Sleep Disorders Community
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Avatar universal

Only get 4h sleep/day! Caused by medicine? Which?

I cant sleep until 20h after I have woken up and when I get to sleep I wake upp 4h later.
I´we had this in an increasing degree the last SEVEN MONTHS!
I am so frustraded with this, I can´t function or do anything anymore!

"I have no idea", the doctor says.

But I have an idea!
But I have two alternative hyphoteses - maybe you can help me find which one is right (if any or both)?

The reason why the problem has increased is because I slowly have gotten rid of Zyprexa.
Underlying this was a medicine-"induced" problem (I presume).
One of the following is causing it:
- Paroxetine/Paxil - I now take 20 mg in the morning.
- Amphetamine: I take 25 mg (08.00 10, 12.00 10 and 16.00 5mg).

24 Responses
Avatar universal
Well, I think you are right to peel off one medication at a time, if you are on multiple medications and you need to withdraw from some or all of them.  Also, another general principal is to reduce the dose gradually, when withdrawing from psychotropics.  I wouldn't go cold turkey off of anything.  So if you're going to withdraw, do it one drug at a time, and do each drug gradually.  The drug that you're not even sure you need would be the logical one to start with.  The drug that has the strongest probability of being responsible for your side effects would also be the logical one to start with.

It is normal to get depressed when withdrawing from an amphetamine.  That is simply what happens when you withdraw from a stimulant; you get depression.  If and when you withdraw from the amphetamine (or anything else), you might have to tolerate some temporary discomfort.  With amphetamine withdrawal, the discomfort usually comes in the form of depression and/or fatigue.  If you can't tolerate lowering each of the three daily doses by 5mg, you might consider starting by lowering only the 5pm dose by a tiny amount, maybe even by less than 5mg.  Some medical doctors are of the impression that people can stop taking psychotropic medications more easily than they in fact, can.  

If it was withdrawing from Zyprexa that caused your insomnia, then the insomnia should gradually get better over time.  It might take a while.  The longer you have been on a psychotropic drug, the longer it takes for your brain to get back to baseline, once you stop taking it.  Had you known at the time, it might have been better to taper off the Zyprexa gradually.  

FYI, paroxetine has a reputation as being one of the hardest psychotropic drugs to withdraw from.  Also, it sounds like you are certain that you have anxiety and depression, and that is what the paroxetine is for.  And paroxetine does not particularly have a reputation for keeping people awake at night, at least not that I have ever heard of.  So I don't know about getting off paroxetine and staying on the amphetamine, when you're not sure you even have ADHD, and amphetamines are well known for causing insomnia.  

You really need a skilled physician to work with you on all of this stuff.  You need help deciding what it is you need to be on, help deciding what it is you need to be off of, and help in working through the whole process.  Friends can talk to you and share what they know, but there really is no substitute for a good medical doctor who works with you face-to-face and is available to help you if your symptoms get intolerable.

Avatar universal
My guess is that it is probably the amphetamine that is causing you to have difficulty sleeping.  I hope you are seeing a psychiatrist for your medication management.  If not, it may be time for a psychiatric consultation.  With appropriate medical supervision, maybe you can drop the 5PM dose of amphetamine or change to some kind of different regimen for your, let me guess, ADHD?  

If the amphetamine regimen can't be changed, some psychiatrists would prescribe a sleeping medication to be taken at bedtime to counteract the stimulating side effect of the amphetamine.  Sometimes clonidine is used for this purpose, and sometimes other drugs.
Avatar universal
Yep, I am diagnosed with AD/HD.

I have never heard of Clonidine, interesting.
If it is amphetamine - I hope it does a better job than Propiomazine, because it doesn´t matter how high dose I take, I only sleep maximum 5h, and the next day I´m totally... :(

But... If it is amphetamine that is causing it, why do I wake up to early, does amphetamine really have that side effect?

Hopefully I will get an answer to get a "sleep investigation" tomorrow.

