Please reply with your helpful hints and suggestions for 1. Difficulty falling asleep and 2. Difficulty falling back asleep after getting up to pee or drink or from a nightmare.
It's OK to re-post replies you previously made. I want this to be comprehensive. I think it will be great to have a full community response to this...I'll pin the post as a resource for us all. Thanks!
I've never had much problem with falling to sleep or going back to sleep if awakened, but due to research over the years indicating the negative effects of sleep cycle disruption, I started taking small dosage of melatonin some years back. With more recent research indicating positive results from large dosage melatonin for PCa, I've been taking 20mg at/near bedtime for 6 months or so. I tried this about year ago, and it seemed to make be tired/sleepy during the day, but this time around I have not noticed any effects of the larger dose. I have also been drinking a cup of camomile tea most evenings an hour or so before bedtime. Not sure it helps me sleep, but the apigenin in it is beneficial in many other ways, so I consider it a win-win nighttime beverage.
Fully Darkened Room:
Most research indicates that a fully darkened room is needed for restful healthy sleep and night lights, bedside clocks, etc., are disruptive to circadian sleep cycle. Since I am unable to fully control the amount of external light where I normally sleep, I use a sleep mask most of the time.
Turning on lights during the night:
Disruptive nature of turning on exposure to lights during sleep interruptions, like getting up to use the bathroom, etc. (Negotiating the toilet in the dark requires a bit of practice, but as I live on a boat, my physical environment is small and easily mastered.) When I travel, I just try do do it with as little light as possible.
Reducing late night beverage consumption:
Eating early (see link below) and reducing late night beverage consumption & before-bed snacking, should reduce the need to get up during the night to use the bathroom. (And allow the digestive track to sleep as well.)
Disruptive effects of evening exposure to blue spectrum lights:
Most sources recommend reducing exposure to such light sources for several hours before going to bed. Think LED TVs, laptops, tablets, smartphones, new LED light sources and replacement bulbs.
Here is a good description of Circadian Rhythm & common disruptions & Q&A from FredHutch:
6 Circadian Rhythm Sleep Disorders that May Be Disrupting Your Sleep
alaskasleep.com/blog/circad...
Fred Hutch Q & A: Supper, sleep, circadian rhythms and cancer risk
fredhutch.org/en/news/cente...
Here is a good overview of the relationship between sleep cycle disruption and cancer.
Circadian Rhythm Disruption in Cancer Biology
ncbi.nlm.nih.gov/pmc/articl...
Many of these seem like common sense, but I/\'m willing to bet that most of us regularly exhibit at least one of these habits that can cause sleep problems.
May not be exactly what you are looking for, Darryl, but it should help start the conversation. Be Well - cujoe
You live on a boat? You are my new favorite person. Rocking of the boat. Soft sound of the waves. Nearest porthole to do your business. You are to be envied Sir.
Well, while it sounds a lot more glamorous than it is, I do like to comment that it IS the ultimate waterfront property since: "If you do not like your neighbor, you can move to a different slip, and if you don't like your neighborhood, you can move to a different marina." I've been a liveaboard for most of the last 20 years, and occassionally have to remind myself how fortunate I am to have been able to maintain the lifestyle for this long. 20 knot winds today, so I'm doing a bit of rockin' and rollin'. Funny thing, once you spend enough time on and off a boat at dock, day in and day out (and in normal weather), you keep your sea legs 24/7.
Anything is possible. You just have to get up one day and do it. As Joseph Campbell always said, "Follow you bliss". Be Well, Monte - "Captain" cujoe
I had a boat once, I named it Passing Wind.
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 03/13/2019 4:57 PM EDT
I HAD A SMALL SAILBOAT 19 FEET
"LIGHTENING" CLASS
I KEPT IT ON ONE OF CANADIAN LAKES
WHERE A NEIGHBOR, SAILOR, WAS TEACHING ME HOW TO.
THERE WERE HAPPY TIMES.
THE PICTURE STILL HANGS ON MY WALL
AND SHOULD I GET UNDER "STRESS"
EG THINKING ABOUT PC
I CLOSE MY EYES AND MEDITATE
ABOUT SAILING SOMEWHERE.
USUALLY, IT HELPS.
