(Note: I will be mentioning my experiences with medications in this article. I am not a doctor and I am not your doctor. I am only speaking about what happened to me. Don’t use my experiences to medicate your own body!)
You know the old string of advice you get when you tell a doctor (or Dr Google) that you can’t sleep: no blue light, read a book, no caffeine–not even chocolate–or nicotine or alcohol before bed, exercise but not too late in the day, make it dark, make the temperature right, keep a journal to hold all the stressful thoughts so they don’t follow you to bed.
Most of these tips never worked for me. Why?
Well, for one thing, I never actually did them right. I never gave most of them the real try they deserved. I’ll talk later in this article about what happened when I finally did.
I’ve had trouble sleeping ever since I can remember. I’ve finally figured out the problem, I think; but I’d like to share some of the journey it took to get to my current solutions–which are still not perfect–because maybe you’ve had a similar trip, and maybe mine will help you figure yours out.
Let’s start here. This is the main thing that has kept me from sleeping since I was very, very small. I remember having to invent games with my stuffed animals that involved moving my legs–holding them up, raising them against a wall, whatever–until they wore out enough to quiet down and let me sleep.
If you have RLS, you’re nodding. If you don’t, you’re wondering why I couldn’t just put my legs down and go to sleep; you’re thinking a little girl probably just wanted to play instead of rest. Well, everyone in the 90s agreed with you, latter person. I remember going to my mom and telling her, my legs hurt and I can’t sleep. And she–half-asleep herself–said, go to sleep and you won’t feel it. And I tried!
Even now, RLS is not well understood. We’re just not sure what causes it in some cases. It might be a problem with your nerves, with your brain, with your iron levels, with other micronutrient levels.
We’re not even sure how to test for it correctly. When I was a kid, I was tested, but they were only looking for a specific movement of the foot, and since I moved my legs differently, due to having come up with my own coping mechanisms over the years, I didn’t get the diagnosis. Twenty or so years later, I got tested again, as part of a polysomnography to see how my overall sleep was. Even though I woke up twice with my legs caught in the wires, they said I didn’t have restless legs. My iron levels are great. Eventually I had to have my husband come in with me to verify my subjective experience, by saying he knows I move my legs at night. (Misogyny and being brushed off by doctors is a subject for another post.)
We have no idea how to treat RLS. I’m very lucky that the first medication they threw at me, Mirapex, worked; but for many people it does nothing, or has unbearable side effects. A lot of us have to turn to home remedies, such as sleeping meds that override the movement impulse, massage, and just plain moving ‘em until they wear out. I found, shortly before I found the medication that worked, that a weighted blanket, folded so all the weight was on my legs, was a big help. It still is, on days where the Mirapex doesn’t get the whole thing.
The fact that Mirapex worked for me means that my particular case of RLS is caused by a problem with dopamine in my brain.
Yeah, dopamine again! I know we just talked about this. By now you might realize that my brain is, shall we say, not good at handling it. It does so many things, though, and in so many different parts of the brain and body, that you’re going to be hearing about it again.
Meds That Didn’t Work
So, speaking of dopamine, the other reason I’m bad at sleeping is that my brain does not stop thinking. Turns out, if you’re in the early 2000s and you say “I can’t sleep because my brain won’t be quiet” to a (harried, extremely overworked) psychiatrist, she views that as a psychotic disorder and prescribes Seroquel. This isn’t a correct diagnosis; in a psychotic disorder, the thoughts may race or be very “loud,” and often have disturbing content. Mine don’t. Mine are just normal daytime thoughts that never get quiet and dim and eventually soften into sleep, the way they do in the mind of someone who can sleep on command (like my husband, the lucky jerk).
Now, the title of this section is misleading, because Seroquel does work. It kept me asleep clear through the next morning. Which meant clear through my first three classes every day. Which counts as “unbearable,” so I eventually stopped taking it, and stopped seeing that doctor.
And it didn’t help the other “mental problems” that it was prescribed for. That’s because it works on dopamine but in the wrong direction: My brain, or certain parts of it, have too little. Schizophrenia and psychotic disorders mean your dopamine system is overactive.
But hey, it did make me sleep.
To round out the list of meds that didn’t work: Benadryl (diphenhydramine) and Trazodone both worked well until they suddenly stopped working. They both started to have a paradoxical effect, where I would get extremely light sleep with many awakenings, a lot like one sleeps after being drunk. No one seems really sure why diphenhydramine or Trazodone stop working after a while, but it’s not uncommon; most people just put it down to “building a tolerance.” Nyquil completely stopped working after they changed their formula a few years ago, but that was true for almost everyone.
I went to my doctor–which is my main advice, by the way, if you take nothing else from this article, please go to your doctor if you need help sleeping and nothing is working–and she, being a good doc who listens to me, switched me from Trazodone to amitriptyline, which does work. For now.
Drinking, by the way, disrupts your circadian rhythm because it reduces melatonin production. And what’s the flip side of melatonin reduction? Dopamine. I drink very rarely, but when I do, these effects are very easy to see. If you drink and you also sleep lightly, those facts might be connected.
I also used to take cyclobenzaprine, a muscle relaxer, at night. This is because I get tension headaches almost every day if I don’t. Did you know that excess muscle tension is prevalent among people with ADHD? (Spoiler: It’s Dopamine.) Anyway, I finally found a yoga routine (link) that worked to keep my shoulders relaxed most of the time, and now I only take cyclobenzaprine as needed, when a headache gets bad. It puts me to sleep after a few hours, but if I took it more often, it wouldn’t do that as reliably.