Avatar universal
The clonidine, if your doctor even chooses to use it, would most likely be administered at bedtime.  In my comments above, I meant that sometimes it is one of the medications that can be used to induce sleep when a person's nervous system is jacked up on stimulants.  Clonidine is actually an anti-hypertensive medication that has a side effect of somnolence.  

On a different note, I have sometimes heard of clonidine being used as the primary treatment agent for adhd and given during the day -- but in my experience, I have only seen it used this way in very behaviorally hyperactive and impulsive individuals.  Generally, when clonidine is used in the daytime to control behavior, it is with wildly acting-out individuals, oftentimes adolescents.  Or if it was used that way with an adult, I would expect  the adult to be someone who had a lot of difficulty controlling impulsive behavior.

ADHD covers a lot of territory.  There are a lot of "flavors" of ADHD, and different meds can be used in different cases.   Some people need uppers, and some people need downers, to treat it.  You're on an upper.  Being given three doses a day of an upper is pretty unusual, for the exact reason that the late dose tends to interfere with sleep.

As for why you wake up early, I can only speculate, but my hypothesis is this:  your body is so stimulated from three doses of amphetamine a day, that you can only sleep when exhausted, and you can only sleep for the bare minimum amount of time.  I have seen people who drank two pots of coffee a day who had similar sleep problems to yours.  They didn't feel that the coffee was what was interfering with their sleep, because, "I can drink a cup of coffee and go right to sleep."  But they were drinking so much coffee that their whole system was altered.  

Anytime you are on a high regimen of stimulants, your physiology has to accommodate to it.  After a while, you may not react to the stimulant in the same way that a "naive" (new to stimulants) person does, but you never become someone for whom the stimulants have no effect.  If the stimulants had no effect, then why would you be taking them for your ADHD?  Of course the stimulants have an effect on you.  If they help you with your ADHD, great.  It's just that some of the other ways that they affect you may not be so desirable.  

You might end up having to modify your psychotropic medication regimen in some way -- add something, subtract something, or change something, so you can sleep.  If you could get a consultation with a psychiatrist who specializes in adult ADHD, that would be great.  Or if you are already seeing a psychiatrist who you like, I invite you to persist in complaining about the sleep issue.

Avatar universal
Thanks for your response Skydnsr.

My "flavor" of AD/HD has been ADD or no hyperactivity and only tired.

My money is now on paroxetin, therefore I/we change that and I do no not want to change to medications at the same time.
I am not shure about tapering down amphetamine. The doctor that I used to trust basically said that one can quit cold turkey. But when I have analysed my documentation of sleep and medicineintake I could see that I seemed to get depressed a couple of days after lowering it only 5 mg. So therefore I do not want to lower it now.

The reason why I say I might not need amphetamine is that I might not even have AD/HD. The thing is that the sleepproblems began when I lowered and removed 12,5 mg Zyprexa (in . Since then everything in myself has changed to the better (except the sleep). I was on 5 mg Zyprexa when they did the AD/HD "investigation". I have gotten Zyprexa for depression, and then later i guess it was remained partly on the indication of GAD.

Avatar universal
I understand your concern, especially regarding tapering of amphetamine, which is well known to cause insomnia, rather than paroxetine. However I do have contact with a doctor, a specialist, who is supposed to be competent.
And I do have some experience, I have been tapering off medicine full-time for soon 14 months now, Zyprexa took 4-5 months. The only suggestion I´we gotten from the doctor and another one is to start with the same **** again.
I have found some notes from 2005 and 2006 which strongly indicates that it is Paroxetine that is the main cause of the insomnia. It may be amphetamine as well, we´´ll see. In any case I want to change from Paroxetine.
If I can I will try to taper amphetamine as well (in time) so I´ll save your suggestions.
Avatar universal
I do wish you well, and it sounds like you are considering all possibilities.  Everybody has a unique physiology, so I will never say that anything is impossible.  I do believe you'll find out what's going on, one way or another, sooner or later.  I'm sorry for the situation you are in.  Good luck, and post again if you feel so moved.  I always like to learn, and I would love to hear how things turn out for you.  
Avatar universal
Thanks :D

So far I have managed to change from 20 mg Paroxetine to 10 mg Paroxetine and 10 mg Fluoxetine. It has been difficult and it is not quite over with that change but it was easier than just lowering Paroxetine. Next step is lowering fluoxetine to 5 mg, I am pretty confident that the sleep will get a litte longer, hopefully enough to sleep four hours without sleepmed.

