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Insomnia, disrupted circadian rhythm, need help.

Posted by dopaminergic on September 27, 2007, at 8:20:15 that article is very informative, though I haven't had time to read it critically.

I am an 18y male. It can take me over two hours to fall asleep, and I do not know why. Lately, I have had a lot of trouble with staying asleep; I can wake up multiple times per night. This problem has occurred in varying intensities for over a year:

-When I worked late (got home around 10:30; this was for most of the year of 2006) and had to wake up at 5:30 for school, I was completely exhausted and lethargic
-After quitting that job, my sleep didn't improve much, but I managed to get by with a bedtime of 8:45 (WAY too early)
-After graduating high school: over the summer my sleep wasn't so bad since I could sleep later
-In college now: I have a class 3 days a week at 8:30, so I generally wake up between 7 - 7:30AM. This happens regardless of whether I have class or have set an alarm on a given day; my circadian rhythm of waking seems to be just fine.
-I tend to go to bed between 10:45 - 11:15. My roommate goes to bed after midnight; sometimes he gets to sleep sooner.

What I have tried:

-Refraining from using any stimulating media (computer, etc.) 1h before bedtime
-Meditating before bedtime (can be difficult)
-Keeping lights very low before bedtime (doesn't seem to help much)
-Valerian root - useless
-Melatonin - seems to induce drowsiness to some extent, but not reduce sleep onset latency; have tried in dosages ranging from .3mg - 3mg
-5-HTP - 100-150mg seems to increase melatonin's effectiveness slightly but does not do much on its own
-Exposing myself to bright light in the morning - didn't seem to do a whole lot; I'd appreciate more information on bright light therapy, though
-Writing down my worries before sleeping - just tried that last night to no avail
-Ramelteon (Rozerem) - completely useless and increased daytime sleepiness; tried for 2 weeks
-hypnotics - zolpidem (Ambien) and (S)-zopiclone (Lunesta) seem to be somewhat effective in higher doses, but being CIV substances and requiring another prescription is a pain. I'm also concerned about their long-term effects on cognition and memory, as well as dependence and rebound insomnia
-Polysomnogram - utterly useless. Revealed no abnormalities with sleep other than abnormally long onset to persistent sleep. Thus, apnea, RLS, etc. are ruled out.
-Exercise - actually haven't done this much (I'm a lazy person, heh), but it hasn't made any difference when I have exercised regularly. Nonetheless, I plan to start a routine soon.

The only logical reason for my insomnia would be 5x weekly usage of Adderall (prescribed for ADHD), but that has only been for a couple of months and typically <= 20mg/day (rarely dosing past noon).

I personally think my problem involves poor cognitive patterns/learned anxiety. No matter how tired I am, I can feel alert and restless when trying to sleep. I think of boatloads of useless, unimportant things, but despite really wanting to sleep, the thoughts keep coming. I just don't know what to do about this.

Disrupted circadian rhythm may also be a factor. I'm not sure that I suffer from DSPS, but it seems to be that I simply am not tired enough after 16 waking hours to sleep. Could this be attributed to a malfunctioning melatonin system (I'm not too versed on sleep induction pathways)? Perhaps a disparity between the circadian and homeostatic sleep mechanisms (e.g. circadian rhythm does not allow one to sleep despite homeostatic sleepiness)?

Should I just not worry about getting a full 8 hours of sleep, even though I seem to be tired and unmotivated when I don't? I currently use stimulants to provide myself with the energy I need to do the things I like to do, but that isn't a healthy long-term solution, and I currently have weekends of lethargy (breaks from Adderall).

Sorry for the long post, but this is something that has bothered me for a LONG time that no one has been able to help me with. Indeed, all anyone ever seems to tell me is, "don't worry about it so much." The problem is that it so negatively impacts the quality of my life - when I was in high school studying for AP exams, I was so tired I could hardly read books! Not acceptable!




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