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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by bark2323 on March 29, 2005, at 17:52:05
Ok, I have really bad insomnia. First Ill say what meds I am currently taking; zyprexa 15mg, klonopin 4mg, and provigil 400mg (I know this may be contributing to the problem, but when I dont take it I still have insomnia, and its benefits keep me from wanting to stop it). I am also taking 8mg of gabitril for insomnia, but it doesnt work, so more often then not I dont take it. Instead I drink my self to sleep (around 4 beers). I am diagnosed with either depression and schizotypal personality disorder (more likely), or else BP2.
My main problem is not the absence of feeling tired (although I dont ever feel too tired), but rather the inability to stop my mind from racing/worrying/ruminating.
Heres what Ive already tried (recently) and hasnt worked: ambien, sonata, trazodone, neurontin, sedating TCAs (I forget which), ativan (I tried 3mg which helped a little, but my doc is unwilling to prescribe more), and most recently gabitril.
I have a feeling that anticonvulsants or GABAergics are the most likely to help, or possibly upping the zyprexa or adding another AP, but I would like any suggestions. Would increasing the gabitril work? I have considered chloral hydrate and barbiturates, but I doubt my doc would prescribe them, but if they have helped people (especially long term) I would like to hear about it. Any suggestions would be welcome, and as I said especially ones that have helped long term.
thanks,
matt
PS- as to upping the AP or adding another, I overall feel ok with the combo Im on now. But lately Ive been literally thinking IN, not about, equations, sometimes imagining I am one who is supposed to produce a number. I am in calculus right now, and have also been feeling constantly stressed, so is this reaction just stress or very mild psychosis?
Posted by RjLockhart98 on March 29, 2005, at 18:08:10
In reply to bad insomnia, posted by bark2323 on March 29, 2005, at 17:52:05
i hear you. I didnt hardly get anysleep last night.
Well, i dont know how to act to show i pdoc how serious it, should i calmly tell him, or go balistic! I take Trazadone 50mg, mainly for sleep but it didnt help, then 2mg of Klonopin, got more lethargic, but i really didnt feel like doing anything, even sleeping.
5-HTP supplements help at high doses, 300mg. They really do. I didnt have any, and all stores where closed. But i dont want to get this post redirected by the administraion so i will shut up about that.
Seconal really i think is the last choice, i dont think it is prescribed for much for patients 35 or younger. I thought that was choice for that Fatal Insomnia Diesease.
Seroquel you might look into, i dont know with a beer, maybe.
Xanax, and Restirol, or Halcion are good hypnotics, also i heard about this new Lunesta sleeping med, approved for Long Term Use.
Also choices depend on docs too.
Best Equation to you.
Posted by Phillipa on March 29, 2005, at 18:41:52
In reply to Re: bad insomnia, posted by RjLockhart98 on March 29, 2005, at 18:08:10
Sounds like you're under a lot of stress. I took chloral hydrate for 8 years and it really worked well for me. I was started on 5cc and over the years I required l0cc. I always woke up during the night except when I was initially rx'd it. I had 3 different pdocs Rx it for me as they all thought it a safe drug. You can't drink on it though as it is a "Mickey Finn". My new pdoc put me back on valium as it was the first medication I ever took and it worked well. I'm also on a small dose of remeron which is supposed to help sleep at low doses. I hope this helps. Fondly, Phillipa
Posted by Minnie-Haha on March 29, 2005, at 18:46:53
In reply to bad insomnia, posted by bark2323 on March 29, 2005, at 17:52:05
I have Bipolar Type 2 and OCD. I recently had severe insomnia for 15 months. I went to sleep OK, but I would wake up 2-4 hours after falling asleep. I tried Ativan, Ambien, Klonopin, Sonata, Elavil (TCA), plus a host of alternative treatments. (I tried Zyprexa too -- one night, and a very low dose -- it knocked me out, but I felt like a zombie the next day. It wasn't the right med for me, but it certainly turned off the noise in my head.) An endocrinologist did a 24-hour urine test and my cortisol was twice the high-normal amount. This lead me to believe I had pseudo-Cushing's, which can result from un- or under-treated depression. (Actually, someone on this board, bless his or her heart, suggested this possibility.) Anyway, I don't know if the anxiety/insomnia caused the depression or the other way around, but I got no relief until I got on an antidepressant.
None of the drugs you listed as being on right now look like a true anti-depressant to me (unless I missed something) though some may have something of an AD effect. Have you talked with your pdoc/therapist about trying a good 2-3 week trial of an SSRI or SNRI? (If you are Bipolar, you should start off first with a mood stabilizer.)
Also, you seem to be on twice the recommended dosage of Provigil. Can you at least cut back on that, even if you're unwilling to quit it entirely?
Finally, what is your workload like? Can you let something go? And are you doing any kind of talk therapy? I think it really helps you get a little more out of your drug therapy.
Good luck!
PS: I take Trileptal (mood stabilizer), Cymbalta and Wellbutrin XL.
Posted by Maxime on March 29, 2005, at 19:49:16
In reply to bad insomnia, posted by bark2323 on March 29, 2005, at 17:52:05
I think a mood stabiliser would help you the most. If you can get those racing thoughts under control then you would be able to fall asleep. I am surprised 15 mg of Zyprexa doesn't knock you out so you must have a high tolerance of meds (metabolise them really quickly). Depakote might be a good med to try because it is a stabiliser and it is sedating.
