Chronic Insomnia - Please Help

Hi Michael,

I know all about sleep anxiety, having experienced it myself for much of my life.

I know it's horrible feeling exhausted all the time, but it won't actually harm you. You've obviously got your head round this in the past, and you'll do it again.

What I found helped when I was going through these phases was to take a small dose of one of the older antihistamines (the type that make you sleepy) just for two or three nights in a row, to get a bit of sleep. Then I'd tough it out again for a week or so before repeating the process. My preferred antihistamine was promethazine (marked as Phenergan in Europe) but there are others in this class.

If you do want to try this, it's important to take the dose at an hour or so before bedtime. It's not a knock-out solution and takes quite a while to work. It's also important not to get into the habit of taking them every night, as you quickly develop tolerance to them - just like sleeping pills - and they'll soon stop working. And don't take a second dose if you wake during the night, as this will make you groggy the next morning.

Alternatively, you could ask your doctor for sleeping pills, but the same rule applies here. Don't take them every night. Just keep them for the odd night when you've really had enough, otherwise they'll soon stop working.

I very much doubt whether your circadian mechanism has been switched off. (I'm a former neuro nurse, btw.) However, some people do find taking melatonin helps a bit. The main thing, as you clearly know, is not to give way to anxiety. You will eventually start sleeping again, though you may have intermittent problems throughout life (as I've had). In the meantime, you won't be physically or mentally harmed by your lack of sleep, however awful it makes you feel.

Thank you so much for your reply, but I do have to disagree at least on the "you won't be physically or mentally harmed by your lack of sleep".  I think we all know this isn't true.  My mental health has hit an all time low because of this and on top of that, physically, I feel (and look like) hell most days.  So I don't know how you could think that.

Maybe at this point trying something like melatonin before bed to see if I could get a few good nights of sleep would be good after all.  Then stop and see if it goes there.  It's just SO frustrating knowing that I have beat this before (i.e. the first time back in December and then the few nights when i first put the alarm clock away) yet can never get it to stay.

My biggest fear is what you implied, how because of this whole horrific phase I may now be prone to anxiety and sleep problems on and off for my life.  In my opinion it almost doesn't matter that I slept well for the first 31 years of my life, I feel like once that type of anxiety enters your life it just becomes extremely difficult to get rid of it, much like other mental things.

Well Michael, the reason I made that statement is because I went through all this too, for years, and it didn't seem to do any lasting harm. I'm 72 now. I was actually working as a nurse for 10 years of this. I eventually suspected it might have been putting my patients at risk - which was part of the reason why I gave up nursing - and it certainly felt as if it was affecting my health at the time.

However, there were no long-term implications as far as I can make out. I did get quite depressed in the first few years, but I came out of this by the time I got into my 30s - in spite of the fact I was still sleeping badly a lot of the time. Now, apart from a mild autoimmune condition - which may or may not be related to my earlier sleep pattern, but doesn't bother me too much anyway - I'm in excellent health. Blood pressure, kidney and cardiac function etc. are all OK and I'm still fitter than some people much younger than me. I'm beginning to have a few minor gaps in my memory, which is only to be expected at my age, but my concentration is actually better than it was when I was young. This is probably due to the fact that my sleep problems disappeared as soon as I retired from paid employment!

I understand perfectly your comments about mental health. Lack of sleep and impaired mental health obviously feed back into each other. But that doesn't mean your mental health will be permanently affected.

I don't think you necessarily have to worry about having poor sleep for the rest of your life. On re-reading your original post, I see you say you had perfect sleep for the first 31 years of your life. That certainly wasn't true in my case. I had problems sleeping from early childhood, and they were made worse when I was forced to work an impossible shift system for a year or so in my mid-20s. You have every chance of returning to normal sleep once you can get over this current period of sleep anxiety. That's one of the reasons I was suggesting some kind of short-term medication. (But it has to be short-term.) It may be that you will return to this pattern from time to time, but I can assure you from personal experience that these episodes get shorter and easier to manage over time, as one amasses more experience of how to deal with them.

