Cannot stay asleep
August 15, 2016 5:15 PM   Subscribe

I'm having no trouble falling asleep. But I can't stay asleep.

Today is the fourth consecutive night that I’ve woken up at 3 AM and not able to go back to sleep. I’m taking sick leave today from work because I’m barely able to function. Yesterday I had to take a nap in middle of the day. I don't get what is going on because I’ve never had these kind of sleep issues before.

It’s possible it’s to do with feeling stressed - there's a lot going on with my job now, and I just went through a breakup that I'm not sure if it was the right choice (another question on that later). I went to therapy and yoga yesterday, both of which were very relaxing and should have helped me, but instead nothing changed.

I have no issues falling asleep, it’s the waking up at 3 AM and not being able to go back to sleep. I usually get up in middle of the night anyways to pee, without any issue falling back asleep. The first time it happened it was stress that kept me up. Then now it's like my brain is like: "oh good idea, let’s keep doing this now it's a habit" and I need to kick it!

I've been taking melatonin. The first three nights I've taken one. This past night I've taken two, but barely any effect.

Other things about me:
--Female, early 30s
--Taking birth control and Accutane (does timing of the day in which I take these drugs have any impact?)
--Average weight and very in shape
--I have good sleep hygiene. I read every night and there's barely any light in my room, and I don't use my devices before bed.
posted by pando11 to Health & Fitness (22 answers total) 11 users marked this as a favorite
So, I just went through a sleep study and several follow up appointments for the same issue. I don't have sleep apnea, and nothing else showed up during the sleep study. Their diagnosis was that it's stress.
posted by MexicanYenta at 5:37 PM on August 15, 2016

Melatonin will help you fall asleep, but it's not as effective for staying asleep. Staying asleep (sleep maintenance) is harder to treat than sleep-onset. It's most likely the stress, unfortunately. Are you willing to take a bit of benadryl for a few nights to try to reset the pattern?

Alternately, get up when you wake up, leave the bedroom, do something in low light that's calming, then try to go back a bit later.
posted by cobaltnine at 5:45 PM on August 15, 2016 [1 favorite]

This started happening to me in my early 30s. The most important thing I had to embrace was an attitude that it was nooooo biiiiiiiig deeeeeeeeal, nosirree, being awake isn't upsetting at all!

Aside from getting up to pee since I'm awake, I also make any necessary tweaks to my climate control, flip my pillow, and then lay down and tell myself a story - usually a story about, like, the world's most comfortable bed or floating in a perfect-temperature pool on a perfect-temperature night, or some other thing that's not too compelling to keep me up and soothingly murmurs to my brain about sleep. I might also play the Alphabet Game or do that relaxation exercise where you start with your toes, tense and relax, and then your feet, then calves, etc, if I'm having some rabbit-brain issues.

Worst case scenario, I put on an audiobook I know well or the Sleep With Me podcast, on speaker, down very low, with a sleep timer set for 30 minutes (enough time for me to pass out and get enough asleep that the absence of sound doesn't wake me again).

The other thing to watch for, though, is your blood sugar. 3am is a common point, from a circadian standpoint, for a glycemic drop. You might experiment with bedtime snacks to see if they make any difference. Maybe try a lightly sweetened Greek-style yogurt for a little sugar plus a little protein, or a piece of cheese or peanut butter toast.
posted by Lyn Never at 5:46 PM on August 15, 2016 [9 favorites]

Not being able to stay asleep is a sign of depression. It's something to consider. And for some reason it's always 3 am.
posted by orsonet at 5:52 PM on August 15, 2016 [6 favorites]

I found as I got older (past 30s) it became harder to stay asleep at night.

I didn't like melatonin because it always made me feel pretty groggy in the morning, but I found adding Magnesium citrate was really good in helping me stay asleep throughout the night. Consider trying that for a few weeks.

I've also added a night mask and earplugs and those also help.
posted by Karaage at 5:58 PM on August 15, 2016 [9 favorites]

What about caffeine? I'm more sensitive to caffeine than i used to be, so i have to stop around 11 a.m. Maybe try limiting caffeine?
posted by answergrape at 5:59 PM on August 15, 2016 [2 favorites]

L-Glutamine Powder to help you stay asleep and sleep more deeply. Melatonin to get sleepy. Magnesium Citrate because it relaxes you and you're probably deficient (according to current thinking, anyway....)

Vit D because most people really are deficient and this will def help in multiple ways.
posted by jbenben at 6:04 PM on August 15, 2016 [4 favorites]

3rding magnesium citrate and don't take the full dose at first; you need to ramp up to a full dose or it will also give you the trots, because it's also a laxative. Add me to the people who find melatonin doesn't help me stay asleep, but does make the 3am insomnia period way shorter.
posted by molasses at 6:20 PM on August 15, 2016 [1 favorite]

The only thing that helped me was medication (either sleeping pills--which I tolerate well--or anti-anxiety medication). Eliminating caffeine, eliminating alcohol, eliminating screens, adding exercise, adding white noise, regulating temperature--Nothing keeps me asleep except pharmaceuticals.

