severe insomnia

[adlai5]

I have had insomnia for nearly three months. It's severity has increased gradually to the point where I now sleep 3-4 hours every other night. I know a lot of this is anxiety related. I definitely feel cognitively impaired during the daytime, and my mood isn't up to par - both of which are affecting my school and work life.

Beyond all the standard CBT techniques and other remedies--warm milk, etc. I have tried trazodone, melatonin, klonopin, valium (currently at 20 mg), remeron, lunesta and ambien CR--all to no avail.

Thank you,

adlai

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

It sounds like you have insomnia that is severe and is affecting your quality of life. It seems like you have tried several of the medications conventionally used for insomnia without help.

Insomnia is defined as the inability to initiate and/or maintain sleep. Occasional insomnia is very common and is usually transient. However, chronic insomnia, such as yours, is as you know very disabling. Insomnia may be idiopathic, meaning with no known correctable cause, relate to abnormalities in the sleep centers in the brain (either in the center that causes arousal or the center that leads to sleep). Another type of insomnia is known as psychophysiological insomnia. This may start in times of stress, such as the anxiety you are experiencing. Sometimes, the insomnia perpetuates itself when the person experiencing it starts to anticipate insomnia, tries to "sleep too hard", which causes arousal and aggravates the insomnia. Medical causes of insomnia include muscle jerks ("myoclonus"), restless legs syndrome, heart or respiratory disorders, pain, obstructive sleep apnea disorder, medication or drug side effects, and other conditions. There are other types of insomnias such as circadian rhythm abnormalities.

It sounds like you have tried several medications for  insomnia and some behavioral therapy. Without the ability to obtain a history and examine you, I can not recommend a therapy. However, if you have been suffering from anxiety and stress related to life events, it may be that you need treatment of your anxiety and depression (i.e. medications to treat these rather than the insomnia they may be causing). Medications such as valium may be helpful but also lead to dependence, addiction, tolerance, and worsening insomnia ("rebound insomnia). There are other pharmacologic options, as well as non-pharmacologic options such as behavioral therapy, which you are currently receiving, and phototherapy,

While a polysomnogram may or may not be beneficial for you, evaluation by a specialist in a Sleep Disorders Center may provide you with a beneficial plan of management.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[adlai5]

Thank you very much for your informative and sensible  response. Just to update, I saw my psychopharmacologist today and he is going to try to target my depressive symptoms with Lexapro and to also use some Neurontin in the hopes it will alleviate my anxiety and be sedating. Hopefully my sleep problem will improve once any mood/anxiety problems are resolved. Thank you again.

[Rob2008]

What about getting a sleep study?