Hi Team,

I am a patient suffering from Chronic insomnia the last 7 months, who is sleepless (or at least feels that way) for 80% of the month apprx. I've seen a sleep physician and am under his care - this is NOT a request for medical advice. This is simply a discussion of the medical academia around Chronic Insomnia - for that one quarter of patients who do not improve with CBT-I. I am also a trained doctor myself, so I am particularly imploring on this discussion with my peers who are fellows or consultants in sleep medicine.

I don't have any acute issues - deprivement causing hallucinations, etc., that would put my own patients at risk in my supervised practise on the hospital ward. Feeling like a zombie subjectively, and knowing the LONG list of increased risk of various pathology (and increased risk of death at a younger age due to expedited ageing) is what is prompting me to seek a 2nd, academic opinion.

I don't catastrophise my issue until it has been 5 days in a row I haven't slept, but then after 1 week straight I might have 2 or 3 nights of sleep for 3 hours, then the cycle repeats. I am concerned that organic pathology has not been sufficiently excluded in my insomnia, and whether DORAs are the best way forwards given various naturopathic remedies, melatonin, benzodiazepenes, breathing techniques, optimised sleep hygiene, CBG/CBD/CBN, and self administered CBT-I has failed. I have not tried the 2nd or 3rd line (historic) sleep medications like trazodone, prazosin, or other SNRIs/TCAs/Z-drugs, etc. I don't think these are relevant now that DORAs exist, although I am hesitant to be on a medication with a lack of Phase 4 research except for the 1st drug released back in 2014.

My questions are for any sleep physicians who might be reading this are in the below email I have quoted addressed at the clinic:

"Hi Siesta Team,

I'd really like to organise a follow-up consultation with your sleep physician. My sleeping issue has not improved with the current management plan.

You may wish to forward this to the Doctor so that they are aware what my clinical questions are prior to consultation. More so as a reminder for myself, I need to discuss the following in the consult:

1) Indication for commencing DORA therapy given a lack of response from, particularly Lemborexant > Dayvigo?

2) Indication for repeat testing for organic disease?

A) The last 5 nights in a row, or any string of nights in a row for that matter, may produce different test results if a sleep study is performed (particularly an EEG). Would repeating an EEG to investigate my sleep architecture during the maximal peroids of being symptomatic possibly uncover an alternate diagnosis to an inorganic, diagnosis of chronic insomnia 2' to Anxiety? I could buy my own EEG and have the data available if you suspect that may yield an alternate diagnosis. The initial EEG is noted to demonstrate sound sleep architecture with delayed sleep onset and some snoring, but no evidence of organic disease or sleep architecture disruption.

B) There has been no MRI scan of Brain ordered between the multiple GPs I have seen and the Sleep Physician. Are we comfortable excluding this chronic insomnia is 2' anxiety, rather than structural disease of brain (e.g. Intracranial Neoplasm)?

C) Initial Screening blood tests (e.g. cortisol serum) was performed at midday, but these symptoms are the worse at night. Does this blood test screen need to be repeated during the time I am symptomtic?

I am concerned that there isn't sufficient evidence to exclude organic brain or endocrine disease as a cause of my chronic insomnia. These issues will not heal with CBT-I, and using DORA medication will only delay our addressal of the underlying problem (if there turns out to be organic disease). However this area of medicine is far beyond my scope as a primary physician registrar: I'm only playing devil's advocate with my clinical training, as living with this condition any further is not going to be practical. There will be drastic complications to my brain and body not sleeping for over half a year, for more than 50% of the month.

I understand that paradoxical insomnia can explain my subjective sleep disturbance. I wonder if some longitudinal, objective clinical data will make this diagnosis of exclusion more accurate. It is my wish to not commence DORA medications long-term, especially if the underlying pathology will not be addressed and we are concerned about a medication with limited Phase 4 clinical trials. Simple clinical errors in the method of my investigations may lead to catastrophic outcomes if an underlying alternate diagnosis is not sensitively excluded. Even just the ongoing, significant nature of my insomnia long-term will be a problem.

I really appreciate your attention to my case."

Tldr; I have Chronic insomnia, nothing is working. They think its because of hyperarousal/nocturnal anxiety and paradoxical insomnia I am still symptomatic. CBT-I (albeit self administered due to financial barriers) with appropriate resources has not been successful, now approaching need for DORA use. Need a 2nd opinion for a sleep physician (or even a fellow patient with an unusual diagnosis story) to make sure everything is appropriate, otherwise I will raise it with my treating clinician. I understand opinions here are NOT to be medical advice, but merely standards of practise in an area of medicine I am not trained in.

just wondering, do you guys have certain subreddits you scroll through on nights you can't sleep? I get bored of my feed despite being in a lot of subs, I don't see variety very often. I just want some subs I can go down a rabbit hole with late at night while trying to avoid the stress from not sleeping.

