Problems sleeping

[Fleur de Me]

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I've never been great at sleeping, but ever since I started med school, I've become MUCH worse.

I've tried all of the usual things- I exercise regularly, don't drink caffeine after lunch (I only drink green tea anyway, not coffee), try to "get relaxed" before bed by chilling with the lights off and music. STILL, I can't fall sleep.

It's even worse before exams- I literally don't sleep a minute. I'm not even "stressed out"- it is almost like my mind is so pumped up from learning all this crap that it doesn't know how to turn off!!!

Has anyone had similar problems? I'm really tempted to go see a doctor about it since even benadryl isn't working well (I try to avoid it, but even in "emergencies" I seem to have become immune). Have also tried melatonin, which is useless for me.

I'm afraid no doctor will take me seriously because I'm a med student, but I don't know what else to do!!!

 

[JuniperTree]

I react similarly under stress.
Try tylenol. I find it doesn't put me to sleep, but it enables me to relax just enough that my mind can stop thinking and start sleeping.

 

[Guyton Killah]

I react similarly under stress.
Try tylenol. I find it doesn't put me to sleep, but it enables me to relax just enough that my mind can stop thinking and start sleeping.

Is it an OTC drug?

 

[bomgd3]

Is it an OTC drug?

 

[21CentSouldier]

Diphenhydramine. It's OTC. 😎

Also, don't study before you go to bed. Don't study IN your bed, or do anything else for that matter other than sleep or practice making babies. And you can try a hot shower 20 minutes before bed.

 

[TallScrubs]

Are you a guy?

 

[mfrizzo3]

I've never been great at sleeping, but ever since I started med school, I've become MUCH worse.

I've tried all of the usual things- I exercise regularly, don't drink caffeine after lunch (I only drink green tea anyway, not coffee), try to "get relaxed" before bed by chilling with the lights off and music. STILL, I can't fall sleep.

It's even worse before exams- I literally don't sleep a minute. I'm not even "stressed out"- it is almost like my mind is so pumped up from learning all this crap that it doesn't know how to turn off!!!

Has anyone had similar problems? I'm really tempted to go see a doctor about it since even benadryl isn't working well (I try to avoid it, but even in "emergencies" I seem to have become immune). Have also tried melatonin, which is useless for me.

I'm afraid no doctor will take me seriously because I'm a med student, but I don't know what else to do!!!

Anxiety?

I went to see a doctor about not sleeping and this is what we came up with. He then gave me some choices on how to handle it and voila, one little 75mg pill every morning.

 

[mindsg]

Gammahydroxybutyric acid restores NREM sleep cycle length but is rx-only and habit-forming. Otherwise anticholinergics tylenol and Diphenhydramine could be used long-term (watch for adverse liver rxns though).
Sleep tight! 🙂😴

 

[hermit]

I've never been great at sleeping, but ever since I started med school, I've become MUCH worse.

I've tried all of the usual things- I exercise regularly, don't drink caffeine after lunch (I only drink green tea anyway, not coffee), try to "get relaxed" before bed by chilling with the lights off and music. STILL, I can't fall sleep.

It's even worse before exams- I literally don't sleep a minute. I'm not even "stressed out"- it is almost like my mind is so pumped up from learning all this crap that it doesn't know how to turn off!!!

Has anyone had similar problems? I'm really tempted to go see a doctor about it since even benadryl isn't working well (I try to avoid it, but even in "emergencies" I seem to have become immune). Have also tried melatonin, which is useless for me.

I'm afraid no doctor will take me seriously because I'm a med student, but I don't know what else to do!!!

Ambien is a wonder drug. Exercise, diet, blah blah blah. You'll be sleeping like a baby on day 1. Get the generic. Like $12/month at walmart. Problem solved.

 

[Jorski]

I myself had trouble sleeping, starting in undergrad when I chose medicine, and randomly continuing throughout med school.

It sounds like you have covered all of the basics (no caffeine after a certain time, exercise, all of that jazz). After modifying my sleep hygiene and all of that, I came to find that I was overly anxious about school. Even though I knew I shouldnt be, knew that my grades were OK, I had a plan for the next day, etc., I was still 'geared up for battle' so to speak, and couldnt get to sleep. What is bad about it is (for me anyway), it would (and still does) go from being geared up about school for one or two nights, to being geared up about not being able to sleep. Its a bad cycle to get into.

