Insomnia: treatment without prescriptions?

[ChimneyFish]

Dr. Steve,

Two things.

I suffer from very bad insomnia, and my Doctor told me take Tylenol PM to help with it, as he doesn't want to put me on anything else due to my addictive personality and I haven't had insurance in a few years. Wondered what your take was on that.

Also, at what point does not being able to sleep start to cause a serious health risk????
Usually the PM's do the trick, twice in the last two weeks now I have had a night where they didn't work.
Last week, I decided to "tough it out", so as to try to get back to a somewhat normal schedule. That was a total of 35 hours.

Since yesterday I've been up, and I'm now looking at 32 and was going to stay up until 11PM/12AM. So at what point does this actually became dangerous????

Thank you.

[RAAMONE]

so thats why you were roasting garlic at 8am

[ChimneyFish]

so thats why you were roasting garlic at 8am

That was exactly the reason, my friend.:laugh:

And the reason it took me all day to make roasted garlic mashed potatoes.

[Dr Steve]

Dr. Steve,

Two things.

I suffer from very bad insomnia, and my Doctor told me take Tylenol PM to help with it, as he doesn't want to put me on anything else due to my addictive personality and I haven't had insurance in a few years. Wondered what your take was on that.

Also, at what point does not being able to sleep start to cause a serious health risk????
Usually the PM's do the trick, twice in the last two weeks now I have had a night where they didn't work.
Last week, I decided to "tough it out", so as to try to get back to a somewhat normal schedule. That was a total of 35 hours.

Since yesterday I've been up, and I'm now looking at 32 and was going to stay up until 11PM/12AM. So at what point does this actually became dangerous????

Thank you.

You know, it's amazing, I thought I could search the literature and come up with a number, as in "Sleep deprivation is defined as no sleep for x number of hours..." but it just ain't there. The best I could come up with is a very vague: "general lack of normal sleep" as a definition. I do know that during residency I'd go 48 hours without sleep easily without any deficits that I could point out (though I'd probably show decline in some fancy neurologic function tests).

Chronic sleep deprivation can cause a host of symptoms including muscle aches, irritability, blurred vision, and hallucinations. Sleep deprivationhas been used as a form of torture because it's so effective in making people miserable.

There are lots of causes for insomnia and they can be broken down into three categories:


Sleep disorders
Medical Problems
Psychiatric problems


Sleep disorders include sleep apnea, primary insomnia and other things like that.
Medical problems include restless leg syndrome, overactive thyroid and other stuff.
Psychiatric problems that can cause insomnia include schizophrenia, bipolar disorder, anxiety, depression, etc.

PRIMARY insomnia just means that the insomnia isn't caused by something else. The treatment for all the other kinds of insomnia is to treat the underlying condition. For primary insomnia, the treatment is geared toward the insomnia itself.

Lots of studies have indicated that if you train 100 people in the techniques of "Sleep Hygiene" and give 100 people a "sleeping pill", the people on the pill will start out doing better sleep-wise, but the sleep hygiene group will eventually win out and sleep better.

Since I'm lazy, I'm going to cut and paste this information on sleep hygiene from http://www.healthpsychology.net/Sleep_Hygeine.htm:

Ways to Improve Sleep
Timing:

Establish a pattern to your sleep by going to bed at the same time each evening and getting out of bed at the same time every day, even on weekends regardless of how much you slept.
Avoid taking naps but if you do nap, make it no more than about 25 minutes. If you have problems falling asleep at night then you should not take naps.

Sleep Behavior:

Establish a pre-sleep ritual to give your body cues that it is time to slow down (e.g., taking a bath or reading a few minutes before bed).
Use the bed only for sleep or for sex (don’t use your bed as a desk, do not read, eat or watch TV in bed).
If you are unable to sleep for more than 15 minutes then get out of bed. Engage in a quiet un-stimulating (boreing) activity and return to bed when sleepy.
Restrict the amount of time you spend in bed to your usual amount of sleep (e.g., 7 hours) even if you did not sleep as well as you would have liked. Do not lay in bed extra hours in the morning feeling frustrated - it will not help.

Bedroom Environment Tips:

Sleeping is associated with a decline in core body temperature from a state of relative warmth. You can raise your body temperature by taking a warm bath 20 minutes before bed and as your temperature cools it will signal your body that it is time to sleep.
Fluctuations in room temperature disrupt the dream state so maintain a steady temperature in the room throughout the night. A cool room is more conducive to sleep than a warm room.
Eliminate illuminated wall clocks or other sources of light (Note: A night light is often needed so that people can get up in the night to go to the restroom with out falling).

