Friday, March 25, 2016

The vicious cycle

I realize I sound like a broken record on this blog...feeling blah, trying to feel better in all my usual ways, still feeling blah. This is lasting well beyond my typical "feel blah for a few weeks, bounce back & everything is amazing". And I think I know why.

I haven't slept well in MONTHS. I can't recall a single time in 2016 that I've had even 2 good nights of sleep in a row, and more recently, I don't think I've slept more than 4-5 hours/night. I am not on call or being woken by my children or my husband or anything else. Its just...my stupid freaking brain. I can't fall asleep, sometimes for hours, and then I wake up crazy early and can't get back to sleep.

The thought of another sleepless night has also led to a really intense visceral anxiety...about sleeping. Every evening I look forward to being done with the bedtime routine and the tasks so I can finally rest, and then the moment its time to turn off the light my heart starts racing and my stomach clenching. I swear I can feel my blood pressure rise and the blood pounding in my head. I feel like I've taken shots of espresso or as if I'm about to do something terrifying. I try deep breathing, imaging a calming space, progressive relaxation etc... and nothing works.

I've done all the usual things---I exercise in the morning, I only have one cup of coffee in the morning, I've stayed away from alcohol, I dim the lights, I avoid blue light, I tried meditating before bed etc... None of that is working.

I thought the insomnia was a symptom of anxiety, but my therapist pointed out that perhaps the anxiety was caused by the insomnia. I've been anxious many times, and I've never had three months of not sleeping in my life. She recommended melatonin and I tried it. The first day I thought it worked...I got sleepy and was able to calm down and fall asleep about an hour after taking it. But the next day, same time, same routine---didn't work. I stopped it for a while, started again---same hit or miss effect. But now with the side effect of "excessive daytime sleepiness" and all-day headaches. So...defeats the whole purpose of trying to get a good nights sleep, right?

I bought some magnesium today and will start that this evening. I also finally bit the bullet and made an appointment with my primary care doctor to discuss prescription sleep medication---I'm going in 2 weeks.

I need to fix this---I can't really function in my life on half-empty. I notice a difference in my efficiency at work (and lets not get into motivation, which is a struggle at the best of times lately).  I'm always irritated & quick(-er than usual) to anger with my kids & husband. I can't get excited about anything. I struggle to write "3 good things" in my journal about each day...everything just seems like a struggle and something I need to get through. Its all about endure and not enjoy. Yes, I might be depressed, but I think its related to the lack of sleep. I remember this happening in the newborn days and a good night or two of sleep made ALL the difference in my outlook and mood.

My mother has not slept more than 3-4 hours/night in over 10 years. She is always tired and, while she's learned to cope with it, its a constant frustration. I admit I'm terrified that I will share her fate.

Any advice or even anecdata appreciated!

34 comments:

  1. Good luck!

    I know you're the doctor, but it sounds like getting a sleep work-up would be a good idea in case it is something chemical and you can fix the cause instead of the symptoms. (But again, I don't know anything about the topic.)

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    1. nah, I'm perfectly healthy. it really is a mental thing---I get so anxious about not being able to sleep that surprise! I can't sleep. I just need to break out of the cycle so I can actually believe that I can/will sleep.

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  2. UGH. As a lifelong terrible-sleeper, I can empathize. Once I get into a pattern of not sleeping, it's often the fear of not-sleeping that keeps me up.

    A few years ago I finally got an Ambien prescription from my doctor. I VERY rarely take one (very rarely = I was prescribed 15 pills and I still had a bunch left when they expired!) but simply knowing they are in my medicine cabinet has helped me. The only time I ever take one is if I've gotten into a funk of multiple days with major difficulty falling asleep -- I'll then take one to get myself out of that cycle. I'm very careful with how I take them; I wake up at 5:00 for work so I only take one on a night when I can take it suuuuuper early so I know it'll be out of my system by the time I wake up. I've also heard that they are less effective on a full stomach so I eat dinner really early if I'm going to take one.

    Anyway, I'm glad you're going to talk to your doctor about the possibility of a prescription. When I finally got one, I was kicking myself for not doing it earlier.

    (Also, hi! First time commenter. :) )

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    1. yes, this is sort of what I envision. I definitely don't want a daily long-term prescription

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  3. I probably have no real helping words but can relate to the sleep crap. I'm 42 and feel like it might be menopause trying to make her acquaintance?? I was so desperate about 6 months ago and almost made an appointment for sleep meds....but did not. Things improved slightly so..

    Even two glasses of wine upsets my sleep considerably so I drink way less even though I don't think I was drinking that much to begin with. It really is so hard to function with chronic sleep issues!

    Anon in Massachusetts

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    1. sorry you are dealing with the same thing. I thought about possible early peri-menopause but then remembered that I'm taking birth control. I didn't notice any real difference between drinking/not drinking; if anything, the alcohol reduces my anxiety about sleeping which helps a little (but is, obviously, a terrible long-term solution...)

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    2. Pubmed says bc reduces peri menopause symptoms but does not eliminate them.

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  4. Sometimes Zyrtec helps me sleep. I find it sedating. Yes I am a total lightweight. NyQuil if it's really bad (1/4 dose). There's also Benadryl but I read somewhere that it loses efficacy after a few days. I also kicked my husband and dog to the back bedroom, got a white noise machine and blackout curtains. I cover my clock when I sleep because looking at it makes me anxious. No idea if any of this is helpful for you at all, but it has helped me. Insomnia sucks. I remember one of the chief residents going on and on about how awful it was to give patients sleep meds while they were in the hospital and my first thought was that he was a total douche who had clearly never experienced insomnia himself.

