In urgent need of the Straight Dope regarding INSOMNIA.

Factual Questions
1

Fact 1: For nearly a month, I have had trouble getting a full nights sleep. The usual pattern is this:

  1. Fall asleep
  2. Wake up, regular as clockwork (I don’t know if this regularity is significant of anything) approximately 3-4 hours later
  3. Lie awake for an hour, frustrated at my inability to sleep.
  4. Wake again approximately 1-2 hours later
  5. Lie awake for another hour or so
  6. Snatch (if I’m lucky) another half an hour to an hours sleep before waking up for good.

This leaves me with, on average, between 4.5 and 6.5 hours sleep per night whereas in the past I used to average 9+ per night.

Fact 2: I am an incorrigible hypochondriac. On This test for hypochondria the normal person is supposed to score between 14-28. The hypochondriac is supposed to score 32-55. I scored 58!!

In the past I have imagined that I have the following fatal diseases.

  1. Motor Neurone Disease
  2. Deep Vein Thrombosis
  3. Mucormycosis
  4. Brain tumour
  5. Brain Aneurysm
  6. Heart Disease
  7. Stomach Cancer

As well as a few others here and there which I cannot recall at this moment (mainly because I got fuck all sleep last night).

At the moment I am deeply concerned that I am suffering from New Variant Creutzfeldt Jakob Disease. Learn more about it

here

My insomnia began the very day I discovered that insomnia is a symptom of new variant Creutzfeldt Jakob Disease.

Here is the thing I do not understand. When I go to bed, it is now customary for me to think “When am I going to fall asleep? When am I going to fall asleep? Why haven’t I fallen asleep yet?” and so on. The more I think this the longer I stay awake and the more my fears about New Varient Creutzfeldt Jakob disease are perpetuated.

However, I always fall asleep eventually, sometimes quite quickly. Surely, at this point, since I have calmed down enough to actually get to sleep I should have a full fucking nights sleep after this point!. But I never do. At some point I am able to relax to a point where I can fall asleep but I always wake up 3-4 hours later.

Question: Can these sudden awakenings be caused by my anxiety? If so, how am I able to fall asleep in the first place? Surely, by the time I actually fall asleep the first time I am relaxed enough to sleep all night long.

Further Fact: I know that, even once I have calmed down, fears of CJD are still prevalent at least in my subconscious. I know this because I dream about them. I dreamed last night that I was explaining news of my ‘official diagniosis’ to my mother. I did not wake up either during or directly after this dream as I went on to have another one wherein I was pelting Paul Weller with water balloons.

Right, that’s my question. As you can tell, it is troubling me somewhat. I’d just like to field a few likely responses.

Q1) Go see a shrink.

A1) Already doing that.

Q2) Calm the fuck down, nancy boy!

A2) Even when I am calm when I fall asleep, I still wake up 3-4 hours later. Case in point, I had my only decent nights sleep (7 uninterrupted hours worth) a couple of days ago. I was so excited (but in a good way) when I woke up that I couldn’t get back to sleep again. The next night I fully expected to sleep soundly and didn’t worry in the least. I still woke up 3.5 hours later and then couldn’t get back to sleep because I had an early lecture. Now I’m back at square one.

Q3) Stop worrying about New Variant CJD. The odds are like a million to 1 against, wake up and smell reality.

A3) Sorry. Not an option. Can’t do it. Tried and failed.

Q4) Do you have any other underlying psychological conditions?

A4) I was recently diagnosed as having Obsessive Compulsive Disorder (although not particularly seriously). I will soon be starting on anti-depressant medication.

That’s everything. I would really appreciate some help on this as the little warning label on my packet of non prescription sleeping tablets which I bought yesterday but haven’t opened yet says that any bout of insomnia that lasts more than 2 weeks should be brought to the attention of a doctor. As I said above this has been going on for nearly a month.

2

Also, another likely question might be

“Do you have anything else on your mind?”