Something mild to help you through a rough patch of life is not a terrible thing to ask of your doctor.
posted by crush-onastick at 6:26 PM on August 15, 2016 [3 favorites]

This can be a stress side effect, definitely. This used to PLAGUE me and I've gotten better at it so that 19 times out of 20 I can go back to sleep. The big deal with me was to basically make going back to sleep my job and realizing that sometimes focusing on nothing/sleeping was harder than just letting my mind race with should've/could've stuff. And having a plan. So I had a few guided meditations for getting back to sleep, I'd turn on a fan or noise machine, I'd focus on blanking my mind and/or thinking of something tame like haircuts or future vacations, and, on rare occasions when I couldn't make those things work, took some anti-anxiety medicine which might make me feel a little zombie the next day but at least well-rested. And the deal was only do that after 45 minutes of non-sleep but it was like Dumbo's magic feather, I knew I had it in my pocket. How about exercise for you? Would that help? I find getting exercise-tired (but not too tired) can help. But really, meds can help when you just need a one-time reset button while your mind sorts some shit out.
posted by jessamyn at 6:28 PM on August 15, 2016

The technical term for this is "terminal insomnia" (where terminal just means "at the end of sleep", not "fatal"), and in my experience if there are no other physical factors at work it is very much a symptom of stress. I went through a bout of just what you're describing earlier this year when work-related stuff ratcheted up a couple of notches. It's as if your brain is sitting there waiting for the point when your body is just rested enough to make it through a day (maybe), and then shouts "wakey wakey!" and that's that.

I didn't have much luck with supplements, increased exercise, swapping pillows, etc.--tackling the cause of stress was the most effective aid. In particular, finding whatever in the situation makes you feel like you've lost control and coming up with strategies for controlling it as best you can.
posted by Creosote at 6:32 PM on August 15, 2016 [1 favorite]

I just kicked this habit with the help of sleep therapy! I've slept in phases for decades (female, mid-30s) and it is amazing to sleep through the night now.

The therapy was a little counter-intuitive. First thing was to never lie in bed awake. If I couldn't sleep, I had to get out of bed and out of my room, and do something else until I felt sleepy again. Ahead of time, I came up with a short list of tasks that would be distracting but not too engrossing and wouldn't require a lot of light. Folding laundry, etc. Reading is one that works for many people, but every time I tried that, I literally stayed up the rest of the night. Anyway, I'd fold laundry until I got bored/tired, and then go back to bed. Basically, retrain your brain to not wake up at that time because there's nothing interesting to do. It also helps because if you actually do get up for the day at 3 a.m. once or twice, you are so tired that it is way less likely that your brain will wake you up at 3 a.m. the next day - but you do have to watch your caffeine intake the following day and - very important - do not go to bed earlier the next night to make up for it. The point is to retrain your brain AND increase your sleep drive to get a new habit going.

The second thing is to rewire the catastrophic thinking that happens at 3 a.m. I had to turn all my clocks around so I couldn't look at them, and I had to go through "so what" thinking anytime I started stressing about not being asleep. So what if I don't sleep any more tonight? I've gotten by on three hours of sleep before and it's unpleasant but not impossible. It's not true that I'll never sleep again ever. That has never happened in the history of forever, so it won't happen to me. Basically, logicking the heck out of those illogical thoughts, which in and of itself is super boring.

Third was sleep hygiene, which you are already doing a good job of. I had to stop reading in bed AT ALL, but otherwise I was pretty much on target. I worked on adding some additional exercise, outdoors if possible, to help ratchet up my sleep drive.

It's been a few months and I'm still playing around with finding the exact right amount of sleep for me, but the majority of the time I now sleep 6-7 hours straight (used to be 3) and no longer get stressed when I have a run of rough nights. I just get up a little earlier for a few days and it corrects itself.
posted by peanut_mcgillicuty at 7:09 PM on August 15, 2016 [7 favorites]

Echoing peanut_mcgillicuty re: sleep hygiene, only sleeping in bed.

