Sleep hygiene hypocrisy

[MD Puffer]

I'm the worst hypocrite when it comes to sleep hygiene.  It's one of the bread and butter issues I treat in my practice.  Yet I keep irregular hours which prevent me from falling asleep at a decent bedtime.  Interestingly enough, I had a finely honed sleep regimen in college at a time in my life when it seemed like all other aspects of my life lacked discipline.  I was able to fall asleep 5-10 minutes after getting into bed.  I tell all my insomniacs to do what I myself fail to do.  Since I don't have to work tomorrow, I'm pulling an "all nighter" and resetting the circadian clock.  I just need to hit my second wind around 9 am and fend off that tricky late afternoon nap and I should be able to effortlessly fall asleep at a normal bedtime in 16 hours.

On the other hand, with the wife and kid asleep, the weather being very mild with a gentle breeze, and a great nighttime panorama from my deck, I've had the time to smoke three cigars tonight completely undisturbed and in a very relaxed fashion.  Sooo, I'm either righting this ship or steering it directly into the eye of the storm.  Wish me luck- or don't - I haven't decided.  I think I'm going back outside with a Siglo III.

[Duxnutz]

Preaching to the choir. As an airline pilot, I’m all over the place when it comes to sleep. The old adage, sleep when tired and eat when hungry seems to work well enough. 

Failing that, melatonin on days off. ?

[MD Puffer]

Melatonin and Rozerem linger too long for me and I feel groggy the following mornings.  

Antihistamines (and anything that has antihistaminergic activity) are even worse.

Ambien works but it's too disinhibiting.  I end up buying stuff on Amazon I don't remember.  And I did yard work at 2am once.  Not to mention regrettable remarks made on various forums.

If push comes to shove I think I'll try a small dose of clonidine.

[Fuzz]

Sleep? I know not of this strange concept.

[Cayman17]

55 minutes ago, MD Puffer said:

Melatonin and Rozerem linger too long for me and I feel groggy the following mornings.  

Antihistamines (and anything that has antihistaminergic activity) are even worse.

Ambien works but it's too disinhibiting.  I end up buying stuff on Amazon I don't remember.  And I did yard work at 2am once.  Not to mention regrettable remarks made on various forums.

If push comes to shove I think I'll try a small dose of clonidine.

I find a 2 percent ounce pour of El Dorado 15 or Glenmorangie 10 while resting on the couch relaxes the nerves and makes one yearn for the bed. 

[MD Puffer]

Alcohol disrupts my sleep maintence.  And I cannot stomach them unless they’re mixed into girly concoctions that only a spring-breaker would find palatable. 

[HarveyBoulevard]

I sleep from 9pm to 5am daily.  Takes me 2 or 3 minutes to fall asleep. I find I am intolerant of sleep deprivation...or maybe I'm just intolerable

[wineguy]

3 hours ago, MD Puffer said:

Melatonin and Rozerem linger too long for me and I feel groggy the following mornings.  

Antihistamines (and anything that has antihistaminergic activity) are even worse.

Ambien works but it's too disinhibiting.  I end up buying stuff on Amazon I don't remember.  And I did yard work at 2am once.  Not to mention regrettable remarks made on various forums.

If push comes to shove I think I'll try a small dose of clonidine.

Have been trying 10mg. of melatonin lately but have the same morning lag that you mentioned.  Maybe its the scotch I wash it down with.... Whether I take depends on what is happening the next day.  If I have to be on point early in the day, I am better with less sleep that groggy.....

[wineguy]

Just now, wineguy said:

Have been trying 10mg. of melatonin lately but have the same morning lag that you mentioned.  Maybe its the scotch I wash it down with.... Whether I take depends on what is happening the next day.  If I have to be on point early in the day, I am better with less sleep that groggy.....

I have also considered CBD oil, anyone with experience with that?

[alloy]

Non-alcoholic ZQuill? Works great for me. But don't have any type of schedule since I'm retired.

[Shelby07]

32 minutes ago, alloy said:

Non-alcoholic ZQuill? Works great for me. But don't have any type of schedule since I'm retired.

That was my cure too. Retirement works great!

[SCgarman]

1 hour ago, FatherOfPugs said:

I slept like crap until I got my sleep apnea taken care of. Didn't realize how disruptive it was. First night I had the CPAP on, slept for 8 hours straight, didn't even get up to piss like I usually do. Now that I've been on therapy for about 6 months, I sleep like a baby for 6 solid hours and then I am up and ready to go. Put the machine on and I"m out in 5 mins. Don't even need naps anymore. If anyone thinks they might have sleep apnea get it checked out. The therapy has been a LIFE changer for me. I feel great, I'm actually losing weight now with my workouts, and I have energy again like when I was in college. Oh, and my wife doesn't need like 3 fans running to drown out my snoring. 

