I’ve been struggling with sleep issues for over a decade now. My Doctor has prescribed me all sorts of medication, all of which has had many adverse side effects. What I do know that works, is Xanax. My wife was prescribed it for some stress issues and occasionally will give me one so I can finally sleep. Obviously asking my Doctor, “can I have Xanax” Will not go well. I’ve eluded to it in ways and the response has always been along the lines of “that’s habit forming, I’d rather you try this”. Of the many medications prescribed, none have worked. Resorting to the dark web is something I’d really rather not do. Fentanyl laced drugs took my sister and it’s a road I hope to not have to explore. Any suggestions?
Apologies for giving you a boring canned answer when you are sleep-deprived and looking for help. But I swear these things really helped me.
Number one: think about getting a sleep study done by an actual sleep doc (pulmonary doc or neurologist). This was life changing for me. Don’t go to a chiropractor or whoever the fuck and get a CPAP machine.
Also, and this is important: Have you looked into tips for “sleep hygiene”? None of them are a quick fix like Xanax, but they can be powerful when used together.
These include things like:
- going to bed and getting up at the same times every day. this means getting up at your normal time, even if it’s a weekend, even if you didn’t sleep well that night, just make yourself do it
- when sleeping…making sure the room is dark, cool, and quiet (ear plugs are a big help here). by cool, I mean 68-69F (about 20C).
- cutting way back on caffeine and/or eliminating it…and absolutely no caffeine after lunch (the older we get, the longer it takes to metabolize caffeine)
- not looking at any glowing screens (TV, phone, computer, tablet, etc) before bed time… for at least 15-30 minutes
- avoid eating / drinking a couple of hours before bed time
- using your bedroom only for sleeping and for sex
And when you have trouble sleeping, it’s a very good idea to get out of bed, go to a different room (one that is not too bright) and do something boring like read a text book for 15-20 minutes then go back to bed and try again.
When we stay in bed and aren’t sleeping, we’re training our brain that it’s OK to do that. You want to beat it into your subconscious brain that the bed / bedroom is for sleeping.
And I should have included exercise. The best sleep I ever get is when I get in a really good amount of exercise during the day. I won’t lie to you, I’m pretty lazy about it myself. You don’t want to do this close to bedtime, either. Go for a really long walk / jog / whatever in early afternoon if you can squeeze that in somehow.
Seriously. Nothing puts you to sleep better than 10 hours of hiking.
Obviously that’s unattainable most days, but I struggle with insomnia all my life, and one of the things I look forward to most from backpacking trips is the restful call of sleep when I “actually” feel like I “need” it.
Thanks for the advice. There’s definitely some stuff here I can try. I have a stressful computer job so cutting back on caffeine makes sense along with several other tips you mentioned!
I hope you find something that works. Not getting sleep is the worst!
100%. It’s all I look forward to these days. I know that fact in itself is a huge problem though.
A few things to add to this great list:
Magnesium supplement before bed. They’re not all the same. Don’t just take a pill. Get one of the proper powdered ones magnesium citrate or threonate. I really like this one.
Also, pod casts and audiobooks. I use headphones and turn the volume down just far enough so I really need to concentrate to hear the words.
Thanks!
Also the exercise thing. I find that when stress from the computer job is likely to keep me awake, a fast walk before bedtime is enough to help smooth that out
Definitely need to exercise more so I’ll give this a shot, thanks
Caveat: doctors will only let you have a sleep study if they suspect sleep apnea. Other sleep studies that capture off-the-wall sleep disorders don’t seem accessible, at least in my local health system which is a Catholic-run local monopoly. Perhaps HCA, or Kaiser, or others may have a different philosophy.
This is not universal. I have average US insurance in Colorado and my GP sent me for a sleep study after we tried just a few things for my insomnia.
I wasn’t aware of this. That is discouraging. I think there are like 30-something sleep disorders. Though apnea is extremely common. Some insurance plans will also push hard for an “at home” sleep study first, which is fine if you just need a CPAP machine. But it’s no bueno if you need someone to monitor you and hook you up to all those Star Trek devices like they did to me.
