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STENDEC

The Sleep Thread 😴

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I went to bed at 2330. I slept soundly with earplugs and a mask. I woke up by 3AM when the FUCKING BIRDS started their chatter. Got to bed for a while longer, but more bird chatter as 0530 approached rendered my attempts to go back to sleep useless.

 

Lately, earplugs and a mask are necessary to stay sleeping past my ~4-5AM piss break. I've been employing them pretty much full time for the last week and overall, it has paid off.

 

I really wish I could sleep more like my wife...sounds and light don't bother her at all. 

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5 hours ago, Something Anonymous said:

 

I just looked up the Zeo. Looks like they can still be had online. I am curious.

 

I went to bed last night at 11, fell promptly asleep, and woke up at 6:30. I don’t recall waking up once, but I do recall dreaming. This is not how I usually sleep. My baseline is to take 25-30 minutes to fall asleep, wake up once or twice, and after 4.5-5 hours of sleep I’m wide awake.

 

I worry that I am sleeping longer because I am sleeping poorer on the modafinil and building up a sleep debt? I read a study that modafinil increased slow wave sleep in recovering cocaine addicts which lead to improved abstinence outcomes vs placebo so maybe its making my sleep better somehow. I never used cocaine or other recreational dopaminergics but I did recently (2 months) drop a long standing heavy nicotine habit so maybe it’s helping with that. 

 

Regarding Modafinil: I'd have the same concerns. Modafinil has an extremely long half-life for a stimulant. You still have a good amount of Modafinil in your blood when you wake up the next morning. I've often wondered if chronic Modafinil could worsen sleep in some, but mask it with the stimulant effect during the day.

 

 

The Zeo is an interesting tool, but it never really produced any major revelations for me. I still trust it more than any of the crude fitness band sleep trackers that try to guess your sleep cycle according to your movement. You can't expect an accelerometer to match the accuracy of a basic 1-channel EEG like the Zeo.

 

The Zeo headband has replaceable contact pads that only last about 1-2 months. Even if you could buy a Zeo, you'd have to make your own EEG pads for it. There are some DIY guides online. I've been storing my last good Zeo headband pad for some future sleep experiment. I should pull it out and use it.

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Philips has a new sleep headband that claims to enhance deep sleep: https://www.usa.philips.com/c-e/smartsleep-headband.html

 

It claims to enhance slow wave sleep by playing specific audio tones when SWS is detected. If this was a Kickstarter project or some random startup company, I wouldn't have believed it. However, this is Philips, and there are some studies that support the claim. To their credit, Philips has even run registered clinical trials on the device: https://clinicaltrials.gov/ct2/show/NCT03665844

 

At $400 it's not cheap. I'd buy it right now if I was confident it would provide some benefit, but I'm not convinced yet. Even anecdotal reviews are hard to find online.

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Regarding modafinil:

 

F that stuff. It ruins sleep. I don't care what the study shows. Maybe being on modafinil allowed better sleep than being on coke, but being on neither is best. 

 

I got some RXed when i was switching shifts for work. Bad idea. It kept building up until it felt toxic even with smaller and smaller doses. Kinda like buprenorphine but in a different way. My jaw was constantly clenched and even when I had the opportunity to sleep 8hrs, that shit would cause me to not be able to sleep more than 4hrs. And it masks the fatigue, but my body started showing the signs. I lost more and more weight, had headaches, and felt shaky from fatigued nerves. My poor jaw was sore from being clenched all the time. 

 

Remember, my dosing was tapered down until i found that 25mg was even too much and decided to stop it. 

 

Studies don't show everything. If you're of a certain personality/behavior type, this stuff doesn't mesh. I'm kinda hyper already, move a lot, dominant personality. Modaf was a horrible combo for each of those traits.

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That’s good to know, and I share your concerns. After maybe a month now of continuous use it is definitely feeling a bit that way to me as well - that I’m borrowing from tomorrow to have more of today. 

 

Appreciate the feedback.

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On 6/2/2019 at 11:06 AM, Construct said:

At $400 it's not cheap. I'd buy it right now if I was confident it would provide some benefit, but I'm not convinced yet. Even anecdotal reviews are hard to find online.

Zeo was a good machine, but the price was about 2x what the market would bear. I looked into buying the Zeo database when I was with a machine learning startup, but someone else had already grabbed it (Philips?)

