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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by mattdds on December 31, 2003, at 13:11:25
Hey dude,
Glad you're back.
Is your sleep still screwed up?
I ask because mine has gotten so out of whack recently, that were it not for the fact that I'm on break, I would not be able to function very well.
My pattern is delayed sleep phase, the rhythm keeps getting later and later...pretty soon, I'm going to bed at 6 am and getting up at 2 pm! I feel like such a slob, although I do study (part II dental boards coming up) to make good use of the time. I sleep well once I get there, it's just that my rhythm is so out of sync with the rest of the working world. Initiating sleep is *always* a problem, as well.
Did you find anything that helped? Ambien used to work wonderfully, but seems to have lost its magic.
What do you think about bright light therapy for delayed sleep phase? Any other treatments you know of?
Hope you're doing better than I am.
Matt
Posted by Ron Hill on December 31, 2003, at 23:25:55
In reply to Larry, how is your sleep?, posted by mattdds on December 31, 2003, at 13:11:25
Posted by Ron Hill on December 31, 2003, at 23:32:28
In reply to Larry, how is your sleep?, posted by mattdds on December 31, 2003, at 13:11:25
Matt,
> My pattern is delayed sleep phase, the rhythm keeps getting later and later...pretty soon, I'm going to bed at 6 am and getting up at 2 pm!
Do you think that the l-tryptophan you took (or are taking) affected your sleep either for the better or for the worse?
-- Ron
Posted by mattdds on January 1, 2004, at 8:34:03
In reply to Re: Matt's sleep problems » mattdds, posted by Ron Hill on December 31, 2003, at 23:32:28
Hi Ron,
I think you've mistaken me for someone else (I think there was a different Matt here that posted about l-tryp). I don't take l-tryptophan.
Happy New Year!
Matt
Posted by Larry Hoover on January 1, 2004, at 10:48:37
In reply to Larry, how is your sleep?, posted by mattdds on December 31, 2003, at 13:11:25
> Hey dude,
>
> Glad you're back.Thanks.
> Is your sleep still screwed up?In a word, yes.
> I ask because mine has gotten so out of whack recently, that were it not for the fact that I'm on break, I would not be able to function very well.
>
> My pattern is delayed sleep phase, the rhythm keeps getting later and later...pretty soon, I'm going to bed at 6 am and getting up at 2 pm!It is easier to move to a longer day than a shorter one. One possible "solution", to adjust the phase to something closer to that of the sun, and the normal work day, would be to simply not sleep one day (or sleep no more than two hours), then attempt to get to sleep at a more "normal" hour.
> I feel like such a slob, although I do study (part II dental boards coming up) to make good use of the time.
Negative thoughts about yourself will not improve the situation.
> I sleep well once I get there, it's just that my rhythm is so out of sync with the rest of the working world. Initiating sleep is *always* a problem, as well.
Bright light therapy is also a valid method of adjusting the cycle (and may possibly also solve the sleep latency problem). I've just read about a product called, I think, the Litebook. It uses very bright LED sources, so it draws only something like six watts, permitting it to use battery sources as well as normal electrical outlets.
> Did you find anything that helped? Ambien used to work wonderfully, but seems to have lost its magic.Not yet. My trial of low-dose Remeron is disappointing. I think I may push to try the tricyclics doxepin or trimipramine. Both have shown efficacy in recent double-blind trials for treatment of insomnia.
> What do you think about bright light therapy for delayed sleep phase? Any other treatments you know of?See above.
> Hope you're doing better than I am.
>
> MattI hope you do better, period.
Lar
Posted by Ron Hill on January 1, 2004, at 11:29:25
In reply to Re: Matt's sleep problems » Ron Hill, posted by mattdds on January 1, 2004, at 8:34:03
> I think you've mistaken me for someone else (I think there was a different Matt here that posted about l-tryp). I don't take l-tryptophan.
Oops, sorry Matt. Good luck on your exams.
-- Ron
Posted by Ron Hill on January 1, 2004, at 11:41:59
In reply to Re: Larry, how is your sleep?, posted by Larry Hoover on January 1, 2004, at 10:48:37
Hey Larry,
> > Is your sleep still screwed up?
> In a word, yes.
> My trial of low-dose Remeron is disappointing.I know that you do not want to conduct numerous trials simultaneously, but I was wondering if you have tried the vet grade tryptophan that you ordered several weeks ago. If so, does it help your sleep at all?