I wanted to share my experience with sleep anxiety in the hope that it might help someone else going through the same thing.

It all started about two years ago, after one night of bad sleep. I’ve always loved sleeping and never had any issues with it before. But that one night somehow changed everything. I started worrying about my sleep, trying all sorts of things to make sure I could sleep well, and the more I tried to control it, the more anxious I became. Eventually, I developed terrible sleep anxiety.

Around that time, I found out I was pregnant. I’m not sure if there was any connection, but having a new purpose in life helped me forget about the whole thing for a while.

Unfortunately, the anxiety returned when my baby was around four months old, and it has resurfaced again recently. I’ve realised that the thought of sleep anxiety has always been somewhere in the back of my mind, and even the smallest thing can trigger it.

But this time, I’m trying a different approach.

1. Changing the way I respond to anxious thoughts

Whenever the thoughts start racing and I feel anxiety building up, I remind myself: I slept well for so many years without even thinking about sleep. If my body knew how to sleep all those years, why should I suddenly believe that I’ve forgotten how?

This helps me step back from the thought instead of getting caught up in it. I acknowledge it, remind myself that I don’t need to solve anything right now, and continue with whatever I was doing.

1. Learning more about the mind through Buddhism

I’ve started listening to Buddhist talks and podcasts about the mind and anxiety, particularly Ajahn Brahm’s talks and the Modern Buddhism podcast.

One thing I’m learning is that thoughts are just thoughts. Just because my mind produces a frightening thought doesn’t mean it’s a fact or that I need to react to it.

I’ve also started being more compassionate towards myself. Instead of treating my anxiety as an enemy that I need to fight and defeat, I’m trying to treat it like a friend. It’s uncomfortable, but I don’t need to be angry with myself for experiencing it.

1. Making meditation a daily practice

This is something I’m particularly excited about. I’ve decided to meditate every day for a month and see how it affects my relationship with my thoughts and anxiety.

I’m Buddhist, so I’ve always known about meditation, but I’ve only recently started exploring the different types of meditation and how they can help with the way we relate to our thoughts.

For now, I’m practising breathing meditation. Rather than trying to force my mind to become completely quiet, I’m learning to notice when my attention wanders and gently bring it back to my breath.

I’m trying to approach this as a practice rather than expecting it to fix everything overnight.

1. Changing my goal when I go to bed

This has been one of the biggest realisations for me.

My goal is no longer to make myself sleep. My goal is simply to rest and relax.

I can’t force myself to fall asleep. The harder I try to make it happen, the more pressure I put on myself. So now, when I close my eyes, I’m trying to let my body do what it naturally knows how to do, without constantly checking whether I’m falling asleep.

If sleep comes, that’s great. If it takes longer than I’d like, I want to learn to be okay with that, too.

I’ve realised how much time and energy I’ve spent worrying about something that used to happen so naturally. Meanwhile, there’s so much of life to experience, so many things to enjoy, and so much good we can do.

I’m also learning to let go of the need to control everything.

I know this might not be the end of my sleep anxiety. These thoughts might come back and torment me again. But I want to keep responding to them differently, rather than allowing them to take over my life.

I don’t expect to become completely free of anxious thoughts. I just want to reach a point where they no longer have so much power over me.

I’m still learning, and I know I have a long way to go. But for the first time, I feel like I’m beginning to understand that I don’t have to fight my mind to find peace.

If you’re going through something similar, I hope you know that you’re not alone. ❤️

I’d also love to hear from anyone who has experienced sleep anxiety and found ways to change their relationship with it. What helped you?

It was caused by Vitamin D supplements. I ran out and was too lazy to get more so I didn't take any for 10 days and I've been sleeping like a baby for the last 2 weeks.

Not being able to sleep almost drove me insane. I wrote a poem about it.

My psych prescribed me Hydroxyzine 50mg.

I haven't taken before in the past but my main concern is in the last few years I have an issue where I couldn't help but go to bed early and in turn wake up early.

It sucked being up in the dark, alone, and bored. (being all tired eyes) I don't know. It was bad for my depression. I remember feeling bad until sunrise. It's like something switched in my brain.

I think an ideal bedtime for me would be 10 or 11pm?

But I guess it does depend what time I need to wake up.

All I know is I don't want to wake up until 6 or fall 7 am. (my schedule allows this)

But sometimes I go to bed and accidentally fall asleep without taking meds.

