Dubious Expert Advice

Middle of the Night Insomnia affects a lot of us.  Despite my best faith effort to standardize my sleep times with widely accepted Sleep Hygiene rules, my first awakening comes with the red numerals on the clock radio behind me displaying approximately 3AM, sometimes earlier, rarely much later.  To be sure, it's never anywhere close to my aspired wake up time.  The books, and the professor whose seminar I just took at a modest fee to support the sponsoring organization, advised arising if not back to sleep in twenty minutes or so.  I set my smartwatch timer for a half hour, extend it once or twice a little beyond that, affirm my intent to enjoy the warmth of my down comforter for that interval, and avoid thinking about the last day's events or next day's agenda.  Never back to sleep before the wrist buzz.  Eventually I do get back to sleep, and frequently find myself restored to some respectable stage of the sleep cycle, I don'ttts know which, when the buzz from the smartwatch awakes me with intent.  If not really asleep I get up.  If sleep cycle interrupted I wait a while longer for the morning radio to blare its 7:15AM Sousalarm March feature, then get up almost always without fail

But the professional advice is not to do that.  It is to get up and do something relatively mindless.  Laptop and cellphone screens off limits, big screen TV OK.  Reading OK.  Studying not OK.  My default is a documentary on the Big Screen in My Space while I lean back on the recliner.  Nature shows.  Geography or geology shows.  I've exhausted most of the history shows.  Podcasts sometimes, though they tend to keep my mind too engaged for what I am trying to achieve.  Eventually I get drowsy, probably a little sooner than I had if I had stayed in bed, but not that much sooner.

Having now done this for consecutive nights, my observation is that I feel less rested when the intended wake up time arrives.  I still arise from bed, head to the sink for morning dental hygiene irrespective of how I feel, go downstairs where I successfully brew coffee in the Keurig Express, which I then take upstairs to sip at my desk.  I have the function to do a few petty chores, whether watering the indoor plants or retrieving the newspaper for my wife, and doing a few dishes still sitting overnight in the tub in the kitchen sink.  But I mostly really need that coffee back at my desk.  It washes down the morning antihypertensives and PPI.  And by about half the coffee consumed, adenosine receptors adequately blocked, I am reasonably ready to do a few of the day's projects outlined the night before.

Do I feel better or worse in the mornings when I follow the expert advice?  My assessment is worse, at least to the completion of that coffee.  That may not be the goal, however.  The purpose may be a more sustained ability to function for the duration of nature's daylight hours with the morning ookies the price for being able to do that.  I'm not sure yet if that will play out.

Continuous Sleep

For the first time in recent memory, perhaps a few years memory, middle of the night insomnia did not present itself circa 3AM.  I remember not falling asleep easily, estimated by Sleep Tracker at just over an hour. Usually my sleep latency, the time from lights out to being asleep is relatively short.  But my next awareness came with a wrist buzz.  The smartwatch sent its alert at the programmed 6:30 AM, prominent enough for me to notice it.  I still thought I needed more sleep, but got up momentarily for the bathroom.  Not long after, at 6:45, the music from Sleep Tracker, which could begin anywhere from then until a half hour later depending on other signals built into the program that I don't understand, turned on.  I felt almost awake, not yet 100% but not deprived enough to challenge modern electronics, so I completed the night's sleep interval.  It estimated I had been asleep about 6.5 hours, but its rare continuous nature caught my attention.  Since the purpose of sleep is to enable activity the following day. Whether this made a difference should play out later.  For now I feel adequately rested, maybe a notch or too shy of optimally renewed, but fully functional.

Suddenly Fully Awake

Sleepig tracker helpful.  While I have been waking overnight on a chronic basic, those 2AM  awakenings have all had their element of drowsiness inviting a return to sleep.  Not so last night.  This time at just before 2AM I recall abrupt awakening following a dream.  No drowsiness at all.  It felt like the night was done and I needed to dive into whatever the day would bring.  I stayed in bed, still fully alert for more than an hour, then just got up, though not quite ready for morning hygiene and a new day.  My mind fully functioned.  

To my laptop whose blue light reinforces wakefulness, at least it did for a short time.  Then a modicum of drowsiness returned, and I returned to bed the rest of the night.