GOOD LUCK TO US ALL,
MAY BE IN FEW YEARS
SOMEBODY "GENIUS"
WILL SOLVE THE CANCER ISSUE.
I use marijuna to help me fall asleep (it is legal in WA). It eases anxiety. I never sleep thru the night. I usually get up at least twice. And I try not to turn on bright lights. We have few small lights left on so I can navigate. This started long before I was diagnosed with PC. If I can't fall back asleep in half an hour I get up. Best thing to help me fall asleep is eating starch like 3 or 4 pieces of toast or a left over burrito ( I don't have a weight problem, in fact I have lost 10 pounds in the last year). Another trick is to get on the computer and read. It diverts my attention instead of worrying about something. My third trick is to go to a different bed (I rationalize that the second bed will somehow be better. It's not me! Must be the beds fault)
I use the Breathe app. You can download it to your mobile for free. It’s a meditation tool which has a few options specifically for sleeping.
I use an app that makes rain or ocean noises. It has a train way off in the distance and thunder.
So do I. mostly rain sound now. We have lived close to trains twice. It is a nostalgic and soothing sound.
I used to get up 2-4 times to pee at nite, but since I am taking Aloe Arboresences and Kalanchoe Pinnata, I get up 1X, maybe 2X and sometimes none.
I also have Narcolepsy so I sleep with the Earth Pulse tuned to 3.2Hz which also helps to keep me in "sleep" mode. I also sleep on a FIR heating pad, tuned to 40C which takes care of any joint pain. I am pain free all nite as well as during the day. Scans have shown that I have arthritis all over.
I don't "darken", the room, found that drinking fluids close to sleep or otherwise don't have an influence on me. I take 12 mg of Melatonin /nite. I get up to pee and get back to sleep right away. BTW dreams are very vivid in that low frequency(Delta)
What brand FIR pad are you using ? Do you recommend it ?
Here is my theory re: FIR pads: Both Germany and TJ use hyperthermia as a supplement to low dose chemo or radiation. And a common temp is 40-42C. That is for local treatment. Whole body treatment requires more treatment. So I decided to mimic the local treatment by useing the 32X20 size local pad at 40-42C, what ever you can tolerate. I actually sleep on the pad all nite at that temp. 40C works best all nite. I have it built into my foam mattress.
I am familiar with this pad source- Healtyline- from NewYorkStart.
ebay.com/itm/HealthyLine-Na...
Stay away from the cheap chinese pads. Most brands will supply the same benefits.
Full pads supply Jade, Amethest and Tourmaline with PEMF built in. I use the one with only Jade and Tourmaline with no PEMF- Your option.
Don't worry about it being "Used". That means open box, meaning it was returned and not used. Some come with full warranty and some come with 30 day warranty. I have not had any problems with this brand. I am a massage therapist and have sold 9 to my clients. Not problems with this brand.
I have prostate cancer so I also take one of my anti cancer supplements at nite to mimic what it does with the low dose chemo and radiation.
PS- I found it to be very helpful for joint pains. Scans showed I have arthritis everywhere, but now no pain when I wake up or during all day.
Thanks
Cyclobenzapraine (take it for leg cramps), melatonin, Sweet Dreams tea and a pee pee bottle.
Sleep like I'm hibernating.
Crabcrusher
Thanks for the tip, because I've been getting leg cramps and restless legs since beginning chemo.
Ambien - better living through chemistry!!!
There is preclinical data demonstrating that estradiol can improve sleep quality and reduce fatigue for androgen-deprived rodents. There is good reason to think that some add-back estradiol (which should not be taken orally) should be helpful for PCa patient on hormone therapy with sleep problems. There are researchers in both Canada and New Zealand currently looking at that.
The preclinical data are in:
Wibowo E, S Deurveilher, RJ Wassersug & K Semba 2012 Estradiol treatment modulates spontaneous sleep and sleep recovery after sleep deprivation in castrated male rats. Behav. Brain Res., 226:456-464.
If anyone wants a PDF, they can contact me directly.
Very interesting.. sounds promising to me. Thank you.
Good enough for androgen deprived rodents = good enough for this androgen deprived dude.
Poor rodents..
After decades of trouble sleeping, I was put on Lorazepam, 0.5 mg an hour before sleep. This was to control my anxiety, but it has done wonders for my sleeping.
