It’s been like 3 weeks now that I’ve woken up at 4am without good reason. Have tried physical activity, melatonin, going to bed earlier… nothing seems to work. Any advice is appreciated.
In medicine we are taught that the first line treatment for insomnia is treating the underlying illness—in your case, potentially depression— otherwise, CBT-i (cognitive behavioral therapy - insomnia).
So my first recommendation is to seek care from your physician for your depression.
Otherwise, there are well described self taught classes for CBT-i. I have told patients to check out the VA’s website for this: https://mobile.va.gov/app/cbt-i-coach
It is a lot of the sleep hygeine described in another excellent post hew.
I dealt with this for a while, although I don’t think that it was depression related. I think it was more to with stress from work/ moving.
Exercise is good, I think going to bed earlier is counterproductive. You may want to look at sleep restriction therapy- the idea is that you are trying to minimize the time you spend in bed while not asleep.
What do you do when you wake up? Keep in mind that waking up in the middle of the night is completely normal- everyone does it, it’s just normally you fall right back asleep and don’t think about it. Are you scrolling on your phone, getting up or just laying there? Definitely don’t look at your phone at all, that’s probably the most important aspect of sleep hygiene.
Ultimately I think for me what helped me get over this was just becoming “zen” about waking up early. When it first started happening to me I was thinking “ah shit not again! I need to relax right now to fall back to sleep! Oh no another 30 minutes have passed and I’m still awake!”. But over time I would just wake up early and be like “eh whatever, hopefully I can get back to sleep.” Being okay with not falling back asleep makes it easier to fall back to sleep, it’s kind of a catch-22.
Other things that have helped:
- I don’t like melatonin on a nightly basis. Honestly I don’t think taking ANYTHING on a nightly basis is a good idea. Your body will adjust and you will be back where you started. Melatonin worked for me for a week or two and then stopped. I still use it very rarely but only to reset my sleep schedule, like if I have to go to bed really early one night.
-Going back to the being chill about waking up early, try taking magnesium glycinate. Again I wouldn’t treat this as a long term fix but it might help short term. It’s a mild sedative, I find it helps me sleep more deeply and relax.
-Are you getting cold? I have a high metabolism and I get colder as the night goes on. Adding an extra blanket when you wake up might help you fall back to sleep by lowering your metabolism.
-if you’re laying awake for more than an hour it’s time to get up. That goes back to the sleep hygiene thing as well. You want to make your bedroom a sleep sanctuary. During the day keep your time in the bedroom to a bare minimum and don’t go to bed until you feel properly tired.
I hope it gets better for you m8. Improving sleep is tricky because it’s not something you can actively try at, at least not the same way you exercise or something. I should add that there are super-short-duration antidepressants that you can take to fall back to sleep. There mentioned to me by a doctor although I never took them so I don’t remember the name of the drug.
This takes me back to the bad old days!
I will say depressive naps I took probably contributed to this more than anything else. When you’re getting 4+ hours of sleep during the day, you’ll only sleep so much at night. When I stopped doing that this problem almost entirely went away.