I´ll let you know.
Avatar universal
Thanks for the update.  I have been continuing to think more about how paroxitine could possibly keep someone from sleeping, and I think it could, if it were to cause restlessness.  May I ask, Derrick, do you ever have kind of a creepy feeling in your lower limbs, especially about the time of night when you need to try to go to sleep?
Avatar universal
Wow, almost creepy.

Since I started with Fluoxetine and at the same time lowered paroxetine I got a lot more energy and I discovered that I could just lay down and... do nothing at all if I wanted! It was quite horrible to be so extremely tired and at the same time not be able to relax for more than a while, then I had to do something.

But I don´t think I had it in my lower limbs thou.
I also have been kindo... or... I have been and are manic. Today was the first day that started to open up, the "dream" started to become more real and it was relaxing and "refreshing".
Today I also feelt 20-30 pounds lighter and relaxed and awake and could experience more feelings and understand how other people feel much better.
I am not going psychotic, this is a big step forward. It will probably go back a litte or much tomorrow but...


Avatar universal
I'm glad you are resting better.  It does sound like you were having some restlessness -- not Restless Legs Syndrome, but just generalized restlessness.  Restless Legs Syndrome is a creepy-crawly feeling in the lower limbs, and some psychotropic medications cause RLS as a side effect.  But people can also have generalized restlessness.

I have, in fact, seen restlessness listed as a side effect of paroxetine but just have not personally known anyone before who experienced it from this drug.  When you first posted about your insomnia, I just did not think of it in terms of restlessness, and I wish I had, because I would not have been as skeptical about your suspicion of paroxetine.  

Hopefully, things will continue to get better for you.  I appreciate your keeping us posted.  I will be thinking about you in the coming days, weeks, and months.
Avatar universal
Skydnsr :D
I needed to read that (last) now.

For you and anybode else interested I got Tardive dyskinesia-symptoms today. :(
You can read about it and a story that to me seems to be hanginging toghether more and more, except for - TD, I think, in Neurology Community.

To be continued...
I think.
I... setback.
I am exhausting myself to sleep today, manic, racing. Don'twant to think right now.

Avatar universal
Take it easy, Derrick.  You'll be okay.  Maybe you need to take a step backward on the taper.  Easy, fella.  We're with you.
Avatar universal
Thanks :D
You are actually the only person that says these kind things to me.

A little better with the TD today, bur not solved.
I am a little calmer now.

The withdrawal symtoms seems to have changed a litte.
Better memory and concentration, the racing thoughts is not as intense.
Instead easier to get panicanxiety, and what are that goup called - with balance and head in a litte swinging fasion. The only one of the new ones I haven't had before during the withdrawal is panicanxiety in everyday situations.
Maybe the worst period is over, but with Paroxetine day 11 and 12 were the worst days, we'll see.

Thanks again! :)
Avatar universal
The restlessness, why are you less skeptical that is Paroxetine that cause the insomnia when you heard of that? I am very curious about that.
Avatar universal
Because if you are restless, you can't sleep.  
Avatar universal
Take care of yourself.  Don't be so eager to get off of these medications that you get too symptomatic and you become unable to function.  If you get greatly worse during a taper, you are tapering too fast.  You've got the rest of your life to get off of this medication.  There's no hurry.  Mania can put you in the hospital or worse, so take things slow.  Real, real slow.
Avatar universal
Hi! :)
Does any body else read this. I don't know.
Anyway, update...

