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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Guy on July 23, 2003, at 13:14:51
I've been suffering from chronic insomnia for about 7 years and this has greatly exacerbated my anxiety disorder. I always awaken in the middle of the night and start to worry about not going back to sleep. This has unfortunately developed into a phobia. Sometimes I panic, and that really sets me up for a terrible day...like I'm having a nervous breakdown, complete with horrible pain and suicidal thoughts. I have been on many meds, but most do not make me feel better--just make me fat, lazy and impotent. Currently, I take 15 mg of Remeron before bed and then 1 mg of clonazepam when I wake up at around 2 am. Usually, the clonazepam is enough to get me back to sleep. I never feel really good though, even when I get enough sleep...the anxiety is never totally eliminated. I do lots of exercise, but still have adull headache all day and a "buzzing" nervous system. I'm 49 now Is this what it's going to be like for the rest of my life? Pdoc wants me to go on 100 mg of Seroquel but I'm afraid of serious side effects, such as cataracts, especially since I am already blind in one eye. Sorry for long, sad story. Just wanted to share.
Posted by jlo820 on July 23, 2003, at 16:16:48
In reply to Chronic Insomnia, posted by Guy on July 23, 2003, at 13:14:51
Seroquel is very sedating. and although I do not favor using anti-psychotics for problems other than psychosis, if your problem is serious enough, it might work very well.
Another option to ask about might be the anti-depressant Deseryl (trazodone) which worked wonders for my insomnia.
Also, I have used the supplment Melatonin with great success.
Posted by crazychickuk on July 23, 2003, at 16:28:36
In reply to Chronic Insomnia, posted by Guy on July 23, 2003, at 13:14:51
awwww i feel for you i really do, have the doctor done any tests?
Posted by linkadge on July 23, 2003, at 16:53:45
In reply to Chronic Insomnia, posted by Guy on July 23, 2003, at 13:14:51
You should really try Sinequan. This med is used *very often* for insomnia. Probably fewer side effects than Remeron as well.
Linkadge
Posted by juanantoniod on July 24, 2003, at 0:58:43
In reply to Chronic Insomnia, posted by Guy on July 23, 2003, at 13:14:51
Hi Guy,
I too suffered from insomnia, although not quite as dramatic as yours.
There are 2 excellent medications that may be of help to you. One is Ambien, the other is Sonata. Sonata is designed for early awakenings because it has a short half life, and can be out of the system by morning.
Halcion is another medication that worked wonders for me until I became benzo tolerant. It was a hard sell getting my pdoc to prescribe it, but he eventually did.
I did not have good luck with Seroquel. Initially, it caused me to be lethargic for 12 hours, more than I desired. Also, my body quickly became accustomed to it and I had to keep increasing the dose to get any benefit. Eventually, on doctor's advice, I tried increasing it to 2500mg. That was horrendous. It caused me to have severe such low blood pressure that I almost fainted when I got out of bed. So I spent almost the entire night awake in bed but unable to move because of the low blood pressure. You, however, might have better results.
As for Trazodone, it is my understanding that it works for sleep by lowering the blood pressure. (Perhaps another reader can enlighten us on that.) For me, it did not make me sleepy at all, but I did feel a little bit wobbly when I got up at night to use the restroom.
I'm curious -- is your anxiety disorder being adequately treated with medication for the daytime anxiety? If so, perhaps a nighttime dose of the same medication or an overall increase might help some with the nighttime anxiety, which would help a medication like Ambien do it's work better.
My story is that I took Ambien for about 6 years and it recently stopped working. However, according to a sleep doctor I consulted, it stopped doing it's magic after about 3 months. I wish someone would have told me! So the last 6 years were all for psychological (placebo) effect. FWIW, he also said that Melatonin is good for resetting the body's natural clock and advised me to take it for 3 months while I get used to sleeping on my own. However, he said that it does not put you to sleep. If I can give you any advice, I would try and deal as much as possible with the insomnia without medications, and save the effectiveness for when you absolutely need it. I would also have different medications that you can rotate through so that none becomes ineffective too early.
I hope this is helpful. Please submit a follow up posting if I can answer any questions.
