Greetings

[breezeshadow]

I saw this community linked and figured that it is pretty appropriate for me...

So I have insomnia. That's the easier way to put it. My body has no idea how to sleep, what the concept is, what's enough, etc. My psychiatrist keeps telling me to wake up at the same time every day and go to bed at the same time.

As if, you know, that's possible.

I have set alarms and turned them off in my sleep, even if it may require getting up. Once when on Remeron I got up, walked across the room over to my computer, typed in my password, and clicked off of Firefox that was playing an alarm. Then walked back to bed, without ever remembering any of this.

Right now I'm going off of Cymbalta, which makes it even worse. My body thinks that its bed time is 3-3:30AM. I don't know when it wants to get up, but I wake up tired no matter what.

It doesn't how matter hours of sleep I get, I usually wake up exhausted. Five, ten... Makes no difference. But when I get insomnia and get four or less hours of sleep? I usually feel more awake. It makes no sense whatsoever.

The other day I had bad anxiety and got an uncommon but aggravating side-effect: I was too terrified to sleep. I was afraid to even step toward the bed because I was afraid I would wake up to something bad having happened. So I just stayed up until 8AM, when I felt stupid and went to bed. Woke up at 11:54AM, naturally, with no alarms. Because that's enough sleep, brain.

I usually toss and turn for at least 15 minutes before falling asleep, sometimes up to an hour. I call it "insomnia" when I'm tossing for more than two hours. Once I went to bed around 2AM in the horrible heat and humidity, and woke up at 4AM, fully awake. That was a fun day.

I have no idea what my natural sleep rhythm is. I'm pretty sure I don't actually have one.

It doesn't help that I'm at a school where I swear it's considered awesome and tough and bragging to NOT sleep, so during the semester when I could have tried to sleep enough, I didn't because I felt like I "didn't deserve it" or would otherwise be looked down upon (social phobia and depression combo go!).

To top it all off, I have weird dreams. Really weird. I've died in dreams at least three times before (became a ghost in one), had a friend die in one once, and as an example once I had a dream I was kayaking through an aqueduct without the kayak after being kidnapped by supervillians. When I dream? I never wake up feeling like I slept well. The rare moments I have nightmares, they are horrifying.

I also have a number of severe anxiety disorders, which don't help me fall asleep when I'm too busy worrying or catastrophizing.

So yeah. I have absolutely no idea what is wrong with my sleep schedule, or my brain, which is determined to not have one. I just know I kind of look like I've been punched in the eyes with how dark the streaks under my eyes are. And I'm sick of doctors implying I somehow do this to myself when no, sorry, when school isn't forcing me to stay up to do work, my brain screws itself up anyway.

For those who are curious, I just graduated with an engineering degree at a competitive university, and am going to be starting grad studies there soon. Just to shed some context into the "It's cool to not sleep" deal here.

So yeah... If anyone can relate, or has any idea what is wrong, I'm all ears. Happy to be here. :)

Comments

[erika]

Have you had a sleep study done? Tried meds? (I'm not assuming you haven't done these things, you just didn't mention them and it's important information for thoughts on what might be wrong.)

[breezeshadow]

I never considered getting any sort of sleep study done; I've always had wonky sleeping habits so I guess it just didn't occur to me. I'm not sure I could afford one anyway.

As for meds, I hate taking meds, however, Sleepytime tea by Celestial Seasonings tends to calm me enough to sleep. I think chamomile just settles my brain.

[synecdochic]

(Disclaimer: I am not a doctor; I am just a patient who has done a lot of research on her particular disorders and issues. This is not medical advice. Consult your doctor before implementing any plan. Cape does not enable wearer to fly. Etc.)

From the information you've given here, it sounds like you might be suffering from Delayed Phase Sleep Syndrome, or its bigger nastier cousin, Non-24-Hour Sleep/Wake Syndrome (disclaimer: I have the worst case of freerunning Non-24 that any of my doctors have ever seen, so most of my research has been into Non-24.) Untreated DPSS or Non-24 can result in serious insomnia or hypersomnia problems, and will often result in alarm-resistent behaviors like you've described. (In my early 20s, when I was still trying to keep a 9-5 work schedule, I once slept through my alarm that was set for 7AM. For seven hours. I woke up at 2PM with the alarm still blaring and 10 calls on my voicemail -- the phone was right next to my bed -- asking where the fuck I was.)

