[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.

[samstave]

hahaha thank you for the reply.. we both win (in tight Richard Simmons type font)

[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.