Sleep, I need sleep

I don't know what to do. I haven't slept more than a few fitful hours this past week. Ambien didn't work. White noise isn't working. My Pdoc says I shouldn't take melatonin because it worsens depression. He doesn't know how valerian root works and says I shouldn't take that. He says OTC sleep aids cause rebound sleepiness. But then again he also tells me that Celexa doesn't work. Uh, YES IT DOES!!!!

I just want some sleep, at night, when it's dark, and the rest of the household is out cold.

I don't want to go on an antipsychotic for sleep like he suggested. He said it causes weight gain and hangovers. Yeah, like THAT'S going to make me feel better.

I have battled with sleep for the longest time and I know how aweful it is to lie there and your brain will just not shut off. I take seroquel and I really like this drug. It is not just a sleep aid but it helps with the mania and anxiety in bipolar disorder as well. It takes a while to find just the right dose but once you get the dose right, you won't have a hangover in the morning. I also like it because it doesn't make me feel "drugged". It just makes me feel ready for bed.

((((wi_fighter)))): I soooo hear you. I haven't had a decent nights sleep for weeks. Started Effexor 2 weeks ago and it seems I can GET to sleep but I can't STAY asleep for more that about 1 hour at a time. It's really starting to wear me down.

My doc doesn't want to give me anything either - says that any sleep aid has the potential for addiction and wants to me to tough it out.

I know it's frustrating. I've tried the relaxation CDs which helped me get to sleep. The one other thing I have tried that seems to help me relax is the squeezing of fists. It was suggested to me by someone here at PC. I lay in a comfortable position and first squeeze my left fist and release, then the right, release, left, etc. Keep doing it for as long as it takes. Even when I awake during the night, I use this technique. At least it gives me a little bit of relief.

Good luck and sweet dreams.

Seroquel is what he suggested.

I just don't have a lot of faith in him. When I told him Celexa works for me but it needed to be increased, he switched my meds and I ended up worse. Then he put me on Lexapro even though I'd never had problems with Celexa. I asked to go back on Celexa because it works as well and it's cheaper. He insists Celexa is a worthless drug. I and my therapist disagree. I'm doing better now than I ever have, minus the sleep difficulties.

So if he's wrong about the Celexa, maybe he's wrong about melatonin and valerian and everything else I suggest trying.

I tried the fist squeezing too. I saw that suggestion in your sleep thread. So far, no luck.

Getting comfy with lots of pillows and my daughter's stuffed animals hasn't helped either.

The comfort part isn't what's killing me, it's the laying in bed, feeling tired, but can't fall asleep that's getting to me.

I think there's a valerian root thread around here somewhere. I'll have to see if Larry wrote anything about it being a contraindication with ADs. It usually works for me. I don't care what my darn Pdoc says.

Darn it...I soooo know how you are feeling.

Wishing you luck with this because I know how taxing it is. I'd do anything to sleep through an entire night.

Let us know if you find something that works well for you.

I *so* understand your quandary. What I am not absolutely clear on is what you're already taking.

About melatonin. Most of the available melatonin supps are in huge doses, well above the amount that your own body would normally produce in a single day. I don't know why that is, that the standard dose is so high. Maybe some people don't absorb it well, or don't get much crossing into their brains, once it is in the blood. But telling a person with serious insomnia that there might be a consequence of getting some sleep borders on the absurd.

Another thing about melatonin is that if you take too much, nothing happens. Unfortunately, you have to experiment to find the proper dose for your own system.

Most melatonin comes in 3 mg doses. I need about 1/4 of a tablet. More or less. Taken about 90 minutes before you intend to hit the pillow, it will most resemble the normal sleep induction cycle. Although I find that small dose is perfect, I have corresponded with people who need 6-9 mg. More is not better, though, because if you completely saturate the melatonin receptors, they shut off, and nothing happens. So you have to find the dose with the peak effect for your body. I wish there was a foolproof way to use it.

We just had a thread about valerian, within the last couple of weeks. It does not interact with any common psych med. Valerian works best, though, after you've been on it for a couple of weeks (according to my lit search). It could work the first night. It might be all you need.

OTC sleep aids may cause rebound effects, but again, you need primary help. Screw rebound issues.

Diphenhydramine. AKA Benedryl. Available dirt cheap at Walmart, as a generic. The first time I took it, when the sleepiness hit, I was afraid I wouldn't make it 30 feet to my bed. Whammo! Tolerance often develops quickly, but that is irrelevant to someone sleep deprived like yourself. First things first.

You could take melatonin and diphenhydramine safely together. Talk to me, more, after you get some sleep.

Your doctor is an ***. He would give you an antipsychotic in hopes of hitting you with a side effect. And he trivializes the other side effects of those powerful meds, yet he criticizes simple treatments for insomnia because of side effects? What's wrong with this picture?

I urge you to find another doctor. Any doctor. Temazepam (Restoril), or Doxepin, or trimipramine (Surmontil), all have excellent hypnotic activity. You are not getting proper support and treatment from this doctor.

Lar

Larry, I'm on 40 mg of Celexa. That's it.

When I tried the melatonin, it didn't do anything. I took the highest dose recommended, 9 mg. I'll try a lower dose next time.

Doc said that melatonin increases SAD. I don't see his point, since I don't have it. Everytime I go in for a med check, he forgets who I am, what I'm taking, hasn't looked at my chart, has to dig it out of a pile on his cart.....

Dear W-Fighter,

I am the big pusher on here for Valerian and the Fist Squeeze thing...... and I am taking Celexa as well. I personally take 3 Valerian about 30 minutes before I want to go to sleep and away to dream land I go..... I LOVE IT!!!

Good Luck....

