F.E.A.S.T's Around The Dinner Table forum

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joysomeday
Hi, looking for some help on my ds insomnia.  For the past year or so she has had insomnia, sometimes better sometimes worse.  I definitely believe it is to some extent situational, as she does sleep better at home than at school.  She has tried several prescription and non prescription sleep aides and nothing works consistently.  I have encouraged her to  try guided meditation and to improve wherever possible good sleep routines.  She claims to give it all a try but nothing works in her opinion.  She is currently using Temazapam, but it is not working as well as in the past.  I have tried suggesting to her to alternate or cut back, so when she does use it the effectiveness may improve, but I think she winds experiencing a rebound type of insomnia.  She is currently taking effexor, which can be activating so she takes it in the morning.  She also takes geodon.

Any suggestions would be greatly appreciated.

Thanks
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IrishUp
joysomeday - I am sorry that this is an issue for your d. Insomnia is pretty common in people with ED or other anxiety related issues. It does not surprise me that medications are only of limited help. It is often the case that internal states can overwhelm a drug's effects - Idgie posted an article by someone with profound anxiety symptoms that illustrated this dynamic pretty well.

Our d would frequently make the claim that "I've tried that and it doesn't work" about behavioral strategies. Even when things like relaxation techniques, improved sleep routines, and the like are helpful, they don't work INSTANTLY, and it takes a real commitment to making that kind of thing a pattern for long enough for it to start to be effective. But of course, insomnia and the attendant fatigue, raised stress and irritability, and lowered distress tolerance that sleep deprivation bring, only serve to further reduce many people's ability to put behavior mod in action, if they don't have adequate support.

I am assuming she is away at college. Is she living in a dorm or with roommates? Is she working with a T when she is away? It seems like a good first place to start, is to identify resources near her you can enlist, to help increase her on-the-ground support. Ideas off the top of my head:

The overall idea would be to get her to agree to commit to a concerted effort for a short, but long enough time - like say a month. 

Break it down into baby steps: maybe first work on making bed/wake up time routine? Or identifying relaxing things she can do in bed, even if she can't sleep? Or help her identify a calming pre-bed routine. But put one thing in place first, and when that is happening, add another helpful element in.

Could parents then act (via phone or text) as nightly reminders (or wake up calls) to help keep her on a good schedule? 

Is she working with a T? If parental support feels like too much of a step back, maybe she'd agree to some limited sessions with a T or MD who specializes in sleep and/or anxiety?

See if you can talk to a roomie, and get a sense of how busy/noisy her living space (and bedroom) is. See if you can get roomie to help you help her find a routine. 
IrishUp
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Foodsupport_AUS
My D too has had significant sleep issues. There are a number of factors including the anxiety, and eating disorder thoughts creating a running commentary at night time, and making it hard to go to sleep. She also tends to wake early as well and then the same factors stop her going to sleep. My D does take some anti-psychotic medication still for ongoing intrusive thoughts because this tends to be sedating she does find it somewhat but not always helpful in getting her off to sleep. (She too is also on Efexor taken in the morning).
I have also had the old, tried that nothing works. Part of the problem is that distress tolerance can be very low in people with ED, and my D is no exception. If she struggles to sleep she gets more worked up about it.

So what has worked:
Regular sleeping and waking hours. No excess sleeping in, or excess late nights either.
Turn off technology at least an hour before bed. Quiet activities, reading, showers etc..
If when getting in to bed sleep doesn't come soon, continue to relax. Don't have a clock nearby so she can't check the time.
If really can't get to sleep, get up and do quiet activity eg. read, draw until feel tired again, then return to bed.
Remind her that despite the feeling of not sleeping that she really is getting rest even just lying in bed.
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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lostmum
Have they tried Melatonin? This is natural and helps regulate sleep and is very effective,it is only used short term to retrain the body into a good sleep pattern alongside good bedtime habits
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dms
Melatonin 3 mg worked well for our daughter to re-establish sleep patterns after too much use of caffeine based diet pills.
 Found that the "melt away" tablet worked best  due to faster absorption from the mouth rather than the regular tablets that had unpredictable absorption from the stomach. Currently she is using Vitamelts brand by Natures Made, comes in a small container looks like a Tic Tac container.
Also got her a wonderful CD with Delta Waves woven into the sounds of the ocean which seems to help her. Ironically, bought it at the hospital's gift shop when she was inpatient back in October.
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joysomeday

