Help me fix my sleep maintenance insomnia

April 20, 2018 9:25 AM

I have had sleep maintenance insomnia the past few years and I'd really like it to go away.

I used to sleep normally but I've had sleep maintenance insomnia the past 3-4 years and I don't know how to fix it or whether fixing it is even possible.

40, female. This started around age 36-37.

I fall asleep as soon as my head hits the pillow, almost always. I wake up again sometime between 3am-5am and stay awake for a couple of hours. During that time, there is NOTHING I can do to get myself to fall back asleep until my body is ready. During that time, it feels like I've had enough sleep, not tired at all, etc. It feels like my body sleeps the bare minimum then says, "ok! you've had just enough, that's all you get!"

I eventually do fall back asleep, and the early-morning hours feel like some of my most important sleep, but alas, work is a thing so this early-morning sleep gets interrupted and I feel like crap.

This pattern is definitely worse when I'm very stressed but it happens even when I'm not.

The internets tell me that this is a common thing women experience in their 30s as they're listening for babies to wake but I don't have kids.

I've tried cutting out caffeine entirely, exercising, limiting screens, all the usual sleep suggestions, but honestly this feels a lot bigger than most everyday sleep problems. And again, falling asleep at the beginning of the night is not an issue for me whatsoever.

I tried taking 400-500mg of magnesium before bed, and for a while I felt it was working; I could tell that I was sleeping much more deeply (I'm normally a very light sleeper) and I still woke up in the middle of the night but I fell back asleep much more quickly. But the magnesium stopped working for me at some point. I still take it now but it doesn't seem to do anything.

If you had this problem, how did you make it go away?

posted by anonymous to Health & Fitness (21 answers total)

I'm the same demo as you and I was having the same issue and started taking melatonin before bed. I actually sleep through the night now. I go to sleep at 930p and was waking between midnight and 2a. I thought melatonin only helped to get one to sleep but it keeps me asleep all night and I'm able to wake easily at 530a.
posted by smashface at 9:32 AM on April 20, 2018

If you just stay awake from whatever hellishly early hour you wake up until your normal bedtime, does that help in any way or do you still continue the early waking pattern?
posted by poffin boffin at 9:36 AM on April 20, 2018

L-Glutamine before bed.

L-Glutamine helps you stay asleep.
posted by jbenben at 9:39 AM on April 20, 2018 [3 favorites]

I've also heard that this can be related to your blood sugar dropping. What if you try having a small carby snack then trying to get back to sleep? That has worked for me, as I'm also a childless lady in my 30s who started to experience this sometimes.
posted by miratime at 9:41 AM on April 20, 2018 [1 favorite]

I have had this problem (mid 40s guy here). I fall sleep at the drop of a hat (or book on my face), and then am up at 3, ruminating on all things past and present. I didn't make it go away so much as embrace it. I generally get up, have a glass of water or make some tea, do the dishes, perhaps play the piano (with headphones; it's electric), or read. Sometimes I go back to sleep, sometimes not. I found that eating dinner earlier and not drinking (alcohol) keeps me asleep longer, but sometimes it just happens, I imagine because I'm (consciously or not) worried about something or anticipating an event at work or upcoming travel or something.

I have read something somewhere that in the pre-electric past, waking in the early hours was a common thing, and various cultures even had names for those times of night when you were awake. No idea where I read that, but I've kept it in mind. So I have tried not to let it get to me too much, and have chalked it up to "natural sleeping rhythms meets modern world"
posted by gyusan at 9:42 AM on April 20, 2018 [9 favorites]

It was magnesium that fixed this exact specific problem for me. I see that you've tried it - but my doctor (whom I talked to at the time) also cautioned me that you have to sort of keep it at a specific level to work.

Are you taking magnesium just by itself? If so, you may want to try a combined calcium/magnesium/zinc tablet, which is what I do. The calcium and zinc sort of help process the magnesium.
posted by EmpressCallipygos at 9:43 AM on April 20, 2018 [4 favorites]

You can talk to your doctor about drugs. Old antidepressants at low doses can help you stay asleep. They may or may not also sedate you during the day. Ymmv.
posted by Kalmya at 10:07 AM on April 20, 2018 [1 favorite]

Might want to look into Trazodone. My brain is a jerk and I'm on multiple medications for insomnia. It does nothing to put me to sleep, but significantly reduces time awake during the night. I've found it to be very mild with no side effects but YMMV.
posted by storminator7 at 10:12 AM on April 20, 2018 [6 favorites]

Same, same, same.

