Sleep in withdrawal

 

Sleep problems affect most of us in withdrawal, experiencing an adverse reaction or tapering off our Antidepressants to one extent or another. Sometimes it comes just before or part of a fresh wave of symptoms and goes with a window, for others it’s a regular feature of their recovery.

 

Melatonin and Cortisol levels (the sleep and wake hormones) can be disrupted leaving a signature list of sleep disruptions.

 

In the acute initial phases of healing, sleep can be very challenging with users often reporting just a couple of hours a night or even no sleep at all.

 

We sleep in ‘cycles' of around 1.5 hours dropping down through the stages of sleep in the first cycle to stage 4 deep sleep and lifting to the REM stage, the nearest one to awake. It’s here you may find yourself waking up when a ‘normal’ person would just continue onto the next cycle. As the cycles progress throughout the night, the depth of the sleep reduces and you spend more and more time in REM stage, which further increases the chances of waking and can eventually lead to great difficulty getting back to sleep.

Its often reported there is a ‘ceiling’ of around 5-6 hours where after sleep is much harder to achieve and if it happens its more broken and fragmented.

 

You may find the need to urinate during the night increases. This is again possibly due to changes in hormone levels the body normally makes to reduce urine production overnight so the body can sleep.

 

Initiating sleep is a common problem. With Melatonin production reduced, actually getting to sleep can prove difficult. Other symptoms can add to this frustration:

 

-Hypnic Jerks (Where you wake suddenly just as you drop off)

-Hot Sweats or a general lack of ability to regulate your temperature

-Out of character thought rumination

-Nocturia (Constant need to urinate)

-Sensitivity to light and sound

 

Sleep quality is greatly affected with sufferers experiencing very light, possibly nonrestorative sleep and no dreams or even the opposite extremely vivid dreams.

 

Others have found that they wake up very early when they do sleep. As well as early awakenings, it’s not uncommon for folk to wake to a surge of energy, panic or find waking triggers symptoms such as anxiety. Others feel their symptoms improve as the day goes on, only to restart all over again after a sleep ‘reset’.

All of this is likely caused by too high Cortisol levels (the body’s natural awake hormone) produced unhelpfully early in the morning making further sleep impossible and creating these chemical symptoms.

 

We don’t know exactly what happens during sleep, but we know it is important to the healing process and our wellbeing so it’s vital to get as much rest as you can. It’s often observed in the community that sleep is one of, if not the last, of the symptoms to resolve.

 

Getting enough sleep we can see is a challenge but there are some things we can do help ourselves.

 

 

Sleep Hygiene

 

Creating good routine in WD is one of the keyways to cope whilst we taper and heal from injury. An important part of this is our bedtime regime. Finding habits that help us and sticking to them is very important.

Some examples might be:

 

-Low temperature in the bedroom at night.

-Using your bed for just sleep can help teach your brain that it’s time to go to bed.

-A regular bedtime and awake time to help encourage our natural circadian rhythm.

-No eating or drinking 2 hours before bed. The later can help with middle of the night calls of nature!

-Avoid foods that are high in histamine levels particularly later in the day.

-Reduce or eliminate caffeine intake

-A relaxing bedtime routine, a nice bath, shower, a good book or perhaps a bit of meditation, whatever gets you relaxed and ready to sleep.

-Cutting out screen time an hour before bed or at least utilising blue light filters or glasses to reduce the impact our devices can have on our systems natural sleep/wake cycles.

-Eye masks and black out blinds can be great to stop the early morning light or interruptions from outside such as cars and streetlights etc.

-Ear plugs to reduce the levels of distracting sounds that are not conducive to getting off to sleep quickly and staying there.

-Some people find white noise machines effective so worth considering. There are even apps you can download.

-Weighted blankets or a light blanket to keep you cosy but not too hot! Having a second or third laid out next to you to pull over as the night gets chillier is also a very good system!

 

 

Light levels

 

Our brains naturally respond to light, this stems from caveman days where we didn’t have much in the way of supplemental light. The nighttime was for sleep, and the daytime was for everything else.

We can mimic this by adjusting the exposure we have to different light qualities throughout the day.

Start by getting as much natural day light as possible first thing to signal the new day to your brain. Try getting a walk in first thing and letting your system experience the sun rise!

As the evening approaches reduce the use of ‘big lights’ in exchange for smaller side lights. The colour of the light matters too. White isn’t white. You can buy ‘white’ lights at different ‘kelvin ratings’. Go for ‘tungsten’ lights around 3200k for that warm cosy feel. Avoid the higher daylight balance 5600k bulbs in the evening but these might work well as supplemental light first thing on those dark winter mornings.