When I first started school, I'd be up until 3 or 4 in the morning (after laying down at 10) and then would have to get up for class at 8. I went to the doctor and got Ambien. It worked for the most part, even though there were some nights that I still wouldn't sleep. When I started to be of the mindset "if I dont take this pill I wont get to sleep", I weaned myself off of it and stopped taking it. I got into talk therapy to manage the anxiety of school, and this has reduced the not sleeping nights quite a bit. You might consider this route if you are adverse to taking a pill (addiction runs in my family, and I found it wasn't for me).

I still dont sleep too great on the night before a test, but I can usually pull off 4 to 5 hours, take the test, and then crash.

Hope that helps.

 

[VoiceofReason]

i had the same problem, smoke weed.

 

[MediCynical]

Melatonin + diphenhydramine + ZMA = 😴 (without any groggy hangover)

 

[ScronCron]

Melatonin works wonders. I would discourage ambien (zolpidem), especially since it can affect memory and (in some cases) cause amnesia... a very counterproductive side-effect for a medical student.

 

[MossPoh]

Melatonin and working out till I near vomit work for me most of the time.

Ramelteon (Rozerem) is supposed to be really good too. Doesn't work through GABA like the other prescription sleep drugs. We have a professor that does a lot of sleep research with melatonin and what not and he seemed to think very highly of it.

 

[kdburton]

I use melatonin as well. 5mg about a half hour before bed and I'm ready to pass out. I also work out which probably helps.

 

[Guillemot]

Ambien is very effective, but also addictive. Aside from chemical addiction you can become psychologically dependent on it as well.

I have personally used this medication a significant amount, and I feel that I might be addicted to it. I dont really know though that it has produced much adverse side effects for me. I dont doubt that it has improved my quality of life.

I guess in determining in whether to take a drug one must consider both the therapeutic benefits and adverse effects.


Melatonin is mildly effective for me.

 

[gschl1234]

I've never been great at sleeping, but ever since I started med school, I've become MUCH worse.

I've tried all of the usual things- I exercise regularly, don't drink caffeine after lunch (I only drink green tea anyway, not coffee), try to "get relaxed" before bed by chilling with the lights off and music. STILL, I can't fall sleep.

It's even worse before exams- I literally don't sleep a minute. I'm not even "stressed out"- it is almost like my mind is so pumped up from learning all this crap that it doesn't know how to turn off!!!

Has anyone had similar problems? I'm really tempted to go see a doctor about it since even benadryl isn't working well (I try to avoid it, but even in "emergencies" I seem to have become immune). Have also tried melatonin, which is useless for me.

I'm afraid no doctor will take me seriously because I'm a med student, but I don't know what else to do!!!

Sorry to hear about your predicament. Sleep hygiene (no studying, reading, TV watching etc... in bed) never worked for me. Sleep deprivation (and rarely light box) is the only thing that's consistently worked. If you limit yourself to 4 hours (or whatever is considerably less what you need to be comfortable) for about 3-4 nights, you'll be able to fall asleep as soon as your head hits the pillow. I'm usually set for a few weeks to a few months depending on environmental stressors. Beware of pharmaceutical options, such as Ambien, which is designed for short-term use only. Many people, unfortunately, end up using sleeping aids chronically. There's also the concern of quality of sleep which may be different from natural sleep depending on the drug (disrupted REM). Remember, the purpose of sleeping is not merely to be unconscious. REM sleep is actually quite active, and it's function is not yet well understood. People who have disrupted REM sleep report feeling less refreshed. Good luck.

 

[Fleur de Me]

Thanks for all of your responses!

For the record, I'm a girl, not a dude 😉

I've actually been trying the melatonin, but don't notice it helps at all. I've used diphenhydramine so often over the last year that now it takes several (ie. 4) to get me kind of sleepy, and sometimes doesn't even work. I stopped taking it weeks ago because I felt like I was taking it too often. Even when I was taking it, I was having trouble sleeping so it seemed like I was just pumping crap into my body that wasn't doing much.