The most important thing is to try to avoid getting angry about your lack of sleep. I understand that one too. I sometimes used to get angry with myself, the people around me who slept effortlessly, the Universe, and so on and so forth. But that doesn't really help. It's no one's fault, and certainly not yours. Hard as it is, try to accept that this a phase - albeit a long one - that you will pass through. And accept some sleep medication if you find it helps. I wouldn't, however, recommend taking medication for your anxiety. Withdrawal from benzos can last a lifetime, and one of the main symptoms is insomnia.

Hi Michael. I agree with you in the fact that insomnia does affect your mental health. I'm such an outgoing person normally, organised etc but after a bad nights sleep, I feel low, so unproductive, anxious etc. Work that day is a complete struggle, I can't tell people how I feel as no one is interested in how tired I am..it sounds so feeble..I don't tend to plan social activities etc because I don't know how I will feel on the day. Why would I want to socialise and party etc when I can hardly string a sentence together through pure brain fogg.  It's like I'm two different people, depending on how much sleep I get.  

On bad days I even consider going to docs for anti depressants, as I know I am an over-thinker but I believe they can make insomnia worse, a common side effect.

I have tried everything from sleeping pills, melatonin, hypnotherapy...I've spent shed loads of money trying to resolve the problem & nothing works long term . No pill is going to cure this problem. 

I do however admit that a lot of this is in my head..it's learning how to relax and not worry when I do wake up. 

Going to to bed too early makes it worse.  Some of my bad nights have been after a very good night, the night before. It's as if I've had too much sleep, but that good night is bed at 10 & up at 7 and although still waking a couple of times, I managed quality sleep. 

Try not to control it... I don't think we ever can. 

n

Hi Michael,

I've heard that sleeping in total blackout can help to reset the circadian rhythm. It might well be worth a try. However, it's my understanding that it doesn't work immediately. I never tried it myself as I suffer from a REM sleep disorder as well (I got the full flush!) and that can be made much worse by sleeping in total darkness.

Nic is right about not going to bed too early, though I know how tired you can get in the evening after a poor night's sleep. It was never an option for me. I've always found that if I go to bed too early either I can't get to sleep then lie awake the rest of the night worrying about this, or else I fall asleep immediately then, like you, am wide awake by 3am.

You're right in saying that antidepressants can cause all kinds of sleep problems. They really are best avoided. Ditto anti-anxiety meds, as I've already stated. If you need medication, it's better to go for sleeping pills but only use them for a couple of days at a time.

In spite of how lack of sleep makes you feel, medical opinion usually has it that you can survive on as little as two hours sleep per night on a regular basis, though you need five to feel well. And don't forget that a number of public figures have famously coped with very little sleep. Mrs. Th@tcher was one example, existing on three hours per night. I'm not suggesting this is ideal (or that you'd want to emulate her in any other way) but it just goes to show that we're not all designed to need the usual 7-8 hours per night.

That's fine for fun facts but I personally have always been unable to feel refreshed the next day without at least 7 hours of sleep.  I've actually always been a little 'OCD' when it comes to sleep in the sense that I always tried to make sure I got a good night of sleep especially before an important day for example, bc I know just how horrible being tired is, at least for me.  So seeing as how this has gone on for 5 months you can only imagine how much this has been destroying my life.

Still trying to be calm and optimistic of course.  For now I think I will hang dark sheets over my window starting tonight so there is now zero chance of anxiety due to a clock or not seeing sunlight when I wake up in the middle of the night.  Isn't it sad just knowing that waking up in the middle of the night is a given now?  Still fascinating to me how it happens like clockwork, even on the nights when I go to sleep completely exhausted.

Me too - Some nights even when I go to bed completely exhausted I still wake up every couple of hours. I understand that we can go through several sleep cycles that last 90mins each. Apparently it's perfectly normal to wake after each cycle. Some people sleep through to the next cycle while others like me tend to wake.  I think the most of slept is 4 hours- ish. I've had this problem for years, it's not as bad as it used to be. I go a max of 2 days with good sleep but can't manage a third. My dream is to go on holiday somewhere on my own with absolutely no stress and see how I sleep😴 but I would have to take my ear plugs, eye mask etc as like you Michael I've always been a little OCD about sleep. 

Interesting last point, Nic. You probably know that health anxiety is now classified as a form of OCD - and generally thought to be the most difficult form to treat. I'm wondering whether sleep anxiety will one day be put in the same category. It certainly felt that way during all the years I suffered from it.

