Pseudoinsomnia, should I consider ECT?

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I may have developed pseudoinsomnia. My sleep is half-awake sleep and in 90-minutes-each fragments. It started one evening, when I tried to incorporate an unincorporable thought into sleep. That thought is now perpetually incorporating on its own; it's like a 24/7, autonomous background process.

I went to a sleep specialist and a psychiatrist for help, but I personally didn't find them helpful. I am now desperate.

I have tried treating myself with herbal and sleep restriction, and I am on eight sleep medications, with two strong ones and two that have been found to aid in pseudoinsomnia. I don't find any of these to be effective. I'm now eyeing ECT and am curious to how it will affect me. There is no consensus on its mechanism of work yet, but I know I have a dulled default mode network that is now hijacked and altered by this persisting thought; and somehow ECT can delete these alterations if it can.

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  • Posted

    Is it possible you're over-thinking this a bit? I'm speaking as a chronic insomniac (at least throughout my working life, though it got better when I retired), a sufferer from a number of sleep disorders, and a former neuro nurse.

    I too used to have sleep state misperception in my younger days. I'd be convinced I hadn't slept a wink all night, and even retain memories the next morning of what I'd been thinking about all night, but roommates and partners would tell me I'd even been snoring for quite long periods.

    Also, the waking every 90 minutes is quite common. I'm sure you realise this is the average length of a sleep cycle. If you put people in a sleep lab they'll all show some degree of arousal at the end of each cycle, and many will awake fully - though most have no memory of these awakenings next morning. These days I sleep much better than I used to, but I continue to wake fully at the end of each sleep cycle then naturally fall asleep again.

    I'm concerned that you think electroconvulsive therapy could help you. I suppose it might just alter your sleep pattern, but it's also likely to cause long-term memory impairment and all kinds of other problems. Has a psychiatrist actually proposed this drastic treatment?

    I'm wondering what the sleep specialist and the psychiatrist said/did about your problems. Did you spend the night in a sleep lab, for instance, and if you did, what was the outcome? "Unhelpful" isn't really enough information to form any idea of what went on. You also don't say how long this has been going on.

    Pseudoinsomnia basically does what it says on the tin: it's not inability to sleep, just a perception of insomnia. I agree it's annoying but it's not damaging to your health - unless, of course, you start obsessing about it, in which case it may harm your mental health. Usually treatments like CBT - accompanied if necessary by low-dose anxiolytics or antidepressants - are the most effective for this kind of anxiety disorder. However, there's no magic bullet and CBT requires time and hard work on the part of the patient.

    • Posted

      Hi.

      In my meeting with the sleep specialist, I was prescribed some medicine and was also informed that a psychiatrist will be the one to recommend ECT. Our conversation seemed to imply that they were on board with me or at least, were considering the possibility of ECT.

      What I forgot to add here (as I would like to present it first as a sleep problem) is that I have been enduring a condition for eight months now; I am incapable of forming affective memories and creative narrative about life or having real feelings; "I" doesn't feel like the me, I have acquired persistent psychogenic fever and an altered perception of surroundings.

      Psychosocial trauma: unlike a scarring or emotional trauma, psychosocial trauma is resolved with an explanation that makes psychosocial sense.

      The thought that I forcibly incorporated in my sleep is the resolution of my trauma. I have tried getting past this incorporated thought and managed a sound sleep, leading to the untraumatized, full brain functioning, that I felt.

      Sleep lays the "fix" to the equation. I myself am against the risky treatment; still looking for alternative ways to undo the sleep-wake paradox I created three weeks ago. But like you said, maybe this will come to pass. This might not even be like pseudoinsomnia at all.

      I still have a month of deciding whether I should lay my foot on ECT or not.

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