Nobody really knows what neurologic processes regulate consciousness.  For maybe an hour and a half, i had now drowsiness at all.  That transition from one sleep cycle to the next not only didn't happen, as I often experience, but the signal for it to occur at all disappeared.  

Restoring Sleep Predictability

At 1:40AM I arose.  Not only awake, but not the least bit sleepy, maybe about 3–4 hours after lights out.  Trying to return to sleep based on the clock would be a lost cause.  I went downstairs to the kitchen, being a little thirsty as well, poured half a cup of raspberry-lime seltzer, then tackled some dishes.  Mostly mugs that had accumulated but also my tall tangerine Swarthmore Latte cup and the beer glass that I bought myself on a tour of the Yuengling Brewery in Pottsville quite a number of years ago.  I returned the dry mugs done that afternoon to the closet, repositioned the ones that needed to dry more completely, returned a couple of dinner plates to the closet, and washed another load to include the Latte cup and beer glass, though I no longer had room to wash the porcelain mug with the seltzer and find a drying spot for it in my milchig rack.

Maybe TV would be better.  Netflix had a documentary on cats, amusing maybe, entertaining or enlightening, didn't seem so.  And The World According to Briggs on YouTube.  Looked at live TV.   By now the show times were within a few minutes of transitioning to the 3AM listings.  Another try at sleep seemed possible, so I shut down TV.  On returning to bed, I checked email, for which there was none.  Something taboo for me between 11PM and 5:30AM.  A personal transgression.  Cell phone off.  And successful return to sleep.  Biological clock nudge at 7AM.  Upright at 7:30.

Despite the wee hours, while really not very long, I did not feel sleepy in any way.  Everyone is familiar with restorative naps.  I wonder if there also might be a parallel restorative wakefulness, a break from sleep and the subconscious mental reframing it entails.  Despite the discontinuous nature of last night, I do not feel sleep-deprived.  Yet, as a matter of health, longer duration sleep seems more desirable than last night's discontinuous segments, so I'll see what the sages of cyberspace offer as remedies.

OOB Mid-Morning

Illness recovery not as complete as I thought.  Last two days I functioned largely normally until bedtime.  Then coughing, wheezing, hard fought expectoration.  But no rest.  I had not taken any medicine to bring about the fairly normal days.  My Go-To generic NyQuil.  Cough suppressant, sedative, decongestant.  Off to the recliner in My Space, some gentle TV, then a night's sleep in the chair.  Awoke at what I thought was a reasonable arising time, not quite 6:30AM but still tired.  Returned to bed, still able to breathe without cough or other interruption.  Back to sleep in no time.  Wife had set radio, I noticed it was on momentarily but slept through WRTI's daily SouzAlarm, a feature played at 7:15AM each morning to prod people who needed to head off to work.  But I was warm and oblivious.  Next glimpse at the red numerals of the clock radio: about 9 AM, then 10:16AM.  Still wanted to avoid being left out in the warm, but got up, proceeding to some hygiene and coffee.

The illness has played havoc with my sleep patterns, something carefully nurtured over about two years.  I'll have to let the respiratory disruption resolve more completely, then reconsider how I'd like to reset my daily sleep-wake patterns.

Final Fifteen Minutes

My sleep pattern subsequent to withdrawal of my chronic SSRI seems to be declaring itself.  Bedtime uncertain, though later than before the SSRI.  Into bed also less certain as is the latency between putting myself supine and actually entering one of the sleep phases.  First wakening approximately 4AM, sometimes 5AM.  Nocturia usually not the cause but a convenient time to empty bladder to avert another awakening.  Then drift off to sleep an hour later.  When the wrist alarm prods me at 6:30AM, I don't really feel ready to arise.  I always feel obligated, but haven't always been getting up.  Real biologically driven wake time arrives closer to 7:15.

Good sleep hygiene depends upon predictability, something not yet adapted to my CNS so longer supplemented with the SSRI.  Some variations to the pattern.  Nocturia at 6:15AM.  Could wait for alarm, but really couldn't wait.  Returned to bed, got a real snooze for twelve minutes, glance at iTouch Slim, then semi-snooze until the wrist buzz.  Didn't really want to arise this time but did, moving along to dental hygiene followed by a stroll downstairs to check my indoor plants, make coffee, finish last night's dishes, retrieve newspaper from the driveway, empty recycling, and make a k-cup.  Those fifteen minutes of snooze, and maybe a little grit on my part with morning dental care, seems to have put me back in control of my time, at least for the morning.

