RE: Benadryl and REM sleep
Old thread, but the concerns are timeless. I thought I'd share some some hard-won learnings of the last 20+ years for me. Prior posts here touch on searching for a med to help stay asleep, so I'll start there ...
(1) Mirtazipine (generic for Remeron) is an antidepressant that brings sleep like nothing else. Melatonin is not remotely in the same league. Melatonin just begins sleep, it does not keep you asleep. Mirtazipine keeps you asleep. In fact, the one tricky part is that you have to - with great confidence - ignore the official doses, and start dialing in the dose to fits you. Too much and you will be still too "in love" with more sleep when the alarm goes off, and groggy most of the day. That's not much of a "win." Too little, and you don't really sleep as well as you could. But if you buy yourself a precise little scale (I got one that goes to 0.01 gram accurately), and keep a log of what you took, and how you did both overnight and the next day, you will find your new best friend, my fellow insomniacs. My sleep has gotten strong enough after years of multi-faceted support, that I've dialed my mirtazipine dose down to just 2 mg a night, and I do fine on that little. A doctor might tell you that I'm nuts & just convincing myself; that it's all placebo effect. Well, I'm a career R&D chemical engineer, of 31 years now. That does not make me right; but it makes me very practiced in the methods of experimentation. In this forum, I can't really write a whitepaper, so instead I'm giving a sincere testimonial: the med works. And I swear I'm not in any way employed by the maker. (I make specialty chems, not pharma.) I'm actually pretty disillusioned about most pharmaceuticals. Just not this particular one.
(2) For sleep apnea, I had several surgeries, raising my palate, and firming my turbinates (by scarring them). This helped a lot, but was not by itself enough. The post-op recoveries were no picnic, but I'd do them all again, if I had to.
(3) I also got a bite plate "for bruxism" (misdiagnosed by my dentist, who doesn't realize what 50+ year old teeth look like for someone who eats a very fiber-rich natural diet), which I happily got, primarily as a way to keep my jaw a bit more open. I know there are more carefully optimized bite systems for apnea/snoring, but I felt tapped out on health costs. The extra ~5mm open position from the bite plate helps. I just had to fight my dentist to not slope the underside, since that would create a backward-force tending to move my jaw toward my throat. Fortunately he relented, and I got my flat underside, and it works well: less snoring/apnea, as reported my my own experience, and my wife's observation of me sleeping.
(4) I lost ~25 lbs, getting down to a BMI of 26. I did that mostly by giving up grains and sugar, and replacing them with fats, especially saturated fats. I won't give book titles here, so no one can accuse me of hawking products, but Google grain-free diets, and you'll hit the big ones right away. Lots of really good information available, to those not married to medical dogma that's been debunked repeatedly over the last ~25+ year by all of the best research universities and colleges. I'm sure that losing the weight helped with the airway some. But here is the real benefit: before, I was always just a bit congested, despite living on a steady dose of antihistamines. But once I stopped eating grains, that of all went away. I take zero antihistamines now too. After ~2 weeks sugar/grain-free, I stopped craving carbs & sugar, too. Which made it possible to lose the weight and keep it off. Unlike most people who lose a fair amount of weight, I've kept the weight off for over 3 years now, all because I don't feel I'm fighting to do so (due to the diet change; those carb-loving species of gut fauna that feed the brain hunger signals are long dead).
(5) I'll confess that I use a nasal dialator strip, but I think it's just a security blanket. I'll probably stop them at some point here, but for now I just feel too protective of my sleep, and they don't cost that much in the big picture. But really, I can't see how they would affect apnea or snoring -- too far from the airways involved. I only ever used them for the nasal congestion (to avoid the discomfort of breathing through a teeny nasal airway). Which congestion is gone now (from stopping grains). So I should stop the the nasal dialators.
(6) Okay, I'll endorse a couple books on sleep hygiene: "The Promise of Sleep" and "Lights Out." I read 'em both around 1998 or so, and although they're long, I feel they focused me on on important habits to break, and to build. Sleep is the culmination of your day-long daytime behaviors. Many behaviors. All can have real impact on sleep:
[A] Excessive light in the last 2 hours before bed is a huge mistake. I put dimmers on every light in the house, and they all go down (or off) at 8:30pm. Computer monitors get dimmed too.
[B] Daily aerobic exercise - before 5pm preferably - is also a major pillar of good sleep. Shoot for every day, and if you miss one or two days a week, that's okay. And mix it up so it doesn't get stale. Doing that same one thing every day forever is just too hard on even the most Spartan of us. I have at least four core aerobic options, and variations within each of them. (And I don't skimp on good music while exercising. Good music is the best drug I know.)
[C] Also crucial is regular focused relaxation during the daytime -- some call it meditation. The point is to train the mind to know how to stop worrying. Most of us either work hard or play hard every waking moment, one way or another, even if it's physically passive like watching something on TV (say, a cop drama? .. nothing emotionally calming there). Learning to embrace calm pays huge dividends. I do it on my commute, on average a few times a week. Sometimes I do it on the elliptical machine in the gym (great since you have hands and feet guided, so you can close your eyes and zone out, while you exercise into a mild runner's high).
Granted all of this is a lot of work. But it's worth it. There is no shortcut to getting your life back from insomnia. When you start really sleeping again, you start to find how much balance can return to life -- the full range of feelings; not just a brave little spirit bearing up in some dark and empty place.
