[LCF]

I’ve had bouts of insomnia since I was a child of 6-7, but it was only ever an occasional thing until I hit menopause.  Since then it’s been horrific.  While I was working, about 20 years ago, my GP put me on Lorazepam 1 mg, and I used it happily for 15 years with no side effects.  When I retired I came off it, and then the trouble started for me.  I was able to sleep right away, but often I’d wake up after an hour or two.  It’s progressed now to the point where I often don’t sleep at all.

I’ve tried everything, and I mean everything.  Low-dose antidepressants worked for a while, and then they stopped abruptly and have never worked since.  Progesterone therapy worked for a while, and then stopped.  The natural remedies worked for a while, and then stopped.  My current doctor has given me some sleeping pills for when I absolutely have to sleep, but I can’t live this way. Most nights I sleep 0-2 hours.

I’m dealing with a partner who is dying of cancer, and I am his emotional support and will be his caregiver.  I have to sleep.

I tried SRT earlier this year and became so ill I had to stop.  Is this the wrong time for me to even consider SRT?

 

[Martin Reed]

Sorry to hear about your struggle with sleep, LCF.

Can you tell us a bit more about the sleep restriction therapy you tried? How many hours of sleep were you getting and what was your prescribed earliest bedtime and latest out of bed time?

—

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 Mastery 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.

[LCF]

My sleep restriction therapy (it’s euphemistically called sleep consolidation therapy here) was the basic one:  don’t lie in bed awake for more than 20 minutes, keep a diary, get up at the same time each day, don’t take naps.

My initial sleep window was 6 hours; from midnight to 6 am.  In the whole 5 weeks I don’t think I slept more than three hours in a night, and even then it wasn’t three contiguous hours, it was broken by an hour or two being awake.  A few times I had to break down and use a sleep aid because I can’t drive on the amount of sleep I get.  Most nights I got between 0-2 hours, which is about what I get now.

The only way I can survive at all is to use sleep aids a couple of times a week; otherwise I wouldn’t be able to function at all. I’m trying to stay positive for my partner, but it’s almost impossible on no sleep.  My exhaustion also comes with nausea and dizziness, which means most days I’m afraid to drive.

Of course, I also fear my future.  I imagine another 25 years of life like this, and frankly, it wouldn’t be worth living. That doesn’t help, I know.

(By the way, the avatar your site chose for me is very apt; it looks like I feel).

• This reply was modified 5 years, 5 months ago by LCF.

[gsdmom]

I know you said you have tried hormone therapy, was that progesterone and an estrogen patch? That helped me some after menopause, maybe you need your dosage tweeked?

I too am a caregiver of an adult disabled child and unfortunately an emotionally abusive spouse that has kidney failure. My insomnia started from a side effect of medication, but my home life has exasperated the situation. I had to take a sleep aid last night, I’m upset because I was doing very well for 4 nights.

I spoke with a therapist and she said I put to many performance requirements on myself – you may be doing the same being a caregiver to a critically ill spouse. Maybe for a while ask God to fully support and take care of your spouse, or seek respite care, something to ease your caregiving so you can take care of yourself. My sleep doc told me to keep the last hour before bed, only to myself, my time. Dim the lights, take a warm shower, do gentle, relaxing things. He gave me a whole bunch of things to do, which ended up being stressful. So far the most calming activity before bed for me is coloring. I have a couple books and about 50 colored pencils. And also getting exercise during the day even on only 2 hours sleep makes me feel a bit better.

[LCF]

gdsmom,

Thank you for your kind reply.

Yes, I am on both estrogen and progesterone and my levels are in the normal range. A high dose of oral progesterone had me sleeping like a rock for 18 months, even after my partner’s diagnosis — but one night it didn’t work, and that was that.  For good.

I practise good sleep hygiene — and was overjoyed to see that the new Kindle device has a warm backlight so I can read before bed without worrying about blue/white light affecting my sleep. I have a regular bedtime and try to get up within half an hour of 7:00 am every morning.

