Sleepless Nights

 

As I think I have mentioned before, I have really struggled with insomnia since moving to Humboldt County. I don't have the "onset" insomnia (i.e. difficulty falling asleep) that some people have (falling asleep is NO problem, as evidenced by these pictures...); rather, I have "maintenance" insomnia, which means I can't stay asleep. I wake up about 4-5 times in an average night and have probably slept through the night about three times in eight months. Granted, I'm usually able to turn over and fall right back to sleep, even after getting up to use the bathroom, but it still makes for very interrupted sleep, and I don't usually feel rested during the day, leading to exhaustion the next day, and inability to stay up past 9 or 10 pm.

Pep's preferred sleep position!

(yes, she really sleeps like this!)

I must say that I have newfound sympathy for patients of mine who come in complaining of insomnia and requesting treatment.  I used to think that benzodiazepines and Ambien were the devil, but now I'm not so sure; however, I have never tried either. One lady told me that she hasn't slept through the night in over 20 years, ever since she was militant about waking to breastfeed her under-weight newborn every 2 hours. I can see why people become desperate from not sleeping.

I'm not sure the "cause" of my insomnia. Sleeping through the night has never been a problem for me, before this year. Maybe it is sharing a bed? (a few friends have suggested getting a larger, i.e. queen- or king-sized bed). Maybe it is actually not being sleep deprived every day from 30-hour calls of residency?

My first recommendations for patients with concerns about their sleep include optimizing "sleep hygiene," which includes the following:

- Sleep as long as necessary to feel rested (usually 7 to 8 hours for adults) and then get out of bed (after residency, this is actually possible)
- Maintain a regular sleep schedule (nearly impossible for me due to being on call)
- Try not to force sleep-- if you are not sleepy, get up and do something else that is not super-productive until you are drowsy (not a problem)
- Adjust the bedroom environment as needed to decrease stimuli (eg, reduce ambient light, turn off the television or radio)
- Resolve concerns or worries before bedtime (not an issue)
- Exercise regularly for at least 20 minutes, preferably more than four to five hours prior to bedtime (easily done)
- Avoid daytime naps, especially if they are longer than 20 to 30 minutes or occur late in the day (who has time for naps?!)
- Only use the bed for sleep and sex; avoid watching TV or reading in bed (I am kind of guilty here... I like to read in bed)
-  Avoid using the computer, phones, or other electronic devices before bedtime as these can stimulate the brain (I could be better about this one)

afternoon nap time (a no-no, I know)

Avoid caffeinated beverages after lunch (hard for me to do esp when I'm so fatigued)
Avoid sugar, as highs/lows can cause un-restful sleep (sugar is a weakness of mine)
Avoid alcohol near bedtime (eg, late afternoon and evening)- (actually, I sleep pretty soundly after a glass of wine!)
Avoid smoking or other nicotine intake, particularly during the evening
Try to increase foods rich in magnesium (which is a natural sedative), like legumes and seeds, dark leafy green vegetables, wheat bran, almonds, cashews, blackstrap molasses, brewer's yeast, and whole grains.

While there are a few things I could improve, I really try to do most of the above. I have tried restricting liquids after dinner as sometimes having to go to the bathroom annoys me in the middle of the night. I try sleep-depriving myself, i.e. forcing myself to stay awake until 11 or later, so as to try to prevent the awakenings which often start as early as midnight or 1 a.m. I have tried the occasional benadryl but I don't really like taking meds. I have done some "herbal" research, finding that valerian, melatonin, chamomile, and lavender all have soothing, sleep-promoting qualities.

I bought some melatonin from Costco but am afraid to take it when I'm on call. I recently visited the local herb store, Moonrise Herbs (great resource for "natural" remedies), in Arcata for some suggestions, and came away with a sleepy-time tea (with chamomile and other herbs) as well as lavender essential oil, which I place on my wrists prior to bed. I swear this has helped with sleep quality; it also helped me fall asleep after getting back from a late-night c-section, which often leaves me wired and restless.  K worries I'm going to become one of those organic, herby hippies who don't bathe or shave, and refuse to vaccinate their (future) kids, but he is wrong. I just want to sleep!

Lavender flowers

So let it be said that, when something works, you want to stick with it. I'm now slightly obsessed with lavender-- check out my assortment of scented beads, fabric spray, scent diffuser, dried herbs in sachets (with the mini bottle of essential oil in the middle).  I'm already getting drowsy..... :)

Please let me know any other sleep suggestions you may have!