Yup! Been on a cpap machine for over 10 years now. It is a life saver, when they did the sleep test on me apparently I stopped breathing a disturbing amount of times throughout the night. No more snoring, sleep for a solid 8 hours, much more energy etc. All folks who are heavy snorers should get a sleep apnea test.

[SCgarman]

1 minute ago, FatherOfPugs said:

Agree 100%!  I did the same during my sleep test. So much so that they schedule my follow up appointment 3 days later to test me with the CPAP machine on. My second test came back so positive (meaning the therapy worked) that they sent me home with a machine the following morning. Since then I've slept like a baby. 

Before having a machine I once fell back asleep sitting on the couch in the morning with a hot cup of coffee in my hand. I awoke quickly when the hot coffee spilled all over my lap! I knew then there was an issue with my sleep that needed to be addressed. Ouch!  And BTW, I am not a big fat guy like some of the sleep apnea stereotypes hint. I am 5ft8, 220 with an average build. 52 yrs old

[Corylax18]

Sleep Hygiene? Really? That's a thing now?

I'm happy for you that you are able to profit from it, but that is a boom time "sickness" if I've ever heard of one. 

I'm all for more doctors, but if were to the point that "Sleep Hygienist" is a type of Doctor, I think we've hit saturation. 

I have battled with bouts of insomnia through out my life, so I understand how it can affect a person. I also had a grandfather who would stay up drinking until 1 or 2 in the morning, then wake me up at 5 am go fishing all day, and he was still on top of everything. Telling me "Don't be a Candy Ass" any time I complained about anything. I wish everybody had a grandfather like him. The world would be a better place. 

[Corylax18]

4 minutes ago, NYgarman said:

Before having a machine I once fell back asleep sitting on the couch in the morning with a hot cup of coffee in my hand. I awoke quickly when the hot coffee spilled all over my lap! I knew then there was an issue with my sleep that needed to be addressed. Ouch!  And BTW, I am not a big fat guy like some of the sleep apnea stereotypes hint. I am 5ft8, 220 with an average build. 52 yrs old

5'-8" 220 is a normal build? When did that happen? If the Body Mass Index means anything (its up for debate) a BMI of 34+ puts you well into the "Obese" range. At 6'-3" and about 155-165 I'm technically in the meat of the "normal" range, but try finding a pair of pants that fit me off the shelf. I think we can both agree that a true normal would be somewhere in between the two of us.   

https://healthjade.com/what-is-body-mass-index/

[HarveyBoulevard]

25 minutes ago, Corylax18 said:

Sleep Hygiene? Really? That's a thing now?

I'm happy for you that you are able to profit from it, but that is a boom time "sickness" if I've ever heard of one. 

I'm all for more doctors, but if were to the point that "Sleep Hygienist" is a type of Doctor, I think we've hit saturation. 

I have battled with bouts of insomnia through out my life, so I understand how it can affect a person. I also had a grandfather who would stay up drinking until 1 or 2 in the morning, then wake me up at 5 am go fishing all day, and he was still on top of everything. Telling me "Don't be a Candy Ass" any time I complained about anything. I wish everybody had a grandfather like him. The world would be a better place. 

I love you Cory. However, sleep hygiene is a very important medical field. Sleep patterns, or lack thereof, are one of the leading causes of stroke heart attack and cardiovascular disease in the world. Undiagnosed sleep apnea is a primary cause of many an early death. I wouldn't exactly call it a boom time sickness, I would argue that new medical science improves our lives and is not just a way to make a profit. As a user of a CPAP machine, I can tell you that my life is dramatically different not only for myself but also for my wife and two young children. My father would very likely be deceased had he not been diagnosed with sleep apnea about 30 years ago. Now, it doesn't help that I am a fat bastard, but there are lots of skinny bastards with sleep apnea as well.

[Corylax18]

4 minutes ago, HarveyBoulevard said:

I love you Cory. However, sleep hygiene is a very important medical field. Sleep patterns, or lack thereof, are one of the leading causes of stroke heart attack and cardiovascular disease in the world. Undiagnosed sleep apnea is a primary cause of many an early death. I wouldn't exactly call it a boom time sickness, I would argue that new medical science improves our lives and is not just a way to make a profit. As a user of a CPAP machine, I can tell you that my life is dramatically different not only for myself but also for my wife and two young children. My father would very likely be deceased had he not been diagnosed with sleep apnea about 30 years ago. Now, it doesn't help that I am a fat bastard, but there are lots of skinny bastards with sleep apnea as well.

