When I was younger, I never thought I’d suffer from a sleeping disorder. I was the kind of kid that could sleep for 12-14 hours straight. Once I went to bed, I never got up during the night – not to use the bathroom, not to drink water, not for anything – and nothing, quite literally, could wake me up. I’d have to use multiple alarms in the morning, and getting up before 10 AM was pretty much torture. Yeah, I hated school.
But then, in my early 20s, things started to change. I was working for a creative start-up at the time, and was obsessed with my work; working on the weekends and through holidays like there was no tomorrow. I was chugging down 8-9 cups of coffee a day, eating only once or twice a day, and drinking 2-3 glasses of wine on most nights, to come down from work. I started leaving my phone on at night in order to be always reachable, and started waking up to check my email (seriously, WTF was wrong with me). It was then that I started noticing the first signs of insomnia.
Back then, I had most trouble falling asleep. Staying asleep wasn’t that big of a problem, and I could still sleep through the night if there wasn’t an incoming phone call from my freaked out boss. In September 2009, I had my first severe insomnia flare-up after I quit my job on a whim. Immediately after I quit, my body started falling apart, and it became obvious that I had been running myself to the ground. I had anxiety attacks, I was brain-fogged and I couldn’t fall asleep before 4-5 AM in the morning. I did see a homeopathic doctor who helped me immensely, though, prescribing L-tyrosine, 5HTP and some other remedies whose names I can’t recall, or never really knew in the first place. Within 2 weeks, I was literally symptom-free and, about two weeks after that, I was back at my old job and self-destructive routine.
The thing about your early 20s, is that you think you’re indestructible. Looking back, my lifestyle was clearly a recipe for disaster but, back then, nothing could have convinced me that another way was possible; that success din’t mean killing yourself along the way. A few years later, I found myself in London doing a masters in anthropology, and doing 2-3 internships on the side at all times. Yeah, apparently I hadn’t grown any wiser.
London was tough, but my health didn’t really start falling apart until 2012, when I moved to Los Angeles to pursue a PhD. I started experiencing double vision and muscle weakness, which turned out to be the first signs of myasthenia gravis (MG). My sleep also became increasingly disrupted. I still had trouble getting up before 10 AM, but I was constantly exhausted and no amount of sleep seemed to alleviate that. As the symptoms of MG grew more intense and persistent, so did my insomnia. I still don’t know exactly how the two connect, and there’s not enough research to draw any conclusions, but insomnia has been linked to inflammation in the brain and the nerves, and myasthenia is a neurological disease, so there’s that. Given I’ve suffered from depression and mood swings since my teens, as well as migraines between the ages of 9 and 21, I’m pretty sure my brain is inflammed AF.
Anyhow, back to my insomnia. Over the course of my PhD, my insomnia patterns gradually shifted from having trouble falling asleep to having trouble staying asleep. Currently, I wake up around 5-6 seven times a night and, although I will usually fall right back asleep, I rarely feel that I reach deep sleep and I very rarely feel rested. I’m also not able to sleep past 7 AM, regardless of how late I go to bed. Sometimes I will have trouble falling asleep, but that’s usually when I have excessive stress due to a looming deadline etc. – its not the norm. I’ve seen three sleep doctors at UCLA so far, and they suggested CBT and psychotherapy, along with ambien (“as needed”).
We also tried Belsomra (suvorexant – a sleep medicine that is supposed to regulate your sleep and wake cycle) with one of the doctors, but I had a terrible reaction to it. After just one dose, I became super drowsy and was unable to work, think and pretty much function for an entire week (!!). I suspect that it somehow interacted with my MG, but the doctor denied that. Yeah, whatever you say.
I also want to point out that Ambien is contraindicated for MG, something that I had to find out on my own (like, seriously?). I do still take it on occasion, however, especially if I’m traveling overseas, or if I haven’t had a decent night’s sleep in several days. It’s a vicious cycle, because lack of sleep flares my MG and herbs don’t always work, particularly when I’m changing timezones. I try not to overuse it though, because I’m pretty sure it’s the devil.
One thing that I’ve learned about insomnia remedies over the years, is that what works and what doesn’t is highly dependent on the type of insomnia one suffers from – and getting to the root of one’s insomnia can be incredibly challenging. The other thing about insomnia, is that most people who have it, also have other medical or psychiatric conditions. That makes it even harder to isolate the exact effects and causes of each one of them, and ultimately to cure.
