Everyone is different so I'm not suggesting this as a general cure-all, however I'd like to relate my own personal anecdotal experience.

I've always had insomnia since I was a kid and I just chalked it up to "being a night owl." As a teenager, I mostly solved this by living in a permanent fog during the week and "catching up" by sleeping in on the weekend. As an adult, I was suffering greatly from chronic sleep deprivation because adults (mostly) don't have much control over when they can wake up to start the day.

Around 10 years ago, I started taking 5mg melatonin. It's going to sound like I'm overselling it, but it changed my life. It _very reliably_ makes me sleepy 1-2 hours after I take it. If I forget to take it, I am fully awake until the wee hours of the morning. Is it important to note that (for me), after I take it, I have to engage in some passive activity like (calm, non-shouty) YouTube repair videos or reading. Also, the "window of sleepiness" is at most about 30 minutes and if I decide to power through it, I will come out the other side fully awake again. Melatonin does not "force" me to sleep, only highly encourages it.

I was skeptical of melatonin for the longest time. Generally, I rarely see much if any positive effect from supplements. But (for me!) this stuff really works. If anyone reading this is on the fence, I highly recommend giving it a try. (With the acknowledgement that it takes about a week to get into a solid sleep schedule if yours is currently disorganized.)

This is a very important paragraph from quern's article

> There are few to no side-effects to melatonin use in adults (there is uncertainty about the risks & benefits in children & adolescents28), and it is not addictive or habit-forming like caffeine is. The usual dose for a night is 0.5-3 mg and I take 1.5mg [29]; my dose is highly likely to be too high. High doses may well be responsible for why some people try melatonin and report that it does nothing or hurts them, since in one study, the best dose for old people was 10x smaller (0.1mg or 0.3mg) and for one blind person, 0.5mg [30 31 32] . Zhdanova et al 1996 found 0.3mg & 1.0mg to affect sleep onset similarly. A study of delayed-release melatonin found with their high dose of 4mg (but not 0.4mg) elevated melatonin levels 10 hours after bedtime ( Gooneratne et al 2011) - potentially interfering with waking time.

It is difficult to find doses as small as 1mg sublingual (dissolve under the tongue) in my area. Everyone is trying to sell you 5-30mg chewables. And, I expect everyone is buying them under the assumption that more is better. But, here it explicitly is not.

The way melatonin works well for me is to wait until I'm already settled into bed and should be asleep, but I'm not. Do a couple body scans to relax for real. Try to think about something mindless. Then if I'm still awake, pop 1mg under my tongue. I'll usually wake in the morning with half of it drooled on my pillow :P

The evidence that humans would naturally be designed to sleep “multiple times a day” is quite mixed. “Multiple” does a lot of heavy lifting here, when basically most evidence points to two batches, following either of these patterns:

- a long uninterrupted night cycle and a short (20-60 mins) afternoon nap. Around 2pm. - a night cycle split into two halves. With a 1-2h break (maybe up to 3h) starting around midnight to 2am.

The former is still very common, and imho stretching the definition of multiple cycles. The latter is more historical (more common when there are long winter nights and no electricity).

Also making it a “Western” problem is kinda weird? There are other cultures where single cycle sleep has existed. Even hunter-gatherer groups with little to no contact with the west. And alternatively afternoon naps are still quite common is some western areas. I guess the main thing that prevent it would be the classic work day schedule.

The comment above just said “sleeping pills” which is ambiguous. Melatonin is an OTC supplement. True “sleeping pills” are usually controlled substances and few doctors would prescribe them as first-line options for a patient who shows up with first time complaints of sleep problems. They won’t be prescribed long-term either. The part of the post that says doctors (plural) tried to prescribe the pills makes me think it’s not traditional sleeping pills, because in this environment you would be unlikely to find one doctor willing to prescribe scheduled sleeping pills long term at all, let alone multiple doctors pushing them.