-- Ron
Posted by Larry Hoover on January 1, 2004, at 11:57:43
In reply to Re: Larry, how is your sleep? » Larry Hoover, posted by Ron Hill on January 1, 2004, at 11:41:59
> I know that you do not want to conduct numerous trials simultaneously, but I was wondering if you have tried the vet grade tryptophan that you ordered several weeks ago. If so, does it help your sleep at all?
>
> -- RonIt hasn't come yet.
I had 11 grams of prescription tryptophan from an earlier trial (apparently in 1999), so I did one 5 gram bolus. I didn't notice anything beneficial from it, but my sleep was disturbed that night for other reasons (sick children to care for).
I'll probably do two three gram trials this weekend.
I ordered a bunch of horse stuff (but not the fish oil....a gallon of too-fishy oil doesn't seem too appetizing, even thinking about it). Have blender, will smoothie.
Lar
Posted by Ron Hill on January 1, 2004, at 12:20:56
In reply to Larry, how is your sleep?, posted by mattdds on December 31, 2003, at 13:11:25
Matt,
> My pattern is delayed sleep phase, the rhythm keeps getting later and later...pretty soon, I'm going to bed at 6 am and getting up at 2 pm!
I'm bipolar II and in the past I have had insomnia problems. I will not bore you with the details of my prior sleep woes except to tell you what fixed the problem (for me, YMMV). I take 800 mg of magnesium (measured as elemental Mg) at bedtime and it is the best sleep aid I have ever used (and I used several over the years). Currently I take 200 mg of Mg citrate, 400 mg of Mg malate, and 200 mg of Mg glycinate. As soon as I get around to ordering it, I plan to substitute 200 mg of Mg taurinate (sp?) in place of 200 mg of Mg malate just to see if I like it.
I can't take magnesium during the day because it makes me too sleepy-tired. Also, if I increase above about 1000 mg/night of Mg, diarrhea results.
Have you ever tried magnesium at bedtime? If not, it might be worth a trial.
-- Ron
Posted by Ron Hill on January 1, 2004, at 13:30:07
In reply to Re: Larry, how is your sleep? » Ron Hill, posted by Larry Hoover on January 1, 2004, at 11:57:43
Larry,
> > I know that you do not want to conduct numerous trials simultaneously, but I was wondering if you have tried the vet grade tryptophan that you ordered several weeks ago. If so, does it help your sleep at all?
> It hasn't come yet.
>
> I had 11 grams of prescription tryptophan from an earlier trial (apparently in 1999), so I did one 5 gram bolus. I didn't notice anything beneficial from it, but my sleep was disturbed that night for other reasons (sick children to care for).
>
> I'll probably do two three gram trials this weekend.Two days ago I bought some pharm-grade (not to be confused with farm-grade) tryptophan and I took 500 mg. I liked it, but I'll resist the temptation to draw too many conclusions from a single dose response. I took it on an empty stomach and noticed the effects within about 30 or 45 minutes. It provided a soothing kind of feeling, eliminated my slight irritability, and it almost felt like a mood stabilizer in my brain. I didn't expect the mood stabilizer effect. On the downside, it made me feel a little weird; almost like a slightly drugged feeling. Also, it seemed to adversely affect my fine motor skills to a small degree.
For now, I’m going to use tryptophan on a PRN basis (and only if I absolutely need it) because I’ve been doing really well for about a week now and I don’t want to rock the boat with a new trial right now. About two weeks ago I sank into a very deep atypical depressive episode and I’m not sure what caused it. It was worse (and somewhat different in nature) than my usual bouts of bipolar II depression. My best guess is that it was caused by either: 1) seven weeks of l-theanine at 400 mg/day, 2) two days of Rhodiola rosea at 205 mg, or 3) I’m cycling (bipolar). I want to keep my meds and supplements steady for a while too see if I’m cycling. When I fell into depression a couple weeks ago I stopped taking Rhodiola rosea and, for the time being, I take l-theanine on a PRN basis and only if I absolutely have to have it to reduce my irritability.
In summary, I liked my one dose of l-tryptophan and I will eventually try using more of it. Also, at some point in the not too distant future, I plan to try tyrosine and taurine.
Please post your response to your upcoming tryptophan trial.