I found lorazepm very helpful and used it for years for occasional insomnia. When I tried to get my prescription renewed my new doctor refused. It is a controlled substance that requires paperwork and with the DEA/FDA crackdown on opioids this got tagged. Doctor is literally afraid to prescribe it. He prescribed trazodone instead, 50 mg. I can take 1/4 or 1/2 pill and it seems to work. If I take as much as 3/4 of a pill I'll wake up with a raging boner that lasts hours, which isn't conducive to sleep👀. Research indicates that some men have suffered dire consequences from this priapism effect.
sexualmed.org/risk-factors/...
I had to give up on trazadone. It caused dry mouth. Hard to fall asleep when you have to take a sip of water every five minutes. I now use a low dose indica gummy to help me fall asleep.
CBD, between 40 and 100 mg per day. Use tincture dropper. Break up over every 6 hours. Guaranteed to help with no side effects.
2Dee
What is CBD ?
Cannabidiol-comprises app. 40% of the chemicals in pot. Pretty much non-psychoactive, but with "calming" capabilities.
Crusher
Cannabidiol (CBD) exclusively from hemp plant can only naturally contain <0.3% THC so no "high" side effects nor any special restrictions on purchasing or using while driving. Rather than CBD isolated from a Cannibis plant.
I purchase product "Relax" branded product in small tincture bottle with dropper lid on line.
Lots of rhetoric available on web.
I'm just saying 😉 what helped improve my sleep significantly. No interest in getting into any rant about such products in general.
Taking small doses regularly at 6 hour intervals noticeably improved pain and sleep for me and other cancer friends.
Started at about 20mg a day and increased to around 100mg day till most pain addressed. Larger doses not needed for sleep, just for pain.
I have a mental procedure that works for me, either getting to sleep initially or after getting up to pee.
Starting at the top of my head I trace a point slowly around the outer edge of my body, trying to feel the point on my body where my mind is focused. This includes tracing around individual fingers and toes. I am usually asleep before I make one trip around my body.
Melatonin, CBD:THC 50:50 oil, breathing
What is your dose of Melatonin?
Well he takes it not only to sleep but because of studies saying it is also against PCa, so at beginning it was 3mg but now 12mg.
I use 10 mg melatonin in a form that is half quick release and half delayed release (Nature’s Bounty Dual Spectrum Melatonin 5 mg). It seems to work pretty well. I used regular melatonin before I found this Dual Spectrum variety; the dual spectrum variety seems to keep me asleep longer.
I do find that melatonin does impact my dreaming at night. The dreams seem a bit more vivid and mildly unpleasant (anxiety dreams frequently). However on balance I find it worth the mild side effect.
I am hoping the melatonin has some anti-cancer effect as well; there are some studies suggesting this...
I take a Benadryl tablet at bedtime and another about four hours later. This seems to work pretty well for me
Having difficulty falling asleep...? Try reading anything written by Proust. Here's a sample where he writes of places he has slept....,
"But I had seen first one and then another of the rooms in which I had slept during my life, and in the end I would revisit them all in the long course of my waking dream: rooms in winter, where on going to bed I would at once bury my head in a nest, built up out of the most diverse materials, the corner of my pillow, the top of my blankets, a piece of a shawl, the edge of my bed, and a copy of an evening paper, all of which things I would contrive, with the infinite patience of birds building their nests, to cement into one whole; rooms where, in a keen frost, I would feel the satisfaction of being shut in from the outer world (like the sea-swallow which builds at the end of a dark tunnel and is kept warm by the surrounding earth), and where, the fire keeping in all night, I would sleep wrapped up, as it were, in a great cloak of snug and savoury air, shot with the glow of the logs which would break out again in flame: in a sort of alcove without walls, a cave of warmth dug out of the heart of the room itself, a zone of heat whose boundaries were constantly shifting and altering in temperature as gusts of air ran across them to strike freshly upon my face, from the corners of the room, or from parts near the window or far from the fireplace which had therefore remained cold — or rooms in summer, where I would delight to feel myself a part of the warm evening, where the moonlight striking upon the half-opened shutters would throw down to the foot of my bed its enchanted ladder; where I would fall asleep, as it might be in the open air, like a titmouse which the breeze keeps poised in the focus of a sunbeam — or sometimes the Louis XVI room, so cheerful that I could never feel really unhappy, even on my first night in it: that room where the slender columns which lightly supported its ceiling would part, ever so gracefully, to indicate where the bed was and to keep it separate; sometimes again that little room with the high ceiling, hollowed in the form of a pyramid out of two separate storeys, and partly walled with mahogany, in which from the first moment my mind was drugged by the unfamiliar scent of flowering grasses, convinced of the hostility of the violet curtains and of the insolent indifference of a clock that chattered on at the top of its voice as though I were not there; while a strange and pitiless mirror with square feet, which stood across one corner of the room, cleared for itself a site I had not looked to find tenanted in the quiet surroundings of my normal field of vision: that room in which my mind, forcing itself for hours on end to leave its moorings, to elongate itself upwards so as to take on the exact shape of the room, and to reach to the summit of that monstrous funnel, had passed so many anxious nights while my body lay stretched out in bed, my eyes staring upwards, my ears straining, my nostrils sniffing uneasily, and my heart beating; until custom had changed the colour of the curtains, made the clock keep quiet, brought an expression of pity to the cruel, slanting face of the glass, disguised or even completely dispelled the scent of flowering grasses, and distinctly reduced the apparent loftiness of the ceiling."