Ingestion:

Caffeine (a stimulant) should be discontinued 4-6 hours before bedtime
Nicotine (a stimulant) should be avoided near bedtime or if you wake at night . Dont smoke a cigarette if you can not sleep.
Alcohol (a depressant) may initially promote sleep onset but it causes awakenings later in the night
A light snack may be sleep inducing but a heavy meal too close to bedtime might interfere with sleep

Mental Control:

Avoid mentally stimulating activity just before going to bed (e.g., action movie, stimulating conversation, loud music)
Relaxation techniques such as deep breathing and visual imagery can help sleep onset
Mentally quiet tasks such as listening to relaxing music, calming thoughts, etc can help sleep onset


Now, Tylenol PM has diphenhydramine in it. This is also known as "Benadryl". It's an antihistamine that has the side effect of making one sleepy. so they're using the side effect in this case as the primary effect! Now, the side effects would be dry mouth, dry nose, hangover, dizziness. If your doctor is ok with tylenol PM, he/she will be also happy with you just taking a benadryl at night. Generic diphenydramine is dirt-cheap and doesn't have that pesky tylenol in it that can cause liver troubles (especially in drinkers).

Hope this helps. We could discuss prescription drugs for sleep, too, if you guys want.


your pal,


steve

[jauble]

No, you can't die from insomnia.

What about narcolepsy? I nod off, I wake up in strange places, I have no idea how I got there.

No. You need healthy, natural sleep. Chew some valerian root and get some more exercise.

Hey, come on. I'm in pain.

You wanna see pain? Swing by First Methodist Tuesday night. See guys with testicular cancer. That's pain.

[MobCounty]

No, you can't die from insomnia.



Tell that to these guys..

http://www.mediacircus.net/insomnia1.jpg

[TheGameHHH]

No, you can't die from insomnia.

What about narcolepsy? I nod off, I wake up in strange places, I have no idea how I got there.

No. You need healthy, natural sleep. Chew some valerian root and get some more exercise.

Hey, come on. I'm in pain.

You wanna see pain? Swing by First Methodist Tuesday night. See guys with testicular cancer. That's pain.

i wish i knew a guy named Bob with bitch-tits, he'd help me sleep

[thejives]

You know, it's amazing, I thought I could search the literature and come up with a number, as in "Sleep deprivation is defined as no sleep for x number of hours..." but it just ain't there. The best I could come up with is a very vague: "general lack of normal sleep" as a definition. I do know that during residency I'd go 48 hours without sleep easily without any deficits that I could point out (though I'd probably show decline in some fancy neurologic function tests).

Chronic sleep deprivation can cause a host of symptoms including muscle aches, irritability, blurred vision, and hallucinations. Sleep deprivationhas been used as a form of torture because it's so effective in making people miserable.

There are lots of causes for insomnia and they can be broken down into three categories:


Sleep disorders
Medical Problems
Psychiatric problems


Sleep disorders include sleep apnea, primary insomnia and other things like that.
Medical problems include restless leg syndrome, overactive thyroid and other stuff.
Psychiatric problems that can cause insomnia include schizophrenia, bipolar disorder, anxiety, depression, etc.

PRIMARY insomnia just means that the insomnia isn't caused by something else. The treatment for all the other kinds of insomnia is to treat the underlying condition. For primary insomnia, the treatment is geared toward the insomnia itself.

Lots of studies have indicated that if you train 100 people in the techniques of "Sleep Hygiene" and give 100 people a "sleeping pill", the people on the pill will start out doing better sleep-wise, but the sleep hygiene group will eventually win out and sleep better.

Since I'm lazy, I'm going to cut and paste this information on sleep hygiene from http://www.healthpsychology.net/Sleep_Hygeine.htm:

Ways to Improve Sleep
Timing:

Establish a pattern to your sleep by going to bed at the same time each evening and getting out of bed at the same time every day, even on weekends regardless of how much you slept.
Avoid taking naps but if you do nap, make it no more than about 25 minutes. If you have problems falling asleep at night then you should not take naps.

Sleep Behavior:

Establish a pre-sleep ritual to give your body cues that it is time to slow down (e.g., taking a bath or reading a few minutes before bed).
Use the bed only for sleep or for sex (don’t use your bed as a desk, do not read, eat or watch TV in bed).
If you are unable to sleep for more than 15 minutes then get out of bed. Engage in a quiet un-stimulating (boreing) activity and return to bed when sleepy.
Restrict the amount of time you spend in bed to your usual amount of sleep (e.g., 7 hours) even if you did not sleep as well as you would have liked. Do not lay in bed extra hours in the morning feeling frustrated - it will not help.