I'm not feeling overly anxious, I'm doing well in school and feel like my life is pretty great. But anxiety (and subsequent alcoholism from self-medicating) runs in my family, so maybe even if I'm not feeling consciously "stressed"- I should maybe go see someone to see if addressing this will deal with my sleep issue. I don't drink much, and stay away from most drugs, but maybe I could use a little help so I don't constantly feel like a zombie!!

Do you think doctors will give me a hard time because I'm a medical student? I'm kind of afraid they will be like "buck up, I survived without medicating myself, so can you."

 

[hrandani]

Wasn't that long ago where medical students took dex to make it through, so I wouldn't worry too much about that.

This is seriously a field with a long tradition of uppers and downers.

 

[MossPoh]

I use melatonin as well. 5mg about a half hour before bed and I'm ready to pass out. I also work out which probably helps.

5 mg? Where did you find those? Only ones I ever see are 3 mg.


Anyway, how you take melatonin is important too. Supposed to take it at the exact same time every night and immediately hop in bed. Really, you use it along with proper sleep hygiene (No caffeine, intense exercise, eat healthy, bed for sleeping and sex only, etc.). I really think that if you do an intense workout and practice all those things, along with the melatonin and some kind of meditation/breathing exercise as you get in bed, you will up your sleep dramatically. By intense workout I'm not saying a light jog for 30 minutes. I'm talking about either going to the gym before school or taking a break and doing all out sprints, stairs, circuits with large compound motions and things that make you so winded you will have to take a 5 minute break just to get the key in the ignition. You can't do this 2 or 3 hours before bed because it will amp you up for a bit.

The Rozerem is just amped up melatonin really, so it may be worth a shot. It isn't as addictive as the others. I'm not sure the sleeping so little you have to fall asleep method is any safer than drug. A chronic state of sleep deprivation followed by enough sleep one night never really makes up that sleep deficit and is probably not that great for you in the longterm.

REM sleep is a weird thing. The whole relationship with depression makes me wonder if there isn't something else going on that we're missing.

 

[Myuu]

Melatonin works wonders. I would discourage ambien (zolpidem), especially since it can affect memory and (in some cases) cause amnesia... a very counterproductive side-effect for a medical student.

Careful with the timing of that one. One of my friends took one during the day and ended up sleeping through one of the loudest percussion sections I've ever heard.

 

[kdburton]

5 mg? Where did you find those? Only ones I ever see are 3 mg.


Anyway, how you take melatonin is important too. Supposed to take it at the exact same time every night and immediately hop in bed. Really, you use it along with proper sleep hygiene (No caffeine, intense exercise, eat healthy, bed for sleeping and sex only, etc.). I really think that if you do an intense workout and practice all those things, along with the melatonin and some kind of meditation/breathing exercise as you get in bed, you will up your sleep dramatically. By intense workout I'm not saying a light jog for 30 minutes. I'm talking about either going to the gym before school or taking a break and doing all out sprints, stairs, circuits with large compound motions and things that make you so winded you will have to take a 5 minute break just to get the key in the ignition. You can't do this 2 or 3 hours before bed because it will amp you up for a bit.

The Rozerem is just amped up melatonin really, so it may be worth a shot. It isn't as addictive as the others. I'm not sure the sleeping so little you have to fall asleep method is any safer than drug. A chronic state of sleep deprivation followed by enough sleep one night never really makes up that sleep deficit and is probably not that great for you in the longterm.

REM sleep is a weird thing. The whole relationship with depression makes me wonder if there isn't something else going on that we're missing.

They sell a 5mg dose at one of our local grocery stores (I'm sure you can buy it online somewhere as well). I personally have a bottle of 3mg ones at my apartment, but I stay at my GF's house a lot and shes got the 5's. When I'm home I take two 3mg pills lol. I feel like I can tell a difference, but who knows.

 

[armorshell]

5mg?! A physiologic dose is 0.3mg... If I need one I get the 3mg ones and cut them into quarters...

http://jcem.endojournals.org/cgi/content/abstract/86/10/4727

 

[cowme]

I've never been great at sleeping, but ever since I started med school, I've become MUCH worse.

I've tried all of the usual things- I exercise regularly, don't drink caffeine after lunch (I only drink green tea anyway, not coffee), try to "get relaxed" before bed by chilling with the lights off and music. STILL, I can't fall sleep.

