Ask HN: how did you fix problems with bad sleep?

https://news.ycombinator.com/item?id=205153

by Tichy • 18 years ago

26 55 18 years ago

news.ycombinator.com

I am exhausted most of the time, because I never sleep well. Doctor diagnosed "restless legs syndrome" and wants to give me pills, but I wonder if there are any other things to try? Just interested in any stories of how people fixed their problems with bad sleep.

SwellJoe• 18 years ago

Exercise is a cure for many things, including poor sleep. Take a brisk walk in the afternoon. 20-30 minutes is fine. It's not guaranteed, I guess, but it always works for me.

Also, if you're a coffee, tea or soda drinker, switch off to herbal tea or plain water after lunch. Caffeine has a 6-8 hour period of effect, with the peak effect happening at about the 4 hour mark. If you do drink things with caffeine, consider reducing or cutting them out entirely. I can drink 2-3 cups of green tea in moderation without any adverse effects, but more than one cup of black tea is too much (and one isn't quite enough, so I don't drink black tea). Coffee and sodas aren't worth it, to me, as the caffeine in coffee is a jittery spike and all the sugar in sodas makes me sleepy by lunch time (which totally throws off getting to sleep when I actually want to at night).

LogicHoleFlaw4• 18 years ago

Basic sleep hygiene is a good starting point. Sleep on a consistent schedule 7 days a week. Use your bedroom only for sleeping. Don't read, work, or study there. Avoid eating right before bedtime. Get away from bright lights, emissive display devices, and loud noises for about an hour before you go to bed. Exercise is great too, but not right before bedtime. Do note that once you start using this routine it may take 4 to 6 weeks to really see the benefits.

SwellJoe's comments on caffeine and sugar are true. My doctor told me that caffeine has about a 10-hour half-life. After noon it's generally something I avoid.

If you try these things (or at least a good portion of them) and you don't see any improvement it's time to start looking at health conditions rather than merely poor habits. Sleep apnea is a major cause of chronic exhaustion. Restless Leg Sydrome is another. With both of these you are constantly waking up during the night and never attain the deep sleep needed to rest.

My father had sleep apnea - when he did an overnight EEG sleep study the doctors determined that he was waking up over 80 times an hour due to airway blockage. He started using a CPAP about two years ago. The CPAP is a face mask which generates positive air pressure to keep airways open. The difference was dramatic. He's much more energetic, much less grumpy, and has in general been much happier since he started using it.

I personally had awful sleep for years. I was perpetually exhausted. The only way I was able to sleep was to stay awake for 24 to 36 hours and then pass out for 12 to 18 hours. I was miserable. I finally broke down my pride and went to see a sleep specialist. I implemented the sleep hygiene strategies and saw slight improvements but no major gains. I didn't have RLS or apnea, so the possible suspects were narrowing down. On a long shot we decided to try a medication called Rozerem. It's a synthesized melatonin available as a prescription. In most people the pineal gland regulates the sleep/wake cycle via the production of melatonin. As it turns out I have extremely low melatonin production, so my body never got the signal to shut down and sleep. With the introduction of melatonin in pill form about an hour before bed I was actually able to get a good night's rest. The difference was astounding. I had forgotten what being rested even felt like. Interestingly the melatonin had an immediate dramatic effect on me. It doesn't force drowsiness like a sedative does. It allows me to feel sleepy (rather than just tired or exhausted). Rozerem won't do anything for someone with normal melatonin production however. Past a certain level the body just metabolizes the extra melatonin and it is neutralized. For the same reason increasing the dosage of the medication won't have any effect.

For me the combination of improved sleep hygiene and the synthesized melatonin made a dramatic difference in my quality of life. Treating my father's sleep problems made him a much happier individual. If your doctor thinks that a medication for RLS will help you attain better sleep, I highly recommend that you at least try his suggestions. There is no substitute for being well-rested and you owe it to yourself to find out what will allow you to gain a good night's sleep.

rms3• 18 years ago

Did you ever try regular melatonin?

