I used to have no problems sleeping at all, falling asleep whenever I wanted to, staying asleep all night, sleeping through noises… until I had mono for the second time and developed chronic fatigue syndrome. The worst symptom was inability to fall asleep, to stay asleep, and the crazy health impact that had (take a normal person and poke them til they wake up several times a night and they will soon develop the symptoms of fibromyalgia).
I would get tired, but never sleepy; none of the usual sleep hygiene stuff helped. I had no racing thoughts, I wasn't lying in bed thinking about all the bad things I'd done or reliving my day. I'd come to grips with all that stuff a long time ago. There was nothing wrong with me psychologically, it was like my body was broken.
I couldn't exercise because of the CFS, I'd be wiped out for days (but not sleeping). Quit caffeine, no help. Warm milk, tea, green tea extract, eyemask, earplugs, whatever, nothing helped. I would start to fall asleep and the slightest sound or movement would wake me. Or a stray thought as I started to drift. Again, not an important thought but I might start dreaming about sofas and where to put the sofa and then BAM, I'd wake up, like somebody ripped the sweet blanket of sleep away from me by main force. Not only would I be awake, I'd be unbearably furious. Sleep deprivation creates an inability to regulate emotion.
Even my body temperature was out of whack, getting cold and warm (yet never warm enough) at all the wrong times. This is one of the major signs of true delayed sleep phase disorder as opposed to psychological or chemical insomnia. (The original article does touch on this but doesn't describe the details: if your morning temperature is very low, and your evening temperature warmer, that's out of whack. My temperature on first waking used to be 96.5 - 97 F, and evening I'd get quite hot, although never above 98 F even though for all of my previous life I'd always been bang on 98.6 F.)
After months of this torture, I finally figured out that it was CFS. I found a book that absolutely gave me back my life: From Fatigued to Fantastic. I got my doctor to prescribe the author's recommendation for sleep troubles (after trying the herbal stuff and experiencing a paradoxical effect).
The sleep recommendations alone gave me at least an 75% improvement in quality of life:
Trazodone is one of only two drugs known to improve sleep architecture -- it's not a hypnotic, it doesn't knock you out, it actually helps you spend more time in deep sleep.
Melatonin at just 300mcg (MICROgram, not mg) to do the "knock out" portion.
Big doses of magnesium at night (I prefer the fizzy Austrian tablets and now I import them). Helps both with sleep, and muscle pain/stiffness from CFS/FM.
For unknown reasons, this current winter has been brutal to me. I've been sick constantly and tired, tired, tired despite the fact that Philadelphia gets at least 3x the sun that Vienna does in the winter and despite the fact that I am taking mega doses of b-vitamins which always helped before. Also I am a lot happier here and work stress is much reduced. Still… exhausted. all. the. time.
Over Christmas, my (Austrian) neurologist mother-in-law heard my winter symptoms and said "You have low serotonin. I want you to be on Welbutrin or Cymbalta." ( she obviously used the Austrian brand names.)
I said, "But I'm not depressed." (And indeed, I am not, plus the 2 meds above were totally doing the trick in terms of falling asleep. The key is that I am too tired to do what I want to do… but I still really want to do it.)
She told me, "That doesn't matter. Low serotonin can simply be a physical deficiency and not emotional."
I said, "OK, but I'm not taking Welbutrin or Cymbalta."
The trazodone I'm on has no "hangover" effect. It doesn't build up in the body and it's not addicting at the doses I take. These other drugs, though, can be opening a serious can of worms.
So with permission from my actual doctor, I got an herbal supplement with huge doses of B vitamins, St John's Wort, Suntheanine (green tea extract), and GABA. This replaced my existing B-vitamin complex. Plus I started taking huge doses of vitamin D because my blood serum levels were ridiculously low (despite the extra sun!) and got my 10,000 lux SAD light habit back in gear.
HUGE improvement.
I have been able to reduce my trazodone dose by 33% and some nights I don't even need the melatonin. I actually get tired and fall asleep like a normal person. Can't tell you how amazing that is after 3 years of sleep problems. (Most amazingly, I have even slept once or twice without earplugs… something I thought I'd never be able to do again. EVER.)
The 10,000 lux SAD light, the Vitamin D, and the herbal supplement has been an enormous improvement. The elements alone don't do the trick for me (I tried), but all 3 in combination make my life so much better.