Renee Donnelly

Everyone with sleep issues needs to see this ☝️

I don't give a f*ck if this upsets you. I am going to say something that nobody with insomnia wants to hear. I delivered my 1,412th dementia diagnosis on October 3rd, 2024. Sixteen days later, at 2:47 AM on October 19th, I fell asleep at the wheel of my own car. I was 58 years old. I am a board-certified neurologist with a subspecialty certification in sleep medicine. Twenty-two years of practice. Nineteen electrodes glued to my own scalp four days later, in my own sleep lab, scored by a fellow I had trained three years earlier. I was unconscious behind the wheel for eleven seconds. The hospital bill was $71,000. The neurocognitive workup that followed was another $9,200. They will let me practice again. My hospital privileges are intact. But I will never read another sleep study without remembering that I was the one wired to the box with someone I had trained scoring my own brain waves because everything I was taught to prescribe had not saved me. I am writing this because I know exactly what my colleagues will say when they see it. I do not care. If you are over 50 and you have insomnia, or someone you love does, please read the entire thing. I know it is long. I know you are scrolling. I know you have things to do. Fifteen months ago I would have given anything for someone with my credential to sit me down and tell me what I am about to tell you. Nobody did. I was diagnosed with chronic insomnia six years ago at 52. Sleep onset latency 68 minutes. Total sleep time four hours and fifty-one minutes. The diagnosis surprised me and it did not. My mother had died with dementia at 64. She was an insomniac managed on a sleeping pill and a blood pressure pill for eleven years. My father's memory was being watched for a decade before he passed. I had watched the pattern in my own family and I had built my entire practice on diagnosing the disease that took my mother in patients who looked exactly like her. I did what any sleep physician would prescribe. I started Amb*en at diagnosis. My internist, a colleague at my own hospital, added trazodone the following year when I was still waking at 3 AM every night. She added lisinopril the year after that when my blood pressure crept to 138 over 84. Three medications. Two of them medications I had personally prescribed to hundreds of my own patients. I walked four miles a day. I stopped drinking. I cut caffeine at noon. I lost 18 pounds in the first year of the diagnosis and kept it off. I ran the sleep hygiene protocol I hand to every patient at their first visit. Blackout curtains. Sixty-six degrees. No screens after nine. Same bedtime, same wake time, seven days a week, including call nights. I ran a full-night sleep study on myself the year I was diagnosed. Slow-wave sleep, 41 minutes. I checked every box on my own protocol. By last September, my sleep log averaged 6.1 hours. My Epworth score was 7. My blood pressure was 128 over 80. By the standard of the guidelines I had helped write for our hospital's sleep medicine program, I was managed. Managed. That word again. I ran a second full-night study on myself last September, six years after the first one. I did it because a hunch would not leave me alone. The slow-wave number came back at four minutes. Four minutes. Across seven hours and nine minutes in bed. For context, I have called patients over the phone with four times that number and used the sentence, we need to talk today, not tomorrow. I called my practice partner and asked her to screen my memory. She did. It was equivocal. She recommended an amyloid PET to be safe. I scheduled it. And then I did not go. I want to tell you why. Because sitting in my office at 6 PM staring at my own sleep architecture on my own screen, I recognized something. I was doing exactly what my mother had done. She had been managed for eleven years before the disease that took her mind. She had been on a sleeping pill and a blood pressure pill. Her sleep logs had read fine. Her numbers had been controlled. And she had died at 64 in the memory unit of the hospital where I did my neurology residency. I did not go to my own amyloid PET because I already knew what it would show. I did not want to see it in writing. I told myself I had time. Twenty-four days later I was on Route 9 at a quarter to three in the morning. I had been awake since 1:52 AM. I remember the time because I looked at the bedside clock and thought, fourth night this week. The hospital called at 2:20 for a status epilepticus consult. I had taken call for twenty-two years. I got in the car. I do not remember the last eight hundred feet. The state trooper's report says I crossed the rumble strip at 2:47 AM and struck the guardrail at fifty-one miles an