitive science approach to helping users fall asleep.
posted by fairmettle at 4:28 AM on March 19, 2016 [3 favorites]

Have you tried non-prescription, over-the-counter sleep meds? In my experience generic-brand diphenhydramine and doxylamine succinate are quicker-acting and more effective than the prescription meds I've used, resulting in a deeper sleep, it's just that they're also prone to make you tired for an entire 24 hours or more after taking them, fatigued the next day. But maybe it would be worth it in your case, or you might react differently than me.
posted by XMLicious at 4:36 AM on March 19, 2016 [1 favorite]

When and where was your sleep study? Did they count only apneas or did they also count RERAs?

A lot of sleep studies count only apneas, but some people can have respiratory flow restriction events severe enough to cause sleep issues, including insomnia, even when they are below the level of sleep apnea proper.

If your lab/doctor didn't look at RERAs, you could have Upper Airway Resistance Syndrome which was missed. Insomnia's a common side-effect.

The downside is that it's hard to find sleep doctors who diagnose UARS, because it's a relatively new diagnosis and the treatment often isn't covered by insurance. (I asked the first sleep doctor I went to about UARS, since I'd done enough research to know it was a possibility for me, and he looked at me like I was crazy and then said "Oh, you mean snoring? Yeah, insurance doesn't pay for that." On a related note, if you're in Boston and want a referral to my second sleep doctor, the one who DOES diagnose UARS, drop me a memail.)

Beyond that, you could check with an ENT to see if you have any potential breathing restrictions like nostrils that collapse in your sleep.

You could also try Breathe-Rite strips, since you don't mention that. I snore minimally (nobody had heard me snore until the sleep study and even then, minimal) but my sleep issues are still caused partly or wholly by my nose. Extra-strength Breathe-Rite didn't solve the problem but they have helped a substantial amount. (Go for the brand-name extra-strength, though, and don't waste your time on generics. They're set up differently and the Target ones did nothing for me.)
posted by pie ninja at 5:14 AM on March 19, 2016 [4 favorites]

Oh, I hear you. I rarely get more than four hours a night. One possibility to avoid lying awake in bed when you can't wake up the rest of the house: I put a comfy chair in my bedroom and can read on my tablet without turning on any lights to wake up a partner. It's not ideal, and getting out of bed doesn't actually seem to help my sleep in the long run, but it's better than sitting in the bathroom...

Sleep restriction also didn't help me (I was getting a bit more sleep, but actually feeling WORSE during the day because my body wasn't getting the rest it needed), but is definitely worth a try.

I assume you've tried ambien and lunesta... they don't help me, but might work better for you than Benadryl.
posted by metasarah at 5:18 AM on March 19, 2016 [1 favorite]

Ask your doctor about trying gabapentin. It helps many people sleep better and you rarely get a hangover from it. It's a prescription anticonvulsant and pain management drug but is being used for insomnia by some doctors.
posted by biscotti at 5:44 AM on March 19, 2016 [1 favorite]

Realize that if you just lie still and close your eyes, you will get 75% of sleep rest. So if I wake up at night or 4:30 a.m., I'll put on my headphones and listen to a podcast on my phone. Not anything too rowdy or with lots of noises. Just even toned speech. I lie there as still as I can and just listen. Sometimes I'll drift off. I also get the podcast app ready to go before bed, so I'm not looking at a bright screen for too long at night.

This is an easy trick you can try and see if it helps you feel more restful the next day.
posted by Coffeetyme at 5:52 AM on March 19, 2016 [11 favorites]

It might have been checked already in one of your earlier doctor visits, but I know two people whose insomnia turned out to be from their bodies not making enough hormones, and were fixed when they were prescribed replacement hormones. I don't know how rare that is and don't want to send you down any crazy self-diagnosed medical paths, but it seems like something that could be checked along the way just to rule out a possible source of the problem (especially as you note that it runs in the family).
posted by Dip Flash at 6:03 AM on March 19, 2016

You have done a lot and this may be a stupid question that is encompassed by sleep hygiene, but have you tried different mattresses? I'm not saying it's the mattress for you, but, for example, when I slept on a Tempurpedic I slept soundly and went from waking up to go the bathroom multiple times a night to maybe once a night. I sleep on 2 different mattresses now (Ikea and Serta). I wake up a bunch and often way too early in the IKEA and usually relocate to the couch, which sometimes provides a decent additional chunk of quality sleep and, on the Serta, I usually wake up only once, but often with aches and pains. So, I fully believe your mattress can make a huge difference. Good luck!
posted by katemcd at 6:33 AM on March 19, 2016 [1 favorite]