My partner doesn’t require any special kind of care right now.  My concern is that my lack of sleep leads to depression, and right now we’re focused on having as much fun as we can, so depression really gets in the way. I’m his emotional support, and that’s what’s suffering because of my insomnia.

I am two different people.  When I sleep you can’t hold me back — I’m like the energizer bunny.  But after a week of 2 hour nights, I can’t even get dressed.

[Martin Reed]

Most people with chronic insomnia have great sleep hygiene! Sleep hygiene is known not to fix chronic insomnia.

When you followed a sleep window of midnight to 6:00 AM for five weeks, did you make sure you didn’t go to bed before midnight, not nap during the day, always get out of bed by 6:00 AM, and always get out of bed during the night when you couldn’t sleep, every single day (without fail) for those five weeks?

If so, how long ago did you try these techniques, and were you being regularly supported by a therapist or coach? Was it explained to you why these techniques can be so helpful or were you expected to simply blindly follow those directions? I think a key to success is understanding why individual CBT-I techniques can be so helpful (and how they work) and having adequate support and guidance throughout implementation.

—

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 Mastery 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.

[LCF]

I went through the CBT in March/April of this year, about a month after having a night in the local sleep clinic to rule out apnea.

It was a five-week course.  I kept a sleep diary on line. I had a weekly “coaching” session, which was really just a review of my on-line sleep diary plus a few pretty basic relaxation techniques

I went to bed at midnight without fail, got up at 6 without fail, I never stayed in bed if I wasn’t sleeping, and I have never been able to nap, so that wasn’t an issue for me either.  As the days went by I became more and more anxious, I was constantly nauseated and dizzy, and by the end of the first week I no longer dared to drive.  I had to cancel a dinner party we had planned because there was no way I could cook for eight people and sit and be sociable with them. After a week I was also loathe to go into my bedroom at all.  My asthma became so pronounced I had to back on my puffer full-time after nearly a year of not needing it.

The most sleep I got on any night was three hours, but not in a three-hour block. Also, my pattern has always been to fall asleep quite quickly and then I wake up after a couple of hours.  Because of the requirement that I had to get up if I wasn’t asleep within 20 minutes, I just couldn’t go to sleep at all, I was so worried about it.

The other thing is that once I get up, my heart starts racing and won’t stop. I don’t have heart disease, but I do have low blood pressure, which can do this.  So every time I got out of bed, my heart would start racing and pounding, and then of course there’s no going to sleep with that going on.

In the end I think I must be one of the 20% who aren’t helped by these techniques.

 

[gsdmom]

Sounds like your underlying issue is anxiety, so maybe the structure of Sleep Restriction was too much for you. Have you tried any forms of meditation, like progressive muscle relaxation or listening to guided meditation? I’ve found many decent mediation practices on YouTube and I swear there were days when I was so stressed and sleep deprived that if I didn’t listen to  one of these I’d probably be sent to a 5150 mental health lockdown unit.

My sleep doctor recommended the practice of Stimulus Control first before Sleep Restriction. Martin has the info on SC here under “resources”. I practiced it for 3-4 weeks and then had a very decent week of sleep. That week I decided to take back my bedroom, (it was suggested I sleep away from my spouse for a while) I got an assortment of ear plugs to try to block out my husband’s Bi-Pap, bought some new crisp sheets and took a warm shower before bed each night. Then I had a setback for 3 days due to some stressors like job interviews and arguement with spouse, but thanks to the support here, last night was a little better falling asleep at midnight (after getting out of bed 3x) waking up at 5am with my husband’s alarm. I do not have a “sleep window” but try to fall asleep between 9:30pm-10pm knowing I will probably wake up around 5am. For me its so much less stressful than knowing I have to stay up until a certain time.

Like with you there are days I could not drive, and I realize that for this time in my life I am also adding stress by seeking a full time job, when really a part time job would be better for my sanity. Hopefully your friends who you would like to have over for dinner will understand and support your situation. Last week was my birthday, my adult daughter wanted to take me out but the thought of making a plan was stressful, so I just told her I call her the morning of my bday and see how I feel. Without the stressor of a dinner reservation I slept really well and the day of my bday we were able to go out and enjoy ourselves. Maybe your friends can be a bit spontaneous with you.

