When I am stressed about something I tend to wake up far too early and struggle to get back to sleep, even if I'm not actively thinking about whatever is stressing me, it's like my general subconscious levels of stress are the problem. I wasn't very functional on little sleep even before my injury.

Things which reduce my stress also seem to help my sleep. A Mindfulness course I have been on has been the most help in that respect.

I also no longer drink any liquid after 8pm. That way when I wake up hopefully I can drift off again without needing to wake up properly to use the toilet, after which all is generally lost!

Here's the sleep info we got from Nedley:

- Eat plenty of tryptophan. Your brain needs it to convert to melatonin. Top sources of bio-available tryptophan are tofu, flax seeds (ground), roasted pumpkin seeds, gluten flour, sesame seeds, almonds, black walnuts, and blackeyed cowpeas.
- Have your blood levels of vitamin D and calcium checked. These must be present in order for the brain to convert tryptophan into melatonin.
- Get sunlight through the skin (for vitamin D) and through the eyes (for melatonin).
- To help regulate circadian rhythm, get a light box. There are different times for different colors and lux capacities. We got the Philips GoLight Blu, which you can use for shorter amounts of time. With this light, use for 20-40 minutes between 5-7 AM if you have trouble falling asleep. If you have trouble with early waking, use again for 20-40 minutes between 2-4 PM.
- Get up between 5-7 AM. Go to bed between 8-10 PM. Sleep that occurs before midnight is more restful.
- Eliminate all caffeine.
- Avoid eating after 3 PM, or if you do eat make it a very light meal (soup, fruit, crackers or toast). This enhances melatonin production.
- Exercise a minmum of 60 minutes sometime during the day.
- Expose yourself to daylight in the daytime (open blinds, sit by windows, go outside). In the evening, close the blinds, turn off lights, make things dark. When you are sleeping, make it very dark. Use room-darkening shades or an eye mask if needed. Melatonin production in the brain is related to receptors in the eyes, so exposing yourself to the correct levels of light and dark at the correct times of day can affect your circadian rhythm.
- For really really optimal circadian rhythm regulation, avoid lighted screens in the evening (TV, computer, phone, etc.).
- If you wake up in the night, stay in bed, stay still, and keep your eyes closed as much as possible. Even if you do not subjectively feel that you are asleep, you may in fact be in stage one sleep and then be able to drift off to higher levels if you stay still. If you move around or get up, you definitely are not sleeping at all.
- Try to replace anxious or upsetting self-talk such as "I can't sleep AGAIN, I'm never going to get rested, I'm going to be a mess again tomorrow." with more calm or realistic self-talk. NOTE: If somebody figures out some good self-talk for this, please let me know, because I still get myself worked up when I wake up in the middle of the night.

ALL THAT SAID: I did sleep somewhat better while I was actually at the retreat but I never did actually get to sleeping all the way through the night. Since I have come home I have still really been struggling with it.

ALSO PLEASE NOTE: This info is primarily geared toward depression, not PCS. So, while it is brain-friendly, it may or may not specifically address all the needs of the brain-injured brain.

I've always been a poor sleeper my whole life and have tried many different things. The anxious self talk is very destructive to sleep habits as you've said but is so "natural".

Over the years, I've developed different ways of coping with it. When I notice I'm heading down that path of "If I don't fall asleep now, tomorrow will be horrible" etc, I replace it with things like:

"It doesn't matter if I sleep right now, its only one night and I will do ok with a bit less sleep."

Then I start to really think about my individual body parts and how they feel.

"My feet are nice and warm and feel so comfy resting on the mattress" and really feel my feet.

"My knees and thighs sink deeply into the soft bedding, that feels so nice".

"My back is so supported and relaxed"

And if I come to a body part that isn't in its most comfy spot, I think about that too and think maybe if I shift a tiny bit this way it will be nicer. Or if I tuck this pillow like that.

I think really focusing on each part and its comfort and how the sheets feel and the softness makes me really relax, calm down and fall asleep quickly.

By the same token, if something is really uncomfortable (like the dog accidentally got upstairs and ate a cookie in the bed leaving crumbs!) I get up immediately, change the sheets and try again. Otherwise, all I can think about is how prickly things are

Not sure if that will help you, but that has improved my ability to ward off the negative stressed out "must sleep now" thoughts that don't allow for any sleep.

Starr

Hi Nick,

The troubles I have falling asleep have gotten much better over the last year. A year ago, I had a lot of trouble falling asleep and staying asleep and would wake up several times each night - it was awful!

Now, I generally fall asleep within a half an hour to two hours after going to bed.

Aside from time, and just getting better cognitively, which has reduced my anxiety levels a great deal, I think the number one thing that has helped me to fall asleep each night is to wake up at the same time consistently every morning.

I tried taking 5-HTP, which my acupuncturist told me is tryptophan, but it didn't seem to help at all. But I do think it's worth trying because I'm pretty sure it's helped a lot of people.

Nowadays, when I have trouble going to sleep, I usually try to meditate to relax. I've also used the trick Starr uses to relax each part of my body, starting with my toes and moving through each part until I get up to my head. Or I eat a light snack, like a yogurt cup, or some cheese or beef jerky. (Sometimes, I'm hungry and I don't realize it and then putting something in my tummy makes me sleepy.) When none of that works, I get out of bed and read a little bit of something light in another room and that usually does the trick.

I know there are other sleep aid medications out there. Tell your physiatrist about the trouble you had with the newest one you tried and see if they can give you something else.

I now have good luck with Ambien, but it didn't start that way. Regular Ambien would get me to sleep, but I would awake a couple hours later. We switched to ER, but then I stayed groggy during daylight hours.

For some reason my body got used to non-extended release Ambien, and I now get a full night's sleep with it. I have no idea why, but I'm not looking a gift horse in the mouth. I'm not happy about being dependent on another prescription, but am very happy that the sleep problem is not a problem for the time being (I certainly have enough of those).

Thanks everyone.

I'm going to bookmark this thread because there is lots of good advice/suggestions to try. I took 400mg of Gabapentin last night and it knocked me out until about 2am. Then, I fell back asleep until my alarm went off. First time that's happened in awhile. So, I'm gonna keep using Gabapentin as a sleep aid until that stops working - then its on to these suggestions.

Thanks again guys and gals.

Nick

I've been trying 5-HTP per my FNP's suggestion, and I really not sure if it's helping that much. 5-HTP is a precursor of melatonin and serotonin. I'm taking it along with my Ambien. I actually wanted to try it more for my depression and it's helping a little with that. Interesting research here, seems it also helps with weight loss and migraines, check it out! http://www.charlesgantmd.com/article...-precursor.pdf

Ambien works great for me for sleep. There's tricks to it tho, see my post up a ways from the TBI forum, in Sleep Apnea & Sleep Disorders forum. Mostly it's just that it needs some room in the gut to absorb quickly enough to work; so eat early.

A good self-talk suggestion from my counselor:

Say something rote and boring to yourself. Some ideas are to recite times tables, play a very easy alphabet game (a is for apple, b is for banana, c is for cherry), or anything else that you can occupy your mind with WITHOUT ACTUALLY THINKING.