hour. No brake lights. No skid marks. Eleven seconds of unbroken drift across two lanes. I was asleep. I could not sleep in my own bed. I fell asleep at fifty-one miles an hour. My husband, an oral surgeon, got the call at 3:20, while the paramedics still had me in the collar on the shoulder of Route 9. He was in the bay before I was. He is not a sleep clinician but he has heard me describe microsleep at our dinner table for twenty years, and he knew what had happened to me before anyone told him. I asked the paramedics to take me anywhere but my own hospital. Because I did not want the people I had trained to see me strapped to that board. I did not get a vote. It was the closest trauma center. I had spent twenty-two years in that building. They saw me anyway. The neurologist on call was a woman I had trained through her fellowship in 2021. She walked into the bay, saw me on the board, and her face did the thing. She said my name. — Non-contrast head and a C-spine, I told her. I did not have a seizure. I did not have a stroke. I fell asleep. — Yes, ma'am, she said. They wheeled me down the corridor I had walked down thousands of times going the other direction. I looked at the ceiling tiles and counted them because I did not want to look at the fellow who was about to scan my head. The CT was clean for trauma. Fractured sternum from the belt. No bleed. That was the good news. The MRI they ran the next morning showed hippocampal volume at the fourth percentile for my age and small vessel change I had spent twenty-two years pointing out to families on a screen. Four days later, in my own lab, with the same fellow scoring the study, my brain produced three minutes of slow-wave sleep across seven hours. I was in the trauma unit for two days. Observation for two more. I came home on October 26th with my husband, a rib belt, a fractured sternum, and a shopping bag of prescriptions I had personally recommended to hundreds of patients over twenty-two years. I did not want the full neurocognitive workup my colleagues were suggesting. I ran it on myself anyway. Because I knew that if I did not, in eighteen months I would be reading somebody else's chart from an outside institution and seeing my own name on it. The neuropsychology battery was run by a colleague I had trained with in residency. MoCA 24 out of 30. Delayed recall three out of five. She used the phrase, early amnestic mild cognitive impairment. Nobody had flagged it because my sleep log read managed and nobody orders a memory screen on a 58-year-old attending who is still charting. The cardiologist ran a 24-hour ambulatory monitor. My blood pressure never dropped at night. Not once. He used the phrase, non-dipping nocturnal pattern, and the echo showed early left ventricular thickening. I had been blaming the cuff. The endocrinology consult ran a fasting panel. Glucose 118. A1C 6.1. Prediabetes. I had been eating at 2 AM for six years. I had blamed the hospital cafeteria. The inflammatory panel came back with an hs-CRP of 4.8. Chronic low-grade systemic inflammation. I had had four sinus infections in eighteen months. I had blamed the clinic. Every system in my body was showing the pattern I had watched in hundreds of my own patients in the ten years before I finally gave them a name for it. Same cause. Same missing depth. Damage in my memory. Damage in my blood pressure. Damage in my blood sugar. Damage in my immune system. And finally, damage in the structure of my brain. I sat in my office on November 8th with all five reports in front of me and I understood something I had never let myself understand before. Every drug in my medication cascade had been treating a downstream measurement. Amb*en was treating how fast I fell asleep. Trazodone was treating how often I woke up. Lisinopril was treating my blood pressure. Not one of them had put a single minute of slow-wave sleep back into my night. I am a neurologist. I am supposed to be the person who knows how to prevent this. I had prescribed the exact three-drug protocol I was on to a thousand patients who looked like my mother. Every one of those prescriptions had passed peer review. Every one had followed the guidelines. Every one had been the correct standard of care. And it had failed me at 58. I sat at my desk that night at 11 PM after my husband had gone to bed and I did something I had not done since medical school. I opened PubMed and I searched for the actual mechanism. Not the practice parameters. Not the pharmacokinetics. The mechanism. I read for four hours. I found what my training had covered lightly and never in the depth it deserved. The glymphatic system. Slow-wave-dependent clearance of amyloid-beta and tau from the brain overnight. Age-related decline of the body's own melatonin output