Reset your sleep pattern

[JamesF]

I recently read a few books on insomnia and CBT to eliminate bad habits around sleep. Most of these are common sense and I summarised these sleep "rules" in my intro thread. I'm quoting this at the bottom in the chance that anyone might find it useful. They're well worth adopting for anyone with insomnia, since even insomnia with physiological causes can become psychological/behavioural after a short period.

 

However, with this thread what I'm wondering is how to start sleeping in a certain window like 11pm - 7am again when it's totally messed up and upside down.

 

Right now, I often don't fall asleep until 4 to 6am, then sleep in small fragments of 0.5h - 1.5h. I get up at a varying time, this depends entirely on if I have slept enough not feel totally exhausted. If I have then I'll get up, if not, I might stay in bed all day trying to sleep. I've tried to go to bed at the same time, but I'm often too agitated to sleep. Likewise I try to get up at the same time, but I'm often far too exhausted and it's just seems very unkind to force myself to stay up for 16 hours. 

I think my body is possibly capable of sleeping more deeply and in longer stretches, since it happens occasionally. But during withdrawal, it's been super habituated to 1) sleep in tiny fragments 2) get up to eat something 3) have trouble going to bed at the same time due to agitation 4) have trouble getting up at the same time due to exhausted from insomnia.... it's a vicious cycle. 

I would really like to press the RESET button and start sleeping at the same time every day... but the last 5 months of broken sleep habits has a huge amount of weight... 

Does anyone have any advice on how to reset it and start falling asleep and waking at reasonable hours? 

 

Quote

1. Get up at the same time every single day (after which you do not try to sleep again). 
2. No napping. 
3. If you're awake in bed more than ~20 minutes, get up and do a low exertion and low light activity such as reading. It's better to have an activity with a definite finishing point, like 100 pages of the book, or cleaning a certain room.
4. Return to bed on sleep cycles (every 90 minutes) or simply when feeling sleepy again. 
5. The same sleep window every day. E.g. 7.5 hours. It's not said within the CBT books, but within psychiatric drug withdrawal, I think it's good to be very gentle with reducing this window. For instance, allowing yourself 10.5 hours or even 12 hours within which you're allowed to sleep to start with, while you develop the other patterns on this list, then to very gradually reduce it to say 9 hours. Restricting sleep too much at the start can definitely cause a profound stress reaction, sleep deprivation or intensification of symptoms, which is definitely not what we want.In my case, I'll sleep for 1.5 or 3 hours, then won't be able to sleep again for many hours, so I'm keeping the window fairly large at the start then gradually reducing it. 
6. If you're spending significant time awake during this sleep window, reduce it by 30 minutes for a few weeks. Do this again until sleeping 90%+ of the window. But always keep wake time the same. Apparently 90% of insomniacs can significantly improve their condition simply by reducing their total time in bed. 
7. If you're spending all your time asleep during this sleep window, yet not feeling refreshed, increase it by 30 minutes for a few weeks. Stop if not sleeping 90%+ of the window. But always keep wake time the same. 
8. Fairly obvious sleep hygiene rules like no electronics or screens in bed or near bed time, no intense light, no strenuous activities prior to bed, etc. Whatever is associated with wakefulness needs to be totally removed from the room your sleep in.
9. Interrupt any rumination or negative thought loops! For instance, if you'd usually stay in bed becoming more anxious about not sleeping, slice through this loop by getting up and immersing yourself in another activity. On the other hand, positive thought loops can also be cultivated using techniques like affirmations (e.g. I sleep well throughout the night, it doesn't matter exactly how much I sleep, etc), EFT, hypnosis, etc. 
10. Have a relaxation routine you do every night prior to sleep. This can be hypnosis, meditation, a bath, some breathing exercises. The key is just that you do it every single day for at least a month so it has time to both work and be associated with winding down into sleep. On the other hand, trying lots of different techniques for only a few days would be negative, developing thinking patterns like "nothing works" when the truth is that it has not been given a fair trial. 

Warm regards,

Jay

[compsports]

Hi Jay,

 

Why don't you fall asleep until 4am?  I think answering that question is the first step in working towards a "normal" sleep pattern which by the way will take time to establish.

 

Sorry, I have a big-time problem with CBT as I feel my sleep issues led to my getting lymphoma.   Therefore, in my opinion, saying it doesn't matter how much sleep I get is total BS.

 

I agree it isn't helpful to ruminate on issues but there is also reality.

[Altostrata]

Please look at the topics pinned to the top of this forum.

[andy013]

Hey Jay, one of the most important things you can do to regulate your sleeping pattern is to control light exposure. You have cells in the back of your eyes that are not used for seeing but instead when light hits them they regulate the release of certain hormones that can make you feel tried or alert. If you can control light exposure at the right times relative to your current sleeping pattern then you should be able to gradually shift it backwards. It generally takes a few weeks for this to work though as your body clock is only influenced a small amount each night, but the cumulative effects add up and if you keep it up you should begin to find it easier to fall asleep earlier.