To add to the ‘canned answers’ here is one more:
As non medication, Magnesium has a muscle relaxation effect. With a big cup of water before going to sleep it could help falling asleep. (Tho make sure you are using the right kind of magnesium pill that actually gets absorbed into the body)Magnesium threonate cured my insomnia, it’s fucking wild how well it works. I’d tried everything until I discovered it, from melatonin, to antihistamine sleeping pills, all the way to downing 350ml of whiskey every night just to force sleep.
Magnesium works better than every single thing I’ve tried (but you HAVE to let yourself fall asleep when you feel it starting to work.)
Thank you! Today I learned. (I’m usually kind of skeptical about supplements but what I’ve been able to find supports what you’re saying here).
doc doesn’t want to perscribe you xanax because xanax will stop working and this fucks up many other things in the process
Ahh ok. That makes sense, while it works great, long term it doesn’t seem to be a solution.
It’s a really bad solution honestly. Benzo withdrawal can kill you and it’s extremely habit forming. Especially if you’re using it to treat insomnia, finding a way to stop taking it is gonna be tough.
No solution provided, just giving some caution and saying that using Xanax to sleep is roughly equivalent to getting drunk to sleep. Both affect your GABA receptors and both are habit forming and dangerous to withdrawal from.
Yeah Xanax is literally the worst thing possible for this, especially as a frequent thing. It’ll significantly worsen your sleep quality in the long run. (Hi I’m a psych nurse and I meet a lot of people stuck in insomnia hell because they’ve been slapping a Xanax bandaid on it for a few years while it just continued to devolve and now they’re basically psychotic because they never actually fixed the root issue.
I’m also hearing a lot from you about medications and next to nothing about any lifestyle changes. No medication will ever actually fix this kind of problem. Medications just give you a leg up on fixing yourself.
First of all what stimulants do you use, especially caffeine and nicotine? (I would also hope you already know to avoid meth and cocaine and not take stimulant ADHD meds at bedtime.) Are you avoiding them in the last 6 hours before bed? A lot of people (especially with ADHD) will say stimulants calm them down but what they’re actually feeling is a change from their baseline restless anxious awake to a focused, productive awake. The second one feels more settled, and can actually help you fall asleep briefly if the specific problem is difficulty holding still long enough to sleep, but it’s going to completely fuck up your circadian rhythm in the long run.
Speaking of circadian rhythms, are you trying to keep your body in a steady daily routine? This includes a consistent bedtime, but your mealtimes and daily physical activity are part of your circadian rhythms too. There’s a lot of different schools of thought on how to time meals and exercise to best support sleep, but the general consensus is just don’t do either right before bed. I would also recommend adding a structured “wind-down” period to your nightly routine that takes 15-30 minutes where you do one of like three basic things:
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something mind-numbingly boring
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something you’ve always found soothing/comforting
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Journaling about the day to give your brain a head start on the memory processing it’s about to do.
It’s also very helpful to create full sensory environments that you use to trigger pavlovian responses. You know how pavlov’s dog drools when the bell rings because it’s used to food showing up when the bell rings? The biggest difference between you and a dog is that you get to decide what you want to be trained to do. The downside to this is that it can take a while to train these responses into your body, so be patient and don’t just give up after like a week. So you’ll want to create at least two full and distinct sensory environments. The specifics don’t matter as much as creating a consistent routine for yourself, but here’s some examples of things I’ve tried or seen people try:
Alert
- Sight: Curtains open / sunlight / full spectrum white light is the input that aligns most closely with most people’s existing natural rhythm.
- Sound: Music, white noise of people talking in the background.
- Smell: Essential oils are actually really good for training pavlovian responses in yourself because of how powerful scent memory is. A lot of people like to incorporate citrus-y smells for alertness, but personally I actually really enjoy just keeping my used coffee grounds from the morning in a cup on my desk. That also brings us to the next one…
- Taste: Coffee has a pretty distinct taste that most people associate with alertness, and you can get a similar taste from chicory root and/or decaf coffee, but one real cup right after waking up shouldn’t mess you up too bad. Chewing gum is also an option, however.