 

Electronics are so capable these days, I don't understand why a consumer-level device isn't available at the price of a Fitbit

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1 hour ago, Sanction said:

Zeo was a good machine, but the price was about 2x what the market would bear. I looked into buying the Zeo database when I was with a machine learning startup, but someone else had already grabbed it (Philips?)

 

Electronics are so capable these days, I don't understand why a consumer-level device isn't available at the price of a Fitbit

Some day we'll have to meet up for a beer so I can hear about that ML startup.

 

ResMed bought the Zeo IP. They didn't actually do anything with it, as far as I can tell.

 

I had the original Zeo, but I never used the website. They were a hacker-friendly startup at the time, so they offered a custom firmware update that emitted the raw data out of a hidden serial port on the back of the device. I just logged that directly. I still have months of timestamped sleep waveforms from over a decade ago. Might be interesting to compare them against my current waveforms, but really I'd need some analysis software to make it work.

 

As for the Zeo hardware: It would trivially easy to make a battery-powered, bluetooth EEG headband prototype these days. Could probably piece most of it together from reference designs on Texas Instruments' website, really. The real problem is lack of real-world utility. I could look at my Zeo score and think, "That looks about correct for how I feel". It didn't really provide any actionable info, though. I still enjoyed it.

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7 hours ago, Construct said:

I could look at my Zeo score and think, "That looks about correct for how I feel". It didn't really provide any actionable info, though. I still enjoyed it.

 

This is, of course, the issue with sleep tracking. It's all retrospective and it is also hard to know what to do to change it....and in most cases, how you feel in the morning is as accurate as anything else.

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I don’t know how long I have been taking 200mgs. of Modafinil now, I stopped keeping track, but I think it’s been 6-7 weeks. In that time I am fairly confident based on just how I feel that it has improved my sleep quality. I fall asleep fast and sleep soundly for 6-7 hours a night with multiple dream cycles that I can recall. I wish there was a way I could measure this stuff objectively. The only odd change is that my normal self will wake up full of energy and ready to go after 5 hours of sleep, but on Modafinil I sleep soundly for 50% longer but wake up like I imagine most people to wake up - hitting the snooze button a few times. 

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11 hours ago, Ras said:

Do you think you may be experiencing micro-awakenings/REM parasomnias based on the increased dream recall? What you are subjectively reporting sounds like degradation in sleep architecture to me.

 

https://www.nature.com/articles/npp20146

 

Well, that sucks. This very well could explain my increased dream recall. Damn. I wonder if I am going to crash hard on this when I come off.

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For some reason my doctor has reversed her opinion on Ambien. Now believes it to be the superior choice over Trazodone for sleep quality. I didn't have time to ask why, but I did specifically ask for the CR version instead of the regular instant release version. I also asked for the lowest available dosage to play it safe.

 

So far, I like the CR version much better than regular old Ambien. Comparing the pharmacokinetics shows the additional area under the curve for the CR over the IR. The absolute differences at the 7-8 hour mark isn't massive, but subjectively the CR is much better than the IR for staying asleep through the night.

 

I collected Zeo data for a week before switching and I'll collect a week after switching. My sleep fragmentation, overall sleep duration, and early morning waking were worse than I was admitting to myself. Seeing the 60/100 Zeo sleep score multiple days in a row put it in perspective for me, hence the return to the doctor. Maybe the Zeo has more value than I gave it credit for.

 

 

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34 minutes ago, Something Anonymous said:

What about the correlation with hypnotics and dementia? Isn’t that a thing? I don’t recall the specifics.

That is probably most true for anticholinergics. I would avoid those meds for long term use.

 

WRT non-anticholinergics, I don't have a recent list of studies but the ones I recall are hopelessly confounded -- epidemiologically, there is an association between drug use and impaired cognition. But what causes what? People don't take sleep meds because they are doing well. They already exhibit problems. So, surprise, those sleep drug users may already have mild cognitive impairment. Over time that may develop into Alzheimers for a subset of users. Non-drug users feel better (don't need a sleep aid in the first place) for whatever reason, and that leads to better health in the future.

 

The authors (usually MDs) assume the drugs cause AD, and that assumption is an undergrad-level error of experimental logic. Such MD-led studies are rife with ultracrepidarianism. I'm not saying they are wrong, just that they don't know.

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3 hours ago, Sanction said:

That is probably most true for anticholinergics.