(Meanwhile, the reason you're usually more well-rested with 4 hours of sleep than 5 or 10 can have something to do with sleep cycles; if you wake up at or near the end of a sleep cycle, you'll feel more rested than if you wake up in the middle of a sleep cycle. Everyone's sleep cycles are timed differently, but usually in most humans it's between 1.5 and 2 hours for one cycle. My body's latest sleep shenanigans is to wake me up after the first cycle to get up and go pee, so I'm waking up 1.5 hours after I fall asleep every. damn. day. Fortunately I am usually able to get straight back to sleep.)

Your anxiety is probably also affecting your sleep cycles and your ability to fall asleep (and maintain sleep once you get there) -- my wife is coping with GAD, and without external assistance, she generally wakes up after two sleep cycles and can't get back to sleep. (There's something about the middle of the night that makes anxiety thrive!) She also has the nightmares issue to deal with.

I'm assuming that you don't have the insurance/money/time/yadda for a full, week-long inpatient visit to a sleep clinic to put you in a windowless room and run an exhaustive sleep study, so my recommendations in this case would include:

* Work on treating and reducing your anxiety as much as possible. (This is of course very easy to say, and very hard to do, but recognizing that the anxiety is influencing the sleep disorder and vice versa can sometimes be really helpful in reminding yourself that it's not a personal failing, it's a legitimate medical condition.)

* Practice good sleep hygeine as much as possible: only use your bed for sleeping (no reading in bed, eating in bed, watching movies in bed, etc), try very hard to keep bedtime at the same time of day every day (which is what your psychiatrist was getting at when s/he made that suggestion -- the context probably got stripped from the suggestion), and -- this is something I find particularly helpful -- only allow yourself 20 minutes of tossing and turning at a time: if you can't fall asleep within 20 minutes of bedtime, get up (ideally without turning on any lights or engaging in any physical activity that would increase your heart rate) and go sit on the couch and do something else for a bit. (Knitting or reading by candlelight is best, since candlelight isn't of the frequency to hit the "awake!" signals in your optic nerves.)

* Install f.lux and set it up to change the temperature of your computer screen's light starting 3-4 hours before your required bedtime. The temperature of light can affect your sleep/wake cues.

* Drug assistance: this is very individualized, but many people find that melatonin taken 20 minutes before desired sleep time works. My wife is one of them; she can't sleep at all without taking it, and sometimes has to take another pill if she wakes up in the middle of the night. (She also says it helps with her nightmares.) Her doctor says it's okay to rely on it long-term, as long as you're choosing reliable brands that have some form of QA on what dosage you're getting. Many people also get good results from valerian root, although that's less regulated and usually harder to find a consistent dose. (It also smells like used sweatsocks, even in pill form. Hold your breath when opening the bottle.) Ambien is frequently recommended for sleep problems, but there's research showing it doesn't do much against actual sleep-phase disorders. (When I take it, it keeps me awake for 72 hours and then makes me sleep for 36. Not what's intended.)

* Off-label drug use: many muscle relaxants will send you straight to sleep as long as you don't take them regularly for your body to habituate; see if your doctor's willing to prescribe Flexeril (cyclobenzaprine) or Soma (carisoprodol) for the occasional really bad nights. This shouldn't be a long-term solution and it shouldn't be for nights when you either a) have to be bright and perky the minute you wake up (they can give you a hangovery-type feeling in the morning) or b) will not be able to schedule at least a full eight hours for sleep (when they knock you out, they knock you out; in our household the phrase 'Soma coma' gets used a lot). My wife also reports that this helps with her nightmares; she doesn't get them badly when she's taken a muscle relaxant before bed. Problem is, if you take them regularly (for more than about three weeks) they can cause heart rate increases/heart irregularities and you generally lose the "knock you out" benefit.

* Light therapy: this doesn't work for me, but it does work for some people. A dose of concentrated sunlight-equivalent light in the morning in addition to changing the temperature of your artificial light in the evenings can help some people. See if your doctor will prescribe a lightbox, or if you can borrow somebody else's or rent one to see if it helps you at all.

* Videotape yourself asleep for a night and watch how you're sleeping, or ask somebody to spend the night with you and observe. If you naturally find yourself sleeping with your knees in the air, it can mean that your spine is out of alignment and you're trying to compensate for the pain in your sleep. It makes your sleep not-restful, since you can't truly relax: your muscles have to stay tense to keep your legs up. If this is the case, a triangle-shaped wedge shoved under your knees can help. (As can regular visits to a chiropractor who is realistic about what chiropractic adjustment can do for you -- none of the "adjustment can cure cancer!" woo-types, but a good chiropractor can do wonders. Ditto a good massage therapist.) If you find yourself tossing and turning a lot, and keep trying to adjust your pillow, it can mean the pillow you're using is too high or too low for you, or is forcing your neck and spine out of alignment. Try a chiropractic pillow (one of the ones that looks like hills-and-valleys) or an oval, bolster-type pillow instead.

