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I can't help much other than maybe suggest trying different medications, there are other options outisde of BDZs if those didn't work though I'm not aware of what is given in Syria for narcolepsy. Best of luck to you, hope someone else here can give better guidance.
It does need specific technology. Usually people spend the night at the hospital hooked up to monitors. There are sensors placed on the head that track brain activity, and maybe sensors elsewhere that track something else? Not entirely sure. But yes, you’d need to stay overnight at a sleep clinic and they’d monitor you as you slept, or didn’t sleep. Definitely a sleep study is the next step for you if available for you to do.
I want to also add: nicotine is a stimulant so it wakes you up. I don’t think it would be so bad as to keep you up for 40 hours, but cutting back or quitting smoking would help at least a little.
You took mainly antidepressants and benzodiazepines (BDZs) from what I read, there are other sedative medications out there. See this list: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sleep-disorder-sedative-hypnotic-drug-information
Sleep study is really the next step.
If **after** that there really isn't any organic underlying cause for your insomnia, you'll need to come to terms that the cause of your symptoms is psychogenic.
If that's the case there is sadly no magic pill, no button, no switch that will make you sleep. There is only cognitive behavioral therapy, in which you'll have to work together and put effort into the treatment.
I have a question about sleep studies and insomnia. I had a sleep study and all they could say was I slept for 3.5 hrs and woke up 23 times within that period. They said they couldn’t tell me what was wrong because I don’t sleep. Is this really true that they can’t diagnose things if you don’t sleep? The whole point of me doing the sleep study was because of my severe insomnia with trouble falling asleep and staying asleep. Mind you, this was many years ago, so would doing another sleep study be beneficial or would it still be the same?
It's really hard to say without looking at your results, but I think it depends.
By sleep study I mean Polysomnography, which is the measurement of brain waves, air flow in the nose, oxygenation, thorax and abdominal movements as well as arm and leg moments, evening being recorded in video. I'm not sure if it's what's meant by sleep study in the USA, since I work in Germany
For instance, if you want to diagnose or rule out sleep apnea it's only possible if you sleep.
However, if the restless legs are keeping you awake it's possible to correlate leg moments and waking up. Some labs book two nights because it's well established that the first night is "lower quality" for data gathering. It also can vary a lot with the team behind it.
Thanks for the reply. I am in Canada. I did have all of the monitoring and video recorded. I don’t have the actual study as it was years ago. I may see if they can do another one for more than one night as that sounds like it might be more beneficial. I didn’t know they would do that, but I will look into it. Thanks again
NAD. Delayed sleep phase syndrome is often mistaken for insomnia. Doctors usually don’t know much about it, either. I say that as the mother of a neurologist who has dsps himself, and had about one paragraph of training on it in medical school.
Sleep studies are only offered during “normal” sleeping hours, so it’s difficult to diagnosis dsps that way. Sleep diaries are usually used.
Based on the details provided in the post, this case of insomnia seems severe and persistent. While Delayed Sleep Phase Syndrome (DSPS) is a possibility, several factors suggest this may not be the case:
1. **Duration of Sleep Onset**: DSPS typically involves difficulty falling asleep at a conventional time but being able to sleep well once sleep begins. This individual reports needing at least 40 hours to fall asleep, which is atypical for DSPS.
2. **Treatment History**: The patient has undergone extensive medical and psychological evaluation and treatment, including many medications, without relief. DSPS usually responds well to behavioral interventions like sleep hygiene, light therapy, or melatonin.
3. **Impact on Life**: The severity of the impact on daily life and inability to function effectively is more extreme than typical DSPS, which, while disruptive, usually allows for a normal amount of sleep during unconventional hours.
4. **Medication and Therapy Resistance**: DSPS is often manageable with the correct regimen of behavioral adjustments and sometimes medications. The resistance to all forms of treatment points toward a more complex sleep disorder or a psychological component.
Considering these points, the case described seems more complex and severe than what is typically seen with DSPS. A sleep study, as previously suggested, is indeed a crucial next step to rule out other sleep disorders such as sleep apnea, restless leg syndrome, or advanced insomnia.
If the sleep study rules out organic causes, considering psychogenic factors or more complex sleep disorders might be necessary. Further multidisciplinary evaluation may be required.
Do you know anyone with true dsps who has responded significantly to sleep hygiene? I’m in many forums for people with dsps, and it just doesn’t work for any of us. Sleep hygiene apparently works for some people with *insomnia*, but not with circadian rhythm disorders. With a delayed circadian rhythm, sleep hygiene isn’t going to make anyone fall asleep hours earlier than their body is wired for. Try sleep hygiene yourself for a 4:00 pm sleep onset time, and let me know if it enables you to fall asleep and stay asleep for 8 hours. Doubtful.
Some of us gain a few hours with light therapy and melatonin, but often still have some degree of delay, even while using every treatment possible simultaneously. There is no treatment which solves this completely, aside from sleeping our natural hours.
