There's nothing quite like being told obvious advice by some idiot when you've been struggling with a serious issue for years. I can't tell you how many times melatonin has been "recommended" to me by "casual professionals," for lack of better terms. The latest one I got was to avoid caffeine. Wow, really? You mean I should avoid the very thing that keeps me awake? Jesus what a revelation.
This post is about all things sleep. And boy have I become an expert. However I still have not solved my own such problem. If you're struggling, and you've yet to find the solution, here is all the data I've compiled in my half-decade-long search for sound sleep. Mostly first-hand experience, but some things avoided for reasons detailed below. Here are three categories of sleep aides, in order of potency.
Natural solutions
5-HTP: Precursor to serotonin which is necessary to instigate the sleep cycle. If you're deficient in serotonin it will help. Otherwise not so much. It can also keep you awake for the same reason (serotonin can be stimulating). Be careful taking it if you're prone to mania.
Alcohol: Alright this is NOT a sustainable solution but technically it might help you sleep. I just feel like my list has to be exhaustive y'know. I don't recommend this method of knocking yourself out. Over time it will mess up your sleep, and it won't help you stay asleep.
Ashwagandha: Hard to spell. This is what's known as an "adaptogen". I have no idea how adaptogens work. Supposedly they lower what's too high and vice versa, but how your body or the herb knows how to do this beats me. Anyway, this is meant to regulate your cortisol and raise/lower it at appropriate times. For me personally, it kept me awake. So I'm not sure adaptogens are really a thing.
Cannabis: Good old weed. Mary Jane can work like the Sandman for some but for others she can cause paranoia and anxiety at best, hallucinations at worst. Long term this is a poor choice because it tends to disrupt deep sleep, which is the restorative kind, in favor of REM, or the dreaming kind. It could also potentially cause psychosis and bring out latent psychiatric disorders if you're predisposed. Yikes. Use with caution.
CBD: Cannabidiol, an extract of cannabis with no psychiatric properties or THC. Can be vaped, used as oil, or smoked, but the flower will have an amount of THC in it. You can buy this online when derived from hemp. Good for pain management too. It can work as an antipsychotic/anti-anxiety as well. Kind of weak for sleep though, at least in my experience.
Chamomile: Found in "Sleepytime"-type teas. Can help relax and calm your mind but probably won't put you to sleep, to say the least.
GABA: A somewhat lesser-known supplement that's used for anxiety. GABA is actually a neurotransmitter, the one that calms, as opposed to the one that, well, opposes it: glutamate. Some claim it can be addictive but there is not much evidence to support this. There is also some debate as to whether it can cross the BBB (blood-brain barrier) in supplement form. PharmaGABA is a specific type that is supposed to do this more effectively. GABA works best as an anti-anxiety supplement, and only relieves mild insomnia. It can have a bit of a rebound anxiety effect the following day.
Homeopathy: I'm gonna be honest, I think homeopathy is a hunk of junk, and it has about no science to prove it works. But it can work for some people, paradoxically. Its modus operandi is it takes an ingredient that provokes the symptom you're trying to eliminate, and waters it down to an undetectable minutiae and packages it in some water or a sugar pill. There are infinite concoctions of insomnia-related homeopathy and I don't care to list any of them for reasons stated.
Kava (kava): Like theanine, it works with GABA and acts as an anti-anxiety/relaxant. Commonly used in a tincture or drank as tea. Can have some trippy/recreational effects when taken in high doses.
Kavinace: Very strong and thus very addictive. Some people are behind this one but I compare it to benzos (see below). It will give you just as horrible a withdrawal, without the seizures. Panic attacks, possible sweating, the whole gamut. Once a week is probably the most often you wanna take this. It starts to lose effect after a while anyway.
L-Ornithine: An amino acid. I haven't tried this one so I guess it's still on my list, but I have a feeling it's not quite strong enough for my level of insomnia. It's supposed to be relaxing and eliminates ammonia in the gut (which, obviously, is inflammatory, and inflammation = insomnia). More of a stress reliever, methinks.
L-Theanine: Similar to GABA but does not have its own neurotransmitter, though it does work with GABA. Better used as a mild anxiety reliever than for sleep but can calm your thoughts down if that's what's keeping you up. However, if you have a sensitivity to GABA-ergic drugs this can produce a bit of a rebound effect the next day, like GABA itself.