and the loss of the signal that carries the brain down into slow-wave sleep. The suppression of slow-wave amplitude by GABA-A agonists, the class my own sleeping pill belongs to. The mechanistic explanation for why the three medications I had been prescribing for twenty-two years managed downstream measurements without addressing the upstream failure driving all of them. None of this was hidden. It sat in journals I had had access to for twenty-two years. Science. Sleep. JAMA Neurology. The New England Journal. I had read those journals every month. I had read them for the trial data and the practice parameters. I had never read them for the mechanism papers because my training had told me the mechanism was managed and the treatment was to manage the downstream measurements. My training was wrong. I closed my laptop at 3 AM. I sat at my kitchen table. I could not sleep. I never could. I understood at that moment that I had prescribed the exact protocol that failed me to hundreds of other people. And every one of them was lying in bed tonight with a brain that was never going to get rinsed, waiting for their October 19th to arrive. Two weeks later I saw a patient in follow-up who should not have been in the numbers she was in. Her name was Ruth. Chronic insomnia. Twelve years post-diagnosis. She had been my patient for three years after transferring to me following a failed course of behavioral therapy. Her sleep log at intake three years earlier had averaged 4.9 hours. She had been on Amb*en, trazodone, and lisinopril. I pulled her chart before she came in expecting to add another medication. Her sleep log averaged 7.2 hours. Her MoCA was 30 out of 30. Her blood pressure was 118 over 74. She had come off trazodone twenty months earlier at her own insistence and her nights had not gone backward. I looked at her across the exam room and asked her what she was doing. She was quiet for a moment. Then she said, — Doctor, my mother left the Amish church when she was nineteen. Her older sister still farms in Lancaster County, Pennsylvania. She has been telling all of us for years. I did not bring it up because I did not think you would take it seriously. I asked her what her aunt had told her. She wrote a name and a set of directions on the back of my prescription pad. Rebecca Stoltzfus. A dirt road off a county route I had never heard of, in Lancaster County, Pennsylvania. A farm her family had worked for four generations. I drove there the following Saturday. I did not tell my husband where I was going. I did not tell my practice partner. I did not tell anyone in my institution that a board-certified neurologist was driving three hours to meet a 78-year-old Amish grandmother because everything I had been taught in twenty-two years of practice had not saved me. I did not have an address. I drove until I saw farmland and turned down a dirt road when I spotted a hand-painted sign. Vegetables and Preserves. I pulled in at 11:40 AM. The garden along the front walk was unlike anything I had seen. Horehound. Boneset. A row of old sour cherry trees down the lane behind it. Plants I recognized from the botanical section of pharmacology journals I had not thought about since medical school. She was on the porch shelling peas into a wooden bowl. Small woman. Thin. Late seventies. Gray hair pulled back under a white cap. No reading glasses. No notes. Just fast, steady hands. I introduced myself. Not as a neurologist. As Renee. She looked up with sharp clear eyes and asked me why I had come. I told her. I told her I was a neurologist. Twenty-two years in practice. That I had fallen asleep at the wheel of my car five weeks earlier. That my three medications had not saved me. That five systems in my body were showing the pattern I had watched in hundreds of my own patients. That one of my patients had told me about her. She listened. She did not interrupt. When I finished she set the bowl down and said, — Come inside, doctor. Her kitchen smelled like coffee and rising bread. She poured me a cup without asking. She sat across from me and said, — Your pill is fighting the wrong battle. You know this. That is why you are sitting at my kitchen table. I did know it. She said, — Every drug you prescribed for yourself. Every drug you prescribed for your patients. All of them work on the number on the chart. The hours. That is all. What actually cleans your mind at night — the part underneath the hours — none of them touch it. I said, — I understand the mechanism. I read the papers last week. She smiled. — Then you understand it clinically. You do not yet understand it in your own body. She held up two fingers, separated. — There are two kinds of sleep. The sleep that looks like sleep on a chart. And the sleep that actually cleans your