Sleep Reset

 For a long time, my effort at sleep hygiene had gone very well.  Into bed at a certain time, out of bed when the iTouch watch buzzes, no bed for anything other than what a bed was intended for with the addition of a book I am reading and practicing an upcoming Torah reading.  Sleep cycles still had not transitioned from one to the next but I had a good inkling of when I would awake and for how long.

I now find myself more wakeful.  I assume it is a desired effect of setting aside my daily SSRI dose a few weeks ago, but other causes are possible.  I no longer feel a need to rest on the recliner at mid-day.  Falling asleep has taken longer with onset at a later hour.  Sleep cycle interrupted transitions seem longer, including one where it did not happen.  I followed sleep hygiene protocol and went to the recliner in another room.  

It is likely that this new situation, whatever its cause, will persist.  The principles remain the same: set wake and sleep times, restriction of what I do in bed to things that should be done there.  Maybe just the set times need some alteration.

Contiguous Sleep Cycles

My upper respiratory infection has been trending to resolution with symptomatic intervention.  Cough drops, some therapeutic, some more tasty, have done what they should.  Fluticasone may be taking effect  on the rhinitis, or perhaps I am just recovering.  NyQuil has proven the most valuable, not so much because of any anti-tussive or sympathomimetic properties but because it enables me to transition from one sleep cycle to the next seamlessly.  This rarely happens spontaneously nowadays.  My iTouch buzz even woke me this morning from a more significant part of the sleep cycle.

Despite some effort to understand sleep and sleep hygiene better as it increasingly affects me, the role of transitions from one cycle to the next seems ill-defined.  Nature did not intend it to be wakefulness, though perhaps a periodic scan for predators each night might have evolutionary purpose.  Probably not as much purpose as full alertness when daylight arrives.  Even if mediated by exogenous chemicals, I appreciate the more continuous nightly snooze, even if I don't understand its mechanism or how the NyQuil components compensated.  Though, for sure, it is not a suitable chronic sleep aid.

OTC Sleep Aids

Sleep Hygiene captures the natural, from set times to Cognitive Behavioral Therapy.  After getting by for a while, it became time to see what the chemicals could do, cheap stuff from the Dollar Store that undercuts CBT both in price and convenience.  Our Dollar Store offers two options, melatonin chewable tablets and diphenhydramine.  I had both on hand.  Having taken their melatonin twice at bedtime with a negative outcome, I tried one during the daytime, which makes more sense since melatonin levels were already elevated when I took them after dark.  Good result.  I didn't sleep during the day but could detect a relaxation that I might be ready for sleep.  A good horizontal four hours ensued, feeling a bit refreshed  by mid-afternoon.  At a prespecified normal sleep time, still reasonably awake but ready to call it a night, I swallowed two 25 mg tablets of diphenhydramine.  Within a half hour I was asleep.  Most importantly, I did not have awakening between sleep cycles like I usually do.  Often I feel dragged when I do this, but this morning I feel reasonably refreshed, not at all sleep-deprived.

This is not something to do nightly, even though the results seem favorable.  But either has its utility when I've been experiencing interrupted sleep over an extended time that carries forward to the day.

Overnight TV

Sleep has become more restful now that I adhere to sleep and wake times with little variation.  My smart phone tracker, while not terribly accurate, has proven consistent on consecutive nights.  I will have one major awakening following about two sleep cycles, stay up a bit, then get two more then a fifth sleep cycle, feeling adequately rested when the wrist buzz of the smart watch signals it is time to arise, which I do.  If I violate the principles, it has been by staying in bed too long after each sleep interruption.  I set a limit on myself, which I exceeded last night for the first time in a while.  After an hour of watch watching, I got myself up, heading into My Space for some TV, impeded by misplacing the needed Roku remote from its usual resting place.  Finding it, I scrolled what was one, made and initial poor choice on Smithsonian Channel followed by a better choice on Science Channel.  I took my tracker to the lounge chair, but eventually just put it on my desk where it remained.  It took about 50 minutes to get drowsy again, but on return to bed, the remainder of the sleep cycles seemed OK.  Perhaps a little less total sleep than average but reasonably functional for what I have on my Daily List today.

