I’m surprised no one has mentioned sleep restriction.

About six months ago I herniated a disc pretty severely in my lower back. Initially totally messed up my sleep with real pain…then the pain turned to annoyance and just caused me to wake up frequently and have a tough time ignoring and going to bed. And eventually the pain went away all together…but what was left was a major sleep problem. Couldn’t go to sleep, couldn’t stay asleep. And I have been a perfect sleep through the night sleeper my whole life. Was super rough.

Benzos didn’t really help. But what did was sleep restriction. I must have totally obliterated my circadian rather over months of dealing with the back pain.

So I set hard 6 hour sleep time every night. In bed at 1:30am. Out of bed 7am. Even if you don’t sleep a wink. Up same time. Then immediately go outside and stand in the bright sun. Spend zero time in the bedroom other than to go to bed. Rinse repeat. First couple days were brutal…but then it started to come back. I was tired again at night. My body was begging to sleep. And getting up in the morning got hard. And after two weeks…added 15 min. Earlier bed time. Two more weeks…15 more minutes. Two months later and im totally back to normal.

Yes and it was a magnesium deficiency. Try a pill with a good amount of magnesium (400+ mg). Jamieson magnesium + vitamin d 500 for instance: https://www.jamiesonvitamins.com/products/magnesium-d3

Magnesium is a great addition in any situation.

I recommend trying high-dose magnesium from magnesium chloride, it's easy to dissolve some (up to 15 grams at once) in some water and drink.

How did you settle on Mg cloride?

Mg orotate doesn't upset my tummy. Determined thru trial & error. I tried reading about the differences, but failed to understand.

Multiple sources say it absorbs best, it's also extremely cheap which means you can use it in baths, and topically in general.

Other forms bound to various amino acids like magnesium glycinate are good too, but you can also supplement those amino acids separately.

Magnesium chloride is water soluble so it's great to dissolve in your drinking water and drink throughout the day.

Note: Allergy sufferers who rely on Allegra have to be careful with when they take magnesium supplements since magnesium can sharply decrease absorption of Allegra.

I had severe bouts of anxiety and insomnia about a decade ago and by far the biggest improvement I saw was when I started taking magnesium supplements.

Is there a certain recommended time of day to take these supplements? Like at night so your blood levels of Mg rise to help you calm down?

Before bed

I take a multi every day, but I’ll try this.

Multi vitamins are generally a complete waste of money. Check how much magnesium and what type yours has. Magnesium oxide for instance practically does not absorb into the body.

> Multi vitamins are generally a complete waste of money.

I think we should be more careful about saying this. I've heard both professors and doctors say this, and then I've personally read the (reputable, mainstream) research papers showing that double digit percentages of people have various vitamin deficiencies.

I'll just Google real quick to see if I can find some examples of common vitamin deficiencies, but these are obviously just web articles, not research papers...

https://ods.od.nih.gov/factsheets/Magnesium-HealthProfession...

"Dietary surveys of people in the United States consistently show that many people consume less than recommended amounts of magnesium"

https://pubmed.ncbi.nlm.nih.gov/10357726/

This one recommends 120mg of vitamin C, but I've seen another that recommends 200mg, and I suspect a lot of software engineers are not eating enough fruit on a daily basis to meet the recommended level.

Also, what's the harm in taking a multivitamin? At a cost of under $1/day, if you don't need the vitamins, it's a small cost (< 1% of Bay Area rent), and if you do need them it may have an impact on your health.

I agree that a multivitamin doesn't usually include enough magnesium or vitamin D, but that's an argument for adding additional supplements, not to stop taking multivitamins.

Multivitamins are a waste because they are generally low quality. Vitamin d and magnesium are both very common deficiencies and like the OP demonstrated, they give people a false sense of security.

Unless we are talking about some high quality stuff like athletic greens.

Indeed, same goes for Vitamin D and Zinc.

To know your Vitamin D shortage, take a look here: https://vitamind3-cholecalciferol.com/vitamin-d-deficiency-t...