I'm not disagreeing with Sleep Apnea being a real thing. Its a diagnosable, preventable, treatable, and relatively well understood medical condition. 

But the OP didn't mention sleep apnea, he was discussing a far more abstract set of problems leading to irregular and therefore unsatisfactory sleep patterns/quality. That sounds like a lifestyle issue to me, not a medical problem. Lets not conflate the two.

Again, I've battled insomnia, and General anxiety for most of my life, but I've learned what causes the issues and what I can do to not only prevent them, but solve them when they do pop up. I didn't run to a doctor asking him to invent some "medical condition" to justify my feelings and make me feel like I'm part of a "community." I just don't understand people's need for constant validation of their myriad(and often made up) issues. Everybody seems to think their so f$&king special, so marginalized, so unique. I'm over all the constant whining. 

Do you think "Sleep Hygiene" is a thing for Cuban citizens? When people have real problems to worry about like feeding their kids, keeping their house standing, trying to find and figure out how to pay for the Basic's,  these kinds of "conditions" don't seem to appear. Have you ever heard of a Cuban with a peanut allergy? Lactose intolerance? Gluten Intolerance? Unhygienic Sleep? I haven't.

[BrightonCorgi]

1 hour ago, Corylax18 said:

5'-8" 220 is a normal build? When did that happen? If the Body Mass Index means anything (its up for debate) a BMI of 34+ puts you well into the "Obese" range. At 6'-3" and about 155-165 I'm technically in the meat of the "normal" range, but try finding a pair of pants that fit me off the shelf. I think we can both agree that a true normal would be somewhere in between the two of us.   

https://healthjade.com/what-is-body-mass-index/

You could be shredded at 5'8" and 220, would you still be obese?  Traditional BMI scales do not take muscle mass into account. 

President Trump and Tom Brady have similar height and weight yet look totally different.  Only one is on the obese side.

[BrightonCorgi]

1 hour ago, FatherOfPugs said:

I would say 5'9" 220lbs is an athletic build. BMI is something insurance companies use to jack up your rates. What a person really needs to look at is lean mass (bones, muscles, and organs) and fat mass. So I stand at 5'9" and currently at 259lbs. I know what my BMI says 38.2, BMI says I'm Class I obese.  However, I also know that my body fat % is 17% so that means I have 44 lbs of fat on my body, the rest is lean mass. Average adult male body fat % is between 18 - 24%, considered the healthy range, athletes from 6 - 13%, and "fit" folks 14 - 17%.  I bench press 315lbs, squat 405, and can run a mile in under 8:30, and workout 6 days a week. Show me an "obese" person that can do that. Hell, I know people whose BMI are perfect and are so out of shape, it's not funny. I would say I'm in pretty good shape. The BMI would say otherwise. BMI is just a crock of crap. Are body builders who have a body fat % around 6% but have BMIs over 35 due to their height to weight ratio considered obese? I think not. Lean mass vs fat mass. My sleep apnea was not due to me being "obese."  

I am in the same boat...

[HarveyBoulevard]

31 minutes ago, Corylax18 said:

Have you ever heard of a Cuban with a peanut allergy? Lactose intolerance? Gluten Intolerance? Unhygienic Sleep? I haven't.

Are you actually putting forth the proposition that because they are living in a third world country that none of the population suffers from any of the above?

I agree they probably have bigger problems facing them but it doesn't discount the fact that they suffer from the same maladies as the rest of the planet.

Despite the above I know what you are saying and I don't disagree that we all just need to suck it up a little bit better these days.

I have a high BMI but the doctor says that's what happens when you have a big weiner LOL

 

 

[Corylax18]

33 minutes ago, FatherOfPugs said:

Disagree. People don't realize just how much NOT sleeping affects a person. Just ask the kids I coach. You can tell very quickly when the kids have had a good night's rest and when they have not.  Same for adults. Not sleeping well is NOT being a candy ass, and seeing a doctor to help with your sleep is most certainly not a "boom time sickness."  

Not sleeping well = immune system suppression, lack of release of growth hormone for muscle repair, higher cortisol levels which may lead to higher blood pressure and diabetes (mainly due to lack of GH and raised cortisol levels), and the worst part, can lead to lack of libido! No thanks!

If you don't believe it's a thing, perfectly fine. 

