[robg]

If you have any doubts about sleep quantity and quality, worth reading about the glymphatic nervous system, which is so newly discovered likely you didn’t learn about it in school.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636982/

In short it explains, mechanistically, why poor sleep affects daily cognition, mental health, and age-related declines. Robust scientific theories explain more of the evidence. The glymphatic nervous system explains why sleep is so key to surviving and thriving. Maiken Nedergaard will end up winning the Nobel for its discovery.

[magicalhippo]

It makes me sad as my SO struggles a lot with sleep. It's been years since she's had a good nights sleep.

Sadly her issues are mostly psychologically rooted due to past trauma, while all the treatments seem to be geared towards "simple" physical issues. She's tried contacting various sleep clinics here and they've all said they can't help.

She struggles a lot with falling asleep, she's exceptionally sensitive to sound and vibration while trying to sleep or sleeping, and if she falls asleep she almost always have nightmares, which significantly reduces the quality of the sleep even if they don't always wake her up.

One issue is that when you're that close to the limit of what is no longer bearable, it's hard to just try things. For example, I've been thinking exposure therapy might help for her sound and light sensitivity, but she's not convinced it'll help and doesn't want to try potentially sleeping even worse for many weeks. Which I understand, but...

[milesvp]

I’ve been watching a lot of healthy gamer youtube channel, the host likes to really geek out on brain science. One of the big take aways I’ve gotten watching him, is that sleep serves a layered purpose psychologically (and physically as per this article), that you work through social problems, then physical problems, then consolidating memory, sort of in that order.

One of the study tricks that the host figured out, was that if you want to memorize something, you should get rid of all the other things you don’t want to learn, and that journaling is amazingly good at that. Basically if you write down all the things you don’t want to remember, it sort of leaves space to move things to long term memory.

I say all this, because I’ve been experimenting with journaling at night, and it really helps with some of the restless nights where it feels like something is keeping me awake. It’s not a magic bullet, and it takes effort, but it may help to write down the things bothering your partner prior to sleep to allow for some of the ”less important” processes to happen.

[softsound]

Learning to control your dreams is what I did with my nightmares, at some point it becomes so easy you can do it on command but... It doesn't always work and requires extra energy to stay in control often leaving me falling asleep in my dreams which ironically means I don't sleep well. And there are still nightmares I get, just had one a few days ago that left me too afraid to sleep again. Still, I think it's overall a good long term skill about building mental awareness. I learned it as a child on my own, and I believe adults can also learn it by simply studying their environment often and looking if anything else is amiss or "unrealistic". Sometimes you can also ask yourself questions before bed, and try to use visualization before sleeping or sleeping to sound or audiobooks to help you relax too. My family has a history of being more prone to spiritual and psychology issues so bring aware of family history can also sometimes make you idk feel less alone too. Just being able to shift the narrative can mean a lot and give you power when you feel powerless sometimes, but it can be tough to get there but baby steps can make a huge difference. Something I personally did as a child when I felt afraid was to visualize a golden warm light around me almost like a bubble, it didn't always work but I guess it helped to get away from negative thoughts by trying to focus on something protective for me. Soft repetition also seems helpful because it's predictable so perhaps finding something predictable may help too. And maybe looking into CPTSD.

[michaelkeenan]

I know you've probably already tried lots of things, and you're also inundated with ideas from others, but:

Here's a psychiatrist's guide to solving insomnia: https://lorienpsych.com/2021/01/02/insomnia/

And here's a psychiatrist's guide to solving nightmares: https://www.astralcodexten.com/p/peer-review-nightmares

Prazosin is the standard drug for PTSD-related nightmares: https://en.wikipedia.org/wiki/Prazosin

[infradig]

I'd be careful with Prazosin. Awful few weeks of violent and suicidal thoughts before it mellowed out into an emotionally zombified plateau, then I quit it. Cured my PTSD though.

[canadiantim]

She should try ketamine. Sounds like it’s exactly what you say, past trauma, that’s holding her back from a good nights sleep. Ketamine has done wonders for someone I love and I would wholeheartedly recommend it. The person in my life who benefited greatly from it only needed one weekend (2 relatively low to medium dose sessions of ketamine) and she was cured of her ptsd.