The usual suggestions from doctors for first line treatment are more mild medications that have drowsiness as a side effect, prescribed at low dose. I would actually prefer many of these low dose options over some of the high dose melatonin supplements. Melatonin is a hormone and taking it can throw off natural production

I take melatonin to sleep on a redeye, but otherwise don't use it. I find the effect is similar to taking a weed edible to fall asleep— basically, my wearable registers a lengthy period of deep sleep but instead of waking up feeling refreshed and ready for action, I'm groggy and fog-headed for several hours, or dependent on coffee to reverse the lingering effects.

As someone who has never been a regular coffee consumer, I really didn't want to end up with the dual dependence of melatonin at night and then caffeine in the morning.

This thread is stimulating me to want to get my magnesium checked, but barring that I've found the most effective sleep interventions are the basic ones: get some exercise earlier in the day, and don't do screens for the last few hours before bed.

I agree with Gwern in that I think for the vast majority of people, short-term melatonin supplementation is useful and can cause little harm, and it is extremely safe as far as supplements go.

But I don't think it does anyone any favors to oversell the idea that it has "few" or "no" side effects -- it has mild side effects, most commonly reported in the literature are daytime fatigue, headaches and GI symptoms, and also nightmares. Mild doesn't mean it isn't a nonstarter for some people.

It's also important to remember that there are major gaps in what we know about melatonin; notably the effects of chronic supplementation are not well-studied, but earlier final awakening has been documented and this is quite commonly reported in anecdata -- I can contribute a datapoint there, as can most people in my circles who have used it.

To be clear, melatonin is great and useful, but as someone with a rare lifelong chronic sleep disorder who is intimately familiar with this substance, I think it's most useful when we're clear on what we know, what we don't know, and what actually are the limitations on a substance.

Just because downing a bottle of it probably won't cause systemic organ failure or otherwise any kind of medical emergency in most people doesn't mean there aren't tradeoffs to consider when using it, especially if you are sleep-challenged

The problem with that take is that the evidence for melatonin is quite poor outside of jet-lag and certain more serious sleep disorders, and there can be unexpected effects elsewhere in the body when supplementing hormones, e.g. increased rates of depression for melatonin in particular.

Not sure why I would trust the opinions of this random person?

Your report matches my experience as well!

Funny how it's basically do all the things you're supposed to do - exercise, diet, stress management - then sleep is then easier.

Mg or melatonin have 0 effects on me, Mg helps if I over-exercise but thats for muscles regeneration.

I dont have problems normally, just cant sleep in high altitude, 3000m is already showing mild effects. Guess what, I do/did quite a bit of mountaineering, its easy to get above 5000m in himalayas, highest I've been in tent attempting to sleep before summit push was 6000m on Aconcagua. Tried both Mg and melatonin up there over multiple nights, 0 improvements. I had highest O2 blood level measured in 5500m by doctor (mandatory there) from whole group.

Physical effort makes better sleep for literally everybody, thats age old knowledge and I havent met a single exception yet.

Magnesium Glycinate has been a game changer. My legs used to be tense to the point of cramping at night, and they’re now relaxed, enabling better sleep. I also use L-theanine as an additional supplement for a long duration deep sleep, and think it helps.

I've tried both Magnesium Glyconate and Magnesium L-Threonate and both have helped my sleep, Magnesium Citrate did very little. Which makes sense, the latter is known to not be absorbed very well.

I've not noticed any significant difference between the other two.

I find that Magnesium Glycinate works well for me. Magnesium Taurate also works.

Magnesium Glycinate worked well for me, take it an hour before bed or so. L-Threonate is too expensive, citrate gave me diarrhea.

Much more deep sleep with Glycinate, some folks don’t like it because they feel too groggy after waking.

Good point about L-threonate. It is indeed expensive. I use some of it, but mostly I rely on Magnesium Glycinate.

Even a simple ZMA worked wonders for me when my fitness coach recommended it. Got some of the deepest sleep of my life

Interesting, my doctor recommends doing a blood panel every 5 years.

In some people they can do ths.

Most magnesium doesn't cross the blood brain barrier, such as the one you tried.

Try magnesium threonate, which does.

