Can't Seem to Wake Up
September 28, 2016 2:10 PM   Subscribe

I can't seem to get up in the morning. It's affecting my ability to get to my job.

What's the opposite of insomnia, because I think I have that. For the past two months I have been constantly late for work and just recently called in sick for two days just so I could sleep. It's bad. Things I have tried:

- Going to bed earlier.
- Having a sunrise alarm clock to wake me up gently.
- Moving said alarm across the room so I have to get up to turn it off (I do and then go back to bed).
- Using a sleep tracker on my phone so that I wake up during a "light" phase of sleep.
- Waking up an hour earlier and taking vitamin B pills in the hopes they will wake me up.

Other information that is relevant: I'm on multiple meds for depression and anxiety. But I have been on these for years and take them only in the morning. This sleep thing has been an issue since August only.

Sleep tracker tells me I am getting quality sleep, and I live alone, so there's that. I'm getting desperate. Before I go to my doctor is there any tips or advice you can give?
posted by aclevername to Health & Fitness (25 answers total) 9 users marked this as a favorite
If this were me, I'd get a blood test for vitamin and mineral deficiencies. Many nutritional problems can lead to extreme fatigue.
posted by monkeymonkey at 2:13 PM on September 28, 2016 [6 favorites]

Sleep tracker, as in like a phone app? Those are fun, but I'd probably still talk to my primary care physician about a sleep study.
posted by DirtyOldTown at 2:19 PM on September 28, 2016 [1 favorite]

What happens if you drink a whole glass of water and make yourself get out of bed and sit outside? It's very difficult for me -- I have similar issues to you in waking up and staying awake -- but when I am able to make myself do this it works. But yeah, go to the doctor.
posted by sockermom at 2:20 PM on September 28, 2016 [1 favorite]

Do you drink coffee or smoke cigarettes? Either of these destroyyyyys my ability to get up in the morning. I limit myself to green tea (or black tea in the morning if I really need it), it helps a lot.
posted by stoneandstar at 2:20 PM on September 28, 2016

Do you get exercise during the day, no closer to bedtime than 4 hours? It might help you sleep more deeply and wake up feeling more refreshed.

Have you ever been told you snore? If so, you may want to ask your doctor about sleep apnea.

Are you well-hydrated? Being slightly dehydrated all the time can make you feel sluggish.

Is excessive sleepiness a possible side effect of any of your medications? Sometimes even meds you've taken for a long time can start having side effects.

Is it possible your meds are no longer working as well to combat your depression and excessive sleepiness is a symptom of that?

Since this is impacting your life so greatly -- trouble getting to work on time for months and calling out sick just to sleep is a pretty major impact -- I would seriously suggest you see a doctor.
posted by erst at 2:21 PM on September 28, 2016 [3 favorites]

Definitely push for a sleep test, especially since this is affecting your life and job. You want to tell your doctor "I cannot wake up in the morning, and I've called in sick just to sleep. This is putting my job at risk and negatively affecting my life."

Sleep trackers are not nearly as sensitive as an in-lab sleep test, which is the gold standard. This, btw is what detected my severe sleep apnea. I got a CPAP and it changed my life for the better. I wake up rarin' to go instead of dragging myself out of bed.

If you live alone, you won't have anyone to tell you if you snore or kick in your sleep. But a sleep test can tell you.

Push hard, if necessary, for a sleep test.
posted by Rosie M. Banks at 2:28 PM on September 28, 2016 [6 favorites]

Toxicologist here. This is your likeliest culprit, even if it's a new issue after a long-term medication regimen:

I'm on multiple meds for depression and anxiety

Most, if not all of these medications, are associated with changes to the chemistry of sleep and wakefulness. Take a look out (or download) the product insert for each medication. Read through them (some make specific statements about drowsiness, wakefulness, etc.). Bring this up with your doctor at your next visit, especially if there may be a known synergistic effect between some or all of your meds that relates to sleep.

If you consume caffeine, it may be time to try a washout period. This is a very, very common issue clinically (not just in clinical research, but in the clinic proper--some physicians won't prescribe pharmaceutical sleep/wake meds until a patient agrees to stop using caffeine for a couple of weeks).

At a very basic level, aside from medications and pharmacology, if I don't get some sort of exercise on a routine basis, I can't fall asleep or wake up with any measure of routine. The time of day I exercise plays a role, too (if I jog in the morning before work, I'm ready to fall asleep by early afternoon; if I jog after 7 pm, I'll have trouble falling asleep; if I run between about 5 and 6:30 pm, I'm able to fall asleep easily and waking up isn't difficult).

Good luck!
posted by late afternoon dreaming hotel at 2:29 PM on September 28, 2016 [8 favorites]

I'm on the "see a doctor" train too.

But in the short term, you might try the "I Can't Wake Up" app (Android, iOS) which forces you to complete a number of tasks before you can turn off the alarm. It's highly customizable as to which and how many tasks you must complete, how difficult they are, etc. I find by the time I've completed the ones I've set up, I'm usually awake enough to actually stay awake and get going.

