#103

I have been experiencing quite severe insomnia for several weeks now. I have difficulties falling asleep and staying asleep. All sleep medications seem to have drawbacks, such as the risk of dementia. I have a prescription for Mirtazapine and Trazodone. I also have Meclizine, which I haven’t tried yet. Meclizine is associated with dementia…

Mirtazapine elevates resting heart rate significantly for several days, and the last time I used it longer period of time my neutrophil count dropped significantly. Trazodone causes severe dry mouth, and I wake up because of it. Melatonin does not help sleep-maintenance issue.

I have tried the supplements below, no significant help.

  • Glycine 3g
  • Taurine 3g (not the same evening with glycine)
  • Magneisum glycinate
  • GABA 500mg
  • 5-HTP 200mg
  • Phosphatidylserine 400mg
  • Ashwagandha 300mg ( I don’t like this because possible liver issues, low risk but too little upside)

Do you have any recommendations? Which medication has the least long-term side effects? Supplements?

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#104

Sleep is quite a complicated thing with timing issues related to the sleep cycles. That makes things a bit more complicated than just take something at a particular time.

I used to have very serious issues with sleep, but have overcome those. However, part of that was using a sleep tracker (fitbit).

It strikes me you are generating too little endogenous melatonin, but you cannot solve that simply by taking melatonin as the pineal gland injects melatonin into the 3rd ventricle of the CSF and when you eat it it just goes into the serum.

Are you taking vitamin D? How much magnesium are you taking?

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#105

Sleep issues are complex. Have you tried to reduce the effects of day time stress?

Relaxation, yoga nidra, meditation at lunch time, (but not much later than so)?

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#106

I use a sleep tracker (Apple Watch). I take Vitamin D 40 ug and magnesium 300 mg

#107

How long is your initial sleep?

Do you try NSDR/Yoga Nidra to get to sleep?

How old are you?

#108

I do a little yin yoga. Btw, my morning HRV (RMSSD) is moderate level, but not as good as it has been before.

#109

I’m 44. I’ve always been a little bad at falling asleep, but now I wake up and can’t sleep anymore.

#110

With a long and ongoing disturbed sleep, I would take a break from all supplements and all medications ( but of course not those that are vital for your life).And talk to your doc first.

Cleans your body. Then see how you feel and start adding one at a time.

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#111

I already tried leaving all supplements for 2 weeks, no difference. Only Ezetimibe (5mg) and Rosuvastatin (2.5mg) remained. And the Doc prescribed Mirtazapine, but maybe I need to see another doctor…

#112

I will try NSDR/Yoga Nidra. I’ve never tried it before. Thanks for the tip.

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#113

Sleep is quite complex. Part of it is getting the autonomous nervous system into the parasympathetic state. NSDR can help with that when going initially to sleep. If your body does not generate enough melatonin you are likely to wake early.

Don’t take melatonin on waking at say 3am or 5am.* You need to wait until the sleep cycle (which is an ultradian cycle) is about to end. They take around 90 mins. So you need to wait about an hour then take melatonin spread over about 30 mins (this varies from person to person). The next sleep cycle then may be in parasympathetic mode and you will get to sleep. It is, however, complex and varies from person to person.

  • it is possible to wake just before the end of the sleep cycle and immediately take a dose of melatonin which keeps the body in parasympathetic mode, but that is quite difficult.
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#114

Alcohol makes quite a difference to this as the alcohol rebound may make it really difficult to get to sleep until two or more HPA/Ulttradian/Sleep cycles have passed,

#115

Should I take melatonin before going to bed? Time-release version?

#116

@Jay, Doxepin isn’t an MAOI. It’s a tricyclic. You may be thinking of Deprenyl.

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#117

I am going through this right now. I started 2 months ago. My belief is that meds are a crutch. A crutch is a useful way to let a broken leg heal but a poor way to get around town. Heal the leg.

If you are not committed to meds, here’s some stuff to think about.
Get help from a real sleep doctor (check out the Sleep is a Skill podcast).
I stopped all supplements at night. Everything, not just sleep meds. Just in case something was affecting me.
I eat dinner earlier…go to bed with an empty stomach. My HR is lower faster if I skip dinner or eat by 6pm.
I do easy exercise when I wake up and after dinner. Easy. <100 bpm.
I don’t do hard exercise after 6pm…I’m trying to shift it to AM
I have a wind-down routine: HRV biofeedback, stretching, make a list of thoughts for next day, turn off phone and do not bring into bedroom
I set an alarm for the same time every day; I go to sleep when sleepy. Some nights i don’t get enough sleep; I get more sleep the next day because I’m more sleepy than normal.
I read in bed instead of watching TV.
I make sure I won’t wake up hot…fan, no shirt…whatever is necessary
Usual “sleep hygiene” – dark, noise maker, etc.
I used to wake up at 2-3am every night. Now I sleep through the night, and when I get up to pee I fall back asleep without trouble. I am now working on extending my sleep from 6.5-7 hours to 8 hours.

Good luck.

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#118

Cognitive behavioral sleep therapy is considered first line, most effective and safest therapy for disordered sleeping. If you’re in the USA, Psychology Today has a free online therapist finder tool.

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#119

I think room temperature is important. It has to be colder rather than warmer. My favorite temp is 68-69 F in winter.

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#120

A complex question and i dont have enough information to answer it

#121

Excellent point. Totally agree. I usually keep it at around 64-65 winter time and then about 70-72 during summer. I believe we are better off if we adjust for seasons a bit. Keeping temp constant as some people do (I.e 72 degrees all year round) confuses the heck out our internal clock, and I tend to believe it is not healthy.

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#122

Two 2023 papers on glycine:

The effect of glycine administration on the characteristics of physiological systems in human adults: A systematic review 2023

The nervous system demonstrated the most positive effects, including improved psychiatric symptoms from longer-term glycine administration in psychiatric populations. While longer-term glycine administration improved sleep in healthy populations, these studies had small sample sizes with a high risk of bias. Larger and long-term studies with more robust study designs in healthy populations to examine the effects of glycine administration on preventing, delaying or reversing the ageing process are warranted.

Tiny trial (13 athletic males): Collagen peptide supplementation before bedtime reduces sleep fragmentation and improves cognitive function in physically active males with sleep complaints 2023

The primary aim of this study was to examine whether a glycine-rich collagen peptides (CP) supplement could enhance sleep quality in physically active men with self-reported sleep complaints.
CP supplementation did not influence sleep quantity, latency, or efficiency, but reduced awakenings and improved cognitive function in physically active males with sleep complaints.

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