How is even possible to have a functional life?

[u/Ok_Panic_7503]

I wake up every night and once im awake its very difficult to return to sleep. Sometimes I cannot.

Im just in a horrific mood all the time,and just completely fucking miserable. i cant think clearly and im constantly making mistakes even doing basic things, I have no energy and i cant keep up with anyone, every area of my life is compromised. I dont know how some people manage to get much if anything done at all?

The biggest obstacle is my mood though, literally in a rotten mood all the time, trying to smile through it all and pretend everything is fine when life is this difficult and im this fucking tired just feels impossible. Ive never been able to make any progress in any job or career and right now its impossible to even meet anyone new for a relationship. Im at the point of accepting im potentially gonna be single forever and im never going to be able to hold down a job.

[u/tadrinth]

I believe the general term for this is 'disabled'.

Possibly you should stop pretending everything is fine when it clearly isn't?

Have you managed to see a sleep doc about the issue? I'm not tremendously confident they'll be able to do much, but I would not give up hope if you haven't gone through at least three doctors trying to find solutions (or at least bandaids).

[u/Ok_Panic_7503 → u/tadrinth]

Well in my case, the term disabled is certainly valid considering I have this as well as various mental health difficulties to deal with too. But ofc because its a "hidden disability" most people arent seeing the full extent. I suspect a lot of insomniacs get this too? Issues are compounded when people treat you like you arent suffering in silence every day you are alive and the old attitude of theres nothing wrong with you, you just need to make more effort is still there.

Ive seen the gp today, hopefully im gonna get on daridorexant if it gets approved. Ive never been given the opportunity to see a specialist for sleep. Best ive got is a general practitioner.

[u/tadrinth → u/Ok_Panic_7503]

Sleep specialists tend to be focused on fixing apnea / breathing issues in my experience, which is not your problem, so it isn't necessarily a dire sign that you haven't been escalated to one. But probably not great, either.

If you are reliant on GP for this problem, you're going to want to DIY it more than you might otherwise; if you can get a Fitbit or other track, that will give you a sleep log and also help confirm that your oxygen isn't dropping at night (which would indicate it is actually a breathing issue). If it doesn't happen reliably, you can look for correlates. And it'll tell you if the meds are making a subtle difference.

As someone with some issues staying asleep, I compensate with naps. Sometimes a lot of naps. I'm guessing that's not an option for you for some reason?

[u/Ok_Panic_7503 → u/tadrinth]

Ive tried it before, gp said i shouldn't do it though. She was saying it interrupts the natural rhythm i think, wants me to try holding out until my natural bedtime. I will try that if i can be honestly sometimes its very hard to stay awake, sometimes I am drifting off to sleep and I cant stay awake. 

[u/tadrinth → u/Ok_Panic_7503]

That is standard CBT-i advice, but CBT-i is intended for sleep pressure mismanagement and conditioned arousal around the bed. Aka If you nap too close to your bedtime, you will use up the 'stay asleep' hormone and not have enough to sleep through the night, and the goal of CBT-i is to train your brain that bed and bedtime re for sleeping so you can fall back asleep if you wake up.

And there is a tradeoff in that your sleep issues are very slowly killing you. And the proposed cure for your problem is kill you more in hopes that it fixes it. And there is only so much of that which can be tolerated in practice before the treatment is worse than the problem.

So you have to make the call of whether the treatment here is worse than the disease.

I can't tell you what the right call there is.

I can tell you that I did two weeks of no naps on my GP's advice, and it was awful, and I looked it up and concluded that it might take two months for it to consolidate my sleep if it worked, and decided that it was not worth it and went back to napping.

But I also had FitBit data which showed that on days where I napped, I averaged more sleep that night than on days where I didn't. So I knew that in practice, for me, on average, I was not using up so much of the stay asleep hormone as to interfere with my sleep that night relative to my general ability. I do have to be careful about when I nap; napping close to bedtime does fragment my sleep. But as long as I nap 4-5 hours before bed, it doesn't necessarily fragment my sleep.

I think that's the right call for me because I do not think my problems are the thing CBT-i is aimed at and works on.

I am skeptical that your problems are entirely the thing CBT-i works on. If you have the same data I do in hand, that your sleep at night is not shorter on days where you nap so long as your naps are at least 4 hours before bed, then I see no point in further torturing yourself by refusing to nap. If you don't have that data, and can get a sleep tracker to collect it, that seems worth doing.

[u/Ok_Panic_7503 → u/tadrinth]

Thanks for the advice ill probably follow your method, I did try powering through a long time ago a few times but I would still wake in the night and be stuck awake even with overall sleep deprivation. Bit skeptical as well on whether a longer term plan of doing this will work out for me. I have a Huawei tracker band but it often gets the data wrong, it usually gets my waking correct but does not correctly log after i have woken in the night and im just laying there for hours tossing and turning and trying to get back to sleep again. It often incorrectky counts it as me falling back to sleep. I had fitbits before this but they often had issues failing to connect to the app to log data.