A Brain That Just Don’t Quit
Let’s go back to the main reasons I don’t sleep again: RLS and thoughts that just keep going.
One of the tips that doctors will give you is to keep a journal. They think that the thoughts that don’t stop are actually depressive or stressed rumination. And hey, maybe yours are, I don’t know, I’m not listening to them. If yours are, there are a lot of ways to help you out of that spiral.
Mine aren’t, though. Like I said above, they’re just regular daytime thoughts. Maybe they’re a repeating song stuck in my head, but that’s not rumination. That’s a malfunction. Journaling isn’t the solution. Writing down the first verse of Chvrches’s “The Mother We Share” twenty times isn’t going to get it to stop repeating in my head. CBT’s method of identifying and arguing with the thought is also not going to help. And when the thoughts aren’t glitchy repetition, when they’re just thoughts about nothing in particular, CBT and journaling aren’t going to put those to rest, either.
There is also a phenomenon called Delayed Sleep Phase Disorder. This is where your body clock is just set a few hours off of a normal, daylight-influenced circadian rhythm. You naturally stay up a little later than everyone else, and then you get a normal amount of sleep and get up a little later than everyone else. The problem is that everyone else is setting your work or school schedule, so you have to force yourself to go to bed and get up before you’d like to. Imagine if a person with a typical circadian rhythm were forced to go to sleep at 5pm every day and wake up at 2am. They’d have gotten plenty of sleep but they’d feel gross, because it didn’t match with when their body wanted to sleep.
You might be thinking that you have this now. But I want you to try good sleep hygiene at a “normal” bedtime before you diagnose yourself. It might not be a rare disorder; you might just have plain old trouble sleeping.
Did you know that when people are put into a situation where diurnal rhythms can’t affect their sleep-wake cycle, it’s pretty common for them to fall into a cycle that is slightly longer than 24 hours? Somehow we didn’t evolve to match perfectly to the cycles of this planet, and it’s really screwing some of us up!
So what do we do?
Well, here’s where I’m going to tell you the secret, and you’re gonna be mad. All those tips? The temperature, the darkness, the routine? They work. Sorry!
Which Tips Work For Me
For a very long time, my husband and I had the TV on in our room while we were asleep. He has diabetes insipidus, a condition which makes him need to use the bathroom a lot sometimes, and he said he needed the TV on for light, so he could get to the bathroom. This is totally legit; I’m not trying to blame him or anything, he is human, with human eyes, and he does need light to see. Finally, I found a light that would work for a nightlight.
Then he said he couldn’t sleep without the noise of the TV. Makes sense; I’ve always slept with TV or music (or at one point the audiobook of The Silmarillion (link)–I always fell asleep before the Discord of Melkor!) to sleep, because my brain could follow it instead of generating its own thoughts all night. So we used music on my phone for a couple of weeks. And then for a couple of nights I forgot to turn it on. And he was fine, and I was fine. And now we both sleep better.
Isn’t that weird? We had both thought for so long that we “needed” certain conditions to sleep, and we were just different from everyone somnologists had ever studied. But we weren’t.
I also plug my phone in on his side of the bed most nights, which prevents me from sitting there and scrolling. We’ve already talked about how scrolling disrupts your sleep: there’s the continued action of your thumb; and the excitement, however minor, of the next post and the next like and the next reload of the page.
I use an ereader to read between turning the light out and falling asleep. But wait, you said blue light is bad! It might be, it might not be. Either way, it’s not a point to worry about if you use a Kindle Paperwhite or another e-ink reader. An e-ink screen doesn’t affect you the way a backlit screen does. Plus it’s grey and black and boring to look at, so the excitement and dopamine aren’t there. And for me, I only use it after dark, so it’s a very reliable signal to my brain that it’s bedtime.
Yeah, that’s another tip that really works: a bedtime routine. Make it a whole ritual, with brushing your teeth and putting on your jammies and turning out the lights and everything. It takes a while for it to take hold, but your brain is very easy to condition. You just have to remember that your brain is the dog and your intention is Pavlov. You’re in control. Don’t listen to the dog when it says the experiment isn’t working.
Hand in hand with a bedtime routine is another common tip: don’t do anything in bed except sleep (and, um, et cetera). If you’re living with your parents or otherwise in a limited space, or if you have a condition that keeps you in bed, that might really be the only place you can hang out all day. In which case, just skip this next part. If you can get out of your bed during the day, please try. For me, I just have a chair at the end of the bed where I sit and read and knit and stuff. It makes it such a mental shift when it’s bedtime to get out of the chair and get into bed.
Give It a Try!
So, to recap: your body and brain are probably just as weird as my body and brain. If you need meds to sleep, get them. If the meds you’re using aren’t right, get new ones. If your doctor isn’t helping you, get a new doctor (yes, that’s harder than just saying it, but you might need to try anyway). And in the meantime, help your meds along by at least trying some of the normal insomnia tips.
Your brain is a delicate, complex thing, and you can influence it more than you realize. Sleep is insanely important, and you need the correct amount for your body.
And if you found this article because you’re awake when you don’t want to be, and you’re scared you’ll never sleep again and you have work in a few hours, here’s my crisis tip: Relax. If you don’t sleep for one night, it’s okay. You get to try again tomorrow.
The secret is that the minute you stop being anxious and worrying, and tell yourself “Well, I guess maybe I’m just not sleeping tonight”, your chances of falling asleep in the next fifteen minutes go up by 80%. Trust me.
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