- Touch: The big one for me doing classes from home during COVID was still getting up and putting on “outside clothes” even if I was just sitting at the computer at home.
Rest
- Sight: usually red-yellow spectrum light, and much lower brightness around bedtime. You can turn on a red-shift filter for most electronic devices these days, and LED bulbs also often come in a yellow-orange incandescent style color (and a lot of hobby/makeup lights have multiple color settings for this reason as well, white for when you’re working, orange/yellow for resting/relaxing.
- Sound: some people listen to soothing music, I conditioned myself to fall asleep to the sound of a raging thunderstorm because I sleep during the day and work at night, and the thunderstorm sounds easily block out daytime noises.
- Smell: Lots of options here too for essential oils or other scented products. You could also use a specific lotion or wash your sheets in a specific scented detergent. A lot of people say they find lavender scents to be particularly soothing, but again, the exact sensory trigger isn’t important as much as you picking one to use consistently.
- Taste: Herbal tea is my biggest recommendation here, but you could also go with a small snack/sweet as part of your nightly routine.
- Touch: We already covered wearing different clothes, but some additional options include a weighted blanket or one of those compression sleep pods (I just got one to try out recently and like it so far!)
Anyway like I said, these can take a while to train your body to do, so pick things that will be easy for you to do, set up your space to make it as easy as possible to keep doing them, and keep at it. The most important thing is consistency and routine.
Thanks so much for all this. I only intake caffeine, marijuana and alcohol. Going to start weening myself off coffee for sure and I’m always trying to minimize the other two. Going to spend some months this summer relearning how to live.
Alcohol used to wreck my sleep. I’d come home, dog-tired at 7 PM, have a few (and a few more) drinks, look up and 6 hours had passed.
I ended up burning out, and having to quit both booze and weed. It was the best thing that ever happened to me. Along with all the obvious health, psychological and financial benefits, I sleep amazingly well now.
I’m glad to hear that but how much alcohol? If you’re maintaining a constant blood alcohol level and get the shakes when you try to quit you should go to the hospital/ER and have them help you withdraw because those shakes can eventually turn into full blown seizures.
Wow. I just want to say thank you for such a thoughtful, informed, detailed response. You are an amazing person!
Ty! Sometimes it’s nice to give you guys tips because my patients usually just start swearing at me at the suggestion that they may have caused at least some of their own problems.
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Do not hop on the xan, your doctor knows what they are talking about.
Here is my best suggestion and it is serious. NO CAFFEINE after lunch. Period. No naps. Go to bed early every night at the same time. Wake up early to start your day. Drink lots of water every day.
Als, your bed is for sleeping (and sexy times). No phones, no tv, no distraction.
Proper meditation training, and I’m not talking about some quick-fix youtube video.
I’m talking about weeks or months of training, like you’d do at a gym for your body. Just sit down, and focus on not thinking. You’re going to fail a lot as your mind tries to wander, but keep practicing until you can do it for longer and longer. Do this before bed each night, and don’t stimulate yourself in any way (no electronics, no book, no talking, no eating) between the meditation and the sleeping.
Also, trying to have a routine for your bedtime is excellent. Make it into a ritual so your brain gets used to it. Meditate, Go get a glass of water, Put it on your bedside table in the same spot, then go pee, remove and put your clothes in the hamper, climb into bed, get into your preferred sleeping position, and then I usually continue the meditation and I’m out before I know it.
Do this process slowly, there’s no rush. Calm everything. It takes time to complete, but it’s still faster than laying awake for hours like I used to.
Sounds like hokey bullshit, but it works amazingly. It’s like counting sheep on steroids (to continue the gym metaphor)
Thanks for the advice!
Are you seeing a family doctor, or a sleep specialist? You want the latter, and a sleep study.
The classes of drugs that might help are imperfect at best, I’d be partial to a benzo before e.g., Ambien or related, given the inherent risks of sleepwalking and worse with those drugs.
I’m going to do a sleep study this summer. I have some months off so my plan is to focus on health and wellness.