Answer: No. In fact the only thing I can *ever * recall worrying about is my health. It’s like I don’t have it in me to worry about anything else. I don’t worry about money and as such I don’t worry about work. I don’t worry about home life. I don’t worry about my sex life. I don’t have any issues with my family and I have plenty of friends.

I spend every waking moment worrying about my health.

3

Don’t lie in bed staring at the ceiling. This never helps. You’ll just stress out further about falling asleep.

Get up and leave the bedroom. Putter about for an hour or two. Read something. Post something. Discover the glories of late-night TV.

When you feel tired, go to bed. If you still can’t sleep, get up again. Eventually you’ll be ready.

4

Not meaning to sound unhelpful here, but you say you’re already seeing a shrink? Why not ask the shrink about the insomnia?

And anyway, it sounds like you already know perfectly well why you can’t sleep. :wink:

You admit that you’re a hypochondriac, so I won’t burden you with all the other diseases that insomnia is also a symptom of. :smiley:

Talk to the shrink. :wink: That’s your best bet, IMO.

5

Ben, I think what mostly working against you here is your Hypochondria. About a two years ago, out of nowhere, a spot appeared in my vision (right eye only) and did not go away. It wasn’t a blind spot, but more like that effect you get when you stare at a bright light source for too long, and have that after image. It’s roughly the size of a CD held at arms length just top-right of center vision.

Anyway, when it first appeared, I was a little more than curious, but was able to keep down any negative thoughts for the time being… but then it didn’t go away… two weeks passed, and I became ever more concerned about it. My concern grew exponentially. I could feel it swell. There was a literal breaking point… BANG! I was in full blow panic mode. Thoughts of Brain Tumors, Cancer, Glaucoma, Blindness, and many other terminal illnesses went through my head. Also, leading up to the point of my panic attack, I had started getting symptoms of TMJ (I believe due to the constant worrying). I had never experienced this before, and didn’t know what it was, so I made the assumption that the vision thing and the TMJ thing were related in a BAD way. So that night I went to emergency. Convinced I had some form of rapidly spreading cancer (I have to tell you i was FREAKED). Anyhoo, of course, the doctor assures me I am fine, explains TMJ, I fell 110% better and I go home…

…and then it begins. How does the doctor REALLY KNOW I’m ok? She didn’t run any tests. This spot is still a mystery. Now I am back where I started, but worse off. Long story longer: After multiple visits to the Ophthalmologist, GP and what have you… I still wasn’t convinced I was all right. I went into a DEEP depression. All I could think about was my health. My life suffered. Everything I saw reminded me of my eminent doom. I wasn’t myself. I couldn’t sleep. I bought over-the-counter sleeping pills. I couldn’t eat. I couldn’t have normal conversations or even watch TV. I just couldn’t relax or calm down. Always anxious and in a deep pit of despair. So when I read your post, it all came back to me, and I felt i needed to respond.

How did I overcome my depression/anxiety? Eventually, I had to realize I was FINE. I realized no matter how many tests were run or how many doctor visits I had, there was no satisfying this recursive downward spiral I was in. I had to STOP it. I can’t explain it, but there was something deep inside of me I just shut-off. And I gotta tell you, it wasn’t long before I was back to my former, laid-back, fun-loving me. Sure there were times those thoughts crept back in… But I “will” them back. I think it helps realizing and admitting you suffer a form of Hypochondria. I think that’s where it starts. And, yes, after two years I still suffer the same symptoms I had then (spot in vision, TMJ, various other scary pains). But now, I’m sure most of them were brought on by the monumental stress and anxiety I put myself through. Kind of like a self-fulfilling prophecy. but I’m glad to say that after a year, not a bout of depression.

I know this isn’t really an answer to your questions, but I hope that maybe this can do you some good or give you a little hope, that most of it is probably in your head (you seem to already realize that) and that it CAN pass. I wish you the best of luck, and a long and, most importantly, happy life.

-kev

6

Ben Hicks, you mentioned that you will soon be starting to take antidepressants. That may well help you sleep. Many people with sleep disorders also are treated for depression, and antidepressants seem to help in that area.