Are you tired at this point? Some people simply don't need as much sleep as others. My roommate functions on 5 hrs/night, while I need 9 or I am a wreck. If you try to force yourself to sleep before you are tired, you are only making the problem worse. Listen to your body. When you get tired, go to bed. Even if it's midnight and you have to be up at 7. If you aren't tired, don't force it.

Are you in bed tossing and turning? Get up, do some work, reading, etc. Don't waste valuable hours tossing in bed. If you stress about not sleeping, you will just make the problem worse.

 

[kdburton]

5mg?! A physiologic dose is 0.3mg... If I need one I get the 3mg ones and cut them into quarters...

http://jcem.endojournals.org/cgi/content/abstract/86/10/4727

Well unless you are truly an insomniac there really won't be a difference between 0.3mg and 5mg anyways. It could be a placebo effect with me, but hey I'll take it 😀

 

[gschl1234]

Do you think doctors will give me a hard time because I'm a medical student? I'm kind of afraid they will be like "buck up, I survived without medicating myself, so can you."

No one will give you a difficult time. My worry is how your doctor will treat. Many PMDs write prescriptions for Ambien like candy and inappropriately prescribe it chronically, which is NOT the proper way of using the medication but it is easier than changing behavior (e.g. adhering to good sleep hygiene, sleep deprivation, light box) or dealing with any underlying anxiety or environmental issues contributing to the problem. It is more cost-effective to spend 5 minutes and write the script rather than properly counseling you.

 

[Fleur de Me]

By intense workout I'm not saying a light jog for 30 minutes. I'm talking about either going to the gym before school or taking a break and doing all out sprints, stairs, circuits with large compound motions and things that make you so winded you will have to take a 5 minute break just to get the key in the ignition. You can't do this 2 or 3 hours before bed because it will amp you up for a bit.

Haha- believe me, I do very intense workouts, I was a professional athlete for several years before I went to med school. Maybe I'm just used to 6 hours of working out a day and not 1? Only kidding....

I don't think exercise is the issue. I don't know- I really try to have good sleep hygiene, but maybe I need to actually stop working in my room altogether, which kind of sucks, but my room isn't that big and there are times when I will study a good 6-10 hours there. Not on my bed, but at my desk which is right next to it.

Sigh. Sleep shouldn't be this hard!! I'm going to try to make a few more adjustments and then might give in and go see someone. I just hate the idea of taking drugs because I generally like to keep my body pretty clean and don't want to feel dependent on stuff.

 

[adaptation1]

Is your performance during the day affected by your lack of sleep? I mean, I envy the people who can get by with less sleep. They have more time to be productive as well as time to just chill, relax, listen to music, aka downtime.

Haha- believe me, I do very intense workouts, I was a professional athlete for several years before I went to med school. Maybe I'm just used to 6 hours of working out a day and not 1? Only kidding....

I don't think exercise is the issue. I don't know- I really try to have good sleep hygiene, but maybe I need to actually stop working in my room altogether, which kind of sucks, but my room isn't that big and there are times when I will study a good 6-10 hours there. Not on my bed, but at my desk which is right next to it.

Sigh. Sleep shouldn't be this hard!! I'm going to try to make a few more adjustments and then might give in and go see someone. I just hate the idea of taking drugs because I generally like to keep my body pretty clean and don't want to feel dependent on stuff.

 

[476515678234896]

I've never been great at sleeping, but ever since I started med school, I've become MUCH worse.

I've tried all of the usual things- I exercise regularly, don't drink caffeine after lunch (I only drink green tea anyway, not coffee), try to "get relaxed" before bed by chilling with the lights off and music. STILL, I can't fall sleep.

It's even worse before exams- I literally don't sleep a minute. I'm not even "stressed out"- it is almost like my mind is so pumped up from learning all this crap that it doesn't know how to turn off!!!

Has anyone had similar problems? I'm really tempted to go see a doctor about it since even benadryl isn't working well (I try to avoid it, but even in "emergencies" I seem to have become immune). Have also tried melatonin, which is useless for me.

I'm afraid no doctor will take me seriously because I'm a med student, but I don't know what else to do!!!

Melatonin's good but by the time I realize I need one it's already around 4:00 am.

I never thought that my breathing could be better until I tried breathe-right strips, but they're alright..maybe something you should look into.