That link is interesting, thanks, but it doesn't appear to be run by a medical professional and some of its advice directly contradicts the NHS' own advice (https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-...) - I would suggest anyone contemplating overdosing vitamin D (more than 4000IU/100ug per day according to the NHS) should only do so under guidance from a doctor.

Yes of course, consult your doctor on any health related stuff.

Anecdotal: Around the time that I started my day job, I experienced light depressions during winters. For me it was just a winter-dip. I didn't think much of it but my then girlfriend (now wife) recognised that we got into fights much more often than during summers. She studied something along the lines of "Biology, Food and Health", and she thought I'd have a minor Vitamin D deficiency. I've started taking 75mg every day and after about 3 weeks I started seeing more vividly. I remember very well that when I walked out of the office during winter, even though it was near dark, I saw all colors much more bright and it was like a sort of pressure on my sight was gone.

Now, when I'm not in the sun during the day for at least 30-60 minutes (for maintenance in the garden, or working for clients during WFH in the garden), I take on avg 50mg (2000IU) every day and I've never had a dip anymore.

Interesting; a relative of mine was diagnosed with a mild deficiency and was told that it's very common in the UK - presumably even more so now we've all just spent the last twelve months stuck indoors. Seems like we could probably all benefit from supplementing at least some.

The one you recommend above seems to have at least some of it in oxide format:

"Elemental Magnesium (Oxide, bisglycinate, glycerophosphate, malate, aspartate)"

Unclear what ratio of each of the above.

Regardless it absorbs well. I've tried many and this one works best for me.

Don't discount the short-term use of sleeping pills to help you reset your rhythm a bit. Using them for a week isn't going to create a dependency, but it may be enough to help you get through whatever is making it difficult for you to fall asleep.

> Don't discount the short-term use of sleeping pills to help you reset your rhythm a bit.

Yes but before reaching for benzos maybe try something milder like zopiclone?

I think a lot of people don't really know the difference between benzos and Z- drugs, so we don't really know what the prescription was for. Also, many countries have decided that the research hasn't shown any reason to prefer Z- drugs like zopiclone over benzos for short-term use.

I took one, one night when I felt particularly hopeless. But I might just do the rest every night in a row to do that reset. In my mind I don’t want to “waste” them as it feels somehow safe to have them in my drawer just in case. It’s Temazepam btw.

if it's just for rhythm trying Melatonin first is better, since it doesn't cause lower-quality sleep and has no addictive properties

Yes, I went from somewhat normal sleep to about a month averaging 3.5 hrs. That average was composed of days of no sleep, followed by a crash. Rinse and repeate. My GP gave me a benzo, Lunesta and some other new worthless z-drug (orexin receptor antagonist). None of it worked.

GPs & sleep medicine physicians are worthless for insomnia issues. You need to see a psychiatrist. Sleep issues are a huge component to mental health treatment, so they have much better insights. And since you've correctly identified that anxiety is related to sleep loss, psychiatric help is doubly useful.

Talk to a psychiatrist about low dose trazodone, mirtazapine or seroquel. They have relatively good safety profiles and are not habit forming like benzodiazepines. They also act like a safety blanket; I know that if I'm having trouble sleeping they will knock me out and right the ship. That is super helpful at releasing the anxiety around 'I can't sleep'.

And of course, if you have other stressful things in your life, you need to focus on working them out. Stress doesn't just 'release itself' because we are going to bed. Having a high base level of stress throughout the day makes sleep difficult for _everyone_.

For a long time I had problems falling asleep, no matter how physically or mentally tired I was. And after some introspection I found out that I could not fall asleep because I kept thinking actively about the day that passed or making plans for the next day.

Now I can fall asleep in 10-15 minutes by focusing that mental energy into imagining a favorite place and once the image is established in my mind I let go of control. Then the image kind of comes alive on its own - I like to imagine a clearing in a forest so all kind of creatures appear randomly. I think all this random auto-generated sensory input overrides the real one allowing me to fall asleep.