All kinds of reasons, Michael. There isn't just one. At one point, when my REM sleep disorder was at its worst, and creepiest, I went through a phase of about six weeks where I woke up at exactly one minute later every night. I can tell you it really spooked me!

I subsequently saw a documentary on BBC TV which explained that we have a real "biological clock" in our brains. Apparently there's a group of cells somewhere in our midbrain - I forget exactly where - that turns on and off at a rate of once per second. In other words - we tick.

I extrapolated from this that the fear generated by my hallucinations etc. (all related to my REM sleep disorder) had caused my unconscious to wake me exactly one minute later every night to spook me. Don't dismiss this. I've had 50 years of dealing with my own unconscious due to this disorder and if there's one conclusion I've come to, it's that my unconscious is not entirely on my side. You're in a state of high anxiety. Never underestimate the power of the unconscious in these circumstances.

This isn't entirely as weird as it sounds. Have you never had the experience of waking in the night and knowing exactly what time it is before you looked at the clock? (I mean before you started waking at exactly the same time every night.) I get it all the time, even now, after my REM sleep disorder has largely burnt itself out. Many people, including those who don't suffer any form of sleep disorder, report this phenomenon. I put it down to having looked at the clock shortly before going to sleep and my automatic time-keeper then having taken over. I don't have this ability during the day, presumably because my attention is taken up with other things.

The workings of the unconscious are still a whole other country to most scientists. And - just in case you were wondering - I don't think it's necessary to stray into the world of the supernatural to explain these phenomena. We tend to use the word "supernatural" to explain - and, in the case of scientists, dismiss - anything we don't yet understand. A bit like prehistoric man facing his first experience of fire. Do your own thinking.

Michael. It is very normal to wake in the night. I slept ok last night but still woke about 3 times. I think the tricky bit is telling yourself to relax and just rest.. Don't put yourself under pressure and then sleep will come. Sometimes when I've woken, nipped to the loo and gone back to bed.. I feel so wide awake that I think I could never go back off.. But I do. Sometimes it takes a bit longer. Honestly research sleep cycles.. As I say they last 90 mins. Take care. 

Me too, Nic. I seem to have at least half-woken after each 90-min sleep cycle all my life, and I often wake completely. This isn't normally a problem - at least not these days, when I'm retired from paid employment. However, I can sympathise with what's happening to Michael too. In younger, more stressful days, awakenings nearer the end of the night would have me looking anxiously at the clock and unable to get back to sleep too! It can still happen now occasionally, especially on the night before travel or an important meeting.

It's just something I had to learn to live with. Once I accepted that this was just going to happen, things got slightly better.

I personally don't feel its normal to wake up every single night.  Maybe you meant occasionally?  What exactly are your insomnia problems if you don't mind me asking?  Age they started, how they started, etc

Michael

Michael, I realise you were replying to Nic but yes, it is normal to wake between sleep cycles. This is always observed in sleep labs, unless the patient is taking medication that damps down the cycles. In most individuals, the awakenings are very brief and they don't remember them the next morning. However, a lot of perfectly normal people wake up sufficiently between cycles to remember their awakenings the next day. I always have.

The problem starts when anxiety begins to creep in. This can make you more aware of these normal night-time awakenings - especially the ones occurring later in the night - with the result you then become hyper-alert and unable to get back to sleep.

I just don't know what else to do at this point.  When I wake up I feel completely wide awake and only THEN does the anxiety creep in.  Allow me to explain one last time... I am more calm when i go to sleep than i ever have been through this.  I have the right mindset towards the insomnia where I know i can't force fix this and I should not be worrying about it.  Yet EVERY single night I wake up around 3am, and when I DO wake up, thats when the anxiety kicks in.  What does this all tell me?  It tells me that i truly feel my circadian rhythym might just be 'broken' from going through this for so long.  It tells me that instead of anxiety popping me up at 3am, that my brain is now simply programmed to become wide awake at the time.

It's just so heartbreaking to know how close I felt to beating this last week when I put my alarm clock away.  Those few nights the 3am anxiety temporarily disappeared and I drifted back to sleep so quick.  I legitimately felt as if it was all behind me.  By night 4 it came back.

