Sleeping better - methods and supplements

This information is not medical advice.

This blog entry covers the methods and supplements I use to get a decent night of sleep.

My sleep used to be like this: lose consciousness, toss and turn all night with very shallow sleep (intermittent consciousness), then wake up feeling like nothing restorative had happened during the night. It was about as effective as closing my eyes and opening them again hours later. There was no sense of time having passed, no sense of having slept, no dreams, just more feeling exactly the same as when I went to bed.

I had no idea how bad my 'sleep' had become because the sleep quality degraded very slowly. When I read that 'non-restorative sleep' was a CFS/ME symptom, I knew exactly what that symptom felt like.

After a lot of experimentation I've found a mixture of methods and supplements that help me get a much better night of sleep. Each of these contributes a little but all of them together add up to a decent night.

I can now go to sleep fairly easily, and when I wake during the night I feel a little groggy and can usually go back to sleep without difficulty. I still wake up to change position several times per night but go right back to sleep. In the morning I feel like I've actually slept and sometimes have a pleasant 'I just want to lie here for awhile' feeling that was missing for almost a decade before I arrived at my current sleep methods and supplements.

Physical Support

Inclined bed
The head of my bed is inclined by 6 inches using bricks. I was surprised at how much this helped my sleep. It also helps to prevent or reduce nocturnal urination by influencing blood circulation and reducing the amount of liquid that enters the bladder during the night.

Memory foam bed
A very soft memory foam bed helps to reduce how often I wake up to change position. And, because I'm bedbound so much of the day, a comfortable bed is very important. Even though it's a 'low odor' bed it still needed to offgas for a few days when I first got it. When the mattress is covered in a couple of bed sheets I can't smell any odors from the foam.

Weighted blanket
I feel better and more comfortable with some weight on me, possibly because I have such low blood pressure. It's a 20 pound blanket that has many pockets filled with tiny glass beads to add weight. The usual recommendation is to use a blanket that is 10% of a person's body weight, plus a couple of pounds.

Many people sleep better with a weighted blanket. Some people with autism, anxiety, or PTSD also find benefits.

Ear plugs
I'm a very light sleeper so ear plugs help to block out noises that could wake me. 3M Ear Classic are the most comfortable that I've found. I buy them in bulk and use them for roughly 5-10 days per pair.

Darkness
Blocking out light (at least from my eyes) for a dark sleeping environment is important to encourage my body to produce melatonin (in addition to the supplemental melatonin that I take).

Not over-exerting
Difficulty sleeping is a sign that I have pushed too much. If I stay within my energy envelope and don't over-exert then I usually sleep better.

Supplements

LDN (Low Dose Naltrexone)
Possibly the biggest aid to sleep although I had some insomnia while I was adjusting to it. I take 2.5mg per day. I need to take regular breaks for a few days to maintain effectiveness.

Methylfolate
Within two days of starting methylfolate I was able to relax more because the wired-but-tired feeling was starting to dissipate.

Melatonin
Time release melatonin before bed, (Natrol brand) 1mg. Regular melatonin doesn't keep me asleep, but long acting does. I dream more often when I take melatonin. Update: I've recently been using liquid melatonin, roughly 0.75mg. See update for May 2019 below.

Sleep tea
Nighty Night Tea with valerian. There is a Nighty Night Tea with catnip but I wake up feeling as if my brain has been deprived of oxygen, so I avoid it. Update: I don't use this anymore, see update for May 2019 below.

L-Tyrosine
750mg at bedtime. Update: I don't use this anymore because it now makes me slightly more cheerful for about 1/2 hour but then drops me into a very negative mood for several hours.

Magnesium
200-350mg at bedtime; then (sometimes) another 175mg in the middle of the night. The amount varies based on how much calcium I have consumed in a day. I always wake up around 12-1am and sleep more lightly after. The second dose of magnesium helps me to sleep more deeply after midnight. This post helped me understand why I woke frequently, especially after midnight -- I needed more magnesium.

I use Vitacost Natural Tranquility (powdered magnesium carbonate with citric acid dissolved in hot water to form ionic magnesium citrate). I like this form of magnesium because it fully dissolves into the liquid which I expect results in easier absorption, and it doubles as a stool softener.

Magnesium is a muscle relaxant that helps calm the body for sleep.

Iodine
At least 12mg/day. I take it with the cofactors; selenium is especially important.

CoQ10
60mg an hour before bed. It deepens sleep, and without CoQ10 I rarely dream. Too much CoQ10 lowers my blood pressure.

Oatmeal
Sometimes I take a few spoonfuls at bedtime. It's enough to help with taking supplements (they're easier to swallow with food), maintains blood sugar during the night, and encourages the release of serotonin for better sleep.