Of course, it helps if there are no sudden changes in your real environment (loud sounds, sharp changes in lighting, etc.)

It sounds crazy, but it works for me.

It sounds a bit like the way mild depression affected my sleep during covid. I wasn't obviously depressed--still exercised, did my job, etc--but my doctor said that may be a cause of my sleep issues. He suggested spending more time outside, more time with friends (outside), etc, etc and it did the trick.

Try the benzos or a mild andidepressent (discuss with your doctor of course). Do not take more than the prescribed dose (maybe even start with half of it). The important thing is to use it along with a solid bedtime routine. Same time, lights out, no TV, etc. I had a bad experience with it when trying to use it as a replacement for a bedtime routine, but its been wonderful in addition to a routine when I needed the help.

I struggled with a very similar situation 2 years ago and my heart goes out to you - it can be brutal.

But I did want to offer a ray of hope. After trying everything under the sun for months (including benzos), someone told me about CBTI (Cognitive Behavioral Therapy for Insomnia). Rather than go into all the details, just Google it. Its really the only proven successful (non-drug) way of dealing with insomnia (notice I did not say 'cure').

My only advice for those looking into CBTI is DO NOT TRY TO DO IT ON YOUR OWN. Its a very rigorous program that should be supervised by a doctor who specializes in CBTI. If you try it on your own, you are likely to fail - it can be a challenging program to follow through on.

Be careful about the benzos. They are extremely habit forming (again Google it) and can be difficult to stop.

One key point that my CBTI doctor talked about. Sleep is generally a combination of 2 factors. Your natural daily rhythm (day = awake; night = sleep) and how long its been since you last slept (ie. nap at 6PM is bad idea). If either one of these gets out of whack, sleep will be difficult. CBTI helps you align these two factors.

Lastly, in my case, I believe the insomnia was a symptom of a depression that I found myself in. Treating the depression along with CBTI was (literally) a lifesaver for me.

That is weird, I have the exact same problem. Just that it has been going on for a few months. It became a little better in the middle but now I am back to the same problem. My eyes are burning,so tired but I cannot sleep. And even when I sleep it is not the deep sleep I used to have.

For me atleast it started like 5-6 months ago with VIVID dreams and then around 2-3 months ago the lack of sleep started. It started with an anxiety attack about a health scare.

Went to the doc, got some anti anxiety meds, got some tests done. Nothing looks wrong according to the doc. The meds made me drowsy constantly but did it for 2 weeks. Slight improvement. And now it feels like I am back to square 1

It started for me after I got vaccinated and rode in public transport for the first time in a year. I was reading some articles back then on HN about how readjusting to “normal” life is particularly difficult for some people. I’m thinking it might be this. Inner turmoil that life will be normal again and the stressors of life will come back. I dunno.

If you can, and haven't already, take up running/jogging/walking. I'd be a mental wreck without it and the quality of my sleep is inversly proportional to how regularly I'm running. No running means lying in bed for 60-90 minutes before sleep. Running means out-like-a-light in about 45 seconds. I might even be stressed about something but my brain in just like 'LOL no bye-bye.' This plus at least 10 mins of meditation at some point during the day, just sitting somewhere pleasant and stepping off the thought merry-go-round and internally looking the other way for a while.

Regular, daily exercise in general is the key. I wouldn't recommend running as most people only have hard pavement to run on and it's too high impact. Brisk walking, cycling, swimming and weight training are all low impact and better. But I do think getting outside is a rather important part of this too. Even if I'm doing exercise, living a life between buildings is not good for my health.

I run 3x a week. I would like to every day, but my shins won’t allow me to.

Shin splints can be fixed. A good physiotherapist can tell you what's wrong.

Bad running form (over striding, low cadence), weak core and hips, weak glutes, pelvic tilt, bad desk setup, one body part overcompensating for another, and so on all lead to typical running injuries.

Do you mean just before bed, or in general during the day?