brain. They are not the same thing. Your log measures the first one. Your mind runs on the second one. Two different numbers. And only one of them matters, and nobody is measuring it. She picked up two peas from the bowl. Then a third. Then a fourth. Then a fifth. She set them on the table in front of me. — This one is your memory. This one is your blood pressure. This one is your blood sugar. This one is your immune system. This one is the brain itself. She tapped each one. — Same missing depth. Starving all five. Every one of your specialists has told you they are treating five different problems. It is one problem. It is one night, repeated year after year. You already know this. But you have been trained for twenty-two years to prescribe for each of them separately. I nodded. I could not speak. She said, — The Amb*en quiets how long it takes you to go under. The trazodone quiets how often you wake. The lisinopril quiets your blood pressure. Three numbers on three different chart lines. Below all three, your brain has not been rinsed in years. She folded her hands. — Every night your brain makes waste, the same as your body does. And every night there is a system up there that washes it out. Like doing the dishes before bed instead of letting them pile in the sink. But that rinse only runs in the deepest part of sleep. Skip the deep part and the waste just sits there. Night after night. Year after year. It hardens. It builds. And that buildup is what they finally put a name to when your mother was 64. My chest tightened. — And here is the part no one has told you. What carries you down into that deep part is a thing your own body makes. Melatonin. Your body used to make plenty of it. Enough to put you under before eleven and hold you there until morning. Somewhere in your forties the part of your brain that makes it starts making less. Every year a little less. By your fifties you are running on a fraction of what you had at thirty. That is not a lifestyle problem. That is biology. She leaned forward. — No melatonin of your own, no key. No key, no depth. No depth, the brain never rinses. You can lie in that bed eight hours. You can swallow the pill every night. If you never reach the depth, the dishes just pile up in the sink. — And do not go buy it in a bottle. That is the first thing everyone does. Melatonin from outside is not the same as melatonin your body makes. Your body reads it coming in and makes even less of its own. You get a night or two, then you are further behind than when you started. And it still never carries you down to the depth. She looked at me. — And here is what your own profession has not told you. That pill knocks you out, but it flattens the deep part. On the chart it looks like you slept. The rinse never ran. So every night you were on it, your brain looked asleep and the waste kept piling up underneath. The pill hides how bad it is getting. And the worse it gets, the more they raise the dose. My eyes started to burn. — The car did not put a mark on the inside of your head. Years of nights that never went deep did that. If the depth does not come back, you will be back in a memory clinic within eight years. Not as the doctor. This is not opinion. This is the mechanism you already understand. I said, — I know. She said, — I want to be clear about something. I am not telling you to throw your pill in the trash. What you take is between you and your doctor, and nobody should stop a prescribed medicine on a stranger's say-so. The point is only this. The pill was managing the hours. It was never going to clean the brain. That job needs your own melatonin running again. She said, — Now here is what nobody taught you in medical school. My grandmother preserved tart cherries on this land. Her grandmother before her. Put up cold in the cellar, in glass, every August. I am seventy-eight. I have never taken a sleeping pill. I have never lost a word. My daughters sleep through the night. She stood. She walked to a shelf. She pulled down a dark glass jar. Inside was a concentrate so deep red it was almost black. — Tart cherry, she said. Not the sweet cherry they bottle for the grocery store. A different fruit entirely. Cheaper. It has almost none of what matters in it and forty grams of sugar in a glass. And what they do bottle from the tart fruit is pasteurized at high heat so it survives shipping and a six-month shelf life. Heat destroys the very compounds you need. By the time that bottle hits the shelf, most of what mattered is cooked out of it. She set the jar down. — Real tart cherry has two compounds your body needs. The first is called tryptophan. This is the raw material your brain builds its own melatonin out of — the melatonin your training tells you simply runs out with age. Give