Q. I’ve had chronic, severe insomnia all my life. All I get from well-meaning people is the advice to stop drinking coffee. All I get from doctors are more and more drugs, which work for a while, then quit.
I go days at a time without sleep. My brain is so fried. Any suggestions would be really welcome.

A. Although yours is an extreme case, you are not alone. Millions of people also have great difficulty falling asleep. Others awaken in the middle of the night and can’t fall back asleep. Regardless, sleep deprivation can contribute to a range of health problems from hypertension and forgetfulness to impaired immunity and weight gain.
Some tricks to try include vigorous exercise early in the day, a hot bath an hour before bedtime or a high-carb snack half an hour before climbing into bed. Non-drug approaches such as relaxation CDs, magnesium, melatonin or herbs like valerian, hops or lemon balm may also be helpful.
We are sending you our Guide to Getting a Good Night’s Sleep with more details on prescription sleep aids like Sonata and Lunesta as well as further details on non-drug approaches.

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  1. pdc
    Reply

    Would you notify me of any additional comments from readers on this article. Thank you.

  2. Raffaella
    Reply

    HI
    I was interested in your posting as I too suffered an accident (in 1997, I was hit by a motorcycle in Italy while crossing the street) and sleep is often a hit and miss.
    Generally, I fall asleep quite easily but invariably I wake up very often and unable to return to sleep. Can you elaborate on the “lead” issue? Thanks.

  3. pat
    Reply

    I appreciate you and your column and website! I am particularly interested
    in sleep problems. I plan to try several of the suggestions. Thanks to all who responded with ideas to try!

  4. Cheryl
    Reply

    I’ve had several home sleep tests requested by the doctor and they did not pick up anything unusual. After two years of running around to various doctors to check all the different types of hormone, iron, thyroid, etc levels with nothing being “remarkable” I decided to pursue the sleep tests since my boyfriend said I was just not sleeping right and that I was such a light sleeper with bionic hearing.
    The constant tiredness and chronic insomnia were unbearable. Working out, tweaking my caffeine intake, going to bed at the same time, no alcohol, no, none, etc., did not work. The test at the Sleep Center indicated pretty low REM – diagnosing Narcolepsy with insomnia which I feel would have never been caught if I hadn’t had all the various tests in one night at the Sleep Center. They started me with Ambien but unfortunately I have had a bad stomach since I was an infant and the unfortunate genetic history of being highly sensitive to chemicals, perfumes, etc.
    Trying Lunesta now and what a hassle to get – not covered by insurance, etc.
    You think when you talk to your friends, etc about napping that your naps are the same – no way, I can fall asleep during the day for two minutes and have a full blown dream – they’re mini-naps but almost never have a dream at night when I do fall asleep except every blue moon. So you guys that can nap for two or three hours – good for you. I don’t have the “typical” symptoms of Narcolepsy like falling asleep while I’m in the middle of a conversation but the REMs at night are really off so you feel like you’re always drugged during the day with absolutely no energy and mourning the lack of your life.
    Keep looking for an answer, something will come up… but first get tested at a Sleep Center!

  5. Rebecca
    Reply

    I went through something similar. This is not garden variety insomnia we are speaking of. It is debilitating and life threatening. Forget the warm milk, hops, tryptophan, turkey, valerian, etc., etc. So many people meant well including the doctors who threw drug after drug at me. Finally, I read about getting a “serum ferritin” level drawn and it saved my life.
    Ferritin is a form of storage iron. Testing for anemia will not reveal if you are low. It has to be a “serum ferritin” level. Ferritin is a co-factor in the production of dopamine and greatly affects sleep, mood, limb movements during sleep, among others. My heart goes out to you. I hope this helps.