It's not recommended to do high intensity exercise right before bed. This can cause difficulty sleeping. Get the high intensity stuff done at least a couple of hours before bed.

"According to this study[1], morning exercise might be more helpful; there is no sign that evening exercise disrupts sleep, but it might not help as much either."

From https://lorienpsych.com/2021/01/02/insomnia/ which also has other advice

[1] https://sci-hub.st/https://www.sciencedirect.com/science/art...

One positive effect of morning exercise may sinply lie in the associated tendency towards increased exposure to natural (i.e. more intense) light in the morning hours [I don't have a quote at hand, but Prof. Andrew Huberman speaks about the effects of calibrating one's circadian rhythm by morning light exposure in his YouTube podcast.]

Exercise very close to bed affects many (myself included) as it can take a little while for your increased circulation/elevated core temperature to return to normal. Otherwise a few hours before bed shouldn't be a problem.

I’ve had chronically bad sleep for most of my adult life, but the last 12ish months has been the best, most consistent sleep I’ve ever had. I think I’ve finally hit a good combination of helpful things. I was diagnosed with an anxiety condition, and working to improve that has helped my sleep to a life changing amount.

A jog or sprints most mornings, followed by meditation, and a low dose of lexapro (5-10mg). At night a melatonin and mindful breathing usually gets me to sleep within 20 minutes, instead of hours.

I am interested in taking an anti anxiety med, but I find the sexual side effects terrifying.

For me there hasn’t been a huge impact, I just take half a dose (5mg) or skip it for the day and everything is sweet. Spoke with my GP about it and he said after 6-12 months the body should adapt and Things should function well.

I had this exact situation, it led to panic attacks eventually.

Come to find out that the reason was apnea. I'd drift to sleep, have an apnea event and wake back up. I didn't feel like I was suffocating, but more that I just couldn't sleep. After 5 months on a CPAP I'm finally starting to feel like my old self.

Find a clinic that is specialized in sleep medicine (e.g.[1]), they might be able to diagnose you. This could be caused by some underlying disease.

[1]https://med.stanford.edu/sleepdivision.html

One thing which has helped me is to listen to a podcast or any audio of your favorite topic while lying down. Initially your mind will try to remain attentive but after 20 min or so it becomes harder. After a while you will feel so sleepy that you would want to stop the audio.

I use an Android app for this called "Simple sleep timer"; I set it to Fade out and close the youtube app after 30 minutes.

I've listened to the episodes of the same production for almost 3 years now; The Ricky Gervais show / podcast. Hilarious and lighthearted, always takes my mind off of anything else.

I fall asleep with podcasts all the time, makes for some weird dreams related to whatever is discussed. But I find the sleep quality is not the best.

Does your podcast tool have an "auto-sleep" function to turn it off after a while?

Oh, thanks, I might try that. I do remember a period years ago when I had the habit of falling asleep in front of the TV. I would put the TV on a timer and at 2-3am the sudden silence when the TV turned off would wake me up.

Yeah, I also have found the abrupt jolt of silence (from podcast or audiobook) can jolt me awake, and also that all-night droning on also disturbs me and wakes me up.

Apps that can slowly fade out the sound are great. The Audible app fades out very quickly, but even that quick fade is enough not to wake me if I am already asleep.

(If I am awake, though, I find that it disturbs my "almost asleep" vib, so I wish they had an option to fade out over x minutes.)

My wife puts on some of the investigative TV shows where the anchor has a droning, monotone voice. (Using earbuds)

Do try the benzos, they will help, and in the short term it might be the best option you have. If you are seeking something lighter, guaifenesin (an OTC muscle relaxant available under different brand names) can help according to my experience to give you the 'kick' from "sinking" towards sleep to really sleeping. And, importantly, give up as much caffeine as you can, if you are consuming any. Caffeine shifts your inner clock.

Otherwise, as other have suggested D3+magnesium, and physical fatigue can really help a lot (as tired muscles can then signal to the brain that they really want to sleep).

Since you mention it only started about three weeks ago, I would try to look at what's changed in your environment (if you haven't already).