Bedroom Environment Tips:

Sleeping is associated with a decline in core body temperature from a state of relative warmth. You can raise your body temperature by taking a warm bath 20 minutes before bed and as your temperature cools it will signal your body that it is time to sleep.
Fluctuations in room temperature disrupt the dream state so maintain a steady temperature in the room throughout the night. A cool room is more conducive to sleep than a warm room.
Eliminate illuminated wall clocks or other sources of light (Note: A night light is often needed so that people can get up in the night to go to the restroom with out falling).

Ingestion:

Caffeine (a stimulant) should be discontinued 4-6 hours before bedtime
Nicotine (a stimulant) should be avoided near bedtime or if you wake at night . Dont smoke a cigarette if you can not sleep.
Alcohol (a depressant) may initially promote sleep onset but it causes awakenings later in the night
A light snack may be sleep inducing but a heavy meal too close to bedtime might interfere with sleep

Mental Control:

Avoid mentally stimulating activity just before going to bed (e.g., action movie, stimulating conversation, loud music)
Relaxation techniques such as deep breathing and visual imagery can help sleep onset
Mentally quiet tasks such as listening to relaxing music, calming thoughts, etc can help sleep onset


Now, Tylenol PM has diphenhydramine in it. This is also known as "Benadryl". It's an antihistamine that has the side effect of making one sleepy. so they're using the side effect in this case as the primary effect! Now, the side effects would be dry mouth, dry nose, hangover, dizziness. If your doctor is ok with tylenol PM, he/she will be also happy with you just taking a benadryl at night. Generic diphenydramine is dirt-cheap and doesn't have that pesky tylenol in it that can cause liver troubles (especially in drinkers).

Hope this helps. We could discuss prescription drugs for sleep, too, if you guys want.


your pal,


steve

Now I have ADD doc.
Can you shorthand that and add a sexy picture?

[ChimneyFish]

Thanks a lot, Dr. Steve.

I'm going to go out this week and get some of the generic diphenydramine, as I do enjoy a drink or two.:happy:

As far as all the other info........I could be the worst example of how to get a good nights sleep. I have every single bad behavior on there.:blink:
Being unemployed is certainly not helping the situation at all.

Thanks again.

[silks]

My doctor recommended trying Melatonin. It has helped quite a bit. I'm not sure if it's all in my head or not, but it definitely has helped my quality of sleep, and doesn't make me feel sluggish in the morning like diphenhydramine does.

Any thoughts on Melatonin, Dr. Steve?

[zildjian361]

now i know why i don't sleep thru the night, i drink and eat till i go to bed.theni gotta get up and piss 3 times a night :smoke::drunk::flush:

[Alice S. Fuzzybutt]

I tried Ambien and didn't like the way it made me felt (very groggy in the morning). Lunesta made me feel the same way. I asked my doctor if I could take Tylenol PM when I'm having trouble sleeping. He said it would be ok. works like a charm when I can't get to sleep some nights.

When I was in the nut hut their doctor prescribed a low dose of Seroquel before I went to bed. Wowee! I could sleep for HOURS on that stuff. What did it matter? I wasn't going anywhere for a while! :laugh:

[KEITHJAY]

I tried everything the best is vit-d with calcium tab and some melatonin tabs 3.95 for 90 at walmart zzzzzzzzzzzzzzzzzzz:sleep:: ps: jimmy takes melotonin:laugh:

[silks]

I tried Ambien and didn't like the way it made me felt (very groggy in the morning)

Ambien made me feel like I was in a bar fight the night before... I even had some short term memory loss from it too.

[boosterp]

Being unemployed is certainly not helping the situation at all.

Thanks again.

Bingo!

[PapaBear]

I'm really surprised your doc recomended Tylenol PM. You can get the same sleep med without it having acetaminophen in it.There's no reason to include the pain med with the sleep med, if you aren't feeling pain. At least, that's what I've been told. Isn't constant use of acetaminophen a bad thing, when it's not needed?

[Alice S. Fuzzybutt]

I'm really surprised your doc recomended Tylenol PM. You can get the same sleep med without it having acetaminophen in it.There's no reason to include the pain med with the sleep med, if you aren't feeling pain. At least, that's what I've been told. Isn't constant use of acetaminophen a bad thing, when it's not needed?

