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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by mattdds on December 18, 2004, at 9:35:26
Hey all,
I've lurked too long without posting. Now I have a question for anyone with similar problems.
I've been plagued with sleep problems for a long time. It *was* mainly with onset (still is), but now it's getting my rear out of bed. Once I do fall asleep, which takes forever, it's such a deep sleep, that it's almost like willing myself out of a coma.
Waking up is so hard for me, that sometimes I literally can sleep through my alarm clock (which is very loud). I've resorted to a computer alarm which blasts very loud rock music when it goes off (my poor neighbors). Anyhow, sometimes even that doesn't work...I find that I'll sometimes unconsciously just go shut it off and hop back in bed, only to wake up late for work. I'm truly a complete zombie in every sense in the morning. I stagger around like a drunk, and I rarely drink.
What's going on here? I've considered sleep apnea, but it doesn't seem to fit. I'm not at all overweight, and I feel relatively refreshed if I sleep the normal 6-8 hrs. It's mainly the initial 30 mins after waking, I literally am not even safe to drive.
It's a real problem for me. I am a dentist for the US military. Tardiness is a HUGE deal. Every day is such a challenge for me. Luckily, there have only been 2 rather low-profile incidents where I overslept, so I'm not in hot water yet. But if this keeps up, it's just a matter of time before some pretty severe punitive stuff happens (think Full Metal Jacket).
In the military, commanders usually don't accept medical explanations for tardiness, they just assume you're lazy. Far from it. I'm really motivated to do my best and I love my work as a dentist.
Any ideas as to what might be going on? Or any pragmatic, and foolproof solutions? I've considered constructing an alarm, with an IV, and a caffeine drip...and I'm not joking! It's seriously unacceptable to be late in the military. It's also very demoralizing when it happens...it will wreck a week!
Thanks for any help or support. Good to see a lot of you still here, and good to see new faces.
Matt
Posted by Glydin on December 18, 2004, at 13:07:55
In reply to Forget reality, waking up is hard to do..., posted by mattdds on December 18, 2004, at 9:35:26
Hey Matt...
Are you taking meds?
Could that be a factor?
Posted by mattdds on December 19, 2004, at 1:32:16
In reply to Re: Forget reality, waking up is hard to do..., posted by Glydin on December 18, 2004, at 13:07:55
Hey,
I am taking clonazepam 2mg daily, but I don't think that's contributing. I really don't feel sedated by clonazepam. Actually, I don't really feel *anything* from clonazepam. I just don't get panic attacks (which is why I still take it - panic disorder).
I'm also looking into delayed sleep phase syndrome. My natural circadian rhythm seems to be to sleep at 4am and wake around 11 or 12. If only the rest of the world revolved around me, haha. Only problem is that there isn't very good treatment for this, other than to adjust your schedule...difficult to get the military to do that.
Thanks for your reply!
Matt
Posted by KaraS on December 19, 2004, at 4:34:20
In reply to Delayed Sleep Phase Syndrome? » Glydin, posted by mattdds on December 19, 2004, at 1:32:16
> Hey,
>
> I am taking clonazepam 2mg daily, but I don't think that's contributing. I really don't feel sedated by clonazepam. Actually, I don't really feel *anything* from clonazepam. I just don't get panic attacks (which is why I still take it - panic disorder).
>
> I'm also looking into delayed sleep phase syndrome. My natural circadian rhythm seems to be to sleep at 4am and wake around 11 or 12. If only the rest of the world revolved around me, haha. Only problem is that there isn't very good treatment for this, other than to adjust your schedule...difficult to get the military to do that.
>
> Thanks for your reply!
>
> MattSeems we have the same issues. I have recently developed panic disorder after many years without it (although I was on medication all of that time and now I'm not). Also, I've got delayed sleep syndrome and 4:00 am is the time I naturally like to go to sleep. It's terrible when you live in a world of early birds. Supposedly a good treatment is melatonin at night about an hour before you want to fall asleep and then using a light box first thing in the morning to reset your clock. Have you tried this yet? I occasionally take melatonin or use the light box but I haven't religiously used them together to reset my clock yet.
