Update from the Insomnia Wars

[robysue]

Another month, another appointment with a sleep doctor. *sigh*

Back in May I was fired by my first sleep doctor's team of PA's. You can read about it here if you really want to.

And in June, I went to a new sleep doc. You can read about that appointment here. Back in June, the new doc told me to work on extending my sleep time. Not by taking naps, but by working on "both ends" of the night: She told me that since I'm a night owl, that if the only way I can get up to more than 5 1/2 hours of sleep is by sleeping until 8:00 or 8:30 (instead of moving bedtime back to 12:30) then I should do that since I've got the freedom to sleep that late right now in the summer. And worry about fixing the problem of getting up in time to teach in the fall closer to fall.

And how has that strategy worked out?

Before starting the new strategy this was the situation on a typical night:

• Time into Bed: between 1:20 and 2:00 AM
• Time Out of Bed: between 7:30 and 7:40 AM (required an alarm to get up)
• Total Time in Bed: between 5:30 and 6:00 hours consistenly
• Latency to Sleep: 5 or 10 minutes
• Number of Wakes: 3--4 wake ups on a typical night, some of which were 10+ minutes long
• Total Sleep Time: between 5:00 and 5:45 hours most nights.
• Sleep Efficiency = (total sleep time)/(total time in bed) > 85% on about 50% of the nights

So after about a month and a half of throwing away the alarm clock and not worrying about bedtime, what's happened? Well, for July, the numbers for a typical night look like this:

• Time into Bed: between 3:00 and 4:00 AM
• Time Out of Bed: between 8:00 and 9:30 AM (and I'm getting up WITHOUT the aid of an alarm)
• Total Time in Bed: between 4:30 and 5:30 hours
• Latency to Sleep: 5 to 10 minutes
• Number of Wakes: 1--3, and only rarely are they more than 10+ minutes long
• Total Sleep Time: between 4:00 and 5:45 hours per night.
• Total Sleep Time: between 4:00 and 6:00 hours per night.
• Sleep Efficiency = (total sleep time)/(total time in bed) > 85% on about 75% of the nights

A couple of notes about that TST data for July do need to be made: There are as many nights with less than 4:00 of sleep as there are with 5:30 hours or more. And over half the July nights have less than 5 hours of TST for the night. The data is remarkably well spread out with five or six days in each of four broad categories: Less than 4:30 sleep, 4:30 -- 4:59 hours of sleep, 5:00 -- 5:30 hours of sleep, and more than 5:30 sleep.

So clearly the strategy of just being my night owl self is not working in the sense of increasing my time asleep. And it's not hard to see why: Night owlishness has crept into Bed Time much more so than Wake-up Time. I think at today's appointment this development was a bit of a surprise to the new doc.

On the other hand, the news is not all bad: The number of wakes AND their lengths are really now down to something that doesn't seem to bother me on most nights. And overall sleep efficiency is up a bit. And I continue to see "almost refreshed" in terms of how my body feels upon waking on a pretty regular basis, although my mind is still waking up "kind of groggy" on most days. The daytime sleepiness, lack of energy, and cognitive problems have not gotten any worse even though I'm sleeping less. Indeed, there's been some improvement in terms of daytime sleepiness and overall energy level there's actually been some improvement when I look at the figures from my RobySue's Daily Data spreadsheet that tracks a whole bunch of things related to How do I feel?

And of course, there are nights where I have a lot of more restlessness and more wakes than these average figures, but they are becoming more rare and, notably, there is usually an identifiable trigger in the sense of non-CPAP, non-insomnia related stress or worries---such as some on-going department politics issues at work for example. I can deal with this kind of intermittent insomnia.

So if I were retired, I'd just declare victory and go home .... in the sense of: I'd be happy to continue to go to bed between 3:00 and 4:00 and sleep for as long as I do waking up without an alarm clock. And not getting too focused on how long I slept each night as long as the sleep was decent quality and I could function in the daytime.

But my fall semester starts in about one month and this crazy 3:30 to 8:30 sleep schedule just won't work once classes start. I need more sleep in the first place to cope with the day-to-day requirements of teaching and I need more cognitive ability during the daytime to focus better on what needs to be done as well as for learning student names.

So I really need to move that sleep schedule back to something closer to 1:00--7:00 by the end of August. Without losing any of the other progress I've made. So that's what I wanted to address at today's meeting with the sleep doc. And yes, the meeting did focus on that for the most part.

Her ideas? First---try a sleeping pill (rozerem this time). Even though I've said repeatedly that I don't want to go that route for multiple reasons I don't want to get into here. After a bit of touch and go on that, she finally did put on her doctor's thinking cap and came up with several things for me to try:

1) No caffeine at all. Last week I had already come to the conclusion that my beloved full caffeinated cup of coffee in the morning was indeed a migraine trigger and hubby and I have talked about this. And last night agreed I need to give "no caffiene" a good solid two week trial on the migraine front.

