A happy follow up on my sleep problems.

RE: https://hachyderm.io/@opalmirror/117162231977542980

A happy follow up on my sleep problems.

My doctor prescribed a medication to improve my sleep maintenance. The goal is to restore my ability to fall right back asleep after waking up, instead of being awake for 15-60 minutes several times a night.

After two nights, I am happy to report that the medication has been remarkably effective, converting all that exasperating awake time into light sleep, moving me to 98-99% sleep efficiency, and leaving me better rested. I am slightly groggy in the mornings, but a functional groggy, and not the profound wiped out kind of groggy that benadryl leaves me with.

I had to go to my PCP's clinic to get a prescription, despite pleading my case to the sleep medicine doctor. The advice from the sleep doctor was: avoid all caffeine, EtOH, THC, CBD, only use bed for sleep, leave room if awake for 20 min, same sleep and wake time, limit in bed time to only needed sleep period, extinguish all light, regular moderate exercise. That is all good advice, but no matter which combination of these things I tried, I was continuing to see sleep hours, sleep efficiency, sleep quality getting worse, and feeling increasingly miserable and desperate.

We'll see how this journey progresses. It's a little annoying to see my body getting older and getting a little less functional/less happy year by year. But that's just part of a full human life, which I am grateful to be having.

#sleep #medicine

@opalmirror
What medication is that??? I thought they all had major issues (like not working, preventing REM sleep, etc.)

@dougmerritt Doxepin is a tri-cyclic antidepressant, but in very low doses (3 to 6 mg) it acts as a drowsying antihistamine. AIUI, the theory is that during arousal, histamine is a key part of developing alertness - so doxepin inhibits alertness so you'll go back to sleep. The daytime drowsiness is typically much less than benadryl. It is not compatible with EtOH, THC, and CBD, with doxepin these these reportedly leave people with major daytime drowsiness and significant impaired function.

@dougmerritt Doxepin is a tri-cyclic antidepressant, but in very low doses (3 to 6 mg) it acts as a drowsying antihistamine. AIUI, the theory is that during arousal, histamine is a key part of developing alertness - so doxepin inhibits alertness so you'll go back to sleep. The daytime drowsiness is typically much less than benadryl. It is not compatible with EtOH, THC, and CBD, with doxepin these these reportedly leave people with major daytime drowsiness and significant impaired function.

@dougmerritt oh, BTW I do take a more modern non-drowsying antihistamine - loratadine/Claritin - and have for over 20 years. It doesn't do a thing to help with sleep (aside from breathing better through my narrow nose), apparently it requires a drowsying antihistamine to get sleep improvements.

According to my fitbit (which is hardly accurate), my amount of REM and deep sleep is the same, but the awake hours during the night has been converted to light sleep. Still the same number of microarousals and the patterns all look the same. This is hardly scientific evidence but matches my experience of it.

Note that in the published studies low-dose doxepin improved sleep amount by an average of 25-38 minutes per night for ALL participants, which sounds pretty minor, but it was quite consistent in showing some improvement. The studies also say it was less effective and required a higher dosage in young people, and more effective and required lower dosages in older people, that older people were more helped by it. I don't have access to the full text so I haven't looked at the details.

Short version (tl;dr: as the young folk use these days): if you're older you might be helped quite a bit more than the average by this medication. And so far this seems to be true for me. Hoping this lasts!

@opalmirror
I would think that the body develops *some* kind of tolerance over 20 years, but ok.

Yes, I hope it lasts for you, thanks for the info, and good luck on that!

@dougmerritt I REALLY notice if I don't take my loratadine. I am mildly allergic to cats, pollen and dust mites. I live with four cats and am not a super excellent house keeper. So I know the daily antihistamine is still helping me tons.

Hoping your wife and you find answers to better sleep.

I have had a few periods in life where sleep has been routinely impaired (most recently obstructive sleep apnea and prostate, both which are being treated), and over the weeks and months it erodes a lot of my resilience against depression, anxiety, distraction, and unhealthy coping strategies. So I hope that supporting better sleep helps me not suffer those other issues. I really am trying to do all the right things!