I worked with a sleep MD who gave me a week's worth of Lunesta (ambien and trazodone were non starters as they'd given me hangovers when prescribed in the past) to get me some immediate sanity-inducing sleep. BUT, he said, CBT is now shown to be as or more effective than sleep aids short- and long-term, so he referred me to a sleep therapist specialist. (They're fewer and farther between than you might think.) Anyway, she helped me find my body's natural sleep window and it was life changing. It means that if I go to bed at the "right" time, I can get 6-8 hours naturally. If I go to bed after that, I have the 2am-3am waking that keeps me awake for a few hours, like you. We did other work like identifying what I could do during waking hours, and other strategies for good sleep.

My sleep window isn't terribly convenient but I know where it is and when to go to sleep when sleep is important, and I know how to rearrange my schedule enough to make it happen. The sleep therapist wasn't too concerned about naps at the right time and for the right length (i.e., at times and durations that weren't going to impact my natural cycle) so on days where I wake early, I know I can get a 20 min power nap in that will recharge me.

I highly recommend finding a CBT therapist trained in sleep issues.
posted by cocoagirl at 10:25 AM on April 20, 2018 [5 favorites]

Have you talked to a doctor? I’ll be the one to add the standard ask.me response but there may be more going on (based on personal experience, same age as you with no kids). Talking to my regular doctor got me a referral to a sleep specialist and it seriously improved my life. Some of the previous generation of sleeping pills (now in generic formulations) actually target the middle of the night wakefulness. I hope you find something that helps because I know how much this sucks.
posted by mrcrow at 10:34 AM on April 20, 2018

I'm a fellow sleep maintenance insomniac, and Ambien and generic only helped for falling asleep (not something I have trouble with these days thankfully).

2nding trying old-school antidepressants, from what I'm told by my doctor they're prescribed at a much lower dose and they're often used for sleep maintenance. But you might need to try different kinds until you find the one that works for you...

- Trazadone congested me so badly it felt like I was suffocating and made my sleep even worse.
- Nortriptyline worked, but took away my appetite and made me feel jittery in the morning.
- I'm currently taking doxepin and it's working like a dream (hee hee)!

Hope you find a solution that works for you.
posted by sweetpotato at 11:09 AM on April 20, 2018

I had sleep maintenance insomnia, and it turned out to be exacerbated by severe sleep apnea. I suspected something was wrong, but didn't know for sure until I got a sleep test. My CPAP helps a lot. I still use melatonin and magnesium to put me to sleep (works a charm) and find that taking a hot bath with Epsom salts and lavender essential oil/bath bombs about an hour before bed also helps.

I have f.lux installed on my laptop to cut down on the blue light which can cause insomnia. Sleep music playlists and soothing podcasts (with drone-y voices talking about stuff that I don't find especially gripping) help me, too.

Keep your room cool! If I get too hot in the middle of the night, I wake up. Make sure your PJ's, sheets, mattress pad, etc. are breathable. I had to ditch my down comforter for a cotton quilt because now that I'm older and fatter and on Synthroid, I run hot at night.

Trazodone did not work at all for me - my nose stopped up and it gave me a vile hangover the next day. YMMV, as I know Trazodone is a miracle drug for some. Ambien works for me as long as I use it sparingly and give myself long breaks, otherwise it loses its effectiveness and gives me a hangover.

But get a sleep test! Things like sleep apnea and restless leg syndrome can creep up in one's late 30's. If you don't have a regular bed partner, it can be hard to tell if you snore, kick, toss and turn, etc. at night. Sleep apnea presents differently in women than in men and insomnia is often a telltale symptom. I was about 40 when apnea crept up on me.
posted by Rosie M. Banks at 11:29 AM on April 20, 2018

Is there a pattern around days of week? I had the same problem, and noticed over time it was much worse Sunday-Thursday. It was entirely work-anxiety-induced. I improved my work situation, and the problem almost entirely abated.
posted by Jellybean_Slybun at 11:49 AM on April 20, 2018