L-Tryptophan: Sounds familiar because it's that ingredient in turkey that allegedly makes you tired after Thanksgiving dinner. That's actually more likely from eating massive amounts of food but anyway. It's another precursor to serotonin which is necessary for sleep. If you're not deficient in serotonin it probably won't work. If you are but can't covert tryptophan well it probably won't work.
Magnesium/CALM: CALM is a drink with magnesium in it. Magnesium is relaxing. It is an electrolyte so it's necessary anyway. Too much will give you the shits but it's not really dangerous unless you're mainlining it. It can calm your thoughts down and give you a feeling of relaxation but it won't relieve anything more than mild insomnia.
Melatonin: Yep, you got it, the number one Google solution for insomnia. More an insult than a suggestion for us hardcore insomnia sufferers. It's a natural hormone produced in your body when it gets dark out. Some people don't produce enough of it, in which case they need supplementation. No more than 3-5mg should be necessary. If you aren't lacking in it, you won't benefit from it. This is for people who need to reset their sleep cycles, mostly. Not hardcore insomniacs such as myself.
Progesterone (cream/suppository): Funnily enough this is actually a sex hormone. Yeah, I know, unusual to mention this in a sleeping post, but it is also relaxing, and if you're short on progesterone (hello PCOS) it can help calm you down when applied/taken at night. Be careful when messing with hormones. They are powerful and any alteration in one affects the rest of the hormone network too.
Rehmannia: This one is new to me, someone randomly mentioned it on a message board for Lyme disease regarding cortisol regulation. I have not tried it yet as it is not sold in stores. It's a Chinese herb that is supposed to lower cortisol, which as you will read below, can be a problem, so be sure this is your problem before treating it. It also alleges to give you more energy when you're depleted from stress/lack of sleep. So basically an adrenal supplement. No word on this one yet.
Schisandra: Like rehmannia, I'd never heard of this one either and have yet to try it or find it. It promotes calmness and relaxation, and like ashwagandha, is an adaptogen. No word from me on this one either.
Seriphos: Phosphatidyl serine, or phosphorylated serine. This, uh, chemical? Lowers your cortisol. Take it at night if you have high cortisol keeping you up. Be careful because too low cortisol is a problem too. It won't lower it to dangerous levels likely, but it can lower it enough to paradoxically raise your anxiety. If high cortisol/irregular diurnal cortisol cycles are keeping you awake this will help. Otherwise you're tampering with something that doesn't need tampering with.
Valerian root: Another GABA-ergic drug/herb. This one is a little more potent than the others. It has a strong taste and is usually taken as a tincture. It can definitely induce sleepiness and might be helpful for moderate insomnia or problems falling asleep.
Other miscellaneous relaxing supplements: Echinacea, holy basil, lemon balm, magnolia bark, passionflower, vitamin B6
OTC solutions
Benadryl: That little antihistamine you take when you have a cold is also supposed to help get you to sleep. Lots of antihistamines do this. It can however have the paradoxical effect of keeping you awake like it does for me. This one can be good if you suffer from MCAS/histamine intolerance that keeps you awake, but of course you're better off avoiding reactive foods/items in the first place.
Doxylamine: This is the "stay asleep" part of Unisom, which also includes benadryl (diphenhydramine). This is the one that helps me sleep best, after NyQuil.
NyQuil: Contains doxylamine, acetaminophen, and DXM (dextromethorphan). For some reason this one knocks me out the best, even though the actual ingredient for sleep is very low in dose - about 1/4 of the regular tablet dosage. Unfortunately can't be used long term. Acetaminophen is hard on the liver.
ZzzQuil: Don't be fooled, this is just Benadryl repackaged as a pricier sleep med.
Psychiatric/prescription solutions
Ambien: Everyone's favorite DUI drug. I've been a victim to it myself. Got my license suspended for about a year. Fun times. Personally all it does is put me in a hypnagogic state, but for some it's a lifesaver. Unfortunately long-term use is highly ill-advised due to addiction. It's considered a z-drug (see below), which is similar in mechanism to a benzo (see below again).
Antihistamines: Basically, hydroxyzine and Vistaril. Powerful antihistamines that will probably knock you out or at least make you fairly groggy. Side effects include sleep hangover and weight gain.
Antipsychotics: These are the second line of defense by psychiatrists when a patient has sleep issues, after short-term solutions. Antipsychotics work against dopamine which is a stimulating neurotransmitter. It may knock you out, or it may just make you really slow. Often lasts into the next day. Majorly problematic side effects of weight gain and metabolic syndrome.