I particularly like the Scan Barcodes task: in my case I've set it up with about 20 barcodes on items around my home, and it randomly selects 4 which I have to scan. That way it gets me moving and isn't something that can be done from bed, or even in one place. I used to be one of those "snooze several times even if the clock is all the way across the room" people until I started using I Can't Wake Up.
posted by DevilsAdvocate at 2:31 PM on September 28, 2016 [4 favorites]

Does your problem persist with exhaustion throughout the day, or is it a getting-out-of-bed barrier only? When I suddenly felt exhausted all day, with a problem getting up also, it turned out to be mild pneumonia. I had no other symptoms. It sounds like you've tried lots of common-sense approaches; I think the doctor is the right move.
posted by epj at 2:35 PM on September 28, 2016 [1 favorite]

It sounds like you are avoidant. If you go back to bed that is the problem. I suggest therapy.
posted by Ironmouth at 2:54 PM on September 28, 2016 [3 favorites]

Yes doctor.

Also, the main site that I link to for the concept of "practicing waking up" is coming up as mal-ware on my work's firewall, but a super brief version is step 10 here.

But you'll need to take your practice sessions beyond just standing up. Stand up, turn off the alarm, walk into the bathroom and get in the shower (or something equivalent that works for your routine). You need to make it harder for yourself to get back into bed.

Since you live alone, could you do something as drastic as stripping all the sheets off of the bed so it's no longer comfortable? Throw your pillow down the hallway?
posted by sparklemotion at 3:26 PM on September 28, 2016

You can google this specific to your medication, but many meds in the class you describe have the side effect of blocking or depleting vitamins. This often effects sleep patterns. Or other stuff like anxiety levels. Depends on the drug interactions.

Vitamin D helps sleep. 5HTP helps sleep. Magnesium depletion hugely effects sleep. B Vits you have covered. Melatonin. L-Glutamine is another biggie that helps you stay asleep. Vit C helps. I mean, it's a long list....

But yeah. That's one of the simpler hacks you can try.
posted by jbenben at 3:38 PM on September 28, 2016

Doctor, definitely.

I only get up because my cat jumps on me, licks my face, and mews until I feed her. Prior to adopting a cat I was one of those people who could not get up to save my life. I wouldn't recommend adopting a pet unless you have been wanting one, but if you have been thinking about it, a cute living thing who depends on you for breakfast and has no problem reminding you can be a big help.
posted by kapers at 4:27 PM on September 28, 2016

Yeah, doctor, and hopefully a specialist.

Just as an aside, if you DO have a bed partner and you turn out to have sleep apnea, there's no guarantee they'll notice anything. Or that there will be anything to notice--I didn't snore much, didn't visibly stop breathing, and I never kicked or thrashed or woke up gasping.
posted by wintersweet at 4:40 PM on September 28, 2016

I went years with problems with excessive/extreme fatigue and a really difficult time waking up. (And depression, too!) Turns out it was all due to several undiagnosed food intolerances. They did not show up on food allergy tests, but I've done enough self-experimentation (taken the foods out of my diet for extended periods and put them back in for a week or so) to be confident that they're the cause.

Granted, I had other serious issues (mostly vomiting repeatedly every morning) that eventually led me to look into food intolerances/allergies. Fixing this issue of being chronically unable to wake up in the mornings was an unexpected benefit! MeMail me if this sounds relevant and you want to know more.
posted by cnidaria at 5:44 PM on September 28, 2016

Hypersomnia is the opposite of insomnia. I, too, suffer from this problem. You might find my previous question about waking up faster helpful.

I agree with the above comment that the most likely culprit is your depression and anxiety medication. Specifically, I would guess that you are experiencing the so-called "poop out" effect, where medications you have been taking for years suddenly become less effective or stop working altogether because you have built up a tolerance to them. Talk to your psychiatrist about this. They may advise to increase dosage or try a different medication.

It sounds like you've tried many things. One thing I didn't see mentioned was reducing screen time before bed. A good start would be using a screen dimmer that makes your screen less blue at night, such as Flux, which is available for both smartphones and regular computers. (For iPhones, Apple has its own version called Night Shift.) Even better would be choosing to avoid screens for 1-2 hours before you want to fall asleep. Find another activity to wind down with (possibilities include reading, meditation, a bath, writing in a journal, etc.) and try it for a week or two to see if it helps.

How are your eating habits? Have you recently added any new foods to your diet, or stopped eating something you used to eat a lot of? Could you have a newly-developed allergy to something? If so, you might expect that some days are worse than others depending on what you ate. You could try taking a multivitamin and/or ask your doctor to get bloodwork done to see if you have any deficiencies. And definitely make sure you're drinking plenty of water. Dehydration often manifests as grogginess or a headache. Try drinking water right before bed and right when you wake up.