You don't mention this in your explanation, and it solved about 60% of my sleep problems: a really, really dark room and quality white noise. Also, I've recently kicked my husband out of our bed (it was actually mutual! And it's all good!) and sleeping alone has solved at least another 30% of the rest of my sleep issues.
posted by cooker girl at 6:55 AM on March 19, 2016 [2 favorites]

Assuming you don't have UARS as someone else mentioned above you may want to look into Cognitive behavioral therapy for insomnia. The fact that you had some improvement with sleep hygiene may indicate you'd also have some benefit from CBTI.
posted by teamnap at 6:58 AM on March 19, 2016 [1 favorite]

I've had insomnia my entire adult life. Does your sleep hygiene program include cutting out all caffeine and alcohol? When I did a Whole 30 (which strictly forbids alcohol) in January, I got AMAZING sleep. I stopped drinking coffee, even decaf. That's helped.

But the thing that's helped me most reliably is 1) calling it biphasic sleep instead of insomnia and 2)changing my routine to go to bed earlier. That way, even if I am awake for 2-3 hours in the middle of the night, I'm still racking up almost enough hours. Can you move your entire family's bedtime to be even slightly earlier? Even by one hour?
posted by ImproviseOrDie at 7:19 AM on March 19, 2016

cooker girl: "You don't mention this in your explanation, and it solved about 60% of my sleep problems: a really, really dark room and quality white noise. "

Seconded. A white noise machine is the one thing I didn't see mentioned in your OP and it worked wonders for me.
posted by capricorn at 7:21 AM on March 19, 2016

my sleep routine, in case you'd like to try (and some of it isn't sleep hygienic but it works for me):
10 pm - take doxylamine succinate (OTC sleep aid - only one that works for me)
Get in pjs, brush teeth, set morning alarm
Get my special pillows set up just right (body pillow, flat pillow and
Memory foam pillow)
Crawl into bed, turn off lights, turn on fan
Set up the iPad and turn on a show - has to be a mindless show that I
wont mind missing the end of (Big Bang theory, or whatever)

10:30 pm - sleepy enough to turn off iPad

I know that watching the iPad in bed isn't good sleep hygiene but it works for me. And it works really well. I'm watching something mindless so my mind isn't busy and is shutting down for the night. Plus I'm in bed and so I'm not getting up, walking from couch to bed and not doing any jarring activities that might wake me up enough that I can't fall asleep.

The doxylamine succinate helps me get to sleep within half an hour but mostly it keeps me fuzzy headed enough the rest of the night that if I do wake up in the middle of the night I'm able to go right back to sleep.
posted by Sassyfras at 8:14 AM on March 19, 2016

Have you looked into circadian rhythm disorders...?

If a tiny bit of a benzodiazepine or Z-drug gets you back to sleep in the wee hours, I would not be scared of it -- that has been the status quo for most of my adult life. There are issues with declining efficacy over time for some people, but it's not a universal, but I have never heard of an insomniac who does not have a pre-existing substance abuse getting hooked on them in any way beyond 'Yes, I do need these to sleep enough to function.' (Much the same as with opiates and pain relief -- I take opiates, have no idea what all the fun there is supposed to be about, and am told they work differently in the brain for people who are actually in pain. Lots of scare stories in the news, but the % of for-real pain patients without substance issues who end up with psychological addictions is tiny.) It sounds like a very small dosage of a very short-acting benzodiazepine (0.5mg sublingual Ativan?) would make a big difference.

Or -- IANAD -- I could be full of it; I'm not a specialist, just a long, long-term insomniac.

Also, in re. I think maybe stiff muscles are waking me up? -- have you tried addressing this? Many muscle relaxants are soporific to boot. Methocarbamol is considered benign enough to be OTC here in Canada, so it's not like they all fall under the category of Scary Prescription With Abuse Potential etc. I had some pain problems that wake me and just dramatically improved my sleep by taking an extended release pain pill at night, which I had previously been resistant to, and which I now feel silly about having been resistant to. All the sleep hacks in the world will be of marginal help if there's an underlying cause going untreated, I fear.

You've had your thyroid checked, I'd guess...?

