Another "help me sleep" question
November 16, 2018 6:52 AM   Subscribe

I struggle with insomnia, and am seeking advice.

I’ll just throw a bunch of spaghetti at this wall in hopes that different people might have suggestions for various aspects. Also pardon any sleep-deprived word salad.

Lifelong insomniac. Noise of any kind other than things like crickets or gentle rain keeps/jolts me awake.

Our neighborhood is quiet but we do live in a city. Dogs bark, neighbors are occasionally loud. I would like to move to the middle of nowhere but not an option currently. Besides, I apparently need tomblike silence in order to sleep peacefully. My partner getting up to use the bathroom at night will wake me up resulting in three or more hours of increasing misery trying to fall back asleep.

When I am woken up at night, I try everything from lying in bed waiting for sleep to come back (usually ineffective), getting up and going for a walk (sometimes calms me down and I can fall asleep shortly thereafter), standing in the middle of the kitchen reading a book (I can’t sit anywhere or continue to lie in bed reading because then I get restless).

Even if I am physically exhausted, I get into a state of rage and churning where I’m thinking about everything that is wrong with my life and the world. Obviously it is impossible to fall asleep in this state.

I work a variable schedule, currently not an option to change, involving shifting late nights and early mornings. Am working towards a more flexible work-at-home career but efforts are being hindered by sleep deprivation.

Cats also sometimes wake me up. We have a hyper young cat who will be noisy in the middle of the night despite strenuous efforts to occupy him during the day. Will claw at bedroom door if door is shut, which dials my rage up to 11.

Partner and I sleep in separate bedrooms. He is also a light sleeper who struggles with insomnia, which means if I'm awake then I'm probably keeping him awake. Our house is small and you can hear any noise in it throughout the entire house. Would love to move to larger, less echoey house in quiet neighborhood but currently not an option. ($$$)

I hate earplugs and white noise/rain apps. I will try them in desperation but they make me feel weirdly claustrophobic.

Drugs I’ve tried:
Ambien: causes suicidal thoughts
Lunesta: does not work
Melatonin: causes me to wake up in the middle of the night with vertigo, causes nightmares
Benadryl: effective about 50 percent of the time. Results in a hangover the next day. I don’t like taking it when I’m awake at 2 am because then the hangover is severe.
Various sleepytime teas: do not work, cause me to have to pee in the middle of the night

I exercise, eat reasonably well, try to practice good sleep hygiene, limit caffeine to two teas before noon

I am thinking I might try to noise-proof my bedroom and sleep with door and windows closed, much as I hate feeling closed-in. Rented house, so will have to rely on things like rugs, blankets on the walls, etc.

Am losing days to feeling like a zombie, and the nights are horrible. This has been an off and on lifelong problem. Oh, and I have some fun combo of ADHD/autism/anxiety, so sure that doesn’t help. Oh, and am about to hit menopause so that also probably factors in.

Anything else I might try? Thanks.
posted by whistle pig to Health & Fitness (38 answers total) 10 users marked this as a favorite
Lifelong insomnia solidarity. The only thing that seems to help me, and it isn't a full fix but makes it somewhat better, is making sure I am not deficient in Vitamin D and iron. Might be worth a quick doctor's visit, if you can.
posted by wellred at 6:58 AM on November 16, 2018

Intermittent fasting has helped me a lot. For me, this means not eating after 7:00 at night. It hasn't been a perfect solution, but it's definitely improved my ability to fall asleep.
posted by FencingGal at 7:06 AM on November 16, 2018

I pop a couple of B complex vitamins before bed. They are said to prompt a bit more melatonin production, but whatever the mechanism, they have stopped the “2 am wake ups and stay that way for two hours” that used to plague me.
posted by notyou at 7:09 AM on November 16, 2018 [2 favorites]

CBD oil! I take the gel capsules so it takes about an hour to go into effect (tea works faster), but I fall asleep and stay asleep. I also use a fan to cut out all of the outdoor noises.
posted by littlesq at 7:14 AM on November 16, 2018 [1 favorite]

I find things that physically produce white noise to be more pleasant than apps for whatever reason. Specifically, I have fallen into the habit of using a space heater on fan only mode (because that’s what I have) and it seems about equivalent to the the white noise machines I’ve seen.