Yep, I've been taking glycine and magnesium for years. I am not as consistent as I should be but it makes a big difference when I use them.

Never taking a supplement for too long is great advice. Always cycle things in and out to avoid some potential for accumulating too much in the body.

There are some horrifying case studies where people took like too much zinc, or copper, or some other thing for years and got really really messed up.

I don’t think it’s AI-generated, but it is repeating a lot of the points that are commonly repeated in supplement ads: The claim that Mg L-threonate is special originates from the person who patented it and sues anyone else who produces it. The claims that multiple doctors tried to push “sleeping pills” and they’re all bad is a common theme in communities that accept supplement research and claims unquestionably (like patented magnesium forms being superior) but have an innate distrust of doctors and medicine.

I think this is just what happens if you read a lot of supplement forums and listen to the supplement podcasts a lot: You start developing elevated beliefs about the supplements, disdainful beliefs about doctors, and think you’re making superior choices having done your own research. That last point is some times critical for the supplements working, because if you believe you’re taking something special after having cracked the mystery by listening to 50 hours of Huberman or Rhonda Patrick (as examples) then the placebo effect will supercharge the result. Having belief that you’ve solved the problem makes the effects much stronger, especially for cases like this where the underlying problem was already pointed out as being stress related.

So where's the advert link to his favourite supplement, search those phrases and there will be 200 different brands selling this same commodity so which one is paying him commission ? All?

Hmmmmmmm

People sharing their experience doesnt immediately mean AI-generated advert

Why AI-generated? Because the quality of his writing is better than that of his critics?

Blood tests are pretty useless for magnesium. The deficiency is in cells, magnesium level in blood is not a good test for that deficiency.

From my experience, it took about a month of 150mg magnesium supplementation per day to see effects, two months for my insomnia to go away entirely.

Doing a quick search for magnesium-rich foods, it seems like it would take either an unsustainable focus on eating these foods to see results on a similar timeline or an extremely prolonged timeline to see similar results.

That said, I am not a doctor or nutritionist. But my instinct is that you can get so far in the hole with a lifetime of magnesium deficiency that supplementation is by far the most time- and lifestyle-efficient to digging yourself out. Whether or not switching to magnesium-rich foods can sustain you being at correct levels will end up depending on what the size of the deficit was in the first place, but is probably worth a try.

Histamine has different pools, functions, and receptors in the body. You’re reducing it all to one single level that goes up or down with diet but that’s not how it works.

The brain histamine in your neurons is primarily synthesized from an amino acid. The histamine levels in neurons are different than the levels in mast cells.

There are a lot of degrees of hand waving in your theory that don’t work.

I don’t know anything about the specifics of this case. I do know there are lots of bad doctors. Doctors routinely make mistakes or overlook things, especially relatively trivial things like this.

I don’t know what people think you learn in medical school that makes you an infallible source of health knowledge.

Trained doctors pushed opiates and benzos on me when they were very much not needed and in both cases led to dependancies and horrific withdrawals. I'm sure many others can chime in with their own similar experiences. Medical professionals are incredibly crucial to the wellbeing of society, but they have also been responsible for much suffering because they are human just like us.

> Holy Dunning-Kruger effect…

Do you know they’re wrong? Please don’t invoke Dunning Kruger like this, it’s cliché and also wrong to do. There’s no indicator for whatever it is Dunning & Kruger showed, you cannot know if it applies to a single person. Their main plot showed a positive correlation between confidence and competence. Their paper has problems, their methodology has been rightly questioned, and some attempts to reproduce have failed. Plus keep in mind that, ironically, for people who are intimately familiar with the debate over DK, using it to essentially name-call someone backfires and has the opposite of the intended effect, it makes the name caller look confidently ignorant.

In Mice!!!!

I am a brogrammer and I fix problems, bro. Magnesium for life.

Why?

I get what you’re saying, but I think it’s fair to view it as equivalent to drinking a protein shake after a workout. You used the resources in a productive and healthy way, now you need to replenish them.

The magnesium deficiency would probably still exist if you removed the stressful job. Unfortunately switching jobs or careers is not an option in this current job market.