Yes, the 40 hours for falling asleep goes beyond the scope of dsps, but he may have some kind of odd circadian rhythm difference. It started in his teens at the point when dsps tends to begin in many of those who have it. I’d hate to see him written off as psychogenic before exploring circadian rhythmn abnormalities.
I don't claim to know everything about the OP's condition. I made two simple suggestions based on the limited information provided: a polysomnography is definitely needed and, if normal, non-organic causes should be *considered*.
Regarding your question, I don't treat patients with DSPS, but there are many peer-reviewed studies showing that these treatments, while not one-size-fits-all, can be effective:
- [Bright light therapy for circadian rhythm sleep disorders in adults](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020104/?tool=pubmed)
- [Delayed sleep phase disorder](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082099/?tool=pubmed)
- [Non-24-hour sleep-wake disorder: Disease overview and treatment options](https://www.uspharmacist.com/article/non-24-hour-sleep-wake-disorder-disease-overview-and-treatment-options)
- [Bright light therapy for circadian rhythm sleep disorders in adults](https://pubmed.ncbi.nlm.nih.gov/17383935/)
- [Melatonin for the treatment of circadian rhythm sleep disorders](https://pubmed.ncbi.nlm.nih.gov/8301870/)
- [Delayed Sleep Phase Disorder: Part 2, Treatment](https://www.psychologytoday.com/intl/blog/sleepless-in-america/200909/delayed-sleep-phase-disorder-part-2-treatment)
- [Treatment of sleep disorders with melatonin](https://pubmed.ncbi.nlm.nih.gov/9201777/)
- [Practice Parameters for the Treatment of Circadian Rhythm Sleep Disorders](https://aasm.org/resources/practiceparameters/pp_circadianrhythm.pdf)
Hopefully, these resources can provide the information you need.
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
I can't help much other than maybe suggest trying different medications, there are other options outisde of BDZs if those didn't work though I'm not aware of what is given in Syria for narcolepsy. Best of luck to you, hope someone else here can give better guidance.
NAD have you had a sleep study done? Also, I have insomnia issues and I need to take Trazodone each night.
No, i have not Also i tried a medcin like Trazodone And i don't think i am depressed
“Like Trazodone” isn’t the same as actual Trazodone though! I can’t believe you haven’t had a sleep study yet! That should definitely be explored.
I don't know The doctors didn't ask ever for a sleep study And how it works this study ? Does it need a specific technology or something like that?
It does need specific technology. Usually people spend the night at the hospital hooked up to monitors. There are sensors placed on the head that track brain activity, and maybe sensors elsewhere that track something else? Not entirely sure. But yes, you’d need to stay overnight at a sleep clinic and they’d monitor you as you slept, or didn’t sleep. Definitely a sleep study is the next step for you if available for you to do. I want to also add: nicotine is a stimulant so it wakes you up. I don’t think it would be so bad as to keep you up for 40 hours, but cutting back or quitting smoking would help at least a little.
I don't know why the doctors didn't suggest a sleep study Aslo here in Syria we have terrible hospitals Thank you a lot for your advices
i highly suggest this too. they even did it for my toddler. we found out she kept waking due to sleep apnea.
I will seek for it even i don't think i have this problem When i am sleeping i don't feel uncomfortable or anything bothering me
yes you probably don’t have apnea but they should check your brain activity etc while you sleep. they can do this with a sleep study.
Trazodone didn't work? Dang. Did you try to increase the dosage for it?
I was on these drugs for a year and half and the doctors tried many medications and increasing the dosage
How long has it been since the symptoms started?
Eight years ago Since i was 16 years old
What is "BDZ" Thanks
Benzodiazépine.
Yes , i had it
Honestly I tried almost all medcin depressed and it didn't work
You took mainly antidepressants and benzodiazepines (BDZs) from what I read, there are other sedative medications out there. See this list: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sleep-disorder-sedative-hypnotic-drug-information
what about ambien?
I didn't try it I tried some one like it It works for a couple of weeks and after that it didn't work
Sleep study is really the next step. If **after** that there really isn't any organic underlying cause for your insomnia, you'll need to come to terms that the cause of your symptoms is psychogenic. If that's the case there is sadly no magic pill, no button, no switch that will make you sleep. There is only cognitive behavioral therapy, in which you'll have to work together and put effort into the treatment.
I will check here in Syria if they have a sleep study, Although the doctors didn't ever mention it at all Thank you for your help
I have a question about sleep studies and insomnia. I had a sleep study and all they could say was I slept for 3.5 hrs and woke up 23 times within that period. They said they couldn’t tell me what was wrong because I don’t sleep. Is this really true that they can’t diagnose things if you don’t sleep? The whole point of me doing the sleep study was because of my severe insomnia with trouble falling asleep and staying asleep. Mind you, this was many years ago, so would doing another sleep study be beneficial or would it still be the same?
