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Hi,
A little backup for those who don’t know my story (I’ve been on this forum for a while now, but it’s very dinamic). I have been suffering from insomnia my whole life. For the first 28 years I struggled to fall asleep, but once I did I slept fine. This was often tough, but ultimately manageable.
Now for the last 5 years it’s the other way around and it’s been killing me. I fall asleep easily, but wake up after roughly 5 hours and the sleep drive that I had built up during the day is no more. I tried all the usual tricks, getting up, changing beds, but all those things just add pressure on me to sleep. I maybe get a little sleepy, lie down, and my eyes are wide open again.
To make things A LOT worse, I can’t nap during the day, not even with the help of pills and not even on the days when I used to miss entire nights of sleep. During the day I’m exhausted, but certainly not sleepy. This is an enormous problem for me that not even many insomniacs fully understand. They think 5 hours a day is great, but believe me that when it happens EVERY DAY, without exception, and without a chance to take at least some of the edge off with a nap or a snooze like most do, then it’s pure torture. Don’t get me wrong, I’m not saying that all other kinds of insomnia (not getting enough deep sleep, sleeping a few hours a nught then crashing for a few hours during the day, etc.) aren’t torture, but so is this one. Imagine getting woken up 2-3 hours too early EVERY SINGLE DAY, no weekend sleep-ins, no naps, no nothing, and you’re only 32 and still have to work and socialize with a bunch of FULLY RESTED peers as well as students.So, to get to the point (sorry) – nighttime has always been my only chance to get enough sleep to feel good and function the next day, and for the past five years the system got broken. So, I started taking small doses of Valium to put me back under when I wake up. When that stopped working, I increased the dose. When that stopped working, I combined a little bit of Valium with a few sips of beer. Nothing too scary.
Now, for the past month or so it’s evolved into a full pill of Valium (5mg), sometimes even a bit more, combined with half a bottle of beer or a few good sips of some strong liquor, usually gin. Sometimes not even that works.
I know this stupid and foolish method can’t last forever and I am very worried, but I see no other way. Once my sleep drive leaves me and I wake up knowing that I had only slept for 3,4 or maximum 5 hours, I am forced to, in a way, anesthetise myself to get the extra couple of hours of sleep that I need.
Then, when I wake up again later (after this terrible method did its job), I think of how this was what killed MJ. This was how Heath Ledger, Marylin Monroe, Bruce Lee all died. Sure, I am using much smaller doses than they did, I assume, but it’s still a dangerous game.
When will this early awakening stop? What do I have to do to make it stop? Why is it happening in the first place?
I will never be able to nap, I am just not wired that way. Perhaps I’m neurotic like Woody Allen, I don’t know.
Therefore, what I have to do is find a safer way to prolong my nighttime sleep to at least 6, 6.5 hours, but I don’t see how. I don’t know what to do.
Sleep restriction, that last resort that helps people get their sleep in order, is slowly stopping to work for me. What else is left to do for a brain that is too focused on insomnia to just relax and fall back to sleep, a brain that has always struggled to fall asleep unless it accumulated a very high deal of sleep drive, that it now burns through too quickly.I am sorry for a lengthy post, and I thank everyone who takes the time to read it.
Edgar.
Hi. Sorry for not answering, hope you’re still here. I just lose hope in these forums, I feel most people here are in the lightweight sleep problems category, where I was some 10 years ago. I feel I am too far gone to be helped by a forum, but I still write since nobody in real life has ever had any sort of sleep problem, so people here can at least somewhat understand.
My sleep schedule is I go to bed around 23, fall asleep immediately, then wake up a few hours later, wide awake. I immediately take a little Valium and a few sips of whatever alcohol I have in the house, otherwise I don’t fall back to sleep.
Most nigths I have to do this once a night to get some 6-6.5 hours of sleep. Some nights I have to do it twice a night.
My final wake up time is around 6, 6:30.I don’t sleep in between (during the day).
My main concern is the fact that this thing is progressing, in a bad way. From no sleeping pills to 2.5 mg Valium, onto 5 mg Valium, now to 2.5 mg Valium + alcohol, once or twice per night. When will it end?