Dr Mark Horowitz has said he uses LED colour changing lighting in his house which change as the evening progresses mimicking a sunset! Brilliant!

 

 

Supplements

 

Some people choose to not use any supplements or find them too activating and are generally to be avoided. There have however been others who have found the following helpful during their recovery.

 

-Melatonin, our natural sleep hormone. Not available everywhere as a supplement but some have found it works very well. Little seems to be the key. Starting with a very low dose of perhaps 0.25mg. Others have reacted badly to taking this so caution is advised.

-Magnesium. Calms our nervous systems and many have found this to be a vital part of their bedtime routine. Again, start with a low dose and see how you get on.

-Omega 3 Fish oil

-Epsom Salt Baths

 

It’s worth mentioning that, as with all these things, some have seen no benefit and others have even reported reactions to the above so please bare this in mind.

 

 

Mindset

 

Our nervous systems are in a heightened and sensitized state during WD and tapering so we must do what we can to reduce the impact we have on it. This is especially important when it to comes to sleep. Most nondrug insomnia is caused by anxiety and its crucial we do what we can to not add to the sleep issues we face by overthinking or worrying about it. Its counter intuitive. The more we worry about sleep the less we sleep. It’s worth remembering that when you go to bed your only job is to relax and enjoy a rest. You can’t choose sleep, but your body knows how to get it. Remind yourself of this when sleep onset is challenging. It’s not your fault and you will sleep as much as your body needs!

 

How much sleep should I be getting?

 

This varies for everyone. As discussed above in acute stage, sleep can be scarce. But as we heal our sleep duration and quality increases, the body will always strive to achieve min sleep of around 5.5 hours. This can be a challenge in WD but trust your body knows how to do it and how much it needs. Some people naturally need less than others but 5-6 hours in WD is good. More is better!

 

What do I do if I can’t sleep?

 

Conventional sleep therapy suggests a technique of sleep limiting rather lying in bed for hours at a time. During WD we should perhaps be a little gentler than this. Where possible perhaps allocate a period of time for sleep each night and include a little more than you would like to get. This allows for any potential difficultly getting to sleep and stops the worrying at the start of the night. It also allows for some more sleep later on should onset be a challenge.

If you find it hard to sleep and or waking early, just resting in the dark and staying relaxed is in itself beneficial and it’s often possible to grab a few extra bits and pieces during these resting periods. Also, our brains will ‘secret sleep’ without us knowing. By staying in bed (if you can) for a set period of time you maximise the amount of sleep/rest your body will get and lay down the ground works for better sleep as you heal.

 

 

Napping

 

Some find an afternoon nap essential and, honestly, get the sleep where you can if that works for you. Others either can’t or find they wake to a feeling their sleep was somehow ‘toxic’ and perhaps choose to avoid. Overall trying to encourage a ‘normal’ sleep cycle is the goal.

I recently learned a very helpful trick - when you wake up at night with terrors - my prominent symptom in the beginning - putting a cold compress (cold pad) on your forehead for 15 min allows to fall asleep quickly instead of ruminate.

Thank you so much for this! Insomnia was always the reason I reinstated in the past. But something good came out of it:

 

Lots of mainstream "advice" is full of horror scare stories about all the bad things that can happen to you if you don't get "enough" sleep. I won't list them. You've all heard them, I'm sure.

 

I'm here to tell you: none of those stories are true. I didn't sleep at night FOR MONTHS. I got maybe 20 minutes in naps during the day. I was in a lot of psychic pain, but I never lost it.

 

So, mindset is really important. 🙂

I absolutely agree @mars. I am not a fan of my GP in general but when I was panicking in the beginning that I couldn't sleep (I still don't sleep well) - he reassured me that I would be fine. I, of course, argued - how dare he, I will surely have a psychotic break. But he was right. Once I accepted that fact my sleep actually improved. I think sleeping longer is still better but I would also like to be a billionaire, I would like people to work for peace and for me to live on a beautiful tropical island - we rarely get what we want :) 

Lol. You sound quite mature in your radical acceptance. It has taken me a long time to recognize my need for that. 

And AMEN to spreading the word that insufficient sleep won't kill you or break you. Not ideal, but that's life. 

Thanks for sharing your  story

Oh no, not at all, I regularly throw mental tantrums when things are unfair. But sometimes there is no other way but to accept.

OMW