Supplements I avoid
Note that some people have found these additional supplements to be very helpful so experiences vary by individual.
  • I've tried niacin and l-theanine but both caused excessive tiredness and brainfog for several hours after waking.
  • Inositol and glycine suck the energy out of me so badly it's like I've been sedated all day long.
  • Vitamin-D helps my sleep but increases my light and sound sensitivity.

Edits
  • May 6, 2019
    • I now rely on liquid melatonin (roughly 0.75 mg) plus Dr. Christophers Relax-Eze liquid. Sometimes I take a break from Relax-eze for a few days and use either a 50:50 mix of THC:CBD spray, or Gaia SleepThru.
    • General document changes: Fixed a typo, changed wording and organization in a few places, a few minor additions.
  • Jan 8, 2018 - Updated medical disclaimer; added CoQ10; Updated entries for magnesium, and ear plugs.
  • Mar 10, 2018 - Updated the magnesium section to include info about taking a second dose for better sleep after midnight; added the section on using a weighted blanket.

Comments

Pat, how long did it take you to get past LDN's insomnia effects? I'm glad you figured out how to get better sleep. It truly makes all the difference in the world.
 
LDN is probably working by inhibiting microglial activation, which is probably caused by LPS. Cort mentioned in one of his articles that Trazodone has a similar effect - combining this with dietary changes and gut treatment has meant that I have gone from waking up every 30 mins to sleeping through the night most nights.
 
Sorry for the late reply @perchance dreamer, I didn't get the alert that you had posted a comment here.

I had disrupted sleep for the entire time I was titrating the dose. It took a month before I stopped at 2.5 mg/day, and shortly after that my sleep stabilized. Even though my sleep was disrupted it had periods where it was better. An example is that I might have had deeper than usual sleep before midnight, then no (or interrupted) sleep after, but still felt better in the morning than I would have had without taking the LDN. So I lost sleep for awhile, but the sleep I did get was better quality.
 
Hi PatJ,

Thanks for sharing your protocol. I recently discovered that upping my melatonin from 3 mg to 6 mg. has made a big difference for me. I have a friend who takes about 15 mg, and will take another 15 mg in the middle of the night if she's unable to get back to sleep. She said she's never had a negative reaction to taking that much, and that she started taking that much after reading about another person who routinely took 60 mg per night. Makes my 6 mg. look pretty "measly" compared to that!
 
Hey PatJ,
I like your advice to use memory foam, I bought a memory foam mattress a year or two ago and it has done wonders for my back pain, hasn't fixed it completely but it is bearable where it wasn't before. The issue I've been having with it is that every now and then my spine will start hurting, sharp pains and whatnot, I think because of the way the spine sort of sinks into the bed instead of being supported by it. When the spine pain gets bad to a certain degree I end up having to sit and stand straight for a few days till it goes away, this will drive the pain away for a time. Have you experienced anything like this and if so has elevating the head of the bed helped?

Don't get me wrong, I'm interested in elevating the bed in general even if it isn't going to help my spine. How did you arrange the bricks in order to accomplish the elevation? Is it a single layer of bricks under the head of the bed longways or is it more complex?
 
"Have you experienced anything like this [back pain] and if so has elevating the head of the bed helped?"

I haven't had any back pain since I've had this bed. Even before then I rarely had any back pain from a bed.

Elevating the head of the bed changes the way blood circulates and is reported to help with many different health conditions, so it might help you.

"How did you arrange the bricks in order to accomplish the elevation?"

I use two bricks, one on the other, and then a piece of 2x4 on top of them to add a little extra height. They're perpendicular to the head of the bed so they provide a broad base for the wide legs and better support. I've only had to adjust it once in 18 months.
 
"Do you recommend taking LDN in the morning or evening?"

I've never tried taking it in the morning because evening works for me. From everything I've read, it seems that the response varies by individual. Some people do better taking it in the morning, some better in the evening, some like a split dose (one AM, one PM).

At one point I experimented with different evening times and noticed some small differences. Now though, I just take it when I wake up during the night, which is usually between 11:30pm and 1:30am. Then I usually go right back to sleep.
 
You didn't mention diet. For me, quickly-digested carbs trigger insomnia. I've had to give up all foods made from white flour, or other refined starches, and sugars. I'm a bit less sensitive to such foods early morning or just before bed, but they're best avoided.

Physical exertion late in the day triggers my insomnia now too. It didn't last year.
 
Great list. A few more that may be of interest:

The inclined bed also helps avoid gastric fluids from creeping up, e.g., with a lower esophageal sphincter that is not completely shut or too relaxed.

If you are a side sleeper, having a long pillow in between your knees also helps the spine position.

Having zero LED lights in the bedroom, and having old school incandescent light bulbs with a natural light spectrum when reading before sleeping also helps.

I turn off the electricity completely at the breaker box for the bedroom and have measured the difference in EMF field. I notice the room feels much calmer.

Air quality and fresh air also helps. I often run an air filter in the bedroom before sleeping to bring pm2.5 and pm10 to below 10, and always have a window open a little.
 

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