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Old 05-20-2015, 07:26 AM
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Default Sleep Problems

One of the most common problems I hear in my practice is about sleep problems- especially in those middle aged and older. People either complain about not being able to sleep until 5AM-- and then it's time to get up, or only sleeping in 2 hr episodes and then waking "to go to the bathroom" all nite long.

Any other travelers in this same boat?
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Old 05-20-2015, 11:37 AM
connie189 Female connie189 is offline
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Do you refer your sleepless patients to a sleep disorder specialist?

I sleep like a rock and soon as my head hits the pillow. Will sleep 7 hours unless some drunken student is bellowing in the alley or I pick up through my sleep someone trying to pick a lock next door.

Hubby has intermittent episodes of not getting to sleep.
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Old 05-20-2015, 07:35 PM
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Sure!

I have sleep apnea, and I never could sleep with that airway machine. The machine keeps me awake.

I learned to position my head so that my windpipe stays open. To ensure that it is correct I deliberately shut my throat, and then I relax. If my throat stays closed I do not have it right, yet.

To breath is instinctive, so if I simply relax my body will keep enough tension in my throat to keep my airway open, and I don't even notice it. Until I fall asleep

If m head is not positioned carefully enough, when I relax because I am falling asleep my windpipe will close and I wake up.
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Old 05-20-2015, 10:23 PM
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In my 40 yr career, I've diagnosed sleep apnea in at least 100 people. Maybe 3 of them have tolerated the d*mn machine and actually use it. Nobody has dropped dead because they don't use it. They're just tired alot because they only get shallow, disrupted sleep.

I don't refer to "sleep specialists" because that's a boondoggle. As I see it, there's three types of sleep problems: [a] the problem common to many 50 y/o +-- waking up every two hrs [2] tossing and turning until 5AM, then ready to sleep, but it's time to get up, and [c] cyclic insomnia- insomnia for a week or so, then too sleepy for a week or two, then insomnia again etc etc.

We sleep in two hour cycles: fall asleep-->REM sleep-->shallow sleep, then repeat. When we're young, we stay asleep for 4 cycles, then wake up. After middle age, it's common to wake up between cycles. Don't fight it. Just relax. You'll go back to sleep (after going to the bathroom).

Then there's the problem of your body being on a schedule that you want to sleep from 4AM to noon, but your obligations say you gotta be up at 6AM to go to work. You hit the sack at 10PM, but you can't make yourself sleep. Teenagers are often on this schedule. Solve this problem by working nites. Some people are just night owls.... OTOH, old folks, like me, often poop out at 7PM and are ready to answer the fire alarm at 4AM. This variation in schedules worked out well for the cave men: there was always someone in the clan ready to guard the cave entrance at any given hour.

The last type of problem is one where your body is on a natural cycle of, say, 28 hrs, but the sun is on a rhythm of 24 hrs. So you start out more or less in sync with the sun: you're awake days and sleep nites, but each day puts you a little further out of sync until you're exactly opposite the sun phase: you wanna sleep days and are awake nites. Keep on pluggin'. You'll soon re-synchronize with the sun, only to go off schedule again.

There's another less common sleep problem. You'd swear you're awake all nite, but in fact you are asleep to anyone looking in on you. Part of your brain does stay "on" all nite while the rest of it is asleep. Those other problems are solved by patience and adapting to the problem, but this one may need some medication. "Sleeping pills" don't really make you sleep, they just give you amnesia so you don't remember not sleeping. (cf-pts taking Ambien who get in car accidents and not know they were out driving.)
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Old 05-20-2015, 10:24 PM
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I have a hard time falling to sleep.
I go to bed at 9 PM every night but never get to sleep before 10 or 11. I wake up around 4 AM every day. Sometime even earlier and I rarely get back to sleep.
I have Apnea and I wear my CPAP without fail. I never, ever sleep without it.
I used to wake up to go to the bathroom a lot but my Urologist fixed that problem.
Last night I slept pretty well.
I had a beer while I grilled steaks.
I may start doing like my 89 year old Grandma did.
A shot of Macnaughton whiskey every night right before bed.
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Old 05-20-2015, 10:42 PM
connie189 Female connie189 is offline
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Makes sense that one doesn't remember not sleeping...