My advice (also) would be to tolerate only so much advice on the 'sleep hygiene' front. The evidence to support it is rather limited, and, tellingly for me, it has little relation to how the majority of humans slept for the majority of human history. Notice that you can not use your bed for anything but sleeping -- and sex, as though sex was akin to reading a book rather than gymnastics at times; Western medicine was unable to say "go schtup each other on the sofa," so this completely incongruous bit of advice -- you can't use your bed for anything but sleep and this one type of exciting exercise -- seems so silly...
posted by kmennie at 8:21 AM on March 19, 2016 [2 favorites]

Have you tried melatonin supplements? It's the only thing that's ever worked for me, but then I have trouble falling asleep more than staying asleep. But it only works if I stop drinking caffeine at least by 3pm. Even teas and such. If I don't, I get restless fitful sleep.

All it does is stimulate melatonin in your brain that makes you get naturally sleepy. Once you take it, it's best to go to bed immediately because if you don't you can push past the melatonin cycle and it'll wear off pretty quick. It usually takes me 30 mins for it to kick in and for me to wanna curl up and sleep. People sometimes say they get weird dreams because of it but I haven't had any side effects.

It probably won't stop you waking up early necessarily, but you can always take another at 4am to try and fall asleep again. I hear this might reset your body clock, but I've taken it in the late night sometimes, at like 3am, to fall back asleep and it's been fine.
posted by Dimes at 8:34 AM on March 19, 2016 [1 favorite]

Things that worked for me.

Weight training. Going hard, not half assing it

No caffeine, limiting sugar.

300mg 5htp before bed (speak to your doc)

Metagenics makes a supplement called Benesom

No screens before bed and keep the bedroom dark. I don't sleep if my clock is too bright

Good Luck
posted by kbbbo at 9:27 AM on March 19, 2016

Taff: Or/and just lying still with your eyes closed is an excellent option. It's 80 % as restorative as actual sleep

posted by WCityMike at 9:38 AM on March 19, 2016 [2 favorites]

Trazodone just puts you to sleep. It doesn't keep you asleep. I take clonazepam along with the trazodone at bedtime so that I stay asleep. I sleep the required 8 hours.

Now most people shouldn't take benzodiazepines for years on end (I am at 11 years and counting). I have bipolar 2 disorder so the risk of early dementia doesn't mean much to me; the bipolar has that risk too and my quality of life is better if I treat the bipolar. What I can say is that this works for me. I am physically dependent on the clonazepam but I do not have a problem with escalating dosages.
posted by crazycanuck at 10:19 AM on March 19, 2016

Try making changes to your sleep environment: darker room, sleeping alone, different mattress, different bedding/pillows, cooler or warmer temperatures. Try taking your own temperature before falling asleep and then during the too-early waking time, in case you're having hormonal changes while you sleep that are making you too hot or too cold and causing the disruption.

Perennial favorite Epsom salts bath, for the magnesium that has helped before. (Also, what kind of magnesium were you taking? Some are better absorbed/work better for sleeplessness.)

Urinate just before going to bed, and get out of bed and try to go again when you wake up too early - an overly sensitive bladder might be pushing you awake, but grogginess/being prone/a lifetime of training yourself to 'hold it' means you're not recognizing the need. There are medications to re-train your bladder if this is the issue.

Best of luck.
posted by Iris Gambol at 10:36 AM on March 19, 2016 [1 favorite]

Are you sure there isn't something (noise coming from outside) that's waking you up at a certain time every day? I've had sleeping issues since I was a teenager. At a certain point I started waking up at 3 AM-ish every day and thought it was weird but chalked it up to another sleep thing. It turns out one of my neighbors was leaving for work/whatever at that time every morning and that's what woke me up.

Other than that I too would recommend napping during the day if you never manage to get a full night's sleep (someone else mentioned biphasic sleeping). You said you're not a napper, but if you at all feel tired during the day (or at least after work), lay down and go for it.

Do you stress/think a lot while trying to fall asleep? Anxiety can keep you awake or give you a night of restless sleep, even if you feel tired and want nothing more than a deep slumber. It turns out this was one of my issues and I didn't even realize it could be a problem, when in hindsight it was so obvious - of course you won't sleep or sleep well if your mind's racing. Now I try to catch myself when thinking and try to shift my mind to visualizing clouds in the sky (my version of sheep jumping over the fence I guess). And often that's the last thing I remember before falling asleep, so I guess it works for sleeping. If I do find myself stressing, it has an obvious effect on the quality of my sleep, which can include but isn't limited to waking early and feeling tired but not being able to fall back asleep.