Also strongly recommend weighted blankets, especially for someone like your SO.

All the best eh

[magicalhippo]

We've investigated ketamine treatment, which does indeed sound very interesting. However very few clinics here that offer it, though it seems to have improved recently. Definitely will follow up on this.

[canadiantim]

I’m from Canada but still I went to one in Iowa, called Driftless Integrative Psychiatry. I can whole heartedly recommend it, the therapist is an absolute gem of a human being. It’s maybe on the bit more expensive side but it was a one off expense and has been one of the best decisions we’ve ever made.

There’s lots popping up now though. Even in Canada I thought we’d have trouble getting support from our family doctor but she was actually supportive so now if we look to do any more can just get referral from the GP here and do it in toronto.

Definitely do hope you give it a try, might be just what your SO has been looking for. Also seriously don’t discount the weighted blanket!

[thejazzman]

Look up Spravato. They are also online doctors. And there are similar DIY methods you can grow at home if you're ambitious.

No promises it'll help, though. But hope feels good by itself sometimes.

[Horffupolde]

You just need one clinic there that offers it. Why is the relative number relevant?

[magicalhippo]

Few clinics means limited number of openings.

[hn_throwaway_99]

I'm sad that you were downvoted. I've suffered from depression episodes throughout my life, which could often lead to a "doom loop" of waking up every night between 2-3 AM (early morning waking is a common feature of depression), and then the insomnia made my depression worse.

I had been in therapy for nearly 15 years, and I while I wasn't on antidepressants long term, I had taken them for a couple episodes in the past. For my most recent episode (partially brought on by a particularly bad prolonged string of insomnia) I was having constant suicidal thoughts. I went in and had a ketamine session - I'm reluctant to talk to much about the details of my ketamine trip, because one theory I have for why it worked well for me is that I didn't have any preconceived notions about what I'd experience, and I specifically didn't want to get my hopes up.

The next morning I was singing in the shower. If there was ever a substance that I believed "miracle drug" fit the bill, for me it was ketamine. It helped me develop a whole new outlook on life and how I related to myself. I know that I was very lucky (my psychiatrist says I am a "ketamine responder") and not everyone has that same response. For me, though, I firmly believe ketamine treatment saved my life.

[JoshGG]

Sounds so hard.

I’ve experienced that a moderate or intense exercise regimen can help a lot with sleep.

If she hasn’t tried therapies directed at trauma and recovery that may also be helpful.

[magicalhippo]

It's brutal.

She did start exercising some years ago, and it did improve. But then real-life issues triggers her anxiety and it's back to square one.

She's tried therapy for a long time with little result. She's very smart, but most likely has ADHD, so for example mindfulness and similar doesn't seem to work well (either "boring" so she loses focus, or too "obvious" without actionable content).

Though we recently found a therapist which she really resonated with. It's slow work but I think it's been helping.

[Doxin]

> she's exceptionally sensitive to sound and vibration

I'm assuming you've tried ~everything already, but just in case: Have you tried white noise yet? Your brain is very good at filtering it out after listening to it for a while, but it'll still drown out other noises.

[magicalhippo]

The low frequency sounds she's triggered by have a tendency to cut through. But can't hurt to try again.

[onesillybilly]

On the off chance you haven’t explored it, I would recommend looking into EMDR therapy. It made an incredible difference in my PTSD.

[magicalhippo]

Thanks, that one hadn't popped up on our radar before.

[Doxin]

Yeah if it's contact sound there's not a great deal you can do unfortunately

[danielscrubs]

Sounds too simple but high doses of vitamin C before sleep removed all of my stress induced nightmares.

[magicalhippo]

Interesting, most sources I could find say vitamin C should make you less sleepy.

[CooCooCaCha]

How healthy is she in general? Does she eat well? Exercise? Have a consistent night routing? Has she tried melatonin? What about sleep apnea?

If she's sensitive to sound and light, what has she tried to address that? Like blackout curtains?

I find it a bit odd that sleep clinics would turn her away so readily.

I understand the struggle though which is why I asked so many questions, because all of these things have factored into my quest for better sleep. The psychological stuff is hard.

