Sleeplessness

Hi, this is my first time on Medhelp.  I have struggled with Manic Depression for 7+ years now, doing OK but you know our ups and downs.  What do you think is the best thing for insomnia?  I have switch to Lithium a month ago (from Valproic Acid) and still am cycling but not as bad.

Look forward to discussion within this group.

T

[bernie40]

Hi, Welcome to the site!

Have you mentioned trouble sleeping with your p.doc or GP (regular doc)?

I struggled with insomnia for years and tried various things; lavender baths, milky drinks, cutting all lights (even the alarm clock) and making sure there were no electrical appliances in the bedroom.  I also tried relaxation techniques.  My problem was more waking throughout the night, I never had any trouble falling asleep, I just couldn't stay asleep.

I now take Zopiclone (probably called something different if you are not from the UK) this is a non addictive sleeping tablet.  I've also been told that an antihistamine can help with sleep.

I am attending a sleep health clinic on Weds so I shall share any nuggets of wisdom I may pick up there.  The guy running it reckons he can get me off the zopiclone and sleeping naturally in a 2 hour session - we shall see :-)

I'm also on lithium - same length of time as you and I've found my sleep more disturbed than it was before despite the fact that insomnia is not a side effect listed - yet drowsiness is ??

[cowgirlnerd]

I am like bulldozer - I can go to sleep fine - it's the waking up during the nights.  I haven't slept more than 2-3 hours at a time in YEARS.  It's exhausting.  

Luckily, with my stabilization of the Lamictal, I am actually able to sleep more than I used to  - thank goodness.

Bulldozer - let us know how the sleep health clinic goes- I am curious.  I have thought about doing the sleep apnea thing - since I can't sleep anyway!  Will you start a new topic so we can find it when you finish?

THanks
Racheal

[daledude]

Like Bulldozer and Rachael, I can generally go to sleep okay but keep waking up throughout the night. In the past, I've felt like sleep was my worst issue, and that if I could just sleep well that a lot of my other problems would go away.

It is tricky to give any advice because of potentially bad med interactions, so you'd need to talk it over with your doc. But I can tell you what's currently working for me. I currently take 1 to 3 capsules of stuff called Tranquinol by Premiere Research Labs that I got from my Naturopath. It's not prescription, but I don't know how generally available it is. I also take 5-HTP which, from what I remember, will partially convert into melatonin and partly into serotonin as the body deems fit. I only take 50mg at night of the 5-HTP, as I have had issues where it has actually made my sleep worse if I get too much built up over time.

I used to take trazodone, which was powerful and I could only take a relatively tiny amount, and I generally didn't like it, but I needed it because Wellbutrin messed up my sleep quite a bit. I'm taking Wellbutrin again and I feel very fortunate that the Tranquinol works, as it does so without any noticeable side effects.

Also of note is that my body often seems to work backwards to most people, in that Valerian as well as other commonly used things make my sleep worse, as does Lamictal. In fact, I'm only able to take a very small dose (6.25 mg) of Lamictal because it really screws up my sleep badly, and it generally helps people sleep better. I'm still hoping that my body will get used to it.

Now that I'm having restless leg stuff and some sort of muscle spasms, that adds a whole new layer on top of the usual sleep issues. Fortunately these symptoms generally come and go, so if history repeats, which I'm hoping for, I'm not stuck with these particulars forever.

[ILADVOCATE]

Valererian kept me up all night so if it worsened things for you as well that must not be uncommon. Lamictal caused insomnia for me as well but one thing for sure is unlike Lithium or Valproate its not generally a sedating medication (Lithium isn't sedating right when you take it but overall you feel a bit sluggish and need to sleep more, I found the coated version known as Lithobid to be more tolerable and easier on my stomach).
  As I've said before, Rozerem and Lunesta are two sleep aides that can be taken every day. Rozerem is the better of the two choices because it works in the same exact fashion as Melatonin but is a prescription medication. It actually adjusts the sleep cycle and has no potential of addiction. That is easily a good first choice. I can't personally reccomend Tradazone for reasons of concern I've already detailed before (and couldn't take it now) but I know for some people its helpful.

[bernie40]

I shall certainly post and let everyone know how the sleep clinic goes.

I'm wondering whether to take my blanket, teddy and pyjamas :-)

[monkeyc]

Lithium is not remotely sedating - its not psychoactive - it does make people feel sluggish to start with as its moderating moods and its very effective at that - I think what people miss is that Lithium is a real mood stabiliser.  

The mood stabilisation effects of Abilify, Seroquel etc etc are side effects of the drugs not their intended usage - these drugs are after all designed to be anti epileptics and anti psychotics not mood stabilisers.

I take Valium to sleep, good old, effective valium - its safe, easily tolerated, nowhere near as addictive as people make out and its a natural sleep because it does not work as a sleeper - its a muscle relaxant and it calms the thing that keeps most of us awake nights - the racing mind and cluttered heads.