Also another hack (that I think I learned here) was the sentence: we don’t solve big life problems in bed at 3am. I interpret this as descriptive rather than prescriptive but in this case those two things sort of reinforce each other. It gave me permission to just drop things more easily.
posted by needs more cowbell at 7:21 AM on November 16, 2018 [2 favorites]

.5 Clonazepam works perfectly for me when I need it. I take it 1 hr before I want to go to bed and it keeps me asleep all night and makes it easier for me to go back to sleep when I wake up to pee. If you're game, talk to your doc. For me it's been a game changer.
posted by jeszac at 7:37 AM on November 16, 2018 [3 favorites]

Stop all caffeine. Tea, coffee, chocolate. It will make it easier to tell when you are tired and fall asleep.
posted by tooloudinhere at 7:55 AM on November 16, 2018 [2 favorites]

Oh. Also-- the Clonazepam is great for anxiety. So for me that's a two for one benefit.
posted by jeszac at 7:58 AM on November 16, 2018

I find things that physically produce white noise to be more pleasant than apps for whatever reason.

seconded. In the summer I use a box fan and in the winter I use a warm mist humidifier.
posted by carrioncomfort at 8:06 AM on November 16, 2018 [2 favorites]

Ativan/lorazepam has been critical for me in breaking cycles of insomnia. I use it only rarely because I worry about side effects from regular use, but when I've had several sleepless nights in a row it can kinda reset things and help me get back on a better schedule. Also just knowing it's there if I need it can be soothing.
posted by adiabatic at 8:26 AM on November 16, 2018

Lifetime insomniac here. I learned a technique 7 years ago that beats insomnia about 80% of the time. It's simple. When a persistent thought, that is one that lasts for more than a few seconds, appears I convert from thinking about it in words to using visual images. Soon the thought fades away as I fall asleep. I have no idea how I do the conversion, but it was easy the first time I tried it and most times since then.

For example, one morning I rolled over to go back to sleep. Started thinking about the checklist I'd made last night for that day's photo shoot. I was thinking in words 'Gotta have a hat, sunscreen, sunglasses' then caught myself and switched to images. I saw myself in the sun wearing hat, sunglasses and holding sunscreen. Saw my legs with cargo shorts and sandals. Looked at the right cargo pocket and saw my camera bulge ... That's as far as I could later remember because I'd fallen asleep.

To emphasize the process I'll quote Yoda: "Do or do not ... there is no try". The only conscious part (i.e., the the 'try') of my shift from thinking in words to thinking in images is to stop the words and generate the first 1 - 3 images. For me, at that point the images continue to generate on their own and sleep soon follows, or my mind is filled with thinking about being unable to generate images and sleep eludes me.
posted by Homer42 at 8:43 AM on November 16, 2018 [8 favorites]

I did not think I could ever sleep with a noise machine but I had to start for some reason and it's really helped. I am also one of those "Lack of sleep makes me seriously bonkers" people and a few things I haven't seen mentioned that helped

- gabapentin (I started taking it for shingles pain and a side effect was significant;y improved sleep)
- THC edibles if you can tolerate that sort of thing
- no screens for at least an hour before bed, nothing with a light. Paper books or one of those old Kindles
- meditation to sort of unwind before closing my eyes
- HEAVY blankets

Like Homer42 I do a lot of visualizing that seems to help. It's weird to think that spending more effort on sleeping would actually work better, but for me somehow it does.

In general, this (insomnia+rage) sounds like a mental health issue that could maybe benefit from a medical opinion. My sleeping got a lot better when I started managing my anxiety better. Best of luck, I know it's no fun.
posted by jessamyn at 8:47 AM on November 16, 2018 [1 favorite]

I have to have white noise to fall and stay asleep. I can't use apps, I can't use white noise machines. It MUST be a fan. A smallish fan, not a box fan. I literally travel with a fan packed in my suitcase.

And we shut the cats in the basement every night. I cannot with cats wanting in. And then out. And then in. If we didn't have a basement, we'd find some other way to keep them separate from us.

I also sleep separately from my husband because he breathes at night. And he moves in the bed, which is a no-go.

When my insomnia gets too bad, or stays for too long (which hasn't been a problem for a while now), or if I'm traveling for more than a few days (I sleep terribly/not at all away from my bed/routine), I take Ambien.
posted by cooker girl at 8:58 AM on November 16, 2018

I used to wonder if what I thought was insomnia was periods of very light sleep between deeper sleep, but seemed to be a continuous stretch of being awake. Scientists also wondered. A Gizmodo piece in 2014 quoted a study published in New Scientist:

In other words, their problem is not so much that they don't sleep but that, asleep or not, their brains are never quite off. "It's the major hypothesis of what insomnia's about," he says.