[hn_throwaway_99]

> I find it a bit odd that sleep clinics would turn her away so readily.

I don't. I've had significant problems with insomnia in the past, and in general I've found that sleep clinics really only focus on two issues:

1. Restless leg syndrome

2. Sleep Apnea

Beyond that, there really isn't much they can do besides (1) recommending standard "sleep hygiene" stuff, or (2) drugs, which all come with various tradeoffs.

[magicalhippo]

Yes, healthy, eats well and exercises daily, has blackout curtains and sleeps with plugs. No apnea.

As sibling reply says, clinics seem to treat sleep apnea and similar direct physical causes, as well as provide very basic information.

She got a referral from her doctor but all the ones she contacted were very clear they couldn't do anything for her so wouldn't even take her in for observation.

[tonis2]

Bad gut health screwed up my sleep, after working on it it got better. But if im not careful with what I eat, my sleep quality is screwed again

[magicalhippo]

While I don't doubt that for a second, she's had her issues before when she didn't care too much about what she ate, compared to last few years where she's been actively eating healthy.

There's certainly a correlation for my self though.

[QuantumGood]

Promethazine (1) helps some people, myself included (UK Sominex). And occasionally, phenibut.

(1) https://www.inhousepharmacy.vu/p-1189-phenergan-tablets-25mg...

[Aeglaecia]

1st gen antihistamines = dementia, phenibut = the worst withdrawal mankind has to offer

[samstave]

Promethazine the Proud! Flamer of Flames! Gayest of Gallopers!!!

Sounds like the name of a Centaur Character in any D&D style game.

[iisan7]

You had "Phenibut" right there and you went with Promethazine?

[samstave]

(sorry - but I am not sure if you are making a ref I dont get but "Promethezine" is the actual name of the pharma-thingy...

If you made a popculture ref, I miss...

:-) aleays participate though

[iisan7]

no problem -- it was just a throwaway comment to the effect that "Phenibut" in reference to the other drug mentioned the parent comment sounded much more like a gay D&D centaur to my ear.

[thatcat]

Has she tried cannabis? It prevents dream memory formation and can help with nightmares

[magicalhippo]

Not yet. It's not legal here yet, though recently it's softening up.

But we've talked about it, though mostly to reduce her anxiety. If it can help with nightmares as well, then would indeed be quite interesting.

[MaxfordAndSons]

+1 to this. As a long time cannabis user who is quite skeptical of many of the purported health benefits, this is one I’m not at all skeptical about. It’s actually just the other side of the coin of the degraded short/mid term memory that is a well known downside of habitual cannabis use. But as someone with frequent, vivid nightmares when I’m sober, I can attest that cannabis effectively blocks my ability to remember most dreams - which again is a mixed bag, as I enjoy recalling happy or neutral dream, but when I’m stressed being able to basically opt out of vivid nightmares is a huge boon.

[conkeisterdoor]

I'm also a long time cannabis user and can't remember dreams at all with THC in my system. I'll vape/smoke/eat edibles daily for weeks or months at a time, then stop cold turkey. A few days after I stop, my dreams become super clear and vivid, and I remember most of the dream in great detail for days. This happens almost every night for the next week or 2 after stopping. It always happens every time I stop. Been doing this for years and I always look forward to stopping cold turkey so I can have those super vivid dreams.

I really enjoy the experience, but granted, none of the dreams were nightmares. I wonder if this happens to other people, and how badly it could affect people who use cannabis to suppress recurring nightmares.

[pdntspa]

In my experience you need a pretty high tolerance and smoke pretty regularly for it to start preventing dreaming. When I intentionally reduced my tolerance to very low levels I started having dreams again.

[vanattab]

The reason you don't dream is it prevents the rem cycle. It might help in falling asleep but your sleep quality suffers.

[whimsicalism]

i mean if you are consuming daily in the evenings you will develop a high tolerance

[swed420]

As someone with a tolerance, I've learned that consuming too close to bedtime will cause me to have difficulty falling asleep, and also not enter REM sleep.

However, by consuming throughout the day on a daily basis but stopping by late afternoon or early evening, my sleep and dreaming is vastly improved.

