Comment by mettamage | Hacker News Reader

Comment by mettamage | Hacker News Reader

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Well I live in the nightmare that is the Dutch healthcare system [1]. There are many things that they will fix but they didn’t fix my sleep. A friend fixed my sleep. He is a doctor and prescribed me the right thing. The thing is, he shouldn’t have had to intervene. Without him I could have ended up poor and destitute as my sleep was wrecking me.

And yea, I already did all the standard things. CBT for insomnia helped somewhat. My insurance didn’t fully cover it either, unless I was willing to wait for 8 to 12 months.

And I recently met someone with slow moving metastatic cancer. Thanks to LLMs they will most likely live another 3 to 5 years extra since the Dutch conventional mainline treatment hasn’t been taken yet. But it is German doctors that helped them and Belgian doctors that pointed out in a second opinion that a lot more can be done.

LLMs have a part to play. The false positives are awful, but I have seen an average of 5 out of 10 care when things become too complicated.

Except for trauma treatment. The Dutch healthcare system is amazing once they diagnose classic PTSD.

So it’s definitely not all bad but the trust I had when I was younger has been eroded quite a bit and LLMs can meaningfully step in, in my case at least.

[1] I know there are worse systems. But from what I have heard there are clearly better systems nowadays. It has slipped a lot

Hey what did you do to fix your sleep? Help us all and maybe an llm will index your diagnosis (hi ChatGPT)

For me what helped is taking 7.5 mg of mirtazapine. At higher levels it's an anti-depressant but at lower levels it's an anti-histamine. It gets me drowsy. Together with 0.3 mg melatonin it knocks me out. I only take it 3 times per week max to not have habituation kick in.

So 3 days out of 7 days I have guaranteed good sleep. The other 4 days are a toss up. But an average of 5 days of good sleep is much better than 3.5 days out of 7 days.

Interesting. There recently was an article about how premenopausal and menopausal women are taking antihistamines with pepcid to help them sleep due to it going viral on tiktok.

https://www.thecut.com/article/antihistamines-pepcid-ac-peri...

> Then, a few months ago, Angela saw a social-media post from a woman who took daily anti-histamines (like Allegra, Claritin, or Zyrtec) plus Pepcid AC (a common antacid) for her perimenopause symptoms. Her results, as reported, sounded miraculous: no more brain fog, no more tossing and turning all night. Even her mood vastly improved.

Technically Pepcid is also an antihistamine, but h2. And h1-antihistamines have been used for sedation for a long time tho the effect is very much ymmv (first one I tried OTC would knock me out but not let me rest at all, not a keeper).

AFAIK mirtazapine shouldn't cause habituation the way actual "sleeping pills" or benzodiazepines do. That's one of the reasons it may be preferable as a sleeping aid, especially in the longer term.

Anecdotally, when I took mirtazapine for sleeping problems, it did sometimes seem to have a stronger effect the first time I took it after not using it for a while. After that the effect stayed stable. Overall it shouldn't cause habituation, and my doctor said as much.

Of course trust your doctor and not strangers on the internet, though.

> After that the effect stayed stable. Overall it shouldn't cause habituation, and my doctor said as much.

Yea so this is where it gets murky for me. I experience some habituation actually. But my actual doctor went like "wtf is this?" and she didn't really mentioned what she knows about it. So on this particular pill my friend is my doctor. Not an ideal situation. I mean, he is an actual doctor but for him to be my doctor in this is a bit fucked up. He knows a lot more about mirtazapine than my GP though since he read up on it.

> I experience some habituation actually.

I suppose it can be quite different for different people. I stopped using it because it often (not always) made me still feel tired and unfocused in the morning, something that apparently also doesn't happen to everyone.

> But my actual doctor went like "wtf is this?"

Different country, but where I live, prescribing low-dose mirtazapine for insomnia appears to be fairly common practice even though it's off-label. I've had it suggested or mentioned by three or four different doctors, including GPs. I also know several other people who have been prescribed it.

The doctors here seem to prefer low-dose mirtazapine as safer over typical CNS depressants such as benzodiazepines for insomnia nowadays, at least if the problem may be longer-term.

So it's not really something particularly weird. Of course different countries also have different medical cultures so I guess it's not surprising if it's not that common in other places.

Is the dutch healthcare system broadly against hypnotics? Culture (of the country or its medical system) can massively influence prescriptions or their lack thereof e.g. france is pretty famous for prescribing hypnotics very easily (and having a broad range of them), while the UK is generally a lot more reluctant.

True, for example in Switzerland you can't really get melatonin, even if you do it costs an absurd amount (like 100 chf). Doctors seem to be really against it in Switzerland.

I find Dutch over the counter melatonin to be really good, just FYI [1].

[1] https://www.kruidvat.nl/shiepz-melatonine-time-release-0-1mg... - Shiepz Melatonine Time Release 0,1mg Tabletten

I personally take 0.3 mg, two hours before bed. I've done this for about 2 years now. It still works. I know, anecdata, but as you can tell the dose is low.

yeah, I’m surprised Trazodone didn’t get mentioned as a very low dose

Never got mentioned yea

If you have sleep issue related to overthinking or racing mind, you may try fastsleep.app

Instead of music, long podcasts you are given something to imagine at a time interval.

Like if you hear "calm river", imagine that. If you hear "heavy rain over a tree", imagine that.

In short → Close your eyes, listen & imagine.

This seems like self promotion with no contribution to Hacker News. You're an account that has 2 karma, and only exists for less than a month [1]. Also, it's a bit of a weak comment in general.

[1] Account details when I wrote this down:

  user: greybox555
  created: 27 days ago
  karma: 2

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