Goodnight.
Holy run on sentence, Batman. I can see being conked out from asphyxia, being unable to catch one's breath while reading this.
They have all the science end covered below....watch Andy of Mayberry or something that will make you laugh. Be positive and understand sleep helps us fight this stuff. Problems we deal with the next day...
Meditation music. I use either the Pzizz app (iPhone free version) or PowerThoughts Meditation Club on youtube, youtube.com/watch?v=o-9T184...
I don't know how either one ends since I'm out before they finish.
My husband uses a biPap for his sleep apnea. He also tries not to drink too much before bed. I believe he takes 20mg of Melatonin before bed. We also meditate for 10-20 minutes before bed. We use the meditations from the themindfulcenter.com - they have a free one available. He also has an earthpulse and a grounding pad. I think he sets his earthpulse in the sleep-ez mode. The grounding pad was from Earthing.com (they were A BOGO earlier in the month. He used to drink Reishi elixir at night but it is a diuretic and he stopped that.
I do something similar, I also will use a chi-machine to help me relax. It is very soothing and does not take up much space. I also often have Lavendar diffusing in an aromatherapy device in the bedroom and a sound machine to make our bedroom extra-soothing.
My husband sleeps well but still gets up to the bathroom a couple of times.
I hope this helps! Sweet Dreams!
Sex used to conk me right out. But that was long ago. Now it is old mellow classic rock songs from Spotify via Echo dot timed to turn off in 20 minutes.
Mind over Matter. You want to sleep fast? Just build a log house with your mind.
1. Dig Foundation
2 . Cut logs
3. Sleep
Works all the time... Never get past cutting and splitting logs.
When sleeping I always dream I'm sleeping.
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 03/15/2019 5:05 PM DST
CBD tincture under tongue or vaped. Then a 50-50 THC-CBD vape until I feel calmed and starting to float a bit. (Local MMJ outlet sells this as an RSO oil.) Then whatever to remove anxiety. And finally a calming, sleepy feeling inducing vape - for this I use GDP (Grand Daddy Purple) or 9LB (nine pound hammer). I usually wake up after an hour, take 4 more puffs of the GDP/9LB and go back to sleep quickly. It I wake up after that, more of the same. It works ok. I also take 20mg of melatonin.
I don't like prescription sleep aids - addictive and really bad for cognition. I used to use benadryl, but gave that up when it stopped doing much except bother my thinking a bit.
I love a snack after dinner, but strong chocolate will keep me up for at least 3 hours. I miss being able to do that.
One nice thing about vaping is I do it in bed with no worries whatsoever.
Beermaker aka Marshall
My problem is peripheral neuropathy. I take the following drugs and supplements to get a good nights sleep:
1. Mirapex 1 tablet 0.25mg - prescription
2. Gabapentin 2 capsules (300mg) - prescription
3. Acetyl L-Carnitine 1 capsule 500mg - over the counter
4. Leg Cramps (by Hylands) 2 tablets over the counter
5. Aleve PM 2 220mg - over the counter. Because Aleve can cause liver damage with long term use I have substituted Zyflamend 1 capsule.