When you say you cannot sleep, do you mean you didn't fall asleep for full 3 weeks a single time?

I end up lying awake until 4 am and then have some very very light sleep for about and hour or two. My Garmin shows me that I get no deep sleep at all.

If it came on sudden I would say look for changes in your direct environment. Something dramatic? Did you maybe hurt yourself? Did you start eating a new food? Someone pop back up in your life that you thought was gone? That sort of thing. If you can not bisect the issue a sleep study would be better. Medication may help but it may mask the underlying issue.

For me it was more of a realization it was my diet. I changed my diet to remove some particular types of foods and now I sleep good. If I eat those foods I sleep like crap. Pop a tums and I am good (it is the upset stomach waking me randomly, so the bad sleep). Everyone has different reasons why. But the top ones are typically stress, injury, or food are a good place to start.

check this out - https://insomniasos.net/, and Huberman's guide on sleep - https://www.youtube.com/watch?v=nm1TxQj9IsQ

Any naps during daytime?

No - I’ve never been able to nap.

Just my personal opinion: go to a doctor with a sleep laboratory and get consultation there. Also if I were you I would try to get a brain CT scan.

This sounds a bit like it could be the prodromal phase in psychosis. I would take this seriously.

I'm sorry you’re going through this, I recognize it.. actually it's the first time I see someone else explaining the sinking and lack of 'click'. I’ve struggled for 2 years, but am slowly doing better now. I can tell you more if you'd like but I don't want to flood this thread.

[shortened backstory]

- Always had normal sleep, even in stressfull times - 2 years ago, over the span of a few days my sleep went away: from 5 to 3 to 0 hrs. I then was awake for 2 days. And after that only slept max 3 hours for ages (nearly a year). - I couldn’t take naps - I lost all my energy (could hardly walk for 15), thinking etc - had to chase after specialists to check things, and correct them on their assumptions... which was emotionally exhaustive. - It led to them seeing symptoms of an endless list of possible causes, but they never found a culprit. - One hypothesis was that I was struggling with the results of a virus, and basically was left with all kinds of damage. - I was constantly asked about / advised on bed / food / daily routines, even though mine were identical to their advice (perfect) going into this, and I had been stress free.

[ on improvement ]

+ It’s hard to say if it helped me improve my sleep, since I continued to struggle, but a very strict (though fairly standard) bed routine did make me feel more in control: * same time to bed every day, pre-bed routine of stretching the body, cooling my hands and feet, while in bed stretching the face muscles and ‘yawning’ * no exciting media or social meeting / discussions in the evening (or close to bed time) * using an app to play the same comforting / funny podcast every night, and having it fade out after a set time (the Ricky Gervais show / pilkboys yt channel) * For a while I developed my own meditation routine in bed

+ asked people to not ask about my sleep, just how I’m doing + be very open, forward, non apologetic about your condition + there might have been an influence of some gut problems I had, which were eventually treated by antibiotics + I’ve been prescribed temazepam and diazepam to at least calm my body down, and it made me feel closer to sinking into sleep – but never really went all the way. I got semi addicted to them, and hated the desperation I had to at least have some control over my body. After I got off them, and my twitches had declined, I only used temazepam if im on my way to a second sleepless night in a row. So I don’t reach for them on th occasional setback, but I’m glad they are there if it escalates.

+ I focus on daily activities, and excused myself from existential worries + I’m now up to 5 / 6 hours on a night, not necessarily of quality, but I don’t feel terrible every day

>all she did was give me benzodiazepines

What a hack. Have you tried melatonin?

Yes I have, including formulations with vitamin B, and other herbal remedies.

No effect.

I can only recommend book by Matthew Walker 'Why we sleep - The new science of sleep and dreams'

I really wanted to love this book, and I was if anything biased heavily towards believing it. I read it cover to cover in less than a week.

Sadly, I found that book made my sleep worse. (A quick Google will show I'm not alone).