When I wake up in the middle of the night, I get up and move to the couch. Something about the change makes me less stressed about not sleeping. Just ready to relax...zzzzzz. HOWEVER this might counteract your sleep hygiene efforts.
posted by meemzi at 8:13 PM on August 15, 2016 [1 favorite]

I feel like this is an issue that many, many woman go through as they get older, but no one really talks about it. I am in a book group with woman who are 5-10 years older than me, and each one has complained about sleeping. Personally if I listen to a podcast when I wake up in the middle of the night, I find that I fall back asleep faster. I feel like it silences the noise in my head. As noted above, Sleep with Me is great, it is a guy talking a in a low soothing voice about god knows what.
posted by momochan at 8:51 PM on August 15, 2016 [1 favorite]

Same thing happened to me - potentially related to stress or bad memories of various things for a year before and about six months after my mum passing away. What fixed it? OTC sleeping pills (ZzzQuil) over an extended period of time (months) to "retrain" myself to sleep through the night. I know it's bad to take them for long periods, but what's worse is not getting enough sleep. Good luck.
posted by ryanbryan at 9:04 PM on August 15, 2016

Are you very in shape because regular exercise, like 30-45 minutes/day? The exericse doesn't have to gym-type but as simple as a brisk walk. Ideally, your exercise should come early in the day rather than right before bedtime.
posted by dlwr300 at 6:10 AM on August 16, 2016

My experience:
I used to get up at 3-4 a.m. and not be able to go back to sleep. I then went on a moderate low-carb diet and poof, it stopped. It turns out that before low-carb I had fluctuating blood sugar due to eating lots of sugary treats. Then, at night, as my blood sugar dropped and dropped, my body would get a surge of adrenline at 3 a.m. and I'd be unable to get back to sleep.

Getting rid of desserts and sugary goodies gave me a more even blood sugar level throughout the day and so I sleep much better.

This is only a theory I've researched to understand why I don't have this anymore. Just putting it out there for you to consider.
posted by Coffeetyme at 7:44 AM on August 16, 2016

Zzz-thing the Sleep With Me podcast to bore you back to slezzzzzz
posted by sconbie at 8:20 AM on August 16, 2016

Do you have any other symptoms other than the insomnia? I ask because it sounds like it was a sudden onset thing, and when this happened to me, it was one of the early symptoms of thyroiditis. (Woman, early 30s, and summer is the classic pattern, too.) If you have any of the other symptoms (anxiety, sudden weight loss, heart palpitations, difficulty swallowing, etc.) I'd schedule an appt with your doctor.

I think everyone above has some excellent suggestions about stress, sleep hygiene, etc. That being said -- if you try everything and it's not working, it could definitely be worth finding a good sleep doctor to talk to. Sleep disorders are way under-diagnosed in women for a variety of reasons and it's possible to get them, even in your 30s, even at a normal weight. Waking up and not being able to get back to sleep can be a classic symptom for women with e.g. sleep apnea.

Good luck!
posted by pie ninja at 9:38 AM on August 16, 2016

Nthing what many say. I'm awake at 3am every night. I get up, go pee, adjust anything that needs adjusting, but I also have rules: no turning on the light, no opening the laptop, no reading.

My cell phone is ready with the most boring audio books and podcasts I can find, which I set at a 30 minute sleep timer (sometimes even 15 min at a time) and turn down to the lowest volume I can stand--I can barely hear it, but it's enough to distract me from stressful thoughts.

Right now I'm listening to Volume one of Gibbon's Decline and Fall of the Roman Empire and old radio mystery podcasts like Dragnet and Johnny Dollar.

I also have incorporated the 4-7-8 breathing technique.

This combination works like a charm. It helps that I don't share a bedroom with anyone and I've learned not to stress about the I WOKE UP AGAIN thing. I've come to terms with the reality of it, and I make sure to go to bed early (no later than ten most nights), and I have no problem getting up at a normal early time.
posted by RedEmma at 10:20 AM on August 16, 2016

This has been an issue for me as well. 32 here. One thing I found that helps me fall asleep, and then get back to sleep in the night, is running a Twitch stream of a nostalgic childhood video game with full flux settings (I think it's the setting darker than ember). My eyes get so tired watching it, and the content feels so safe and familiar, and knowing someone else is actually playing the game right then, makes me feel safe and cozy. I also have a 20-30 minute monitor timer, and I'm usually out by the time it goes off. If not, I tap an arrow to bring the screen back up, and roll over.
posted by avalonian at 11:01 AM on August 16, 2016

Early wakening is a symptom of depression, as someone previously mentioned. With all the stress you are going through, perhaps it is possible you are experiencing depression? Others have some great suggestions, specifically not staying in bed while awake, not turning on lights, and staying away from exercise and caffeine just before bed. One thing that seems to help me is lying down sideways on my bed. For some reason, changing the direction in which I am lying helps me fall asleep. If you are taller then just reversing your head and feet positions should help. Also, having calcium (preferably with the aforementioned magnesium) before bed can be effective for some (like the warm milk grandmothers seem to encourage, although I prefer ice cream). I would still be concerned about potential depression, since this is the number one reason I see people with early wakening (I'm a psych nurse).

Good luck with everything. I know how debilitating it is not getting enough sleep.
posted by tacotacotaco at 12:31 AM on August 17, 2016

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