Saturday, March 10, 2018

A minor miracle...

A minor miracle...  But one that looms quite large for me.

I have suffered from insomnia for my entire adult life – almost 50 years now.  Over the years I've tried just about everything one could imagine to address it, including two overnight “sleep studies” at clinics, both over-the-counter and prescription medications, meditation, and probably 30 other things.  Nothing worked.  Nothing.

Something like 30 years ago I got into a rough pattern of having 3 or 4 nights of little-to-no sleep (probably averaging 4 hours) followed by one glorious night of 7 or 8 hours of wonderful sleep, repeated ad nauseum.  A few things could predictably cause variations in this.  If I drank some alcohol a few hours before going to bed, I'd go to sleep easily – and then wake up 3 or 4 hours later with no possibility of further sleep.  A big meal too close to bedtime would keep me awake.  Watching an exciting movie before I went to bed ensured a sleepless night.  Working hard, physically, for a few hours would ensure a good night's sleep.  Other than those things, though, that pattern was what I could expect.

The first sleep study I participated in (about 25 years ago) identified one thing unusual with me: I responded to opioids backwards from most people.  Instead of making me drowsy, it's more like I drank 5 cups of coffee.  If I took even a small dose of any opioid after about noon, there was zero chance of me sleeping that night.  From what I've read more recently, this backwards reaction is true of 5% to 10% of adults (the proportion depends on what study you read).

The second sleep study I did just two years ago.  This time they had me wired up with about a bazillion sensors, and I didn't sleep at all – not one wink.  The technician who monitored me wrote of my sleeplessness in her report.  The doctor who reviewed the results diagnosed me with sleep apnea – something that, by definition, you can't exhibit the symptoms of if you're not asleep!  My GP tried her best to persuade me that I should try a CPAP machine, but I refused on the basis that the diagnosis couldn't possibly be right. I wonder, actually, if there's some incentive for the sleep center to make sleep apnea diagnoses...

About six months ago I was feeling achy, as I had been working hard that day (shoveling, as it happens).  I did something rare for me: I took a couple pills of a “nighttime” pain medication that we had lying around for some reason.  It was concoction of acetaminophen and diphenhydramine.  To my knowledge I'd never had diphenhydramine before in my life.  It's most commonly used as an anti-allergy medication; it's an antihistamine and the active ingredient in Benadryl.  I slept like someone who had been knocked out, for ten hours.  Further, I woke up groggy as hell – it took a couple hours, a hot shower, and two giant mugs of tea for me to be even barely functional.  I don't know how unusual that sounds to you, but for me that was a stunning result – I hadn't slept for ten hours straight for at least a couple of decades.

That, as you might imagine, got my attention.  I started experimenting to see how often I could take that drug and have it still work.  I quickly figured out that if I used it three nights in a row, the third night it hardly worked at all.  That was repeatable, too.  More experimentation and I figured out that I could take it one or two nights in a row with good effect, and then I had to lay off it for a couple days.  That means I could get 3 or 4 nights of good sleep in one week.  This was the first miracle for me – the best sleep, overall, of my adult life.  But it gets better!

About a month ago, I started worrying about the effects of regular use of diphenhydramine, so I started researching it on the Internet.  If you've ever tried to research a common medication on the Internet, you can probably already guess what I ran into.  I'm sure I could have found a paper whose conclusion was anything between “essential for life” to “potent poison”.  However, in general the papers were very reassuring: there don't seem to be any generally recognized horrible outcomes of regular diphenhydramine.  Great!

But in the course of that reading, I ran across one paper (and I can't find it now, dang it!) that noted something that resonated with me: a significant percentage of people with “backwards” opioid reactions (like me!) were unusually sensitive to the sleep-inducing effects of diphenhydramine.  Furthermore, these people often could reduce the bedtime dose of diphenhydramine to as little as 5 mg (I was taking 60 mg).  At the lower doses the quality of their sleep was actually better, and most of them could adjust the dose to eliminate the early-morning grogginess.

I suspect you would have to be a long-term insomnia sufferer to understand why that was so exciting to me. :)  I immediately started experimenting with lower doses, and within a few nights I had positive results.  I'm still experimenting, but I have a relatively narrow window to refine: my optimal dose is somewhere above 7.5 mg and at or below 15 mg.  I've tried as many as four nights in a row at 15 mg, and it still works just fine.  My morning grogginess is very mild at 15 mg.  Next up are some tests at 10 mg.

But the bottom line is that for an entire month now, I've been able to sleep well most nights.  Quite literally, I cannot remember another month like that in my life.  I've completely stopped my old pattern of waking up at 2 or 3 am.  This morning I slept like the proverbial log until 7:30 am – something that until this past month was something I only rarely experienced.  It's probably to much to say that I'm sleeping “normally”, but this is by far the closest approximation I've ever made to that!

I can still scarcely believe that this common, cheap, over-the-counter drug could have such a profound effect on my life.  It's undeniable, though.  Now I have a new fear – that this miraculous change in my life will somehow disappear or become ineffective.  I'm being stingy with its use because of that, and if I see that starting to happen I'll back off even more.  But in the meantime ... not suffering from the effects of insomnia sure feels good!

One word of caution for any fellow insomniac reading this: from my research, it appears that my reaction to diphenhydramine isn't the most common one.  It's also, apparently, not exceptionally weird.  If you decide to try this, your results might be anywhere from the opposite of mine to merely wildly different.  In other words, your mileage may vary.  But for me (so far, at least) it is well into miraculous territory...


  1. That was interesting. The list of drugs there almost exactly matches the drugs the "sleep doctors" tried on me - except for diphenhydramine! Those comments about not being addictive I read elsewhere as well, and I was very glad to see that...

  2. I think every parent knows the Nyquil trick lol. Not sure all the ingredients in that one but it's antihistamines that put you to sleep. Now they even have something called zzquil with the main ingredient being Diphenhydramine HCl.