 

And it is worth noting that many hypnotics are not anticholergenic either. Benzos and Z-drugs don't have much anti-cholergenic activity, neither does trazodone. 

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1 hour ago, Sanction said:

That is probably most true for anticholinergics. I would avoid those meds for long term use.

 

WRT non-anticholinergics, I don't have a recent list of studies but the ones I recall are hopelessly confounded -- epidemiologically, there is an association between drug use and impaired cognition. But what causes what? People don't take sleep meds because they are doing well. They already exhibit problems. So, surprise, those sleep drug users may already have mild cognitive impairment. Over time that may develop into Alzheimers for a subset of users. Non-drug users feel better (don't need a sleep aid in the first place) for whatever reason, and that leads to better health in the future.

 

The authors (usually MDs) assume the drugs cause AD, and that assumption is an undergrad-level error of experimental logic. Such MD-led studies are rife with ultracrepidarianism. I'm not saying they are wrong, just that they don't know.

 

 

That was my question as well - I haven’t read the research but I thought I had seen something that showed a direct correlation when other confounding variables were accounted for. 

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I certainly don't think Ambien is great for long-term health. If I could get back to 7-8 hours of sleep most nights then I'd gladly abandon the Ambien plan. Right now, Ambien is the lesser of two evils in my book. It's a short to medium term solution while I work on cutting some other stressors out of my life.

 

Sleep deprivation itself has some correlations with Alzheimer's disease severity: http://www.jneurosci.org/content/early/2019/06/17/JNEUROSCI.0503-19.2019

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I don't know that it is bad for you per se...the biggest risks seem to be from car accidents the next day or sleep walking/eating/driving so if you are not having those problems, I don't know that you are doing any real damage.

 

I just ordered one of these because one of the side effects of trazodone is (apparently) more snoring....I suspect that the significant increase in "deep sleep" is the cause. My wife says no indication of apnea, just noisy and persistent.

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4 hours ago, STENDEC said:

I don't know that it is bad for you per se...the biggest risks seem to be from car accidents the next day or sleep walking/eating/driving so if you are not having those problems, I don't know that you are doing any real damage.

 

 

I don't sleep walk on Ambien, fortunately. The few times I've had to be awake in the middle of the night on Ambien I've been fully aware of my medicated state and my limitations. It helps to take the lowest available dose.

 

As for long term effects: I've never noticed much in the way of tolerance to Ambien, but I can't imagine someone could dose a GABA-related drug night after night without inducing some GABAergic changes. I can't provide any evidence for that, but I'd prefer not to risk it.

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The z-drugs were developed in an effort to avoid the tolerance and dependence issues of traditional benzos and from what I have read, they were largely successful at that. Most of the case reports that exist in the medical literature involve individuals with other drug dependence issues.

 

I suspect the biggest risk aside from daytime impairment and somnambulism is psychological dependence.

 

 

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"An overall number of 33 240 (e.g., 23 420 zolpidem; 9283 zopiclone; and 537 zaleplon) misuse-, abuse-, dependence-, and withdrawal-related adverse drug reactions, corresponding to some 6246 unique patients given Z-drugs, were here identified."

 

This was over 15 years of surveillance in Europe...given the number of times z-drugs were prescribed in that population over that same time period, the incidence of of problems seems pretty low, even factoring in a high level of under-reporting. It might also be worth noting that ~40% of the ADR for these drugs in this dataset were intentional overdoses.

 

Clearly the risk is not zero but it also seems pretty reasonable given that unmanaged insomnia carries its own set of risks

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31 minutes ago, STENDEC said:

"An overall number of 33 240 (e.g., 23 420 zolpidem; 9283 zopiclone; and 537 zaleplon) misuse-, abuse-, dependence-, and withdrawal-related adverse drug reactions, corresponding to some 6246 unique patients given Z-drugs, were here identified."

 

This was over 15 years of surveillance in Europe...given the number of times z-drugs were prescribed in that population over that same time period, the incidence of of problems seems pretty low, even factoring in a high level of under-reporting. It might also be worth noting that ~40% of the ADR for these drugs in this dataset were intentional overdoses.

 

Clearly the risk is not zero but it also seems pretty reasonable given that unmanaged insomnia carries its own set of risks

Yeah, the peril is with the prescriber in this case - if you are prescribing to a patient with pre-existing issues, you are asking for trouble. Also, if you look at the PRRs of Table 2, you will see most of the confounders that you listed above are identified.

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