Dr. Saraswat Kumarshri Shriniwas
Psychiatry
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Patient's Query
Hello doctor,
For about a few months, I have been surviving on less than an hour of sleep per night. For the first 27 years of my life, I have always had a little bit of trouble getting sleep (overactive mind), but I have never had any trouble getting a full night rest (anywhere from 6 to 9 hours).
This recent bout of extreme insomnia had nothing to do with the habit (i.e.- It is not like I made the choice one night to sleep only a little bit, and then my habit got out of hand). Try though, my brain simply is unable to let me sleep normally. One day, I could not sleep at all. The next day, and the day after that, the same thing happened. I finally managed to get a decent night sleep the next day, and after that, the pattern of only being able to sleep for less than an hour (if at all) maintained itself. I struggle and struggle to sleep, and then I dream for a little bit, and then my brain kicks me out of sleep, and I cannot go back I cannot even nap. And yet, usually, my mind and body find a way of feeling rested after one measly dream. I ought to feel like a zombie, but most days I feel physically well-rested.
I have heard of cases where people who used to sleep well became insomniacs after periods of great stress or depression. I am almost certain that I became an insomniac because I was nervous about starting my new job. The thing is, though, that it does not look like it is going away any time soon. Will it be permanent, how scary is that? I know the dangers of not getting enough sleep and I have tried certain things, like sleep hygiene, relaxation techniques, etc. Nothing seems to work. The only thing that helps a little is 400 mg of Seroquel prescribed by my psychiatrist. However, I have such a high tolerance for sedatives that I have to stop it and reintroduce the drug after a matter of days.
I guess what I am trying to say is there probably is not a solution for my extreme condition yet, as sleep and the human mind are both great mysteries. However, I would like to have an opinion as to what is going on in my mind, and how it started. I hold the theory that the stress leading up to my new job somehow fried my brain. I do not know in what sense, exactly did the sudden onset of stress somehow deplete some of the chemicals in my brain that are necessary for sleep? Or could there be another explanation or hypothesis?
Hi,
Welcome to icliniq.com.
You have a unique situation and though I do not have a clear answer to your complaints, I can give you some relevant advice.
The first thing to do is to evaluate your insomnia. I would suggest you use a camera to video record your sleep. You can use your phone camera with good memory capacity and place it somewhere higher, so you can see your movements at bedtime. The reason for this is that personal evaluation of one's own sleep is far from objective. I frequently come across patients who say that they cannot sleep while their partners say they do and occasionally even snore.
There are phone applications like sleep as Android, etc, which record your movements in bed and can give you a reasonable estimate of your sleep time.
Another possibility is that you are sleeping but not getting enough deep sleep. Deep sleep is characterized by slow waves on EEG (electroencephalography) and the feeling of having rested during sleep. That is why sleep study is the ideal investigation for sleep issues as it does an EEG recording as well as a video recording of your sleep. Sleep as android also gives a rough estimate of your deep sleep percentage during your entire sleep.
In such a scenario, there are specific medications which enhance deep sleep like Pregabalin which you can ask your doctor about.
Sometimes, trying too hard to sleep is counter-productive. Beliefs like I should get seven hours of sleep at any cost and if I do not, it will cause great harm to my mind and body are incorrect and very likely to impair with sleep. These irrational thoughts need to be addressed via cognitive behavioral therapy if you think this could be the problem with you.
The most important component of sleep hygiene is if you cannot sleep, leave the bedroom, sit somewhere else and do stuff like reading or listening to music. This breaks the classical conditioning (association) between your bed and inability to sleep. Go to bed only when you feel sleepy. Remember that the use of electronic displays in the late evening could be a major cause of insomnia. Keep their use to minimum and use a blue light filter app on your phone after evening.
Try taking natural sleep promoters like Melatonin 3-6 mg which you can find on the internet. This should give you some guidelines to investigate into your sleep and hopefully improve it.
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Psychiatry
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