I don't know if they can have controls for "specific activity that changes their sleep schedule".

In the past few years I went from having relaxed 11AM daily meetings to rigid 8AM meetings, and my sleep has suffered immensely. But nothing else in my life has changed, so it wouldn't show up in my socioeconomic data.

> the number is statistically insignificant ... they dont measure sleep but they estimate if someone was maybe asleep based data from an accelerometer

These two goals are kind of at odds with one another. We can only get insight into depth of sleep achieved if we bring you into a sleep clinic, but we can't do that for a significant sample size...

No they didn't. A control group inherently implies the researchers made an intervention in the first place (or else there was a "natural experiment" where people were randomly placed in group or another). That didn't happen here, as this was purely an observational study.

We could pick a company car in my previous company (it's a tax thing). We could pick any color, apart from red, because the insurance forbade it - red cars get into more accidents. Somehow that must have made it all the way to the policy without someone asking "is it the red car or the kind of person that picks a red car that causes more accidents?"

What about speed holes?

Original comment assumes the size of my hands is not 50m^2. Very presumptuous.

I think the point is that while it does act as negative acceleration there isn't a causal relationship with the actual speed of the car, which is mainly related to how far the gas pedal is pressed.

You think blocking the wind from hitting your hand slows the car down?

But what color is that bike shed ??? /s

> ... you should worry that your car is going fast.

Only if we know of an intervention that will likely slow the car down and the risks+cost of that intervention justify the benefit.

Otherwise, we worry without purpose.

EDIT: I will say that there is a philosophical question here related to "basic research" / "pure science" / "fundamental science." Usually just "knowing new things" eventually proves valuable, especially in a long timeline. So in that sense, TFA could be important.

> Sleep regularity may be a simple, effective target for improving general health and survival.

But why would it NOT be? Seems stupid for us to have evolved into beings that need our sleep to be irregular.

only if the book is being held by someone in the car.

Presumably, the example missed the part where they stated the book was being held in front by an outside agent, because that is the only way it would make sense.

But they choose to. Alcohol, caffeine in the afternoon, just not realizing blackout curtains matter, lights or displays on in the room... you can't help someone who isn't making bad choices, but most people can make simple choices that improve their sleep a lot!

Oh for sure. It's a carrot-type program though. So you don't get any penalties for not doing something, but you get rewards for doing things.

I my younger self had a terrible sleep schedule. I suffered pre-occupied thoughts of either what did or was about to happen.

I have a very consistent sleep schedule now and it is a real pleasure. I my sleep schedule has 2 or 3 3-4 hour stretches of solid sleep. I make my own schedule now so sleep is usually available when I'm ready.

I feel like your example is flawed, I just can't put my finger on it.

Maybe it's because I don't see how sleep regularity is a factor you can change as willingly as visits to the fridge, or maybe its because I don't see why people wouldn't just eat more before heading to bed.

It could also just be that I find a treatment of symptoms to be less desirable than causes.

Sometimes it is a cause vs causation. Sometimes the scientist didn’t adjust for a variable that clearly would impact both fields they were measuring. To make such a claim, I think it’s appropriate to name that hypothetical third variable. Otherwise the comment is so general it applies to all statistical studies.

Would love to see a causal model [0] to help better understand all of the mediators considered as well as confounders. I'm close to finishing up an interesting read from Judea Pearl/Dana Mackenzie - The Book of Why: The New Science of Cause and Effect [1]. Talks alot about Causal Models, Causal Inference, the 3 ladders of causation, etc. I liked the graphical approach to help outline exactly how one thinks about direct and indirect effects and how it facilitates counterfactual analysis and causal mediation analysis.

[0] https://en.wikipedia.org/wiki/Causal_model

[1] https://en.wikipedia.org/wiki/The_Book_of_Why

What I wonder is even if they did the perfect adjustments, what would have been driver for different sleep regularity.

E.g. considering some common causes like work stress - if they did the causation and compared people who did the same type of work, and they controlled for stress levels then why did one group of people have sleeping regularity issues more than compared to others?

