Please help me sleep
December 11, 2019 7:38 AM   Subscribe

I've had trouble sleeping for a long time (mostly waking up too early), but recently, I've barely been sleeping at all. I can't fall asleep until the last couple of hours before the morning, and I'm unable to take naps. I'm so exhausted right now that it seems like my body can't relax enough to fall asleep. I think I may need some short-term medication to get back on track (melatonin didn't help when I tried it the other night, nor did diphenhydramine the next night, nor did lorazepam last night.)

I did use Ambien a decade ago in another bad bout of sleeplessness, but I had a weird experience with it, and I'm interested in trying something else. I'm going to ask the doctor for recommendations for medicine, but do you have any?

I'm also open to other non-drug suggestions, though I think I'm familiar with most tips. I've been trying yoga before I go to bed, etc. Some challenges: it isn't possible to fully block light from outside of my studio apartment, I don't have anywhere to really hang out outside my bed if sleep isn't working, and there are some noise issues from the neighbors. But the main reason I think I'm having trouble is just intense anxiety about not sleeping. I'm having trouble not thinking about insomnia or worrying about the future, as the situation right now is 100% affecting my work.
posted by pinochiette to Health & Fitness (24 answers total) 18 users marked this as a favorite
Best answer: This is annoying, because I can't find it here, but maybe someone else can. Sometime in the last month or two, someone here had a mental-trick type suggestion that's been working surprisingly well for me -- I'll try to give it from memory, but hopefully someone will link to the original thing I read.

Pick a word -- I think the original had a suggested word, but it doesn't matter what. Say, "Charter". Then take the first letter and visualize a word that starts with the same letter. A Cat. Then a Car. Then a Crane. Then some Corn. Whatever. As soon as you have any trouble coming up with the next picture, switch to the next letter. Hat. Then Heron. Then Hallway. Then Honey. And keep going.

It may be idiosyncratic, but it's been working astonishingly well for me: the task occupies my mind enough to make my internal narrative shut up, but it's easy enough to keep going with even as I'm drifting off to sleep. And it sounds pretty well fitted to the kind of problem you're having, which sounds like the same sort of insistent-internal narrative thing that keeps me up.
posted by LizardBreath at 7:45 AM on December 11, 2019 [16 favorites]

Best answer: You might try Trazodone it has worked wonderfully for a couple of family members.
posted by tman99 at 7:48 AM on December 11, 2019 [8 favorites]

The Sleep With Me Podcast got me past a long spell of difficulty getting/staying asleep.
posted by Emera Gratia at 7:57 AM on December 11, 2019 [7 favorites]

Your story sounds much like mine! (Including the weird bout with Ambien a decade ago).

+1 to Trazodone and LizardBreath's word game. I don't do the visualization part of it - just think of the words. This helps me fall asleep intially, but I still haven't solved for the waking up early part. Will be watching this thread for more ideas.

Good luck!
posted by too bad you're not me at 8:04 AM on December 11, 2019

What has improved my sleeping is very heavy weight lifting 3 times a week, especially deadlifts.
posted by bdc34 at 8:12 AM on December 11, 2019 [2 favorites]

A white noise app and a good small speaker with a bit of bass helped me a lot. RelaxMelodies or Lightning Bug or any where you can tailor the sound mix to block out the neighborhood noise. Also, no screens an hour before bedtime; you can read a paper book or magazine.
posted by Pastor of Muppets at 8:30 AM on December 11, 2019

The typical state of affairs is "can't get to sleep = anxiety, can't stay asleep = depression." You can be depressed without knowing it (ask me how I know!). You should consider seeing someone about the possibility, even if it's just for a single session that rules it out.
posted by ubiquity at 8:30 AM on December 11, 2019 [1 favorite]

Without knowing what is causing the sleeplessness, some non-medication things that have helped me at different times:
Light disturbance - sleep mask.
Noise - a fan, just point it away from you if you are cold.
General Anxiety - weighted blanket (I can't believe how helpful mine has been).
Intrusive thoughts - long book, simple breathing exercises (4-7-8 technique), math or word games like LizardBreath suggested above.
Apnea/allergies/congestion - arranging pillows so that you can sleep with your head slightly elevated, cleaning sinuses before bedtime (neti pot or saline spray).
Specific Anxiety - Shower, lay out your clothes, go over next day's activities about an hour before you go to bed, then do something fun for awhile.

