Medical Delayed Sleep Phase Syndrome - Will Power, or better see a specialist?

[Raizy]

I slept at 5:30 p.m. today, woke up at 12 midnight because I slept 1.5 hours yesterday night. I think the only reason why I slept for 6 hours is the melatonin. I took another dose of it at 1 p.m. but I'm still here typing at 2:30 a.m. so chances are I won't feel sleepy until 10:00 a.m. AND THIS IS THE TIME WHERE I'LL BE SITTING IN MY FIRST PERIOD CLASS.

On going for 5 days now... I can't count how many days this has happened to me back in high school and work.

Oh yah, I did manage to wake up at the same time everyday for about a month several days before this situation, darn I never adapted. I never took afternoon naps either.

 

[Evo]

I have no idea what you are asking. If you are relying on something as mild as melatonin to help you, you probably don't really have a problem except for having gotten yourself out of a routine sleeping habit.

Stop taking the melatonin and just get into a habit of going to bed at the same time and waking at the same time. If this doesn't help and you cannot go to sleep for extended periods or cannot stay asleep for more than a couple of hours without falling right back to sleep, consult a doctor to rule out illness.

A good diet and excersize can help a lot too. Hope you get back to sleeping well. I suffer from a rather serious chronic sleep problem, so I can sympathize with you.

 

[Raizy]

Do you find that, if you manage to maintain a steady sleep-wake cycle, you will all of a sudden encounter that one day where you just twist and turn in bed, and that will in turn have you start all over about re-gaining the schedule?

 

[Moonbear]

You could have a sleep disorder, especially if this has been happening for a long time, but you might also be experiencing the stress of school work preventing you from sleeping well.

I have to correct Evo's comments though. Melatonin is NOT a mild medication. If you do have a sleep disorder resulting from a lack of adequate melatonin production (this would be rather rare), then you would need to take the right dose at the right time of day, and this may require seeing a sleep specialist to sort out. Taking it at 1:30 in the afternoon makes no sense at all. That would make you sleepy in the afternoon, when you don't want to be sleeping...if it worked at all. That would just cause more problems when you woke up again in the evening unable to sleep all night. Taking the melatonin about a half hour to an hour before your desired bedtime is more appropriate, and should be at night, not during the day.

If you really have a sleep disorder, though, melatonin may not fix it. It could also be an inappropriate response to melatonin. This is where getting a proper evaluation comes in.

However, it sounds like you have more of an erratic sleep schedule rather than delayed sleep phase disorder. With delayed sleep phase disorder, you would wake up later and later every day, not be awake at a normal time one night and sleepless the next.

Consider potential environmental triggers before worrying it's a disorder. If you're still online at 2:30 AM, that alone could be part of the problem. There's a lot of light coming from your computer monitor, and you're staring right at it. Don't underestimate all those other little lights that might be on in your room at night...lots of things have little LED lights that add up to a fairly bright room at night...does the cell phone blink? Is your computer monitor on? Does the power cable on the computer have an LED light on it to show it's connected? Lit alarm clock? Light coming in from outside? Banish anything with LED lights from your room at night...turn them off, unplug them, or cover them up in some way that darkens the room more.

What about noises? Do you live in a dorm or apartment building where people are coming and going at night and disturbing your sleep? Near a busy road? You might consider earplugs if you can't block out noises in other ways.

Try this routine and see if it helps...
First, decide what is a good bedtime for you...for example, maybe 11 PM.
An hour before that, start to ready yourself for bed. First, turn off the computer. Stop doing any work or other stimulating activities. Turn off excess lights. Pull the drapes or blinds to darken the room. Shift to doing a quiet activity that you can do with dim lighting...maybe reading a book with just a lamp on. No TV.
About 45 min to a half hour before bedtime, take a warm shower or bath, and start to prepare to go to bed.

This routine serves three purposes to help you sleep. Dimming the lights signals your brain that night is coming, and your own melatonin production will begin to increase. Creating a restful routine where you slow down your activities and take a shower will help you relax before bed and set aside the stresses of the day.
Taking a warm (or hot) shower or bath about a half hour before bed will also lead to first warming your body (initially waking you a bit, but that's okay) and then allowing your body to cool again over the next half hour. That cooling of body temperature helps signal that it's night and bedtime too.

During the day, avoid any form of caffeine after noon. Avoid alcohol. Both of those can shift your sleep cycles, even if you don't immediately notice any effects. Definitely avoid taking melatonin unless a physician recommends it (if they do, you should always take it at the same time every day, about a half hour before you're ready to go to sleep...it does NOT work like a sleeping pill and you can't take it any time of day and expect it to work right or not disrupt your sleep cycles further).

In the mornings, set an alarm clock for the same time every day and force yourself to at least sit up in bed and turn on a bedside lamp if you can't convince yourself to get much further than that.