Hi, and thank you all for your replies.  My d has tried melotonin separately and as an add on to her sleep meds, but has within the past month or so not taken any, going only with the scrips.  I am going to suggest re-introducing them, perhaps on alternate days, as this is how she started out to see if it helps.  While she is home it will be easier to see how she does.  I am also going to encourage her to do some light exercise-she has been away from it as a combination of both a slightly lower wt status which has improved and loss of interest.  It has always been a stress release for her, and not compulsive.  I am not naive to think that it has not crossed her mind to use as a wt management tool, but not one she has implemented even while away at school.  So, while she says she does not like yoga, we have a am/pm yoga dvd that maybe she will do with me and some short walks to re introduce some activity.  It should help with her mood and hopefully her sleep.  DMS-we have been using tablets, I will look for the meltaways, also if you could forward the name of the CD perhaps I can find it and give it a try-if she does not like it, it sounds like something I might enjoy and find helpful-as we all know how this rollercoaster affects us and our sleep too.

Irish up you have really described what is going on with my d and the cycle and pattern that developed.  It makes sense what you indicated about the in the internal states overriding the meds.  My ds idea of trying for a long time, would probably consist of a few times a week, and then not getting any where stating it does not work for her.  Now that the commotion of Christmas is over, I am going to  push for a commitment to gradually try and re introduce some of the suggestions noted here.   .  I have told her to stay away from logging onto the computer when she can't sleep as between the computer lighting and the the stimulus of watching a video etc, or texting, as it is too engaging, though she would say  it distracts her from her thoughts about why she cant sleep and then stresses about not sleeping.  She does like to draw and that is calming so that is a good idea to give to her, and pehaps find her some boring magazines or catalogs to page thru.

The distress intolerance on the sleep issue, as you and Food Support both note is so key as to how it affects the ability to try and really implement good bedtime habits. 

She does see her psychiatrist on a wkly basis and he has suggested some of these ideas as well.  She has an appt w/her MD in a wk and I will inquire, and have her speak to my d as well.

Thanks, will provide an update as things move along.  Again, I appreciate all your input.  Always helpful.


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dms

Hi Joy,
the CD is called Sleepy Ocean by Dr. Jeffrey Thompson (you can google him -he is well known for his work in acoustic therapies).  It integrates delta waves with the sounds of the ocean - we live at the beach and love the ocean sounds, but if you don't love the ocean, there are others in the series that integrate delta waves with other sounds for sleep like thunderstorms (which would only make my daughter more anxious since we don't have those in southern California!)
Can buy his CDs on amazon or just google him and find his web sites.
Also are CDs for theta waves for relaxation, but the delta waves are for sleep.
  For the melatonin, if you can't find the Nature's Made Vitamelts, there is another brand, Natrol, also makes a  meltaway melatonin that she and I both have used.  
Oh, we have an am/pm yoga DVD too which we have done together   - but we ended up laughing too hard every time he got to the part about " relaxing the inner corner of your eyes" [smile]  We started recording episodes of yoga on the Veria Living channel instead.
Oh, and I use the Sleepy Ocean too..definitely need the help for the rollercoaster of hope and hurt.
Hope the next part of your journey is more of the hope end of things.

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Amoma
There are drugless approaches to insomnia that also work. I personally went through a period of acute insomnia and saw a renowned sleep psychologist who used CBT to retrain the brain to recognize the bed and associate it with sleep. Anyone can do the following to improve sleep tonight. It costs nothing and can improve your life...start tonight:

Improve sleep hygiene.

1. Go to sleep at the same time every night. The body follows what are called circadian rhythms cyclical in nature
2. Make the room cool and dark at bed time
3. The body's core temp needs to be lower at bed time comparatively to during the day
4. unplug from devices an hour before bed time. Studies have shown that the ambient light from devices keep the brain in an awake state
5. Bed is for sleep and (well for adults for one other thing)
6. Exercise, but during the day. This will allow the core temp to be lower at bed time

DO meditation daily to elicit the relaxation response
breath meditation
listen to a guided body scan.
ps dms thanks so much for the recommendations!
those delta waves CD's sound amazing. Just checked them out. You can buy on iTunes for $9.99

If she can't fall asleep get out of bed, go to a couch or lounge chair and in low light listen to some relaxing music or read a low level catalogue or magazine until feeling sleepy again. Come back to bed. Do this again until the brain associates being in bed with sleep.

Soon the zzzz's will improve
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