One last (weird) triage idea - once or twice this week, try putting yourself to bed instead of just going to bed. So, care for yourself as you would for a loved one who you know is exhausted AND try to experience that care as the grateful, exhausted beloved person. Arrange the bedclothes and pillows, put out a glass of water or a cup of tea, your book, etc. Then climb into bed and experience the feeling of being cared for and looked after.
posted by hiker U. at 8:37 AM on December 11, 2019 [8 favorites]

The word game is called the cognitive shuffle, invented by Canadian cognitive scientist Luc Beaudoin, who also created the app linked above. It’s a neat trick and has been very effective for me personally in drastically cutting down the time it takes to fall asleep, or even to take naps, which otherwise I’ve found to be pretty much impossible.
posted by KatlaDragon at 8:40 AM on December 11, 2019 [11 favorites]

nthing the cognitive shuffle; it's no cure, but it is the best thing I've found for derailing my horrible broken consciousness train from whatever track it's traveling. I don't use an app; I pick a letter and come up with words that start with it as randomly as possible.
posted by asperity at 8:46 AM on December 11, 2019

The typical state of affairs is "can't get to sleep = anxiety, can't stay asleep = depression." You can be depressed without knowing it (ask me how I know!).

How do you know?

I have the same issues, I often sleep just 6 hours, it's rare that I sleep more than 7.

But I am perfectly functional. I've read that it's usually anxiety that causes early waking -- that once your body gets enough "functional" sleep, it's ready to go. Or aging.

What is the rationale behind this being caused by depression? I listened to a podcast that said intermittent fasting will cause it, because hunger is prompting the body to extended wakefulness so that it has more hours to find calories.

I've tried a ton of remedies, which have been effective to varying degrees:
- eye shades
- white noise machine
- ear plugs
- melatonin
- mouth-taping (to prevent waking up from dry mouth)
posted by Borborygmus at 8:56 AM on December 11, 2019

Trazodone is probably what you'll be offered next by a doctor, as others have suggested. It works well for a lot of folks.

I have a list of drugs I've tried for insomnia in this blog entry; the ones you mention all failed for me too, and I can't take benzos or the Ambien class ("Z-drugs") because of paradoxical reactions, so if Trazodone doesn't work for you, maybe you'll find some hits there.

I will caution that some of my list are definite second-line, third-line, and last-ditch options, and thus some are likely not to be received well as suggestions to your doctor, especially if you mention them before failing with all the more usual meds.
posted by jocelmeow at 9:29 AM on December 11, 2019

I accidentally found a new sleep aid this week, funnily enough, though it's not for everyone. I rolled a joint with a combination of weed and mugwort. The weed was a strain that usually makes me passive but not necessarily sleepy, so I think the mugwort was the x factor. I didn't notice any particular feeling other than relaxation at the time, but I went to bed less than an hour later and slept like a rock, unusually so. From what I've heard some people also make tea from the mugwort; you don't have to smoke it like I did. I was already exhausted too, similar to how you described it: lots on my mind, I know I need to be sleeping, and yet hadn't slept well in days. I didn't expect to be knocked out like that.

Also, this isn't a failsafe for me, but often I'm able to calm spinning thoughts by counting breaths up to 100. If I'm really worked up I'll then count backwards from 100 in multiples of 3, doing the math all the way down (99 is 3 by 33, 96 is 3 by 32, etc). If I lose count, I start over. Often I fall asleep midway through.
posted by saramour at 10:32 AM on December 11, 2019

Best answer: I've had bouts of insomnia off and on for a while for various reasons; most often it's either stress or menopause (yaaaaaaay hot flashes I think I'm almost done with you).

Melatonin didn't work great for me either; magnesium was what really did the trick. Bear in mind, though, that magnesium is a gradual thing - it's not like you pop a vitamin and it knocks you out. It's more like, take it daily, and over a week or two it will build up in your system and then will get working. I'm still convinced that it's what did it for me, though, because there was a midway point between "I can't sleep" and "yay I finally can sleep again" when I was like, "well, I'm still only getting five hours of sleep instead of eight, but I definitely slept better IN those five hours."

Also: some years back I put out a call in AskMe for a "put me to sleep" playlist I was building, and it worked so well I've come back in other AskMe's to share it. I call it Auditory Ambien for a reason.
posted by EmpressCallipygos at 10:34 AM on December 11, 2019 [4 favorites]

But I am perfectly functional.

Hmmm this is very difficult for individuals to assess of themsleves. Have a read of the book, Why We Sleep (by a cognitive scientist specialising in sleep research) for some sobering reading around under sleeping.