Like there has to be some other driver then that they didn't control for, as in personality, environmental or physical difference?

Most people do want to have healthy sleep, the ones who don't usually have something causing those issues.

Did they explain how exactly they adjusted those results?

Pretty much my thoughts. People in lots of pain don't have a regular schedule to do anything, including sleep.

Kinda funny seeing this reply side to side with the "I just took LSD" one

I wish your doctor's advice worked on me. I'm in the same boat as the person you're responding to, and I follow all this advice as well.

okay, I'm curious, have you build an addiction? or do you think you can keep on reducing the dose and stop using it but still have the benefits. I've read somewhere that LSD can kind of re-wire your brain

Watch male lions they sleep when they want, laze about all day until they need to eat. Or you can be a deer caught in the corporate wage slave, alarm clock prisoner headlights.

Nearly all predators spend large portions of their day sleeping, why would humans have been different?

My PhD advisor likes to drink a coffee just prior to falling asleep. That way the caffiene slowly kicks in and wakes him up. I can't do this--I already have trouble sleeping and I feel the effects of coffee quickly.

But to answer your question-- for me, washing my face helps a lot. I don't know why. Not that I nap all that often.

I am groggy but I drink a Coke Zero and within 10-20 mins I feel great. Whereas without sleep I would be flagging.

You are spot on. I see all this in me, too. Very interesting to encounter your take.

I try to turn what-ifs into actions. Instead of a what if rumination it is a small task, or a small trial of something, or a move in general forward rather than not. Not even remotely close to doing this well all the time, but I notice an overall boost in mood and productivity when I reorient my mint to progress rather searching in the uncertainty space.

Lifelong severe insomniac (sleep onset mostly) and cured myself pretty much entirely over the last year or so. My suggestions in order of what I perceived to be their cost vs effectiveness ratio:

1. The Sleep With Me podcast, especially if you struggle with racing thoughts (if you have a partner who can't stand hearing this, the Ozlo Sleepbuds are a good if imperfect solution)

2. Stellar Sleep, an app that delivers CBT-I, evidence-backed cognitive therapy for insomnia; this reset my sleep clock in about two months, which is now maintained by the other items on this list

3. Eight Sleep mattress pad to keep temperature low during sleep, especially on warmer nights

4. Manta Sleep Mask to get full light blackout

Also I've definitely just doxxed myself. But worth it to help some fellow insomniacs!

Don't watch any kind of screen in the evening. Read a book instead. You'll fall asleep sooner.

The only thing that worked for me was having a kid. He wakes up early every day, so I have no choice. Taking care of him is so taxing, being sleep deprived isn't on the table.

Did you cut out all caffeine?

Conventional wisdom does work for me but it is immensely difficult. I would say take the advice seriously but don't take the timeframe or problem difficulty assesment coming from other people.

It is only natural that it takes months to years to fix a problem if you had the problem for years.

Let's create a Discord/Signal/WhatsApp/mailing list group to help each other figure it out... it's time to end our sleep irregularity once and for all!

Hard to answer precisely without knowing what conventional wisdom didn't stick.

The common levers I know and that worked at least a bit for me:

- start by having a fixed waking time, and get sunlight or bright light quickly after waking up. Normally relatively fixed sleep time is supposed to follow. For me waking up is the easy part, transforming that into getting up and going outside is harder. Another option here is a strong (like, really strong) lamp on a timer, or letting the morning light in your bedroom (this one is usually not recommended I think, most people seem to be blackout curtains style, but for me it gave me a nice 6am waking time with good sleep last summer).

- melatonin. Two main ways: using it as a kind of hypnotic, so ~30 minutes before sleep, experimenting with 0.3mg to ~2mg doses ; then using it as a circadian regulator, this is a good resource https://lorienpsych.com/2020/12/20/melatonin/, search for "TO TREAT" in the page.

- app timers, for me it was mostly no twitter and no youtube, or a very low time for each.