He told me to take it INSTEAD of the sleep meds.

[PapaBear]

He told me to take it INSTEAD of the sleep meds.
I meant Chimneyfish. I was surprised his doc told him that as first response to his problem.

[KC2OSO]

One thing I notice is that cycles of the moon affect my sleep big time - as well as all of the stuff Dr. Steve mentioned above. Into and through the full moon, I sleep less. Fucking Aquarius. Fertile mind always on and in gear. Especially at changes of the season. Other things, as you might expect, like job family and worries keep me up too.

I use insomnia though as an opportunity to get more tired - get shit done. Read. Work more. Mine is not true insomnia though I guess. Mine is pretty infrequent like once a month. Wish I still smoked weed. Problem would have been caused/solved.

'Nite (no pun)

[ChimneyFish]

I meant Chimneyfish. I was surprised his doc told him that as first response to his problem.

I think it was more that I was uninsured and I had asked him if the PM's were alright, as I already had some at home.

He told me Benadryl, or anything with diphenydramine, would work fine. Also, he didn't want to put me on anything prescription.

I'm almost out of PM's, so I'll be looking for some generic diphenydramine soon.

[WhistlePig]

I get insomnia as a symptom of PMS. I hate it. I can count on 2-3 nights a month of no sleep about 10 days before my period. It's like my whole body is buzzing and my brain is bubbling over with disturbing thoughts so I can't sleep. I'm guessing it's a hormonal thing but maybe it has something to do with the moon. I don't know. But I feel for you, Chimneyfish.

[ChimneyFish]

When I was working it really really sucked when it happened.

Now that I'm laid off, it's not that big of a deal. It's more annoying than anything else.

That day I was up for a total of 42 hours, because I didn't want to screw up my "sleep schedule". Around hours 25-30 it was getting rough.:happy:

[hunnerbun]

I get insomnia as a symptom of PMS. I hate it. I can count on 2-3 nights a month of no sleep about 10 days before my period. It's like my whole body is buzzing and my brain is bubbling over with disturbing thoughts so I can't sleep. I'm guessing it's a hormonal thing but maybe it has something to do with the moon. I don't know. But I feel for you, Chimneyfish.

Insomnia is my new PMS since my hysterectomy. My no sleep cycle seems to be on more of a 6 week cycle. Sometimes it is just not being able to get to sleep at all and other times I fall asleep easily but wake up after a couple of hours and thats it, I am awake for the rest of the night.
Its frustrating as hell to my b/f because he is a shift worker and can fall asleep anywhere anytime no problem. He keeps telling me to just close my eyes and go to sleep and i can't seem to make him understand that it doesn't work that way.
I will have to try the diphenhydramine next time it happens. It really does suck when you have to get up for work the next day and you only got about 2 hrs of sleep.

[ChimneyFish]

It really does suck when you have to get up for work the next day and you only got about 2 hrs of sleep.

Especially when you have a labor-based job, and you have to be on a roof or a ladder and it's 95 degrees out.
I do not miss those days.:dry:


And I love the whole "just close your eyes and go to sleep" gimmick. People that don't have this problem just don't understand at all.

[Dr Steve]

My doctor recommended trying Melatonin. It has helped quite a bit. I'm not sure if it's all in my head or not, but it definitely has helped my quality of sleep, and doesn't make me feel sluggish in the morning like diphenhydramine does.

Any thoughts on Melatonin, Dr. Steve?


Melatonin works better than placebo for sleep, but I have some concerns about it. From a review in International Journal of Clinical Practice, melatonin "is involved in numerous physiological processes including circadian entrainment, blood pressure regulation, oncogenesis, retinal physiology, seasonal reproduction, ovarian physiology, immune function and most recently in inducing osteoblast differentiation." Just taking more of this stuff for sleep makes me nervous when we don't understand all the things it does in the body. It may be perfectly safe, but there are no studies that show it's safe long term for insomnia.

I'm paranoid, though.

[GreatAmericanZero]

i don't have anything close to Insomnia, but I always considered myself a light symptom. But I recently cut back to drinking caffiene only on weekends, and the difference is amazing. Now i can even fall asleep in couches and chairs, when before I could only fall asleep in my own bed. I even had difficulty sleeping in a hotel bed

[KingGeno]

I've tried melatonin drops from GNC after it was recommended to straighten out my sleep patterns. I ended up having pretty visual nightmares and waking up in the middle of the night feeling like I was tripping. Be careful with that crap.