I take these at 20 minute intervals a hours before bedtime.
On top of these I take two Melatonin tablets (Mid-nite). I have found that not all melatonin is the same. Some make me restless while trying to sleep. I found the Mid-Nite brand to be the best.
sometimes if I still can't sleep I will get up and walk back and forth in the den for 20 minutes. Losing testosterone is one of the causes of sleeplessness. I get too hot under the covers. I find walking in the den in my underwear makes me cold. I am then glad to hop back under the covers.
Thank you always for your neuropathy regimen Magnus. Also thank you....I didn't know different brands of melatonin work differently either. Always find great info here.
Glad to help, I suffered with sleeplessness for a long time until I came up with the right combination of drugs and supplements.
I'm so glad you found the right combination that helps you to sleep Magnus. The last few nights I've been Zonking... so quickly for no rhyme or reason 
I'm so thankful when that happens. It's such a GIFT to just lay down and fall to sleep.
I've not heard of aleve causing liver damage. Are you confusing it with tylenol which does have liver damage warnings?
I did a quick search and found this:
Nonprescription pain relievers such as acetaminophen (Tylenol, others), aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others) can damage your liver, especially if taken frequently or combined with alcohol. Prescription medications
Almost all medications taken to get you to sleep, keep you from getting to the deep REM sleep that is needed so you are not tired the next day. CPAP masks stop sleep apnea. Myrbetriq is a drug that keeps from peeing all night. Leaning relaxation techniques are best for falling asleep and knowing that most people take 20 minutes to fall asleep. Most sleep medications only work temporarily for maybe a month. Understanding that faith erases fear (anxiety), and that most fears never actually happen and that fear is of the future. You can not control the future. Love erases anger (in the present). Acceptance erases resentments, not that the people, places, or things did acceptable things but rather you have made changes and now the resentment is gone and is accepted as gone. Peace is the mind set for sleep.
Huge sleep problems last year mostly due to extreme pain from aPCa. Working on reducing bone pain has resulted in better sleep. I believe my body needs a varying amount of rest to just maintain during any form of curative therapy. You have to actively judge and document for yourself what the minimum therapies are to reduce pain to a manageable level. In addition to pain pills (I want to wean off so I have them in the future when necessary), I'm currently using CBD, 95mg total a day spread over every 6 hrs. Consistency absolutely works the best. Causes a reasonable build up and overlap of substances. I use tincture (dropper) method. This has REALLY helped me sleep and return to sleep. I recently added 20mg THC to reach an unresponsive pain site with some success. I continue to carefully experiment to judge the minimum strength and schedule I need. This area is a producing many studies, and claims mostly anecdotal, like this one.
Leupron ADT (slows down some kinds of pain), can create some very vivid dreams. I have found no way to get out of them once started. I now have outlines for many imaginative books though as a side effect.
2Dee
Keep in mind that the THC varies from strain to strain. Indica is relaxing and Sativa is energizing. Hybrids offer a wider group of experiences. People may find relief and relaxation from an edible (brownie, muffin, etc.) as opposed to vaping, which can cause lung problems. We made our own RSO and I also made a cream and edibles. I have made organic creams for eons, but forgot to wear gloves ONE time while making a shea-based RSO cream for my husband and a friend with bc. I literally could not speak or move for three+ hours after making that cream. Couchlock. No wonder my husband sleeps on that stuff after I give him a massage (with gloves)! He got a big kick out of my experience.
My husband too experienced nightmares??? From diagnosis of hormoneHe swears by plain old Panadol rapid has to be the rapid
Says he’s back to sleep quickly
I have REM sleep disorder (RSD) and sleep apnea. CPAP works for apnea but RSD is a real problem. Graphic and sometimes violent dreams . Has anyone found a cure for this?
20 mg of melatonin 30 minutes before sleep time and 2 to 3 hours later if I wake up...10 mg more. Total of 30 mg. I'm seldom groggy upon awakening....but start with two cups of coffee in bed.