* Ask your doctor for a referral to an endocrinologist, and get a full hormone panel workup done. Especially with women, low vitamin D levels can mess with sleep, as can thyroid problems and low levels of estrogen/progesterone. (For instance, every time I go back on the Pill, I immediately and without any adjustment period click into a "normal", 24-hour, sleep-at-night-awake-during-the-day schedule. For the three weeks before the Pill makes me go crazy by triggering my bipolar disorder.)

* Cut out caffeine entirely, or if this is utterly unrealistic (I know it is for many people!) then don't drink any beyond about four hours after waking. Again, this is very individual, since caffeine is another one of those drugs that hits everyone differently -- I get zero benefit or detriment from it, and have been known to fall asleep after drinking a whole pot of coffee. But some people are really sensitive. (If you are one of the sensitive people, it might also help with your anxiety -- the physical effects of caffeine can mimic a panic attack or anxiety episode, and trigger the mental state by mimicking the physical state.)

I don't want to totally overwhelm you, so I'll stop there! But feel free to ask me anything you have questions about. I am fortunate enough to be in a place in my life where I can indulge my Non-24 instead of fighting it -- I'm running on about a 30-to-36-hour day these days -- but I remember trying to fight it, and can give at least some guidance!

[breezeshadow]

I once slept through an alarm set around 10AM and woke up around 4PM. Remeron did truly delightful things to me and I swear I have just stayed alarm-resistant since. *sigh*

(I thought it may be a sleep cycle thing, but sometimes it just seems so random/absurd, hence the frustration.)

And yeah... I'm a broke grad student with horrible insurance, so I doubt I could afford a sleep study, unfortunately. As for your points:

The biggest problem I had with my psychiatrist's suggestion is that she didn't seem to get that I can't really implement proper sleep hygiene. I've tried to wake up at the same time every morning, but I really can't help it if I sleep through my alarms and thus wake up at wonky times. Same with going bed at the same time every night; sometimes I'm just not tired, sometimes I'm working on homework until stupid hours in the morning. Maybe once I get out of the insanity that is school I'll be able to try this better, but for now it's not easy. Even over this summer I did terribly... Possibly I'm just terrible at implementing this.

I will have to try the getting up after twenty minutes... I'm honestly so used to having to wait at least 15 minutes to an hour to fall asleep that I don't even consider it that strange/problematic. These days school and work have me tired enough to fall asleep quickly, but not always.

I also know that I toss and turn in my sleep, or I assume that's why I wake up with the sheets everywhere. Or sometimes even me everywhere (I fell out of bed once). I may consider those pillows, but I'm not sure I'd adjust to them and often find them uncomfortable when I test them out (that may be OCD though).

I do have low Vit D, actually; I'm taking pills for it. So that could be contributing to the insanity.

Caffeine actually doesn't do much to me in terms of insomnia. I drink mostly tea, and I've never noticed having tea before bed giving me insomnia *shrug* I avoid coffee usually since it makes me very jittery, though not actually energetic.

Everything else seems like something for me to keep in mind. Thanks for the information =)

[synecdochic]

Yeah, all the suggestions about sleep hygeine always seem to be focused on an ideal world, and forget the fact that we do not live in an ideal world! But when you're living with Delayed Phase Sleep Disorder, it's really temping to just listen to your body and convince yourself that no, really, this time I really do have to stay up that extra two hours, and as soon as you do that once and wind up indulging your body's desire to set its own schedule, your body will try to grab the indulgence and run with it. If you can try juggling your life so that you can schedule your homework, etc, to be finished earlier in the day, and rigidly enforce the same-time-each-night bedtime, after a few weeks it can start to help your body get the memo that no, you really aren't going to indulge its DSPS shenanigans.

At any rate, this is the sort of thing where there's no One True Answer -- everybody's body reacts differently, and everybody's got different triggers and therapies that work for them. I hope that some of the things I listed off will prove to be useful as you find the things that do work for you!

The one other thing I'd say is, be patient with yourself as you experiment. You're not going to get it right immediately, and you're probably going to have to try a ton of things before something helps -- and one thing isn't likely to be the Magic Bullet, either. Hang in there, keep trying, and don't get discouraged!

[rydra_wong]

Knitting or reading by candlelight is best, since candlelight isn't of the frequency to hit the "awake!" signals in your optic nerves.

I have an orange-tinted LED bulb in my bedside light, which seems to have the same effect without triggering my anxieties about fire. *g* With all the other lights out, I can read without going into "awake!" mode again.