[GreatAmericanZero]

I've tried melatonin drops from GNC after it was recommended to straighten out my sleep patterns. I ended up having pretty visual nightmares and waking up in the middle of the night feeling like I was tripping. Be careful with that crap.

wait. that sounds cool!

[Jughead]

Im kinda unsure on this subject???Diphenhydramine(the sleep aid in (Ty) Pm is just benadryl or over the counter antihistamine????Why take acetaminophen(TY) if there is no pain involved?????......Especially if drinking is involved????Why add this ingredient to the mix???? Just buy generic benadryl... It is also a lot cheaper..Dr Steve Please????Im drinking so please excuse me like you always do I love you!!!!Juggy

[Leticia]

I have tried every fucking thing to sleep and it doesn't work.


Melatonin can eat my ass.

So can Valerian Root.

And Unisom and Ambien.

And no caffeine after 4pm. And laying in bed in the dark for hours.

And taking a warm shower....


argh.

The thing that makes me the angriest is that someone is going to try to solve it with pills and I just want to feel good about going to sleep.

And not, not hear alarms even when I set 3 coming from different places.

I can either sleep 15 minutes, 13 hours or not at all.

13 hour long nights are usually after not sleeping for 2 days...

[ChimneyFish]

Did a 12 hour bid myself last week.

[GreatAmericanZero]

Im kinda unsure on this subject???Diphenhydramine(the sleep aid in (Ty) Pm is just benadryl or over the counter antihistamine????Why take acetaminophen(TY) if there is no pain involved?????......Especially if drinking is involved????Why add this ingredient to the mix???? Just buy generic benadryl... It is also a lot cheaper..Dr Steve Please????Im drinking so please excuse me like you always do I love you!!!!Juggy

haha..so when you're drinking you decide to use multiple puncutation at the end of every sentence? weird

[Dr Steve]

Im kinda unsure on this subject???Diphenhydramine(the sleep aid in (Ty) Pm is just benadryl or over the counter antihistamine????Why take acetaminophen(TY) if there is no pain involved?????......Especially if drinking is involved????Why add this ingredient to the mix???? Just buy generic benadryl... It is also a lot cheaper..Dr Steve Please????Im drinking so please excuse me like you always do I love you!!!!Juggy

yeah, I totally agree...the tylenol in Tylenol PM seems quite superfluous to me, unless arthritis pain is keeping you awake.

[Leticia]

Question...


When getting diagnosed as an adult for the first time, is it better to go to a psychologist/psychiatrist or a General Practice doctor??

[Dr Steve]

Question...


When getting diagnosed as an adult for the first time, is it better to go to a psychologist/psychiatrist or a General Practice doctor??

diagnosed...with insomnia? or something else?

with insomnia, probably a good family practice or internist can do the majority of the workup and treatment; for really tough cases there are sleep specialists.

70% of psychiatry is done in family practice and internal medicine offices. Psychiatrists are specialists who deal with all kinds of mental disorders and can prescribe medication. Psychologists often have a PhD in psychology (but not always) and excel in psychotherapy and psychological testing. Psychologists don't prescribe medication, however.

does that answer your question?

[Leticia]

diagnosed...with insomnia? or something else?

with insomnia, probably a good family practice or internist can do the majority of the workup and treatment; for really tough cases there are sleep specialists.

70% of psychiatry is done in family practice and internal medicine offices. Psychiatrists are specialists who deal with all kinds of mental disorders and can prescribe medication. Psychologists often have a PhD in psychology (but not always) and excel in psychotherapy and psychological testing. Psychologists don't prescribe medication, however.

does that answer your question?

Yes! :thumbup:

Thank you. :happy:

[FUNKMAN]

I tried Ambien and didn't like the way it made me felt (very groggy in the morning). Lunesta made me feel the same way. I asked my doctor if I could take Tylenol PM when I'm having trouble sleeping. He said it would be ok. works like a charm when I can't get to sleep some nights.

When I was in the nut hut their doctor prescribed a low dose of Seroquel before I went to bed. Wowee! I could sleep for HOURS on that stuff. What did it matter? I wasn't going anywhere for a while! :laugh:

Ambien made me feel like I was in a bar fight the night before... I even had some short term memory loss from it too.

most i'll sleep on ambien is 4 hours. do get some 'hangover' affects on occassion. the worst affect is taking it one night and not the next, the next night i feel like i've had a couple cups of espresso and can't fall asleep... then if I do have some coffee in the days following after taking ambien I get major wired, don't like it!

best thing is stay away from it, also stay away from caffeine anytime near close to bedtime