I'm certain this happens to me. Typically I'll wake up, pee, and check the sky to see if it's close enough to morning to not bother going back to sleep (no clock in the bed room). Then I'll lay awake in bed until what seems like a half an hour has passed, get up to pee several hours worth of accumulation, and see the dawn sky. Knowing that I had slept doesn't prevent this psuedoinsomnia from happening. It does prevent me from beating myself up for not being able to sleep.

posted by Homer42 at 9:02 AM on November 16, 2018 [3 favorites]

There are a bunch of nuances to white noise usage, you don't just blare it into one ear from your nightstand and it puts you to sleep. It's a screen. Get a real machine, the apps have a flat unrealistic tone that grates on a lot of people's brains, or start with a couple of fans you have around, and try them in the hall outside your room, in an opposite corner to your bed, in a closet with the door open, on the floor directly under your bedroom window. Try a combo.

I've had insomnia since I was a kid, and about 12 years ago I accidentally reframed my insomnia narrative after hearing the (possibly exaggerated or apocryphal) story about second sleep, so that the idea of being awake in the middle of the night seemed normal and unoppressive and not the worst thing that has ever happened. I removed as many agitation factors as I could (moved the clock so I couldn't see it and stress about it, as an example), adopted the motto "rest if not sleep", and if I woke up I'd go to the bathroom and take care of any other pressing need (water, food) but then go back to bed and tidy the covers, get in, meditate, tell myself a story (usually about sleeping in an amazing bed somewhere) until I fell asleep again. I was confident I would fall asleep again.

I don't, always. Sometimes I only doze, at best. But not freaking out about it makes a huge difference in how I feel, even when I'm short on sleep.

Maybe once a year or so, I will experience a really unusual agitation, rabbit-brain, can't get comfortable, can't manage to meditate or tell my stories. It almost always means I'm getting sick, and I just recently figured out I can drink some electrolytes and it'll help a lot (I've leveled up from sports drink/smart water to fancy drops). Studies have suggested a link between low magnesium and bad sleep, and between low potassium and leg cramps or restless legs. If you haven't had routine bloodwork done lately, it wouldn't be a bad idea just to make sure there's not a problem there that can be easily fixed once you know what it is.
posted by Lyn Never at 9:07 AM on November 16, 2018 [3 favorites]

As part of your sleep hygiene, are you keeping room temps around 65 degrees, wearing very lightweight night clothes--no socks ever no matter how cold you get? Low temps reinforce the body's natural drop in temperature as you get tired. A small fan is a great substitute for white noise machine. Keep it on your side of the bed so you feel a teeny breeze. And, of course, no screen time right before bedtime.
posted by Elsie at 9:10 AM on November 16, 2018 [1 favorite]

Never tried earplugs until I lived on a street with a fire station. Every pair I tried was either too uncomfortable, unable to block the noise, or both. Then I tried Laser Lites. Like any physical change in what touches me while sleeping, it took a few nights before wearing them seemed normal. Been using them ever since. They're intended for one time use. I've found the sound protection lessens noticeably after using 3 nights in a row.

Available on eBay in bags of 50 pairs for about $8.
posted by Homer42 at 9:18 AM on November 16, 2018 [1 favorite]

I'm not a chronic insomniac, but I do deal with sleep problems fairly often. One new thing I've found that's been surprisingly effective is My Sleep Button, which uses random item imagery to short-circuit intrusive and racing thoughts at bed time.
posted by hanov3r at 9:19 AM on November 16, 2018 [2 favorites]

I had a housemate who used construction-quality hearing protection. He said he couldn't hear a THING through the hearing protection.
posted by aniola at 9:20 AM on November 16, 2018

Progressive Muscle Relaxation?
posted by enfa at 9:34 AM on November 16, 2018

A box fan is a really great way to drown out other noises. Ideally, I would go to somewhere like Home Depot where you can see some sample fans, as I find certain fan noises to be a more pleasing frequency than others.

Alternatively, I'm a big fan of the "myNoise" app that I use on my iPhone. It has a massive range of white noise soundscapes, and you can customize each sound to a pretty impressive degree. To access the full features, you do have to pay, but you can get a sense of what's available on their web page.

For the medication route, I'm a big fan of clonidine, which was originally intended as a blood pressure med (sort of like how beta blockers are used for anxiety after originally being intended for blood pressure, although clonidine is not a beta blocker). I take 0.3 mg each night, and I've taken this dose for like 6 years without it losing effectiveness. I get zero hangover from it. I also have no problem taking an extra 0.1 mg if I wake up in the night.

It won't knock you out, but I find it relaxes me in a way that makes it so much easier to get to sleep. I think it might also help with the rage/anxiety feelings you get. I also believe it's used off label for ADHD symptoms.

