thank you all for the in-depth responses. I really appreciate your time trying to help a friend!
I'm also scared by how common insomnia is. I bet I could stop a random stranger on the street and there's a high chance of him being an insomniac too. this shouldn't be like this.
I suppose our society has changed so drastically since the invention of artificial lights, especially after industrial revolutions.
we now breathe polluted air, live in noisy urban areas, are affected by electromagnetic radiation (EMR) coming from everywhere, drink tap water that is contaminated with heavy metals, SRRIs, birth control pills and many other drugs, live fast-paced stressful lives, work in meaningless jobs, eating ultra-proccessed garbage (food-like products with tons of cheap, nutrient-poor and addictive ingredients), are disconnected from each other and many other things of our modern societal life that tends us towards disease.
Drugs that help sleep are very difficult to find.
I would check with a doctor the possibility of using quetiapine
A doctor can help you in this matter but they will probably point out the whole "Healthy Exercise, Healthy Food, Healthy Sleep
obrigado! I'm aware of quetiapine. although I tend to avoid anti-psychotics in general due to their side effects, this one is used in very low doses when it's intended for insomnia, so I'll definitely consider.
I tried everything almost everything that is considered "healthy".
just so you can have an idea, it's 6:00 PM now in Brazil and I'm already wearing my blueblocker glasses, with all lights in the house turned off and my screen dimmed out.
as the other guy pointed, at some point it starts to be a vicious cicle: you don't exercise or move because you slept very poorly, and now your chances of sleeping well are decreased due to the lack of movement.
or maybe the drug you used gave you day-time sedation, unexplainable fatique and huge carbohydrates cravings - almost the perfect recipe for weight gain. now that I gained weight, I'm more likely to have worse sleep quality, apnea etc, which also makes me more tired, more carb-hungry and more likely to use more drugs to try to sleep well.
needless to say how it's hard to get out of that cycle. especially given the fact that most of us don't even know why we sleep poorly!
many of these drugs also make you tired, fatiqued, lazy. amitriptyline and mirtazapine are classic examples of drugs that do what they promise, treat your insomnia with success, but their side effects are so bad, that their cost:benefit ratio analysis is viewed by some people as negative, in other words "not worth it", despite the "success" in treating the insomnia.
I'm surprised by how CBT-i (Cognitive Behavioral Therapy for Insomnia) is so respected in academic research, while in practice being often insuficcient for many chronic insomnia sufferers.
honestly, after this decade and a half of experience fighting insomnia, I personally think that most drugs "suck". this may sounds extreme, I know, but it's the honest raw conclusion I've come and I can explain more about that:
most have so many side effects and stop working long-term anyway, that if I can avoid them, it's better to avoid.
the undesirable side effects can be so drastic, to the point that a chronic insomnia sufferer like me (who pretty much always sleeps terribly without drugs since young and feels terrible the next day), feels like it's actually better to fight insomnia "with my bare hands" (and most likely lose) - drug-free - than to bear the side-effects. this tells a lot how bad these side effects can be.
to make things tricky, you get used to your "new normal" mode and don't even realise you're being influenced [by drugs]; often you'll only notice how they were affecting you, after you stop taking them.
I could be biased saying this, because after many years of amitriptyline use with weight-gain and day-time fatique, and now more recently after chronic promethazine use and feeling absolutely trash, tired, weak, photo-sensitive, with memory issues, cognitive issues, brain fog etc, I went drug-free for the last 24 hours and instantly felt better from all these awful side-effects.
the fatique and weakness were so bad, I went by the day without doing almost anything. the photosensibility made me scared of sunlight, which is so therapeutic, a natural antidepressant that cannot be matched by just supplement vitamin D.
the cognitive and memory problems were so bad, I feel I could become demented extremely early in my life, like maybe at 50, if I countinued using if for more years. I'm only 28 years old. although dementia, alzheimer's and cognitive decline in general tend to be associated with very old age, don't underestimate the fact that people are gonna have cognitive decline earlier and earlier in their lives due to many factors, including drug use, obesity, insulin resistance etc...
Long term, no drug will be the solution. They're just tools - a temporary crutch, if you will: once the broken leg heals you stop using it. And it's difficult to find the one that works for you. It seems you've tried a lot of things already but are up against the wall where if things work at all, they eventually stop working. This is because your body adapts - same way chronic drug abuse causes downregulation of GABA/D2 receptors (depending on the drug). And if you take SSRIs long term, likewise, your body will become desensitised to endogenous serotonin or produce less on its own, requiring continual dose increases, until you've reached the ceiling for tolerable side effects or the highest dose they will prescribe - and still struggle with the same issues.
I've no experience with Doxepin but have noticed that effect of Trazodone. I never used to wake too early and be unable to fall back asleep - I would only take longer to fall asleep initially and upon 1-4 subsequent awakenings, but never entirely unable to do so (unless due to meth haha). But when I take trazodone, I notice I tend to also wake earlier. It doesn't really help that much with sleep for me, just makes me fuzzy and slow but still end up lying awake for 1-2 hours and still end up waking during the night. Suvorexant does the same - I get stupid but still lie awake, only now with more blankness and repetition of things because I forget midway what I was doing or lose my train of thought. If it causes me to fall asleep a minute or two earlier I don't notice. The quality of sleep is still awful anyhow.