Posted by mattdds on December 19, 2004, at 5:10:50
In reply to Re: Delayed Sleep Phase Syndrome? » mattdds, posted by KaraS on December 19, 2004, at 4:34:20
Hello,
Actually, I did try melatonin, but it put me in an odd and creepy mental state, somewhere between sleeping and being awake. Not particularly pleasant. I've heard it works for others though...bummer for me.
As for the light box therapy, I haven't tried it...yet. Sounds like something to look into though.
It's such a slippery slope with this delayed sleep onset business. If you goof around for one night, and stay up late, or if you sleep in, your delicate pattern is broken, and all the progress you made goes down the drain. It's like it defaults back to the 4am - 12pm rhythm with even one screw up.
I wish there were a shift rotation for dentists in the military! I'd really thrive with that schedule.
Regards,
Matt
Posted by Glydin on December 19, 2004, at 6:55:52
In reply to Delayed Sleep Phase Syndrome? » Glydin, posted by mattdds on December 19, 2004, at 1:32:16
Hey there Matt,
>
> I am taking clonazepam 2mg daily, but I don't think that's contributing. I really don't feel sedated by clonazepam. Actually, I don't really feel *anything* from clonazepam. I just don't get panic attacks (which is why I still take it - panic disorder).~~I recall your being so very kind and helpful to me in my Klonopin beginnings. I'm glad its still working for you.
>
> I'm also looking into delayed sleep phase syndrome. My natural circadian rhythm seems to be to sleep at 4am and wake around 11 or 12. If only the rest of the world revolved around me, haha. Only problem is that there isn't very good treatment for this, other than to adjust your schedule...difficult to get the military to do that.~~~ Do think about having a sleep study - they are all the rage now (for good reason) and are the start of lookey sees into all manner of sleep disorders. Having a study done may be really helpful.
I worked "nights" for a long while and do indeed understand the "good sleep" happening when everyone else is awake. Luckily, my routine turned around of it's on accord (took a bit of time) when I no longer worked that schedule.
KaraS's light box use is an idea the some find effective - looking into that is an option.
Hope you work it out. Good to have you here again.
Glydin
Posted by Larry Hoover on December 19, 2004, at 8:14:04
In reply to Re: Delayed Sleep Phase Syndrome? » KaraS, posted by mattdds on December 19, 2004, at 5:10:50
> Hello,
>
> Actually, I did try melatonin, but it put me in an odd and creepy mental state, somewhere between sleeping and being awake. Not particularly pleasant. I've heard it works for others though...bummer for me.Ya, but dose may be an issue, too. Too much melatonin can do as you describe. Individual differences in dose-responsivity are such that the typical 3 mg tablet can be far in excess of your individual needs. Saturation of the melatonin receptors actually shuts some of them off, and inhibits sleep induction.
You do seem to be describing a classic case of DSPS. To advance the circadian sleep rhythm, melatonin dosing should be about six hours before retiring.
> As for the light box therapy, I haven't tried it...yet. Sounds like something to look into though.
The sort you'd be looking for is called a dawn simulator. It has a timer, just like an alarm clock. Light intensity gradually increases until you're bathed in very bright light, timed to correspond with the expected time of arising.
You should do everything you can to avoid bright light during the last six hours of your waking period, and to increase bright light exposure early in your day. There are baseball-cap type light sources you can get, too, so you can move around and still get the bright light exposure.
> It's such a slippery slope with this delayed sleep onset business. If you goof around for one night, and stay up late, or if you sleep in, your delicate pattern is broken, and all the progress you made goes down the drain. It's like it defaults back to the 4am - 12pm rhythm with even one screw up.
Time to break out the heavy equipment, then.