 

[mydogtobbi]

I've never been great at sleeping, but ever since I started med school, I've become MUCH worse.

I've tried all of the usual things- I exercise regularly, don't drink caffeine after lunch (I only drink green tea anyway, not coffee), try to "get relaxed" before bed by chilling with the lights off and music. STILL, I can't fall sleep.

It's even worse before exams- I literally don't sleep a minute. I'm not even "stressed out"- it is almost like my mind is so pumped up from learning all this crap that it doesn't know how to turn off!!!

Has anyone had similar problems? I'm really tempted to go see a doctor about it since even benadryl isn't working well (I try to avoid it, but even in "emergencies" I seem to have become immune). Have also tried melatonin, which is useless for me.

I'm afraid no doctor will take me seriously because I'm a med student, but I don't know what else to do!!!

You really should go and see your PCP about this problem. You could also try biofeedback. I had trouble sleeping and went to see a neuropsychologist for biofeedback. It really helped.

 

[painmd87]

See your PCP. If unsatisfied, ask who the best sleep doc in town is. Go see him/her. There may be complications that your PCP is missing. Ambien, Lunesta, Rozerem, etc. are commonly prescribed. Seroquel is a powerful antipsychotic but does a good job of maintaining sleep architecture while promoting sleep.

If using melatonin, take it 2-3 hrs before you intend to get to bed. Anyone who takes it < 1 hr before lights out and falls asleep faster is succumbing to placebo.

Consider progressive relaxation techniques if you think stress is keeping you up. Google it.

Someone suggested GHB (brand name Xyrem) but that is generally only rx for narcolepsy and is controlled by a central pharmacy. It's hard to get for a reason!

 

[Fleur de Me]

Is your performance during the day affected by your lack of sleep? I mean, I envy the people who can get by with less sleep. They have more time to be productive as well as time to just chill, relax, listen to music, aka downtime.

It depends- I can usually function OK- I've taken every exam for the last 5 months on zero sleep and done quite well. I've surprised myself at how highly I function, although if I'm going to get a lot of studying done I need to get good sleep.

My problem seems to be falling asleep, and if I could keep my own schedule, I'd probably be just great. I'd have weird hours (4am-noon), but then I'd feel rested enough to get things done. In the days leading up to exams I just don't care what time I get up and let myself sleep so I can work all day/night.

The problem comes when I have stupid required things at school at 8/9am and then by the time I'm done at 3pm, I'm so tired I can't do the kind of studying I need to do.

So far it has worked out for me fine because the days leading up to exams I keep my own schedule, but no matter what, it seems, I can't sleep a minute the night before exams. Which is funny because I don't stress at all and do super well, but my mind can't seem to relax.

But yes- I'm agreeing with you guys that maybe I should see someone to see what other options they can come up with to try to help me get on a more normal schedule! Now I have the freedom to sleep and keep a weird schedule at times, but that certainly won't be the case 3rd year! and for the rest of my life!

 

[painmd87]

It depends- I can usually function OK- I've taken every exam for the last 5 months on zero sleep and done quite well. I've surprised myself at how highly I function, although if I'm going to get a lot of studying done I need to get good sleep.

My problem seems to be falling asleep, and if I could keep my own schedule, I'd probably be just great. I'd have weird hours (4am-noon), but then I'd feel rested enough to get things done. In the days leading up to exams I just don't care what time I get up and let myself sleep so I can work all day/night.

The problem comes when I have stupid required things at school at 8/9am and then by the time I'm done at 3pm, I'm so tired I can't do the kind of studying I need to do.

So far it has worked out for me fine because the days leading up to exams I keep my own schedule, but no matter what, it seems, I can't sleep a minute the night before exams. Which is funny because I don't stress at all and do super well, but my mind can't seem to relax.

But yes- I'm agreeing with you guys that maybe I should see someone to see what other options they can come up with to try to help me get on a more normal schedule! Now I have the freedom to sleep and keep a weird schedule at times, but that certainly won't be the case 3rd year! and for the rest of my life!

You may want to consider delayed sleep phase syndrome. DSPS is usually well-managed with melatonin therapy (taking it 1-3 hrs before desired bedtime to get the ball rolling) and light box therapy early in the morning. Again, see a sleep doc! They'll believe you; if they don't, find another one.