Of course, IANAD/IANYD, this is not medical advice, etc. I'm just throwing this out there since it worked for me, but ymmv.
posted by litera scripta manet at 10:24 AM on November 16, 2018 [1 favorite]

Try trazodone + some other drug to dampen the anxiety problem (sertraline?) While benzos are effective in the short term, you will need a longer term strategy. A psychiatrist can help keep up your med combo. They have more exotic cocktails than a GP.
posted by crazycanuck at 11:31 AM on November 16, 2018 [1 favorite]

I second eliminating all caffeine altogether. I was surprised to find how much my sleep improved when i cut it out. Previously I'd been having one cup of coffee in the morning (before 8 am!).

Do you have any physical pain? Even low levels of pain make it harder to sleep, in my experience.

I also second that some CBT might be helpful as you try new things. It may be that you're anticipating the wake-rage cycle to the point that it's kind of self-reinforcing.
posted by purple_bird at 11:44 AM on November 16, 2018

Thank you for the suggestions, everyone. There are many new ideas that I hope to try. If I accomplished nothing else today in my sleep-deprived state, I made an appointment with the dr. to look into getting some anti-anxiety meds. Thanks again.
posted by whistle pig at 12:33 PM on November 16, 2018 [2 favorites]

I made an appointment with the dr. to look into getting some anti-anxiety meds.

Well done. Also try the gentle, over-the-counter, much loved Unisom. People report it helps considerably with mid-sleep waking. FWIW, nthing the running fan.

A few things have helped me fall asleep again. First of all, whatever you listen to, you don't have to listen with headphones; you can put the phone next to your head. Second of all, I use two apps -- Calm has body relaxation and sleep stories, and the sleep stories are magic for me; and this Mindifi app has a specific track for falling back to sleep.
posted by DarlingBri at 1:16 PM on November 16, 2018 [1 favorite]

Note: there are two flavors of Unisom. One is diphenhydramine, which is Benadryl. The other is doxylamine succinate, another old antihistamine. I very much dislike the diphenhydramine, but the doxylamine is my go-to when I know I'm going to need to take something, and while it's not the most modern antihistamine does do a pretty good job of chilling out my seasonal allergies for the night as a bonus. Half is plenty for me, and honestly even a third or quarter is enough but they're very small pills and you need a really good splitter to get that small a piece chipped off.
posted by Lyn Never at 1:27 PM on November 16, 2018 [1 favorite]

No idea if this works for anyone other than me but a couple of months ago I discovered that having a regular pillow behind my back helped me get back to sleep. Could be a weird placebo effect or just a weird primitive instinct involving keeping one’s back protected but it has helped me get back to sleep so I’m not asking too many questions.
posted by sciencegeek at 1:52 PM on November 16, 2018 [1 favorite]

In the vein of 'sleep stories' - the podcast Sleep With Me features interesting-but-not-too-interesting ramblings by a man with a droney voice, that are designed to give you something for your brain to do. Many of the listeners are insomniacs, and dont fall asleep but feel less crappy about being awake- the tone of the show is that you don't have to fall asleep, but you also don't have to listen too closely. It's things like a recap of a TNG episode that's as long as the show, but all focusing on the various objects on peoples' desks. So on the off chance that sound you can tune into, rather than attempt to ignore, might be less bothersome, it might be worth a try (Or three. Apparently everyone, including myself, finds it totally un-sleepy the first few tries, but the you get used to it.)
posted by heyforfour at 3:02 PM on November 16, 2018 [2 favorites]

I am a statistician, so I kept a spreadsheet that included everything I thought might make a difference and analyzed the data after a few months. This ended up not being all that helpful and included counterintuitive findings that I didn't really know how to work with (for example, I slept better when I ate junk food while watching TV before bed), but it's worth doing in case you find anything. Include diet, time to bed, evening activities, substance use during the day, menstrual phase, etc. Even if you only come up with something that let's you regularly sleep five hours rather than four, that's real.

I did find that I slept better when wearing clothes, which was surprising to me because I'm actually more comfortable sleeping naked, but pajamas all the way down to socks helped (maybe because it reduced stimulation of my skin). So that's something to consider. Otherwise, gabapentin is the only thing of MANY things I tried that had an effect.
posted by metasarah at 3:26 PM on November 16, 2018 [3 favorites]

I've been experimenting with the optimal room temperature to help me get to sleep (and stay asleep) and found that a colder room really helps. YMMV of course. If you are looking for something to listen to while falling asleep, I suggest giving SomaFM's Drone Zone a try.
posted by jazzbaby at 3:52 PM on November 16, 2018 [1 favorite]

I have periodic insomnia and am currently taking valerian. It gives me some pretty out there dreams but otherwise is good and I get much better sleep. I'm a little surprised no one has mentioned it thus far.

