[nikkwong]

That may not necessarily be totally true, you're most likely referring to hypnotics (ambien, lunesta, etc)—which were used by doctors for patients in some circumstances but are slowly falling out of fashion for the reasons you describe.

There are older and newer classes of drugs on the market that are being used as first-line therapies which not only preserve sleep architecture but in many cases even enhance it. Trazodone (a very old SARI) for example increases the amount of slow-wave sleep in healthy individuals and amount of time spent asleep. There are many newer drugs, suvorexant, ramelteon, etc. These medications are of course not without side effects but for many patients they work very well.

I'd say if you're suffering from chronic sleep deprivation then the cost-benefit analysis strongly leans in the direction of a pharmaceutical that fixes that since sleep is second to none in improving health and wellness outcomes.

There are many insults that can cause disrupted sleep architecture like you're describing—impaired gut microbiota, stress, lack of exercise, etc—all of which may respond to their own remedies. I experimented for years and finally have wonderful sleep with desmopressin + trazodone. And I was at a place where my sleep was seemingly uncureable—waking up every hour or every few hours on most nights.

If you want great sleep, you might have to fight to find the correct path for your own situation.

[mmanfrin]

This is good advice, thank you. I've tried Trazodone, but it gave me really strange nightmares (as someone who never has nightmares). I've found Gabapentin to be useful, but recently it's been less effective and I've had to up the dosage which gives me a bit of anxiety over wondering where that stops.

In the last 6 months the level of exercise I get has skyrocketed, and I thought it would help but it's ironically made it worse. Stress is definitely a possible factor, but there's nothing in my life that is particularly more stressful than it was before. That's why this has all been perplexing: my sleep hygiene and everything surrounding it has gotten better as my ability to sleep has gotten worse.

[nikkwong]

Yeah, that’s strange; I’d say keep investigating. Again I think it’s about cost benefit. I’ve had a few friends who tried trazodone off my remarks and the ramping on period is tough for many. Sometimes the side effects go away and maybe sometimes they don’t.

I’ve meditated a lot in the past to the point where I have a very strong representation of my inner mental state; and because of this it’s glaringly obvious to me when I’m even slightly mentally impaired from even minor sleep disturbances. I think some people may not notice the cognitive attenuation as acutely and for others it may not bother them much.

But if it bothers you keep investigating. As far as exercise making it worse; I’m not sure about that. One thing I do know is that the microbiome plays a key role in exercise recovery, and it’s possible that if you have impaired homeostasis in the gut it could be responsible for sleep disturbances. Maybe you could check your RHR and HRV for the hours or days after a session of exercise and see how long it takes you to return to baseline. People with ideal microbiome profiles return to baseline remarkably quickly even when they don’t have great cardiovascular fitness (from my understanding of the literature). This next point is a bit speculative but another possibility is that exercise forces more slow wave and rem sleep. These are the periods in which people are the most likely to suffer apnea events for those who are susceptible to it. If you’re one of those individuals then the increased number of those events could leave you feeling less refreshed. So that’s another thing that could be worth looking into

[Obscurity4340]

How did you come across desmopressin, isnt that a bed-wetting thing? How does it help with sleep outside of urinary issues?

[nikkwong]

It’s not strictly for bedwetting. I’d generally wake up a few times a night to urinate and I’d noticed that my sleep would become very fragmented for 30-60min before actually being fully awaken to void. Knowing that this was affecting my sleep quality, I tried limiting fluids and compression socks. Neither fully worked, so a pharmaceutical intervention seemed worth a try when I stumbled upon it online. The difference is night and day, I sleep throughout the night rather than the multiple awakenings I had been susceptible to. My urine is also a dark yellow upon awakening rather than the clearish tint I had been accustomed to.

My blood work is normal but my gut floras are not in perfect ratios as revealed by some testing. For some reason in my case that has manifested as electrolyte/fluid balance issues at night which are corrected by the desmopressin.