2) Going back to a stricter wake up time. But not doing it whole hog right away. The suggestion---which is reasonable---is to make myself get up at 8:00 for the rest of this week. On Monday, move wake up time back to 7:30 for the next week. And on the following Monday, move wake up time back to 7:00. (And if I'm brave enough, follow that by moving wake up time back to 6:30, which is really where it needs to be during the school year.) And hope that the bed time issue will begin to naturally resolve in the sense of naturally moving itself back towards 1:00 or 1:30.

3) Light therapy. As in getting a Light Box that's used for treating Seasonal Affective Disorder (SAD) and starting to use it now for about 30 minutes as soon as I get up each morning.

4) As a backup for #2: If by the end of a week or two of "strict wake up time" I'm not making enough progress on moving wake up time from 8:00 to 7:00, I can also try readjusting my circadian clock by going the other way. In other words, take about a ten to fourteen day period to stay up later 2 additional hours (and waking up two hours later) until bedtime and wake up time are where I want them to be.

I've yet another follow up scheduled with her in two months. If I don't have an emergency visit to her during the month of August, that will be the first month since starting this adventure that I will have NOT been to see a sleep doctor or sleep doctor PA in a full year.

[HoseCrusher]

In my very optimistic manner, I am viewing this as progress... Right?

[robysue]

In my very optimistic manner, I am viewing this as progress... Right?

Yes. I view it as progress.

I've still got a big task of moving the sleep schedule back to something compatible with my job before the semester starts, but there's been real, genuine progress that I can feel in my daily life as well as see in the logs.

And part of that progress is that my own inherent optimism that went AWOL at the beginning of this adventure is coming back to visit me on an intermittent basis. The Deplin has helped it find its way back home I think, but rather like a skittish kitten, it's still checking out whether it wants to stay. But I think it will decide to stay (eventually).

[jibb]

I know What you feel.I suffer the same problem.

[CatherineF]

Robysue don't you suffer from delayed sleep phase syndrome? You are going to bed very late. You may try melatonine, agomelatine, liht therapy or chronotherapy. I used to do this when I was suffering from this issue when I wasn't on CPAP, it was helpful. Good luck

[robysue]

Robysue don't you suffer from delayed sleep phase syndrome?

Technically yes, this is indeed a major problem right now. At the beginning of the summer the new sleep doctor told me to throw out the rigid sleep schedule---particularly the rigid wake up time that my previous doctor's PA had suggested---in an effort to get my total sleep time up to something I can function indefinitely on---I most likely need around 6 to 6 1/2 hours of mostly uninterrupted sleep to really function long term. At the beginning of June I was getting 5 1/2 to 6 hours of (still somewhat interrupted) sleep. The new doc's idea was that I'd most likely just start sleeping about an hour later in the morning while maintaining my then current bedtime of 1:30ish. And I could work on moving the schedule back to what I need it to be once I was actually getting enough sleep on a nightly basis to really function full time on all four cylinders.

Much to her surprise (but not really to me), by allowing myself to go to bed "whenever" and get up "whenever", I sure enough started sleeping later (by anywhere from 30 minutes to 2 hours later), but sleeping later kicked in my very old night owl habits/preferences from way, way back. Net result: Fewer wakes (progress! ) but also less total sleep time (backsliding ). And feeling a smidge better, but most of that is due to migraines coming under control with the Deplin, Vitamin B2, and magnesium instead of heavy-duty migraine meds that are also used (in different doses) as anti-seizure meds. And I still feel pretty sleep deprived on a regular basis.

You are going to bed very late. You may try melatonine, agomelatine, liht therapy or chronotherapy. I used to do this when I was suffering from this issue when I wasn't on CPAP, it was helpful. Good luck

I've tried melatonin. All it did was aggravate my TMJ something fierce (and make me moody). And I'd really rather not take anything at all for the insomnia/delayed phase syndrome. It's just a personal choice: There are already too many other pills I'm swallowing even if they are all technically vitamins/minerals except for the Zyrtec and Flonase nasal spray. And I just don't seem to react to sleeping aids very well.

The new doc's current advice/plan is light therapy and one version of chronotherapy. I've been investigating light boxes on the net since the appointment. They are more expensive than I thought they'd be. But then again, I know that I've also always fought winter-time blues (until the snow comes, which brightens up the world significantly). So I've got an ebay bid in on a decent box in an auction that ends sometime tomorrow morning. And so far this week I've had no trouble getting up at 8:10 with the alarm. And the last two nights I've been in bed at 2:00 and 2:40 respectively. Definite progress when you consider that on its own, my bedtime was drifting towards 4:00 AM before imposing the rigid wake up time again. Hubby and I are planning on moving the alarm back to 7:30 come Monday morning and leave it at 7:30 for a week or so to see what happens with my bedtime.