It's interesting no one has mentioned CBTI (cognitive behavioural therapy for insomnia) yet. It's now recommended as the first line treatment by many national health orgs and can be be more effective than medication in some cases. It can also be used with medication.
posted by smoke at 11:51 AM on December 11, 2019

family member is a sleep researcher. common suggestions are:
1) reduce alcohol
2) no caffeine after noon
3) no blue light or screens 2 hours before desired sleep.
4) cardio when you wake up.
5) maintain normal schedule.
6) eliminate LEDs or blinking lights in bedroom.
7) meditate.
8) no food less than an hour before bedtime.
9) drink more water during the day.
posted by evilmonk at 12:31 PM on December 11, 2019 [1 favorite]

Sleep restriction worked for me- estimate how long you are actually sleeping for, and limit your time in bed to that time (with a minimum of about 5 hours). Same wake up time every day, no naps allowed. After two weeks of this, if you’re sleeping again, begin extending your bed time by 15 mins a week.

This cured me of sleep onset and maintenance insomnia that had been a thing for about three years.
posted by Jobst at 1:20 PM on December 11, 2019 [1 favorite]

Adding on to a couple of things above:
- People have mentioned sleep masks. I'm going to be very specific and recommend the Bucky sleep mask. Other sleep masks press against your eyelids, which is uncomfortable. Bucky eye masks have formed foam which keep the mask away from your eyelids. Light is a big issue for me and Bucky eye masks have made a huge difference in my life.
- There's a lot of medications listed here. I'm going to add in the over-the-counter allergy medication Zyrtec. It knocks many people out. Take it at least an hour before bed. I would not take it more than about three days in a row (depression is a known side effect if it's taken too often). It stays in your system for a while, so (for me at least) it can lead to two nights of good seep.
posted by rednikki at 2:58 PM on December 11, 2019

For me (a chronic insomniac) my key combo is Trazodone (non-habit forming with a large safe range) plus white noise machine (one with fan blade type things, not an electronic recorded one) plus a podcast. Oh yeah, and my kitty snuggled up with me. But that's the icing on the cake :-)
posted by kathrynm at 4:19 PM on December 11, 2019

Since I haven't seen it mentioned, I'm going to suggest gaba-pentin, which I use for sleep and it makes a huge difference.

Using gaba-pentin for sleep is an off-label use, but the medication is non-habit forming and really doesn't have major side effects, so it's not a problem. Traditionally used for epilepsy and nerve pain, gaba-pentin quiets the nerves (including the ones in your brain). I have had problems staying asleep (waking up 5-6 times a night) that are drastically reduced by taking gaba-pentin.

A friend recommended it to me and when I brought it up with my doctor she had no issues with giving me a prescription, because it really is very safe.
posted by brookeb at 8:04 PM on December 11, 2019

This one weird trick!

We think in our heads but sleep in our hearts.

So try to move the center of your thinking energy from your head down to the center of your chest. Each time it feels like thoughts are spinning literally in your head, slowly walk them down to “think” in your heart center. You will fall asleep.

Also... for added fun I do the body twitch. Make parts of your body twitch as if you’re falling asleep. Foot twitch. Two seconds later: shoulder twitch. Ten seconds later: side twitch. Etc. it almost jump starts the body’s relaxation process.

Finally, calcium magnesium supplement as a good muscle relaxant.
posted by St. Peepsburg at 8:19 PM on December 11, 2019 [1 favorite]

In addition to suggestions above:
- shower or bath shortly before bed (warm water relaxes but also blood circulates in your extremeties so when you get out you have the temperature drop your body needs to cue sleep.
- don't just do no caffeine after noon -- cold turkey that shit for a few days and see what happens. Caffeine takes a loooong time to process. Caffeine is pernicious because we tend to drink more coffee/tea/coke when we're tired from no sleep, and then there's craploads in our system when we do want to sleep.
- shortly before lights out, read a light pleasant book that you've read before.
- when desperate, I have found Zopiclone irresistable.
posted by i_am_joe's_spleen at 11:47 PM on December 11, 2019

Given what you're identifying as the problem, I'll second CBT. While a counselor could help with it, you can DIY it too. Basically finding ways to remind yourself that it won't actually be the end of the world if you don't sleep on this given night can make a huge difference.

I'll also second gabapentin. I have profound chronic insomnia; it's the only thing that helps even a little, and no doctor ever suggested it to me (I requested it after dong a lot of my own research). It's cheap and safe.
posted by metasarah at 6:43 AM on December 12, 2019

If you are in a state where medical marijuana is legal, try CBD oil (the real stuff, not just hemp oil). I am a long time sufferer of insomnia, and it is the best remedy I have ever tried. No side effects for me either.
posted by nirblegee at 1:50 AM on December 13, 2019

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