I do take Temazepam when needed but its not as effective.

Id say speak to your doctor and get advice but avoid the big league sleepers as these can be bad news for bipolars and normal people alike.

Big part for me when I am normal (not now) is to make sure i calm my mind, lie down and read for 15-30 minutes before I sleep, disengage, go to bed same time every night where possible - build a routine like any other thing in life.

And for gods sake steer clear of herbal remedies for sleep (or anything in my mind) - Valerian does not work for many normal people despite the anecdotal evidence and its not been examined for bipolars - like St John's Wort it might be dangeorous.

PS daledude - Tranquinol has valerian in it among other things... Might be worth reading about herbal meds as well as other meds - I cannot stress enough that most Natural Therapists have little to know knowledge or mental illness just like most GP's - you have a good one perhaps but I would need to be even crazier than I am now to trust any natural therapist to prescribe drugs to me - most herbal treatments have not been tested for mental illnesses and if you get one with st johns wort or some other compounds as a hidden or unlabelled ingredient then you can be REALLY in trouble.

Especially if taking other MS or AD drugs.

Oh and bulldozer - Despite the claims Zopiclone has now been found to be habit forming and addictive....Sorry but there really is no such thing as a non addictive sleeper taken long term, Like and AD or an MS you become dependant on them after time.  BTW Zopiclone also screws with REM sleep which is not a good thing.

[dippy1]

there's no such thing as a perfect sleeper and as usual it can not be assumed to be a one-size-fits all solution. Some natural solutions, IMHO, can work to an extent. Placebo is important if it helps you sleep. I know when I take my sleepers at night, I expect to fall asleep half an hour later...whether I do or not depends on all sorts of things but my expectations are powerful things. Personally, I got to using diazepam too much as a prop and when I decided to go without, prove to myself and others that I wasn't dependent on it; boy, did I have a surprise...put me off it long term full stop. Temazepam I still use every night and I know at some point I'll have to deal with it. Seroquel also helps(yes, it's an antipsychotic not a sleeper but boy can it help to switch your brain off when it doesn't want to go to sleep), again like others you build up a tolerance and I think you have to manage dependence by not giving in to it and staying strong; don't slip into the habit of continually increasing doses.
In my experience sleep patterns vary; they come and go. Today I've been so sleepy I couldn't wake up this morning and went back to sleep for a few hours during the day...last week, like most, I averaged 5 to 6 hours per day and woke early every day...this is not drug related it 's mood related and needs to be withstood not drugged out. I am working on my issues and trying to get better/stronger. Self knowledge is important, medicines and other measures can moderate but not completely assuage sleep problems, a bit like everything else :-s

[daledude]

ILADVOCATE - Thanks for the info on your sleep aids, I might end up trying one of them.

monkeyc - While Tranquinol has valerian in it, it is either in a small enough amount or the combination with other elements overrides it's negative effects for me. Very fortunately, my Naturopathic doc kind of specializes in mental illness because many of her patients have these sorts of issues. I don't know if they have them in your area, but here in Oregon, Washington, and a number of other states, they have essentially the same status as regular MD's, accepted by insurance companies, can prescribe many prescription meds if necessary. I feel kind of in reverse to the way that you do in regards to docs & meds. While I've had some good MD's to be sure, I've also had some that just s*****, and I went to a psychiatrist once that I think was worse off than me, and I've had some prescription drugs that were just horrible and really screwed me up.

My Naturopathic doc has done a fair amount of research for me individually, outside of our appointments. She is actually present with me, kind, caring, and works with me as opposed to giving me orders without listening to my perspective, I couldn't have asked for more in a doc.

You are correct in regards to the herbal or other supplements, it's true that just like prescription meds, which are very often derived from or modeled upon some herbal elements, if you aren't careful, they can have bad interactions with other meds, just like prescription drugs, but I've not had any that messed me up like the prescription ones have. I have a choice of a herbal or natural supplement that works just as well or better than corresponding prescription drug, I feel much safer taking the natural supplement.

[horselover65]

I wanted to add one small cautionary note about Lunesta. I took it before I was on lithium, so perhaps it would work differently now. I found that no matter what time I took it or what time I went to sleep, I would be awake again about 4 hours later. Maybe 5 hours if I was lucky. The other thing is that I quickly developed a strong metallic taste, which is a known side effect. What they don't tell you is that even after you discontinue use, it may take a week or two weeks for that nasty taste to go away. The pharmacist told me when questioned, but it wasn't on the info sheet or shared by my psych at the time (who we not-so-affectionally named Dr. Deaf/Dr. Dumba**). I only finished half the prescription.

***Also, if you have children, be extra-careful. The ones I took were cobalt blue. They looked like pretty candy.  

[monkeyc]

My problem with naturals is they are just not tested properly and especially not for mental illness and thats it.