Good choice, and as hard as it is, trust the boring “drop caffiene” and bedtime advice. After a few weeks your body will acclimate to the timing, too. Honestly though, the best thing for me is a long weekend backpacking trip. After a day or so of strenuous hiking, and a terrible first night sleep, it’s like your body sees the sun set and is like “I’m done”. Can really reset your clock.
Thanks! Definitely going to ween myself off coffee this summer. Finishing up an edit gig now and it’s all that keeps me cranking
So I have some experience with this and have a few things I want to tell you:
Consider a dedicated sleep study. If you have sleep apnea, medication will not fix your problem and some medications may actually make it worse.
Xanax (an anxiety medication) and Ambien (a sleep medication) are very similar drugs with respect to their mechanism of action. Xanax binds to a specific group of receptors to cause anxiolytic effects and happens to also make you sleepy. Ambien binds to a subset of those same receptors to make you sleepy, but don’t have the strong anxiety reducing effect. If Xanax works for you, Ambien should theoretically have a similar effect. In practice, it doesn’t tend to work as well because anxiety can keep you awake. If that has been your experience with Ambien, think about taking some steps to address anxiety even if you don’t think it’s that bad. Yoga, counseling, meditation, whatever. There are also guided breathing audio sessions designed to put you to sleep in apps like Fitbit and calm that may be helpful.
You can also supplement a prescription sleep aid with something non prescription, which is what I do. I take Ambien, and to keep my dose low I supplement with melatonin, tryptophan, and valerian root when I need an extra kick into sleepiness. I’ve heard CBD is also quite effective for this. Magnesium reportedly also helps with restful sleep, but get a sleep formulation because magnesium in the wrong form causes diarrhea.
Don’t underestimate sleep hygiene. For a long time I had the attitude of “I have real sleep problems, basic stuff like cutting back caffeine is not going to help.” The thing is, when taken together, that kind of stuff actually can help tremendously. I scheduled a month where I went hardcore on sleep hygiene. Strict caffeine limits, no late caffeine or exercise, don’t do anything on your bed but sleep and sex, wake up at the same early time every day even when you don’t have to, limit screens before, bed… I mean ALL of it. I found that it actually really helped. In combination with medication it might be a life saver. Might be worth doing your own experiment with it.
Good luck!
Thanks for the advice! I have a few months off this summer so going to dedicate that time to relearning how to live, hah
Listening to a slightly boring audiobook has been the most consistently effective method I’ve found. Also, I had to give up caffeine.
Ahh man, giving up caffeine is going to be brutal
It’s easier if you cut back first so your body gets used to having less of it. I started by only having any before 12pm, then 10am, then I cut out energy drinks entirely, then I’d do part decaf coffee until I finally went full decaf. I definitely noticed some headaches and felt kind of shit occasionally but I don’t remember it being too terrible.
Never tried decaf but I’ll give it a go. Love me some black coffee.
but gaining sleep is quite worth it.
also consider a hot bath/spa.
its all about relaxing your thoughts and your muscles. stop trying to figure things out and let go.
im surprised i havent seen more mention of deep breathing. if you can relax all your muscles and then drop your breathing down to 8 seconds a breathe, you should drift off to sleep within a few minutes.
I’ve of taking some meditation classes or something. The stress has taken its toll on my health and I don’t know how much more my body can take.
you have to figure out if the stress source is worth it to you. maybe you can change your work situation or expectations. maybe its a combination of 10 things and you can control 3 of them.
I’m a freelance video editor for reality tv. It’s extremely stressful, especially now with the state of the industry. I’ve let my other skills (used to be a programmer and designer in the video game industry) decay far too much and frankly that industry isn’t faring too well either. There’s really no great answer for my occupation. I just really need to learn how to manage the stresses of life for another 10-15 years before I can retire. Just hoping I can make it to that goal.
maybe make a list of 20 places you’d rather work and reach out to them. and set some boundaries with your crazy family members.
I understand where you’re coming from but it’s not that simple. I’m freelance, it’s all gig based.
Decaf soda is also good. A little harder to find but it won’t beat up your stomach like caffeinated soda.
