Insomnia Treatment #1

Several members asked me to post the insomnia treatment program I am trying. I will post each step as I go through the program. I certainly hope it works.

1. Sleep Log - keep a detailed log of your sleep habits for 3 weeks. You will use your log to determine what type of insomnia you have. The log should include bedtime, awake time, how many times you woke up during the night, how many times did you actually get out of bed and for how long, any snacks etc. within 2 hours of bedtime, meds taken at bedtime, sleep conditions (too hot, too cool, noisy houseguests, animals waking you up etc.) Keep something handy to make marks with or by morning you will forget how many times you woke up.

Here is an example of 1 night for me. This is a relatively typical night.

12:30 Bedtime
01:06 In Bed, still Awake
01:06 Out of Bed, read boring professional journal
01:28 Drowsy, back in bed
02:01 In bed, still awake
02:01 Sleep
04:15 Awake
05:45 In and Out of bed 3 times, awake
05:45 Sleep
06:45 Awake
07:00 In Bed Awake, Out of bed
Sleep time 3:15 Room cool, dark, quiet
Bedtime meds: Allegra, Lipitor, clonidine
Bedtime snack: 4 ounces of skim milk, 2 Triscuits

Trying to mark on a paper did not work for me because I am always turned the wrong way..so that frustrated me. So I stuck a bag of cottonballs on the headboard and whenever I wake up, I throw one on the floor. Then I can count awakenings in the morning - just sweep those babies up and count them. Sometimes I get some dust bunnies also! If you are awake enough to know that you are awake it counts - you do not just count the ones where you are going crazy and get out of bed. Some nights I will awaken 11 times but not get out of bed. They get counted because they are sleep interruptions and can diagnose your type of insomnia.

It is normal to awaken every 90 minutes as you go through the sleep cycle. Young people do not normally notice the awakenings, however, as we get older (I just always enjoy that phrase), you may realize that you are awake. Doctor told me to just tell myself that this is normal and try to go back to sleep. Do not let your mind start working....easier said than done. You may have to develop little tricks to quiet your mind - I try to say the states in my head, if I am going back to sleep I usually do not make it to Massachusetts.

While keeping your log looking at the clock is necessary. If you have a watch that is backlit that is a good option.
Do not look at the clock unless you are totally awake - turn the clock around so you are not a clock watcher. If you have been in bed 20 minutes and are still awake, get out of bed and move into another room. Do something that could make you drowsy - do not watch TV. It will give you the time. Read, listen to music, do not eat EVER, only small sips of water if you are really thirsty, knit, count tiles on the floor, whatever. When you feel drowsy, go back to bed and try again. Repeat this process as many times as necessary. We are trying to retrain our minds and bodies....it will take a while! Do not read an intriguing book, you will not relax and go to sleep. Remember, boredom is the key here!

2. Rise at the same time everyday - whether you have slept or not. Choose the time that you want to be up and set your alarm and then get up! Your bedtime is not as important. It can vary. I set my alarm for 7:30 - have not made it yet. When you get up, grab your coffe, tea, water whatever and go outside in BRIGHT SUNLIGHT. Do not wear a hat or dark glasses. You want the bright sun to be full in your face and eyes. Please remember your sunscreen. You need an hour of bright sunlight - I have to wait until 8:15 for the sun to come over the mountain in the east. Please consider the heat. This time of year, in the summer heat, you may only be able to stay out for 15 minutes. I am in Tennessee and have done 30 minutes every morning, then I really get uncomfortably warm. The rest of the day, when you go outside, wear dark glasses and a hat with a brim. This step is to attempt to reset your circadian rhythm. Natural sunlight is best but if you live somewhere that this is not possible, then you will need to purchase a broad spectrum lamp to use instead.

Try not to nap. If you get drowsy during the day, MOVE. Do something that gets you moving and gets rid of the drowsiness. If you are totally exhausted, to the point that you cannot function, you may take a nap BEFORE 3PM. Set an alarm, do not sleep more than 30 minutes.

Get ready for bed at least 45 minutes before your actual bedtime. Get your cpap ready to go, nightwear, bathe, whatever you normally do; then sit somewhere other than the bedroom and do something relaxing. I repeat, RELAXING! Paying bills, video games etc are not considered relaxing. Think of something that was making you drowsy during the day and try it. Watching the news is not relaxing, generally, neither is the newspaper.

I have already been diagnosed with Primary Insomnia. This means that I have had it all my life and was born with it. They do not know the cause or the cure. Sleep meds will not help - I learned this already. None of them help. The program the doctor is taking me through is to help alleviate some of the symptoms and attempt to get several hours of uninterrupted sleep. This was all a surprise to me. I have complained for 30 years and all I was told was that I had a REM sleep disorder. I did not know that there was such a thing as Primary Insomnia. I also have "severely broken sleep architecture". Which means I basically stay in stage 1 and 2, no stage 3, 4 REM. I have been working at this since Tuesday and will keep following these steps until I see the doctor again in July. Sorry it was so long but I wanted to convey as much information as possible! Happy Sleeping!

