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Molly Maloof, MD

Director of Clinical Content

Why cant I sleep?!

I can no longer sleep like I used to. Is it because my tolerance is too high? Its affecting my work because im literally up like 24hours :/ maybe sleep like 4 hours in a 24hour period if that. Please help!
  • 28 years old
  • Complaint duration: 30 days
  • Conditions: Allergies

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There could be a number of underlying reasons why you are not sleeping. You need to see a Traditional naturopath. They will evaluate you and locate where the imbalance is and then begin to solve the probem.

Good Luck...
Have you tried valerian root, passionflower, kava kava or chamomile?

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I also agree with many of the responses and suggestions posted by the medical practitioners. Depending on how poorly controlled your allergies are can directly interfere with quality of sleep. Possibly addressing the root cause of your allergies versus only treating the symptoms may be central to discovering why you are suffering from both issues. Allergies are often triggered by an over-reactive immune response to your external and internal environment. I would recommend reviewing your diet and eating schedule by your doctor to determine how to start an elimination diet. By removing certain foods like cow's milk products, wheat, alcohol, and caffeine for 2 to 3 weeks may help drastically lessen the symptoms. Each food type is reintroduced every 3 days to determine foods you are intolerant to. Clinically testing of food sensitivities and allergies is never as accurate as temporarily removing possible culprits from the diet.
I agree with many of the responses and suggestions posted by my medical colleagues (so I'm not going to repeat all of them here). The issue of proper sleep hygiene has been discussed and is a very common cause of insomnia at your age. Also, beware that if you drink alcohol, this could interfere with the quality of your sleep.

One thing that stood out right away is that you report suffering from "allergies". If you are referring to respiratory allergies, this could interfere with sleep secondary to problems with congestion and snoring which can cause a drop in nighttime oxygen levels, or directly impair your ability to sleep and contribute to drowsiness the next day. As has also been mentioned, if you are on an over-the-counter medication (such as Benadryl/Diphenhydramine, etc.)...although these medicines can help with both allergies and/or insomnia, you can develop a tolerance to the hypnotic (sleep inducing) effect.

Your first stop should be to a licensed physician for a thorough physical exam and possibly some labs as well. Although less common at your age than allergy-related or psychogenic causes of insomnia, there are metabolic illnesses (such as hyperthyroidism & others) which may be underlying causes. Your physician may also opt to refer you to a Sleep Medicine Specialist for further evaluation and treatment.

Again, I urge you to read over some of the previous comments and suggestions as there are many good points brought up on the subject.
Jorge A. Sabin
I agree with Dr. Hopkins' comments and suggestions but would also like to add that "tolerance" for sleep is confusing. If you are using sleep aids, whether prescription or over-the-counter, then maybe "tolerance" could be applied to the use of these type of agents. The key thing to remember about having insomnia, if that is truly what your diagnosis is, is that majority of your sleep difficulty is created by your own anxiousness towards trying to sleep. A cardinal principle I explain to my patients when I am doing CBT for insomnia is that the harder you try to sleep the less likely you are to sleep. It is natural to start becoming desperate to sleep but the elements of proper sleep hygiene, setting consistency with your sleep-wake schedule, and engaging in relaxing / mind-calming activities prior to bedtime to allow yourself to forget about wanting to sleep will help. Yes, it is harder said than done but remember that prescription sleep aids or even OTC sleep aids are merely band-aid fixes to the root cause of the insomnia. If one wants to truly "cure" his or her insomnia than behavioral approaches are the route to take. I would highly recommend that you seek out a board certified sleep specialist that is trained in behavioral therapy for insomnia.

Hope this helps but unfortunately there is no "quick fix". Good luck and hope you are sleeping the way you would like soon!
To make more personal recommendations, we would need to know your sleep and work schedules. I too am puzzled about your comment regarding "tolerance." We do not become "tolerant" to the amount of sleep required. At your age, the average person requires about 8 hours of sleep per night. I've listed some suggestions below that may be helpful:

1. Set a consistent schedule: If you work during the day, identify the latest time you can get up on most days and make that your standard wake up time. Then, count backward 7 hours. That is your new bedtime. Once you are sleeping well for 4 days in a row, advance your bedtime every night until you are achieving 8 hours of sleep.

2. Promote melatonin release: Try to keep your home dim starting at 5 pm and eliminate electronic media 1 hour prior to your bedtime.

3. Eliminate stimulants: Caffeine and nicotine are two common stimulants I recommend removing completely.

4. Try meditation: At this point, I assume you are having difficulty shutting down your thoughts when it is time to go to bed. Cover your clock or put it in a drawer and don't look at it at all throughout the night. Learn about progressive muscle relaxation or guided imagery. Try to occupy your thoughts at night with these techniques that offer focused relaxation.

5. Keep a sleep diary. It is rare for people to sleep only 4 hours at a time unless there is and underlying psychiatric illness such as bipolar disorder. Write down your bedtime, sleep time, and wake time for 2 weeks to see if there is a pattern.

6. Other sleep disorders such as restless leg syndrome or obstructive sleep apnea may be considered.

7. See a board certified sleep medicine physician to help you if your complaint persists.

Hope you are sleeping well soon!
Best tips: No caffeine after 3pm. No screens after 7pm (you need to let your melatonin turn on!). Try the app flux for your computer which reduces blue light. Get bright light in your eyes right when you wake up in the morning. Exercise in the early evening. Try a warm bath before you go to bed. Sharpen your nighttime bedtime ritual and stick to it. Tryptophan 500 mg can work wonders for some people. If you snore you might want to get a sleep study for apnea.
Trying to clarify, what tolerance are you referring to ? Are you using Benadryl or diphenhydramine products such as Unisom or Tylenol PM to help you sleep? Chronic sleep problems are often the first sign of depression. If this problem came on suddenly, I would suggest a sleep study to see if the problem is related to decreased oxygenation of your blood or nasal obstruction making you a "mouth breather". If the problem is chronic and has been present for years and you have tried the non-benzodiazepine sleep aids like Ambien, Sonata or Lunesta, then tolerance is possible and that is why increasing doses are available.

Regardless of the cause, I have found that using the Stanford sleep lab suggests are best and try going to sleep one hour LATER each night until you cannot stay awake any longer. In these cases resetting your sleep cycle, making sure the room is totally dark without any night lights and a low dose of 500 mcg ( micrograms) of melatonin has been shown to help after three weeks of regular use one hour before sleep is desired.
It depends. Progesterone is used to help people sleep. If it is low then people have a tendency not to sleep.

Also if your cortisol levels are too high at night that could be a problem too.

I would get your hormones checked by your doctor.
Sleep disturbances have several possible causes. Are you snoring at night? Wake up feeling like you had a restless night? That could lead to obstructive sleep apnea which would need a sleep study to evaluate further.

Other possible causes are mental health related (i.e. anxiety). Lifestyle causes can also affect sleep. Of course there are other causes of sleep disturbance which are less common.

I'd recommend initially to try what we call 'sleep hygiene'. Use the bedroom for sleep only (don't watch tv, read, eat snacks in bed, etc). Make sure the room is adequately darkened. Have a sleep routine which you follow (i.e. don't just jump into bed after a busy night out). You could even attempt over the counter melatonin if you're comfortable with it.

If that doesn't help then I'd go in to be seen. Hope that helps and good luck.
Sumeet K. Goel