Retired in USA for five years now. Sleep issues

[misslillie]

Temazepam is my short term solution but Iam not sure I can stay on it for the long term.

[kaliska0]

That depends on a whole heck of a lot more info. As far as the temazepam effectiveness goes it really depends what dosage is required and how long you can use that dosage. If a low dose continues to work after several weeks you are less likely to develop tolerance and be able to use it for longer. Possibly for many years. Once you start raising the dose tolerance builds faster and the med quits working sooner so chasing the best sleep possible by taking more may get you less in the end than settling for somewhat improved sleep. If when you first start taking it a med requires a larger quantity to help you fall asleep or it's too short acting resulting in not sleeping long enough if you don't take more of it then it's probably going to stop working sooner. For benzos like temazepam that probably means only months of effectiveness before you need something else.

I am assuming you are mentioning being retired because your sleep issues started around or after retirement. There are 2 most likely contributions to that. The first is schedule and light exposure. First though I'm going to ask why do you care if you sleep at a specific time? Unless you are failing to get enough sleep in a 24hr period despite trying to sleep often enough. Some of this still applies but doesn't require doing it on as strict of schedule. You can match a day of ~24hrs any time you want really if you use artificial lighting systems and alter your meal and activity times. It can be morning or night whenever you feel it fits best if you have no reason to maintain a standard work schedule. Although gardening by camping lantern is a little difficult and we once got the police called on us for trimming a tree on our own property with silent manual branch loppers and lanterns at 2 or 3 am.

The human brain is actually not evolved for a 24hr schedule. It generally runs on a schedule between slightly more than 24 hours and 25hours, more for some people, so every person feels the need to sleep a little later each day. For some it's stronger than others and how well you can stay on a 24hr schedule varies. It also is not normal for people to sleep 8hours straight. In all of history until the past few generations and still in some countries it is normal to spend a portion of the night awake and often with it a portion of the afternoon asleep or else to sleep later or earlier. Often different times at different times of the year due to differences in sunlight. There were even names given in various languages for this period at night when people would naturally wake and do things for awhile. It's normal. We've just forgotten that biphasic sleep was normal and for far longer than a single block of sleep.

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With the pandemic and interruptions in schedules many have come to realize the importance it has on their sleep and also some of the negatives a schedule that forces specific hours of sleep has on their levels of stress and constant low level sleep deprivation. In order to sleep at the exact same time, stay asleep all night, and get up you have to force your body onto an artificial schedule by maintaining a very consistent wake and sleep time and using certain wake and sleep triggers. You have to get up to the same alarm even on days you don't work, actually get out of bed, be exposed to daylight or bright enough light to simulate daylight, and remain active enough to fully trigger wakefulness. Then you need to experience reduced lighting at the same time in the evening and go to bed at the same time.

Some people can be less strict about it than others and just fall asleep whenever even after they've ignored a schedule for awhile. Some people have to take even further steps with light therapy lamps in the morning, avoiding electronics in the evening, wearing blue light blocking glasses in the evening, or turning on the blue light filter on electronics(phones, tablets, computers, and some tvs have them now), avoiding bright room lights in the evening and even using red lights or at least going back to incandescent bulbs for evening light. Incandescent bulbs have more red plus yellow spectrum with less wakefulness triggering blue light than standard fluorescents or leds unless you buy specific evening bulbs or use NIR (near infrared) that are red only. If you don't want or need to turn your whole house red to feel sleepy every evening then you can find more balanced evening and morning specific led bulbs instead of hunting for incandescent bulbs that many countries now only allow to be sold for specialty purposes. MiracleLED and Norb are 2 companies that make a line of led mood bulbs that screw into a standard lamp and are meant for improving sleep, waking up, generating more energy, or relaxation based on the light spectrum the bulb gives off.

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Breakfast can also be very important for triggering changes that tell your body and brain it's morning and time to be active. Such as the hormone cortisol and many other alerting substances while reducing the sleep inducing ones. You may be more prone to eating later now and "brunch" instead of breakfast becomes common for a lot of retired people in the US. You need to wake up fully and long enough to feel sleepy enough to fall asleep easily when you want later. People miss that part. The morning and daytime activity or energizing behaviors and supplements are just as important as evening relaxation behaviors and sedating substances to get to sleep. Sometimes you can even do away with the sedatives if you improve your daytime behaviors because by being awake and alert sooner and consistently during the day your body creates more natural triggers for sleep. More serotonin is created which becomes more melatonin. Dopamine is partially impact by sunlight as well but it also just rises as you rest and gets depleted the longer you are awake and the more you are active. Whether mentally or physically but physical activity is more effective for creating sleep triggers. ATP=energy and when used by various tissue but especially when used by muscle activity turns into adenosine, which equals sleep.