Had one sleeping pill in the hospital (day three of bad infection). Weird stuff...

Didn't like it all. Didn't think I slept, either. Wasn't sure what it was, but wasn't sleep (as I know it, anyway). Felt more tired than if I went without, which I did afterwards and felt better about it.
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Old 05-20-2015, 11:49 PM
susang Female susang is offline
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No sleep apnea for me. I do have Interstitial Cystitis, so I do get up for bathroom a fair amount. I fall asleep about 11pm awake about 3am. It's either bathroom or hip I'm on burning.
Doc what about inability to sleep and PTSD?
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Old 05-21-2015, 01:08 AM
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Quote:
Originally Posted by doc View Post
"Sleeping pills" don't really make you sleep, they just give you amnesia so you don't remember not sleeping. (cf-pts taking Ambien who get in car accidents and not know they were out driving.)
Your comments about Ambien reminded me of the conversation with a colleague, who knew I had a prescription for Ambien and wanted to ask me a few question one morning. [I take them very sparingly, with 30 tables lasting me 6 - 8 months or more, but I still have a few tablets from my last prescription.] Now on to my colleagues story.

She had been having a problem sleeping and spoke with her doctor about something to help her sleep. Her physician prescribed Ambien in a 25 Mg dosage for her sleeping problem! Wow. She would weight maybe 100 pounds soaking wet, with clothes and shoes on, as the old saying goes.

She started out, the first night she took one of the sleeping tablets, she awoke to the sounds of her alarm ringing. When she reached to turn the alarm off, she said she noticed her forehead seemed a bit sore, and it was like viewing a very vivid dream in her mind that she was rocking in her rocking chair and turned the rocking chair over striking her head on the fireplace. Well she thought that couldn't be correct since she did not have a fireplace. When she turned the cover back to get up, she said she was still fully dressed.

She continued that just was not right, because she never slept in her clothes, she always dressed for bed in sleepwear. After getting up, she walked into the living room and sure enough her rocker was overturned and the way it was turned, she said I could have hit my head on the coffee table.

The lady was divorced and single, so after eating and doing her dishes the second night, she dressed for sleep and took a glass of water to her night stand by the bed. After sitting down on the edge of the bed, she said thinking to herself, "If I swallow the tablet real quickly, maybe I can stretch out and cover up without getting myself into any trouble tonight."

Then she read some magazine articles with stories others related after taking Ambien which concerned her so she said she quit taking the pills, but was curious to know what kind of stories I could tell about my experiences with Ambien.

I told her nothing like she had just related to me, but my prescription was for 5 Mg. Ambien. I asked her why her physician had prescribed a first time user, especially of her size such a large dosage. She did not know, so the question was essentially just a rhetorical one.

I suggested she cut her tablets in half, which would still be 2.5 times the dosage I was using. She had already flushed her Ambien prescription down the toilet she said after her own personal experiences, but thinking back she did express regret at being so hasty to discard the tablets. She said she did not want to get up and drive to work in her night gown, or do something worse, so she decided to get rid of them.

My written account of this conversation, does not do it justice or provide the humor and direct impact of my colleague telling her story to me of taking her first Ambien sleeping tablet. Apparently there are others like my friend, but I will never forget our Ambien conversation.
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Old 05-21-2015, 07:11 AM
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Originally Posted by susang View Post
No sleep apnea for me. I do have Interstitial Cystitis, so I do get up for bathroom a fair amount. I fall asleep about 11pm awake about 3am. It's either bathroom or hip I'm on burning.
Doc what about inability to sleep and PTSD?
Pts often insist they are waking up because they need to go to the bathroom. I think it's usually a matter of waking up between those 2 hr cycles and then feeling "Well, I guess I gotta go." If you're sleepy enough, you can ignore that urge and fall back asleep. With IC, the urge might be difficult to ignore.

Same argument about pain. It's usually not severe enough to actually wake you from a deep sleep, but difficult to ignore when in a shallower stage of sleep.

Consider PTSD a particular variation of the more general problem of anxiety and it's easy to imagine how it would affect sleep- your brain just doesn't want to slow down & turn off.