I jumped off the soda train long ago. I just drink way too much coffee, it’s going to be tough to give that one up
Maybe go half-caff for awhile?
I’m going to try. I once ditched coffee entirely for tea, but it weaseled it’s way back in with it’s seductive deliciousness.
You don’t need to give it up completely, but definitely don’t have any after 3 pm.
What, specifically, have they tried? Did you try trazodone? I don’t think Xanax is the solution you think it may be even though it worked for you.
Is the issue falling asleep or staying asleep? Do you have an idea of what prevents you from falling asleep? What do you think about when you’re in bed falling asleep? What is your natural sleep cycle timeline? In other words, when do you naturally get sleepy and if given no restrictions, when would you wake up? How is your sleep hygiene (really, not just what you tell people)?
Do not, I repeat, do not go in there asking for Xanax or you will be labeled a drug seeker permanently. A doctor is not going to give you Xanax for this, full stop. They’re going to ask all of the above questions and try other avenues first. If they suspect an anxiety disorder they will move up that avenue and you may need a benzo but you have to be under care for a while and basically prove you’re trustworthy.
I have massive sleep problems too but you don’t have enough information in your post to give any other advice other than the standard sleep hygiene stuff you’ve already been told.
Trazadone was pretty intolerable with all the dry mouth side effects, plus it didn’t really help sleep a ton. I have a lot of problems with stress and anxiety. From a stressful job, to an insane family and some horrific life shit that happened over the past years. It’s tough to get my mind to stop racing sometimes. I’ve depended too much on substances in the past to manage it, and I know that probably means something habit forming may backfire. Honestly I’m always tired, but at times I’ll just lay there, tossing back and forth. Without restrictions, I can normally sleep from about 10PM-6AM, that seems to be the pattern for this point in my life. I’ve recently tried to start going for a hike at sunrise and that did help. Going to get back to doing that soon.
I know it feels tangential to getting a good night’s sleep when you haven’t had one in a long time, but if you have access to therapy consider making an appointment. Any one of those would be worth time with a therapist, and mental wellness definitely affects your sleep quality. This isn’t to say it’s all in your head or your fault you can’t sleep or anything like that, just that your mental health is as important a contributor to your wellness as your physical health.
I’ll definitely consider it again. I’m not a people person and find it extremely hard to trust people. But I also don’t talk much and things just end up festering.
All therapists aren’t the same, if you don’t click with someone after a session or two that’s completely a valid reason to dump them and try a different one. I know it can be disheartening if you have to go through a few, especially when getting to the point that you’re in therapy to begin with is already so much work. But from personal experience I would say it’s definitely worth it.
Be sure to bring up that you have a hard time opening up and trusting people, it’s definitely relevant to why you’re there and it’s a pretty common problem to have when seeing a therapist. Any good therapist will be able to help you find strategies for ways to work around it, like writing things out ahead of time if that’s easier for you.
It sounds like you’ve had a hell of a rough time with it, I hope you get some good rest and healing soon.
Thanks for the advice, have a good weekend
This. Anxiety has a lot of solutions now but a medical doctor (as opposed to a psychiatrist) probably isn’t the place to get them. A simple combo of things can work minor miracles. Good luck!
Thanks
If the Xanax is helping that much, you might have to start considering that maybe your sleep issues are anxiety, or other mental health problem, related. Try to enlist the help of professionally trained psychologist. Sometimes lay therapists could help, but the pros can diagnose and team with psychiatrists to prescribe medication. However, depending on the severity of the issue, you might not even need meds. Cognitive behavioral therapy is usually extremely effective at dealing with anxiety, PTSD and related issues that can cause sleep deprivation. Mental health is complex and reaching for drugs out of desperation can go really really bad really fast, making thing worse in the long term despite a brief short term relief.
Yeah, this is definitely me. I’ve tried talking to someone before but it didn’t go well. Hard to find the right person.
I know it can be frustrating and particularly hard with insurance limitations and all of those obstacles. But finding the right person can mark an extraordinary difference.