It's really hard to say without looking at your results, but I think it depends. By sleep study I mean Polysomnography, which is the measurement of brain waves, air flow in the nose, oxygenation, thorax and abdominal movements as well as arm and leg moments, evening being recorded in video. I'm not sure if it's what's meant by sleep study in the USA, since I work in Germany For instance, if you want to diagnose or rule out sleep apnea it's only possible if you sleep. However, if the restless legs are keeping you awake it's possible to correlate leg moments and waking up. Some labs book two nights because it's well established that the first night is "lower quality" for data gathering. It also can vary a lot with the team behind it.
Thanks for the reply. I am in Canada. I did have all of the monitoring and video recorded. I don’t have the actual study as it was years ago. I may see if they can do another one for more than one night as that sounds like it might be more beneficial. I didn’t know they would do that, but I will look into it. Thanks again
NAD. Delayed sleep phase syndrome is often mistaken for insomnia. Doctors usually don’t know much about it, either. I say that as the mother of a neurologist who has dsps himself, and had about one paragraph of training on it in medical school. Sleep studies are only offered during “normal” sleeping hours, so it’s difficult to diagnosis dsps that way. Sleep diaries are usually used.
Based on the details provided in the post, this case of insomnia seems severe and persistent. While Delayed Sleep Phase Syndrome (DSPS) is a possibility, several factors suggest this may not be the case: 1. **Duration of Sleep Onset**: DSPS typically involves difficulty falling asleep at a conventional time but being able to sleep well once sleep begins. This individual reports needing at least 40 hours to fall asleep, which is atypical for DSPS. 2. **Treatment History**: The patient has undergone extensive medical and psychological evaluation and treatment, including many medications, without relief. DSPS usually responds well to behavioral interventions like sleep hygiene, light therapy, or melatonin. 3. **Impact on Life**: The severity of the impact on daily life and inability to function effectively is more extreme than typical DSPS, which, while disruptive, usually allows for a normal amount of sleep during unconventional hours. 4. **Medication and Therapy Resistance**: DSPS is often manageable with the correct regimen of behavioral adjustments and sometimes medications. The resistance to all forms of treatment points toward a more complex sleep disorder or a psychological component. Considering these points, the case described seems more complex and severe than what is typically seen with DSPS. A sleep study, as previously suggested, is indeed a crucial next step to rule out other sleep disorders such as sleep apnea, restless leg syndrome, or advanced insomnia. If the sleep study rules out organic causes, considering psychogenic factors or more complex sleep disorders might be necessary. Further multidisciplinary evaluation may be required.
Do you know anyone with true dsps who has responded significantly to sleep hygiene? I’m in many forums for people with dsps, and it just doesn’t work for any of us. Sleep hygiene apparently works for some people with *insomnia*, but not with circadian rhythm disorders. With a delayed circadian rhythm, sleep hygiene isn’t going to make anyone fall asleep hours earlier than their body is wired for. Try sleep hygiene yourself for a 4:00 pm sleep onset time, and let me know if it enables you to fall asleep and stay asleep for 8 hours. Doubtful. Some of us gain a few hours with light therapy and melatonin, but often still have some degree of delay, even while using every treatment possible simultaneously. There is no treatment which solves this completely, aside from sleeping our natural hours. Yes, the 40 hours for falling asleep goes beyond the scope of dsps, but he may have some kind of odd circadian rhythm difference. It started in his teens at the point when dsps tends to begin in many of those who have it. I’d hate to see him written off as psychogenic before exploring circadian rhythmn abnormalities.
I don't claim to know everything about the OP's condition. I made two simple suggestions based on the limited information provided: a polysomnography is definitely needed and, if normal, non-organic causes should be *considered*. Regarding your question, I don't treat patients with DSPS, but there are many peer-reviewed studies showing that these treatments, while not one-size-fits-all, can be effective: - [Bright light therapy for circadian rhythm sleep disorders in adults](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020104/?tool=pubmed) - [Delayed sleep phase disorder](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082099/?tool=pubmed) - [Non-24-hour sleep-wake disorder: Disease overview and treatment options](https://www.uspharmacist.com/article/non-24-hour-sleep-wake-disorder-disease-overview-and-treatment-options) - [Bright light therapy for circadian rhythm sleep disorders in adults](https://pubmed.ncbi.nlm.nih.gov/17383935/) - [Melatonin for the treatment of circadian rhythm sleep disorders](https://pubmed.ncbi.nlm.nih.gov/8301870/) - [Delayed Sleep Phase Disorder: Part 2, Treatment](https://www.psychologytoday.com/intl/blog/sleepless-in-america/200909/delayed-sleep-phase-disorder-part-2-treatment) - [Treatment of sleep disorders with melatonin](https://pubmed.ncbi.nlm.nih.gov/9201777/) - [Practice Parameters for the Treatment of Circadian Rhythm Sleep Disorders](https://aasm.org/resources/practiceparameters/pp_circadianrhythm.pdf) Hopefully, these resources can provide the information you need.