> I wish there were a shift rotation for dentists in the military! I'd really thrive with that schedule.
>
> Regards,
>
> MattOr maybe they could just keep reassigning you westwards? The jet lag effect might be just what you're looking for.
Good to see you back, buddy.
Lar
Posted by mattdds on December 19, 2004, at 8:50:07
In reply to Re: Delayed Sleep Phase Syndrome? » mattdds, posted by Larry Hoover on December 19, 2004, at 8:14:04
>>Ya, but dose may be an issue, too. Too much melatonin can do as you describe. Individual differences in dose-responsivity are such that the typical 3 mg tablet can be far in excess of your individual needs. Saturation of the melatonin receptors actually shuts some of them off, and inhibits sleep induction.
Sorry, I'm American, and more is always better.
Wow, hadn't thought of that. This is interesting because I was taking my dad's horse pills (2mg) when I trialed melatonin. Maybe I'll give it another go at a lower dose. Perhaps 0.5mg 6h before bedtime? I'm not even sure what "sizes" they come in.
I remember thinking before taking them that melatonin is released in extremely tiny amounts (measured in nanograms, no?) by the pineal gland, and that 2mg seemed like a whopping dose.
Sounds similar to what supposedly happens during initial SSRI therapy. Autoreceptor stimulation?
Cool stuff Larry, thanks! And hey, good to see you posting here too. I know from my lurking days, that you were missed by many.
Regards,
Matt
Posted by mattdds on December 19, 2004, at 8:58:52
In reply to Re: Delayed Sleep Phase Syndrome? » mattdds, posted by Glydin on December 19, 2004, at 6:55:52
> Hey there Matt,
Hello back!
> ~~I recall your being so very kind and helpful to me in my Klonopin beginnings. I'm glad its still working for you.So glad I'm remembered that way by someone. How are you doing on K? Still working for ya?
> ~~~ Do think about having a sleep study - they are all the rage now (for good reason) and are the start of lookey sees into all manner of sleep disorders. Having a study done may be really helpful.You know, you're right. If for no other reason besides curiosity, I should have one done. The government is paying for it since I'm on active duty in the military. I'd like to rule out sleep apnea, even though I think it's unlikely.
Thanks for the recommendations on light boxes. I think I may have some trouble getting it from where I'm currently stationed, however. We'll leave it at that. ;)
> Hope you work it out. Good to have you here again.
Good to be back, thanks for the encouragement!
All the best,
Matt
Posted by Glydin on December 19, 2004, at 9:15:51
In reply to Re: Delayed Sleep Phase Syndrome? » Glydin, posted by mattdds on December 19, 2004, at 8:58:52
> So glad I'm remembered that way by someone. How are you doing on K? Still working for ya?
>~~~Still works like a charm. Three years (or the majority of the three years). My only RX. Low dosing. A good treatment for me. The doom predictors and life ruination warnings I received from some didn't hold true for me, I'm glad and thankful to report. You were very important in helping me make peace with K. Thank you.
> Thanks for the recommendations on light boxes. I think I may have some trouble getting it from where I'm currently stationed, however. We'll leave it at that. ;)
~~~Bless you, buddy. Keep yourself safe as possible.
Posted by Larry Hoover on December 19, 2004, at 9:42:52
In reply to Re: Delayed Sleep Phase Syndrome? » Larry Hoover, posted by mattdds on December 19, 2004, at 8:50:07
> >>Ya, but dose may be an issue, too. Too much melatonin can do as you describe. Individual differences in dose-responsivity are such that the typical 3 mg tablet can be far in excess of your individual needs. Saturation of the melatonin receptors actually shuts some of them off, and inhibits sleep induction.
>
> Sorry, I'm American, and more is always better.I'm sorry, but the American taxpayer may not necessarily agree with you.
> Wow, hadn't thought of that. This is interesting because I was taking my dad's horse pills (2mg) when I trialed melatonin. Maybe I'll give it another go at a lower dose. Perhaps 0.5mg 6h before bedtime? I'm not even sure what "sizes" they come in.
