Sleep-maintenance problems almost every night for five years

Jools Holland

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I've had ongoing sleep maintenance problems for five years where I repeatedly wake up throughout the night, around 10 - 20 times. Usually I can get back to sleep as soon as I wake up, but the more times I wake up throughout the night the harder it is to go back to sleep, and I end up not getting anywhere near enough sleep. (Before my sleep problems started I would usually sleep straight through for ten hours, except if there was a loud noise, in which case I would just turn over and immediately go back to sleep. Now it usually ends up being only around 7 to 7 and a half hours in total on account of waking up so much. I don't feel refreshed when I wake up, I often feel very sleepy when in meetings, seminars, etc., and I constantly have pallor and blue lines under the eyes and look like a complete mess).

I was also having some on and off sleep-onset problems, but these pretty much completely went away when I started consuming a huge amount of sodium throughout the day. Now I feel very sleepy around the same time every night and can get to sleep straight away most nights.

Recently I was also having problems where when I woke up in the night I would wake up drenched in a pool of sweat as though I had just exercised intensely. I've since come to the realization that I'm pretty sure this occurs when I eat a large meal within the last few hours of sleeping. If I time things accordingly such that I eat my last meal well before I go to sleep, this isn't a problem. However, I've noticed that when I don't consume a meal within the last few hours of going to sleep, and just eat something smaller just before going to sleep when I feel hungry just before going to sleep (e.g., two tablespoons of peanut butter) it's usually harder to get back to sleep the times that I wake up.

I've run out of ideas. I just want to sleep straight through the night and not wake up so many times. I've been to see three sleep specialists. The first one said I didn't have a problem, and the latter two thought I did have a problem but didn't know how to fix it. Things that sleep specialists suggest like sleep hygiene, stimulus control, sleep restriction, etc. don't work for me at all.

Any ideas would be appreciated.
 
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Lou

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I have some kind of sleep disorder. Started about 30 years ago. It has mutated several times and I have adapted to it in a few ways. Its mostly a staying asleep issue. I fall asleep fast and then wake up a few hours later refreshed. But it is the middle of the night. If I lay still long enough I usually will fall back asleep. But it can take hours.

I'm pretty sure that it started with some kind of melatonin issue. I was under stress and anxiety which may have triggered it or exacerbated it. But about a year or two of trying things, I was introduced to sublingual melatonin and it was like a light switch how quickly I recovered. It has to be sublingual. I think the stuff they put in pills doesn't survive the trip thru the stomach. I would just take 1 mg as I started getting ready for bed. The nights where I woke up to pee, i would so tired, I could barely open my eyes to find the toilet.

Right now 1 mg doesn't seem to be enough any longer and I'm hesitant to keep trying larger and larger doses. Last month I tried some 10 mg timed released capsules and got some pretty good results. A month's supply was a little pricey but I think I need to try them another month. One of the things melatonin helps is to establish a sleep pattern. And for various unrelated reasons, I was not able to do that.

Just for a couple of days I've been experimenting with small doses of THC right before bed (5 mg sublingual). So far so good - but it does seem to wear off in the middle of the night and that is where I need it the most. I'm hesitant to up the dose. It's more expensive than the timed release melatonin at higher doses.

There are several other things that have helped in various degrees.
Everyone seems to agree that your bedroom needs to be dark. I bought a sleep mask which I think helps me a lot. Especially now in the summer when it gets light so early. All my problems seem to be related to sleep patterns and I think the dark is an important factor.

Quiet seems to be important. There is not much I can do about this and recently my city has increased the number of times the street sweeper goes by at 4 AM. I've gotten used to it but it really messed me up for a while. I still don't know the street sweepers schedule (he has one - its written on the no parking signs outside). But if I'm not awake already he doesn't seem to wake me up. but maybe he doesn't always come by. There are high-end sleep masks with Bluetooth headphones and I may end up buying one of those next. I have had good results by playing things like ocean waves or rain all night long thru my clock radio.

Keeping a schedule seems to be key. Going to bed around the same time and getting up around the same time. For me, not going to bed early seems to be the most important. If i go to bed early (cause I'm tired), I just wake up even earlier. I once told my doctor I could predict my wake up time by counting each hour before midnight as two hours. and then when the total hit 6.5 I would wake up. So the hours between 10 and 12 count as 4. so i would wake up at 2:30. If i went to bed at midnight I would sleep till 6:30. (he told me that could not be. but I'm still convinced that is the case. and that it has to do with melatonin production and metabolism).

