An Algorithmic Solution to Insomnia | Hacker News Reader

An Algorithmic Solution to Insomnia

ilya.sukhar.com

48 pointsvalgaze37 comments

No screens and no light brighter than single-digit candle power after sundown is a pretty good cure for, I suspect, a whole lot of modern cases of sleeplessness.

Light your whole house up brighter than the mirrored hall at Versailles and engage with devices that put entertainments better than a pre-modern emperor could command at the grandest, most expensive carnival he could assemble at your fingertips and sleep becomes elusive.

“The emperor’s having trouble sleeping! We lit up the palace with thousands of candles and invited over the greatest scientists and sages and show persons of all kinds (including the naked variety) and are holding a 24/7 carnival with all those folks just outside his bedroom and we just can’t figure out what might be the problem.” LOL, I mean, maybe there’s other stuff going on too, but I think I know where to start…

Obviously YMMV, but I've found having an exhausted body works wonders for falling to sleep. So, don't just exercise, do something physically tough that drains you. If you have to do that in the form of running/jogging/biking, fine. But you can also tend a garden. Clean the house. Organize something. Lots of things that are physically demanding.

I'm also skeptical of the advice to not nap. I'd go so far as to say that if you are avoiding naps, you are effectively teaching your body to avoid sleep. Don't do that. Try to move napping, sure, but don't be shocked if eliminating it has bad effects.

Napping reduces sleep pressure, making it more difficult to fall asleep at bedtime.

That is certainly a view, there. Resisting sleep also teaches your body to resist sleep...

That is, I don't think it is cut and dried. I can concede that napping too often is bad. I can also think that napping is not necessarily bad.

A good example might be to look at sleep consultants and books about sleep training infants and small children. What they will tell you is that a baby can learn to go to sleep for bedtime independently, and they can learn to take naps independently, but learning one doesn't mean they learn the other. You have to do it for both naps and bedtime. Babies "know" when a nap is a nap, and when nighttime sleep is nighttime sleep. That is to say, humans are diurnal.

Also keep in mind the context of the article. We're talking about insomnia. You're invoking the idea of behavioral habits ("teaches your body)". In fact, the recommendation for not napping comes from behaviorists, Cognitive Behavioral Therapy for Insomnia. I imagine that the idea is to do things that maximize the chance that you actually get the behavior you're aiming for and building on that (maximizing sleep pressure felt during bedtime).

I don't think there's anything wrong with napping for someone who doesn't suffer from insomnia.

I have probably an unhealthy level of skepticism that has mostly been fine for me. But, I am wary of a ton of the dialog around sleep that has pervaded everywhere. Raising several children, and never having an alarm clock in the house, a lot of what I've been exposed to in the learnings has been... susp. Obviously, YMMV, and I do NOT think they are liars or frauds.

My specific confusion on advising folks to skip naps is that I did not think that was a thing insomniacs even had to worry about. My clearly outdated model of insomnia was people that have trouble sleeping. Period. This did not include people that have shifted their sleep to the day, as that advice seems to imply to me. (That is, I thought insomnia wasn't "can't sleep at night," but "can't sleep." Appears the definition I learned was wrong, or we have expanded it since i learned it. (Or several other possibilities, of course.))

To further add on the recommended app, the VA department also has other fantastic applications such as the mindfulness one. Being government funded they have no tracking, no ads, no plans, and a clear and pragmatic UX.

As they should be, since the vast majority of useful apps aren't really anything that challenges the bleeding edge of software development

I like it! Reminds me of "The hacker's diet" [1] [2]. Hence, it could be even better to use a running average to keep the feedback cycle even tighter [1].

1: https://hackersdiet.org/hackdiet/e4/signalnoise.html#Fa78

2: https://trendweight.com/

I cured my insomnia with MJ brownies. Eat one, and in 1.5 hours you can turn off your brain like it has a switch. I’d take them daily for a period of about 2.5 months. You can fairly easily make brownies cheaply at home using the cheapest store bought MJ. YMMV, I’m not a doctor, etc. I know what I’ll do if my insomnia comes back though. If it’s due to an overly active mind, you can easily make it a lot less active

Not really a good idea IMO to recommend psychoactive solutions without consulting with a dr. Obviously MJ is relatively tame and safe, but insomnia can have a lot of other underlying factors/comorbidities which can also elevate risk for substance abuse (eg depression, OCD, etc) or improper self-medication, and developing a dependence on MJ as a sleep aid in those cases isn’t great. Can also quickly develop a tolerance etc, so if you are just using it to knock yourself out and not putting in other work to improve your sleep, it can quickly lose its effectiveness. As tame as MJ is, it’s still worth treating it with at least some amount of caution and respect when it comes to using it medically in conjunction with anything that borders on the sphere of depression and mental health IMO. Dual diagnoses are a thing after all!

It also might be totally fine and work out well for a lot of people (and possibly even better than other pharmacological solutions like ambien), but IMO you should probably not recommend MJ as a self-medicated sleep aid. If you are having serious sleep issues, see a doctor, and they may very well recommend trying out MJ, in which case go for it! Not trying to be a downer (ha) or anything, just trying to be realistic and at least ask people to be self-critical before adopting a self-administered psycho-active solution to a medical problem.

Hence the disclaimer. All I can say is it worked for me. I make no further claims. I’ve also found doctors to be borderline useless for stuff like this. You might even get a prescription for addictive (and psychoactive) sleeping pills which you’ll then be taking for years. At least with MJ you can just stop taking it.

Yep, I hear ya and mostly agree, that’s why I made the point about ambien. Not trying to sound like a Nancy Reagan or anything. I was just trying to caution against self-medication, because it’s not uncommon for people to not realize that there are other factors affecting their sleep health. It might be the case that MJ actually also ends up being a good treatment for those things as well, which is awesome, but it also can go the other way, and it becomes a mask/crutch etc. Just advocating for people to investigate the causes of their insomnia and think critically about whether or not a psychoactive solution is appropriate for them, possibly in conjunction with a doctor or therapist and if not then at least with some form of accountability if necessary, like a friend etc.

MJ works for a lot of people and is, generally speaking, perfectly safe. For some people it’s not appropriate, and I think that’s at least worth highlighting.

It's great the author found that CBT-I worked for them, but I'm amazed it took them that long to find out about sleep hygiene.

As a life-long insomniac, I learned about sleep hygiene in the 80s. I don't think they called it CBT-I back then. I've done the sleep restriction, I've done it all.

However, the author did pick up on something I've been speaking with a lot of people about more recently.

Usually people associate insomnia with stress. For non-chronic insomniacs, I can see how this would be the case, and seeing as only 10% of the population are chronic insomniacs, for most people, insomnia will be transient, and increased cortisol, and active mind during stressful times obviously creates the opportunity for this condition.

For many of the chronic insomniacs I've been speaking with, both onset and maintenance (wake up in the middle of the night), it seems many agree that our minds are just active at that time. Not stressed, sometimes not even that active. I can meditate in the middle of the night and still spend the next 45 minutes awake.

There is a part of our brains that kinda likes it.

I think calling this an "algorithmic solution to insomnia" is misleading.

What are you referring to as "sleep hygiene"?

It seems like that phrase usually refers to the things the author mentions as being "necessary but insufficient," not to the CBT-I components that they had newly discovered (which I sometimes summarize as "teach yourself that sleep is not as important as you think it is, and then maybe you'll be able to sleep").

Sleep hygiene includes things like not staying in bed if you're not sleeping, keeping a sleep schedule, get out of bed and do something else, etc. These are the things listed as "unintuitive new variants", but they aren't new, or maybe they are new to them.

I used to have a lot of trouble with insomnia, but a few years ago I discovered Drachinifel's YouTube channel about naval history https://m.youtube.com/@Drachinifel

Now I fall asleep listening to his 'drydock' Q&A episodes or lectures on historical campaigns, technologies, etc. & it's not really a problem at all anymore. It's been amazingly helpful.

I find the content interesting enough that I don't feel bored & restless, but not so urgent or exciting that it keeps me up. And I get multiple nights out of each episode by falling asleep fairly quickly

Just thought I'd share in case it works for anyone else

Mine is Mindscape podcast. The AMA episodes are multi hour and filled with intelligent information. I do worry that on bad nights I might not be getting the sleep my brain needs because there’s a feed of input unrelated to my life.

I agree with the 4 suggestions under "Unintuitive New Invariants" but add consider taking magnesium just before bed. My experience is that it helps the whole body relax, enabling sleep to be more easily achieved. Discuss it with your G.P first.

I learned recently that magnesium absorption through the skin is part of how epsom salt (MgSO4) baths “work”.

Also Sulfate bioavailability is why people take MSM for arthritis, so it’s a twofer.

A lot of people wake up at 3 or 4am. This is typically stress related.

Possible solution:

1. Sit up or get up. If getting up, I usually get a mint tea.

2. Journal. Write down your thoughts. Very important: write down _what you are going to do tomorrow_, step by step. Usually the brain is worrying about something and by telling it what you’re going to do about it tomorrow it seems to calm down.

3. When you’ve gotten everything out, read. Just keep reading until you can’t keep your eyes open.

I’ve found this almost always works. Waking in the middle of the night is caused by stress around a problem. Your brain just wants to know the narrative around how that problem will get resolved or improved. Then it will fall sleep again.

> Waking in the middle of the night is caused by stress around a problem

I don't think this is universal. For example: rotating shift workers can have a mostly physiological insomia, due to various disrupted rhythms.

Melatonin.

There's loads of wisdom about improving sleep. Exercise, wind down rituals, avoiding caffeine, various diet ideas. Changing bedtime, changing alarm time. Nothing made a perceptible difference. Dropping caffeine was especially useless advice as it has no impact on my sleep but made me much less effective.

Melatonin tablets however are magic. My pet theory is the CYP1A2 genotype which is known to control how effectively you eliminate caffeine also affects how effectively you eliminate melatonin. Being unusually efficient at metabolising melatonin seems likely to present as insomnia.

This. I used to lay awake for hours, my mind racing. Started taking melatonin every night about 30 mins before going to bed and life has much improved. Once in a while I’ll lay awake like the old days but for the most part I’m out quickly. I never was able to find anything that worked like this

A word of caution on melatonin supplementation: https://ai.hubermanlab.com/s/NKoA_QuI

Huberman takes jumps of logic that no respectable scientist should. Matt Walker has had a paper retracked, and his book on sleep is controversial to say the least:

https://guzey.com/books/why-we-sleep/

In this case, Huberman's neglects to address the fact that melatonin production is reduced as we age, not just in those with pineal gland calcification. He provides no sources for the argument that commercial preparations are inconsistent, and (IIRC) fails to even approach or suggest a solution to the much more problematic fact that even the lowest available dosages are an order of magnitude more than is appropriate. If he thinks it has merit for jet-lag and calcified pineal gland, at least he could instruct people how to take it appropriately.

I used to respect him, avidly listen to every show until I noticed how almost reactantly uninformed he appears to keep himself of anything he's already passed judgement on, as well as the dearth criticality with which treats the sometimes questionable guests on his show.

Also the Athletic Greens thing: someone who's pupporting to be purveying knowledge for the goodness of mankind should not be peddling snake oil, whether he likes the flavour or not.

The health risks associated with insomnia are stroke and dementia.

I can (anecdotally) back that up. Coffee has no perceivable effect on me; I drink several cups a day (because I enjoy the taste, and the ritual) but often go without and don’t notice any difference whatsoever.

However, I’ve had trouble falling asleep for as long as I can remember.

> My form of insomnia starts with an active mind some evening.

Not a doctor, but I’m very confident that this is ADHD. Sleep disorders are very common, ADHD is linked with a late melatonin onset and evening “buzz” or overexciting are almost textbook examples.

Treatments are there, but needs to be discussed with healthcare professionals. And “don’t change schedule” is a harmful advice. Fatigued driving is as dangerous as driving intoxicated. Some professions and activities require heightened focus as they’re dangerous to themselves and others.

Chronically tired people with ADHD or on the spectrum are kind of ticking time bombs. I can’t imaging telling them to intentionally get less sleep.

Tied to the buzzing you mentioned, another model of insomnia that is tied to this is intrusive thoughts. They don’t have to be dark to keep you awake, and even a little dark can lead to spiraling. I knew people who would stay up late doing things like play video games and the pattern there was staying awake until exhausted and falling to sleep five minutes after their head hit the pillow.

You could say they were addicted to video games but they were really doing anything they could to stay out of their own heads.

I struggled with bouts of insomnia, not quite as bad as author. I found taking sea kelp / Iodine has cured it, its a remarkable change, I feel tired after 20mins in bed and fall asleep, and I wake with the sun and don't feel tired when waking. The Thyroid is the Master hormone.

My problem is that I wake up in the middle of the night after 3-4 hours. Vaping one puff of indica cannabis puts me back to sleep until the morning. And even if I don't go back to sleep right away I'm feeling so good that I don't mind.

Apparently it's genetic. My genome has 100% correlation with genetic variants associated with insomnia.

A subtext here might be to try sleep restriction when you have a period of funemployment or PTO and can deal with the consequences of being sleep-deprived and/or can distract yourself from nodding off e.g. by going for a walk, and while you don't need to operate machinery, e.g. a car.