Try that for 2 weeks, and don't vary that pattern even on the weekends. If you've really mucked up your sleep cycles with bad habits and melatonin, it could take 2 weeks to get back to a normal pattern. You might feel jet-lagged during the day...do NOT take naps, no matter how tempting. If after 2 weeks of trying this routine you are still tossing and turning all night and getting sleepy during the day, go ahead and see a doctor about it. If after 2 weeks you are able to stick to this schedule, you won't need to see a doctor about it. Just remember that if you pull an all-nighter or stay out late partying, or have an extra cup of coffee with friends in the evening, it'll set you back again and you should expect it to take a few days to adjust again.

 

[turbo]

Google on "Sleep Hygiene". I was required to work a lot of demanding rotating shifts, including the dreaded "Southern Swing" and a 3-days-on-3-days-off cycle of 12-hour shifts. It takes some dedication and adjustment to adapt to these and manage to stay healthy. Don't resort to supplements of any kind until you have tried the "passive" adjustments like managing your before-bed routine, blocking light and noise, etc. Crutches can help you through rough times, but soon you'll be back in trouble unless you attack the weaknesses in your sleep habits.

 

[Evo]

I have to correct Evo's comments though. Melatonin is NOT a mild medication.

Thanks for the correction MB, I was going from my own experience, melatonin does not affect me. But I do have a serious sleep disorder. The only thing that has ever kept me asleep more than 3 hours is Seconal. Of course I haven't had that prescribed in years. I currently have to take two Ambien per night because they wear off in 2-3 hours. I take one, sleep 2-3 hours, then take another and sleep 2-3 hours, but the sleep even during those 2-3 hours is broken with constant wakening periods, I have had two overnight sleeping studies at a clinic and they had no explanation for it. You are allowed to take prescription drugs for sleep during the tests so they can see how you react.

They tried that PAP machine thinking it might be sleep apnia, but that actually kept choking me and waking me up. I'm a freak. But it is slowly killing me, I can barely function from day to day now, the pain and the struggle are getting to me.

 

[Raizy]

But I do have a serious sleep disorder. The only thing that has ever kept me asleep more than 3 hours is Seconal.

Just wondering, you went through this while in school too?

They tried that PAP machine thinking it might be sleep apnia, but that actually kept choking me and waking me up. I'm a freak. But it is slowly killing me, I can barely function from day to day now, the pain and the struggle are getting to me.

About the clinic thing, just wondering again... did they try overnight sequences of brainwaves to see if that would do anything?

You could have a sleep disorder, especially if this has been happening for a long time, but you might also be experiencing the stress of school work preventing you from sleeping well.

Ever since high school.
Possibly:

My sprout of depression and anxiety
Video game addiction
Will power
Afternoon 2-3 hour naps

I have to correct Evo's comments though. Melatonin is NOT a mild medication. If you do have a sleep disorder resulting from a lack of adequate melatonin production (this would be rather rare), then you would need to take the right dose at the right time of day, and this may require seeing a sleep specialist to sort out.

Here is what's been going on with melatonin in the past week, the first time I took 2 drops (about 200mcg) I slept for a good 9 hours. It felt like a 15 minute nap; I woke up at 6:30 a.m. but I ended up sleeping at 9 a.m. again because I assumed the 9 hours of melatonin induced sleep was different giving me that same feeling as if I never slept throughout the night. Thus, I've wrecked my own schedule again. The rest of the days, there were times where I'd sleep for 6 hours, and that would be enough to give me energy until my next ideal bed time, which is 11:30 p.m. But then when I do sleep at the right time, I would wake up 2-3 hours after falling sleep.

Yesterday from my sleep log, I apparently went to bed at 11:26 p.m. and woke up at 2:13 a.m. I was probably up for another hour trying to fall back asleep, in which I woke up at 7:40 a.m. today. About 6 hours of broken sleep, that's now considered “not bad” in my current situation. Tonight, I am not sure how I'll sleep.

If you really have a sleep disorder, though, melatonin may not fix it. It could also be an inappropriate response to melatonin. This is where getting a proper evaluation comes in.

This is what worries me, I don't want to wait 2 hours to see my physician. She doesn't seem to take me seriously (she probably thinks I'm a hypochondriac). Anyways, I have considered an expensive light visor. I'll take a look into it if after the next 3 months I'm still miserable.

However, it sounds like you have more of an erratic sleep schedule rather than delayed sleep phase disorder. With delayed sleep phase disorder, you would wake up later and later every day, not be awake at a normal time one night and sleepless the next.