-- Ron
Posted by mattdds on January 1, 2004, at 14:20:43
In reply to Re: Matt's sleep issues and magnesium » mattdds, posted by Ron Hill on January 1, 2004, at 12:20:56
Hey Ron,
> I'm bipolar II and in the past I have had insomnia problems. I will not bore you with the details of my prior sleep woes except to tell you what fixed the problem (for me, YMMV).
I've often wondered whether I could get a diagnosis of BP II if I found the "right" doctor. I know sleep issues are a large part of bipolar spectrum disorders. Do you take a mood stabilizer? Does that help the sleep?
>I take 800 mg of magnesium (measured as elemental Mg) at bedtime and it is the best sleep aid I have ever used (and I used several over the years). Currently I take 200 mg of Mg citrate, 400 mg of Mg malate, and 200 mg of Mg glycinate. As soon as I get around to ordering it, I plan to substitute 200 mg of Mg taurinate (sp?) in place of 200 mg of Mg malate just to see if I like it.
>Wow! 800 mg? Isn't that a pretty whopping dose? Also, why so many different forms?
> I can't take magnesium during the day because it makes me too sleepy-tired. Also, if I increase above about 1000 mg/night of Mg, diarrhea results.
>
> Have you ever tried magnesium at bedtime? If not, it might be worth a trial.
>
> -- Ron
>Actually, I trialed Mg supplements (Mg citrate), but for anxiety. It did have a very subtle effect, in that it seemed to augment Klonopin slightly (there's actually evidence it does do this).
The problem? I would get poopy-pants at about 400 mg. So maybe I wasn't able to get up to a high enough dose to make it work. However, I was under the impression that 400 mg was the target dose.
I never tried it for sleep though. Your idea sounds like it's certainly worth a try, judging from your success with it.
Next time, perhaps I'll titrate up slowly, to prevent diarrhea. I don't want to wake up with a big mess in my bed - not a great way to start the day ;).
Mg seems promising. A while back, Larry posted a bunch of abstracts for Mg and mitral valve prolapse (I have MVP without regurgitation).
One last thing. Have you tried conventional sleep aids like Ambien? Ambien worked incredibly well for a while, but seems to have pooped. If you have tried these, how does your experience with Mg compare with e.g. Ambien, as a sleep aid?
Thanks for you input!
Matt
Posted by mattdds on January 1, 2004, at 14:29:35
In reply to Re: Larry, how is your sleep?, posted by Larry Hoover on January 1, 2004, at 10:48:37
Larry,
Thanks for getting back to me on the sleep thingy.
I'm seriously considering purchasing one of those lights (Litebook). That's one of the better deals I've seen on a product like that. Normally, they're gigantic too! This one is pretty compact, and has seemingly good output.
I heard it was good for phase resetting, but I wasn't aware that it could help for latency problems. That would be wonderful if it helped.
What are your sleep issues?
Take care man,
Matt
Posted by JLx on January 1, 2004, at 19:54:47
In reply to Re: Larry, how is your sleep? » Larry Hoover, posted by mattdds on January 1, 2004, at 14:29:35
Hi Matt,
I've used a light visor for several years now. Sometimes when I was in night-owl phase it was the ONLY way I could reconfigure myself to go to sleep at a relatively normal hour. If you try a light box, I recommend this questionnaire to see what time of day would be best using it for your individual circadian rhythm. http://www.cet.org/default.htm?AutoMEQ.htm~main You might also consider a dawn simulator, as waking up gently from a gradually increasing light source mimics nature and is reputed to help many people feel better overall as well as improving the sleep cycle.
I've been plagued with insomnia most of my life, but no longer. One of the best things I've done is discipline myself to go to bed early -- and start turning off lights a couple hours before bedtime, not reading in bed with a bright light, not being on my computer late at night, etc. The other thing, which may sound completely ridiculous, but I swear it makes a difference, is that I cover the LED display on my bedside clock. I read about that in the readers reviews on Amazon of "Lights Out". I also tried then covering my windows and ever other light source but found when I did that I slept so soundly that I was too groggy in the morning.
Also, in my experience, magnesium citrate is the most diarrhea-provoking type of magnesium I've tried. I haven't tried mg taurinate which George Eby on his site about depression/magnesium http://www.coldcure.com/html/dep.html is recommending these days (as it's expensive) but I'm pretty happy with magnesium malate. Still, I don't think I could take 800 mg at a time like Ron does without diarrhea. I can easily take 300 mg of mg malate though, and 900 mg per day total without diarrhea.