Maxime
> Ok, I have really bad insomnia. First Ill say what meds I am currently taking; zyprexa 15mg, klonopin 4mg, and provigil 400mg (I know this may be contributing to the problem, but when I dont take it I still have insomnia, and its benefits keep me from wanting to stop it). I am also taking 8mg of gabitril for insomnia, but it doesnt work, so more often then not I dont take it. Instead I drink my self to sleep (around 4 beers). I am diagnosed with either depression and schizotypal personality disorder (more likely), or else BP2.
> My main problem is not the absence of feeling tired (although I dont ever feel too tired), but rather the inability to stop my mind from racing/worrying/ruminating.
> Heres what Ive already tried (recently) and hasnt worked: ambien, sonata, trazodone, neurontin, sedating TCAs (I forget which), ativan (I tried 3mg which helped a little, but my doc is unwilling to prescribe more), and most recently gabitril.
> I have a feeling that anticonvulsants or GABAergics are the most likely to help, or possibly upping the zyprexa or adding another AP, but I would like any suggestions. Would increasing the gabitril work? I have considered chloral hydrate and barbiturates, but I doubt my doc would prescribe them, but if they have helped people (especially long term) I would like to hear about it. Any suggestions would be welcome, and as I said especially ones that have helped long term.
> thanks,
> matt
> PS- as to upping the AP or adding another, I overall feel ok with the combo Im on now. But lately Ive been literally thinking IN, not about, equations, sometimes imagining I am one who is supposed to produce a number. I am in calculus right now, and have also been feeling constantly stressed, so is this reaction just stress or very mild psychosis?
Posted by bark2323 on March 29, 2005, at 20:50:15
In reply to Re: bad insomnia » bark2323, posted by Maxime on March 29, 2005, at 19:49:16
Thank you for all of your very quick responses! Ok, to address what yall (yes Im a texan) said. I have taken restoril in the past but developed tolerance quickly, and I fear the same might happen with other benzos, but Im at the point where I just want to worry about that when/if it happens. And I agree seconal or the likes are a last resort. And to I believe Ritch now (Rjlockhart98), I would be really upfront to your doc, but some might be put off by this, so I dont really know. Seroquel worked somewhat for me in the past, but it didnt keep me asleep and gave me nightmares. And Phillipa, was the buildup of tolerance to chloral hydrate slow? As for antidepressants, since being off them I have actually had fewer depressive episodes, although I am beginning to get depressed from the sleep issues and stress. (the stress is mainly from school; Im taking a lot of hours and harder courses than usual). So maybe I need an AD; an SSRI could help with ruminations and such even if Im not currently too depressed. My main worry about a mood stabilizer is that I would feel too blunted, as I did when I was on trileptal in addition to zyprexa (although this didnt happen with either drug alone). But they could definately help racing thoughts. So you can see I have a lot of reservations. All of your suggestions are good though, and I will bring them up to my doc. Thanks again everyone.
matt
Posted by bark2323 on March 29, 2005, at 20:56:06
In reply to Re: bad insomnia, posted by bark2323 on March 29, 2005, at 20:50:15
Just wanted to add that zyprexa used to put me asleep just fine. In fact I used to be able to sleep good when all I was on was 7.5mg zyprexa and 400mg provigil. Oh and to answer the question about provigil, Ive tried reducing the dose and just dont benefit as much. I take it more for ADD-type symptoms and some mood lift than for staying awake.
matt
Posted by Phillipa on March 29, 2005, at 21:44:54
In reply to Re: bad insomnia, posted by bark2323 on March 29, 2005, at 20:50:15
To answer your question the build-up in tolerance to chloral hydrate was slow. I wonder if it would have happened at all if I hadn't been beginning menopause at the time and didn't know it. Fondly, Phillipa
Posted by The_Resistance on March 30, 2005, at 16:12:19
In reply to Re: bad insomnia, posted by Phillipa on March 29, 2005, at 21:44:54
I'm really worried that the Provigil your taking is contributing to your insomnia.
Even a small dose of Provigil 100mg taken in the morning stops me from sleeping at night.
I don't mean to be rude and its good your finding it helpful, but perhapse you could switch to a shorter acting stimulent like Dexedrine?
Posted by bark2323 on March 30, 2005, at 19:13:30
In reply to Re: bad insomnia, posted by The_Resistance on March 30, 2005, at 16:12:19
You arent being rude at all. My doc wont prescribe "normal" stimulants for me as I have a history of drug abuse. Well actually one month he had me try adderall, but has since changed his mind for some reason even though I didnt abuse it. I actually like provigil better anyway though. I do agree it is probably contributing to my insomnia, but as I said before I still have insomnia without it, and actually have been able to take the dose I am on now without a sleeping pill in the past, so I think my insomnia is simply getting worse. That was a good suggestion though, so thank you.
matt
Posted by gromit on March 31, 2005, at 20:58:24
In reply to Re: bad insomnia, posted by The_Resistance on March 30, 2005, at 16:12:19
> I'm really worried that the Provigil your taking is contributing to your insomnia.
>
> Even a small dose of Provigil 100mg taken in the morning stops me from sleeping at night.I found I slept BETTER when Provigil was working at 400 mg as long as I took it early in the day. I was physically more active, but more importantly I think, my mind was more active. Just my experience.
Rick
This is the end of the thread.
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