Blank Mind

As I grapple with Middle of the Night Insomnia, the recommended Sleep Hygiene action that I neglected most has been to set a time limit on returning to sleep.  I have more often than not acquired one more sleep cycle but usually quite a bit later.  This additional 60-90 minutes makes or breaks the following day.  Last night I resolved to follow the advice, departing for My Space and the comfy recliner in still looking at the clock a just over a half hour later.  Not succeeding in slumber, I arose for that lounge chair in the other room.  Formal guidance recommends either reading or watching something not requiring much focus on TV so I turned on an episode of New Scandinavian Cooking which Andreas had devoted to chocolate.  I remained awake to the end.  Then transfer the screen from Infinity to Netflix.  I don't even remember what show I ordered the remote to display but that's my last recollection until awakening two and a half hours later, or one and a half hours before my wrist alarm would signal out of bed time has arrived.

Most likely I really fell asleep, probably two sleep cycles.  If I achieved REM's dream state, I don't remember.  In fact, I have no recollection of that time at all but when I awoke Netflix was still on the big screen TV with some modern equivalent of a test pattern.  I remember nothing after switching from one TV format to the other.  Sleep science affirms that the mind becomes more restorative than absent during these intervals, yet I have no sense of the many dangling elements of my waking mind that achieved resolution this morning.

I returned to bed, remaining horizontal but mentally aware until my usual out of bed time, which has almost never been my real wake time.  But I feel mostly OK, as if those two additional sleep cycles really took place.

Feeling More Rested

Much to be said about two additional sleep cycles.  Chronic middle of the night insomnia continues with a wake time of about 3AM pretty much every night.  Current coping techniques have included turning on the air conditioner when going to bed and enhancing nasal breathing with now generic fluticasone.  Whether I've been sleep deprived with impaired daytime functioning is less certain, though I do OK in the morning after coffee but need a respite in early afternoon.

Today I feel a lot better having returned to sleep for two additional hours, which would be an entire sleep cycle, maybe even two, with one that I could recognize as REM.  The AC off and down comforter on until the wrist alarm, which for the first time in ages I didn't even notice.

While I won't really know until mid-afternoon, I can tell a difference on arising.  I don't feel as dragging or as obligated to arise.  My spirit seems cheerful and I want to move along with the day's tasks, even before brewing the first of the day's coffee.  Perhaps nasal care and a cool bedroom are the new habits to maintain.

Tough DST Onset

In trying to improve my disordered sleep, at least my self-impression of it, I set my smart watch to wake me at 6:30 each morning a few months ago.  It has buzzed my left wrist daily to which I sit up, sometimes stretch, more often not, then head into the bathroom for habitual dental hygiene.  I've only resisted the vibration once or twice and virtually always have been upright before the reminder turns itself off about 30 seconds later.  Being truly smart, this watch adapted itself overnight with no help from me to the corrected springtime skipping the 2AM-3AM overnight interval.  It left 6:30 as my wake time.  My circadian rhythm did not.  My inner sense called it 5:30AM, leaving me with a mixed message.  As my sleep pattern becomes consistent with early awakening, I am often awake, or at least can perceive the clock and watch when I glance at them, at 5AM.  Not having to get up then I don't, but at least I sense that I am awake.  Some sleep experts would posit that I should arise.  This morning the vibration may not have truly awoken me, but I felt a long way from arising.  That's probably a good thing, one of the few objective measures that I have that my sincere attempts at predictable times in bed have created some physiologic adaptation.  Visiting a Caribbean island on Atlantic Time would have been a better way to assess the same adaptation, but for now, I think that my sleep may be less disordered than I perceive.