BTW- note the time of this and my initial post. I've been up for an hour already. I have a combination of the 2-hr-cycle problem and the 28-hr-biorhythm problem. Oh, well. Why fight it? At least it's quiet around here at this hour and nobody bothers me
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Old 05-21-2015, 09:44 AM
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doc without knowing my medical history I thought you might find this interesting. I was taking a shot of whiskey every night before bedtime. I seem to sleep fine. My Dr. then said no more whiskey take a Benadryl before bedtime. Then the Benadryl study came out that it was linked to Alzheimer disease. So now my doctor only suggests I try Nasacort at night and maybe a Zyrtec in the morning. Which seems to work. I was going to bed t 10:30 and waking up at various times at night especially at 1:30, 2:30, 3:30, 4:30, 5:30, 5:45, 6:00 and 6:15 when the alarm went off. With my current routine I only wake up at around 3:30 and then 5:30 and there after. Yes I have allergy problems. Yes I do not work and I am wheelchair bound with HSP. Yes my wife works 2 jobs, snores alot (no sleep apnea), and falls asleep in her chair and comes to bed the times I mentioned depending how tired she is. Since she brings in all the income our house is dusty and we can not afford a housekeeper. (that is one of her second jobs). I did find out over last week I was sleeping the best when going to bed at 9:00 or 9:30. Then I read if you sleep more than 8 hours you have a higher risk of a stroke. The days I went to bed earlier I did not take my nap after lunch for 1 or 2 hours. I said all of this for you to add this to your notes in case it may help someone.
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Old 05-21-2015, 12:25 PM
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I'm glad to hear about the normal 2 hour sleep cycles doc.

Before I had RA I would sleep for 8-9 hours all the way through. But since having RA I am awake every 2 hours like clockwork. I do follow the same exact routine each day and go to bed the same time every night.

I had written this off as a byproduct of RA but it seems maybe not. I am always in some sort of pain 24 hours a day but not any more so when I wake at night so I don't think it is the pain waking me as you say.

After reading your post I feel better about it now - that it is just more of a normal occurrence with getting older. Then add to the fact of my inactivity now compared to my pre-RA self and it all makes sense. Most times I do fall back asleep fairly easily and wake up fairly refreshed in the morning. Also the ongoing fatigue and brain fog of the RA force me into a 45 minute nap or two every day.
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Old 05-21-2015, 02:25 PM
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I have sleep problems but i know the cause. its the result of PTSD, nightmares are a part of it, but also from being hyper alert, any sudden unexpected noise can wake me, or if i am just falling asleep bring me back to being fully awake and alert.

best thing for it is to live far away from people
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Old 05-21-2015, 03:14 PM
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I used to have the "racing brain" problem. It would prevent me from falling asleep unless I had something to interrupt the stream of thinking. I discovered that the radio would do that. Music doesn't, but any type of talk radio would do it as long as what was being said didn't make me angry or start the streaming thoughts in another direction. As I have aged, my mind has slowed down, but I find I get cramping or restless legs that seem to wake me up. I started with a calcium supplement before bed, and that helped some; I found a calcium-magnesium supplement HS made that problem go away. I still had the restless legs since my accident. My massage therapist suggested that I take a glass of tonic water before bed. She said the quinine sometimes seems to quiet restless legs. It seems to work great for me. If I take the cal-mag and the quinine before bed, I sleep peacefully through the night--sometimes for nine hours straight.
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Old 05-21-2015, 03:47 PM
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I was wondering if the subject of white noise would come up. I've thought about it often since having problems sleeping.

Now living where I do it is dead silent at night unless the Spring Peepers are going at it so you would think I would be used to the silence. But one thing I have found is that when I have the window fan running all night in the warmer weather I seem to sleep much better.

I've worked with a couple guys over the years who say they have to have a fan running in their bedroom every night in order to sleep.

I get what I think is restless limbs going when I am tired and sitting in my chair but I think mine is more joints aching from the RA - I don't feel it is in my muscles. Also I don't have a problem with it when I get into bed for some reason.
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Old 05-21-2015, 05:35 PM
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Currently I am on a 3 hour cycle. It changes, and I truly believe it is moon related.
Things I have found to help me sleep are :

No nap after 4 pm, not even a minute.

No caffeine after noon, and all soda will keep me awake. Oddly enough, an occasional cup of regular coffee has no affect on me, but a glass of tea is a no-no.