As far as alcohol goes, you didn't mention your drinking habits and probably already know this, but if you don't: alcohol interrupts REM sleep. So while it may make you sleepy initially, it's not good to have alcohol in the evenings if it coincides with sleep issues. I am guaranteed to wake up early after I've had a few drinks the evening before, and I also am guaranteed to not be able to go back to sleep even if I feel dead-tired. And I'm guessing you already avoid coffee or to stop drinking it early in the day.

Exercising before bed and a hot shower can help tire you out and get you ready for bed. Maybe you'll fall asleep sooner and see whether you wake up at the same time or still only get 5-6 hrs of sleep?

And lastly, I'm sure this isn't the best idea, but: sometimes food (especialyl a warm meal) makes me sleepy - this can happen even if I'm eating lunch, for instance. So maybe try eating something when you wake up and then try to go back to sleep? I'm sure tryptophan has something to do with it, but it'll happen to me with pretty much any meal.

Oh, ps - I've tried tryptophan, took it for months. It had absolutely no effect on my sleep (or mood). 5-HTP (which someone already mentioned) put me into a very deep sleep with extremely vidid (and awesome) dreams, but there's not much known about its side effects yet and I read something about how it can be bad for your heart in the long term - something about heart valves. It also might not be a good idea if you're bipolar or on anything else so be cautious/ask your dr if you decide it's worth a try. I would actually recommend it for short-term use if possible because it helped my sleep and cured my depression in less than a week. (maybe cured isn't the right word but it had such a profound effect on my near-suicidal mood almost instantaneously)

Also +1 to every mention of making your room as dark as possible at night - including little lights from electronics, etc.
posted by atinna at 12:12 PM on March 19, 2016

This will vary on the laws in your area of course, but have you tried marijuana? I have a close friend who couldn't sleep for a couple reasons, and she started smoking a joint before bed and it knocks her right out, better than her Ambien prescription.
posted by masquesoporfavor at 12:39 PM on March 19, 2016

Response by poster: You guys! Thanks! New ideas, when I thought I'd literally tried every possible thing!

Here's what I've got so far:

taff : Oh, yes. (or, OH, YES). Except it, uh, violates the can't do anything that would wake spouse (who also has sleep issues, to the point that he is frequently only a couple of hours of sleep in by the time I wake up) rule. (And, sadly, right before bed in the evening just keeps me awake for HOURS).

fairmettle: that's brilliant! Right after writing this post, I tried to go back to sleep, and realized I hadn't written down one of the things that tends to work for me when anything does, which is my version of counting sheep-- "imagine crazy surreal things like unicorns jumping rainbows and turning into jellybeans." This app sounds like exactly that.
I talked to my therapist about this recently, and we talked a bit about how it's not anxiety in the "I'm worried about thing's" way, but maybe in the "I've got a lot of my mind and I can't stop it going" way. So, I think this is in line with the idea of encouraging your brain to just let go into random thoughts phase of sleep: my brain won't let go of daytime stuff to slip into sleep.

pie ninja: that's a good question, and one I was wondering about after reading several posts about it on the green in the last month or two. My sleep study was about 5 years ago at a hospital sleep center, and I was hooked up to electrodes all over. The study didn't show any physical cause of my waking, but I don't know enough about UARS to know if it would? I do know that I have a very seriously deviated septum that the last ENT I visited suggested surgery for (right after a friend had a horrid, smell-destroying surgery for the exact same issue, so I didn't pursue it).

metasarah : I totally forgot to mention that I tried both Lunestra and Ambien and had really bad experiences with both. And maybe one other prescription sleep aid I can't remember? The experience was bad enough to scare me off future meds that might act similarly. (I didn't get the "sleep Amazon shopping" experience, I got the "scream at my family like I'm on prednisone" experience." Awful. Never again, even if I'm on less than 4 hours of sleep a night.) I've done an informal sleep restriction, though not really thinking of it that way, and discovered that I wake up about 4.5-5.5 hours after I fall asleep, whether I go to sleep at 8PM or 2AM. Going to sleep between 10 and 11 seems to be a good compromise-- anytime after 4AM I can pretend I'm a farmer and it's actually morning.

biscotti and kmennie : gabapentin and Methocarbamol! OMG, an entirely new idea! I never heard of this-- I will ask my doctor about it.

