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Comment by mmanfrin | Hacker News Reader

I'd wager most people here who don't get enough sleep aren't doing so out of some sort of grindset mentality, but because they simply cannot. I find it very hard to fall asleep, nearly impossible to sleep in (a consequence of getting older?), and more interrupted sleep. I'm reticent to try drugs to enable sleep because I've heard that the sleep they provide is not true sleep.

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I have this pattern of getting really tired in the early afternoon, and then by night time, I would be fully awake. I couldn’t just sleep when I was tired because then I won’t sleep at night, and it just become this terrible cycle. I can’t stay awake at night because things need to be done during the day.

It’s been better recently, but some years ago, I would come home from work just completely exhausted and pass out immediately. I would only sleep for a few hours, but then wouldn’t get tired again until 4-5am at which point I often would just power through it because I’d have to get ready and go to work in a couple hours anyway. It peaked a few years ago when I completely wrecked my sleep and didn’t sleep for a few days straight. I remember waking up, thinking about something I believe was just utter nonsense, and a second later being unable to recall what I was even thinking about. I ended up getting my sleep schedule back by cycling some light stimulants during the day and crappy sleep aids at night until I was back to a normal schedule, but that probably wasn’t very healthy itself.

I've always been sort of a "night owl" I can stay up to 2 or 3 am pretty easily and like sleeping until 10 or 11am. I seem to get my best "deep" sleep between 6am and 10am.

Yeah that sounds similar to what my sleep schedule has been since I’ve been out of work. Prior to that I was doing mostly 12a-8a, but I was working remotely so it was easier.

I do enjoy the night, it’s cooler and calmer, sadly there’s just not much that can get done. I remember years ago working a night job, where I would often work very long hours, but I would get accusations of being lazy from people who just saw me as sleeping all day.

That was absolutely me too, until about a year ago when I lost the ability to sleep in (at all, I cannot sleep past 8ish). It's been a painful adjusting period.

That sounds a lot like the kind of "brain desynchronization" as I call it, related in my experience to alcohol use. Alcohol kind of puts half of my brain to sleep, and after I sober up and go to sleep that same half us behind schedule, so to speak.

That may not necessarily be totally true, you're most likely referring to hypnotics (ambien, lunesta, etc)—which were used by doctors for patients in some circumstances but are slowly falling out of fashion for the reasons you describe.

There are older and newer classes of drugs on the market that are being used as first-line therapies which not only preserve sleep architecture but in many cases even enhance it. Trazodone (a very old SARI) for example increases the amount of slow-wave sleep in healthy individuals and amount of time spent asleep. There are many newer drugs, suvorexant, ramelteon, etc. These medications are of course not without side effects but for many patients they work very well.

I'd say if you're suffering from chronic sleep deprivation then the cost-benefit analysis strongly leans in the direction of a pharmaceutical that fixes that since sleep is second to none in improving health and wellness outcomes.

There are many insults that can cause disrupted sleep architecture like you're describing—impaired gut microbiota, stress, lack of exercise, etc—all of which may respond to their own remedies. I experimented for years and finally have wonderful sleep with desmopressin + trazodone. And I was at a place where my sleep was seemingly uncureable—waking up every hour or every few hours on most nights.

If you want great sleep, you might have to fight to find the correct path for your own situation.

How did you come across desmopressin, isnt that a bed-wetting thing? How does it help with sleep outside of urinary issues?

It’s not strictly for bedwetting. I’d generally wake up a few times a night to urinate and I’d noticed that my sleep would become very fragmented for 30-60min before actually being fully awaken to void. Knowing that this was affecting my sleep quality, I tried limiting fluids and compression socks. Neither fully worked, so a pharmaceutical intervention seemed worth a try when I stumbled upon it online. The difference is night and day, I sleep throughout the night rather than the multiple awakenings I had been susceptible to. My urine is also a dark yellow upon awakening rather than the clearish tint I had been accustomed to.

My blood work is normal but my gut floras are not in perfect ratios as revealed by some testing. For some reason in my case that has manifested as electrolyte/fluid balance issues at night which are corrected by the desmopressin.

This is good advice, thank you. I've tried Trazodone, but it gave me really strange nightmares (as someone who never has nightmares). I've found Gabapentin to be useful, but recently it's been less effective and I've had to up the dosage which gives me a bit of anxiety over wondering where that stops.

In the last 6 months the level of exercise I get has skyrocketed, and I thought it would help but it's ironically made it worse. Stress is definitely a possible factor, but there's nothing in my life that is particularly more stressful than it was before. That's why this has all been perplexing: my sleep hygiene and everything surrounding it has gotten better as my ability to sleep has gotten worse.

Yeah, that’s strange; I’d say keep investigating. Again I think it’s about cost benefit. I’ve had a few friends who tried trazodone off my remarks and the ramping on period is tough for many. Sometimes the side effects go away and maybe sometimes they don’t.

I’ve meditated a lot in the past to the point where I have a very strong representation of my inner mental state; and because of this it’s glaringly obvious to me when I’m even slightly mentally impaired from even minor sleep disturbances. I think some people may not notice the cognitive attenuation as acutely and for others it may not bother them much.