[pdntspa]

This was how I functioned before I intentionally dropped my tolerance down to very low levels. With a lower tolerance I can enjoy the ganj as a nightcap and have all my dreams :)

[zachkatz]

If the problem is psychological trauma, wouldn’t therapy be the obvious solution?

[magicalhippo]

The root cause is psychological, but it's manifested itself in physical changes. She's hyper-sensitive to certain sounds for example, which causes her to not be able to fall asleep, or to abruptly wake up. Mostly low frequency sounds, so hard to block.

But yeah, as I mention in a reply to a sibling comment, she's tried therapy for years without much progress, though recently making some progress on that front.

[verticalscaler]

I know it really sucks and have struggled with it myself for a long time. Two things really worked for me.

Try these: https://www.loopearplugs.com/products/quiet

And at the same time have some calming barely perceptible background noise from a speaker somewhere in the room. White noise, brown noise, lofi, whatever works. Make sure the bedroom has blackout curtains and soft light.

As for cannabis, she doesn't have to smoke it. Appropriate edibles will knock her to sleep. Doesn't have to be a permanent thing either, breaking the cycle and getting good sleep for a few weeks is life changing and may be the start of a virtuous cycle instead.

I recommend both of you enjoy this video together: https://www.youtube.com/watch?v=mK2iXQm4LJs

Good luck!

[lobsterthief]

As someone who was diagnosed with severe ADHD 20 years ago, marijuana makes my brain far more active. If if I have an edible around 5pm, I won’t sleep until 1am (I normally go to sleep by 9/9:30). I constantly want to do things. For me, weed is an upper.

My wife and my girlfriend are both jealous of the effect it has on me. But I’m jealous on the sleep-inducing or calming effect it has on them.

Please don’t assume marijuana affects everyone equally. It may work, but if it doesn’t, your girlfriend will know immediately so you can stop trying it. Ask her how marijuana normally affects her before trying that.

[verticalscaler]

Note I wrote appropriate edibles. There is a variety.

I leave it to you to research a bit further and perhaps try different kinds, with some trial and error you may get lucky yet.

[magicalhippo]

Thanks, much appreciated.

Just saw they very recently approved some canabis oil drops for medicinal use here, so that might also be an option.

[ajb]

I am sensitive to low frequency sounds . The thing that seems to work for me is to play thunderstorm sounds, with isolating earphones. Because this sound has a high degree of randomness across the frequency spectrum, and its spectrum varies randomly over short timescales as well, external noise is masked even if it's still audible - because the brain can easily fit it into the thunderstorm pattern, and so doesn't get triggered by it.

Your milage may vary of course

[Aeglaecia]

you say that so flippantly

[genman]

If she falls a sleep then can she have the expected sleep length when not interrupted?

[magicalhippo]

Seldom. Usually if she's not interrupted the nightmares show up and ruins the night.

I got one of those Garmin activity trackers. After using it for a while, she tried it.

I know they ain't perfect but there's a very stark contrast between her and me, using the same tracker. It'll show me getting typically 4-5 hours of deep sleep when I have a good night. With her it's typically an hour tops, often less than 30 minutes.

[username135]

Edibles have been a godsend to me. Have you guys tried them?

[scrps]

Has she considered PTSD? It sounds a lot like it and there has been promising work around PTSD from what I have seen in passing.

[karencarits]

Psychoanalysis might be useful, it is my understanding that it can deal with complex issues where simpler forms of therapy fails

[alfor]

My suggestion is to try a religious conversion to christianity. I know it sound weird, but we all live in a story and she relive the same story over and over in her dreams and in real life.

Christianity will help her make sense of what happenend and will help her get over it. She will have a place to put evil and a place to put good and she will be slowly be able to fix the direction of her mind.

She can search for scripture that speak around what happened to her and see what she can do about it. She will ask for help to go past her trauma.

I tought all my life that it was supersitious nonsense (scientific atheist) but I found out that I was wrong. We have no choice, we are religious by nature. Without a solid faith we are free floating, anxious, depressed, confused and stuck in loops.

[moffkalast]

I wonder if eventually once this is more thoroughly researched there could be a way to induce constant cleaning instead of having to do it while unconscious at night? Or at least reduce the hours required. If we could solve this we could just stay awake perpetually and instantly gain a 30% longer lifespan as it were.