- light, ie reduc light before sleeping. Not just blue light and not just screens, if I'm on my phone in bed I'll reduce the luminosity a lot, same with computer, same with e-reader. I also try to avoid using too much the lights in my room. More light tend to make me feel more "wired" and less ready to sleep.

- "meditation" to cut rumination, by which I mean "lay down in my bed, gently try to find sensations in the body and to stay focused on them, by gently I mean it's a very low stakes game where the goal is to find sensations in the body and give them attention, but losing focus for a while is not a big deal".

- shower in the evening, as I don't like feeling dirty when I am in my bed, but also not just before bed as sometimes I don't really want to go take a shower and this delays my bedtime

- clean bedsheets, bedroom, stuff in/on your bed

- AC in the summer, I wouldn't be able to sleep properly without it

- sleeping mask. It helps going to sleep, but it falls of my head every night so it doesn't prevent waking up with light too.

- making getting good sleep the priority of the evening. This is easy/possible for me due to my circumstances (ie low responsibilities in the evening). The way I do it is that unless something is actually important, what I'm trying to accomplish in the evening is prepare myself for sleep and get good sleep. This can look like not starting a movie at 11pm, not booting up games, not eating a super heavy meal, not drinking too much water after 6pm to avoid waking up to pee, if I have things I want to do try to do them early so they're done earlier, move some stuff I want to do every day like spaced repetition in the morning.

Exercise, often, not too hard, over short time you'll get your personal level better than any coach could do. It will also prolong your life easily by 10 years and add tons of quality into it, will make you happier and more connected to your own body. All people I know also corrected their eating habits aggressively, its all connected.

If you dont have enough time get to the point when you can do HIIT safely, its literally 15-20 min max. If you have time, add long walks on rest days for example, or whatever is available to you nearby (ie swimming/surf if usable water body nearby).

No one knows for sure how they will be in their old age. My grandmother didn’t seem to struggle until her mid to late 90s. That’s a lot of years to leave on the table. Years that allowed her to meet and enjoy time with her children, grandchildren, and great-grandchildren.

Had she died at 65, I wouldn’t have even known her. Instead she was around for my entire childhood and well into adulthood.

I'd rather live through my 80s without much struggling. Longevity and quality of life until the end. And I try to live in the way that lends itself towards that.

Easy to say when you're not 65-70.

> having the strangest medical condition where it is literally impossible to sleep past ~6:30am.

It's it really? What if you go to bed at 6am? Will you really still wake up 30 mins later?

I have had a similar experience. I would find my sleep schedule constantly drifting later and later, which made it harder to wake up in the morning, so I would self medicate with caffeine which made me anxious, which contributed to the same cycle. But even when I stopped taking caffeine I always found it difficult to actually go to bed at the same time every day.

What finally worked for me were red light glasses. I wear the True Dark Twilights Classics (though I’m sure there are other brands on the market) for 2-3 hours before bed time and I’m actually sleepy. Way more effective than taking melatonin tablets ever was in my experience. And I haven’t even had to substantially change my screen usage either (though the glasses do make everything come out monochrome, which makes it difficult to use anything that’s not in color blind mode).

Good points, if I am careful about caffeine and do all of that it's not unmanageable. Being outdoors and camping and getting good physical activity is the best I found. But it's a struggle for me.

> Also have the same experience fighting depression-like symptoms and anxiety. It just takes a lot of time and is difficult. Some people just don't have these problems and I do but this doesn't mean I am genetically attuned to be like this and I can't do anything. It is just difficult.

Should I mention that "neurodivergence" and different sleep pattern genes have a large co-morbidity? E.g. many people with anxiety / ADHD / dyslexia / depression / etc have a very high likelihood of having delayed sleep or other genes.

You might find some benefit from an app like Wavekength[1] that uses iPhone camera to coach your light exposure, based on current+desired circadian rhythms.

Disclaimer: I made the app.

[1] https://www.impulsearc.com/wavelength/

People are different. What you find easy and trainable, someone else will find it doesn't require training and someone else will try as hard as they can and won't succeed.

I think I'm gonna try and find a study that had the 50 hour sleep cycles