As you pointed out, after five hours of sleep, sleep pressure is diminished and this means that not only is sleep needed less but it can also be more difficult to fall back to sleep, especially if the arousal system is activated.
The arousal system is typically activated whenever we put pressure on ourselves to sleep, put effort into sleep, strive for sleep, or worry about sleep. When sleep drive is strong enough, it can overpower the arousal system. When sleep drive is low (for example after getting five hours of sleep), the arousal system can win and temporarily suppress sleep.
So, with all this in mind, we can see that your sleep drive system seems to be working as it should be — when it’s strong, at the start of the night, it’s able to overpower the arousal system and sleep occurs quite easily. When sleep drive is lower (after five hours of sleep) then the arousal system is back in charge and this can make falling back to sleep quite difficult.
It might make sense, then, to see what you might be able to do to weaken the arousal system in addition to building sleep drive through the implementation of a sleep window. This might be done, as suggested earlier, by doing things like:
* Not putting pressure on yourself to sleep
* Eliminating sleep efforts
* Not striving for sleep
* Exploring the sleep-related thoughts that seem to generated worry and anxietyIt can be helpful to remind yourself, too, that the techniques you described (such as getting out of bed when being in bed doesn’t feel good) are not intended to generate sleep — they are simply intended to create better conditions for sleep to happen (they do this by addressing the behaviors that typically perpetuate sleep disruption).
So, when you get out of bed during the night — for example — you are doing this simply to give yourself a more appealing alternative to remaining in bed when being in bed doesn’t feel good, and to prevent you from reinforcing a negative association between your bed and unpleasant wakefulness.
If you can’t nap during the day, this suggests that either you aren’t sleepy enough for sleep during the day (most people with insomnia are fatigued during the day rather than sleepy — just as you described) and/or arousal is making it hard to nap. So, there’s nothing particularly unusual when it comes to being unable to nap during the day.
As you pointed out, Valium (especially when combined with alcohol) doesn’t seem to be working — and that’s not unusual because those things don’t tackle the thoughts and behaviors that perpetuate sleep disruption.
The ironic thing when it comes to taking medication is that it rarely has a good long-term outcome on our sleep — if we take a pill and sleep, we believe the pill generated sleep and this erodes confidence in our natural ability to sleep. If we take a pill and don’t sleep, we believe something is wrong with our sleep and this increases arousal!
It sounds as though you have a great grasp of the behavioral techniques that can improve sleep — you might find it helpful to work with a therapist trained in CBT-I (if not already doing so) to help address the cognitive (sleep-related thoughts) side of the equation since it sounds as though that could be where the opportunity exists for you to weaken the arousal system and make sleep a bit easier!
I hope this helps!
—If you are ready to stop struggling with insomnia you can enroll in the online insomnia coaching course right now! If you would prefer ongoing phone or video coaching calls as part of a powerful three month program that will help you reclaim your life from insomnia, consider applying for the Insomnia Clarity program.
The content of this post is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. All content is provided “as is” and without warranties, either express or implied.
Thank you so much, Martin, you are such a great guy.
And so many things you said are spot on!
My problem with sleep doesn’t lie in other life worries. My problem with sleep is sleep itself (the arousal system, as you said).
It’s a catch 22 situation, and so hard to get out of. Poor sleep increases arousal, arousal causes poor sleep.
Thank you so much for saying that trouble napping isn’t that unusual. I sometimes feel like I am the only one. Only one user here, gsdmom, said she has the same problem.
And yes, I am SURE that I have conditioned myself into believing those damned pills are helping, when in fact it is my own body that gives me sleep, the pills for sure lost their effectiveness long ago.
Martin, last night was horrible. I woke up after only 2.5 hours of sleep and didn’t manage to get back to sleep, and I must admit I overused Valium (three pills + vine), but I was still too angsty to fall back under, which PROVES that the mind is stronger than the pills.
In a way I’m glad Valium+alcohol stopped working, otherwise I don’t know if I would ever willingly stop.
