Kishore Naib
  kishorenaib

Insomnia — My battle — Work related anxiety

My long term battle with insomnia — which started whilst CEO of a company, but never went into remission.

Note: A lot of my insomnia is due to my autoimmune disease: Grave's disease, where I had my thyroid nuked and I have to take thyroid hormones by mouth. Any form of HRT causes you to have a constant stream of hormone instead of release according to circadian rhythmic release - this will screw up your sleep by default. I believe the best way around this problem is to "get use to it" or just pretend it doesn't exist and accept it for who you are. We cannot all be disease free.
  • I only sleep when I am depressed and have nothing to get up for. e.g. when I sold my company and felt like life was complete, my insomnia vanished.
  • When I have a plan and goal in life my mind is constantly on fire. I wake up almost in a panic of excitement of things I need and want to do.
  • Sadly, I have resigned myself to accept that 5 hours of sleep is a miraculous achivement. Typically, I live on 3, where I feel like shit and look like shit. And, yes, this is a sob story and I'm not afraid to admit it. Sleep deprivation drives you insane eventually.

What works

  • OTC Anti histamines (e.g. diphenhydramine - Nytol in the UK) - temporary relief only
  • Z-drugs - temporary respite, but withdrawal cost is too great
  • Keeping T3 at mid-low end of normal. If it's high, I have zero chance of sleeping, even if I throw the kichen sink of drugs at the problem.
  • Benzos - as above, temporary withdrawal - short term usage only
  • Normalisation of magnesium levels using supplements, ideally glycinate or citrate
  • Correction of sleep apnea
  • TCAs with antihistamine mechanism of action, e.g. amitriptyline. This only continues to work with dosage escalation.
  • Indica based cannabis - low dosage. Often needs "re-smoking" during the night causing difficulty in getting up
  • Modafinil - helps reset sleep cycles. On a day after 0 sleep, instead of trying to go back to bed, sometimes I find it better to just suck it up and use modafinil for wakefulness
  • Deloading / removing overreaching (if you train with weights). Being overtrained directly causes insomnia.

What has not worked

  • CBT (Cognitive Behavioural Therapy)
  • Mindfulness
  • Any other form of non medication based therapy
  • Nonsense such as using sunset mode on screens, no electronics before bed - nice idea, but doesn't work for legitimate insomnia

What is quackery or an outright con

  • Topical magnesium oil
  • Melatonin
  • Meditation before bed

To try:
When I get heavier (80kg+) I develop sleep apnea to a mild degree. I have yet to use a CPAP machine at home but have done sleep studies which indicate it may provide some relief.