People think natural = safe and its not - Aspirin can kill easily, use St Johns Wort with an AD in your system.. there are lots of natural things which are unsafe and the big problem with natural therapies is they are not prescribed and in many countries the requirements for product labelling are very lax for vitamins and supplements so you do not actually know what is in them making it VERY hard to work out if they are safe.

I dont think natural therapies are all wrong but I do think that for people like us with medications in our systems already its damn hard to just trust someone to give us something like this.  Thats my opinion, mileage may vary and its a trust thing but always ask yourself when anyone prescribes something is this good for me or right - ask questions.

[horselover65]

Didn't finish before. Oops. If it is plain old insomnia, then I would use whatever was at hand, honestly. If there was something around that I knew would make me drowsy, I'd take it. I'm not sure what is the best. I can tell you a few things I've tried, though...

I've been taking antihistimines for a couple of months, but not specifically to sleep. It is to counteract the decongestant (pseudoephedrine) that can cause me all kinds of trouble. However, I have to breathe... I have been more than happy to take advantage of the antihistimine's side effects.

Years ago, I sometimes used Tylenol PM or similar. When things have gotten bad, I have requested and used valium. That seems to work well. I also tried Ambien a couple of times. It was okay, but wouldn't want it long-term.  

I've realized that most of the time I'm just a poor sleeper. I get some insomnia, but I also have more and more hypomania. I don't want to use anything nightly, so sometimes I'm just up for a couple of days. I try not to drive if I haven't slept, though. It's as dangerous or more dangerous than driving drunk. I stay home. I miss some appointments. Life goes on.

I figured out that Xanax sometimes relaxes me enough to sleep, so if I'm on a 2 or 3 day roll and haven't slept much or slept at all, I'll take that at bedtime. Admittedly, I hoard it. I don't want to use it too often and I don't want to run out. I'm willing to take it maybe twice a week for whichever, except when I'm caring for my grandparents and then I usually have to take it at least once a day. The doc worries about that drug and is super-careful about me using it, so I'm vigilant, too.

When I am totally desperate, I can take a prescription anti-nausea medication that knocks me out. I normally take it once a month or every couple of months when I have a sickening migraine, so it's one of those prescriptions that lasts forever. (I don't usually get nausea or vomiting with migraines, thankfully).

Am I losing it or didn't we have a discussion about this a while back? And didn't someone suggest masturbation? It's foggy, but there is something in my brain telling me this is all very familiar. Anyway, I haven't tried it specifically for that purpose, but I'm going to say masturbation couldn't hurt. And, it's natural :-)

[monkeyc]

Masturbation is excellent release and stress relief actually and it does work very well, particularly in men apparently.  Its one of my psychologists reccomended techniques and I have to say its one I do use.

Whatever works works.

[daledude]

I've used masturbation sometimes when I wake up in the night and can't go back to sleep. It does seem to help.

[monkeyc]

Its endorphin release I am told.

[2009toads]

Wow.  Thanks for all the suggestions!  Like alot of you said I have no problem falling asleep, it is waking up (usually around 1:00 am) brain spinning and usually some tune in my head (ELO's Hold on Tight to your dreams).  I am so glad I have found this disussion group.

I see my GP next week, I will talk to him some more, in the meantime I think I will try the Tylenol PM.

Thankful

[bernie40]

Thanks for the comments regarding zopiclone.  I've had a bit of a read and have found info that suggests that as quickly as 6 weeks of use can result in a tolerance and a need to up the dose.  I don't know if the addictiveness (sp) is more psychological than chemical though as I did manage to come off it for 2 weeks without a problem.  I do remember feeling much better in the mornings than I had for a long time.  Then my sleep went all out of kilter again following another med change, so I started back on the lower dose.

My GP refuses to give me any type of benzo to aid my sleep.  Even with the zopiclone I wake 4 hours after dropping off and its incredibly rare for me to sleep through to the next morning.  Before taking zopiclone I would wake every 2 hours throughout the night.

When my sleep is particularly bad then I can take an extra dose as long as I don't mind the "hangover" the next day.

I can't take antihistamines because they give me restless legs :-s

The sleep clinic is tomorrow, right now I don't feel I have the inclination or the energy to attend, I shall have to see what tomorrow morning brings.

[therese83]

I have (had) psychotic depression not bipolar.

When I was really bad (awake most of 24 hours for one month) a low dose of Zyprexa was fantastic for sleep.  2.5 - 5 mg.  A lot of people take too much.

I know it is another debate whether or not to take an antipsychotic unless you really had to, well being awake for one month and having tried everything else, I guess I really had to.

Another 'alternative' is to wiggle your toes over and over, maybe it is just taking your mind off I dont know but if the problem is 'lighter' it can help.