[LCF]

Right now, because of my husband’s situation, I am suffering from anxiety, of course, but the original problem really started 20 years ago, when I hit menopause.  Combined with my Hashimoto’s Thyroiditis, which went undiagnosed for decades, my endocrine system is a mess and no amount of dose tweaking seems to help.  Even when my thyroid numbers are optimal, I still have obvious physical symptoms.   And of course nobody really knows all that much about female hormones because we aren’t tested before menopause, so our individual optimal levels are unknown.

I would say that my insomnia is about 60% medical and 40% anxiety at the moment.

A couple of years ago I worked with a therapist who had me doing 20 minutes of meditation daily.  She swore it would help me sleep, but after a year of practice I gave up.  It did make me feel better in the moment, but as a sleep aid it was a bust.

[sablana]

Hi LSF! I posted you on the other thread and then saw this one. I am so sorry you  suffer from insomnia so badly. I feel my sleep problems are a lot like yours. I was sleeping OK while I was taking sleeping pills (lorazepam and Ambien) on daily basis (for 20 years),  then retired and decided to quit. I tried to go without pills and I barely survived 3 months and started taking Ambien again. I understand you very well regarding inability to drive.  I was hoping I could do so many things when I retire, but I am staying at home on the days I do not sleep

I had thyroiditis and I remember racing heart all the day, dizziness when standing up, inability to sleep, etc.

I try to exercise no matter what.  I  do weights, bike, anything I can do this day.  I walk on the days I can’t do anything else.   Do you exercise?

Do you still take HRT 20 years after menopause?

 

 

[LCF]

Sablana,

The way insomnia hijacks our lives is astonishing.  You and I were both fortunate enough to find sympathetic doctors who kept us able to work, but of course in the long run that isn’t a practical way to live.  And yes, retirement hasn’t been nearly as fun as I hoped it would be.  Even without my husband’s illness, most of the time the thought of travelling just wears me out.

I only started HRT six years ago, when I consulted a naturopath for the first time.  Here in B.C. they are licensed to prescribe most medications, and she was shocked that nobody had started me on HRT previously.  I use bioidentical hormones, which seem to be easier on the body in the long term. HRT no longer helps me sleep, though.

My doctor also prescribed cannabis (legal here in Canada).  I was really hoping it would help, but it didn’t, and because I’ve always disliked the effects I gave up on it.

I try to exercise regularly, though the last year has been difficult because of my husband’s illness. Still, I have a  brisk walk whenever weather permits.

It’s a puzzle.

 

[sablana]

Hi LCF! How are you now? I post you a long reply but I guess I did not submit it. What things are you doing to get you through the night?  I  am out of the sleeping pills and the doctor I see now will not prescribe me any and it still 10 weeks till my CBT-i . Do not understand how to make it until then

[LCF]

My doctor and I are working on a medication regime to keep me sane until after my husband dies and I’ve had a chance to regroup. I didn’t want to be taking sleeping pills every night, so we settled on three times a week just to make sure I can function when I have to through this horrible time.  I also found that I can take Mirtazapine or Seroquel twice a week because they work on an as-need basis (they stop working if I take them more often than that). If I can get three or four reasonable nights a week I’ll be okay.

After that I am committed to trying the CBT regime again.  In the long term I’m pretty sure it will be the answer for me.  A lot of my insomnia is hormone-related (including thyroid) but a big part of it is my attitude towards insomnia.  At the moment it really is a disaster if I don’t sleep, but in the future, when I no longer have to worry about a sick spouse, that probably won’t be the case.

Could you ask your doctor for a low-dose antidepressant until your CBT program starts (such as the ones I mentioned above — Seroquel or Mirtazapine)?  These are far less addictive and easier to get off and even at very low doses they can be wonderfully effective for insomnia. It’s not ideal, but it might keep you sane as a stop-gap measure.

[sablana]

Thanks LCF! I wish you strength and restful nights!

[Author]

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