  6. Sharing
    Reply

    While I do not have any solutions, I did want you to know that I empathize with you. I have had chronic insomnia since, at least, age 9. I have tried everything mentioned including OTC and Rx drugs.
    Some have worked temporarily, at best, while others were complete failures. I have had 2 sleep studies and both showed that I do not get adequate REM sleep (0% and 3%, respectively). Currently I am again using OTC Severe Benadryl under a doctor’s care. But, this is ineffective for falling asleep adequately and getting enough rest. Last night, I took all the Benadryl allowed dosages in a timely manner and still didn’t fall asleep until 9:30am the next day. I also only slept for 3 hours after that.
    Without the Benadryl, it takes me 11 days to get 6 hours of sleep. Then the no-sleep-cycle starts again. I also signed up again to be considered for a medical trial; this one is using Cognitive Behavior Therapy as an intervention for insomnia.
    What I want you to know is that another person suffers like you do. I know the frustration you are feeling. Sleep seems like a easy skill that can be mastered. After all, if babies can do it, how difficult can it be? I feel a little better knowing that there is a reason (poor REM) why I don’t sleep. Yet, it is still so frustrating to not be able to sleep. Another day I would not have had the time to even get the 3 hours I managed to get. My prayers are with you.

  7. Fung
    Reply

    If I can not sleep, I got up, think, and write down everything happened that day or what bothering me, or just copy down from a book / article /dictionary… so boring, less than 30 minutes I’ll fall a sleep. If it doesn’t work, fine; continue writing or learning something/s new, or just doing house work until day break, than catching up sleep what ever time in the dark and quiet room.
    I’m afraid it means the lady would have to switch her job or adjust her time schedule.

  8. cjb
    Reply

    For what it’s worth……….I am a male of 70 yrs of age. I hit the sack about ten PM just about every night. I exercise prior to bed to help knock me out. Without fail I wake up at 3AM. I’ll empty my bladder, have a glass of water and walk around the kitchen for 5 min. Go back to the bed, relax under the blanket and dream about pleasant things only. Before I know it,it’s 7AM. That’s good enough for me. My wife thinks I’m loonie but that’s my nightly routine. I’ve been doing this since I retired. P.S….DO not take naps. GOD bless !

  9. J.E.
    Reply

    I did not have a good night sleep for years.My mind would never shut down and I would toss and turn and get out of bed 3 or 4 times a night. I tried just about every over the counter sleeping aid before consulting with my doctor. Under his advice I tried just about all the latest sleeping prescriptions known to man over a 2 year period with no success. A year ago he tried a drug that has been on the market for about 40 years called Clonazepam (a generic for Klonopin) which is used for treating seizures or panic attack (which I have never experienced).
    It sedates the brain and nervous system which produces a calming effect. This drug works by enhancing the effects of a certain natural chemical in the body. So now I sleep the whole night through, but I must mention that it takes me about 20 or 30 minutes to go to sleep. Another good thing is being a generic it is cheap to buy.

  10. RA
    Reply

    Most of the suggested remedies have not worked for me for any length of time.
    I have not tried lemon balm, hops or Valerian, however. I have chronic progressive MS; I suspect the disease is having an impact on my chronic insomnia. I do not have spasms/pain/etc, so I think the disease is having other, subtle, effects. No doctor seems to have any experience with this or suggestions other than the standard suggestions we have all read/heard.

  11. cynthia
    Reply

    First time on site & I have had this problem for over 20 years now – yikes! i take 2 tynenol pm’s every few nights and sometimes i can get back in a good sleep cycle after that – otherwise i am one of the best read person’s I know…lucky i have a job where i can start a little late if need be…

  12. Susan
    Reply

    After having moderate depression for a while I realized I was not sleeping as well as I should. Pharmacist gave me tamazepam instead of Ambien for a sleep aid which helped a little. Then I realized what it was- a valium derivative. So I tried melatonin for a more natural alternative which seemed to work some.
    A few years later I had more severe depression and Cymbalta was prescribed. That totally messed up my sleep cycle, but I got off it and melatonin helped me again to set my circadian rhythm back to normal. Antidepression meds definitely affect sleep cycle in my limited experience. Now if I just didn’t have to get up to pee ;o)) Good luck!

  13. Sandy
    Reply

    I once received a cassette tape with progressive relaxation on one side and autogenic training on the other. I listened every night for the relaxation, but I soon found myself falling asleep before I got very far into it. For me, the autogenic training did the trick. This was after the government banned tryptophan which worked for me.

  14. bestbet
    Reply

    Only thing that works consistently for me is strenuous exercise, long enough to make me sweat profusely and hard enough to make me crave the couch. 90 minutes a day, 7 days a week.