Not sure about eating. I've heard that a banana before bed helps but I've never established that as a routine. I have decided that eating earlier in the evening and not snacking at night helps a lot. A cup of sleepy time tea before bed seems to help. And I think just establishing that as a routine can help with establishing a sleep pattern stuff.

I got an app called Sleep Score that I have been using for a while. It does insert some objectivity in analyzing my little experiments. However a few times I've forgotten to turn it on. And if i forget to turn off my Bluetooth headphones before be it doesn't work right. I have the free version and I'm beginning to think of paying the extra money for the full version. The full version allows you to look at your history further back than a week. Yesterday I did everything right and I think I got a good nights sleep. but I had left the Bluetooth on and Sleep Score didn't start tracking till my Bluetooth headphones ran out of juice.

Getting outside in the sun seems also to be critical. Again it has to be the melatonin. Maybe my body doesn't make it as well anymore. They say that as we get older we stop making it. That's why old people don't sleep so good but kids sleep 10 or 12 hours. Exercise seems to help a lot too. It is easy for me to incorporate at least a 20-minute walk outside every day. I even enjoy them. but I know that option may not be available to everyone.

Getting in a workout seems to help too. Not drinking coffee in the afternoon, too.

There has been a lot written about screen time. It doesn't seem to be an important factor to me. It has been suggested to limit the amount of screen time all day long, especially in the evenings, and certainly before bed.
 
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My problem is that I have racing thoughts in my mind. I have had sleep problems my entire life. The doctor prescribed Xanax. It works for me.

I have tried using over the counter cold medicine. I knocked me out pretty good. I have also taken an allergy pill to go to sleep.
 

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I have problems too. I wake up sweating. I also dream a lot of very vivid dreams. I find I get into bad sleep patterns, waking after 5 hours, or every two hours. I find it best not to have any protein before going to bed as I cannot sleep then. It's good to find a time when you feel sleepy and then go to bed at that point. so get ready for bed and then when you feel tired go to bed, otherwise you get that second wind and when you are overtired it is hard to get to sleep. I slept badly as a child. When I lived alone I slept for ten or more hours, nothing woke me, but since being married I wake up so easily, whether it be sound, movement or changes in temperature. I also need darkness to sleep. Better to go to bed with a supper of bread and jam, bread and milk with sugar used to be the thing. The combination has some chemical thing that aids sleep. I rarely wake up feeling refreshed. However, my husband sleeps well most of the time.
 
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Lou

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@Sally
I feel for you.
I just Don't Know about the protein thing. I've heard a lot of suggestions about what to eat before bed. But for me, eating early and not snacking seems to be best. That probably has a lot to do with my GERTs which has on occasion woken me up. *

I think getting ready for bed advice is excellent. I don't do this myself but I've been told that it is even better to go to bed at the same time every night. And then just wait in bed with your eyes closed till sleep overtakes you. Now that I said that I'm going to try to make that a goal of mine, too. I could set an alarm and when it goes off its time to get ready for bed.

Last night I took 10mg of THC right before dinner and watched 2 episodes of Stranger Things. Then I was sleepy but it was early. For me going to bed early (sleepy or not ) is like the worst thing but I went and took 1 mg of sublingual melatonin. And I slept great. Unfortunately, I forgot to turn on the Sleep Score App. I remembered to set it up but not the final step of turning it on. I could blame the THC, but I've done this before on several occasions.

I don't have night sweats or the vivid dreams so I haven't really looked into that but in reading about sleep disorders both show up in the literature fairly often. I believe night sweats are associated with other things and can be treated traditionally. If you haven't done so yet you should ask your doctor about it. Let us know what he says. (OH. I just googled it. I put an article on the bottom)

I've read that both melatonin and THC (not necessarily taken together) can make for some weird dreams and I can attest to both.

I remembered reading about L-Tryptophan and its relationship with sleep. So I thought I would double check on it. The Web MD aritcle was pretty informative. I then looked up vegan sources of tryptophan and it turns out my diet is already pretty good in that area. But It would be pretty easy to maybe boost it with a few things. I can already think of a few things like adding my ground flax seed to dinner instead of breakfast or having a handful of nuts as a PM snack.