Along with the loss of typical triggers from job schedule requirements people tend to lose some of their ability to sleep on a consistent schedule and for long enough of period at once the older they get. At the typical age people retire their ability to sleep at the required time for a long enough time is often beginning to decline some. Theories on this are numerous but overall it appears to mostly come down to a change in many different hormones, even more so for women who are beginning or are in menopause but also for men, and a reduction in sensitivity to melatonin. There is a medication studied especially for older people that is meant to increase sensitivity to melatonin. I don't know what it's called now but my doctor tried it on me in my 20s. My problem has never been melatonin though and it's actually a negative for me to manage to get any useful sleep. I recommend extreme caution supplementing melatonin since while it helps in some situations and this may be one of them it can easily cause worsened sleep for many people.

Unfortunately inability to maintain consistent sleep and a steady schedule is just normal both when you no longer are required to do so and as you get older because our natural biology really isn't made for such a strict schedule as society demands. Things you could ignore before when it comes to "sleep hygiene" as it's often called sometimes have to be followed more exactly when you are not forced onto a schedule by other obligations or just over time as you age.

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It may be enough to follow guidelines for quality sleep more exactly and use some low doses of common sleep aids or less sedating but often longer lasting off label meds for sleep such as antihistamines like hydroxyzine, antidepressants like amitriptyline or trazadone, mood stabilizers like gabapentin or lamictal, and a few unique meds like belsomra that have just been crammed in with other meds it doesn't at all match for how it works. If it's not enough and you are retiring at a more typical older age then you may want to look into doctors that deal specifically with the latest research into age related issues and decline. They are commonly being called longevity specialists and treatments. Since it can be hard to find a local specialist of that type and insurance or nationwide healthcare tends not to cover them you can often get recommendations for over the counter supplements as well as some prescription medications that are not strongly controlled or considered to have much side effect risk from clinics/doctors that do mostly online and video consultations. Integrative health or functional medicine doctors also tend to be more well versed in the complexities of changes the body experiences either from lifestyle changes or with age. They also tend not to be covered by healthcare plans but can be extremely useful not only for when prescription sleep aids fail but also for other things you may not realize you can get relief from. Even if those symptoms are merely a minor annoyance right now and considered a normal part of getting older. With current research we basically don't have to suffer the effects of aging anywhere near as much or as early as we do but few doctors apply the most recent knowledge to maintain various minor health aspects that turn into more majors ones over the years.

For sleep I use valerian root, hydroxyzine, belsomra, quazepam (doral), clonidine, and topical progesterone oil at night. My clonidine er is prescribed for ADHD but is also a blood pressure medicine that lowers bp and heart rate by in simplistic terms moving stimulating neurotransmitters from your nervous system to parts of your brain. It improves concentration, memory and prioritization abilities but can produce sedation and for some reduce anxiety symptoms by calming the nervous system. Quazepam is a benzo like temazepam but a very unique and long lasting one. Unfortunately it's also very uncommon and currently only distributed through specific pharmacies by one manufacturer so may not even be available in some countries. I used flurazepam when I couldn't get quazepam for awhile. That worked for 5+ years where the short acting benzos like lorazepam, temazepam, diazepam only worked for maybe a year or 2 each. Sometimes only months. The related z-drugs, which would be meds like ambien or lunesta only worked initially for a few weeks and now for about 4 days and then quit on me. I developed severe insomnia when I was 12 years old so I've had many years to develop tolerance to many meds. Luckily there are a ton of sleep inducing or improving options out there but most of the better options are not actually approved specifically for sleep so generally aren't prescribed first and some doctors may not be experienced enough to know what other meds can work well for various people. A few that were more commonly used in the past and still get prescribed today like seroquel and the entire class of antipsychotics are best avoided unless you are very desperate. First generation antihistamines, antidepressants, and some mood stabilizers are the better options to attempt for long term use when it comes to prescription med options.