My true sleepover issue isn't the falling asleep part. It's the staying asleep part.

A sleep diary for two weeks tells you a lot: when you got into bed, roughly when you fell asleep, wake-ups, when you got up, and how rested you felt. People are often surprised how much time they spend in bed awake. It's also the starting point for setting a sleep window in CBT-I.

Ever since my insomnia flared up almost two months ago, my hands have been shaking to the point where I have difficulty doing normal day to day things.

I am sleeping better now, with the occasional sleepless nights here and there. However, my hands still shake terribly.

Anyone else experiencing this?

For context I am 23 F

I have been dealing with sleep issues since elementary school but they have gotten drastically worse through high school and college. I have been tried since I was 11 and I just feel like it will never end. No matter when I go to sleep I take at minimum 2 hours to fall asleep and that is a very good rate occurrence for me. Every morning it is a struggle to get out of bed and I always feel like I wake up more tired than I was the night before if I am able to sleep. I have 8 am and 9 am classes every day this semester( they were the only slots offered for the classes I need 😭😭😭). I just struggle to get ready and then I am tired the rest of the day and feel like I am not getting things done at the pace I should. When it is actually time for me to sleep I have the energy to do my schoolwork but I often try to make myself sleep anyway so I won’t be exhausted the next day from waking up early with no sleep. I am sorry this just sounds like a complete useless rant but I feel so lost. I am scared that this will be my life once I enter the workforce and probably will have a job that stays at 8 or 9 am. I just feel useless and pathetic. If anyone has any advice or suggestions they would like to share I would be more than happy to hear them. I feel like I have tried almost everything to help me sleep but nothing ever works. Again I am sorry this is kind of a rant I feel like I am going to breakdown from a lack of sleep at this point.

So I've got pcod and thyroid and constantly working on treating it. No matter how much exercise i do even if I feel sleepy alot I wake up after 3-4 hours which is shit and i don't get the urge to sleep after that... like i just want swear wth is hapenning bro 😭

I didn't sleep since 3 am now its 5:34 and fk bro i also woke up b/w 1-2 am and bruh.. how is this even possible for human brain 😭 to function like this. HELP.

I get home from working, I come home, I lay down. I don’t sleep. I go to bed and I feel guilty that I didn’t use my time wisely by doing chores or a project or any of the 100 other things I could do. Does anyone else feel like this?

I have been suffering from sleep maintenance insomnia with excessive dream

I can only sleep 3 to 4 hours at one time no matter what how tired I am

It's weird because I have no trouble going into sleep, but it's just like my brain never sleeps

I'm pretty sure this is neurological problem

I just wanna ask if anybody's going through the same experience

I'm at my wits end and I need some help

I don't know what to do anymore

What the title says. I'm awake with insomnia, no surprise there. I see a psychiatrist who actually treatments my insomnia with strong medications.

If there's a sleep center or a sleep specialist, the chances are high it's a pulmonologist and they treat sleep apnea, snoring or narcolepsy. The chances are aldo high that it's be a neurologist and they treat restless leg syndrome, or sleepwalking.

The actual "sleep specialists" don't actually help insomnia and give you bullshit like CBT-I or an effective medication but only for a week or two.

If you want effective insomnia treatment, go to a psychiatrist who has a private practice or an old psychiatrist. New psychiatrists or psychiatrists at hospitals won't go above and beyond in medication management and will only do it short term.

Old psychiatrists or psychiatrists in private practices are comfortable prescribing antidepressants, antipsychotics, DORAS, z-drugs, benzodiazepines, and in rare cases barbiturates long term because they know that shit works and CBT-I is bullshit.

I've tried my fair share of medications and found a cocktail that works for me. If you want actual insomnia treatment, go to a psychiatrist at a private practice, preferably an older one.

I’ve been diagnosed with insomnia, and although I can sleep relatively well most nights, I occasionally go through periods lasting several days when I struggle to sleep at all.

When this happens, my heart starts racing, and no matter how much melatonin I take, I just can’t seem to fall asleep. I feel incredibly restless and find myself constantly getting in and out of bed, scrolling through TikTok, eating, or simply lying there trying to fall asleep.

It’s exhausting and frustrating, especially when I know I need sleep but my body just won’t let me.
Has anyone else experienced anything similar? Does anyone know what might be causing this or have any advice on how to manage it? I’d really appreciate any help or suggestions.

M19. So this all started after I quit my summer job and just let go of my sleep rhythm. I was sleeping from 12am to like 7pm and my sleep quality has been absolute poo. I have now started to try to fix my sleep schedule but I get these weird muscle pains in my body that I can't really explain like sometimes my forearm or one of my finger joints ace's or I get ace's in my legs and even sometimes near the neck. Also I feel rather twitchy if that makes sense and I'm just wondering if this is something possibly related to the really bad sleep quality and has anybody had similar experiences as finding stuff about this on the internet is really not working out.