> I've been suffering from chronic insomnia for about 7 years and this has greatly exacerbated my anxiety disorder. I always awaken in the middle of the night and start to worry about not going back to sleep. This has unfortunately developed into a phobia. Sometimes I panic, and that really sets me up for a terrible day...like I'm having a nervous breakdown, complete with horrible pain and suicidal thoughts. I have been on many meds, but most do not make me feel better--just make me fat, lazy and impotent. Currently, I take 15 mg of Remeron before bed and then 1 mg of clonazepam when I wake up at around 2 am. Usually, the clonazepam is enough to get me back to sleep. I never feel really good though, even when I get enough sleep...the anxiety is never totally eliminated. I do lots of exercise, but still have adull headache all day and a "buzzing" nervous system. I'm 49 now Is this what it's going to be like for the rest of my life? Pdoc wants me to go on 100 mg of Seroquel but I'm afraid of serious side effects, such as cataracts, especially since I am already blind in one eye. Sorry for long, sad story. Just wanted to share.
Posted by Simcha on July 24, 2003, at 1:24:41
In reply to Chronic Insomnia, posted by Guy on July 23, 2003, at 13:14:51
Guy,
I have had chronic insomnia for my entire life. I feel the pain, man. Here is what I'm trying for now.
I'm still experimenting with supplements to help with sleep. I have found a source (that I cannot mention on this board) for valium. It works but I can only use it on Friday and Saturday night because it leaves me too groggy in the am to drive to work.
Valerian works too but it also leaves me entirely too groggy in the am so I have to be careful with it too. Only 400mg of the Nature's Source brand will make me sleep soundly yet, unfortunately, it can leave me groggy in the am.
I use this supplement every evening and it seems to calm me somewhat. It's called "Sleep Tight Factors" and it's by Country Life. They are hypoallergenic and vegetarian and they are certified kosher. All of this is important to me. Well the formula is as follows. I take two tabs and this is what 2 tabs gives you:
Niacin (as niacinamide) 100mg
Vitamin B6 (as pyridoxine HCL) 10mg
Calcium (as citrate, carbonate, glycinate & taurinate) 100mg
Magnesium (as citrate, oxide, glycinate & taurinate) 200mg
Potassium (as citrate, glycinate & taurinate) 99mgInositol 500mg
Glycine 400mg
Taurine (tree form) 300mg
Hops Extract 4:1 (fruit) 25mg
Passion Flower Extract 4:1 (leaf/stem) 25mg
Scullcap Extract 4:1 (aerial) 25mg
Valerian Extract 4:1 (root) 25mgSometimes I've tryed Benedryl. This is a double edged-sword for me. It can help me sleep at 25mg only sometimes. If I cannot sleep with 25mg and I use 50mg then I will sleepwalk, turn off my alarm (when it goes off), and return to bed without realizing that I had turned off othe alarm. This is not good for work, for obvious reasons.
I called my gp who has said that he will give me ambien if the benedryl does not work. I'm scared of ambien for some reason so I'm trying all the alternatives before I go to get the ambien. I suspect that I will end up with an ambien prescription in the next couple of months if the combination of alternatives that I been trying do not work.
See the pdoc took the Klonopin away because he thought that it was interrupting my normal sleep cycle. For a while Neurontin helped me sleep just fine. Then it did not anymore.
I'm not going back to that pdoc because I think he is benzophobic and the Klonopin worked beautifully for my insomnia, the bruxism, and the RLS. That was all on 1mg per night for a year. I never had to take more.
My gp is much more willing to give me meds that I have researched and I believe might work. We have a great relationship.
I hope it gets better for you,
Simcha> I've been suffering from chronic insomnia for about 7 years and this has greatly exacerbated my anxiety disorder. I always awaken in the middle of the night and start to worry about not going back to sleep. This has unfortunately developed into a phobia. Sometimes I panic, and that really sets me up for a terrible day...like I'm having a nervous breakdown, complete with horrible pain and suicidal thoughts. I have been on many meds, but most do not make me feel better--just make me fat, lazy and impotent. Currently, I take 15 mg of Remeron before bed and then 1 mg of clonazepam when I wake up at around 2 am. Usually, the clonazepam is enough to get me back to sleep. I never feel really good though, even when I get enough sleep...the anxiety is never totally eliminated. I do lots of exercise, but still have adull headache all day and a "buzzing" nervous system. I'm 49 now Is this what it's going to be like for the rest of my life? Pdoc wants me to go on 100 mg of Seroquel but I'm afraid of serious side effects, such as cataracts, especially since I am already blind in one eye. Sorry for long, sad story. Just wanted to share.