Yes I do wake 2-3 times every night. I've suffered with insomnia badly for the last year. Some good nights and some bad. Last night was a good night, the awakenings went as follows. Bed 10pm (I was exhausted) woke 11.30pm. Then woke again at about 1am, feeling slightly anxious as I'm thinking this is going to be a bad night. Then slept for 3.5 hours which was great. 4.30am fell back to sleep until 6am. I bet tonight I won't sleep so well :-( doctors in the past have prescribed sleeping pills but that lead to dependency, so now I just take Magnesium in the mornings and that's it. 

Any idea why this started?  May I ask your age?  And have you practiced "accepting" your insomnia and understanding that you slept well your whole life before this and all those good thoughts?  With your "I bet tonight I won't sleep so well" it seems like you're not fully there yet 

I hate to disagree Michael, but I think it would be very clear to anyone looking in on this forum from the outside that your anxiety is there all the time. That's what's driving up your blood cortisol levels at 3am, which then keeps you awake thereafter. Cortisol is the hormone that wakes us up in the morning. It's supposed to start kicking in around 6-7am - though it varies between individuals and is also seasonal. When it starts being produced too early, it's always a sign of anxiety.

You're clearly doing a very good job of calming yourself down before going to sleep at the start of the night but that doesn't mean the underlying anxiety isn't still there, waiting to ambush you early every morning. I admire you for that ability btw. As it happens, I have to give a presentation and host a Q&A session tomorrow morning. (I'm retired but do a demanding voluntary job in a mental health centre.) Like Nic, I find I'm already getting a bit nervous and telling myself that I'll be awake at 4am tomorrow! Since I don't have your ability to get to sleep early, and am rarely able to drop off before 1am, that means I'll have a very short night. I'm just fortunate in having the benefit of 50 years' hindsight of coping with this, so I know I'll get through it somehow, just like I always have.

To get back to your problem - I've been re-reading your posts. This has been going on for hardly any time at all, though I well understand it feels like a lifetime to you. To resume, you hit the first bad patch five months ago, suffered six weeks of severe insomnia, temporarily cracked it for about four weeks, then relapsed into insomnia about eight weeks ago. Right?

That's more like an anxiety pattern than anything else. Anxiety doesn't have to manifest on the surface. It clearly doesn't with you, and I'm generally thought of as a pretty laid-back individual myself. But I've learned that it's always there. Anxiety about all kinds of things, not just sleeping.

I very much doubt whether your circadian rhythm has been permanently "broken" or "switched off", as you've said several times. That only happens in rare, degenerative neurological diseases, and then only at a late stage. If you'd got to that stage, you'd be unable even to string two words together or use a computer, yet you're posting cogent, intelligent arguments on here! It's clear, however, that it has been temporarily disrupted by your anxiety levels. It's perfectly normal to be anxious about sleep problems, whether it manifests on the surface or not, and insomnia and anxiety inevitably feed back into each other at one level or another.

It's way too early to start telling yourself you're never going to sleep properly again. Most anxiety-related insomnia problems last 6-12 months before spontaneously resolving. Please give yourself a lot more time before condemning yourself to a life of insomnia. Don't be afraid of trying antihistamines or prescription sleeping pills (or small doses of alcohol) as long as you're not taking them every night. Repeatedly breaking the pattern for a couple of night at a time over a long period will often work. It might also be worth trying to get yourself referred to a sleep lab, though this rarely produces answers in the case of insomnia.

Actually I've always been a poor sleeper but this year has been worse. I'm 45 female, no worries as such, I'm just a sensitive person I think. It runs in the family. I dwell on things and would never sleep well before a big day, such as interview etc. My husband tells me it's all in my head.  Lily, you're spot on about the cortisol, I can go to bed as calm as a cucumber but when I wake in the night, I feel really anxious & down. If real stress kicks in, our bodies produce this hormone cortisol and it can keep you awake. I am trying to train myself to stop this negativity during the night but it's hard. I struggle sleeping with no serious worries in life , god knows what I'd do if I had a serious problem - I would honestly be up all blinkin night. But I am getting there slowly, I am coming trying to reprogramme my mind ??  I listen to 'positive thinking' hypnosis before bed, think that helps a bit.