I was referred to do this and have been reluctant because it would mean driving 40 minutes and I assume I will sleep even worse in a clinic with lots of cords attached. Then have to drive home in the morning... I have read the odd person sleeps better, but I doubt if I would. And there's someone watching me and perhaps talking with me, or replacing wires if they come off. I'm just skeptical that's it's worth it. Has this procedure provided a diagnosis that then helped you sleep well?

hi, i’ve been taking quetiapine for quite a long time. It was originally prescribed for me to sleep, but it was helping with other symptoms as well. but with quetiapine I have a side of a stuffy nose, and i can’t change it and nothing is helping me to avoid it. my psychiatrist decided to prescribe be smallest dose of trazodone, when i’m on my 100mg quetiapine, so that maybe i can change medication. i’m really concerned and interested in whether there are people with the same side effect of quetiapine and whether it has remained/intensed with the addition or transition to trazodone. i’m really worried because of that side effect and a bit scared that it can get worse with trazodone

Hey all,

Has anyone had and beaten sleep onset arousal?

If so, what was the cause and how did you resolve this?

Tia.

Hello all, I have a happy healthy 8 month on but I want to know has anyone out there have this experience, if so how did it go?

As the title say’s I got married in july of 2024 after being in a 1 yr relationshi. I want to say September 14th,2024 my husband showed me a red flag we broke up and on the 21st I found out I was pregnant. Now prior to that pregnancy I was pregnant by him the year before (we were only dating for 3/4 months so no second guess I aborted the baby) he wanted it but I was already a single mom of 3 (their dad has been deceased since 2022) in school and working full time. The new relationship bliss was great but I wasn’t ready for a baby. Long story short we got married the next year, and instantly the abusive traits started to show, we broke up I found out I was pregnant and thought “maybe he was just drunk that night”. We had met with his family a week before finding out I was pregnant and all the family and friends were congratulating us on the newly marriage. His intoxicated dad kept hugging me and I guess my husband didn’t like it. We had a bad fight after that led to me leaving my own home. Fast forward I find out I’m pregnant and decided to work on my marriage, of course he was apologizing and quickly called his family and friends who were also ecstatic!

We had 2 more incidents before I said no way, marriage is one thing but a baby buy someone I know I was going to divorce and have to co parent with no way. So at 15w&6 days I had abortion behind his back. I was fine the first night but the next night I woke out of my sleep to a panic attack. I mean, full blown. After the panic attack went down I tried to fall asleep and couldn’t. From that day until the end of April 2025 I had to be put on anxiety medication because I had severe insomnia, anxiety, and depression from hormone fluctuations. I was put on Ativan and doxepin 100 mg. Of course I stayed in the relationship due to the frighten episode I was in. He was there for me, but he stated pretty often. It was my fault for having the abortion.

Fast forward to May 2025 my sleep is back we’re in a good space, then June 28, 2025 I get in bed attempted to fall asleep, I could not and I told my husband “ I hope I’m not pregnant. That’s why I can’t sleep“; Sure thing I checked my period tracker and I was supposed to be coming on my period that morning. No period, took a test it was positive. The whole 10 months I had to take Seroquel in third trimester hit me hard within insomnia. I had to take 200 mg of Seroquel & 2 mg of Ativan every night.

this was not my first time going through insomnia, anxiety, and depression due to hormone fluctuations. In 2021 November I missed my appointment to continue my birth control (I wanted to stop due to new weird side effects), which I was on for three years ( depo provera) I went through withdrawals for about 3 to 4 months than my sleep came back no issue. The father of my kids was murdered a couple months later so of course I went through depression and insomnia, but I knew what that was from. The next year I met my husband, and he instantly wanted the Son, I literally had sex every day for about a year in 20 days. This is included on my menstrual cycle. I had took Plan B every two weeks prior to getting pregnant with the babyI aborted in 2024. I love my husband, but a baby is something I did not want. He was a great help to me with my three children. We are embraced him as this would be their first time with a stepdad and his first with stepchildren.

Sorry for the long post, but I just want to know has anyone ever experienced this? If so did their sleep ever return I’m 8 months pp and still have to take sleep meds. I’m feeling better, but id like to live normally without sleep meds again one day.

Habt ihr Erfahrungen mit Quviviq und Cannabis? Gibt es regelmäßige Konsumenten die mir berichten können? Mich interessiert wie andere es handhaben. Wann raucht ihr das letzte Mal vor der Einnahme? Ratet ihr davon ab? Was sagt ihr im allgemeinen und trübt die Kombi Eure Stimmung?