50-75 mg of Trazodone taken as needed has been a lifesaver for me. When I am feeling especially anxious before bed, I just go ahead and take one- the combination of getting a good night's sleep and the assurance that I will sleep through the night reduces my anxiety even further. I do sometimes wake up with a headache, but I take some Aleve and can (luckily) get on with my day fairly quickly.
posted by Mouse Army at 12:19 PM on April 20, 2018 [1 favorite]

Came in to say sleep apnea. "The 8-Hour Sleep Paradox" was helpful for me for researching it. In all likelihood you're waking yourself up because you can no longer breathe. Do you wake up tired each morning? Have headaches? Get a supervised sleep study.
posted by tooloudinhere at 12:56 PM on April 20, 2018

Trazo. Plus, echoing what’s been said above, don’t fight. If you really are awake with no hope of sleep, make the most of your time. You’ll still feel like a zombie the next day but you’ll be an accomplished zombie.
posted by Construction Concern at 5:43 PM on April 20, 2018

The only thing I've tried that helps me with my insomnia and doesn't make me groggy the next day (wtf Benadryl, what is even the point of you then?) is smoking cannabis. Usually I just use it before bed (I have "regular" insomnia) but on the rare occasion that I wake up in the middle of the night feeling stressed out and anxious and just can't shut my brain off and go back to sleep, cannabis lets me zone out, relax, and stop thinking for long enough to fall asleep again. It works for me.
posted by Anticipation Of A New Lover's Arrival, The at 6:06 PM on April 20, 2018

Get a sleep study. Sleep apnea presents differently in women; insomnia is one of the typical symptoms of sleep apnea in women.
posted by medusa at 7:08 PM on April 20, 2018

I am like this too, went to a sleep specialist, and solved it without drugs or supplements. It took a few weeks but it worked and it's easily repeatable if something disrupts my sleep (like travel, which always sets me off to middle of the night waking again).

First we worked on impeccable sleep hygiene. Solid bedtime routine, restricting caffeine after noon, bed only for sex and sleep, no screens before bed, etc.

Then we started restricting sleep. Yes - when I was so tired, I slept less. The first rule was if I woke up, I had to get up - out of bed, to another room, do something boring. I'd fold laundry or sit in the living room and think. Some people can read, but that would suck me in and I'd never go back to bed. And I went to bed later and got up earlier - I had only five hours set aside for being in bed at first, and I didn't sleep for all of them, and I had to get up anyway. After three days, I stopped waking up after the first sleep cycle out of sheer exhaustion. Then we started extending my time allowed in bed by 15 minutes on either side every couple days. I still had to get out of bed if I woke up so my brain didn't reassociate bed with lying awake anxiously or angrily trying to go back to sleep. After a few weeks, I slept a full eight hours for the first time in my adult life and it was astonishing to me. Now I generally sleep all the way through the night can fall back asleep even if my kids wake me up for something, and wake up without an alarm. If I wake up and can't go back to sleep, I still get out of bed.

Melatonin and even pills didn't work well for me - I'd sleep heavily, still have a midnight wakeful session, and be groggy in the morning. It was hard, and I would advise a sleep doctor to rule out anything else and oversee the process, but it was a great choice for me.
posted by peanut_mcgillicuty at 5:36 AM on April 21, 2018 [3 favorites]

Many many drugs, sleep restriction, and CBT didn't work for me. I still don't get as much sleep as I need, but if other things don't end up helping you, gabapentin gives me a couple more hours of sleep than I could count on previously.
posted by metasarah at 11:25 AM on April 21, 2018

Gyusan is CORRECT that it was common to wake up in the middle of the night pre-electricity. That said...

Traditional Chinese Medicine equates this with Liver deficiency. Just an FYI.

I definitely cure this w/ L-Glutamatamine. I'm female and this started for me in my mid-30's. I tried EVERYTHING. Magnesium helps, 5HTP helps, I looove Melatonin... Try them all. L-Glutamine makes the natural 2am or 3am wake-up a brief thing where I just roll over and fall back asleep.

I think a few things are happening- age + life experience + biorhythms. In Chinese Medicine the liver=grief processing. So, ruminating on troubles or mundane events. My 7 year old does not have the sleep issue, fwiw.

If any of this sparks you, I include this detail because I tried dealing with this exact issue a thousand ways.
posted by jbenben at 9:58 PM on April 21, 2018 [2 favorites]