Dip Flash et al: re hormones. Good point. I have PCOS, so my hormones are checked once a year, but I haven't talked to my doctor about how that might impact my sleep. (And I'm also at that awkward, middle age where my hormones are likely just starting to be weird.)

cooker girl et al: I forgot to mention that I spent years finding the perfect sleep mask and earplugs. When one of my kids isn't home, I'll occasionally sleep in one of their rooms, and I do sleep somewhat better, so light-proof and silent does help, but unfortunately, our house isn't big enough to do that every night. (I used to be able to sleep downstairs on a futon when my insomnia was really bad, but pets now make that less peaceful, mostly defeating the point.) And I still wake up, just not quite as often.

I haven't had caffeine except by accident in almost twenty years (though, actually, that's not quite exactly true, as I've started occasionally drinking tea in the morning in the last couple of months-- it hasn't made much of a difference though). I probably have one drink a week on average? It definitely wakes me up more thoroughly in the middle of the night.

Thanks for the ideas and new stuff to try! Keep the ideas coming.
posted by instamatic at 1:01 PM on March 19, 2016

My issues aren't as extreme as yours, but when I have periods of insomnia it's the same form: I sleep fine for the first four or five hours, and then I toss and turn. I am definitely someone who functions better with at least eight hours of sleep, so I've tried lots of things to remedy the problem. I used a magnesium supplement in addition to melatonin at bedtime with some results, but then I switched to this supplement and improved even more than I had with the plain magnesium. This is another sleep supplement that might be worth looking into.
posted by katie at 1:01 PM on March 19, 2016

I took co-q-10 in the morning for years. Many people are deficient. I was told by someone I believe to be knowledgeable that it wakes the brain up and also prompts it to make an uptick in melatonin about 12 hours later (though it worked better for me to take it about 14 hours before sleep time). I recently tried to find information on the web about co-q-10 and couldn't, so, unfortunately, I have no links. But I took massive quantities (400-600mg) for a few years and it straightened out my horrifying insomnia. I no longer take it, but I seldom have serious sleep issues these days. I do continue to have minor sleep problems, but not major ones.

The other thing I did was cleaned up my sleep area. Cleaned the entire bedroom like for spring cleaning and began stripping the bed and washing everything once a week. This was so helpful, I eventually began trying to reduce how much bedding (and upholstered furniture, etc) I had. I have terrible allergies and respiratory problems and I have found that minimal, squeaky clean bedding goes a long way towards making sure I can sleep.
posted by Michele in California at 1:23 PM on March 19, 2016 [2 favorites]

my brain won't let go of daytime stuff to slip into sleep

this totally used to be me - but now I always have an audiobook playing quietly while I'm sleeping. so I drift off being read to, and if I wake up in the middle of the night I start listening again, and my worrybrain doesn't even kick in, so I can fall back to sleep again after 15 minutes or so (or that what is seems according to the sleep tracker on my fitbit) I don't even remember waking up sometimes. If the book is too engrossing and keeps me awake, I'll put on an old favourite, and that works.

They have sleep-friendly headphones if you don't want your book to disturb your husband, and even if you end up being awake for a while, at least you're getting some reading in, which is pretty relaxing too.
posted by 5_13_23_42_69_666 at 1:36 PM on March 19, 2016

I'd like to add another trick. If you feel tired but can't sleep, use the 4-7-8 method.

You breathe in for 4 counts.
You hold for 7 counts.
You breathe out for 8 counts.

It works by making you lightheaded enough to doze off so do it when you're tired.

At first, it seemed useless but I was truly sleeping in 60 seconds.
posted by Coffeetyme at 1:45 PM on March 19, 2016 [1 favorite]

Response by poster: Oh, interesting! I hadn't realized that was why that breathing trick was supposed to work. It doesn't work for me, which may be because I do a lot of pranayama (breathwork), so it didn't make me lightheaded.

I've recently started to listen to audiobooks at night, and they totally help me fall asleep. Sadly, they don't seem to work to help me fall BACK asleep, though.

But mostly I dropped back in to report that I've spent the last twenty minutes or so reading about UARS and now I am psychosomatically convinced my throat is closing up. I can't breathe, Metafilter, and it's all your fault! ;-) (I am going to buy some nasal strips tomorrow, for sure.)
posted by instamatic at 6:10 PM on March 19, 2016

I thought the culprit was caffeine, but I completely eliminated sugar from my diet a few months ago and haven't slept this well in years.
posted by blazingunicorn at 7:44 PM on March 19, 2016 [1 favorite]

What dose of melatonin have you tried? I used to take 3 mg and would always pop awake at 3 AM (after 4 hours sleep) -- until I bumped up to 10 mg. Now I can reliably get 7 hours of sleep.