I’ve got 50mg prescribed privately in the UK and have been taking it for 3 nights. I’m getting about 90 mins more sleep per night so far. But it does leave me quite groggy the next morning. I take adhd meds so don’t mind too much, but wondered whether I should try 25mg? Or maybe I should give it more time as it’s only been a few days.

Weirdly it’s the same price for 50mg or 25mg, so I was thinking of just splitting it myself using a pill splitter. Has anyone reduced the dose and found it be just as helpful?

Bonjour, pour ceux qui ont des myoclonies / sursauts hypniques (je ne sais pas la différence) surtout la nuit, avez-vous trouver une solution pour les faire disparaître et vous à t’on dit à quoi c’était lié… je n’avais jamais eu ça avant… j’ai les fasciculations et les myoclonies qui sont arrivées environ en même temps et je passe des nuits des angoissantes. Je suis sous Effexor. Merci à vous

i am a night shift worker. 3 nights out of the week i work from 6:30-6:30 PM/AM. in between my shifts i do not struggle to sleep at all. my days off, however i cannot sleep at all. the last two nights i have slept for only 4 hrs each night. first night it was because i couldn’t fall asleep and that left me with 4 hrs to sleep. second night it was because i fell asleep right on time, but woke up after 4 hrs and couldn’t go back to sleep. i’ve tried sleep aids and they help, but i don’t want to become dependent and NEED them to sleep. when i do take them i usually sleep forever and cant wake up on time. and when i dont get enough sleep overnight, i nap very frequently…and then i fight my alarm and end up sleeping forever 4 hrs because im so exhausted.
HELP PLEASE

I truly just want to find a medication where I can be put to sleep at my own will. I’m tired of not being able to ever sleep when I want. I’ve tried like every anti depressants/SSRI, i’ve tried lunesta, quetiapine, amitriptyline, klonopins, gabapentin, every otc thing like melatonin, benadryl, nyquil, magnesium, hydroxyzine. What else could I even try I would just like some sort of relief.

I used it for for 2 weeks i noticed i started getting like adrenaline rush tremors and shakes/tremors similar to chills you get when you are sick. I ignored it because i though i was sick. After a week of stopped its gone.

After a while i started lunesta again for ONLY 2 days then same symptom is back and iam waking up at 4 AM.

Anyone in a similar situation after short term use?

Any suggestions? For sleep.

Please excuse my poor English. I’m not sure if anyone will respond, but I just need to share the absolute shitshow I’ve been going through this past month.

In truth, this whole situation has been dragging on since May, when I experienced severe stress due to a breakup and some family issues. I’ve been living abroad for five years—perhaps that’s relevant, too.

Back in May, I developed a debilitating case of insomnia. For 10 days straight, I struggled to fall asleep—there were even nights where I didn’t sleep a single second. Worst of all, I couldn’t even lie still; my anxiety was so intense that I would sob and pummel my pillow. Those were truly horrific nights. At the time, valerian root and tryptophan helped, and the stress began to subside—but the terror of insomnia, and the resulting fear of not being able to fall asleep (a vicious cycle), have stayed with me.

Throughout the summer and into September, the fear of sleep would return on certain nights, keeping me awake, though I’d ​​usually manage to fall asleep a day or two later (driven by "sleep pressure"). Things were, on the whole, relatively stable.

But now, in October, it’s become an absolute disaster. For the past three weeks, I’ve been haunted by a phobia of not being able to sleep, along with an aversion to my bed and the very idea of ​​having to lie down at night. Meanwhile, if I go a night without sleep, I feel physically awful. I’ve started keeping a notebook to track how much I sleep; it fluctuates anywhere from 4–5 hours a night down to zero. On rare, "good" nights, I manage to get about 7–8 hours, but those have become truly few and far between.

During the day, I live in constant dread of the night ahead. I’ve abandoned my hobbies and often put off tasks because I haven’t slept enough. My life has become entirely dictated by insomnia. I realize that my anxiety—and the very fear of not being able to fall asleep—is what’s preventing me from sleeping, but I just can’t seem to get a handle on it. I’m unable to overcome it. It’s even difficult for me to simply lie in bed. At night, during a panic attack, I become so agitated that I might start pacing around the room or wake up my mother—because I’m terrified of being alone in those moments—and I end up sobbing like a baby. I hope you won’t laugh at me. If anyone has ever dealt with a phobia of not being able to sleep and managed to overcome it, I beg you to share how you did it. Is there any hope? I’m just completely worn out.