I hesitate to look overthink this too much, and I think it may mostly be a question for Mark, but what supplements are best for sleep with PCS and when should they be taken? My usual nightly routine is to get away from doing any work, my phone or really exerting myself and just relaxing at least two to three hours before bed. I try to exercise early in the afternoon as well. I was taking 50 mg of trazodone, but I know it is a temporary fix and the side effects of a dry mouth and sinus have become unbearable with the colder weather. The drops in blood pressure when standing and trying to get going in the morning are also very hard to work through, and I think my sleep has improved because when I wake up early (5:00-6:00) I have been able to get myself back to sleep for another hour or two after.

Thanks!

Try some magnesium citrate or theonate a couple hours before bed. Some find a 5-HTP (50 or 100 mgs is usually OK) an hour or two before bed.

What happens when you get in bed ? What sensations does your brain pay attention to ?

Do you listen to music as you go to bed ? It can occupy the audio part of your brain.

Thanks Mark for getting back to me, I had read some about the 5-HTP. What do you think about tryptophan? Also, I am not sure if any of these would interact with the 20 mg of Celexa I'm on.

I listen to music usually, and that helps. Otherwise, I always have a fan on for white noise to cancel out any noise one of my roommates might make.

I mainly get fatigued, but not sleepy. I don't think it helps that my symptoms are minimal at night and I get a lot of energy if I don't force myself to settle down.

I know what you mean about getting fatigued but not sleepy, being exhausted but unable to sleep is very frustrating at four in the morning. Another thing I find is that I don't yawn like I used to which is strange. I've read that concussion can affect the bodies circadian rhythm, I know I seem to get a second wind at bedtime.

I'm going to try going back on 5htp to see if that helps now the sunlight is getting less. I used to take it an hour before bed and I think I slept more consistantly. Magnesium is another sleep aid which is said to calm the brain.

I think if you can achieve sleep consistancy then that's a good thing as you can build on it. Ironically the more you recover the more alert you become, which is where I am, and more difficult to switch off! I see this as a phase.

One needs to be very careful taking 5-HTP if also taking an SSRI like Celexa. Be aware of the symptoms of serotonin syndrome. But, 20 mgs of Celexa is a small dose.

L-Tryptophan is a precursor to 5-HTP. Some do not convert enough L-Tryp to 5-HTP.

I take 5-HTP instead of Celexa. I like the way I feel and do on 5-HTP. It is far superior to the SSRI daze.

Again, when is your mind doing when you are struggling to get to sleep ?

What kind of music do you listen to ?

What sensory stimulation do you engage in in the hours prior to going to bed ? TV, conversation, reading, ??

You should not be going to bed unless you can fall asleep in a few minutes unless you have something to occupy your mind like gentle music. You need to avoid active thought. When you get that "Why can't I fall sleep" thought going, Get up and find a way to distract your mind while it gets sleepy. I sometimes get caught in an eye movement and blinking state. When this happens, I know I have to get up and start the 'getting sleepy' process all over again.

I need to have proper food energy to stay asleep. 100 to 200 calories of a complex carb or protein/fat combination usually helps me stay asleep. Four saltine crackers and a slice of cheese is my favorite snack. 20 minutes later, I'm usually out like a light or at least ready to climb in bed and go out like a light.

When I go to sleep, I am pretty good about clearing my mind and putting aside thinking about work that needs to get done and rationalize anything that might be stressing me at the time. If I find myself not being able to sleep it is usually because of the energy I seem to get sometimes before bed or some minor noises my roommates might make, and my mind can get caught up in that frustration of having all that energy exactly when I should be tired. As far as music, it's likely not the most relaxing, but it does occupy my mind. I try to cut any stimulation before bed as I have noticed the more I overstimulate before bed the harder it is to sleep. I might engage in some conversation, but I am not a big TV watcher and rarely read for leisure just due to having to read so much through out the day. I always have a carb like a bowl of cereal before bed as well.

One thing I noticed was that when I wake up in the early morning or night my eyes will often be jumpy and moving around, if I consciously keep them steady I seem to get back to sleep faster.

Music can occupy the mind and also trigger adrenaline. Most current music does. That is part of your generation.

You might try cutting back on the cereal. Most is a bit sugar intense. A spike in blood sugar can give you a jolt of energy. Look at the calorie content and calories from sugar amount.

When is you last caffeine of the day ?

You need to understand there is physical tiredness and sleepiness. They are entirely different. Tiredness is body. Sleepiness is brain.

I'm sure you can find some music that is not stimulating. I have some CD's that are like sleeping pills. My favorite is Diana Krall, The Look of Love. Light jazz. It helps to use the same music each night. You can alternate between a few but you do not want music that is new. It causes your brain to wake up to try to understand the new music. The same music allows your brain to just follow along. Radio is lousy. It also helps to have your bed so you are instantly comfortable. When it is cool, I turn on an electric mattress pad before bed then turn it off when I get in bed. Instant cozy bed.

I have never found gray noise to help. Water sounds or waves or wind just do not help me.

For many of us, sleep needs to be a discipline. The PCS brain does not shut out ambient sounds as well as it should. We need to find ways to help it settle down.

Sorry to hear about your sleep. It's something I've struggled with for the past 2 years. I've had many stretches of sleeplessness, including a 7 day stretch once. I've ran the gammit of remedies that you have discussed, trying everything from pills, tea's, supplements of all sorts, mindfulness, breath training, sleep hygiene, blue light blockers, etc. It's dizzying and stressful trying to solve these problems. I'm happy to say though that I fall asleep every night now. I attribute the most weight of this success to a Cognitive Behavioural Therapy for Insomnia protocol that I found on the internet. It's a 5-week protocol that costs a grand total of $50. You get email interaction with a fellow named Dr. Jacobs who has you fill out a sleep diary and he basically tells you when to go to bed and when to wake up. The sleep times get adjusted as you progress through the program. There was a study published that compared his specific program to the use of Ambien, and his CBT-i protocol was found to be much more effective. I would recommend looking into it (http://www.cbtforinsomnia.com/). In fact, I ditched all of the supplements and tea's and stuff and rely on nothing other than my circadian rhythm to fall asleep.

In addition to this protocol, I practice daily mindfulness meditation. This helps me with controlling my emotions as I used to rage when awake at 4 in the morning. This has also improved my finances as I don't have to pay from broken drywall.

I also believe in magnesium citrate. I take it in the morning now. The stress from not sleeping causes the adrenal glands to produce cortisol, and when this happens, magnesium gets dumped out like a faucet. They used to prescribe magnesium as a mood enhancer, I don't know why doctors have forgotten this!!!

Good luck. Sleep Well.

I don't have TBI/PCS but my approach to sleeping well is similar to what Hains has described (mindfulness/meditation, CBT methods and sleep hygiene).

I have found sleep hygiene methods particularly helpful. This link (one of many) explains these concepts Sleep hygiene - Better Health Channel.

Thanks for the good, and encouraging advice. I have done CBT, and wanted to do a protocol that focused on sleep more. I'll look into this!

Mark, as far as caffeine, I stay away from it. I even avoid chocolate and other foods that have caffeine. I also switched up my music and am trying to wait to go to bed until I know I feel sleepy and not just physically tired, though being physically tired seems to help me sleep a lot.