Comment by perl4ever | Hacker News Reader

Comment by perl4ever | Hacker News Reader

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I was suffering from extreme daytime sleepiness that was impacting my job, and I got a sleep study and was told I didn't have sleep apnea and melatonin was suggested which didn't have a perceptible effect.

Even prior to that, for all of my adult life, my sleep habits had not been normal; I always felt like staying up longer and sleeping longer, and waking up for scheduled things was painful, but having commitments like work or appointments was the only way I could force myself to get up.

By accident, I found out my friend was taking bupropion, and I asked my doctor about it, and once I started taking it, my sleep cycle is practically normal. I have no idea why, but it was almost magical. Bupropion is sold as both a smoking cessation drug and an antidepressant, and it seems to do something to nicotinic receptors (of course) and to norepinephrine.

Edit: and caffeine never helped me; I only developed a tolerance and then when I stopped drinking coffee on weekends I would feel even worse than usual.

Something that really bothers me about coffee culture is that coffee is seen as a solution to being tired when really all it is is just an alertness booster. The main neurological cause of sleepiness is the brain’s desire to do memory optimization which can only happen by sleeping at the right time. Correct timing is really important and it seems to me like you have DSPS (delayed sleep phase syndrome). Most people’s circadian rhythms are a bit longer than 24 hours (usually between 24.5-25.5 hours) though external signals like exercise or bright light in the morning reset it to being closer to 24. If you have DSPS, yours isn’t reset well (you can try the aformtentioned morning bright light and exercise to change this) and you have a tendency to wake up later and later each day. The problem is that if you have to wake up at 7 every day and you think you need 9 hours of sleep you’ll try to sleep at 10 to get enough which backfires. The reason it can backfire is that for good sleep you need both strong homeostatic sleep signals (tiredness from thinking a lot or doing a lot of effort in the day) and circadian (sleepiness goes and comes cyclically). If you sleep at 10 and have DSPS, even if your homeostatic signals sleep, it is likely that your circadian isn’t which means you end up tossing and turning throughout the night. If you slept maybe an hour later you’d get full circadian and homeostatic sleepiness giving you good quality sleep but if you have to wake up at 7 you have to cut short sleep with an alarm clock which isn’t great since your brain can’t complete all the memory optimization it wants. I would say though that sleeping later more restfully for shorter will do you better than sleeping earlier restlessly. (Sorry for the essay, sleep is something I care about a lot. I hope this was a little helpful.)

From experience, DSPS (delayed sleep phase syndrome - the blanket term for what you describe) is terrible to have. I have found that most people I discuss it with who have normal sleep cycles will staunchly refuse to consider that such a thing could possibly exist. "Have you just tried going to bed earlier?" (wow, never thought of that thanks), "You just need to form a good sleep habbit", "You're just lazy", "Stop making excuses", "Just try harder" etc. - pretty much the same as telling a depressed person to "just be happy"...

Having had a look, that's really interesting that Bupropion helped, since it seems to quite commonly cause insomnia as a side effect. What kind of dose is that?

Half the typical daily total amount used for smoking cessation or depression. I tried a step up of about 1/3rd, and felt ill, so I went back to the initial amount.

Incidentally, I read just now that it's used for ADHD off-label.

Sudden sleepiness/fatigue is a symptom of benign brain tumors. You should get an MRI scan.

It wasn't really that sudden or novel. It was a tendency I had to varying degree since high school, and it became worse as my motivation decreased.

But the notable thing is that given how long standing it was, it was really amazing to me that I now feel like 7-8 hours of sleep is enough, just like a switch was flipped.

Bupropion is also an antidepressant and fatigue is a symptom of depression.

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