Unfortunately, however, this night was my tipping point, and after years and years of sleep problems and selfmedicating, I got angry, fed up, I got out of my apartment and went to my doctor, who prescribed Ambien. I just did it so that I can say I’ve tried both antianxiety and sleeping pills.
I’ve never used sleeping pills, though, and I am terrified.The deal with the doctor is a two-week trial. I didn’t tell her I am a lifelong insomniac. I just said I have been having trouble sleeping for the past 5-6 months. I am afraid of getting a diagnosis and losing my driver’s licence, which I need for my work.
So I have decided that I will try Ambien for those two weeks just to see what happens, so I can say that I tried it all before quitting it all. I do not think Ambien will work and yes, I don’t see it as a long term solution.
After this, I am going to try to go back to my natural sleep, however much I get,I will do my best to live with it. There really is no other way than natural in sleep.
After the two-week Ambien trial, whether it improves my sleep or not, I am quitting all pills and going back to the way things were. If I fail to get my sleep naturally back on track to at least manageable 5.5 hours, I will look for a private psychiatrist to work with me, but also only through CBT-I, no pills.
I KNOW that I am the reason for my poor sleep, and I KNOW that the cure has to come from inside me.
And just to add: I have been suffering from various kinds if insomnia my while life. Before it started waking me uo in the middle of the night, I found that ignoring it is the best approach. “Live like you don’t have it” was my motto. And most nights I slept fine.
When I started waking up in the middle if the night, my motto wasn’t applicable anymore. No matter how much I tried to ignore it, and successfully falling asleep every night, that awakening a few hours later really unrattled me. And I am exhausted every day.
However, I now know that nothing has changed at the core of the problem. I still have to strive to life my life with as much sleep as I get. Actively fighting it, like I’ve been doing, just causes the opposite effect. And who knows, maybe in time I will get back to the way things were.
Recognizing that sleep-related thoughts are perpetuating sleep disruption is a huge insight, Edgar — since it proves that your sleep system isn’t “broken”, that your insomnia isn’t unusual, and that working on those thoughts will likely prove to be helpful!
I think you’ll find it really helpful to work with a trained CBT-I therapist to help explore and tackle those thoughts and reduce the amount of anxiety and worry they seem to generate.
In the meantime, you might also find it helpful to make sure you are engaged in daytime activities you enjoy and find enriching, rewarding, and engaging. This can help shift focus away from sleep, reduce fatigue, and help you explore how capable you might be during the day, even after difficult nights of sleep.
Just adding “good stuff” to our days can be a really powerful way of lowering arousal.
You’ve got this, Edgar!
—If you are ready to stop struggling with insomnia you can enroll in the online insomnia coaching course right now! If you would prefer ongoing phone or video coaching calls as part of a powerful three month program that will help you reclaim your life from insomnia, consider applying for the Insomnia Clarity program.
The content of this post is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. All content is provided “as is” and without warranties, either express or implied.
I don’t really have much to add – the expert (Martin) has already weighed in so I think its best for you to heed his advice.
The one thing I will say is that there seems to be this common misconception that “my insomnia is heavy duty as compared to others”. I will just paraphrase something I heard an insomnia expert once said while giving a talk on the topic – the only kind of patients this person (Donn Posner) ever treated were heavy duty insomniacs. People who have been suffering for decades with insomnia. People who had insomnia as a result of PTSD. Or people who had insomnia because of chronic pain, etc.
I don’t think it is particularly useful for you to think of your situation sleep wise to be worse than others. I think it is actually more beneficial to think of your situation to be no worse and likely, to be not as bad as others. You see, if you accept that professionals who are trained to treat people with insomnia routinely successfully treat people whose insomnia is as bad or even worse than yours, then you will come to realize that there is indeed a way to help you.
And I am not just making that up. There are dozens and dozens of studies that show that even if you are suffering from chronic insomnia and have been doing so long term with co-morbidities, with proper treatment, not only can you improve your sleep – you even have a chance at becoming a normal sleeper again.