Benzos help but I have never used them consistently as I've not got a script - and anyhow the street quality diminishes by the day - it's all aspirin, paracetamol, or a fentanyl analogue now. Perhaps the tiniest smidge of a -zolam/-zepam. Melatonin, chamomile tea, valerian etc does jack shit for me - not even placebo.
L-theanine worked for one night and then no matter how much I increased the dose thereafter - nothing. Weed can help sometimes, but others it hinders sleep. Same with alcohol.
Diphenhydramine (antihistamine like promethazine but fewer fun narcotic properties) is also useless. I've taken 75mg at once with no tolerance and subsequently laid awake for four hours. Why does nothing work if I'm tired all the time? It's terribly frustrating. And the entire thing about eating well, exercising, etc - good luck sorting your life out when you feel like a zombie because you cannot remember the last time you had a rejuvenating nocturnal rest. It's a horrid feedback loop wherein each exacerbates the other.
I have similar exposure to mycotoxins as you - for almost two decades, since I was an infant. I'm sure that can't be helping either of our situations.
When do you take the magnesium? I would recommend 30-60 min prior to going to bed. And with the gaming - try to finish for the day within that timeframe as well. Whereas with the strength training, if you've woken up early anyhow, it can be a good boost to go to the gym straight away in the morning - perhaps with the help of an energy aid or what have you - and take a cold shower afterward. On the days I do this - it's been months, yikes - I tend to feel less lethargic for a few hours after. Although by 12 onward, I'm back to my usual state. Presumably if you managed to do all these consistently it might help somewhat - maybe in getting to sleep several minutes earlier, or staying asleep several minutes longer.
I'm sure this is nothing you've not already heard but it bears repeating as those are some of the factors in the cycle you can control via your decisions and actions - whereas sleep is the body's domain and most people cannot simply will themselves to fall sleep on command. I know there are meditation techniques and such used in the military to enable soldiers to fall asleep in a few minutes - haven't personally been able to benefit from those.
Every now and again (with or without stimulants, but every time except once with the help of the internet - endless things to do) I stay up all night and the following night I usually tend to fall asleep faster, wake up less often, and sleep more hours in total. But that's bad in every way imaginable, especially if your goal is to decrease inflammation, mental distress, and body fat. And definitely not a sustainable solution long term.
All this to say I empathise with your struggle and have no clue as to the answer. Let us know how you get on. Should you choose to use it, I hope you find the doxepin useful in reorientating your schedule and finding rest.
Quetiapine is not an SSRI - it is an atypical antipsychotic. Its primary mechanism of action is serotonin and dopamine antagonism, and it also antagonises the adrenergic, histaminic, and muscarinic receptors. Trazodone is a serotonin antagonist and reuptake inhibitor, so partially SSRI-type actions. You are right that they are different - the only similarity between them, as far as I'm aware, is the serotonin antagonism.
Be careful with anticholinergics such as diphenhydramine and dimenhydrinate - in excess they can cause delirium and other unpleasant effects. More is not always better.
thanks for all the efforts put into this answer. you're right in many things.
that's what I wanna believe: drugs are not the solution. I feel way better in so many ways when I'm drug-free. I'm hoping to have faith, patience and to put work to allow natural sleep to occur.
I also empathise so much with your experience, I know how hard it can be. have you heard of amitriptyline or mirtazapine? they both work for insomnia, at least for a couple of years before they stop working, but some people have used them for many years. the thing is: if I was desperate to have some good sleep, I'd use one of these two. both cause terrible weight gain and day-time fatique, among other side effects, so I see these drugs as usually having terrible cost:benefit ratio, but at least they seem to make you sleep well.
and they're definitely less dangerous than benzos.
you're right, we weren't supposed to be using drugs. no wonder why our brain adapts, they are basically neurotoxins, weird substances changing the natural homeostasis.
it's a hard decision to make. I don't think it's worth to spend a life "zombie-like" because of chronic sleep deprivation. but many people who think they cannot sleep well without drugs, may be able to, if they improve their habits, apply CBT-i techniques etc.
seeing you saying that spending the whole night awake make your sleep deeper and longer the next night, it makes me wonder if you could benefit from high-intensity exercise and abstinence from caffeine. I mean,
really high-intensity exercise. this depletes adenosine and is a natural way to enhance sleep quality and increase deep sleep.
both mental and physical effort can deplete adenosine, but exercise also has unique and great benefits for health in general.
hot baths prior to going to bed also increase deep sleep.
caffeine and naps, on the other hands, replenish adenosine.
also, caffeine's half-life is suprinsingly long and it can stay in our bodies way longer than we expect, disrupting our sleeps without we noticing its nefarious effects.
it can be silly tip to give, but have you tried zero caffeine?
I mean, it's weird to see an insomniac advising another insomniac, but anyway...
I know my situation would be worse if I consumed coffee. I'm a caffeine slow metabolizer. it's genetic and I can't change that.
as for anticholinergics, I think their biggest problem is the fact that they can increase dramatically the risk of one developing dementia. this is a big thing and few people talk about it. many sleep medications increase the chance of cognitive decline and dementia.