Also there is a lot of debate around the quality of the research underpinning the book, this is the most prominent article: https://guzey.com/books/why-we-sleep/

Also I really do not love his subsequent rebranding as "The Sleep Diplomat" https://www.sleepdiplomat.com/

I'm glad if it made your life better, but I cannot recommend it, and won't see it recommended without comment.

I had the same reaction to the book. I love the content and the science behind it but it impacted my sleep for the worse.

Once I stopped worrying about whether I was having enough sleep every night, I got back to my previous, not ideal but better, sleep patterns.

Being a night person I just wish I could wake up late rather than having to be up early for work but it's better to sleep well for 5-6h than really badly for 3-4h.

That is very interesting perspective, my quality of sleep definitely improved by compartmentalisation of sleep.

And when I can't fall asleep I just get up and do something out of bed (for 15mins until I get bored).

Walker responded to some of his critics here:

https://sleepdiplomat.wordpress.com/2019/12/19/why-we-sleep-...

If anything the poor reasoning (almost all of which is weak correlations) on display on that page makes the criticism even more justified.

I'm not familiar with the book but when you say "the book made my sleep worse", do you mean following the advice in the book made it worse, or simply reading the book made it worse?

The fear of the effects of not sleeping, which I believe are significantly overstated in the book, actually provoke some including myself into having a sleep interrupting fear of not sleeping.

The link above has a section on the possible negative effects.

So yes, just reading it had a negative impact. I'm over it now. Just don't recommend it.

Yeah, I have experienced something like this, and ultimately (after trying like every fucking thing, including quitting smoking (the first onset of it was 15 years ago when I still smoked), quitting alcohol, running and weightlifting during the day, "natural" supplements (melatonin, L-tryptophan, 5-HTP), more sex, less sex, vegetarian diet, meaty "paleo" diet, and a bunch of other shit) I indeed started taking zolpidem (Ambien) whenever I'd had a few bad nights of sleep in a row, and didn't feel like I could tolerate another one.

It did work, for over a decade, for me. I also didn't want to take it though, so I seldom took it more than four times in a month, and often went a few months without any.

In my case, bouts of this kind of insomnia (tired, feel like I might be able to sleep but just can't) happen seemingly at random, every few months, and not connected to any identifiable stressor. (I feel like it might be more likely to experience another insomnia episode when work is too hectic or I have some kind of stressful situation going on, but it definitely also happens when everything is fine). They last days or weeks.

I'd never been able to fall asleep easily (was a night person from high school onward) but I was able to sleep in late once asleep. This changed about 12 years ago, in my early 30s, where I had the first episode of real insomnia. I couldn't sleep well for a week, laying in bed from 23:00 to 3:00, 4:00, finally 7:00 AM.

I visited over 10 sleep specialists and doctors (this was in Tokyo, Japan). They gave various conflicting advice, all of which I tried, but nothing worked for me but the drugs. (I tried a bunch of different drugs, but ultimately zolpidem was the one that, of those that pretty much guaranteed I would be able to sleep, had the fewest noticeable side effects.

Recently my doctor instead prescribed me etizolam, which is a thienodiazepine (but basically, a benzodiazepine), and this also works. I prefer this one because, for me at least, zolpidem causes a kind of drunk/high/bad-judgement "I'm on drugs" feeling and has scary stories about people doing stuff they don't remember later.

Etizolam (1mg for me) relieves the insomnia without the druggie feeling. (It does make you feel good though, and I suspect there is a high risk of dependency if you take it every day.)

After taking a keen interest in this topic over many years (just for the obvious, selfish reasons) I think there are probably many reasons this can occur, and YMMV. But I have never gotten any of the non-drug "remedies" to work.

Even months/years of a heavy exercise regimen, like barbell weight-lifting — which definitely helps me sleep longer and better in general — doesn't seem to have any effect on these episodic bouts of insomnia.

From that standpoint, the drugs have helped me manage it. I never have a full week of bad sleep any more, and eventually each episode of insomnia goes away on its own.