LogicHoleFlaw4• 18 years ago

I did not. I would if I did not have easy access to the Rozerem. Over-the-counter melatonin is not regulated by the FDA and is of wildly varying quality. The advantage of the synthesized capsule is that the dosage is consistent and effective.

deathbyzen• 18 years ago

I would avoid melatonin as regular use can disrupt the natural release of it in the body, i.e. take too many pills and your body stops producing can stop producing it permanently.

Source: My cousin... he's a nurse, so maybe take my advice with a grain of salt.

gizmo• 18 years ago

There's no way coffee has a 10 hour half-life if you're healthy. Unless you're pregnant. See wikipedia or other sources.

iamelgringo2• 18 years ago

It's what his sleep specialist told him, and it's what my sleep MD told me as well. I'd certainly believe what an MD with 12-15 years of education/residency says over wikipedia.

People can build up a tolerance to caffeine by saturating the receptors in the brain that are activated by caffeine. So, after month of daily ingestion, some people can drink 4-8 cups of coffee a day and not have any problems. In this case, it's especially true that your mileage may vary greatly.

I used to be a caffeine fiend. But, when I started having sleep problems, I had to completely quit caffeine, and it does help. I could drink 2-3 triple espresso's in an all-nighter and then sleep like a baby when I was in college. Now, I drink 1/2 a cup of coffee and I'm buzzed for hours, and I don't sleep well that night.

prakash• 18 years ago

www.supermemo.com/articles/sleep.htm -- read this.

eru2• 18 years ago

That boring? ;)

Edit: Actually the linked article seems quite interesting.

mattmaroon• 18 years ago

Oh man, not the jimmy legs.

http://www.thedailyshow.com/video/index.jhtml?videoId=147536...

Just don't start gambling.

Tichy4• 18 years ago

That link crashes my browser, any other sources?

ComputerGuru• 18 years ago

I love how you assume we've "fixed" that problem :)

More seriously though, I suffer from the same problem. My issue is that I can't clear my mind - so I'm lying in bed and actively thinking (verses "passively" letting my mind wander) about people, events, projects, etc. until I get bored and get back up.

My only solution (more of a workaround) is to just do the same as LogicHole: stay awake for 36 hours - you'll force your body to go to sleep thereafter.

arthurk• 18 years ago

Same problem here. I try not to think about the past or the future too much because you can't change or predict it anyway.

jsmcgd• 18 years ago

I sometimes cannot sleep because I can't stop thinking about things. For me the cure is reading fiction. I can't recommend it enough. It totally clears my mind of everything that excites/agitates/stresses. Non fiction won't do and can actually make it worse. Fiction!

Tichy4• 18 years ago

I always need a good book around for getting to sleep. It makes me nervous if I don't have one.

Of course one of the sleep hygiene rules is to not do anything other than sleep in bed, but I think there has to be an exception for reading.

sutro• 18 years ago

Alcohol. To quote Homer Simpson, it is the cause of and solution to all of life's problems.

pixpop• 18 years ago

Alcohol generally worsens RLS. It also makes apnea much worse. Most sleeping pills also make apnea worse. The one I've found that doesn't is Trazadone, and it seems to keep working indefinitely. The pills (e.g. Mirapex) for RLS do work, but make me nauseated every night.

gruseom3• 18 years ago

Alcohol induces wakefulness in the second half of sleep, so this is a bad idea. (There are many sources on this. I found http://alcoholism.about.com/cs/alerts/l/blnaa41.htm in a quick search.)

rokhayakebe2• 18 years ago

Start working out and you will sleep well whether you want it or don't. Guaranteed.