*I've been very successful treating the symptoms of GERTs myself. It's not an issue as long as I take care to watch my diet and eating habits. The only medicine I need is an occasional Tums - and just the regular strength ones too. I sleep on my back on a wedge pillow. I got the GERTs 10 years after the sleep disorder showed up. but at first, it was powerful enough to wake me up. So it just made the sleep disorder worse. But going to bed with an empty stomach is very important in my battle against GERTs.
 
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Whoa182

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Hi Jools!

I used to have sleep issues but it was related to a severe reaction from an antibiotic I took many years ago, but I did learn some things to help me get through it. I sleep fine now, but I was not able to sleep for more than 30 minutes at a time for 4 months and it took about a year before my sleep completely returned to normal.

You mentioned that you wake up sweating, this could be a sign that something isn't right and it could be related to hormone issues, autoimmune conditions, infections, etc. I would say it's a pretty important symptom.

Body temperature is a key regular in our sleep cycle and ability to maintain sleep... so you want to try to keep your room cool. If you can, track your core body temperature (measure by using an oral or ear thermometer) and then look at your temperature throughout the day and chart it. So perhaps, take like a measurement every 2 hours if you can... (or whatever is practical for you).

1. Get a panel of blood tests done: Thyroid hormones (free T3, free T4, TSH), Sex hormones, complete white blood count (CBC), Anti-nuclear antibody test, C-reactive protein, ESR, fasting glucose, B12. Edit: You could leave out ANA test and just look at inflammatory markers and then follow up on that.

2. Deficiencies: While there are some nutritional deficiencies that can cause poor sleep quality, they generally don't result in a problem as severe as yours. Still, I'd recommend supplementing zinc picolinate, magnesium citrate (these taken together improves sleep onset and maintenance), methylcobalamin (B12). Vitamin D can also improve sleep quality. Some of these I mention here are common deficiencies in vegans, especially B12 and zinc (almost 50%).

3. Sleep at the right time: We all have different body clocks and this is determined by genetics, so you need to find which time of the day is best for you. Some of us are early risers, some are night owls. I simply cannot maintain a "normal" sleeping pattern... my natural sleeping time is about 4 am. Trying to go to bed earlier and sticking to it makes me ill and I can't fall asleep. I can't wake up early, I never have been able to, but I sleep perfectly fine if allowed to sleep at my preferred time (this is genetically determined). one of the cues that your body is ready to sleep is a significant drop in body temperature.

4. Are you taking anything (meds/supps?): Are you taking or have taken anything that triggered insomnia? Sometimes it can be delayed... Think back to when it started. Supplements are also not entirely benign. For example, getting too much iodine can cause hyperthyroidism which can result in similar symptoms.

5. What is your calorie intake and current BMI?

6. Is your level of anxiety high or low during the day?

7. Resting heart rate and blood pressure?

I'm guessing that you have tried all the natural remedies like valerian root, chamomile, licorice, etc?

Some of the symptoms you describe are almost like withdrawal effects (the night sweats, constant awakening), these can be caused by modulation of the GABA(A) receptor in the brain, normally as a result of benzo meds, certain antibiotics like fluoroquinolone antibiotics, anti-malaria drugs.

If there is an issue here, you might want to try to look at fixing the GABAergic system (this is what I focused on when recovering from insomnia in 2007).

I found that l-theanine helped somewhat... it's not a cure, but I'm sure it helped me.

Also, stay away from big meals before bed, and make sure you're not consuming too much protein close to bedtime.

If you're consuming any stimulants like caffeine, cut it out over 6 hours before bedtime.

Also, give this a watch:


Any questions, please let me know!
 
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Mom2vegan

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My solution might not be the healthiest one but it works for me - 1 benadryl and 1 glass of wine before bed. I try not to let it turn into 2 glasses of wine and once in a while I take a night off of the wine and benadryl. I found that CBD oil turned off the racing thoughts and helped me get to sleep but then I'd wake up in the middle of the night. Also, valerian root used to work very well for me....I can't remember why I stopped taking it. Melatonin worked OK to help me get to sleep but then I'd wake up in the middle of the night.

I have to get enough exercise. If I don't exercise enough, I can't sleep no matter what I do.

I have bad hot flashes at night - from hormone-related issues. Usually there's a reason for night sweats/hot flashes. I agree you should get it checked out, it looks like you're too young for menopause. The night sweats along with the pallor and dark circles under the eyes warrant a trip to the doctor.
 
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Lou

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Well, I don't know if any of these recipes are going to help me sleep. but I'm going to enjoy finding out.

 
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