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    1. oh yeah, forgot to mention we have black out curtains & white noise. nobody in our bedroom snores (that I've heard). I take zyrtec every single day (it did knock me out the very first time I ever took it) for year-round allergies. benadryl does put me to sleep in normal circumstances but its not working with this anxiety thing

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    2. Well in that case I'm definitely curious to see what your dr suggests. My first guess is ssri, but maybe a tca? Remeron would be fabulous, but it might make you gain weight which I doubt you want.

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    3. No way to TCA or remeron. I took elavil in college for headaches and I was so miserable, I missed 80% of my moRnimg classes Bc I slept through my alarm! SSRI can worsen sleep. I am really wanting short term something like ambien to break the cycle. Then I can also work on CBT stuff (there is insomnia specific CBT that you can learn about online)

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    4. I slept beautifully on Remeron despite a lifetime of insomnia, but I gained about 30 pounds on it. I recently read a book called "Say Goodnight to Insomnia" by Gregg Jacobs (a Harvard physician), and I found the CBT approach to insomnia really helpful. I've been sleeping better since I read it than I have at any time in my adult life. It's a bit cheezy like any self-help book, but I found the advice very helpful.

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    5. Maybe sleeping through your alarm is just what you need (not literally of course, and really I am mostly kidding).

      I'm intrigued by the cbt book for insomnia. I'll have to check it out. And yeah, the saris can worsen sleep, but it's not unheard of for a pmd to decided that your real problem is anxiety, and try to treat that with an ssri despite the activating features they have in some people. Not personal experience, but I've heard of it happening.

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    6. I have a good pmd and enough knowledge to convince her otherwise, I think. Also the fact that I'm going to therapy and my therapist truly thinks I'm not depressed or anxious but that I'm reacting to the insomnia should be helpful

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    7. No it was awful...I need to be able to get up and live my life...I didn't feel well rested, just groggy all the time and also had palpitations and tachycardia. And I was 19 then.

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  5. I'm also a poor sleeper, and the "4-7-8" breathing exercise helps me most of the time. Good luck

    http://www.medicaldaily.com/life-hack-sleep-4-7-8-breathing-exercise-will-supposedly-put-you-sleep-just-60-332122

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    1. Progressive muscle relaxation (it's a CBT thing) puts me to sleep. When I fell asleep in the therapist's office when she tried it, she suggested maybe not that technique for my test anxiety and to stick with the breathing.

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    2. I tried this. It doesn't work

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    3. Yeah, it's never worked for me either

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    4. To clarify---it may work during my milder random days of trouble sleeping, but this is really resistant to everything I've tried (and I did try that 4-7-8 method after reading about it somewhere)

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  6. Oh, Ana. You know I hear you!

    You might read Gayle Green's Insomniac (she has an old blog Sleep Starved?)

    There's no amount of 'sleep hygiene' that will help me. I will try to wean myself off Lunesta (at least lower my dose) but right now it works. Not 100% but it's the only drug that really helps with waking in the middle of the night (as opposed to falling asleep at the beginning of the night)

    Unisom (not the one with benadryl in it, the other one) I've also found helpful.

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    1. Unisom is NyQuil without the tylenol

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    2. Unisom is diphenhydramine aka Benadryl

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    4. Doxylamine, actually but you're right that they are both antihistamines.

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    5. Certain forms (anything but the "sleep tab", apparently) are diphenhydramine. (I had to look it up Bc I was certain I'd read that on the bottle when I almost bought it)

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    6. I've taken the doxylamine version. It's astonishing.

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    7. Fascinating. Ah... marketing. Also, someone else mentioned Trazodone. Intern year I had a lot of patients who took used that and really liked it.

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    8. going to pick up some unisom (doxylamine kind) today.

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  7. I had ppd with both kids and took Ssri. All 3 (Paxil, Zoloft, and lexapro) caused insomnia with Paxil being the worst. (I tried Paxil 1st, switched to Zoloft bc of the insomnia, then with 2nd kid did lexa bc Zoloft caused weight gain)

    I was BF and my ob prescribed trazadone to help me sleep. It worked great with no side effects for me and it wasn't addictive--i just stopped using it when I was done with ssris. It's an old time antidepressant and some people are all oooh but it worked great for me.

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    1. hmmm, thanks for the info. I hadn't thought about trazadone.

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  8. So sorry! I am 4 months into newborn sleep deprivation (twins!!!). & I am definitely experiencing what you describe - lack of patience and lack of enjoyment for life. One of our boys should be able to Sleep train soon & big sister is an awesome sleeper, so I am clinging to that.

    My mom suffers from peri/menapause related insomnia - hers is the go to sleep fine but wake up at 2-3-4 am and not be able to go back to sleep. I had this during pregnancy & am worried I will have this too as I age.

    I hope you find something that works for you soon. It is amazing how restorative just a night or 2 of sleep can be!

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    1. oh man, I'm starting to really freak out that this is a permanent thing! my mom has the same exact thing. I thought I was way too young for peri-menopause but apparently not.

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  9. Just adding a +1 for the "Say Good Night to Insomnia" book mentioned upthread. I went through a brutal year-long battle with insomnia several years ago and it helped enormously at undoing the anxiety I had built up around bedtime.

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