I sleep on a 88f waterbed at night and I take 10mg of Melatonin every night. it takes 30 - 40 minutes for the Melatonin to kick in. I have to use a cpap machine ( for last 20 years ) which makes getting up at night problematic with the masks on, so I keep a pee bottle bedside as well ( after a while you can use it as a reflex and barely wake up ) . I live in a recreational / medical cannabis state , so on nights when I'm particularly awake or stimulated, I eat a powerful cannabis cookie or brownie right before I go to bed and , for me , those can help dramatically with deep extended sleep without waking. the waterbed can be adjusted to about any temp you want, besides being VERY comfortable to sleep on they can act as a heating pad as well. my cpap machine is designed to report on your quality of sleep in numerous ways .... with my regimen my AHI index is always less than " 1.0 " (before the cpap I used to wake 550 times a night with a AHI of 87 ) , which means I sleep better than most babies ...
of course when taking Lupron - Xtandi the " shrivel " effect can make using the bottle a bit more complicated y ahay ahay ahaya h ( tweezers may help in some circumstances, dunno ).
Padded instruments, hopefully. We don't need secondary infections.
absolutely .... for padding I use the same green shag carpet I like to use in my shower. just the mini version. careful not to drop the padded tweezers in the shower tho ... they become invisible and then you step on them. yikes ...
A nice Indica cannabis vaped just before hitting the sack.
Breathing and focus on breath helps clear my noodle and i find relaxing
To help keep me asleep and help with getting back to sleep I take ashwagandha before bed. I use the Gaia and organic India brands. Swapping them out every couple months.
My cost for CBD 95mg and 20mg THC is around $5 a day.
I've switched from a tincture delivery (about 20 drops from 350mg in a 1/2 Oz bottle) to 4 drops on 1/2 oyster cracker under tongue from 10x stronger 3500mg CBD oil 1oz bottle.
2Dee
Rotating all supplements and or scripts each night as not to get too use to any of them except lorazepam. 1/2 to 1 1/2 mg Lorazepam nightly. 1/4 Piece of Ambien to fall to sleep or to get back to sleep twice a week. 1/2 of 5 mg Melatonin twice a week. Too many days of ambien or melatonin causes me to be in a catatonic frame of mind. 1/4 Soma in between days. Hot bath. Electric blanket to warm legs and feet from neuropathy. Couldn't imagine sleeping without having the electric blanket year round. Knowing my furry daughter Ella has my back once I fall to sleep 🌼
I have another approach and now I cannot go to sleep without it.
An audio book.
For me it must be non fiction. Why?
If it’s history, just picturing the mental scenes, and the sound of the narrator reading and I zonk out in five minutes.
Non fiction is normally methodical, organized and progresses from scene to scene. It allows my mind to settle down and forget about the outside world ZZzzzzz z z .
If I still can’t sleep in the middle of the night there’s a go-to audio book on Theodore Roosevelt, The River of Doubt, that almost never fails.
YouTube history lectures are also dy-no-mite and I have switched over from audio books to YouTube.
Started in the 1990s with cassettes then CDs from the library and now streaming YouTube.
With that being said, OTC sleep aids are in my cabinet.
Mark
I find that microdoses of CBD and THC work very well for sleep. I typically take 3 mg CBD and 2 mg THC tinctures. They work fast, about 30 minutes. If I awake in the night I might take another 1 mg of each.
Large doses of melatonin are useful for cancer patients. I take 40 to 100 mg most nights.
5-HTP 200 mg and L-Theanine are also inexpensive, safe sleep aids.
Ativan / Lorazepam. 1/2 to 1 mg before bedtime. Helps me get a full nights sleep. Durine the peak of treatment .. surgey, radiation, chemo, Lupron, Xtandi .. it really helped knowing that sleep would not be a problem.
Seems other used Xanax. Only problem is that in years past it was implicated in the death of the spouse.
Ambien is also not recommend if over 60, for similar reasons but also sleep cooking and sleep driving.
Gabapentine helps.
For me sleeping a full night can be challenging. Walking helps me a lot, couple miles a day soft pace.
Before bed i have a nice cup of lavender tea, and read for a bit then put on guided sleep meditation. It works wonders for me.
I was stressed out at first after diagnosis and asked for something to help- I ended up taking Ambien for about 2 years because it is easily habit forming. I found the best thing to help me sleep is plenty of exercise and a glass of red wine in the evening
A cure - this suggest, there might be...
Need your suggestions, please
Xtandi failed suggested Zytiga
Any suggestions for headache?