In my situation, it may actually be both? I once had no school and did not work for 2 years living with my parents. I slept later and later each day roughly 2-3 hours. I'll cycle through normal ranges of sleep-wake cycles and being nocturnal. Sometimes I would oversleep so much and I would stay up for 24+ hours. I guess my body is running off some 26+ hour biological clock. When I tried to fix it, I just ended up sleeping in again. But now that I'm back in school, this should help reinforce my schedule. I'm just worried the 2 years of abnormal might have caused some permanent problem to me since I have already managed to wake up at the same time everyday for a month from the first school day. My body never seemed to adapt, I was always tired. Eventually I all of a sudden lost the sleep schedule.

Consider potential environmental triggers before worrying it's a disorder.

I considered by my room pretty dark already, other than that LED on my computer and alarm clock... No problems with noise.

Try this routine and see if it helps...

I don't like the idea of a bath, but I do already follow a simple one. I have a sunrise/set simulator clock and I just set that up, and for a few minutes I would just think about the day for 5-10 minutes doing a quick review of little bits and pieces of important information I gathered throughout the day. Whether it be a new bus route or a difficult definition from school..

During the day, avoid any form of caffeine after noon. Avoid alcohol.

Caffeine avoidance is easy, and I don't drink.

Definitely avoid taking melatonin unless a physician recommends it

Too late I don't plan to use it for more than 10 days, just four more days to go, taking it at 11: p.m. everyday.

In the mornings, set an alarm clock for the same time every day and force yourself to at least sit up in bed and turn on a bedside lamp if you can't convince yourself to get much further than that.

Most difficult to do. It's as if my consciousness doesn't exist


... I can't remember the number of times I've performed chronotherapy on myself.

 

[Evo]

Just wondering, you went through this while in school too?

I suffered from insomnia even as a toddler. School was horrible for me due to lack of sleep, I went to school every morning feeling terrible, this was from the first grade on, I had afternoon Kindergarten, so I was spared that year. By the time I was 13, I'd get home from school and go straight to bed. But what I have now is completely different.

About the clinic thing, just wondering again... did they try overnight sequences of brainwaves to see if that would do anything?

The tests are to monitor heart rate, respiration, muscle and eye movements and brain waves. You are also video taped all night. You have wires all over your head, face, chest, back and legs. You have a plastic tube strapped to your face that goes up your nose to monitor breathing.

So, two full night tests done a month apart and the result? I can't sleep. Glad my insurance paid the $5,000 for those two tests.

 

[Moonbear]

Ever since high school.
Possibly:

My sprout of depression and anxiety
Video game addiction
Will power
Afternoon 2-3 hour naps

Depression or anxiety and sleep problems are certainly related. With this information, and everything else you described, I'd recommend you see a psychiatrist. Don't take offense at that or think I'm trying to say you're crazy or anything like that. It's just that general practice physicians don't have the training to deal with a sleep disorder, especially if it's complicated by depression or anxiety. A psychiatrist is the right physician to see about a possible sleep disorder, to get you tested, and to sort out if it's a primary sleep disorder leading to some of these other problems you're experiencing, or the other way around, that the sleep disorder is secondary to those other issues. Either way, the psychiatrist is the one who can prescribe the right medication to treat the underlying problem. This is probably why your regular doctor is not very helpful, because it's out of his/her area of expertise.

 

[Raizy]

No offense taken; I already had seen a psych. about it. My problems aren't at all that severe. As a comparison, it's as severe as thinking I'm the lazy unmotivated type. I already have been taking MAOI's for a couple of months now. Apparently, from the handout the pharmacist gives you about the drug, "it may improve quality of sleep", on the other hand a quick google search on "antidepressants and sleep" says that MAOI's abolish REM sleep. lol.

Weird.

I stopped cold turkey taking my meds 3 days ago. No withdrawals so far :-D Maybe they gave me placebo. I don't know what it is, but after trying to stay on the meds for more than 2 months, I always want to stop because I somehow think it's causing me damage (reverse placebo?)

Anyways this week I stayed home from school 2 out of the 5 days so far, and another day where I slept in first period. Just a couple more months of trying to sort this out myself and I'll see if my dad's insurance will cover the sleep specialist if I don't get anywhere.

5000 bucks?

 

[Count Iblis]

Exercise can also help. It will force your body to repair itself better during the sleep that you do get. If you don't go to school, you don't have to worry about not feeling fit the day after you do exercise.

But before you start any vigorous exercise routine, you have to check with your doctor first. Especialy if you are feeling sleepy/tired to begin with because then you are less likely to pick up any strange signals from your body telling you that something is wrong.

 

[Evo]

Anyways this week I stayed home from school 2 out of the 5 days so far, and another day where I slept in first period. Just a couple more months of trying to sort this out myself and I'll see if my dad's insurance will cover the sleep specialist if I don't get anywhere.

5000 bucks?

It's ridiculously expensive. A friend of mine was discovered to have Restless Legs Syndrome. He also has trouble going to sleep at night.