  15. Brent B
    Reply

    Definitely magnesium works for me too. Also it is very important to practice consistent “sleep hygiene” habits every day — like avoiding too much stimulation / food or exercise close to bedtime. And try to “follow the sun” — getting at least a half hour of outdoor sunshine every day will refresh your melatonin levels (and vitamin D as well). It’s also best to get to bed before midnight if you can, preferably by 10:30 if possible. That will also optimize your melatonin levels.

  16. anonymous
    Reply

    PLEASE consider that you might have sleep apnea. I know that sounds crazy; that’s why I am asking you to really think about this, before you automatically say, “No way!”.
    In the 1980’s I was married to a man who snored when he slept. But that didn’t seem to bother me as much as when I noticed that he was NOT snoring (i.e. not breathing). I read an article in the Reader’s Digest about sleep apnea and then got really concerned about this condition. He also was a veteran and had PTSD (I mentioned that for a reason…).
    Almost twenty years later I found myself dreading bedtime, dragging around in the mornings and unable to concentrate during the day. I tried to be very scientific and figure out what had changed in my life. I reviewed my sleeping habits, diet, exercise, meds, stress, caffeine, etc. No clues. What was weird though was the “dreading bedtime” symptom. Before, I had always been so exhausted from my work that I would welcome the chance to go to bed and I could fall asleep within five minutes.
    I finally figured out what it was, when I noticed that I would have “choking and suffocating” nightmares and I would wake up gasping for air. It would take sometimes a half-hour for my racing pulse to go back to normal, so I could fall asleep again. I realized on some subconscious level that I was scared to let down my guard and go to sleep. You see, I had developed sleep apnea and I too have PTSD. I am single and so there wasn’t anyone to tell me that I was struggling for breath when I slept.
    I believe with all my heart that if someone has tried every suggestion for insomnia and they are still miserable, then maybe they could just open up their mind to the fact that they are LITERALLY SCARED to fall asleep.
    I am not saying that in a judgmental way. I was scared because of the sleep apnea that I would have heart and brain damage. I was scared of burglars because I live in a dodgy neighborhood and my house had already been broken into once before. I was scared because of the mice and rats who scratched on the walls of the house at night despite the fact that a professional pest-control company tried their best to trap them.
    So to end this comment on a positive note, I got a cat from the animal shelter to “guard” me against the rodents at night. I had my home wired for alarms on all the windows and doors. I arm it at night and the monitoring service is on duty to respond if it triggers. Most importantly I requested a sleep study and the results showed that; yes, indeed, I did have Obstructive Sleep Apnea and I am SO very, very happy with my CPAP machine.
    I can look back now and see why I had insomnia. I was afraid to sleep.

  17. Melinda
    Reply

    Magnesium worked for me for a little while and then I added melatonin. The melatonin works very well. I went from insomnia about 50% of the time to insomnia only a couple of days before my period (if at all).

  18. Hank H.
    Reply

    For the past 10 years, my sleep pattern has totally changed. I fall asleep in 10 minutes, but 2 hrs. later I’m wide awake. I’ll either go to my computer for 30+ minutes which sometimes work, rather than lay in my bed “thinking out loud” and being anxious.
    Sometimes I’ll turn on my cassette tape player (next to my bed) and listen to soft music or some Christian sermons — which helps me fall asleep many times.
    Exercising in the mornings don’t work at all. I don’t drink caffeine after breakfast.
    The only thing that works for me is Temazapam pills that I take after 4-5 days of poor sleep, so I can catch up with 6 hrs. and feel good for most of the week. (Temazapam is the lowest cost perscription for me — $10 for 30 pills) — others are very expensive.

  19. SDW
    Reply

    While I did not have problems as severe as this person; my main problem was waking up about 2am and not being able to go back to sleep until about 6 am when I needed to get up for work. Recently, I have found relief in pharmaceutical grade vitamin D, 2-3,000 mg/day, 5HTP combined with melatonin before bedtime – varying amounts depending on the day. And no coffee or other stimulants other than tea in the am.

  20. patty h.
    Reply

    I too suffered from primary insomnia. Had been on meds since 2004. this year in dec 09 I said no more. I checked online what would work best in a natural way. First I prayed and asked that my sleep would be sweet. Second I had about a 14 oz glass of non fat warm milk and a banana. I’ve slept better ever since. I do these 3 things each night, pray drink the milk and eat a banana. I give all credit to the Lord and I love sleeping without meds.