All the ones I see around are 3 mg, but I know you can get a variety of other doses, and liquids, too.
I just break the pills, myself.
> I remember thinking before taking them that melatonin is released in extremely tiny amounts (measured in nanograms, no?) by the pineal gland, and that 2mg seemed like a whopping dose.
Actually, perhaps 300 or 400 micrograms. But there are a whole lot of variables that affect the amount of oral melatonin that gets to the brain, and thus the "individual differences" thingie.
First pass metabolism is going to take out a considerable part of the dose, but that's going to vary substantially, as the responsible cytochrome enzymes exhibit quite a broad level of activity. Then you have systemic dilution. Those poor little melatonin molecules don't have JDAM targetting. We're talking old-fashioned carpet bombing here. Then you've got the high reactivity of melatonin itself. It's an excellent antioxidant, so systemic pro-oxidant status is a totally uncontrolled variable.
> Sounds similar to what supposedly happens during initial SSRI therapy. Autoreceptor stimulation?
I hate to get all caught up in mechanisms. It's nice to consider them, but without any verification, it's all just words.
BTW, magnesium deficiency might be implicated in DSPS, too. QHS magnesium, 200-300 mg, might help with the resynchronization process.
> Cool stuff Larry, thanks!
I do love questions. Thank you!
> And hey, good to see you posting here too. I know from my lurking days, that you were missed by many.
Ya. I'm doing my best to avoid any further incidents.
> Regards,
>
> MattI guessed from the time zone shift that you're somewhere in the middle east region. I hope you can actually access stuff that's readily available on the net. Stay safe, man.
Lar
Posted by KaraS on December 19, 2004, at 13:30:31
In reply to Re: Delayed Sleep Phase Syndrome? » mattdds, posted by Larry Hoover on December 19, 2004, at 8:14:04
> "You do seem to be describing a classic case of DSPS. To advance the circadian sleep rhythm, melatonin dosing should be about six hours before retiring."
Really, 6 hours before bedtime? I didn't know that. The melatonin puts me to sleep though - how could I stay up those extra hours?
I take sublingual melatonin. Should that also be taken 6 hours before hand? I thought that the magic number for me is 1+1/4 of 1 mg. pills but perhaps I should take less if I need to stay up for several more hours?
Also, I wanted to clarify that you recommend the melatonin along with light box (or light visor) as well as one of thoses dawn simulators for the most effective treatment, right? Oh, and the avoidance of bright light several hours before bedtime.
Kara
Posted by mattsit on December 21, 2004, at 7:33:13
In reply to Forget reality, waking up is hard to do..., posted by mattdds on December 18, 2004, at 9:35:26
HEY Matt,
I'm expierencing similar issues to the ones you describe...Falling asleep can take up to an hour or two some nights, then there is the waking up at 3:30 AM wide awake...falling back asleep by 4:30, and then the alarm goes off at 5:30 and I feel like I could sleep another 6 hours....
Maybe I should just stay up at 3:30?
Posted by dove on December 21, 2004, at 8:54:12
In reply to Re: Forget reality, waking up is hard to do..., posted by mattsit on December 21, 2004, at 7:33:13
>Maybe I should just stay up at 3:30?
>Actually, my mate has this problem and when he switched from working from 3pm-midnight to working 8am-5pm, I had enormous problems waking him up. I tried knocking him out with trazadone and Remeron (mirtazapine), which really made him into a zombie, and finally settled on low-dose sublingual Melatonin. And until just lately, he would just stay up if he woke around 4 am, otherwise, he felt completely horrid the whole day after having slept past this "natural" wake-up time.
Another factor to consider, if you do stay up, you will usually be able to go to bed a little earlier and fall asleep easier and hopefully help reset your sleep clock. However, if you keep yourself up just as late you are liable to sleep in the next day.
Best of health to all!
dove
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