As I mentioned earlier, I do think that my myasthenia and insomnia are somehow related, but it might not be in the way I imagine. I also have a a weak liver, and liver disease and insomnia have also been linked, particularly in Chinese medicine. Several practitioners both conventional and “alternative” I have met over time, have pointed out that my insomnia might be related to chronic depression. That includes the homeopathic doctor I mentioned before, a PCP, two psychiatrists, two neurologists, two sleep doctors and a functional medicine doctor. My acupuncturist and ajurvedic doctor think the root is psychosomatic; trauma that I haven’t been able to process or relieve. I also live under constant stress, being a grad student and someone who’s chronically ill in one of the most expensive cities in the world (Los Angeles).
I’m pretty sure that all of these factors form part of the puzzle of my disordered sleeping. Just recently I also participated in a sleep study I hoped would shed some light on the physiological reasons behind my insomnia. Unfortunately, it provided no clues whatsoever, except perhaps that it confirmed the absence of obvious “offenders”, like sleep apnea, restless leg syndrome, snoring etc. I was frankly disappointed to see that they are not even concerned with measuring sleep quality, but test for specific physiological and anatomic traits, as I mentioned. So I guess Western medicine has failed me, yet again.
Despite my overall poor quality of sleep, however, I do feel that some things do make a difference, whether positive or negative. There are herbs, amino acids and lifestyle choices that have improved my sleep, even if I haven’t found that one magic bullet yet. I have also learned so much about what doesn’t work over the course of the last ten years, and I can’t dismiss that because it’s valuable in itself.
Below you can find a list of things that have and haven’t worked, as well things I am working on/ trying out at the moment. I will likely keep updating this post as my journey continues. If you have other suggestions, or just want to share your experience, please do so in the comments below! I always love hearing from fellow insomniacs 🙂
Things that did NOT work:
- L-theanine: This was recommended by my functional medicine doctor, but I didn’t see any difference taking it for 2 months straight. It is an amino acid found primarily in green tea leaves, and it has calming properties without being a sedative (a.k.a. no brain fog the next day). I suspect this might work better if your type of insomnia is anxiety-related, which for me is not the primary driver, or due to cortisol spikes. It might be worth checking out if you have more trouble falling asleep (versus staying asleep) – and if you wanna find out more, this article has a nice, succinct overview of l-theanine’s benefits.
- Valerian root: It makes me drowsy the next day, which actually makes sense, since it is a sedative, not a sleep medication.
- Essential oils: Now, I’m a FIRM believer in using essential oils for depression, mood and anxiety but, when it comes to insomnia, I haven’t found anything that helps me sleep through the night. Oils I have tried for insomnia include lavender, cedar-wood, camomile, frankincense, vetiver, bergamot, and sandalwood.
- Warm bath before bed: Again, great for relaxation and as a self-care routine, but I have seen no direct impact on insomnia.
- Earplugs: That’s one of the first things people suggest when I mention I wake up at the drop of a pin. Unfortunately, I’m a restless sleeper and they fall out of my ears. Yes, I’ve tried various brands and sizes.
- White noise machine: I bought a MARPAC Dohm-DS but I frankly hated it. Even on the lowest setting, I found it so noisy that I had trouble falling asleep to start with, as well as falling back asleep if I woke up in the middle of the night.
- Tulsi Sleep (by Organic India): This is a blend of various herbs that are recommended for anxiety, cortisol-regulation and sleep: holy basil, cardamom, chamomile, peppermint, dwarf morning glory, ashwagandha, gotu kola and stevia. I suspect it might be a question of dosage, but if you have to drink 4-5 teabags in one sitting that doesn’t quite make sense, does it?
- Chamomile tea: Yeah, no. Maybe for the occasional insomniac, but once your insomnia is as bad and chronic as mine, this ain’t gonna fix you up!
- Lemon balm tea: Same as above.