Oddly enough, as some people find it quite stimulating, I also slept better when I started taking TMG.
Insomnia is a special form of hell, imo. I wish both you and Larry luck in finding a way out of it.
JL
> Larry,
>
> Thanks for getting back to me on the sleep thingy.
>
> I'm seriously considering purchasing one of those lights (Litebook). That's one of the better deals I've seen on a product like that. Normally, they're gigantic too! This one is pretty compact, and has seemingly good output.
>
> I heard it was good for phase resetting, but I wasn't aware that it could help for latency problems. That would be wonderful if it helped.
>
> What are your sleep issues?
>
> Take care man,
>
> Matt
Posted by mattdds on January 1, 2004, at 22:51:11
In reply to Re: Larry, how is your sleep? » mattdds, posted by JLx on January 1, 2004, at 19:54:47
Hey,
Thanks for your very helpful post. I'm encouraged to hear there is a possibility for improvement. You no longer suffer from insomnia, or at least suffer significantly less? That's great!
> Hi Matt,
>
> I've used a light visor for several years now. Sometimes when I was in night-owl phase it was the ONLY way...So you had delayed sleep phase syndrome also? I'm beginning to wonder if my problems are not so much latency - I go to bed fairly quickly...when I'm tired. The problem is that my phase advances toward around 4-5 am for in the absence of something to get up for. My problem right now is that I'm in dental school and have erratic clinic hours. Some days I have to get up very early, while others I don't have to get there until 2 pm.
Basically, if I don't *have* to get up, I won't.
>If you try a light box, I recommend this questionnaire to see what time of day would be best using it for your individual circadian rhythm. http://www.cet.org/default.htm?
I did, thanks for the link. Apparently, my melatonin production begins around 11:45 (sounds early). And I should beging light therapy at 8 am.
> I've been plagued with insomnia most of my life, but no longer.
Again, I'm so glad you were able to get relief, it's very encouraging.
>One of the best things I've done is discipline myself to go to bed early -- and start turning off lights a couple hours before bedtime, not reading in bed with a bright light, not being on my computer late at night, etc.
I have a feeling this is the bulk of my problem - my habits. I routinely play around on the computer until late at night, and leave the lights on. These are good ideas you give.
>
> Also, in my experience, magnesium citrate is the most diarrhea-provoking type of magnesium I've tried.The malate salt is perhaps less likely to cause diarrhea?
> Insomnia is a special form of hell, imo. I wish both you and Larry luck in finding a way out of it.Well put, it is hell. I feel isolated and out of sync with the "real" world. Thanks for your insightful post. I got a ton from it. If I can scrounge up enough money, maybe I'll buy a 10,000 lux lamp. Probably have to wait until after dental school to be able to afford the dawn-dusk sim (though I'm tempted, it looks so cool, haha).
Best,
Matt
Posted by Ron Hill on January 2, 2004, at 0:48:40
In reply to Re: Matt's sleep issues and magnesium, posted by mattdds on January 1, 2004, at 14:20:43
Matt
> I've often wondered whether I could get a diagnosis of BP II if I found the "right" doctor. I know sleep issues are a large part of bipolar spectrum disorders. Do you take a mood stabilizer?
Yes, Lithobid.
> Does that help the sleep?
Absolutely. By the way, there is some research out there which indicates that magnesium exhibits mood stabilization properties.
> Wow! 800 mg? Isn't that a pretty whopping dose?
No, not for me; but everyone is different.
> Also, why so many different forms?
Sticking to one form is fine. Some chelating agents offer therapeutic value in-and-of themselves such as, for example taurine. I've just been trying various forms.
> One last thing. Have you tried conventional sleep aids like Ambien? Ambien worked incredibly well for a while, but seems to have pooped. If you have tried these, how does your experience with Mg compare with e.g. Ambien, as a sleep aid?
Yes, I used Sonata. Sonata would put me to sleep okay-fine, but I would wake up after about four hours and I would have a real hard time getting back to sleep. The next morning I would have a mild "sleeping pill hangover" and I did not feel as though I had slept soundly. Magnesium, on the other hand, puts me to sleep, keeps me asleep (except for pee breaks, after which I go right back to sleep), and I wake up feeling refreshed and restored by a full nights deep sleep. YMMV Matt.