It's also possible that you may have sleep apnea, although it would be unusual to have such a sudden onset. You could experiment with sleeping on your side and using nose strips to open up your airway. I wouldn't put a lot of stock in a smartphone sleep tracker, though - it can't measure how you breathe, and it's possible to have sleep apnea even if you never actually stop breathing (you just breathe shallower and shallower until you're hardly getting any air in at all). For a definitive answer, you will need to push your doctor for a sleep study, which is well worth pursuing given how much your sleep affects your job and quality of life.

In the meantime, though, one thing you can do is practice waking up. During the daytime, when you're fully in control of your actions, practice lying in your bed, hearing your alarm go off, and right away sitting up and drinking a glass of water (for example). Make it automatic, so you don't have to think about it or bargain with yourself. Do this many times, I'd say 5-10 times in a row at least, then wait an hour or two and do it another several times, then go to bed. When you hear your alarm the next morning, it should be a bit more automatic to get up right away, because that's what you've trained yourself to do. If you have time, repeat the training sequence for several days, then gradually space it farther and farther apart. If you fall off the wagon, that's okay, just do the training sequence again.

Best of luck!
posted by danceswithlight at 7:10 PM on September 28, 2016 [3 favorites]

Just a note about the sleep study: don't freak out that it's really involved to do. These days an in-lab sleep study is only recommended for muddy/unclear cases. There is an in-home sleep test that's much better than a personal tracker - you take it home, sleep with it, turn it in the next day and they analyze the data from there. Way less expensive and invasive and it still works. Don't let the thought of a night in the lab deter you from asking for an evaluation for sleep apnea.
posted by Miko at 7:39 PM on September 28, 2016 [1 favorite]

Do you have trouble getting up on weekends? If not, think about what has changed at your work and why you don't want to go there.
posted by Joleta at 8:46 PM on September 28, 2016 [4 favorites]

I have long had trouble waking up in the morning. After my doc discovered that my iron level was extremely low, I tried supplements for 2 months, then we discovered that I also have problems absorbing iron. I got a iron IV transfusion and my life has been soooo much better. Waking up and feeling awake in 5 minutes instead of over an hour of groggy anger trying to get out of bed.
posted by fairlynearlyready at 8:50 PM on September 28, 2016 [1 favorite]

I had the same issue when my b12 was low. I could have slept 20 hours per day but I was completely non-functional before 10am. I was also extremely anxious and yet apathetic which predated the exhaustion by a year or so. I am not typically anxious so it was weird and it went away completely with treatment
posted by fshgrl at 10:01 PM on September 28, 2016

When you go to bed earlier, are you falling asleep immediately and sleeping through until you wake up naturally, later than you want? If so, you are dealing with a medical issue, not a wake up training issue. Definitely a thing to take to your doctor, but it might not be easy to get an answer from the broad-spectrum surface level tests you'll get on your first visit. You will need to push for deeper tests in any system that appears off.

When I was in this situation, my thyroid was slightly malfunctioning (TSH = 6.1, borderline hypothyroid). I spent 4 years on levothyroxine on doses that were always too strong or too weak before I insisted on a referral to an endocrinologist. Found out that I underproduce T4 in response to TSH, which means I should optimally take a T4 supplement, not a TSH supplement.

I was a bit surprised about how forceful I had to be in order to get the insurance-mandated referral to a specialist who could dig deeper into the things that seemed off in my initial test results. When you're dealing with fatigue this is a hard thing to do, but you have to demand access to specialists. It's the only way you can access the care you need.
posted by SakuraK at 10:46 PM on September 28, 2016

Nthing doctor.

Also B vitamins don't do much for you if you don't take them with food.
posted by ananci at 11:43 PM on September 28, 2016

Nthing Iron deficiency and adding that taking a Ferrous Fumurate type supplement at appropriate times (calcium/dairy interrupts absorption) CHANGED MY LIFE.

I had anxiety, sleep problems, and was always turned down to donate blood + bruised easily. GNC makes an iron supplement with Ferrous Fumurate and B Vitamins. I take it with C, just in case.

Life Changing.

I don't take it (or any supplements) all of the time, just when things need tweaking. I take the GNC iron when bruising starts up, always cures it. My bruising and sleep problems go hand in hand - so there ya go.

You can be prescribed meds to help your sleep issues. That's cool. But you might try treating the likely cause of vitamin deficiency first, just to rule that out. In moderation this can't hurt. Even a good multi-vitamin for a few weeks might get you improvements overall. It's cheap and easy! Give it two weeks and re-evaluate.
posted by jbenben at 12:08 AM on September 29, 2016

When this was a temp issue for me a few years ago, I moved the coffee pot with a timer (set to start about 15 minutes before the alarm) into the bedroom and put a granola bar next to it.

Seconding going to the doctor, however—this is just a suggestion for the meantime.
posted by she's not there at 1:10 AM on September 29, 2016

Hey all,

Thanks very much for your responses. I went to see my doctor and we're going to do a blood test, and if that turns out normal, a sleep study. In the end, though, she's pretty convinced it's a side effect of grief (my mom passed away in June). But we're looking into it.

posted by aclevername at 6:27 PM on October 4, 2016 [2 favorites]

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