Seeking the Best Night's Sleep

Early awakening still plagues my nights, which carries into my days.  The time of awakening has shifted from about 4AM to 2AM, though I can usually fall asleep again at about 4AM and go past my optimal wake time, which I set at 6:30AM.  The why still puzzles me.  I know where my routine breaks down, but with the schedule time shifted, staying fully upright through each day has not gone well either.  I tried installing a sleep monitoring app on my smart phone, going through about three before settling on one to try out.  My smart phone did a lot better than my not very smart iTOUCH  watch which claims to monitor sleep duration.  Reviewing the data from overnight added some insight, particularly the REM stages and deep sleep that I could not figure out otherwise.  It did fairly well.  What I considered wake time, that 2-4AM interval of repositioning and clock glances, it considered very light sleep.  Maybe it is.  When I eventually arise, not that long after my intended time, I do not feel overly sleep deprived, though crave some more snooze by late morning.  Coffee after cursory grooming perks me up.  Since the New Year, I have been trying to limit myself to two morning cups, but will consider an additional late morning addition.  And I am invariably able to exercise mid to late mornings.  So despite the interruption, I remain very functional.  More focus on what I do during the days that reflects on sleep, though I still do not appreciate the reason for the change in the last month or two after much success with formal sleep hygiene.  I'll just have to get more insight from the sleep monitoring app and trust its validity.

Early Awakening

After making great strides this calendar year with better sleep, incorporated as a component of healthier living, a notable but consistent setback emerged in the past month.  No matter what preparation I take, my internal clock awakes me at about 4AM.  It is not nocturia, which has gotten less, but failure to pass from one sleep cycle of 90 minutes or so to the next.  Typically the close of a sleep cycle brings people to a twilight rather than wakefulness.  I do very well with the previous cycles but at 4AM I pass into wakefulness without feeling fully rested.  Indeed, I can fall back asleep but the new waking time takes me past the 7AM latest arising that I had set for myself and was so successful for so long.  And my energy dissipates over the day, inducing a nap which may create something of a viscous cycle.

Reviewing classic sleep hygiene recommendations, I do pretty well though not perfectly both in the habit and environmental guidance. There is a set wake time, adhered to until this setback arose.  I have a reasonably set bed time, though without the ritual of relaxation.  Last caffeine is at noon, last alcohol typically a glass of sherry late afternoon or beer as my supper beverage, never both.  I have not done as well avoiding catnaps or avoiding using the bed for things other than sleep, though I cannot figure out why that would play out as a new consistent pattern of early wakefulness.  I could do better with putting a time cap on the screens though, particularly the smart phone which connects me to the world.  I have set a moratorium from 11PM to 5:30AM with mostly good adherence.  

My sleep environment could not be better.  Light blocking shades work well.  The room is quiet unless my wife or I intentionally play sleep sounds, which are mostly effective at creating sleep onset.  Great mattress from IKEA, down comforter, decent pillow options, smooth sheets, space heater for when needed.  No recent changes in any of these.  

Where I might do better, and once did do better, is not allowing myself to stay awake in bed too long.  If I fail to fall asleep I go back to my Man Cave for some TV.  When I awake at 4AM I accept that, stay in bed, focus on the comfort of being there, even if awake, and wait for the next sleep cycle, even if it ultimately takes me past the set awake time.  I don't know if that's the best course.

Next step seems to be avoidance of the bed for reading or napping.  Give that a go for a month and see what plays out.

Sleeping Twice

Sleep improvement with better daytime restfulness has challenged me for a while.  I know there were benefits to accrue with more daytime energy and a willingness on my part to do what I could to bring that about.  Retirement has enabled better attention to this, though it could have added to my function at work too.  I've been exercising, grading myself to a proper type and amount with more success than I've enjoyed in decades.  

While exercise is something I might make excuses to avoid, sleep has more of an allure of the now with payoff later.  I want to sleep well and have no barriers for avoiding it.  Optimal sleep hygiene principles are readily accessible from many sources.  Unlike exercise, which for me requires a reward incentive, the behavioral changes for better sleep seem minor, mainly avoiding the bedroom for activities that can be done someplace else.  Other than reading in bed, which I could eliminate now that I've captured two good lounge chairs, I've accomplished that.

Yet sleep depends on cycles that I don't control very well.  Getting up at a fixed time can be committed with an alarm clock, going to bed at a fixed time can be enforced with a light switch.  Being asleep from lights out to alarm on and not beyond does not automatically incur from best intents.  Physiologic cycles don't adapt very well to clocks.

Despite the challenges, I've done well, nearly 100% on the arising time without the use of a device, less well on lights out times or smart phone deprivation times, but not as well at actually being asleep.  