Edit: Let me add that before I was given the proper treatment, I was the kind of insomniac who could take ambien and still struggle for hours to fall asleep. I once took a dose of temazapam (similar to valium), slept for 1.5hrs, woke up, could not fall back asleep and then took another doze and slept for 2 hours. And then I was up the rest of the night. 3.5hrs on double the prescribed dose which btw, is incredibly dangerous.
When I received the proper treatment (I was taught how sleep works, how I could manipulate my sleep system to promote sleep, I was also taught how structure my days and nights to enhance my sleep), within a couple of months, I felt confident enough to ween off of sleeping pills.
So let me say reading the replies, that I both agree and disagree with some of the them.
See, I believe that benzodiazepine/sleeping pill addiction is both a real thing and is a real physical problem (in addiction to a psychological one and therefore, fixing your thinking alone isn’t necessarily enough).
Moreover, the way you’re using the Valium could be actively contributing to your sleep problem (I say “could” because obviously I’m not your personal physician and I am not qualified to make a specific claim). However, I have had your kind of insomnia for 4+ years (except that I wake up after an average of about 4 hours and instead of Valium, I take sleeping pills both at the beginning of the night and the middle of the night when I awaken.)
From working with my current sleep physician and my own research on sleep, here is why I believe using an anxiety or sleeping pill in the fashion you’re using it could complicate your sleep problem:
1) Sleep is very habitual. By taking a benzodiazepine or a sleeping pill frequently or every night in the middle of the night to fall back asleep, you are actually training your brain to wake up in the middle of the night in order to take the pill.
2) As Martin said, even without taking a benzo/sleeping pill in the middle of the night, sleep maintenance insomnia/early morning awakening insomnia can be challenging to treat because your sleep drive is lower in the middle of the night than it is in the very beginning of the night (of course this is a true for both normal sleepers and insomniacs)
3) Lastly, not only is your sleep drive lower after 5 hours than it would be at the beginning of the night, but you could be training yourself to become physically dependent on a benzo/sleeping pill in order to fall back asleep again (ie: literally, you could get to the point where you are like me and need to be knocked out by a pill in order to fall asleep again and that, combined with point 2, could create an insomnia that is much more difficult to treat).
I’m going to write more later when I have more time and tell what I’m doing to try and tackle my insomnia, but I just wanted to give you food for thought.
Thank you both for weighing in (and Martin, too)
It is clear you have a lot of personal experience with insomnia and that you have a lot of knowledge on the subject.
@ Kobalap – it is the napping issue that often has me convinced that my insomnia is worse than other people’s, though of course you’re right, I know I’m not the worst one.
It’s just that people, my colleagues mostly, often tell me how they, too, have terrible insomnia. What they actually mean is that they can’t sleep properly at night, so they are busted during their workday and can’t wait to get back home and crash for a few hours. Don’t get me wrong, what they describe is a real problem,too, I am not underestimating anyone’s sleep problems, but I think that what they have is more of a sleep schedule issue than it is real insomnia. Most if not all of my colleagues would benefit a lot from sleep restriction, if they wanted to try it, but their problems aren’t severe enough, I guess, since nobody’s even heard of SR.
My brother, for instance, often has this kind of sleep problem where his nights are terrible, because his worktime is all over the place. But even he can’t understand how I can’t sleep even if my day is free,on weekends and holidays. For me, every night is a struggle, no matter the situation.I’m grateful to Martin for ensuring me that this isn’t as unheard of as I sometimes feel it is.
Anyway, I’m repeating myself, sorry. When you say proper treatment, are you talking about medication, natural methods or a combination of both?
As for dangerous things you mentioned, I once (but only once) was so desperate that I took 7-8 pills of Valium in one night (no alcohol, though). I could have overdosed, probably. But that was years ago, and I’ve never done anything that stupid again, though these combinations of small doses of Valium and alcohol are not far behind.