[milw]

The new doc's current advice/plan is light therapy and one version of chronotherapy. I've been investigating light boxes on the net since the appointment. They are more expensive than I thought they'd be. But then again, I know that I've also always fought winter-time blues (until the snow comes, which brightens up the world significantly). So I've got an ebay bid in on a decent box in an auction that ends sometime tomorrow morning. And so far this week I've had no trouble getting up at 8:10 with the alarm. And the last two nights I've been in bed at 2:00 and 2:40 respectively. Definite progress when you consider that on its own, my bedtime was drifting towards 4:00 AM before imposing the rigid wake up time again. Hubby and I are planning on moving the alarm back to 7:30 come Monday morning and leave it at 7:30 for a week or so to see what happens with my bedtime.

I've found a light-alarm to be very helpful with waking up, especially in the dark hours in Jan-February. Mine will ramp up to full brightness over a settable period, I think I usually use 30 minutes, to come to full brightness maybe 10 minutes before the alarm goes off. My teen son has a drifting sleep schedule as well, he's now sleeping from ~8 am-6 pm, and we're going to keep working him forward through the clock to be on a 'normal' schedule by the time school starts. I think the light alarm might help him too, but so far he refuses to try!

[SleepingUgly]

Might I also add the suggestion of blue light blocking sunglasses worn at night? They are very chic (not!). eg:

https://www.lowbluelights.com/products.asp?cid=18

[robysue]

I've found a light-alarm to be very helpful with waking up, especially in the dark hours in Jan-February. Mine will ramp up to full brightness over a settable period, I think I usually use 30 minutes, to come to full brightness maybe 10 minutes before the alarm goes off.

Ah yes. In the past I've had a a 40 or 60 watt bedside lamp on a timer so that the light turn on about 10 or 15 minutes before the alarm went off. Made a huge difference. This winter things were so messed up that I literally can't remember if I set it up or not. But hubby was turning the main light on when he'd get up at 7:00 or so to help me hear the 7:30 alarm and get myself up.

I've thought about investing in a sunrise alarm clock that does the light thing right---in the sense of starting out dim and gradually brightening. It may be an early Christmas present---particularly if the light box itself proves useful.

The neat thing about the light box is just how bright they are supposed to be: 10,000 lux really is approaching natural daylight in intensity. Once I get the light box, I'm supposed to sit in front of it doing whatever (like eat breakfast) for about 30 minutes every morning right after I get out of bed.

[robysue]

SU, the blue-blocking glasses are an idea I'll keep in mind---particularly since I have to keep reminding myself that too much computer too late is not got for getting to bed on time. I'll be logging out shortly to try to give myself a good two hours of non-computer, non-tv time to eliminate those sources of blue light before I get to bed hopefully around 1:30 or 2:00 tonight.

As I said in the original post, if I were retired, I wouldn't bother with any of this "get your body on a normal schedule." I'd just go with the flow my body wants to follow. It's so much easier just to be the night owl that I am. But life tends to interfere.

[cflame1]

robysue,
Not sure if these would help... but it's supposed to be a light box and it's less than $100

http://www.pulseoxstore.com/Light-Therapy.html

[SleepingUgly]

My Philips goLite box can be set to turn on like an alarm clock.

[napstress]

robysue, I can really identify with not only your truncated sleep time (except I am a "toast" person: popping out of bed early in the morning and falling asleep early at night) and the fragmentation of your sleep. I, too, teach at the college level and heartily understand where you're coming from in terms of departmental politics and needing to remember students' names, be cognitively together and emotionally stable, etc.

I recently re-read Krakow's Sound Sleep, Sound Mind and kept thinking of you during the first 194 pages. Have you read it? The few irritating linguistic gimmicks aside, I've found his theory compelling and his techniques helpful. It is clear from your writings that you already share some of his views, which makes me think that if you haven't read his book yet, you might find some value in it. It is also clear that you have extraordinary self-discipline. Only a smidgen of that would be necessary for his techniques.

Re: low-blue lights: they also sell low-blue lightbulbs and monitor covers. I got the lightbulb. It was pricey, but b/c it is a CF, I expect it to last a long time. It does make the room yellow. Maybe switching it on instead of your regular lights a few hours before your bedtime goal would help.

Melotonin doesn't work for me, either. For me, it's mainly just good for jet lag.

If you decide to go with the sleep time restriction/shifting route, my very best wishes to you.