I bought a watch with a sleep tracker module that has some tabulating mechanism that I don't understand other than to figure out its inaccuracy.  I'm frequently not tired at the assigned lights out time, or even the somewhat later smart phone off time.  In keeping with principles of sleep hygiene, I go to another room.  Food is off limits from 8PM to 6AM for another reason, but it has also helped eliminate getting up due to heartburn.  And there is nocturia once nightly, for which I am unwilling to resume a medicine that on two attempts made me dizzy.  But generally I have no trouble returning to sleep following the interruption.

Last night brought something different, maybe even of more concern.  In effect, I slept two half nights instead of one whole night.  At about the midpoint I suddenly found myself wide awake, a little achy as well.  It was not a bladder awakening but I took advantage of being up, taking a naproxen tablet for the achiness, and returning to bed with an empty bladder.  Still awake though, but I do not know for how much longer.  Since I've not needed an alarm clock and the usual wake time was just over two hours later, it remained lights out and under blanket.  I did awake, though an hour later than usual to glance at the clock, followed by a mostly involuntary final sleep cycle for another hour, when I figured I better get on with the day, two hours later than my usual daily starting time.

In effect, those natural sleep cycles of 60-90 minutes divided into two half night's sleep instead of one whole one.  After some feeling of teeter with morning hygiene, I feel well now though my daily activities are time shifted by two hours.

Recapturing Bedroom Space

One of the tenets of favorable sleep hygiene is to restrict what you do in the bedroom and when you do it.  I have been working on this for a few months with gratifying outcome, though incomplete outcome.  There are now set get up times, which I follow and lights out times which I follow too.  Sleep cycles come in predictable periodicity, though mine conclude with a period of wakefulness before transitioning to the next cycle.  The experts say that when that happens, I should set a deadline for falling back asleep into the next cycle but go to a different place if still awake by that deadline.  I've not been doing that, but eventually the next cycle takes over.  And I feel better.

Master suites that realtors show customers or appear in those dream house photos offer a lot more to a bedroom than a place to sleep.  For many it emerges as their sanctuary, with electronics, sitting areas, usually with a bathroom alcove offering sensory luxury, storage space which offers access to the things you want and hiding to the things you don't.  My own bedroom has never developed its potential, and the sleep hygiene experts seem to be hinting that maybe it shouldn't.  Yet I set myself a mission of at least making that space more visually attractive and conducive to other activities.  Clutter has to go.  I've worked on it with some success.  Several years ago I bought a leather recliner, inexpensive but comfortable that too often becomes one more flat surface to put things.  Yesterday, I set a very tangible goal of removing those things, putting myself in the chair, allowing it to swivel, and ultimately reclining.  It felt good.  I could have read but didn't, though the intent was to not read in bed, which I did, but at least the book was worth reading.  I recaptured some floor.  Not all of it but some.  Vacuuming by end of week.

The daunting project may be the windows.  One has been stuck for years, should be repaired but maybe not worth the effort.  Temperature control has been solved with a window air conditioner that not only offers a refreshing breeze in cool months but white noise suitable for sleep, which is the purpose of that room.  For some reason, the duct work of the house does not bring central climate control to the master suite very well, so I purchased an attractive space heater which needs to be moved from its storage corner to its prominent and functional fall and winter location.  That corner can be occupied by an attractive storage bin, currently used for extra hangers, suitable for now but not the best option.  I am also committed to replacing the curtains.  Joann Fabrics not very helpful as what I need is the tailoring more than the choice of materials.  Lined curtains, hemmed all around, matching valance, suitable for the adequate rods already present.  Choice of fabric is almost an afterthought.  I could see what might be available online if I don't make reasonable progress locally.

And there is the closet.  Any realtor showing our house would point to the master bedroom walk-in closet.  Unfortunately walk-in implies open floor space which has been co-opted by a where it fits at the moment ethos.  To be recaptured.  I started decluttering the closet in the Marie Kondo mode, doing great on suits and sportscoats.  A lot of dress shirts don't really fit if I have to button the collar for a tie, will get me by sans tie.  They now cost a lot of money to launder, so I should dispose of some.  The Kondo Method requires all to come out at once, select for discard at once, before moving on.  Not worth it for what I need to do with the closet to bring my bedroom to fully functional and mostly restful.  

While it is my bedroom, it is really only half my bedroom.  Not being disruptive remains a priority, though one often in conflict with acting with the end in mind.  But there's still plenty I can do without generating anyone else's wrath.  Those are the things to pursue.