-- Ron
Posted by Larry Hoover on January 2, 2004, at 7:43:10
In reply to Re: Larry, how is your sleep? » Larry Hoover, posted by mattdds on January 1, 2004, at 14:29:35
> Larry,
> What are your sleep issues?
Extended sleep latency (problems getting to sleep), frequent awakenings (what I call skipping stone sleep), and early awakening (inability to get back to sleep when I do awake).
> Take care man,
>
> MattYou too, dude,
Lar
Posted by JLx on January 2, 2004, at 17:01:56
In reply to Re: Larry, how is your sleep? » JLx, posted by mattdds on January 1, 2004, at 22:51:11
> Thanks for your very helpful post. I'm encouraged to hear there is a possibility for improvement. You no longer suffer from insomnia, or at least suffer significantly less? That's great!
I'm continuing to experiment with things, but in general, my getting-to-sleep these days is the best it's been in years. I usually only sleep for 6 hours, however, and hope to add to that a bit. It's convenient to "need" less sleep as I get older, but I've read that it's due to higher than optimal levels of cortisol circulating at the wrong times of day, so that's not so good.
> So you had delayed sleep phase syndrome also? I'm beginning to wonder if my problems are not so much latency - I go to bed fairly quickly...when I'm tired. The problem is that my phase advances toward around 4-5 am for in the absence of something to get up for. My problem right now is that I'm in dental school and have erratic clinic hours. Some days I have to get up very early, while others I don't have to get there until 2 pm.
I would routinely be on my computer, reading or sometimes watching TV (or working when I worked as a board moderator at CNN) until 2-3 AM. 4 AM was not unheard of either. I usually fell asleep by 6 AM at the latest.
> Basically, if I don't *have* to get up, I won't.
Well, that's the trade-off. Some people like the late-night life and if you don't have to get up early, then it's fine. Otherwise, I just readjust the things I used to do in the night to morning.
> I did, thanks for the link. Apparently, my melatonin production begins around 11:45 (sounds early). And I should beging light therapy at 8 am.
I think that if you want to change them to sleeping earlier in the night, then you would actually begin light therapy earlier than 8 AM.
What I remember best about light therapy when I was using it to reorient myself to sleeping earlier, was that at the certain time of night (like 10 PM) I would really feel affected by bright light (uncomfortable) and like I had to get to bed RIGHT THEN. I assume that was the melatonin kicking in.
> I have a feeling this is the bulk of my problem - my habits. I routinely play around on the computer until late at night, and leave the lights on. These are good ideas you give.It's been big adjustment for me but worth it overall.
> The malate salt is perhaps less likely to cause diarrhea?
It's true for me, otherwise I agree with Ron, there are other benefits to some of the other amino acid chelates too.
> Well put, it is hell. I feel isolated and out of sync with the "real" world. Thanks for your insightful post. I got a ton from it. If I can scrounge up enough money, maybe I'll buy a 10,000 lux lamp. Probably have to wait until after dental school to be able to afford the dawn-dusk sim (though I'm tempted, it looks so cool, haha).
I've been wanting one of those for a long time. :) This company has just a plug-in thingamajig that you use with your own lamp that costs $70. http://www.brite-lite.com/UsShop/Publish/vindex.htm?cat238.htm
The Bio-Brite Light Visor is what I have. It cost $400 when I bought it and I've had it quite a few years now. I bought it originally in hopes of treating my depression and figured it had the potential to be cost effective if it did that with therapy and psychiatrist visits being over $100 each.
JL
Posted by Ron Hill on January 3, 2004, at 13:37:55
In reply to Re: Larry, how is your sleep? » mattdds, posted by Larry Hoover on January 2, 2004, at 7:43:10
> > Larry,
>
> > What are your sleep issues?
>
> Extended sleep latency (problems getting to sleep), frequent awakenings (what I call skipping stone sleep), and early awakening (inability to get back to sleep when I do awake).Lar, so if the Remeron is not going to fix your sleep problems, what's next on the list to try?
My brainchemistry unravels quickly when my sleep quantity and/or quality deteriorates. I suspect you experience the same. What can we do to fix your sleep problems?
-- Ron
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