- Marijuana (CBD oil/ CBN pills/ THC): I had A LOT of hope for this one, and I tried different strands, flowers and waxes, as well as edibles, but nothing really worked how I wanted it to. THC edibles generally made me paranoid and gave me nightmares, and if I smoked enough to pass out, I was often foggy the next day. CBD is great for anxiety, but it doesn’t really keep me asleep. I also tried some very expensive CBN pills, which some people swear by for insomnia but, again, not for me. I know I might not have found the right strand or form, but after a certain point (about 6 months), experimenting around just got too expensive.
- Brain Octane Oil/ MCT oil: Keto-ers and biohackers will often swear that a high fat snack will help you sleep better, because we need energy for sleep and these oils provide it in the ultimate form. I tried both BOO and high-quality MCT oil, and neither helped me fall asleep or stay asleep. I do like them for energy in the morning though, especially BOO.
- Ketones: The arguments about ketones helping you sleep are similar to the ones made about medium chain triglycerides, but I saw no difference. The product I tried was Perfect Keto.
- Suvorexant (Belsomra): This is not “natural” in any way, but it was a complete shit-show, and I wanted to add it to the list in case any people with MG read this. Be very careful (see above for my experience with it).
- Sleep study: I finally did a sleep study a couple of weeks ago, but the results were inconclusive. Might be worth doing if you suspect sleep apnea or something other “major”, but they won’t be able to help you with sleep quality issues. In fact, they don’t even look into that.
Things that work (so far):
- Magnolia bark (Hou Po): There’s a reason I mention magnolia bark first, and that is that it works as well as Ambien on me. It’s a chinese herb that is used for weight loss, digestive issues, constipation, inflammation, anxiety, stress, depression and insomnia, among other. It’s not exactly clear how, or why it works, and some people warn against it, but I remain unfazed. It does make you very drowsy when you take it, though, so you wanna be careful with dosage. It doesn’t, however, cause fogginess the next day, and for me that’s the most important thing. Here’s a link to the one I take, if you wanna give it a try. Just FYI, I do save it for when my sleep is more disrupted than usual, and generally cycle it with l-tryptophan and melatonin (see below). I also would not take it if I had respiratory MG.
- GABA: I love GABA. It doesn’t make me sleepy per se, but I do notice that I sleep better when I take it regularly. GABA is a neurotransmitter that literally helps the brain shut down, and studies have found that people with insomnia have about 25-30% less GABA in their brain than healthy sleepers do. There’s also evidence that GABA works better if taken in conjunction with the amino-acid 5-HTP. I take 500mg of GABA in the morning and 500mg before bed.
- 5-HTP: As mentioned above, this is an amino acid, and it’s a precursor to serotonin and melatonin. It definitely does not work on its own, but I’ve been using it on and off for 10 years and I do think that it contributes to a better quality of sleep. It’s mostly used as a mood enhancer, and to treat depression-related insomnia. Some people say it also helps with jet lag, but I’m not one of them (unfortunately!).
- L-tryptophan: Also an amino-acid that is used to treat primarily depression-related insomnia. Tryptophan forms 5-HTP, which in turn forms serotonin and melatonin, which makes you sleepy. The only downside is that the recommended dosage for severe insomnia is pretty high at 3-4g, which comes out to 6-8 (!) 500mg pills. If you combine that with GABA and 5-HTP, you’ve quite literally got a mouthful.
- Going to bed earlier (around 10PM): My deepest sleep seems to take place between 9PM and 2:30AM (I use a tracker), so the earlier I go to bed, the greater the chances of actually getting some rest. Going to bed after 12:00AM is the worst thing I can do, and always results in brain-fog the next day, even if I try to sleep in (which never works anyway, because I’m awake at 7AM no matter what).
- Ashwagandha: Ashwagandha is an adaptogenic herb popular in Ayurvedic medicine that is widely used for lowering cortisol and balancing thyroid hormones. It’s often found in blends for adrenal fatigue as well, like “Adrenotone” and Pure Encapsulations’ “Cortisol Calm”. I use it when I feel particularly wired-up or anxious before bed, or when I’ve had trouble falling asleep due to excess stress. It’s most-effective it seems for insomnia that is stress-induced, which again brings us back to the importance of understanding the root of one’s insomnia. One thing to bear in mind with Ashwagandha, is that it is a nightshade, so you’ll want to avoid it if you have a nightshade sensitivity.
