Thank you so much. I would have responded sooner but I was stuck and didn't sign on again. I thought it was weird that I "woke up" at night and thought that was the reason for the insomnia -- I've gone 36+ hours without sleep. I'm useless then because I'm unfit to drive just when my mood motivates me to do something. I wouldn’t use my night time energy because I thought it would add to the insomnia problem. My psychiatrist said it was related to mood and when my mood leveled out my ability to sleep would also. I live alone and find that my behavior and sleep normalize somewhat when my boyfriend is here or I am staying with other people. My psychiatrist encourages the baby step approach your recommend. I also have lowered my expectations. That was hard to do. I've always had high expectations for myself. I never thought of myself as a perfectionist until I was in DBT training. Frankly I was shocked. I had a highly visible job and in some areas of my work "perfect" was expected and I felt absolutely necessary. I strove for perfection when close is the best anyone can do and not necessary in all aspects of the job and not in my personal life. Since I posted the doctor has increased my dose of lamotrigine. It has begun to kick in and it helps. This is my second attempt. I ended the first when I began to have tremors in my non-dominant hand that I found scary and embarrassing. I also had an increase in the twitches I have due to disk damage in my neck and back. The tremors stopped when I lowered the dose. I do not know if it was a coincidence or a true side effect. I’m sorry this is so long. I am anxious as I’ve backed out at the last minute of six social or doctor appointments and I have my son and his girlfriend coming for brunch tomorrow and have a weeklong visit to out of state relatives. Everyone has been so patient with me and I am so unreliable. Again, that you so much for your response.

Female, age 62, on disability
Treatment Resistant Depression & Anxiety
- Bupropion HCL ER XL 150 mg
- Duloxetine 90 mg
- Lamotrigine 50 mg
- Xanax 0.5 mg as needed
- ECT treatments 23 treatments over five months
Additional medications for:
Acid reflux
Congestive Heart failure
Degenerative disc disease
Narcolepsy, sleep apnea, insomnia