I have in the past used doxylamine succinate, (sold as various names) but if you get a benadryl hangover you'll probably get one from that too. It's very effective though.
posted by deadwax at 4:54 PM on November 16, 2018

Do you use a sleep mask? I'm very light-sensitive and need total blackout to sleep. The slight pressure over my eyes has turned out to be an invaluable sleep cue as well. Get a soft silky one.

I know you don't like earplugs, but it's the single best change I ever made. At first I felt a bit unsafe, like "Will I hear intruders? What if the house burns?" But that died down after a week or so. I'm still able to hear noise, it's just muffled. Also, it may be easier to work on your feelings about plugs than to try to control all exterior noise! I use cheap Mack's, the soft foam and the silicone putty are both good. Try a variety of brands and price points to find a comfortable fit. Experiment with twist angle and pressure. Once they're in you should be able to forget about them. If you use an alarm, set it louder than normal.

Echoing valerian tea and a slightly colder room. After I warm up in my blankets, I stick one foot out to regulate my temperature. When I'm really struggling, a hypnotic meditation will usually sink me down far enough to sleep. I try to get lost in hypnagogic imagery.
posted by fritillary at 5:35 PM on November 16, 2018 [1 favorite]

I've also had success falling asleep faster by lowering my body temperature. Some specific techniques:
  • running cold water over my feet and leaving it there to evaporate
  • putting the blankets over just my legs, leaving my top half and feet uncovered
  • leaving the blankets off of the "warm spots" on the bed so they can cool down before I move back onto them

posted by panic at 7:01 PM on November 16, 2018

Seconding Trazodone, a antidepressant that helps you sleep. I know a couple people who take it and it really helps.

CBT worked for me. I still say that I'm "bad at sleeping" but I know that it has more to do with my anxiety than anything else.
posted by ablazingsaddle at 10:13 PM on November 16, 2018

I'm not an insomniac but I am a light sleeper who has trouble staying asleep.

Buy your cat an electric heat pad and the scratching may stop. We kicked the cats out of our bedroom and pacified them with one and have recently bought a second. They use them all the time.

I have a vornado fan going at night which helps mask all the night noises. I also sleep with the aircon on and find that if the temperature is over 20 degrees Celsius my sleep gets screwed up.

I sleep with earphones in (i used to use sleep phones but my ipod won't let me lower the volume enough) and listen to (semi boring) audio books all night. This gives me something to concentrate on when I wake up so I don't start getting anxious about how little sleep I'm getting.

I can't fall asleep if I'm cold so I often take a wheat pack to bed for my feet. I also can't sleep if I'm too hot thus the air con as mentioned above.
posted by poxandplague at 4:41 AM on November 17, 2018 [2 favorites]

Intermittent fasting has helped me. I now finish eating five or six hours before sleep. Another thing which helped is getting a lot more exercise. An hour of walking or cycling every day works pretty well.
posted by conrad53 at 7:34 AM on November 17, 2018

Son of a sleep researcher, here are his tips:
-keep your room as dark as possible
-only use your bedroom for sleep and sex.
-no screen time 2 hours before bed
-no alcohol 2 hours before bed
-limit caffeine use
-keep as constant a routine as possible
-exercise in the evenings
-don't eat too close before bed
-stay hydrated
posted by evilmonk at 10:06 AM on November 17, 2018 [3 favorites]

Note: there are two flavors of Unisom. One is diphenhydramine, which is Benadryl. The other is doxylamine succinate, another old antihistamine. I very much dislike the diphenhydramine, but the doxylamine is my go-to when I know I'm going to need to take something, and while it's not the most modern antihistamine does do a pretty good job of chilling out my seasonal allergies for the night as a bonus. Half is plenty for me, and honestly even a third or quarter is enough but they're very small pills and you need a really good splitter to get that small a piece chipped off.

Oh yeah, for really stubborn bouts of insomnia, I swear by doxylamine succinate, sold in the US under Unisom brand, but you do have to check the label, since some of the pills are diphenhydramine, as mentioned above. Diphenhydramine doesn't help me sleep and leaves me really hung over, but I get a great night's sleep when I take doxylamine. Definitely start with a half pill (a whole pill is 25 mg), and ideally try it out on a night when you don't have to be anywhere first thing in the morning, since you might get a bit of a hangover, especially the first time you take it. You can get rebound insomnia if you take it for too many nights in a row, so it's not the kind of thing you want to take for weeks on end.
posted by litera scripta manet at 8:02 PM on November 21, 2018

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