 

The first thing I would do is start to log your current sleep and wake times each day. Try and get a sense for when your naturally falling asleep and waking. 

 

You should be avoiding bright light at least a few hours before you are going to fall asleep. One of the main sources of light that disrupts our sleeping pattern in modern life is from computer screens and smart phones. If you use them late in the evening then it will reduce melatonin in your body which is the sleep hormone and you will feel less tried and find it harder to fall asleep. Essentially you are signalling to your brain that it is still daylight and so it will delay the time at which you feel tired. It can be difficult to avoid bright light entirely so you can try various different things to reduce light exposure as much as possible. For example, turn the brightness on any screens down as low as they go and turn them onto dark mode if possible. You can also download programs like f.lux that help by reducing the amount of blue light emitted by your monitor. Those cells at the back of your eye that regulate your sleeping pattern are most sensitive to blue light, so if you can reduce it, it will help. You can also buy orange tinted glasses that will help to do this as well. Even regular sunglasses will help to reduce the overall brightness of light entering your eyes. If you do these things and limit light for a few hours before your natural sleeping time that you logged, you should find it becomes easier to fall asleep. 

 

The second thing you can do is to make sure you exposure yourself to very bright light as soon as you wake up. This means, no snoozing, as soon as you wake you should jump out of bed and immediately head outside or go to a very brightly lit window and expose yourself to this light for at least 10 minutes. This will help to kick start your body clock and signal to your body that it is time to wake up. If you live in a particularly dark country then you can also buy 10,000 lux light boxes that can help with this in the winter. These are much brighter than regular light bulbs and do a good job of simulating natural daylight. I, myself have a 10,000 lux light that I set on a timer so that it will automatically come on and I find that I just naturally wake up after 10 minutes or so of the light shining on my face. 

 

Once you have established these habits and you are logging your sleeping times then you can begin to try and move your sleeping back by waking earlier and falling asleep sooner. It is important to do this quite gradually as you can probably only naturally adjust your body clock by about 1 hour per week max. There is no point in trying to rush or force it as it will only make you feel tried and you will end up napping or sleeping in the next day. If you control the light levels like I have said, you should find that you just begin to feel tried earlier after a few weeks and so you should naturally be able to fall asleep 10 minutes earlier than you did the night before. If you keep doing these small adjustments and controlling the light levels you should be able to get your schedule more in line with natural daylight hours. I have even been able to successful move my schedule back by about 6-7 hours over a few months without ever needing to set an alarm. Simply by having a bright light come on in the morning and getting exposure to it as soon as a I wake and then avoiding bright light in the evening gradually shifts your sleeping pattern backwards over time.

 

Just remember that it is important to maintain these habits of controlling light exposure so you don't slip back into your old sleeping pattern. Most people who fall asleep very late like you do so because they constantly expose themselves to bright light during the evenings and their body "thinks" that it is day time so they gradually sleep later and later. 

 

I hope this helps

Andy

 

[JamesF]

4 hours ago, andy013 said:

Hey Jay, one of the most important things you can do to regulate your sleeping pattern is to control light exposure. 

 

....

 

I hope this helps

Andy

 

Hi Andy,

Thank you for all of these tips. It was very useful. I have ordered a 10,000 lux light box on your advice and it should arrive the next few days. Do you think it needs to be very close to be effective? I saw some recommendations of sitting about 30cm away from one for an hour for SAD treatment. 

Gradually shifting the pattern makes sense too. I think I was trying to change it too much at the start, which inevitably led to the frustrating of lying in bed unable to sleep. I'm going to experiment with light and will post an update in the coming weeks. Thank you again. 

[Rob66]

I've never had the opportunity to establish a regular sleep pattern in my entire adult life.  Little did I know at the time that my career path would lead me to years of shift work.  23 years swing shift, 2 years straight nights thus far.  I honestly don't know what regular circadian rhythms feel like.  I always wondered if things would've been different if I had a regular day job and got "normal" sleep.  I love everything about my job except the hours.  It wasnt ever reason enough to leave.  Hopefully I can grind out another 10 years then retire to a normal sleep pattern.  I guess you could say that I'm fortunate enough being able to cope with it for this long.  Many others before me haven't been so lucky and had to leave.  I like to think some day my reward will come.

[andy013]

On 30/12/2017 at 3:57 AM, JamesF said:

Do you think it needs to be very close to be effective? I saw some recommendations of sitting about 30cm away from one for an hour for SAD treatment. 