Posted by pianolady on July 24, 2003, at 3:09:11
In reply to Re: Chronic Insomnia » Guy, posted by Simcha on July 24, 2003, at 1:24:41
I've tried several of the things suggested. I used ambien for several years and it became ineffective. I've also tried sonata, desyrel, benadryl, and a host of other things. I have been taking seroquel for several years. Also, I am currently using halcion in addition to the seroquel. The halcion has worked fairly well for me, but I keep to a regiment of only using the prescribed dosage regardless of whether it works one night and doesn't another. I figure that way I won't have to be too concerned with overusing benzos or with any potential addictive properties (many people question whether benzos are or are not addictive, but that's a whole other subject).
On the issue of seroquel, I only stopped taking it a week ago and I had been on it for several years. It had a very sedating effect on me and so I used it at night. But, as someone else pointed out, antipsychotics should only be used to enhance sleep if there is another reason for using them (psychosis or other uses as prescribed by pdoc). I typically did not use but 25 mg, but many people take much more than this--particularly those who are actively psychotic. Overall, I would say that seroquel has been fairly effective. I'm not completely sure that I agree with my pdoc discontinuing it, but after dealing with yet another episode of mild/moderate psychosis (one of many), it seemed reasonable to consider another antipsychotic.
The suggestion of using melatonin is one that my pdoc has discussed with me on many occasions. I did not really ever have a successful trial with it, but I understand that it is fairly safe. The information I received indicated that about 300 micrograms were adequate to help in readjusting the sleep cycle rather than the 1 to 3 milligrams that are in many OTC preparations. You may want to consider this.
Another issue that I would discuss with your doctor is whether there is another drug that could be used for your psych illness that would have a sedative effect as a "side effect". (Like the seroquel for me). If a change of this nature is reasonable, this may allow you to take one less medication and in my book that's advantageous (decreased cost and fewer drug-drug interactions when you can go to fewer different meds).
One thing is certain, there are no absolute answers to sleep problems. If there were, I wouldn't be up at this hour! (The new antipsychotic is very activating and I drank a couple of soft drinks with caffeine earlier this evening--usually I find it's better to avoid caffeine when it's reasonably possible).
Also, I typically have this strategy for sleep problems. I go to bed at a similar time each evening (not for the last week because of the new meds) and I will stay in bed for an hour. If I haven't fallen asleep in an hour, I will get up and do something as quiet and non-stimulating as possible. Then I wait until I am truly sleepy to go try sleep the second time. If I don't get much sleep that night, I absolutely avoid napping because it further upsets the sleep cycle. I try the same thing the next night and so on. At some point the body usually takes over and I eventually get a good night or two. But, one caution--I've found that my psych illness is much worse when my sleep cycle is off, so I carefully monitor this and discuss it at most meetings with my therapist and pdoc.
Posted by utopizen on July 24, 2003, at 4:23:41
In reply to Re: Chronic Insomnia, posted by pianolady on July 24, 2003, at 3:09:11
Ask your doctor about Xyrem. He has to register (5 minute process) to a central pharmacy, and you have to listen to a tape recorded message for 5 minutes, and a month later your doctor's prescription is shipped to you.
Just ask your doctor about it, though. Don't go crazy with Google over it, there's enough misinformation on how to obtain it and how "hard" it is to get to put me into a coma.
I'll probably be going on it in a couple of months. It's good to have an overnight sleep study and a Multiple Sleep Latency Study before considering Xyrem. It's been used off-label by neurologists and other specialists for treatment-resistant insomnia. And given how pathetic the current treatments are, that's not hard to have these days. Ambien would be fine if it didn't have me wake up 4 hours after taking it. I often re-dose. Trazodone leaves me too groggy, I've played between 50-100mg a night to no luck.
Posted by Guy on July 24, 2003, at 12:07:49
In reply to Chronic Insomnia, posted by Guy on July 23, 2003, at 13:14:51
Thanks for your input, everyone. This will give me something to discuss with my psychiatrist. Mental suffering is such a lonely condition...it's good to know that others understand what I am going through.
This is the end of the thread.
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