I have a lot inside me that I’d like to get out, just concerned as I’m not a trusting person and I have a lot of dark shit to unload. I’ve spent the last two decades coping with drugs and my body is telling me this isn’t a plan anymore.
There are no effective long term sleep medications except possibly THC. They’re all habit forming and you will get a tolerance, which will make sleeping impossible when you stop taking them. Benzodiazepines are garbage drugs and you will get addicted taking them for sleep. I had a nasty habit for years and kicking it was one of the worst things I’ve had to do. Please do not get involved with benzos.
I don’t discount your experience but I want to point out that benzos can be a very useful tool for people, especially with panic disorder, and they’re not inherently a trash drug.
While some people may develop a problem, others are able to use them on an as-needed basis long term. I’m sorry you struggled but glad you were able to overcome it. It’s absolutely understandable why you would feel negatively towards benzos as a whole.
It’s possible to be both a useful and trash drug. Benzos are inherently dangerous in ways that lots of other drugs are not, it is very easy to fuck up your life with them.
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Despite their effectiveness at treating anxiety I’d still call them bad drugs. I’ve seen more people get their lives fucked up than get better, as they’re frequently inappropriately prescribed for long term use to treat the symptom without addressing the cause. Benzos are also one of the few drugs that can kill you with withdrawal, and the withdrawal lasts significantly longer than opiates. They’re essential for treating acute anxiety, but I really think the manner in which they’re prescribed needs to be improved. I think it would be a good thing to move away from the benzodiazepine class altogether to a more specific drug that doesn’t just hammer GABA receptors so broadly.
For THC I’ve switched over to edibles and they do help sometimes. Had to stop smoking it for various health reasons.
Did you try cbd then? One of my coworker swear by it. One or two drop under the the tongue and he goes to sleep like a baby.
Edit: nvm i just saw you were already on it. You might try to slow down on the thc and give cdb a bigger chance since too much thc might give you more anxiety.
Totally. I’m 100% a burn out and need to tone it down. I’ve battled with learning moderation when it comes to weed but I’ve had lots of bumps in the road. Trying to ween myself off smoking and go straight edibles. I should try the “under the tongue” concentrates though. Thanks
I don’t have an answer and it may not apply to you but Benzos like Xanax are dangerous man.
Like it was nearly the end of me, yet I still get nostalgic for them. Be careful is alls I’m saying.
I hear you. I have addictive tendencies so it probably would backfire.
Honestly if this helps I was wasted on Xans one night and ended up falling in a canal alone and was terrified.
I threw away my stash, not knowing you should taper and can die just stopping.
What proceeded was a week of me lay in bed unable to eat but starving, twitching like a crack head at any movement, insomnia, shaking, sweats like nothing else, panic attacks and just generally wanting to die.
As I said before they feel that good that I would probably have been back on them if I didn’t stop going on the DarkWeb and falling out the loop with marketplaces.
I know it must be hard with your sleep issues, even more so as doctors are not keen on prescribing sleeping tablets due to the addictive nature of them, but I do hope you find a solution that works.
Finally I hope you don’t think I am lecturing you, just really wanted to stress how hard benzos are.
That said if a doctor prescribed them to you then they would manage any tapering off when it was time to come off them.
Good luck.
Don’t know if you tried this. The only thing that stops me from sleeping is my own brain
Sleep is a multifaceted problem. It can be dietary, it can be psychological.
If there is a mountain with a trailhead near you… And I mean like at least 3 miles out, so 6 miles round trip. And I mean at least 1500ft of vertical gain…
Have a day with no caffeine. Eat small snacks during the morning/day. Hike that mountain. No breaks allowed. Go as slow as you need to go in order to not stop. Go as fast as you can. Bring plenty of water.
After, eat a huge dinner. Lots of carbs. Like a spaghetti pizza or something insane on the carb front.
Take a CBN supplement about 2-3 hrs later.
Stop using your phone at this time. Read a book for an hour. Go to bed.
If you struggle after all of this, see a specialist. Because that’s fucked.
Like, even if you’re massively anxious, and your diet sucks… You’ll be out like a light. Unless there’s other issues.