Belsomra: A new sleep prescription med. Not much is known about this one. For me it did nothing. Probably not addictive, but also not very strong.
Benzos: If you're reading this blog and are considering, or on, benzos, I urge you to please stop. If you aren't already, you will become physically addicted to them and will need a higher and higher dose to achieve the same effect. After that the only way is off of them. At worst your doctor could yank you off them way too quickly, and you could actually die from a seizure. They will fuck your GABA receptors up and the withdrawal, unlike what doctors will tell you, consists of much more than a return of your anxiety/insomnia symptoms. There's a wonderful site called benzobuddies that provides support and a guideline to getting off them. Common ones are Ativan, Klonopin, Valium, and Xanax. See also: Z-drugs.
Beta blockers: These drugs should be used with caution because they slow down your heart rate and lower your blood pressure. If you have low blood pressure already they can be dangerous and potentially fatal. A slower/weaker heart beat will get you to sleep but this is not the best solution for obvious reasons.
Gabapentin: More used as a pain drug than a sleep drug but it can have relaxing effects for the former reason. It's a bit of a misnomer because it doesn't work on GABA. This is one I do not have experience purely because I hear the withdrawal is a bitch and well, been there done that with benzos.
Prazosin: If nightmares and/or PTSD are keeping you awake or causing pre-sleep anxiety, this will help. Its actual use is not related to sleep at all, but it does have the side effect of mediating negative thought patterns as it relieves hypertension. It's not a beta blocker but it does treat high blood pressure so once again, use with caution.
Trazodone: Atypical antidepressant that is no longer used for that reason but for sleep. This is the one I use. Now it only prevents me from not sleeping at all. I need an adjunct with it, usually NyQuil, much to my chagrin. It can be pretty sedating and last into the next day. It can also give some people some mild anxiety for some reason.
Xyrem: A.k.a. GHB a.k.a. the date-rape drug. Sure the company will tell you differently but no one's fooling anyone where I'm concerned. This "narcotic" is actually a very useful drug for narcolepsy. It costs upwards of a thousand dollars a month, ironically enough, seeing as the street version is probably one of the cheapest drugs you could find (not that I'd know). Only used in severe cases of insomnia and even then, good luck getting a prescription. You have to take two doses a night. It works similarly to benzos (on GABA receptors) so you can become addicted to it unfortunately, meaning it will stop working. Also has a not-so-sexy side effect of bed-wetting if taken in too high a dosage (again, not that I'd know).
Z-drugs: Ambien/zolpidem (above), Lunesta (zopiclone/eszopiclone), and Sonata (zaleplon) are all collectively known as Z-drugs due to their name. They work similarly to benzos and are just as addictive. Lunesta is known for giving your mouth a nasty metallic taste in the morning. Lunesta worked best for me personally but Ambien is the most popular. Once again, avoid these except in case of emergency.
Other methods
Acupuncture: Now I know some people lump this in with homeopathy, but there are actually a number of clinical studies showing some science behind it, based on using true acupuncture points versus randomly-placed needles. Acupuncture is based on energy meridians and is part of Chinese medicine. It's often covered by insurance to boot. I've tried it, and while it did help me relax/nap during the session, the effect did not carry over into the night. And believe me, I gave it plenty of tries before I gave up on it.
Camping: There is some science behind camping and sleep. Yes, for fellow Lyme sufferers camping is possibly the last thing on your mind, but if you're safe about it, it can be quite beneficial. A week spent falling asleep and waking up to natural light in an area off the grid can reset your sleep cycle potentially. My body for whatever reason resists replenishing its neurons by sleeping, so unfortunately sleeping outside for a few weeks resulted in, well, simply not sleeping for a few weeks.
Diet changes: There are a number of diet changes you can experiment with to help you sleep. Among them are eating carbs at night time (stimulates serotonin release), abstaining from carbs altogether (to moderate blood glucose which can cause midnight awakenings/cortisol dysregulation), intermittent fasting (blood glucose again), and most obviously, avoiding caffeine/stimulants (possibly including sugar). Cutting caffeine out, of course, is usually first on everyone's sleep-improving to-do list.