- Reishi: Reishi is an adaptogenic mushroom and it might be the only thing that helps me STAY asleep. It works by calming the nervous system and regulating immune function, and is used for a wide variety of ailments, including cancer and candida. It’s not a magic pill, but I have seen a major difference in terms of staying asleep when I sip it right before bed. I am currently using the Sun Potion brand, which comes in powder form, but you can also find whole dried mushrooms, as well as an extract, at Mountain Rose Herbs.
- Fidnemed Nighttime Tea (by Mountain Rose Herbs): I love this one, although it’s not enough on its own (have I mentioned that nothing is?) and it does taste kinda funky. It’s a blend of lemon balm, hibiscus flowers, skullcap, passionflower, hops flowers, valerian root, and lavender. I don’t feel that it helps with staying asleep, necessarily, but a strong brew will take the edge-off and make you drowsy. Might work great for those who are dealing with anxiety-related insomnia, or are dealing with an overactive brain.
- Melatonin: I’m almost a little undecided on melatonin, because a) it’s a hormone and I don’t like messing with those and b) I can’t decide on a dosage, because sometimes I seem to need lower and sometimes higher doses. I feel that it works best after I’ve not take it for a while.
- No strenuous exercise in the evening: Hard workouts in the evening are known to spike cortisol and adrenaline in some people, and I’m definitely one of them. Personally, because of MG, anything beyond a yin yoga class or a light walk counts as a hard workout in my book, so I have to be super careful (particularly with vinyasa classes).
- No heavy meals 3 hours before going to bed: That probably depends on the health of one’s digestion, but since many people have a leaky gut, I think that’s a good one to, at least try. Personally, indigestion can keep me up all night.
- No thrillers before bed: Ok, that’s super individual, but I think we all tend to do things that are bad for us, even though we know they’re bad for us. I love cop and crime shows, and they’re exactly what I want to watch on Netflix before I doze off, but they really, really mess up my sleep. It takes a lot of discipline to fight these urges, but I do see a difference when I watch “lighter” things, or listen to music, or read, instead.
- No coffee after 12PM: I gave up coffee for over a year and can attest to the fact that it did not cure my insomnia! I do notice, however, that I have more trouble falling asleep if I have coffee in the afternoon (especially after 2-3PM). Since I make it a priority to go to bed early (see earlier note on that), regulating my coffee intake is essential for regulating my sleep.
- Spending A LOT of time in nature: That’s probably the hardest one to implement because, well, life gets in the way. But it’s also one of the most effective, especially when it involves multi-day camping trips to the mountains, or the desert. I know that – for a fact – I sleep better after I’ve spent a few days immersed in nature, and I also feel more grounded overall. Research backs me up on this one as well, suggesting this has to do with morning light exposure and lack of electronics. On a personal note, I think nature might be particularly healing for me, because I grew up surrounded by it, in the mountains of Greece. Nature is my sanctuary, my god, my home, my peace. You need to find yours.
- Practicing yoga at least 4-5 times a week: The key here is frequency and consistency. I see a big difference in my overall well-being when I practice yoga nearly every day. I’m more… balanced, and more balance = less depression/ anxiety = better sleep. Unfortunately, in reality, most weeks I only make it to yoga maybe three times, which might be good for some, but isn’t enough for me.
- Acupuncture: I mention acupuncture last, not because it helps the least (quite to the contrary), but because it’s expensive (at least in LA) and I can’t afford to do it as often as I need to. When I first started, I did it twice a week for a while and it made me so tranquil. But my insurance will only cover about one treatment per month, which just isn’t how Chinese medicine works. I know some people do it a few times a week, and I can’t imagine what their lives (and sleep quality!) must look like! If you CAN afford it, you MUST try it. I truly think that if performed often enough, acupuncture might be able to cure insomnia by treating the root imbalances that have caused it in the first place.
Things I am currently testing:
- Ayurveda: I started seeing an Ayurvedic doctor about a month ago and we decided to build up to a 3-day panchakarma detox. There’s a lot of “homework” involved, including self-massage with warm oil and other self-care practices.
- Meditation and alternate-nostril-breathing, twice a day: Yeah, really still working on this one. I’m using a mindfulness app and I have a Transcendental Meditation (TM) training come up that I’m really curious about. My Ayurvedic doctor swears by TM, but frankly, at this point, I’m quite jaded…
Image by Flickr user Joanna Coccarelli and used under a creative commons license