But if it bothers you keep investigating. As far as exercise making it worse; I’m not sure about that. One thing I do know is that the microbiome plays a key role in exercise recovery, and it’s possible that if you have impaired homeostasis in the gut it could be responsible for sleep disturbances. Maybe you could check your RHR and HRV for the hours or days after a session of exercise and see how long it takes you to return to baseline. People with ideal microbiome profiles return to baseline remarkably quickly even when they don’t have great cardiovascular fitness (from my understanding of the literature). This next point is a bit speculative but another possibility is that exercise forces more slow wave and rem sleep. These are the periods in which people are the most likely to suffer apnea events for those who are susceptible to it. If you’re one of those individuals then the increased number of those events could leave you feeling less refreshed. So that’s another thing that could be worth looking into

Are you physically tired when trying to sleep? Without a level of physical activity is next to impossible to achieve a good night sleep.

Yes, I've actually been more physically tired than usual lately (training/gym which never used to be part of my routine now are). Last week I was dead tired and had exercised for hours and I still had trouble sleeping.

You may want to consider a short course of sleep aids to see if it can help adjust your schedule. This is unscientific, but I’ve found that if I’m dealing with persistent insomnia, taking something to help me fall asleep when I want to can lead me to “readjust” to the new schedule.

I used this the most when traveling and dealing with jet lag, but I still occasionally find it useful to take an OTC sleep aid when my schedule gets “off.”

Interrupted sleep is tougher. I’ve had some success by just accepting that if I haven’t fallen back asleep in 15-20 minutes I probably should get up and walk around for a bit and maybe try the couch instead, but it’s not great.

That's what I do when I can't sleep. I "give up" trying to sleep and do something for a hour or two. Then I go through the usual prebed ritual.

This gives me more attempts at sleep. Better to have more opportunities then fewer.

Physical labor. Or exercise. If you push yourself to the point where you're physically tired, you'll sleep like a rock. If it doesn't, you're either not pushing hard enough or you ought to see a doctor.

Heavy exercise, like lifting weights after work(5PM), makes me fall asleep eve harder.

I can still feel the adrenaline and elevated heart rate and body temperature that just makes it even more difficult to fall asleep so I have no idea how people who go to the gym at 9PM manage to fall asleep. I wish I knew their secret or had their genetics.

Lighter exercises that don't stress the body, like long walks and yoga are much better for sleeping but not good for building muscle.

My problem isn't falling asleep, it's staying asleep for long enough to feel rested. I usually wake up after 4-5h and can't easily fall back to sleep. By the time I get sleepy again(7-8AM) it's already morning and time to get up for work.

So far I haven't found a (natural) cure for this. There's medication that aids with getting long sleep but the side effects (drowsy ness and brain fog) are nearly just as bad as the lack of sleep.

Have you experimented with sleeping while fasted at all? I have heard a few people say they get their best sleep when sleeping on an empty stomach.

I also find white noise and a sleep mask have helped a fair bit. I’m a very light sleeper so little background noises wake me easily, so having white noise on helps there. And wearing a sleep mask notably improved my sleep as our bedroom can get quite bright (even with blackout curtains).

Anecdotally though, the most important factors for me are sun exposure (particularly morning and evening), weight lifting (or exercise in general), and cutting out caffeine.

Heavy exercise should be avoided in the evening, it's best to do it early in the morning or during your lunch break if you can.

I do think sufficient physical activity helps, but timing is important. I find that if I work out too late in the evening remnants of adrenaline are still coursing by the time I try to go to sleep and actually hamper, rather than help getting to sleep.

Love me an over simplified solution for a very complex problem.

My issues sleeping have gotten worse in the time that I've started to seriously weight train. I am having nights where I'm so exhausted I could cry and still have a hard time getting steady sleep.

Never worked for me, I think if you're physically fit, being physically tired has no correlation on sleep. Since 12y/o I've struggled to sleep before 1-2am, and since 14y/o I've exercised a frankly ridiculous amount.

14-18yo I went to the gym 1hr/day every weekday, boxing 1-2hrs 3x/wk, karate 1hr 2x/wk.

18yo+ I've boxed, run 30-40 miles/wk (some 3/4hr runs in there too leading up to ultras), climbed 2-10hrs/wk, and gym 2-3x/wk for the last 5 years although that schedule and activity level has varied since I have no real reason to kill myself training now that I don't compete in anything.

None of the above have an impact on sleep or ability to fall asleep, I have taken weeks off due to injury or months off due to burnout after a 12hr race, and my sleep schedule hasn't changed. Still tired-ish around 5-7, then 7-2am find it impossible to fall asleep, followed by 5-6hrs sleep and repeat. I 100% agree with the guy who replied to you that got heavily downvoted that "just exercise" is a vastly oversimplified response to the complex issues most people have with sleep. Not everybody's sleep issues are due to an inactive lifestyle, and I'd bet that is not the case for the majority of people.

If you don't like drugs, look up Cognitive Behavioral Therapy for Insomnia (CBT-I). It is kind of a collection of tricks, but it goes further than your basic sleep hygiene checklist. One thing it includes that helps many people if they can do it is the Spielman sleep-restriction protocol: https://stanfordhealthcare.org/medical-treatments/c/cognitiv...

Go in for a sleep study. You may have sleep apnea. Also work on your sleep hygiene.. There is also sleep therapy which may be helpful.

I find I get the best sleep when I go camping. No artificial light and sync'd with the sun.

Most of it is lack of physical activity. If you use your body enough during the day you are very unlikely to have problems sleeping at night.

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