LoVe,
Rhapsody -

Tonight I'm going to try Benadryl and melatonin. I need some sleep.

I need to get some work done, but I feel so zombie-ish that I can't stay focused.

How are you making out? Sleep is so very critical to my own well-being, that I remain concerned about your success with this issue.

Lar

I've been sleeping better the last three nights, but still a little sluggish during the day.

It can take some fine-tuning, to find the least effective dose of sleep aids, but that's really what you should try and discover.

In the literature I've read, the natural amount of melatonin released by the pineal gland, to induce the sleep part of the diurnal sleep/wake cycle, is only about 0.4 to 0.5 mg. The thing is, that's very well targeted. Your body knows just where to secrete that melatonin.

Oral dosing is a bit of a crap shoot. If your liver happens to be very active with respect to certain enzymes, a great deal of an oral dose of melatonin would be destroyed before it could even get to your brain. In contrast, another person would see most of an oral dose get past their own liver. You can only experiment.

If you picture the normal curve, the bell curve, that's what the dose/response curve looks like, for melatonin. The peak of that curve, the optimal dose, is different for different people, unfortunately, because of liver activity and other genetic traits. If you keep that picture in mind, you can see that too much melatonin puts you on the declining side of the curve. I know that's counter-intuitive, but that's the way melatonin receptors work. Tweaking is required, but once you figure it out, you can have some assurance that you've learned the optimal dose for your unique metabolism.

Other sleep aids work differently. The valerian dose/response curve is pretty much a straight line, with a positive slope. The more you take, the more effect you'll get. (Within reason.)

Benadryl also has a straight line dose/response curve, but it is very easy to develop tolerance to the drug. It'll just stop working. So, be aware of that, too. If you become tolerant, you just have to stop using it.

There are many prescription meds that target a special histamine receptor in the brain, that in turn induces melatonin release. Some of the tricyclics, for example, ones that used to be thought of as "dirty" drugs. In this case, though, a small amount of those drugs give you just the side effect you're looking for. Doxepin and trimipramine are the ones with the highest H1 receptor affinity.

There are also the benzodiazepine hypnotics, e.g. temazepam, nitrazepam, and flunitrazepam, but there's this unexplainable resistance to prescribing them right now. Benzophobia.

I hope you obtain good results, whatever your options and choices may be. Restorative sleep ought to be a primary focus of your doctor, as he treats your other symptoms. In my opinion, anyway.

Wishing you success,
Lar

Do you do light therapy, wi? I find I sleep better when I am diligent about doing my light therapy every morning around 7:30 or 8:00 a.m. It really seems to regulate my sleep patterns.

I'm sorry you've been struggling with this. Ambien has worked for me, but I wake up at about 4:00 a.m. and can't get back to sleep. I recently tried Ambien CR, and that makes me sleep about 12 hours. Have you tried Lunesta or Sonata?

Chammomile tea also helps me.

Hope you're doing better.

gg

Larry - Just a note on using antihistamines as hypnotics. While drugs like diphenhydramine (Benadryl) will put you to sleep, they do not give a restful sleep. Sedating antihistamines, especially at higher doses, tend to affect sleep architecture by preventing the onset of REM-stage sleep.

Taken occationally (no more than once or twice a week), sedating antihistamines are relatively safe and effective sleep aids. Taken on a regular (ie. nightly) basis, long-term potentiation of short term memory becomes steadily more impaired by diphenhydramine.

Aside from REM-stage sleep having a restful and restorative
effects on the body, it is the stage of sleep where the brain consolidates and integrates newly learned information that is "saved" in the short-term memory and "hardwires" this information into long-term memory. At least that is more or less what happens.

Those bizarre dreams that one remembers is the brain strengthening certain brain circuitry. This is done by the brain adding &/or thickening the dendridic connections among and between neurons in specific memory circuits. At the same time, other neuronal connections are weakened, or otherwise "rewired".

Just thinking out loud, Lar - Cam

Thanks Cam. I always like it better when you're around.

My personal concern with the way wi_fighter described her situation was just how desperately she needed sleep. Her doctor did not seem to consider the gravity of her need.

I was suggesting Benadryl use as an act of desperation. It is very important to recognize the effects in the context of brain function during sleep. Thanks for putting that in place.

Lar

larry hoover........my friend, ER doc, suggested benadryl.......so i took one.........i sat up on the sofa all night long...wired as if i were on crack or whatever it takes to wire you!!! i was mystified...but not enough to try it again to experiment.......

That's called a paradoxical reaction. There are always people who react the exactly opposite way to what the med is supposed to push them.

You done the experiment, hon. You are a paradox. ical reactor.

I had the same thing with Seroquel. And valerian. Go figure.

Forget the benadryl. It'll stay that way for you.

Next drug! Hey! Next drug, move along now, there's others waiting.

Lar

I am so stubborn I need someone to tell me what to do! I take seroquel for sleep. If I do not take it, I will be awake for 3 days straight. I have not fallen alseep naturally in over a year now. Sleep has always been a struggle for me. I started out on 25mg of seroquel and now 425 mg is not enough. I've had to slowly increase the dosage. I am so stubborn, I often try taking less of it and lay there in bed for an hour and a half trying to fall asleep. Last night I tried to take only 100mg to try and wean myself off of it. I only slept 4 hours. I guess I have this aweful fear that I will be taking a sleeping aid for the rest of my life. My doctor and the pharmacy says it's better to get a good night's sleep rather than to not sleep with someone who has bipolar. However, even though this drug works great with my sleep and my mood, It still scares me to think I will be on sleep meds forever. Can anyone help! Provide me feedback. I know it's important to stick with what works but is what works a long term danger?