Epsom salt baths: Alright, this one is a bit of a toss-up science-wise. Epsom salt baths are known for their relaxation and healing properties, supposedly due to the magnesium in the salts being absorbed transdermally. However, science does not back this up (magnesium can't be absorbed through the skin). So the actual bath might just be the thing doing all the leg-work here. Anyway, this won't cure your sleep woes, but combined with other methods, can put you in a relaxed enough state to get you there.
Essential oils: I should probably lump this in with homeopathy. Essential oils (honestly have no clue why they're deemed "essential") are used for a wide variety of purposes. Lavender oil has relaxing properties to it when inhaled, supposedly, and I believe vanilla might as well. I'm not well-versed on these because they don't do much and their effects are primarily psychological in nature.
Exercise: This can be iffy. Exercise should exhaust you to the point of falling asleep when everything is working right. But when you have chronic insomnia, it's obviously not. Exercise with chronic illness can just make you physically exhausted, slowing you down for the rest of the day at best and overstimulating you at night at worst, paradoxically keeping you awake. For this reason it's best done in the morning. Yoga is the best exercise for Lyme/chronic illness patients as it is done at your own pace and not very intense (unless you do bikram/hot yoga, which is another story entirely).
Hypnosis: Yes, hypnosis. I've tried it and I'll spare you. This should be done if you have anxiety related to falling asleep and/or in general. If your thoughts are keeping you awake at night, or if the bed(room) is a source of anxiety consciously or subconsciously, this is a good option. But if your brain/body just refuses to fall asleep on its own terms, having someone trying to convince your subconscious to do so probably ain't gonna work. This stuff's expensive too. Meditation (below) would be a better option.
Massage: Massage is the ultimate relaxation technique, though this is also a costly habit, and you sure can't get one every day if you're on a budget, though you do need to sleep every day. Touch is an underrated form of healing and we all require it as humans. Whether traditional Swedish massage or deep tissue or hot stone or whatever other kinds are out there (sidebar: reiki "massage" isn't a massage, I'll leave that up to you to research), a massage can't hurt. Well, not unless you're full of knots, in which case I'm guessing you have something else going on keeping you awake.
Meditation: Another classic armchair psychiatrist prescription. Meditation works for some at calming the mind. The point is to sit upright and practice thinking nothing. As soon as a thought comes in, you let it go. Can be done with music or without.
Relaxation/affirmation tapes: These can lull you to sleep, or like me, the talking can keep your mind awake. Basically they are CDs (or Youtube videos) that repeat many affirmations over the course of an hour or more and the monotony is meant to bore you to sleep. They can be helpful if you're prone to subconscious suggestion. Or again, like me, they could just irritate you and keep you up.
Rife machine: The Rife machine was invented a few decades ago. The idea behind it is it emits EMF frequencies on specific wavelengths to kill specific pathogens. Somehow it treats every illness known to man. Sounds too good to be true, right? Mhm. I did get one of these (a cheap-ish spooky2 version) and tried it for a bit. At first I think the waves just kept me awake. After a while though it just seemed to do nothing. And then the machine stopped working. RIP. Proceed at your own risk.
Sleep deprivation: What! Depriving someone of sleep to help them sleep? That sounds like dieting before going on vacation if you ask me. But yes, this is a tactic used by some resistant people to reset their sleep cycles, potentially in conjunction with melatonin. You skip a full night's sleep, with the hopes that you'll be tired enough the next night to fall asleep on your own and continue on from there. Unfortunately for some of us, not sleeping just gives us a hangover and we feel like garbage, only to proceed to another night of no sleep. Similarly, some have suggested if you're not asleep in 20 minutes, to get up and do something (e.g., read something boring). To me that sounds an awful lot like, you know, just being awake. I thought the idea was to tell your brain it's time to turn off? This idea seems like it's scraping the bottom of the barrel.
Warm milk: More of an old wives' tale but there may be some science to it based on anecdotes, if only due to placebo. Warm milk is relaxing and puts babies to sleep so why not you? Someone told me once about a recipe that put them to sleep called "dead soup", which combines bread with warm milk into a soup you eat. Sounds um, odd to say the least, but allegedly you "sleep like the dead". Didn't work for me but if you're down for downing that downer to get you down and out (yes, I'm incredibly lame), have a go.
So, if you're like me, and you've tried every damn thing in the book, and read this whole list, and none of these things work...well, I dunno what to tell ya. Hopefully attending testicular cancer support groups aren't in your future. *
*I would tell you the reference but remember the first rule is we don't talk about it.
(If you have anything else to add to this list - be it successes or failures - write it down below!)
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