Ibuprofen 3 nights in a row will keep me awake, 5 nights will make me think I am suicidal, seriously. My first 2 Dr's I told that to, are know longer my dr's. They didn't believe ibuprofen would do that. My current Dr doesn't say either way. 2 days are all I take it, if I need more relief, asprin and tylenol for a few days. One of my wife's lady friends told their group she thought she was going crazy, lots of pain, living on Ibuprofen. Wife told her my story, she's now a believer as well.

All pm over the counter stuff keeps me awake, and then the whole next day I feel drugged.

Things that help me sleep are:

A hard days work .

A (1) shot of whiskey. Odd side note, this also cures heartburn within 5 minutes, ymmv.

Raising my upper body a few inches.

I have never tried this, but, I think the white noise machine would help also. I do know fan noise helps, but, I don't like the air movement. Fan in the basement works, I can hear it and not feel it.

Maybe this will help someone, my wife thinks I'm odd.
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Old 05-22-2015, 03:47 PM
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I was born an insomniac. I think I was 15 before I learned that laying awake for 3, 4, 5 hours every night was not normal. There were times I went an entire week without sleep, for no reason whatsoever. Just because I couldn't fall asleep. Things got more fun in my mid 20s, when i developed Restless Legs Syndrome, only with me it was more like "Restless Whole-Body Syndrome". I swear that even my hair was twitching.

Things that helped:
-Learning I had Central Sleep Apnea, and how to manage it. Central is different from the snoring kind, so there were no outward symptoms anybody could point to. But realizing, in my dreams, that I was suffocating, usually terrified me out of any more sleep that night.

-Scullcap. It's an herbal muscle relaxer, works wonders on restless, twitchy muscles.

-Tylenol PM. It puts my brain to sleep, while the scullcap puts my body to sleep. The combination has been a Godsend!

-How-to books. On nights when I'm stressed or when my brain just won't shut down in spite of the medication, I read how-to books or herbal guides. The key is to find something interesting enough to keep my attention, but boring enough not to get my adrenalin up. Usually this quiets my mind enough for the Tylenol to work.



I was prescribed Ambien for a little while. I took it for 3 days. On the 3rd day, I was halfway through my shift at work and suddenly realized that I had no idea how I got there. The last thing I remembered was going to bed the previous night. Scared me out of taking it ever again!
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Old 05-22-2015, 07:52 PM
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Caveat (non)dormitor:

OTC sleep aids are usually Benadryl or close cousins. Antihistamines do have mild sedative effects and can be helpful, but us old geezers with prostate problems may wind up with severe urinary obstruction.

While alcoholic beverages can make you sleepy, when they wear off after a couple hours, it may cause a mini "DTs" in some people, an increased state of arousal, actually making the insomnia worse.
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Old 05-22-2015, 10:52 PM
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Originally Posted by coaltrain View Post
I was wondering if the subject of white noise would come up. I've thought about it often since having problems sleeping.

I have a Kindle Fire. I put a app on it that has several different sounds from birds, trains, fans, water falls, stream etc etc.

I find even with the ceiling fan a table top fan helps a lot.
I will get so sleepy early in the evening, around 8. Then I wake up and sometimes get sleepy again around 10:30. But if I go to bead before 1 or 2 am I'll wake up at 1:15 every damn night. I usually go to bed between 2 & 4. I'll either wake up at 8:30 am or 10:15.

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Old 05-23-2015, 09:20 AM
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Quote:
Originally Posted by doc View Post
Caveat (non)dormitor:

OTC sleep aids are usually Benadryl or close cousins. Antihistamines do have mild sedative effects and can be helpful, but us old geezers with prostate problems may wind up with severe urinary obstruction.

While alcoholic beverages can make you sleepy, when they wear off after a couple hours, it may cause a mini "DTs" in some people, an increased state of arousal, actually making the insomnia worse.
Thanks doc for clearing this up for me.
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Old 05-23-2015, 10:10 AM
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Originally Posted by OzarksLady View Post
I have a Kindle Fire. I put a app on it that has several different sounds from birds, trains, fans, water falls, stream etc etc.
I have an app like that on my iPad but haven't tried it yet - do you fine it helpful at all?
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