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Forum Name: Psychiatric Topics

Question: Chronic Sleep Disorder 3 years - prescriptions not working


 Brendy - Thu Sep 04, 2008 12:55 pm

Since 2006, I've been suffering from a severe case of insomnia and its accompanying disorders. I've been under the care of a psychiatrist since 2006 for anxiety and insomnia. My looking at all my receipts of prescriptions I have had filled over the past 3 years, I believe I have been prescribed almost every sleep aid available; the OTC's are of no benefit. The prescribed sleep aids I have been prescribed have not been beneficial, which I surmise is because my tolerance to prescribed controlled substances is so high (benzos and opiods) which are used to treat a severe case of anxiety and a very painful orthopaedic issue, or that the doses which the psychiatry resident is prescribing for me is not sufficient and probably exceeds the recommended dosing listed in the PDR.

Can anyone please suggesti a sleep aid that will hopefully help me achieve more than 1-1/2-2 hours of continuous sleep? I can't seem to get beyond stage I sleep, as I awake after only approximately 60-90 minutes of sleep nightly.

If you kindly respond, please take into consideration my very high tolerance to medications in the classification of the: (benzos) (epams), as well as (opioids). I'm fervently seeking to find a sleep aid medication with adequate dosaging that will provide me with more than the 1-1/2 hours of continuous sleep that I have only been getting for years now. Not being able to reach the REM stage is severely affecting my concentration, focusing, and memory at work; it takes me 3 times as long to complete a task as it normally would when I was sleeping at least 8 hrs nightly.

Thanks very much in advance for your recommendations, advice, and/or opinions.
 Dr. E. Seigle - Fri Oct 03, 2008 7:48 pm

Hi Brendy,

I applaud your honesty in pointing out your tolerance to 'benzos" and opioids. It is probably good to avoid these for this reason. Have you discussed with your psychiatrist the possibility of the following:

1. Do you have a sleep disorder that is interfering with your sleep (such as restless legs syndrome), ? Do you warrant a consultation with a sleep specialist to investigate this?

2. Are you taking any medications, beverages, caffeine, or over-the-counter drugs that are interfering with sleep?

3. Are you using alcohol or any drugs of abuse?

4. Any medical conditions at play?

4a. Is your primary psychiatric disorder not being well treated, and this contributing to your insomnia? If your anxiety disorder is not well treated, then optimizing this will probabbly help with sleep.

5. Other sleep medications that you might consider include: sedating tricyclics such as doxepin or amitriptyline, trazodone, cyproheptadine.

6. You and your psychiatrist might review which benzos you have tried. If you only have trouble sleeping in the early part of the night, one can use a short acting benzo along with a longer acting medication of the types above, or even a long acting benzo. However, this approach is less likely to be helpful than those above.

5. For sleep-inducing medications, the following possibilities come to mind:
a sedating tricyclic such as doxepin or amitriptyline, trazodone, or cyproheptadine.

6. You might consider a self-hypnosis or self-relaxation, cognitive-behavioral sleep protocol.

Hope these ideas are useful! -E. Seigle MD
 Brendy - Mon Dec 08, 2008 11:32 am

Thank you for your response Doctor.

I had a consultation with a sleep specialist and he does not think a sleep study is warranted, nor did he prescribe any sleep medication, but rather brochures regarding sleep hygiene, which I am already well aware of, having worked in the health care field for over 25 years. The consult proved to be both fruitless as well as futile.

Can not step off the pain meds at present; awaiting a joint replacement, and without the meds, I would be unable to perform the daily tasks of living.

The medications you listed I have tried, and again, proved to be of no benefit. Many others have been tried as well, with the same no results. I've grown extremely weary (that's an understatement) of this dilemma and am at my wits end as to what to try next -- if anything.

I'm in quite a conundrum here. My orthopedic surgeon is advising me to stay off my limb as much as possible, and my therapist and the sleep consultant are advising me to stay out of bed and exercise as much as possible; that advice to a person in need of a joint replacement. So whose advice do I follow? They (my physicians) can seem to find a middle, workable ground.

Any additional opinions would be greatly appreciated. Thank you.

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