I would say 5'9" 220lbs is an athletic build. BMI is something insurance companies use to jack up your rates. What a person really needs to look at is lean mass (bones, muscles, and organs) and fat mass. So I stand at 5'9" and currently at 259lbs. I know what my BMI says 38.2, BMI says I'm Class I obese.  However, I also know that my body fat % is 17% so that means I have 44 lbs of fat on my body, the rest is lean mass. Average adult male body fat % is between 18 - 24%, considered the healthy range, athletes from 6 - 13%, and "fit" folks 14 - 17%.  I bench press 315lbs, squat 405, and can run a mile in under 8:30, and workout 6 days a week. Show me an "obese" person that can do that. Hell, I know people whose BMI are perfect and are so out of shape, it's not funny. I would say I'm in pretty good shape. The BMI would say otherwise. BMI is just a crock of crap. Are body builders who have a body fat % around 6% but have BMIs over 35 due to their height to weight ratio considered obese? I think not. Lean mass vs fat mass. My sleep apnea was not due to me being "obese."  

I agree that getting good sleep is important. I also agree that sleep apnea is a thing. But, I dont believe in slapping band aides on everything so we can justify our unhealthy lifestyles. Insurance companies aren't the only ones to blame for Skyrocketing healthcare costs. Sleep Apnea used to be treated exclusively with lifestyle changes. CPAP's and Insurance companies footing the bill for them are relatively recent development. But CPAP's don't cure anything, you aren't suddenly "cured" when you put that on. You still have sleep Apnea, and you still haven't addressed any of the underlying causes. Insurance companies love it, its no different then someone being placed on painkillers for the rest of their life because they throw out their back. I'm sure that would make it tough to sleep, but wouldn't you wanna get your back fixed? Scuba masks are uncomfortable when I'm scuba diving. I would never, ever, get comfortable wearing one of those contraptions on my face everynight for the rest of my life, nor would I put up with lugging with everywhere I went. There are other, therapeutic ways to improve the condition. I would exhaust ALL of them before I even thought about a CPAP. 

BMI is definitely not a fail safe indicator of health, we can agree on that. But lets not compare about .5% of people with high BMI's to the vast majority of them. Just how many body builders are walking around in society? (Not counting crossfitters ?) The vast majority of people with BMI's over 30 are genuinely obese and live unhealthy life styles. I've been to the south, I've seen it with my own eyes. I live in Colorado and work in Boulder. Boulder is regularly ranked among the "Healthiest" and "Skinniest" towns in America. And its not because we've moved the target. Nobody here is complain about the BMI being an insurance company scam. I've also lived in Texas and Kansas City, where lifestyles are drastically different. Its not a coincidence that the drastically opposing lifestyles in these two locations lead to drastically different health demographics. 

Smoking Cigars, eating red meat and drinking alcohol also suppress you immune system, very possibly leading to the issues you mentioned above, as well as a myriad of others. Have you considered the possibility of causal affect or eliminating/cutting back on any of those activities? 

[MD Puffer]

41 minutes ago, Corylax18 said:

I'm not disagreeing with Sleep Apnea being a real thing. Its a diagnosable, preventable, treatable, and relatively well understood medical condition. 

But the OP didn't mention sleep apnea, he was discussing a far more abstract set of problems leading to irregular and therefore unsatisfactory sleep patterns/quality. That sounds like a lifestyle issue to me, not a medical problem. Lets not conflate the two.

Again, I've battled insomnia, and General anxiety for most of my life, but I've learned what causes the issues and what I can do to not only prevent them, but solve them when they do pop up. I didn't run to a doctor asking him to invent some "medical condition" to justify my feelings and make me feel like I'm part of a "community." I just don't understand people's need for constant validation of their myriad(and often made up) issues. Everybody seems to think their so f$&king special, so marginalized, so unique. I'm over all the constant whining. 

Do you think "Sleep Hygiene" is a thing for Cuban citizens? When people have real problems to worry about like feeding their kids, keeping their house standing, trying to find and figure out how to pay for the Basic's,  these kinds of "conditions" don't seem to appear. Have you ever heard of a Cuban with a peanut allergy? Lactose intolerance? Gluten Intolerance? Unhygienic Sleep? I haven't.

My sleep is erratic because I have a 20 month old and because I'm in solo practice I'm on call 24/7.  Those disturbances combined with reading threads on this forum has led to my current bout of insomnia.  It was just a thread created out of boredom.

I'm a psychiatrist who treats common causes of insomnia, but before prescribing medication for insomnia, I try to see if the underlying cause is poor "sleep hygiene" which is a pattern of behaviors which lead to insomnia.  The concept has been around for many decades.  The ideas that form the concept of sleep hygiene have been understood for longer than that.

