Sleep specialist in Portland OR

March 7, 2018 7:56 PM

I have tried to get to the bottom of my sleep issues before, to no avail. It's time to try again. Recommendations?

I strongly suspect I have a circadian rhythm disorder, and I want to find a doctor that knows what to do with that. What I absolutely don't want is someone who will require me to try sleeping pills before anything else.

Additional details, if you wanna play along at home:
* I sleep a lot (10 hours last night!) and hardly ever feel rested when I wake. Sometimes it's the prickly tired of not sleeping deeply, and sometimes - like this week - it's the heavy, foggy feeling of being drugged.
* It's interfering with my ability to work and have a life.
* This is something I've dealt with since I was a kid. I missed a LOT of morning classes in college.
* My sleep hygiene isn't perfect, but it is very good.
* I *do* have periods where I'm ok, but it's been really bad since January. It might be worse in the winter?
* I have tried sleeping pills and they were a disaster.
* I had a sleep study, turned up nothing.
* My caffeine use is dialed in.
* I have a hard time falling asleep after I get in bed. I don't look at a screen; I listen to podcasts.
* I have a hard time "going to bed earlier," and "just wake up earlier" is basically impossible. I have a lot of shame around this. It's easy to stay up too late.
* It's a magnitude worse during my period.

posted by hishtafel to Health & Fitness (7 answers total)

Have you had your bloodwork done? Have you tried moderate exercise? Is your bed good or total shit?

Also, what is dialed in caffeine use? What happens when you drink zero caffeine? I thought mine was dialed in and then I slept a lot better when I cut it.
posted by Kalmya at 8:09 PM on March 7, 2018 [1 favorite]

Also, have you tried a brisk 20 minute walk outside as soon as possible after you get up?
posted by Kalmya at 8:10 PM on March 7, 2018

This is typically the time of year when people with low Vitamin D have issues. The light coming back doesn't really help, because it's too dim and no one is sun bathing right now. Have you ever had your Vitamin D checked?
posted by Marie Mon Dieu at 8:22 PM on March 7, 2018 [1 favorite]

Have you been tested for hypothyroidism before?
posted by Hermione Granger at 8:30 PM on March 7, 2018

Sounds very much as if you might have Delayed Sleep Phase Disorder (or DSPD):

DSPD is a disorder of the body's timing system—the biological clock. Individuals with DSPD might have an unusually long circadian cycle, might have a reduced response to the resetting effect of daylight on the body clock, and/or may respond overly to the delaying effects of evening light and too little to the advancing effect of light earlier in the day.[17] In support of the increased sensitivity to evening light hypothesis, "the percentage of melatonin suppression by a bright light stimulus of 1,000 lux administered 2 hours prior to the melatonin peak has been reported to be greater in 15 DSPD patients than in 15 controls."[18]

People with normal circadian systems can generally fall asleep quickly at night if they slept too little the night before. Falling asleep earlier will in turn automatically help to advance their circadian clocks due to decreased light exposure in the evening. In contrast, people with DSPD have difficulty falling asleep before their usual sleep time, even if they are sleep-deprived. Sleep deprivation does not reset the circadian clock of DSPD patients, as it does with normal people.[19]

People with the disorder who try to live on a normal schedule cannot fall asleep at a "reasonable" hour and have extreme difficulty waking because their biological clocks are not in phase with that schedule. Non-DSPD people who do not adjust well to working a night shift have similar symptoms (diagnosed as shift-work sleep disorder).

In most cases, it is not known what causes the abnormality in the biological clocks of DSPD patients. DSPD tends to run in families,[20] and a growing body of evidence suggests that the problem is associated with the hPer3 (human period 3) gene[21][22] and CRY1 gene[5]. There have been several documented cases of DSPD and non-24-hour sleep–wake disorder developing after traumatic head injury.[23][24] There have been cases of DSPD developing into non-24-hour sleep–wake disorder, a severe and debilitating disorder in which the individual sleeps later each day.[4]

If you have an "unusually long circadian cycle" which resists entrainment to a 24 hour day by the usual environmental cues, you will occasionally be almost in sync with everybody else, which would account for those periods of time when you're doing ok, but you will inevitably drift out of sync again and feel alternately like you are getting up too early, which I would identify with the "prickly tired" you report, and then like you are getting up way too late, which I think gives rise to the "heavy, foggy feeling of being drugged".

It's interesting that your period makes it worse; the linked Wiki article mentions that this is a pretty rare disorder at .15% in adults, but not in adolescents, who have it at a rate of 5-7%.

I would say you should find a specialist in DSPD, and not settle for a general sleep practitioner.
posted by jamjam at 9:07 PM on March 7, 2018

When you say "sleep study," do you mean just the overnight, or did it include the next-day Multiple Sleep Latency Test (MSLT)?
posted by blue suede stockings at 2:35 PM on March 9, 2018

Here is my theory,

Your deficient in calcium and potassium. These are the minerals that help relax the body and help you fall asleep.

Vitamin D helps the body absorb calcium. You dont have alot of Vit D in the winter so therefore you have low calcium. Hence the inability to fall asleep.

Also the fact that your period makes it harder. This makes sense since the body is using these minerals elsewhere.

Up your calcium and potassium through plant sources (dairy or meat sources take and give calcium and overall dont boost it as much as plants).

After increasing your calcium and magnesium you need to sleep wake up after 8-9 hours. 10 hours of sleep is to much and will always result in a groggy feeling. You have to find that window of sleep that gives rest but not so much you feel drugged.

Good luck.
posted by Takeyourtime at 9:56 AM on April 11, 2018