Struggling with Sleep Issues: Seeking Solutions for Better Rest

Sleep issues

Hello, doctor.
When I was younger, I could fall asleep instantly and sleep through the night until morning.
However, over the past decade, I have gradually developed issues with staying up late and difficulty falling asleep.
In the past, this was not a significant problem, as I could compensate for any sleep deprivation by napping in the morning, and I did not experience any lethargy.
However, in the last month, I have been unable to sleep during the day as well.
For the first time in my life, I sought help from a family medicine clinic and a large hospital regarding my sleep issues.
I tried taking Ambien twice, but I felt uncomfortable upon waking and was concerned about addiction, so I stopped taking it.
I then switched to melatonin (given to me by my daughter), but the effect was not significant; even after taking a 5mg tablet before bed, I would still wake up after two or three hours.
Throughout the day, I have no desire to sleep until after dusk, when I feel extremely sleepy, similar to experiencing jet lag after a flight.
However, I worry that if I fall asleep, I won't be able to sleep at night, so I resist the urge to sleep or take short naps while sitting (sometimes I deliberately take a bus to sleep on it, which seems to help).
I usually go to bed around 10 or 11 PM, but I wake up around 1 or 2 AM and cannot fall back asleep, creating a vicious cycle.
Although my daily routine is normal, my left eyelid has been twitching for several days and has not yet recovered.
Sometimes I also feel physically and mentally drained, which makes me fear for my future health.
I am unsure how to treat this.
Please help, doctor.

Ong Picton, 60~69 year old female. Ask Date: 2020/09/21

Dr. Wang Zhenbang reply Psychiatry

Hello, a person's sleep patterns may change with age and other factors.
Here are 10 recommendations for better sleep, especially note the 10th point:
1.
Maintain a regular schedule.
(Go to bed and wake up at the same time.
Regardless of what time you fall asleep, you should wake up at the same time.)
2.
If you experience insomnia, try to avoid napping during the day.
(You should stay awake during the day and limit naps to no more than one hour if absolutely necessary.)
3.
Ensure a comfortable mattress and a quiet room.

4.
Do not engage in activities other than sleep and sexual activity in bed.

5.
Exercise regularly and moderately every day.
(However, avoid vigorous exercise in the evening.)
6.
Avoid stimulants or energizing foods and habits.
(Alcohol, coffee, tea, smoking.)
7.
Do not overeat at dinner.
(You may have a cup of warm milk or a moderate amount of carbohydrates before bed.)
8.
If you find yourself unable to sleep after 20 minutes in bed, it is recommended to get out of bed and do something boring and monotonous.
(Avoid watching engaging TV shows or movies.)
9.
When you can't sleep, do not keep staring at the clock.
Relax and do not feel anxious about needing to fall asleep.

10.
Visit a healthcare facility to check for other potential underlying causes of insomnia and treat them accordingly.
If it is simple insomnia, there is no need to overly worry about the addiction potential of sleeping pills; use them as directed by a qualified physician.
If you have any issues or side effects with the medication, continue to discuss them with your doctor for further adjustments.
Wishing you a good night's sleep!

Reply Date: 2020/09/21

More Info

Struggling with sleep issues can be incredibly frustrating, especially when it begins to affect your daily life and overall well-being. Based on your description, it seems you are experiencing a combination of insomnia and possibly some anxiety related to your sleep patterns. Here are several strategies and insights that may help you improve your sleep quality.

Understanding Your Sleep Issues
1. Sleep Cycle Disruption: It appears that your sleep cycle has been disrupted, which is common in individuals who experience prolonged periods of stress or anxiety. The fact that you used to sleep well but have recently developed difficulties suggests that there may be underlying factors contributing to your current state.

2. Sleep Anxiety: The fear of not being able to sleep can create a cycle of anxiety that further exacerbates your insomnia. This is often referred to as "performance anxiety" regarding sleep, where the pressure to fall asleep leads to increased wakefulness.

3. Physical Symptoms: The left eye twitching and feelings of fatigue may be manifestations of stress and lack of sleep. Chronic sleep deprivation can lead to various physical symptoms, including muscle tension and fatigue, which can further impact your mental health.

Recommendations for Improving Sleep Quality
1. Establish a Consistent Sleep Schedule: Try to go to bed and wake up at the same time every day, even on weekends. This helps regulate your body’s internal clock and can improve your sleep quality over time.

2. Create a Relaxing Bedtime Routine: Engage in calming activities before bed, such as reading, taking a warm bath, or practicing relaxation techniques like deep breathing or meditation. Avoid stimulating activities, including screen time from phones or computers, at least an hour before bed.

3. Limit Naps: While napping can be tempting, especially if you’re feeling tired during the day, it can interfere with your ability to fall asleep at night. If you must nap, keep it short (20-30 minutes) and avoid napping late in the day.

4. Optimize Your Sleep Environment: Ensure your bedroom is conducive to sleep. This includes a comfortable mattress and pillows, a cool room temperature, and minimizing noise and light. Consider blackout curtains and white noise machines if necessary.

5. Mind Your Diet: Avoid heavy meals, caffeine, and alcohol close to bedtime. These can disrupt your sleep cycle and make it harder to fall asleep. Instead, consider a light snack if you’re hungry before bed.

6. Physical Activity: Regular physical activity can help you fall asleep faster and enjoy deeper sleep. However, try to avoid vigorous exercise close to bedtime, as it may have the opposite effect.

7. Cognitive Behavioral Therapy for Insomnia (CBT-I): If your sleep issues persist, consider seeking professional help. CBT-I is an effective treatment for insomnia that focuses on changing thoughts and behaviors that contribute to sleep problems.

8. Medication Consultation: Since you mentioned trying melatonin and experiencing discomfort with other sleep medications, it’s essential to consult with a healthcare provider about your options. They can help you find a suitable treatment plan tailored to your needs.

9. Monitor Your Sleep Patterns: Keeping a sleep diary can help you track your sleep habits and identify patterns or triggers that may be affecting your sleep. Note the time you go to bed, wake up, and any awakenings during the night.

Conclusion
Improving sleep quality often requires a multifaceted approach. By establishing a consistent routine, creating a conducive sleep environment, and addressing any underlying anxiety or stress, you can significantly enhance your sleep quality. If these strategies do not yield results, it may be beneficial to consult a sleep specialist or a mental health professional for further evaluation and tailored treatment options. Remember, prioritizing your sleep is crucial for your overall health and well-being.

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