I can’t offer any advice that hasn’t already been offered, other than to maybe suggest you find a mental exercise/meditation that you could run through when you lay down to bed that might help to clear your mind. This is the only way I can get to sleep some nights.

I have a CD of self-hypnosis for relaxation that is wonderful, but you can also check your library for books on meditation. Once you get your mind focused on your body, i.e. your breathing, heart rate, etc. it becomes easier to fall asleep and stay asleep.

There are no quick fixes, and you’re likely to go through a lot more before you see any respite, but stick with it, and make sure you express all your fears to your doctor. True, you may feel embarassed and they may tell you that you’re worrying too much, but it’s your health, and it’s better to be safe than sorry.

7

The previous two winters, I had significant, prolonged insomnia, lasting about 2-3 months each time. I eventually went to a doctor and got some anti-anxiety medication that enabled me to relax. Unfortunately, I can’t remember what it was called.

8

Meditation. Very good advice.

9

Talk to your docs first about possible contraindications/conflicts with your other meds, but I have found melatonin to be extremely helpful in getting me to sleep through the night. (I was having similar issues of sleeping 3-4 hours and then waking up, albeit minus the hypochondria, etc. that you mention.)

10

You’re worried because you’ve been an insomniac for a month?!

You’re a piker. I’ve been an insomniac for 25 years. Multiple symptoms on a rotating schedule. Tried many therapies/treatments/drugs. Nothing works. I’ve stopped worrying about it.

11

I’d go with the meditation advice.
The key there is to discipline yourself.

An old trick, though, that probably won’t work for you since you’re so jazzed, would be to not ‘try and go to sleep’ but to ‘try to not sleep’–sometimes the reverse psychology on yourself works.

12

Re: INSOMNIA

Hi, Ben. Your question caught my eye last night, but I didn’t get a chance to put in my two cents until now.

What follows is a specialist’s medical advice based on the history you describe. Please feel free to share this info with your treating doctor if you wish. I’m often contacted by primary care docs with similar questions.

You have described a case of pathological hypochondria, not to be confused with realistic health concern. You already know your fears don’t respond to logic or reassurance. Hypochondria is currently seen, and treated, as a subtype of obsessive-compulsive disorder.

OCD, in its many forms, shows up on PET scans as a failure of specific neural tracts to “shut off” the fear when the cause is resolved.

This is NOT a benign or trivial complaint. Terrified about your health EVERY WAKING MINUTE?! People with quadriplegia get to think, socialize, work, feel satisfaction with their accomplishments!!! Your condition is more painful and more disabling than theirs, and you deserve the best treatments available to control it. (asst clinical prof oldbat glares at the medical students and bangs her umbrella on the table for emphasis.)

What doesn’t work?

Traditional psychotherapy.
Sedatives. (As you noticed, you can be knocked out, but your brain just keeps on worrying in your dreams.)
Reassurance.
Relaxation, meditation, etc. These are great for providing the feedback that calms down the fear response, but if you’re “numb” to that feedback they don’t help.
Just keeping a stiff upper lip, etc.
Ridicule or blame. The blame you get from yourself is worse than the hassling other people give you.
Herbs, vitamins, extracts, supplements, etc. There is NO naturally occurring treatment that reverses the kind of brain disorder involved here. NONE.
And the least helpful intervention of all is to try to worry until you feel better, or to look on and on for that one little fact that would
“put your mind at rest.” Like scratching an itch. It makes the problem worse.
Antipsychotic medication. It’s great for delusional thinking, hallucinations, disordered thinking. OCD isn’t responsive.