Tichy4• 18 years ago

The problem with working out is that I am frequently too exhausted to do it. I do sports, but something on a regular basis in general was impossible to me so far.

rokhayakebe2• 18 years ago

Tylenol PM

m0nty2• 18 years ago

I had a tough time sleeping last year, mainly caused by anxiety about work, and the onset of mild asthma which caused me to wheeze as I fell asleep. The wheezing would wake me up, and the anxiety would keep me awake. Incidentally, it took me four doctors to get this point across: I told them my son has asthma, so does my mother, and I have hay-fever, so maybe I had asthma too? Finally, sure enough, it was diagnosed and I was given an inhaler which fixes the symptoms. My point being - whatever your doctor says, (s)he could be wrong, and your problem might lie elsewhere.

Anyway, during the three months or so of bad sleep, I often went for several days (the record being from Thursday until Sunday, ie 4 nights) without sleeping. That puts you in a strange state of mind, believe me. My first, regular doctor told me that I shouldn't worry about the sleep, since after a night I'd be so tired I could sleep through anything. Riiiight. Another doctor finally gave me sleeping pills, which were great - she even said she used them herself quite often. The only problem was getting off the pills after a few weeks, since they're addictive and coming off them causes anxiety and sleeplessness, which seems a bit circular and counter-productive...

Anyway, the lessons learned, the hard way:

* Doctors are fallible and overworked, just like everyone else.

* Alcohol is not the answer. I tried. Sleeping alcohol off is not the same as a good night's sleep, and you'll damage yourself in other ways by over-imbibing.

* Tea is better than coffee. I have one strong, tasty cup of real coffee per day (in the morning) then drink tea. I know many non-Brits complain that tea is a watery, flavourless drink, so I would refer you to George Orwell, who knew a thing or two about making a tasty cuppa: http://www.booksatoz.com/witsend/tea/orwell.htm

* If you are anxious about work, relationships, money, your big project, whatever - deal with that. It's quite possibly the true cause of whatever's troubling you. Find ways to relax, especially socialising, exercising, etc.

* Work out for half an hour each day. I do this and the endorphine rush is fantastic. I don't even work out particularly hard - I'm sweaty but not nauseous by the time I've finished. You'll look better, feel better, and probably sleep better too. I use a rower and a bike machine, so I can watch a DVD or listen to music if it gets boring.

* Most of the crap about relaxation exercises ("tense up your toes, then relax, tense up your legs and relax", etc) is just that - utter crap which probably won't help at all.

HTH. Don't just think about the immediate problem. Look for underlying causes and try your best to deal with those. And good luck.

euccastro• 18 years ago

Actually, alcohol has an enervating bounce effect that kicks in a few hours after intake.

m0nty2• 18 years ago

Also followed by a depressant effect which can last for days. So overall, alcohol only "works" in the short term, after which it's all downhill.

luckystrike• 18 years ago

As others have mentioned, regular physical workout helps one get in to a good sleep schedule (apart from it's various other benefits). e.g. an hour in the gym in the morning, makes me hit the bed at a very consistent time every night.

truebosko• 18 years ago

I try to keep a regular schedule and if I can't get sleepy I read a book. Reading puts me RIGHT to sleep.

Note that reading things online (RSS Feeds, Twitter, whatever) do NOT work :) They'll probably keep you more awake. Grab a good, or boring novel if that's your schtik and read it for 20 min while in bed. Puts me right to sleep on the days I can't get tired (Or just have sex that works too)

gms• 18 years ago

Earplugs

eru2• 18 years ago

They really help with some problems - especially snoring room mates. But they are not a cure-all.

gruseom3• 18 years ago

I know of two things that help. One is exercise, which lots of people have mentioned here. The other is meditation. My brother-in-law suffered badly from insomnia for years and says it made the biggest difference out of all the things he tried.