@ Jodi
You are absolutely right about me training my brain. I have to admit, it was just too irresistible to just pop a pill and add a sip of vine and in that way pretty much guarantee I will go back to sleep. Placebo or not, it worked for a while and I developed a habit of not even trying to go back to sleep naturally. As soon as I would wake up, I would immediately get out of bed, combine the two, go back to bed and just fall asleep. Like I said, I am almost glad that this method stopped working, because I would never stop myself.However, I have to point out that this whole Valium thing only started as a result of my early morning awakenings, not the other way around. First I started to wake up too early (as opposed to having exclusively sleep onset problems in the past), I don’t know why, and then I fought with the issue for about half a year before I finally caved in and started experimenting with Valium. Who knows what would have happened if I had never started. Maybe the early awakenings would stop naturally, maybe they wouldn’t.
I’ve read somewhere that early morning awakening type of insomnia is the most challenging to treat, probably for that exact reason, sleep drive is depleted, arousal kicks in.
I’m sorry you are in the position you describe. I feel it is very similar to mine. Being knocked-out is exactly what I AM doing. Not at the beginning of the night (that I would call PASSING OUT), but certainly at the middle of it. I don’t see a way out of it, other than trying to change my focus on sleep as Martin describes, but it is so much easier to do at the beginning of the night with a lot of sleep drive than it is later.
I haven’t seen the statistics on people who have insomnia and their inability to nap. My impression is based solely on the hundreds of people I have interacted with in various insomnia forums over the last 15 years. And to be clear, I am a layperson.
There are numerous misconceptions related to insomnia that lead people to believe that their insomnia is worse than others. These include:
– I can’t fall asleep at all even though I haven’t slept in many many nights
– related to the above, I can’t nap
– I still don’t sleep well or not at all even though I am taking powerful sleep medicines
– Related to the above, I cannot fall asleep even though I have taken a ton of melatonin and smoked a bunch of marijuana
– Even when I do sleep, which is not a lot, I don’t really feel asleep. I feel awake but the time passes very quickly
– Sometimes I sleep well for about 2 or 3 hours and then I am not able to fall asleep
– Because of the above I must have some terminal illness causing my sleep issues and I will not rest until I prove this illness isI am sure there are all kinds of other variations you can add to that list but those are the ones I hear over and over again. The next misconception that usually follows is – because my insomnia is worse than everyone else’s, these “behavioral” therapies will not work. Or, related to that, I have tried sleep hygiene and it is completely useless.
Below was my personal experience when I went through my bouts of chronic insomnia:
– I went for weeks and weeks with very little sleep. And whatever sleep I got, it was not restful
– I took sleep medications. They would help me fall asleep some nights initially but only for a couple of hours. Other nights, they did not help.
– Despite being sleep deprived, I could not fall asleep during the day. I could never ever nap.
– I had panic attacks and sever sleep related anxiety
– I tried “everything” including sleep hygiene and nothing worked.Sound familiar? I can match you symptom for symptom and make the same claim that my insomnia was worse than yours. Actually, the hundreds of people I interacted with would all claim similar experiences and therefore claim their insomnia is the worst. The reality is, with many people with chronic insomnia, their experience is very similar to yours. I hate to say it but, your case just isn’t very special. It is incredibly unremarkable.
That’s all good news. It’s good news because thousands and thousands of people just like you (and me) have been helped by professionals trained in treating chronic insomnia. As to the treatment, let me just say that you are in the right place talking to the right person (Martin). The treatment approach he provides is the single most effective approach to chronic insomnia bar none. That’s not me saying that, it is several dozens of studies conducted over the last 30 years that says that. If we had a treatment for coronavirus that showed the same level of efficacy, the pandemic would be over. The catch is, his treatment approach is not an over-night fix. It takes time and you have to put in the work. This website has a nice page that describes the treatment nicely:
Thank you for the yime you put in writing this post.
I will answer it properly when I can, for now let me say I agree wth you on many points. I am also a veteran of insomnia forums for well over a decade. They are my therapy when nobody else understands, though they also, in a way, maybe, perpetuate insomnia. Everything with insomnia is a double edged sword.
So you helped yourself exclusively with this behavioural approach? How is your sleep, generally?
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