I was also prescribed propranolol as a mild anti-anxiety med to be taken as needed. When I'm really struggling to sleep, I take 10 mg of propranolol and it typically helps both falling asleep and staying asleep. It's a beta-blocker, so blocks the effects of adrenaline. It isn't sedating like Xanax -- I particularly wanted to avoid anything that would make me sleepy. I can and do also take it for panic attacks during the day, when I need to be awake and alert. It just blocks that whole fight-or-flight, out-of-control anxiety/panic feeling, and apparently that's a big part of insomnia for me.
posted by snowmentality at 10:19 AM on March 20, 2016 [1 favorite]

I haven't read all of these, but I have had a lot of sleep problems which I think are largely tied up with body pain, muscle stiffness, that sort of thing. Since you mention that as a possibility, I'll mention my best sleep "cocktail":
- oral magnesium but NOT calcium (calcium makes my muscles hurt more, YMMV), the powdered stuff you drink seems to work best
- a hot bath with lots of epsom salts
- an NSAID, advil or aleve
- a muscle relaxer, I used baclofen (5-15mg, again, YMMV)

(I also used ambien for sleep initiation when the insomnia was bad, but it doesn't sound like that's currently a problem or a viable solution for you)

I still had a lot of pain, but these all helped and are fairly easy to try (baclofen isn't a crazy risky or addictive med, it's also pretty cheap IIRC, the rest is all OTC), so it might be worth checking on.

Btw, you have my sympathy, I'm pretty sure that laying in bed, exhausted and being unable to sleep (and being in pain) is one of the lower circles of hell.
posted by pennypiper at 12:24 PM on March 21, 2016

Response by poster: Coming back in to report a week's worth of experimental results. I had several days in the middle of the week where I worked midnight hours (server maintenance work), which obviously messed with those nights of sleep. Other than that, i discovered much to my surprise that the nights I took Flonase and Astelin nasal spray at bedtime I slept about two hours longer than usual. This is mind blowing for me! I have had this prescription for years, and I've certainly taken them at night before. These days I try not to use them daily because they're a little hard on my nasal tissues so I save them for when my allergies are really acting up or when I have a cold or sinus infection. I guess I'll change that now!

This makes me think that what I've always thought of as a monolithic insomnia may in fact be caused by different things for different symptoms-- maybe not enough evening downtime caused the bedtime insomnia, and when I stamped that out sleep hygiene issues caused the 2-4AM insomnia, and when I fixed that, my breathing issues caused the 4AM wake up.

I'm not dancing around saying "after twenty years of insomnia I was cured in a week!" but I've gotten more consecutive 7.5+ hour blocks of sleep in this one week than I have had so far this year combined.

For science, I should report that of the other things I tried, I was most excited about the MySleepButton app, but I am sad to report that while I know that thinking about random things consecutively works well to put me to sleep, that having a voice break in every 7 seconds to say a word was really jarring. I would listen to it for about 2.5 minutes, then turn it off and continue in the same vein in my own head-- I think this helped as well on the nights that I had a weird work schedule. Also for science, I should report that the only other "thing I never tried before" was really upping my probiotic intake-- coincidentally, because I just made my first batch of kombucha and drank some daily. I have NO idea if that made any kind of difference at all, and I'm not aware of any "probiotics fix insomnia" claims-- but after years and years of trying all kinds of diet, exercise, CBT, and sleep hygiene fixes, there just wasn't a whole lot "new" I could try this week without seeing my doctor for different prescriptions, so nasal spray (good) + app (bad for me) + probiotics (who knows) is the best I can isolate cause and effect for the really remarkable change this week.
posted by instamatic at 5:30 AM on March 25, 2016 [1 favorite]

Response by poster: Thinking about this a bit more, I realized that it's actually far more dramatic than that-- three times this week I went to sleep at 10:30 and didn't wake up until after 6AM. I think it has been more than a decade since I slept through the night without at least waking up long enough to pee. I don't even count "woke up three times last night" as disturbed sleep as long as I fall back asleep in less than half an hour. Hell, it's possible that it's been twenty years since I slept through the entire night without waking even once. (I thought maybe I was just not remembering waking up, so I used my motion-sensitive sleep app-- yes, completely in the "sleep" to "deep sleep" range all night).
posted by instamatic at 5:41 AM on March 25, 2016

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