Xlp-Thlplylp• 18 years ago

I have chronic insomnia. Now that I'm walking home from work (about 35 blocks), I feel even better, and my insomnia is worse. I tried resetting my circadian rhythm by not eating 16 hours before going to bed: even worse insomnia. Anything I do to control my insomnia exacerbates it.

gruseom3• 18 years ago

That sounds hard, and I'm sorry to hear it. If your point is that your experience contradicts my statement, I agree. Had I run the "comment" command with the -v option, it might have taken the following more accurate form: "I know of two things that have helped me sleep better, although I didn't have insomnia to begin with; somebody else I know who does, reports that both helped him too, but of course it doesn't mean they'll help you, but they might be worth trying."

aravindmc• 18 years ago

It looks like there is some research leading to fixing sleeping problems by simply changing your eating habits. I dont personally know how easy it is to implement these ideas.

http://parentingsquad.com/easy-way-to-reset-your-sleep-cycle...

http://www.news-medical.net/?id=32333

calvins• 18 years ago

I sleep much better since getting a white noise machine that I have on overnight. I use the Marpac 980, which I'm very happy with: http://www.marpac.com/sound_cond.asp

I got mine from Amazon for $50.

khafra• 18 years ago

Eugeroics. Use adrafinil when you need to be awake and alert, let the sleep take care of itself.

icey• 18 years ago

Nothing has improved my ability to sleep more than quitting smoking and quitting or severely limiting my caffeine intake.

chriskelley• 18 years ago

When my girlfriend has problems (studying for the bar... talk about anxiety) I will make her play cards with me for 30-45min or we'll both read our books awhile. As others have mentioned, the key for some is to clear an anxious mind from the days activities before you try to sleep. It would be nice if our bodies has a switch, but until then...

redsymbol• 18 years ago

Hello! I used to have a lot of problems with sleep myself. In fact, there was a period of time where I would take Nyquil to force myself to sleep, because it causes drowsiness as a side effect. Obviously this is not recommended :)

I now have a pretty high quality of sleep without the assistance of any drug, and have for several years. I believe that in my case, most of the change can be attributed to making a regular habit of meditation and exercise.

When I say "meditation", please interpret that broadly as any activity that might be considered meditative. There are many forms that people describe as "meditation" that can help. In addition, I'd put activities such as yoga, qigong and taichi in this category. I practiced many of them at least a little and believe they all contributed.

As for exercise, I mostly did weight training, combined on and off with martial arts practice. I did not do much pure aerobic exercise, but that is only because I personally had a lot of difficulty with it and really did not enjoy it - I think if I had persisted and only done aerobics (walking, running, swimming, etc.) it would have had the same end result of improving my quality of sleep. I don't think you have to do it every day - so long as it's regular, like 30 minutes three times a week, that would be enough to notice the effect.

Finally, one other thing you might try: wear earplugs and a blindfold when you lie down to sleep. This may or may not help you get to sleep, but it's likely to help you stay asleep once you do drift off :) I find that an empty pillowcase makes an outstanding blindfold - fold it a few times around its long diagonal axis, then cover your eyes and tie its ends loosely at the back of your head. Very comfortable and blocks out the light well.

This is what helped me. I really don't know if these will help you - I hope you do discover what works well for you. Good luck!

-Aaron

rms3• 18 years ago

You can get an SNP test for restless legs syndrome if you want to find out if you have a related genetic mutation

Also, and this is definitely not medical advice, anti-depressants might work but they also sometimes cause restless legs syndrome. Restless legs syndrome pills have gotta be under international copyright, but if you're personally comfortable going on happy pills with the knowledge that you need to carefully withdraw from them over 30 days that could also fix all of your sleep issues much cheaper than restless legs pills.

JFred2• 18 years ago

Some people do better without caffeine. There is also a condition called Mononucleosis that can cause fatigue, as well as other conditions. Lots of things from vitamin deficiencies to cancer can cause fatigue.

If you look up the pill on the web you can get information but they tend to list any side effect ever seen. Check out the list of problems with Tylenol and you'll see the kind of CYA exaggeration I'm talking about.

I've never heard of any treatment for restless leg syndrome beside the medicine.

ephextom• 18 years ago

I can't imagine cavemen having problems like "restless legs syndrome", and they managed to get by pretty well without CPAP machines too. The causes of these types of things can generally be found in modern diet and lifestyle factors.