your body enough of it and it starts making its own again. Not from a bottle. Your own. The door to the depth opens, the rinse finally runs, and years of waste start moving out. She held up the jar. — The second is called anthocyanin. The compound that makes the cherry red. It is one of the few antioxidants that gets into the brain, and it mops up the damage that was done while the door was shut. The damage in your memory. Your pressure. Your sugar. Your immune system. And the part of your brain that holds the names of your children. She looked at me. — Two compounds. From one fruit. One opens the door. The other repairs what the waste did while the door was closed. That is why the women on this farm do not go the way your mother went. I asked her if the form mattered. She nodded. — It has to be the right fruit, pressed cold, at the real dose. Sweet cherry does nothing. Heat-dried powder does nothing — that is what is in the capsules on the shelf, ground with filler to keep it cheap. Most of them will not even print the anthocyanin number on the label, because if they did you would see how little is in there. The studies that showed anything used 3,600 milligrams of anthocyanin-standardized extract. Not juice. Not a token capsule. Concentrated. Standardized. Cold-extracted. My grandmother did not know the word anthocyanin. She knew that what she put up cold in the cellar worked and what she boiled did not. She paused. — There is a company my granddaughter in Philadelphia told me about. They press the real fruit cold, the way it is done here. They standardize the anthocyanin content to match the dose in the research. Third-party tested in the USA. No fillers. One thing, done right. She wrote a name on the back of a seed envelope and slid it across the table. GoodGrove. I ordered three bottles from her kitchen table before I left Pennsylvania. I drove three hours home. I did not tell my husband where I had been. The bottles arrived the following Wednesday. I took two capsules that night before bed. I kept taking my own prescriptions exactly as written. Week one. I woke at some point in the night and instead of lying there watching 2:00 turn into 3:00 turn into 4:00, I rolled over and was gone again before I had finished the thought. Twice that week I slept clean through. For the first time in six years I was not watching the clock at 3 AM. Week two. My sleep log averaged 6.4 hours. Up from 5.1 at discharge. I added the nights up twice because I did not believe the number. Week three. Somewhere around day 19 a word I had been groping for on a phone call just arrived. On its own. I had not realized how long I had been losing them until they started coming back. Week four. I ran my own 24-hour ambulatory monitor. My blood pressure dropped at night for the first time since November. Daytime average 122 over 76. I had not changed a single medication. Week six. Fasting glucose 94. Down from 118 in November. I ordered a follow-up A1C two weeks later. Week eight. A1C 5.7. Down from 6.1. MoCA 27, up from 24. Delayed recall five out of five. Week twelve. Full panel. Repeat sleep study in my own lab. Slow-wave sleep, 38 minutes. Up from three. Sleep log averaging 7.1 hours. MoCA 29 out of 30. Fasting glucose 89. Blood pressure sitting at 116 over 72 without any change to my medication. hs-CRP back in normal range. I called the colleague who had run my neuropsychology battery in November and asked her to run it again. She did. Twenty-nine both times. I sat in my office at 6 PM staring at my own sleep architecture on my own screen and I understood that I was looking at a reversal I had not seen in a chart in twenty-two years. I brought it to my practice partner. Another sleep physician. Fifteen years of practice. Someone I had trained. I put the November study next to the twelve-week study on her desk and I did not say anything. She read them. She looked at me. — Renee. What did you do. I told her. The Amish grandmother. The kitchen table. The two compounds. The rinse. All of it. She listened for forty minutes without interrupting. When I finished she was quiet for a long time. Then she said, — I have not been trained on this. But I want to see this in my own patients. Tell me the name of the product. I gave it to her. She has been running it with fourteen of her chronic insomnia patients for the last three months. She called me last week. Nine of them are sleeping through the night. Three have come off their sleeping pill at their own internists' recommendation. The sternum still aches in cold weather. I am still on lisinopril at a reduced dose. My trazodone was discontinued at week fourteen by my internist. I take the Amb*en maybe twice a month now, on call nights, the way it was actually meant to be used. I slept in