If several attempts on my part fails to improve/resolve one's insomnia, I refer them to a sleep medicine specialist.  There are dozens of sleep-related disorders, dyssomnias, which require a sleep study to diagnose and are optimally treated by a sleep specialist.  

The concept of modifying one's behaviors before initiating medication is a concept that spans many disciplines.  Lower salt , decrease calories, decrease sugar intake, get more exercise, the list goes on.  

Hope this clears everything up for you.  

[MD Puffer]

4 minutes ago, Corylax18 said:

But, I dont believe in slapping band aides on everything so we can justify our unhealthy lifestyles.

Sleep hygiene is a free preventative measure.

Sleep Apnea used to be treated exclusively with lifestyle changes.

There are different types of sleep apnea.  Lifestyle changes will not resolve apnea of CNS origin.

But CPAP's don't cure anything, you aren't suddenly "cured" when you put that on.

CPAP usage when indicated can lower hypertension, lowers the risk of stroke and cardiovascular disease, decreases risk of motor vehicle accidents, and helps you have better sex.  The costs of the CPAP device are far outweighed by the sequelae of untreated sleep apnea.

 

Hope this clears things up for you further.  You seem very passionate about your viewpoints.  

[SCgarman]

8 minutes ago, Corylax18 said:

I agree that getting good sleep is important. I also agree that sleep apnea is a thing. But, I dont believe in slapping band aides on everything so we can justify our unhealthy lifestyles. Insurance companies aren't the only ones to blame for Skyrocketing healthcare costs. Sleep Apnea used to be treated exclusively with lifestyle changes. CPAP's and Insurance companies footing the bill for them are relatively recent development. But CPAP's don't cure anything, you aren't suddenly "cured" when you put that on. You still have sleep Apnea, and you still haven't addressed any of the underlying causes. Insurance companies love it, its no different then someone being placed on painkillers for the rest of their life because they throw out their back. I'm sure that would make it tough to sleep, but wouldn't you wanna get your back fixed? Scuba masks are uncomfortable when I'm scuba diving. I would never, ever, get comfortable wearing one of those contraptions on my face everynight for the rest of my life, nor would I put up with lugging with everywhere I went. There are other, therapeutic ways to improve the condition. I would exhaust ALL of them before I even thought about a CPAP. 

BMI is definitely not a fail safe indicator of health, we can agree on that. But lets not compare about .5% of people with high BMI's to the vast majority of them. Just how many body builders are walking around in society? (Not counting crossfitters ?) The vast majority of people with BMI's over 30 are genuinely obese and live unhealthy life styles. I've been to the south, I've seen it with my own eyes. I live in Colorado and work in Boulder. Boulder is regularly ranked among the "Healthiest" and "Skinniest" towns in America. And its not because we've moved the target. Nobody here is complain about the BMI being an insurance company scam. I've also lived in Texas and Kansas City, where lifestyles are drastically different. Its not a coincidence that the drastically opposing lifestyles in these two locations lead to drastically different health demographics. 

Smoking Cigars, eating red meat and drinking alcohol also suppress you immune system, very possibly leading to the issues you mentioned above, as well as a myriad of others. Have you considered the possibility of causal affect or eliminating/cutting back on any of those activities? 

You obviously think you know much about sleep apnea, and that those who have it live "unhealthy lifestyles". Your ignorance offends me. I am 52 years old and healthy. I have worn the same 38inch waist jeans/shorts/dress pants for probably 20 years and maintain my physique. I have never been a "tall, lanky'" build like a college basketball player. Family members in my family are not tall and skinny. I cannot change my body style/shape, nor can many others. Yes, at 5ft8 and 220 which I have maintained for over 20 years, I consider myself an average build. Considering 3 out of 5 adults are now considered overweight or obese I am doing well. I have never been 160lbs, like the illogical BMI charts and never will be. Oh well. Just be grateful YOU are healthy, thin and tall and live in the healthiest place in the country. I am happy for you. Just remember the healthiest, most in shape person who lives the healthiest lifestyle can contract cancer, die of a heart attack or die from a myriad of other reasons. 

[bpm32]

2 hours ago, Corylax18 said:

I've battled insomnia, and General anxiety for most of my life

I'm way fatter than you and I don't have either of those problems, so maybe you could gain 50 lbs and they'll go away? I prescribe a dozen doughnuts a day from the King Sooper, chased with two liters of non-diet soda. Non-diet part is important. Fat goes on quicker if you drink those calories. In fact, you can microwave your ice cream so you can consume it faster.

Also, try to limit movement.