So what works?
Behavioral therapy. It breaks into the negative-feedback cycle if you refuse to act on obsessive thoughts until they calm down from lack of reinforcement. Many people snap their wrists hard with a rubber band every time an obsessive thought pops up. Doesn’t do serious damage, but it hurts enough to derail thinking for a short time.
Antiobsessant medication. All of the antiobsessants are also antidepressants, but ALL ANTIDEPRESSANTS ARE NOT HELPFUL FOR OCD. The ones that help are clomipramine (possibly the most effective, but the one needing most in terms of blood levels, etc.)
Also fluvoxamine, fluoxetine, sertraline, paroxetine, citalopram or escitalopram. We hoped that combined-action drugs like nefazodone, venlafaxine, or mirtazipine would work as well, but I’m not seeing that much in practice. Possibly some of the “atypical antipsychotics” like quetiapine, ziprasidone, or aripiprazole will turn out to be useful, but that’s still a research question. Desipramine, trazodone, and buproprion do SQUAT.

I’m giving these in generic names because they have different proprietary names in various countries. You may not be able to get all of them, but there are several available in all European, Asian, North/South American, Australian, etc., pharmacies.

OCD generally requires larger doses than are effective for major depression, panic disorder, etc. It also takes longer for the OC symptoms to improve. Think 10-12 weeks to see a definite reduction, then slow gradual improvement, sometimes for years. Then think in terms of lifetime maintenance. If the meds are stopped, the disease promptly reasserts itself. It ain’t dead, only sleeping.

If you happen to live in Canada, there are neurosurgeons developing techniques for isolating the malfunctioning brain tract and microsurgically cauterizing that pathway only. This treatment is structural and seems to be permanent. It doesn’t usually get rid of all symptoms, but can turn intractable, intolerable disease into something treatable.

Other countries may also have research surgical programs. Here in the US where I practice, no.

This disease is a BEAR! Successful treatment usually takes a combination of therapies, and in the short term it may feel worse than the disease. But you sound like a man who has tried hard at a number of attempts, and also like a man ready to say “f*** this disease, it’s run my life long enough, I’ll do whatever it takes.” With that determination, you’re making progress already.

Here endeth asst prof oldbat’s standard summary of OCD and its treatment. Without medical school tuition, even!

DISCLAIMER: this essay discusses the treatment of OCD, a chronic and nasty disease. This information is not a diagnosis or prescription of treatment for any individual. Don’t attempt to self-diagnose or develop a treatment plan without supervision of a qualified physician.

Good luck and warm regards, Ben.

13

I’ve had problems with insomnia, but mostly with falling asleep, not staying asleep. I find melatonin to be a life saver. At GNC, you can get 1 mg tablets which you dissolve under your tongue – take 1-3 of them 30-60 minutes before you go to bed. Once you’re awake in the middle of the night, it’s too late – they’re meant to augment your natural “falling asleep” response, so you need to take them before you go to bed. For me, I usually only need to take it a few nights in a row to break out of an insomnia cycle. It’s also great for diminishing jet lag. I always sleep really deeply when I take it.

(FWIW, I’m a scientist and went and read the journal articles about melatonin when I first heard about it. They’ve done tests at dosages of 50 and 500 mg with no ill effects, so 2-3 mg should be very safe.)

14

Wow, thank you everyone for your well thought out responses. Especially oldbatoutahell. FYI, I have just been diagnosed with OCD and am going to start a course of citalopram soon, so maybe things are looking up :slight_smile:

15

Do you snore?

Many sleep problems are a result of snoring (not geting enough oxygen)

It sounds like it’s more of a mental hurdle than a physical one with you.

you are already convinced this stems from a larger problem.
it would help to rid your mind of that. you are practically setting yourself up now, to NOT sleep well.

16

tricyclic anti depressents bring on lethargy and drowsiness
the enhancers like prozac have side effects such as insomnia, nervousness, and others till they kick in
i have taken prozac along with zopaclone, a sleep inducing narcotic which regulates the sleep patterns
i still take zopaclone but have switched to st j wort for my down times.
on a recent return from a long haul i used zopaclone to quickly bring under control the lag.
i take 1/2 a 75mg tablet for 2 nights only and then leave a gap of 2 nights…unless those 2 nights run to a good pattern of sleep
and friend if there is something on your mind…its that that is keeping you awake
no sweat all these drugs are there to be used intelligently
thank God
:slight_smile: