Comment by dpeckett | Hacker News Reader

Comment by dpeckett | Hacker News Reader

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I'm pretty sure at this point I have familial advanced sleep phase syndrome of an unknown genetic etiology [1].

Wake up stupid early in the morning, get drowsy very early in the evenings etc. For a long time due to social pressure/habit I'd just power through the evening drowsiness. That lead to me only being able to sleep six hours or so (due to waking up stupid early), which over time lead to a substantial sleep debt.

Going to bed early helps a lot, but over time it seems like I easily start drifting earlier and earlier. I've recently had some success stabilizing my rhythm using sublingual melatonin when I first waken at 2-3am. Let's me get a couple extra hours of additional quality sleep which is a lifesaver. Wears off quick enough that by 9am or so it's basically out of my system.

I've actually been tinkering/hacking the last year or so on sleep tracking wearables. Initially focused on EEG/HRV monitoring but I'm taking a very modular approach and ultimately want to build a full set of sensors/effectors/etc.

I've recently been experimenting a lot with skin temperature gradients, turns out in the lead up to sleep it's not just blood flow in the brain that is altered [2].

1. https://en.wikipedia.org/wiki/Advanced_sleep_phase_disorder#...

2. https://journals.physiology.org/doi/pdf/10.1152/ajpregu.2000...

You might know this, but sleep debt doesn't just keep piling on. Eventually, and rather quickly, you may begin to experience permanent brain damage after a few nights of sleep deprivation.

https://www.ahajournals.org/doi/10.1161/STR.0000000000000453

From one insomniac to another... In the past I've been lucky if I get 3 hours total of sleep in a night due to physical pain disorders. I have deep trouble getting into NREM. I lucid dream often and my brain is active even when I'm supposed to be sleeping. In my dreams, I have to be careful not to be too energetic or overstimulated, or I will wake up.

I've had insomnia and night terrors since before I was regularly forming memories. An abusive childhood intensified that. I'm in my early 30s now and the damage is clear, both physically and to my life in general.

As much as I fear them, sleeping medication seems like the only way to save myself from early onset dementia or not accomplishing certain goals due to a perpetually low energy budget. It also has prevented me from losing weight. Sleep studies have shown that people who get frequently woken up while sleeping can burn around 50% less fat.. In my case, that's my entire calorie deficit which means in order to lose weight I have to basically starve myself. Melatonin, etc. have never worked for me.

All this to say... Don't wait for the damage to build up even more. Sleeping medication might change your life. I'm hoping it restores mine.

Absolutely, loss of deep sleep is associated with a ton of aging related cognitive decline. There's a number of startups experimenting with techniques to enhance deep sleep in the elderly atm (timed audio clicks, electrical stimulation etc).

There's not a lot of evidence that most common sleep medications are associated with long term improvements in health outcomes. Most have substantial detrimental effects on sleep architecture, can exacerbate underlying issues like apnea etc. Interesting the gabapentanoids (chronic pain) and Xyrem (narcolepsy) are associated with increased slow wave sleep. More research is needed (eg the DORA drugs [1]).

Thankfully circadian issues (in the absence of sleep loss) aren't associated with negative health outcomes. Just a case of finding a way to modify ones life to accommodate them.

1. https://en.wikipedia.org/wiki/Orexin_antagonist

Sorry you’re going through this, that sounds brutal. You mentioned an abusive childhood making things worse; if you’re open to sharing, has anything in therapy (trauma-informed work, CBT, EMDR, etc.) actually helped?

Do you have any take on non-med things like mindfulness/yoga nidra or gentle ambient sound at night? I’m on the fence about starting meditation myself and curious what’s been useful, or not, for you.

And if meds are what’s giving you relief right now, I’m glad you’ve found something that helps.

When you say “sleep medication” what do you mean specifically? AFAIK melatonin is safe but diphenhydramine overuse is linked to dementia.

I'm still exploring my options, open to suggestions. Medications like zolpidem and diphenhydramine are definitely off the table.

Exploring other z drugs (Lunesta, sonata), Benzos, thc, cbd, trazodone, Doxipin, belsomra, gabapantin, whisky, Dramamine, and herbal additions to higher dose melatonin (10mg+) and magnesium glycinate/threonate, like ashwaganda, valerian, gaba, passionflower, hops, lemonbalm, California poppy, jujube seed, chamomile/apigenin, myoinositol, taurine, higher dose glycine, theanine, 5htp (be careful), tryptophan (be careful), nighttime vitamin d, anti-hypertensives, arginine, supplemental oxygen, nsaids, red light therapy and placebo effects may be worth trying alone or in various combinations.

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