[Terr_]

If there is any magic bullet, it'll be something biological evolution can't easily jump-to or stumble-upon. Otherwise I think it would have happened already, given the risks of sleep and the rewards of an expanded activity (or at least awareness) cycle.

[moffkalast]

Well it's not unheard of that some people won the genetic lottery and are more efficient at it, functioning normally with only 3, 4 hours of sleep every day. There's definitely room for improvement for those of us that need 8 or 9 lmao. Hell even reducing it to just 7 or 6 would be such a massive gain.

[Terr_]

For "Short Sleeper Syndrome", it remains to be seen what the long-term tradeoffs are.

Kind of like how someone might excel at a specific test because of a lesser sense of pain, but that lack of feedback loop can be detrimental in the long run as they keep injury themselves without noticing.

[someplaceguy]

> I wonder if eventually once this is more thoroughly researched there could be a way to induce constant cleaning instead of having to do it while unconscious at night?

Hopefully without having to induce those brainwaves, otherwise you might be able to do it during the day but you wouldn't exactly be conscious. But there's also the question of whether those brainwaves are doing more than just cleaning the brain.

I think some types of learning and memory formation also happen during sleep, right?

[LoganDark]

> Hopefully without having to induce those brainwaves, otherwise you might be able to do it during the day but you wouldn't exactly be conscious. But there's also the question of whether those brainwaves are doing more than just cleaning the brain.

...Lucid daydreaming button, anyone? Maybe not lucid if it's the exact same as normal sleep, but I'm sure that if such a thing more exist, you'd be able to adjust exactly how it affects your brain.

[plasticchris]

But your brain is disconnected from your body during dreams, to keep you from flailing around. Sometimes you even wake up before the block is lifted and can’t move. So controlling such a device would be difficult.

[LoganDark]

You're describing sleep paralysis, right? It's not so much a disconnection as it is an inhibition. Attempts to move most of your muscles are blocked, but external stimuli still get in. You know, once upon a time someone started the washer while I was presumably in REM, and I started to hear something in my dream. When I woke up, it only took me a couple minutes to realize that what I had been hearing in the dream was some greatly slowed-down version of the washer that had just been started, since I guess my dream time was travelling faster than real time. I think the only reason it didn't wake me up is because I'm used to sleeping through the sound of the washer running and may even normally filter it out. That's just the first time that someone managed to turn it on in the middle of my actual dreaming phase.

[plasticchris]

Yeah, that’s right. I had it once before I knew it was a thing and could see, hear, feel, but not move. Quite terrifying at the time, even if it resolved pretty rapidly.

[someplaceguy]

> But your brain is disconnected from your body during dreams, to keep you from flailing around

Tell that to sleepwalkers!

[LoganDark]

I believe there are two "obvious" theories on how sleepwalking may occur:

- Sleep paralysis doesn't properly activate, and someone accidentally transfers the motion of walking into real life. proprioception may pass through to the dream, they might perceive a dream environment that allows them to navigate the real one. (i.e. righting themself from bed, staying upright while walking)

- They aren't fully asleep, but they aren't awake/aware either. I've had my fair share of people telling me that I said or did things after waking up and before immediately going back to sleep, and those are things I don't remember doing at all, probably because they weren't properly recorded in memory because my brain was not fully awake. (Some of these cases could have been DID though.)

[robg]

More efficient sleep is possible with ultrasound. But keep in mind that the glymphatic system seems to expand as other systems contract. The waves are tied to brain activity slowing down, can’t have one without the other. That said, could intersperse active times of the day with naps. But naps alone don’t seem sufficient as good sleep.

[krisoft]

> The waves are tied to brain activity slowing down, can’t have one without the other.

But why? Is this knowledge onservation based (“that is how it is in the organisms we studied”) or is it a theoretical limit?

Dolphins for example seems to get by without fully going unconscious. (I’m talking about the literal marine mamals, not a chronotype or anything like that here.)

[rowanG077]

To what degree is it more efficient? For example could you halve your sleep requirement? That would already be huge.

[pedalpete]

The waves are actually tied to the synchronous firing of neurons which is the hallmark of deep sleep.