[tres1965]

This IS a long read, but infomative!
I have a few things to comment on. 1st, Zyprexa in any dose was HORRID to me. I had every side effect possible. Lunesta drugged me TOO much, Ambien makes me confused & sleep too much, but get no rest. Lamictal is a GodSend with me. As is Abilify. I take both & that is slowly working.
I get queasy from the night meds, but if taken in steps they aresn't too bad.
I had a Sleep Study 7 years ago & they put me on this breathing machine to weaar at night, but NO WAY. I looked like a jet pilot *L*, my Daughter couldn't stop laughing for me to get to sleep *L*
Xanax works, but is addictive Trazadone Krocks me out & the headache is not worth it.
Not sure I helped, but thst's my 2 cents! Tres

[2009toads]

I am wondering if you were able to make it to the sleep clinic?  If so, was it helpful?  I am still stuggling with insomnia, a typical night is to hit the hay after the kids are asleep.....sometimes as early as 8:00 pm (exhausted)....sleep hard for 2-3 hours, and I am the most awake at 1:00 am, this is the time I am writing this post.  I am managing at work, but I am not the sharpest knife in the drawer!

I appreciate you moderating this forum, this is the firs time I have joined a group online, and it great....don't feel so alone.

[monkeyc]

Everything is addictive over time the very drugs we take every day are habit forming.

Have you tried good old valium?  Its very effective and no where near as addictive as some people would have you believe and very effective at calming the brain noise.

[bernie40]

I didn't make the sleep clinic :-(  I felt so horrid yesterday I couldn't face going anywhere.  My friend works for the NHS and has promised to get me the print-out that they would have been using.  Once I have that I'll pass on the tips contained therein.

I shall put it under its on post so that its easy to find.

[2009toads]

My doctor was reluctant to give me Ativan which I think is similar to Valium.  I live in Canada and Tylenol PM is not available here.  I think you are right and I am going to push for something.

For me sleeplessness happens during hypomania....during depression, I can't get enough of it!

[monkeyc]

Doctors are reluctant to hand over benxo's full stop thanks to decades of mis information about their addictive qualities.

Meanwhile they hand out anti depressants and ritalin like lollies and have no problem with oxycontin either in most cases.

Honestly some of the prescribing habits of doctors in the modern world need a good review - and a ban stick in some cases on letting them hand out drugs (prozac I AM looking at you when I say that)

[Bear13]

I have found that Seroquel has been the only drug to put me to sleep... and I sleep well... there are nights where I end up taking Ambien as well, but typically, the seroquel does just fine on it's own... I take 200mg/day and that's it.....  Seroquel is also considered to be a mood stabilizer....

[BP2PROFESSIONAL]

Wow, great tips here gang, really appreciate them.

I got onto a way to help me sleep, and actually control a great deal of my hypomania as well as come of an addiction to Xanax which I had to take in large doses after I was misdiagnosed with depression and given anti-depressants (Endep) that launched me into a manic period that lasted 4 months this time last year.

I was pretty mad when I found out the cause of most of my problems were from the drugs my doctor was prescribing, it was my family therapist that spotted I was hypomanic.  Thought I was doing the right thing going to psychologists and GP's which I guess I was just went wrong.  Anyway went to see a Psychiatrist and he simply wanted to stick me on more drugs but I just wanted to be rid of them so went of cold turkey, couldn't sleep for days, particularly as I was really feeling the withdrawals as I came of the Xanax.

In the end I ended up joining a triathlon club and just burned off the energy exercising, swimming constantly (that works the best) but riding and running helps also with burning of the energy.  Just feel like it helps centre me more in some way.  Joining a team has really helped as well, fun to train with and brilliant supporters when a race is on. The exercise really helps you go to bed tired.

I'm also using phernagen from time to time and Xanax again if things get really bad when I simply need an off switch. But I am trying to avoid these.

My triathlon coach recently put me onto a high level sports nutritionist which I met on Friday just gone.  She told me that literally that week she had been given some information on a new genetic test that can now be done to see how antidepressants might react with you.  I'll post some more information on it when I find out some more detail. Included things like how your liver breaks them down (or maybe it doesn't) and whether that drug should be used or another.  I think the plan is you can test against a wide range of different drugs.  

In the meantime I'm getting the full workover with tests, have had to stop taking Xanax and Phernagen (which I'm happy about). So have had to up my exercise regime to make up for the difference and possible withdrawals, should be ok though.

Just wanted to mention though that exercise can really make a difference in bringing you back from manic, depressed and mixed episodes as I've had the lot over the past year.

Not that I'm antidrug really either, although I still have that script for Lithium which I haven't filled.  I'm sure I will have to fill it one day, but hopefully through exercise I won't have to use as much.  In the meantime though I'm going to really push this exercise and nutrition thing as best I can, as well as seeing a psychologist on a regular basis to download my thoughts.