 

I simply sit it on my desk next to my computer. It's probably about 20-30cm away. Any more than that and the effect might be lessened. Please be careful when you first start using it. If I use it for too long then i can experience mind racing that lasts the whole day and that can make it more difficult to get to sleep. I would start by using it for 10 minutes for a few days and see how you feel before increasing it if you think it's necessary. 1 hour sounds a little excessive to me, but other people might need a longer exposure than me.

 

Another point to note is that I remember during earlier periods of withdrawal my sleeping was messed up and sometimes I would wake and then find it difficult to fall back asleep or I wouldn't be able to get to sleep despite controlling light levels. I think you just need to accept that this might happen and try not to force things too much. If you have a night like that then go easy on yourself and allow yourself to sleep in or nap a little if possible. Hopefully over time these things will improve for you and become less of an issue.

[JamesF]

8 hours ago, andy013 said:

 

I simply sit it on my desk next to my computer. It's probably about 20-30cm away. Any more than that and the effect might be lessened. Please be careful when you first start using it. If I use it for too long then i can experience mind racing that lasts the whole day and that can make it more difficult to get to sleep. I would start by using it for 10 minutes for a few days and see how you feel before increasing it if you think it's necessary. 1 hour sounds a little excessive to me, but other people might need a longer exposure than me.

 

Another point to note is that I remember during earlier periods of withdrawal my sleeping was messed up and sometimes I would wake and then find it difficult to fall back asleep or I wouldn't be able to get to sleep despite controlling light levels. I think you just need to accept that this might happen and try not to force things too much. If you have a night like that then go easy on yourself and allow yourself to sleep in or nap a little if possible. Hopefully over time these things will improve for you and become less of an issue.

Thank you. Yes I tried it and think I did it too long the first time. I felt like my nervous system was over stimulated, agitated. Not unlike accidentally having too much caffeine. 

I will try starting with a few minutes and at a distance and build up as tolerated. 

Yes good point on not forcing things too much. Agree with this completely. My attempts to stay up or force myself to go to be to reset the pattern have all backfired, best just to make gradual, gentle changes as you have said. 

: - )

[gardenlady]

Chronic insomnia due to Cymbalta withdrawal caused me to stay awake all night and not fall asleep until morning.  Now, I'm unable to sleep at night at all, regardless of what time I go to bed or how tired I am.  Sleep hygiene suggestions are useless as my sleep is 180 degrees reversed.  Also, I continue to have times when I stay awake for 24-48 hours.  Even then, as exhausted as I am, my body will not sleep until morning.  

 

Does anyone know how to reset one's circadian rhythm when it's completely reversed?  I don't have sleep apnea, so don't need to go to a sleep lab.  My guess is that I need some kind of process to get me back on track, but I don't know what it is.  Additionally, I have severe depersonalization and derealization and a horrible sense of doom and dread that never leaves.  It's like being on a bad acid trip non-stop.

 

All this while doing a "slow, safe" taper of Cymbalta.  I am evidence that a slow taper doesn't mitigate horrible withdrawal symptoms.  Granted, I'm sure it would be even worse if I went faster, but it's been brutal nonetheless.   

[herod]

Hello gardenlady, I'm pleased to find someone with this symptom. I have also on occasion been awake for 48 hours, not by choice. I just didn't fall asleep. Some days it got so bad that I was waking up at 10 PM.

I can't offer you advice because nothing I've tried has worked. It's like my brain knows when nighttime is, it has just decided to stay awake during that time. So any attempt to reverse my sleep schedule is fundamentally futile. Hope I'm wrong on this.

[drugged]

A few years ago I had something similar happen. Even with all the CNS depressants I was on for sleep I started waking up around midnight/1 am and couldn't get back to sleep. I was wide awake and actually alert! The next day I'd be incredibly tired by mid-afternoon.  After trying to fight it for several weeks I finally gave in and decided to just give my body what it seemed to need.  With no job, no kids, just myself, my spouse, and our cat I could get away with it, thank God.  I started going to bed around 5 pm and would sleep until I woke up, usually around midnight or 1 am.  I just went with that and about a year ago my Circadian cycle started to shift back towards a more normal pattern.  

 

I still take two medications for sleep and thankfully they still seem to work so I usually get close to 7 hours.  

[DaisyBell]

Maybe see a sleep specialist? I don’t know much but they could reset your circadian rhythm. I think sleep deprivation, but only under care of an expert, may help. Melatonin is  pretty good too.

[drugged]

5 hours ago, DaisyBell said:

Maybe see a sleep specialist? I don’t know much but they could reset your circadian rhythm. I think sleep deprivation, but only under care of an expert, may help. Melatonin is  pretty good too.

Hi DaisyBell,

 

At this point I'm not suffering from sleep deprivation.  I get about 7 hours of sleep daily so that's excellent.  

 

Truthfully, I'm not bothered by my weird sleep cycle.  As long as my body gets enough sleep I'm fine with when that happens.  I just try to listen to my body.