a hotel bed last week for the first time in six years without taking anything. Seven hours and ten minutes. New room, unfamiliar bed, exactly the kind of night that used to guarantee a disaster. My last study two weeks ago showed forty-four minutes of slow-wave sleep. I was eleven seconds and one guardrail from dying at 58. I am writing this because I still have my practice. I still have my husband. And I have watched every finding in that workup reverse. I have watched a colleague I trained look at my own sleep architecture and say the word I had waited eleven months to hear. Improving. Not managed. Improving. I am also writing this because I know the truth about what my profession is doing. I did not sit at that farmhouse kitchen table because I wanted to. I sat there because everything my medical school and my board certification and my twenty-two years of practice had taught me about how to treat this had failed me. I delivered 1,412 dementia diagnoses before I ordered the workup on myself. Every one of those diagnoses was in a person who had spent ten or twenty years being told their sleep was managed. Every one of them left my clinic with the same protocol I was on. Every one of them was told the hours looked fine. I do not know how many of them could have been stopped. I do not know how many of them are already gone. I know that the standard of care my hospital taught me was built on the assumption that managing three downstream numbers with three separate medications was equivalent to addressing the mechanism driving all three. It is not. I have five reports in my own chart that prove it is not. And my mother's records from thirty years ago prove it was not for her either. If your mother, your sister, your husband, your father, or you have insomnia and have been told the hours look fine while your mind quietly fills up, please listen to what I am telling you. The missing depth is what takes your mind. Not the hours on the chart. The pill lowers the time it takes you to go under. It does not open the door. It does not run the rinse. It does not repair what years of unrinsed nights have already done to your memory, your pressure, your sugar, your immune system, and your brain. Sleep hygiene does not save you. I ran mine perfectly for six years and it did not stop what was coming. Drugstore melatonin does not save you. Same idea. Different lever. Worse — synthetic melatonin from outside tells your body to make even less of its own, and it still never carries you to the depth. There is one thing I know of that opens the door and repairs the damage. The two compounds in real cold-extracted tart cherry. Tryptophan gives your body the raw material to make its own melatonin again. Anthocyanins clean up what the missing depth has been doing to you for years. Together, at the right dose, in the right form, they address what my three prescriptions did not touch. GoodGrove. https://trygoodgrove.com/cherry-sleep Cold-extracted tart cherry concentrate, not heat-dried powder. 3,600 milligrams of anthocyanin-standardized extract per serving, not the token doses in the grocery store capsules. Third-party tested in the USA. No fillers. Two capsules at night. That is the whole protocol. 90-day money-back guarantee. If your nights do not get deeper, you pay nothing. The system that trained me did not give this to me when I needed it. It is reaching you now. P.S. My mother was an insomniac managed on a sleeping pill and a blood pressure pill for eleven years before dementia took her mind and she died at 64. My father's memory was being watched for a decade before he passed. I built my entire practice on the assumption that I would catch in my patients what nobody caught in my mother. Instead I watched myself walk the same road in my own body, one flat night at a time. The difference is that I got an eleven-second warning and she did not. Please do not let your family's warning be shorter than mine was. P.P.S. I do not work for GoodGrove. I do not receive a penny from this. I am writing this at 11:20 PM on a Sunday, alone in my office, because a patient came in Friday whose sleep log had gone from 4.7 hours to 6.8 in six weeks and I recognized my own numbers on her chart. She had found it on her own after reading a post from a woman named Carol about her older sister Linda. She told me the post had been circulating among the women in her book club. I read it that night. It was the second time in six months I had recognized my own patient in a story written by a stranger. Please share this with anyone you love who lies awake. Even a few nights a week. Even if they think the pill is working. I promise you it is not doing the thing they think it is doing. ~ Dr. Renee Donnelly, MD, FAASM, age 60, neurology and sleep medicine