  21. Hal
    Reply

    What I occasionally do to invite sleep more swiftly and deeply, which has also worked for many friends with whom I’ve shared, is to breathe slowly and deeply, both in and out, while thinking the single word “sleeeeeeeeep” throughout each breathe.
    Make the breathe start with ‘s’ and end with ‘p'; and pause one to three seconds at each end of the breathe. I hope this helps you and others!
    Happy New Decade and may peace be promoted by all of us!
    –Hal

  22. DR
    Reply

    I have ADHD and have to leave the radio on all night. It helps. Otherwise my mind would be “going”. You might try that. Doug

  23. fbl
    Reply

    After a fall down 26 steps 21 years ago I had severe sleep problems such as this lady describes. I think it had a lot to do with the head trauma. I learned Transcendental Mediation, took 200 mg of B6 about 1/2 hour before bedtime and later learned about melatonin and inosital.
    I addressed the head trauma issues by getting rid of my toxic lead (IV Chelation), increased my DHA Omega 3, take DMAE and use the melatonin every night before bedtime. I’ve found the liposomal melatonin spray more effective. When the nerves seem particularly frazzled I’ll also take a couple Kava Kava capsules. I drink no tea after noon each day. I am not a coffee drinker.
    I usually do very well with the sleeping now but it did take me years to learn the problems and solutions.

  24. HD
    Reply

    I keep a boom box next to my bed. Listen to books on tape whenever I wake up in the middle of the night. Hearing someone read helps me fall back to sleep. It’s been a lifesaver for me. You could also use an iPod, but that requires downloading, and I can’t be bothered with that.

  25. Neal W.
    Reply

    I can’t begin to imagine your frustration. However, I have two non-drug possibilities that might help:
    First, there is a gadget called the “Little Sleep Machine.” This an iPod-type machine that has three different available sound tracks. One of the three might prove helpful. I find it very useful–I go through the AAA batteries like crazy to ensure good sleep.
    The second is supposed to be a meditation-type CD. My problem has been that I can’t recline and meditate; it puts me right to sleep. The speaker is a hypnotherapist/psychiatrist who does a masterful job. The CD is entitled “The Healing Journey.” It is sold by the following website:
    I hope one of these helps.
    Neal

  26. elsie
    Reply

    This person does not say if she has had a sleep study done. I urge anyone with trouble getting a good night’s sleep or who is drowsy in the daytime to have a sleep study. Unfortunately, they are expensive! I had trouble sleeping and had daytime drowsiness (and felt bad most of the time and could not stay awake to read a book, I had a lot of body pain and thought I had fibromyalgia). I finally had a sleep study and I had sleep apnea. I have had a CPAP machine for several years now and it is a life-saver.
    If a person is having apneas (the wind pipe closes temporarily during sleep and cuts off breathing until the brain wakes up enough to activate the muscles of the windpipe and open up breathing. The person having apneas is NOT AWARE of this pattern of becoming more aroused. The result is that the person never has any deep sleep) no amount of medications or exercise or other strategies will help. The treatment is a CPAP machine. This is a non-drug therapy that provides enough air pressure to keep the wind pipe open during sleep. The result is the ability to have a good night’s sleep.

  27. P. T.
    Reply

    When I finished eating Thanksgiving Turkey, I had to get up and walk around the room. Also I discovered that warm milk before bedtime puts me to sleep. Both of these foods have tryptophan, a natural sleep inducer.

  28. Kathleen A.
    Reply

    Years ago I decided that if I had to lie awake I might as well make good use of my time; learn something. I got a little audio cassette player and got audio books – biographies, history etc. I keep under my pillow. When my mind concentrated on this outside my own anxiety, I mentally relaxed and in essence “bored myself to sleep”. Don’t use music or horror fiction – you have to concentrate but not on a suspense thriller.
    My big problem now is that “they” have stopped making “books on tape”. Now recorded books are all on CD’s and I can’t find a CD player that is a simple, small unit.Radio doesn’t do it, as recorder turns itself off in due time and radio will re-awaken you after awhile.
    Anyway this drugless method saved me & still does.
    Do small noises awaken you? Get a noisy fan and run it to get a constant background noise. Keep your eyes closed; don’t stare at the ceiling or turn on lights.
    Hope this helps.

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