[Onmyway]

Hi drugged, you can usually reverse your circadian rythm by using melatonin. You have melatonin at the time you want to go to sleep and then stay in bright light when you are awake. Repeat every night. There are more elaborate plans online. 

[gardenlady]

I've tried melatonin and it didn't work.

[drugged]

12 hours ago, gardenlady said:

I've tried melatonin and it didn't work.

I tried 1 mg tablets of melatonin and it did seem to improve my sleep though it's hard to say for sure because I take other meds at bedtime.  I did get headaches everyday I took it though.  

[Shane88L]

Hello,

 

This was essentially me up until recently. I had to force myself to stay awake during the morning and throughout the day and then  it started at 4pm. From 4pm until about 7pm, then awake.  Then I eventually managed some longer moments of sleep, increasing by an hour or so. Then, eventually, I managed changed those times to where it is a 10pm-11pm time to sleep and waking at 6am - 7am. This went on for about a month, of slowly trying to stay awake for longer and if I woke up, just try to relax and then fall asleep again. I had to quit caffeine and sugar at the same time. Never imagined I could sleep normally again (except for the vivid nightmares every night)

I really feel for you. It is a struggle to have a messed up sleep cycle, but it can be beaten.

[gardenlady]

3 hours ago, Shane88L said:

I had to force myself to stay awake during the morning and throughout the day and then  it started at 4pm. From 4pm until about 7pm, then awake. 

What started at 4 pm?  Will you please clarify?  Your story is encouraging and the way you gradually got around to sleeping at night makes sense. 

[Valhalla]

Cymbalta/duloxetine... the most awful drug.

 

I'm still awakening between 2-4am after being off the drug for one year and two months. I'm constantly sleep deprived during the day even after getting near six hours of sleep but not restorative sleep. The cortisol spikes during this time have not gotten any better. I'm considering having a sleep study done but unsure if this will ultimately give me answers. I think the only thing that may help is time. 

[gardenlady]

1 hour ago, Valhalla said:

Cymbalta/duloxetine... the most awful drug.

 

I'm still awakening between 2-4am after being off the drug for one year and two months. I'm constantly sleep deprived during the day even after getting near six hours of sleep but not restorative sleep. The cortisol spikes during this time have not gotten any better. I'm considering having a sleep study done but unsure if this will ultimately give me answers. I think the only thing that may help is time. 

Wow, that is tough, Valhalla.  Sounds like you're in protracted Cymbalta withdrawal after a too-rapid taper.  I'm so sorry as I know what a rat poison of a drug it is.  Even doing a slow, steady taper is brutal....much longer and more drawn out than the benzo taper.  It's just as bad, but in different ways.  Sort of like equally bad but different LSD trips.  Yes, time is the only answer as there is absolutely nothing one can do about it.  My sympathy goes out to you.  

[Valhalla]

13 minutes ago, gardenlady said:

Wow, that is tough, Valhalla.  Sounds like you're in protracted Cymbalta withdrawal after a too-rapid taper.  I'm so sorry as I know what a rat poison of a drug it is.  Even doing a slow, steady taper is brutal....much longer and more drawn out than the benzo taper.  It's just as bad, but in different ways.  Sort of like equally bad but different LSD trips.  Yes, time is the only answer as there is absolutely nothing one can do about it.  My sympathy goes out to you.  

Thanks, GL,

 

I did CT from 20mg of duloxetine. Worst mistake I ever made. I did a benzo taper as well and suffered withdrawal as well. 

[Shane88L]

Ah, apologies for the vague description. From around 4pm, when I was beginning to try and make changes to my pattern of sleep, I would fall asleep and only remain asleep for a few hours at maximum. No matter how tired I was, I would wake up with only terrible dreams in my head. This continued for a over a month, where I would simply stay up all night and try to stay up throughout the morning and further into the day. Eventually, I stretched the time I could sleep, from 4pm to where I am now, which is usually 10pm-11pm. I do wake often in the night still, but there are occasions where my sleep is quite unbroken and I wake up at 6am or 7am. It feels wonderful when that happens.

I do still think I am healing, coming up on 15 months c/t off of that horror drug zyprexa, so it really is a matter of time I feel.

So, the most helpful thing for me regarding getting my sleep cycle back was to simply stay up throughout the morning and day for as long as possible (where my sleep was 1-3 hours at maximum), and continue this for a few months, which finally worked for me. The few hours turned in to an eventual ability to remain in the bed for 8 hours, even with some waking up throughout,

Hope I made things more clear.

Wishing you strength throughout this challenge,

Shane.

[emerik]

hows the sleeping @JamesF, im like you when in a waves, cant sleep at all or sleep 1 or  2 hours, when in windows sleep ok !

[Altostrata]

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