Insomnia.... Oh how I dread my visit w/ the doctor.

Thanks so much 4 your reply! I can't go back to my sleep doctor until I've used my CPAP for 8 wks. My how long that 8 weeks is looking.

As far as the sleep architecture goes, I think i may be in the same group as you. My sleep study with CPAP showed absolutely NO sleep in Stage 4. Yep, I had 1, 2, and 3, but no 4. Wierd, but I don't exactly know what it means.

Keep us updated and hope you find something that works. Everyone here knows how bad insomnia sucks, and how much worse it is with its sleeping buddy APNEA involved.

-- Cory

Great post, 2listless. Not too long at all. The info about waking up every 90 mins was pricelss - I've just started noticing it recently... I must be growing older... ...oh well, I've been doing that since the day I was born.
Brilliant idea, those cotton balls!
I copied your post to a special file. I hope you start feeling the difference.
O.

I've suffered from no stage 3/4 sleep as well. They tried putting me on Gabitril which had to be taken with supper no later than 7 p.m. I only got 5% stage 3 no stage 4. So I was switched to Neurontin. No help at all. Right now I'm on Xyrex which I take at bedtime and then again about 2 1/2 to 4 hours later. I know I'm getting those 3/4s now because I finally have energy to do things, and I'm finally losing weight after 6 months on APAP. My cortisol levels have got to be plummeting because my belly was like deflated, comparatively, even the first morning after starting Xyrem. I've been on it about 2 weeks now and have lost 5 pounds. And I'm not really watching my diet that much. Have pancakes a few mornings a week for breakfast, even a donut several times a week and other sweets. And I'm still losing. I usually eat a medium size lunch and then have only a cup of yogurt for supper or maybe a bowl of sugar free/fat free instant pudding with or instead of. But I was doing that even before the Xyrex, well not the pancakes and sweets, and was just maintaining my weight.

WOW!

Great post on insomnia, 2listless!!!

One additional thing that you almost said, is that you should not do anything other than sleep - well, with one exception - in the bedroom. No TV, no computer, no library, etc. Keep all those "activity vibrations" outside of the bedroom.

Just out of curiosity, were you a premie? You know that many people who were born prematurely have ADD, presumably from all of the lights and machinery and the high activity level of the nursery immediately after they were born. Just wondering whether this could be an added factor here?

Me? I have never had trouble falling asleep... but I keep waking up, due to pain, RLS, underventilation, etc.....

Every 90 minutes, huh? That "as we get older" could apply to any age because we are always getting older!

- JB

Well, I have knowledge of three people, myself, my father and my son who all have ADD or ADHD, and none of us were premies. My son had it at birth! Never slept more than 2 hours at a time, was crawling at 4 months! Never still a minute right from the get go. I am sure I had ADD in grade school from my own memories and matching the symptoms. I'm sure my father has it too, although he won't admit it, again just from seeing the symptoms.

And ADD is very hereditary. It is also very prevalent in the US compared to other countries. but I have my own theory on that. People with ADD were the original settlers, because they couldn't hold a job in the original country, couldn't stand living in one place more than a few years, got bored with what they were doing and basically had the old ADD itchy feet syndrome. And that is how our country was settled from sea to sea. And since most of those with this condition left their homelands, there weren't many left behind. Hey, works for me.

Wow, what an explanation of Americans. ROFL!
O.

Very nice post 2listess.
Insomnia is very close to my heart as I have been struggling with it for the past 20 years. I also suffer from a condition called Delayed Sleep Phase Syndrome. My sleep/wake cycle is later that normal (3-11 am). I knew something is wrong, but the "good" doctors treated me with sleeping pills.
I was formally diagnosed with OSA and DSPS 2 years ago after a sleep test. I find all the steps you mentioned very useful. I need to get the diary going though.
Let me also mention that exercise is very improtant. It should also be done in the morning or early afternoon, so it does not make you too hyper for sleep time. My favorite is swimming. It also makes me relaxed. A brisk walk is also great.
I hate taking sleeping pills, but I have been doing so for so long. God knows what the psychological affetcs have been long term

In response to all of the above:

No, not a preemie but was only 5 pounds at birth. Definitely not ADD. I worked in Special Ed for many years so I know ADD.

Yes, I did forget to post that the bedroom is only to be used for sleep and SEX. Evidently, Sleep Doctors are not very adventurous!

And Yes, always excercise but not within 4 hours of bedtime. This means that if you go to bed at 10PM, your excercise session should be DONE by 6PM.

This doctor provided me with so much information that it was difficult to remember it all. I even took notes but could not READ some of my scribbles!

Thanks for the input and reminders!

Interesting post that the spammers hit.

Sorry I didn't realise this was a spammer ressurection, but I learnt some good info from it.

Peter

me too... that's why I commented on it before