It's a double-edged sword in some regard, though, as for some (like myself) the stress of a high-stakes job and the potential consequences of poor sleep are exactly what is preventing sleep in the first place.

I feel very lucky that the sleep physician that ran my CBT-I course helped my realize that I was able to function just fine on less sleep than I wanted, and that I sometimes functioned suboptimally on a full night's rest. Good sleep was neither necessary nor sufficient for me to passably do my job.

Thankfully, this realization helped me make more progress on my insomnia than years of sleep hygiene, and I suspect this helps me do my high-stress job better than "passably."

Probably not for hard cases, but I find brown/pink noise useful when I _need_ to go to sleep. Works for me most of the times.

(2017)

How effective is cbti against the non-restful sleep component of chronic fatigue syndrome?

During these times I toss and turn all night and can't seem to fall asleep. I might also end up in some kind of near psychotic thought loops, where I tried to endlessly solve the current major stressors in my life. Or I may spend hours frantically and compulsively picking at acne on my face chest neck back and ass, in some kind of half asleep hell that I can barely escape. The affective experience is awful

Then after 8 hours of this finally I'm so exhausted that I can now sleep 8 hours. Hooray I just spent 16 hours in bed. Guess what I'm still f*** tired for the rest of the 8 hours I'm awake. And I spend those 8 hours in bed too sometimes because I'm too sick to actually leave the bed.

This idea that you can't stay in bed for longer than 20 minutes unless you can sleep is very challenging for someone who is already spending all day in bed because they're sick, and setting up this expectation, I've found, is a recipe for non-acceptance and self judgment.

Another thing that doesn't work so well about the cbti suggestions is that if I go to sleep only when I'm dying... I might not sleep for 2 days, because that can trigger a manic episode. I end up crashing after 48 hours or so - that's when I'm dying to sleep. Then I sleep 4 hours and do it again for 48 straight hours. A little bit terrifying right?

Instead the best thing I found was to accept that sometimes my sleep will be like this hellish nightmare, because of disabling chronic fatigue flare up and psychiatric issues. Giving myself permission to have awful hellish sleep nights seems like the honest best I can do - anything else seems to be gaslighting me and making me feel awful.

The problem with any kind of conscious cognitive technique, it seems, is that there are large stretches of time where I don't seem to have full conscious experience or control of my behavior. Given this and my propensity for mental OCD, I have had really negative effects from cognitive behavioral therapy in the past. Instead of letting me recognize and eliminate cognitive distortions, the CBT routines seem to add new forms of suffering rumination.

So I'm worried that cbti could have similarly aggravating effects for people who have underlying psychiatric issues. Note that the author did specify that the doctor worked to eliminate psychiatric issues from consideration before moving to CBTi. I don't think that will be enough to prevent people from trying to self help with cbti after reading this article... So I am noting here that if you have psychiatric stuff, your outcomes could be significantly improved - and potential dangerous bends in the road avoided - if you consult with a well-trained, well published, and highly experienced PhD in this field.

> This idea that you can't stay in bed for longer than 20 minutes unless you can sleep is very challenging for someone who is already spending all day in bed because they're sick, and setting up this expectation, I've found, is a recipe for non-acceptance and self judgment.

That sucks, but tbh, it doesn't sound related to CFS (the sleep disturbances certainly do, but not the fugue-state rumination). Certainly sounds like it would exacerbate it though. I was dealing with a similar sounding cycles of 48 hr wakefulness. Awful, awful.

Regardless, may I suggest moving to a chair next to your bed? It's still getting out of bed, but maybe not so debilitating?

> I have had really negative effects from cognitive behavioral therapy in the past. Instead of letting me recognize and eliminate cognitive distortions, the CBT routines seem to add new forms of suffering rumination.

I would hazard that whoever taught them to you was not entirely competent, particularly since it sounds like they should have been known enough not to make you think that noticing one's distortions and dysphoria is all one needs to resolve them would make

If this was significantly in the past, things are quite different now. The last 20 years of mental health treatment are light years more effective than what came before, which was, IMHE mostly useless and often deleterious.

Moreover there are better ways to approach issues like the ones you describe, specifically DBT and its combination of distress tolerance skills, mindfulness and self-compassion. Of the three, it really sounds like what you are going through needs a whole lot of compassion.

https://www.amazon.com/Self-Compassion-Proven-Power-Being-Yo...

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