Thursday, May 17, 2012

Sleep Disturbance

From time to time I go through substantial stretches of not sleeping well, falling asleep before the usual sleep time, awakening when the only things on TV are infomercials peddling things that other insomniacs might purchase to make them slimmer or cast an illusion of future savings, and even my Californian friends have put Facebook away for the night.  Sometimes I get back to sleep, sometimes spend the rest of the night tossing or staring until the clock says I can no longer do that.  Somehow I manage to acquire my second wind by the time the patients arrive but on arrival home I am in no position to remain awake until the usual sleep time, one of the core principles of regulatory sleep hygiene.  I have sampled some chemical regulation including some Ambien CR samples that a drug rep left at the office.  This worked rather well on the four tries.  I dozed off, stayed asleep, awoke at a reasonable time and felt OK the next morning.  For a Saturday night this would be fine.  Risking disorientation during the week when I have a long drive to work and many daytime responsibilities is hardly worth the potential downside.  So I never pursued this, other than a brief comment to my doctor at the last visit.  Benadryl, or more accurately Dollar Store sleeping aid capsules which contain diphenhydramine, also works well at getting me to sleep which has not been a problem and minimizing early awakening.  At the usual wake time I rarely feel rested.  Hot Toddy also has had inconsistent results, doing much better at putting me to sleep than keeping me that way until the next morning.  I've not tried this at 3AM to return to sleep, though I probably could on a Friday or Saturday night.

Having attended enough Grand Rounds on this subject and occasionally guiding patients, I have reasonable familiarity with principles of sleep hygiene that I routinely violate or make excuse to justify non-compliance.  My sleep times are generally not maintained since I often doze off early due to deprivation the night before.  Getting up at the pre-determined time seems to go well, with little variation between work days and off days.  Where I probably go astray is use of the bed for a variety of activities for which it was not intended, from reading to TV to iPod, as my comfortable sanctuary with a warm down comforter that serves me well in all seasons.  We have opaque shades, always closed, so that the room has artificial light all the time.  This tends to be a bigger problem with getting up than with staying asleep, but I overcome this by going downstairs at 5:30 most mornings where curtains are kept open allowing plentiful daylight.

For the most part, the purpose of sleep should be to enable activity the next day, so in that sense I am not particularly incapacitated by this, though I sometimes wish I felt a little more energetic by the time I get home most evenings.  Will definitely have to be more firm with myself in adhering to the modifications that may leave me more rested most mornings.

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