The most effective things I've found in improving sleep and general wellbeing are:

- giving up caffeine;

- reducing anxiety and stress generally particularly before bed.... don't work long hours or work right up till bedtime as you can be running on adrenaline which is terrible for sleep and mental health.

- avoid diet drinks and anything containing artificial sweetener (http://www.google.com/search?q=aspartame) ... I only recently discovered how terrible this stuff is, and giving it up has done wonders for my wellbeing.

- If you snore, have sleep apnoea or any other respiratory condition, look into natural remedies like Buteyko or Pranayama... CPAP machines can help you get better sleep but are counter-productive in the long term as they reinforce your habit of hyperventilation.

- Consider seeing an osteopath or similar type of physical therapist to straighten out your skeleton and attend to any muscle tension you have - most people, particularly desk-based workers - have lots of tension which restricts blood flow, contributes to stress and reduces quality of sleep.

- Regular exercise is great but be careful if you are already prone to anxiety, as over-exercising can push you into depression (this is counter to what most people understand about exercise & depression)

- Consider detoxing and liver cleansing - I've undertaken the lemon detox ("master cleanse") about every 6 months for the last year or two, and found it's done wonders for muscle tension, quality of sleep, digestion and mental health.

Some of these points - in particular the last one - are very contentious and frequently under attack from skeptics, usually who are practitioners of conventional medicine, vendors of costly commercial solutions like CPAP machines, or professional skeptics like Skepdic, which whilst often valuable, is often skeptical about things purely because they are unconventional.

Whilst I don't have any problems with conventional medicine, it generally focuses treating symptoms of clear-cut diagnosable illnesses, and is not particularly good at addressing the vague lifestyle-related conditions like fatigue, poor sleep, anxiety, muscle tension, digestion etc.

These types of conditions can generally be overcome by understanding the fundamentals of the way the body works, and doing everything you can to help your body to work as it was designed.

It's not easy, the world of "natural medicine" is a dangerous place but my experience is that with persistence, a willingness to experiment, and a healthy level of skepticism, it has much to offer to improve your life greatly.

Some helpful links:

http://www.kuro5hin.org/story/2005/5/9/83936/58483 http://www.kuro5hin.org/story/2005/5/16/81428/8007 (I know you didn't mention any issues with depression, but quality of sleep is closely related to anxiety and depression, and can be a warning sign, and many of the same principles apply in overcoming the problem.)

http://www.buteyko.com/ - if you have breathing/snoring problems.

JFred2• 18 years ago

You'll also want to look at this recent NYT article on fatigue: http://health.nytimes.com/ref/health/healthguide/esn-chronic...

Andys• 18 years ago

I had restless legs syndrome. My (herbalist) wife diagnosed it as a magnesium deficiency. There are a variety of reasons why habitants of western society can be magnesium deficient, which I don't have time to go into here.

Rather than waste time with potentially ineffective dietary supplements, the easiest way to get more magnesium is with a bath of Epsom Salts, which is actually just magnesium phosphate. Run a very hot bath with two cups of epsom salts diluted in it, and plenty of it gets absorbed through your skin.

The first day I tried this, I had the best night's sleep in years!

So in my case, I think her diagnosis was correct, and I took the baths every second night until I felt completely better and my sleeping patterns were back to normal. (My coding concentration improved too.)

ps. If you don't have a full-sized bath tub you can use a bucket and just bathe your feet, though I imagine you won't absorb as much this way. Just make it hot.

Tichy4• 18 years ago

Interesting. My family physician also wasn't happy about the restless legs diagnosis from the sleep lab and first wants to test Magnesium and Vitamin B (I went to the sleep lab of my own accord, it was not her recommendation).

agentbleu• 18 years ago

also try monitoring your body temperature, especailly head and feet (socks and a hat), this can also help.

Ask HN: how did you fix problems with bad sleep?

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