The Tarive... and Parkinsonism... I don't have that much symptoms of it right now.
I feel better in some ways and worse in some but overall a litte more under control.
I have come to understand this problem maybe equally as much a hypomaniaproblem as insomniaproblem. (if yor're intrerested I have ANOTHER post :) - this time in Bipolar Disorder).

And I have gotten a new psychiatrist! :) This or next week.
If I would have had a stable relation to them these crisises would probably not have broken out, so we will see. It would be nice if she can see me.

Avatar universal
I don't know if anyone else reads this or not, Derrick, but I read it.  Actually, I bet some others may be reading it and caring about you, but maybe they just don't necessarily know what to say.  

I'm glad to hear that your symptoms are a bit less.  Better that, than a bit worse.  If you can keep getting better, little by little, then someday you will be a lot better.

You might be on the right track in viewing this as a hypomania problem.  It will be something to discuss with the new psychiatrist.  It is a good hypothesis, at the very least.  It is something that you can work with.

You are most definitely right about one thing, anyway -- that having a stable relationship with a doctor that you can trust will be helpful in many ways.

Good luck, and keep us posted.  
Avatar universal
Hi and thanks! :)
I have read it before but had nothing special to say then

Hmm... this will be... complaining yeat again I'm afraid, but it feels good to write it.
Since wednesday it's been... not so good.
A little bit of everything and yesterday evening I was very "confused" or whismy, just wandering around in the apartment forgetting things. I'we had it before I think it's to much serotonin but I shouldn't have it now unless... I called the psychiatrich emergency because there were other symtoms as weel, resting pulse of over 100 bpm. But they think I'm just to worried or something.

The real reason why I logged in is the following....
The Parkinsonismsymtoms got worse again and yesterday I had another reaction - from a allergypill /Loratadin/antihistmin. So I have to quit antihistamines and get something else. Tonight I discovered that the sleepingmedication I have been taking also have antihistamines, and of the same type as the one I had to quit last time (Propavan)!
I asked them especially about this - what should I take, and they had no other suggestions and they didn't say anything about this!
Great - I now have a fourth medicine that can and in this case does cause these things. And this one is much more difficult and takes longer time to get rid of.
:( grrrr....

I haven't gotten to see the new psychiatrist but... I'm thinking about asking the one that gave me all these medications that I have been tapering for soon 15 months and who keept me so filled with drugs I could hardly stand up without amphetaminelike medication. Why him then? He knows my medication and he know that I don't make up things and he is knowledgeble. And time is running out because my brain now seem to react on almost whatever I take. I hate him for some of the things he's done but...
We'll see, I'm going to sleep first.

Some day there will be good news!
Avatar universal
Yes, some day there will be good news.  I agree.

When's the appointment with the new psychiatrist?  If it's not too far off, I might just wait and give her a shot.  But you know best.
Avatar universal
You are an angel :)

I don't know what is going on.
The psychiatry is playing games with me and probably have all along. They do everything in the way I don't like. Today I stopped trying. Tomorrow I'll change the medication myself. They know that and still they are ignoring me, why??

I am tired, my mood switches all the time, I make misstakes all the time, either there is something wrong with my mobile or maybe that is a part of it, sometimes it doesn't give sound for reminders and such. When I started with Mirtazapine things started to get worse, things are more blurry, my memory is blurry. I open up and think less clearly among other things.

Can you tell me what's going on?
I have prepared for the medication changes today and if I get the energy I'll continue soon.
Avatar universal
The stress the extreme stress...
But good news for a change - I reached out to yet another contact in the psychiatry and she took the time to listen and will talk to them tomorrow.
it's almost one o clock in the morning here, took mirtazapin fifteen minutes ago, resting pulse 84.
Good night!
This is crazy, but it can change quickly, we will see.
Avatar universal
I wish that I could tell you what is going on.  If I knew, I would tell you.  Since I don't know, I think that proves I'm no angel.  I can say a prayer, and will, for you.  I admire that you don't give up.  
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