[FooBarWidget]

Philips has a headband product called DeepSleep. They claim it increases your deep sleep by playing some sort of sound during your sleep that induces more deep sleep. For some odd reason, despite being a Dutch company, the product was only sold in the US. I spent a lot of money having it imported to Netherlands.

Unfortunately I can't tell whether it works. I rely on headphones and earplugs to block out sounds during the night. Sounds such as cars and airplanes outside, or other people in the house going to the toilet, tend to wake me up unless I block out those sounds. And the handband is not compatible with headphones or ear plugs.

I wish there is a better solution.

[skinner927]

It appears to be discontinued

[calirepublik]

Check this out, I just saw a reference to this recently:

https://www.nia.nih.gov/news/noninvasive-brain-wave-treatmen...

[robg]

There already is constant cleaning, the brain just can’t seem to keep up. Sleep is more efficient at clearance. People are working on making sleep more efficient. As you can imagine, military leading here.

[jannyfer]

I must be spending too much time on HN. I recognize this exact comment from a month ago.

[ifyoubuildit]

I was thinking the same thing, but I wasn't sure how long ago it was.

[MrDresden]

https://news.ycombinator.com/item?id=39335425

[robg]

I’m thinking it should be pinned to the top of any sleep post!

[Hrun0]

> which is so newly discovered

It says that it was published in 2015, or am I missing something?

[infecto]

Am I missing something? 2015 for a paper feels relatively new enough that people might not know about it and it might not be in school books.

[Culonavirus]

People learn in school, then after they estabilish their career, they have kids and other interests and this and that and they get intellectually stuck. Don't grow. Don't learn new things in their field of (supposed) expertise... I see this ALL THE TIME. Now if middle aged programmer refuses to learn new things, it's annoying to work with them, but you'll survive. If a middle aged physician refuses to learn new things, you're kinda fucked. Sadly, the amount of physicians out there who don't keep improving is pretty large given the importance of their job. Yes, the "pretty large" part is mostly anecdotal - my experience and experiences of my friends and family - but if I see the stuck programmers in my field, I'm pretty convinced there must be quite a few of the stuck physicians.

So yeah, 10 years in medicine? Seems like a brand new paper to me. I expect that knowledge to bubble its way to your average physician some time around 2040.

[Aeolun]

That’s why I am on hackernews though? If nobody posted that paper 8 years ago I’d be surprised.

[yorwba]

5 years ago: https://news.ycombinator.com/item?id=20622712

[thfuran]

I'm about the median age in the US and wouldn't expect anyone less than a decade younger than me to have been taught it in school unless they went for a degree in a related field, and possibly not even then. 2015 is after I finished grad school and something like a decade after I'd last taken a class where it might have been taught if it had already been around for enough years to make it into the curriculum.

[robg]

Great points, I got my Ph.D. in neuroscience 20 years ago. There were disparate theories for why we sleep but no mechanistic description. Most of the research not specifically relevant to my own took 10-20 years to become influential. I’d be surprised if most textbooks for neuroscience-related fields being published today are including the glymphatic system, including psychology / psychiatry and medicine.

[dEnigma]

> so newly discovered likely you didn’t learn about it in school.

So with the slow pace knowledge makes it into the school curriculum, you likely wouldn't have heard about it in school unless you just left the system a year or two ago (if even then).

[robg]

Exactly, my kids are in elementary school and I’ve been talking with superintendents and high school principals. It’s straightforward to teach kids about the brain as a muscle and sleep as critical to rest and recovery to best power cognition. The glymphatic system gives a clear mechanism and yet I haven’t found many places where it’s being taught as a core part of how to best use your brain. Sleep is still considered a nice to have for brain performance, not a driver of working smarter.

[Hrun0]

Ok I think I got confused. I thought OP meant that they will win the Nobel for this specific publication.

I guess I should have slept more

[d_sem]

You are missing the context of age demographics. For example: in the United States of America about 63% of the population is over the age of 32 which represents roughly 200 million Americans which graduated Highschool before the year 2010.

[telesilla]

And the majority of whoever is teaching university or even high school right now probably graduated themselves before 2015, when the article was published.