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Hi there,

I'm new on Crazyboards but have benefited as a visitor from many a post.  I have a rather unusual request/question.  I have sleep anxiety like nobody's business.  What I mean by this is that I worry/obsess that I won't get enough sleep AND if I wake up in the middle of the night and can't go back to sleep I get out-of-control anxiety and then, of course, can't fall back to sleep.  I sweat, get heart palpitations, GI issues, you name it.  And the horrible thing is, these symptoms go into the next day and then usually continue into the next night.  The thing is, before all this happened I was always a naturally great sleeper.  I could sleep anytime and I loved my sleep.  This all started years ago when my first child was born.  I went on Paxil and it worked great except for bad side effects.  I have since gone off Paxil and had quite a few "sleep anxiety-free years" (always had GAD though).  But this has started to rear its ugly head again, off and on for the past couple years.  I have started Trintellix and have worked up to 10mg.  I have also taken .5mg Klonopin for years.  When I started the Trintellix my pdoc bumped me up to 1mg Klonopin but it's not working (!) and this COMPLETELY freaks me out.  I have basically been going to sleep at 11:00, waking up at 3:00, and MIGHT get an additional fitful hour in there by about 5 or 6.

I have started CBT (Cognitive Behavioral Therapy).  I'm doing it on my own for now, using a workbook called The Anxiety and Phobia Workbook by Edmund Bourne.  I understand basically that I need to change my thinking about this problem if I am to make any progress.  But this is extremely hard for me to imagine doing.  What I am asking for is for feedback from people who have gotten only 4 or so hours of sleep a night for a period of time AND IT HASN'T RUINED THEIR LIFE.  I need to be able to tell myself that this isn't the end of the world to only get 4 hours of sleep for a while (and this will be indefinitely until, hopefully, the CBT starts helping).  I'm not working on an insomnia plan because I don't have sleep problems per se; I have major, unbearable ANXIETY problems that make it impossible to sleep.

You might be wondering why I started the Trintellix:  it is for the sleep anxiety but also for pretty intense GAD.  However, I am really, really hopeful that I can manage this with CBT after some time.  I may need to stay on the Trintellix, but the sleep anxiety is so  horrible (it continues all the next day) that I feel I need to at least try something besides meds.

I thank you immensely for your reassurances :) 

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@nervousnellie, as a person with GAD and chronic insomnia, I have to take 3 meds in combination, every night, for my anxiety and insomnia.......I usually get around 7-9 hours sleep with my combo.

I also take 2 other meds for my depression and my OCD, so my situation is a little different than yours.

I have no personal experience with Trintellix, but it may take up to 6-8 weeks to get the full effect......If you don't get any relief from the Trintellix, or the CBT, perhaps your doc could suggest other med options for your anxiety, and the resulting sleep problems........I won't go into listing them here, but there are many other choices..

There is always hope.....

Edited by CrazyRedhead

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Thanks so much for the reply, @CrazyRedhead.  I've been on the 10mg of Trintellix for only one week; prior to that I was on 7.5mg for 4 days, 5mg for 4 days, etc.  So I have definitely NOT been at a therapeutic dose long enough for it to work, and I fully realize that.  I'm also now on 1.25mg Klonopin (I had been on .5mg for years along with Paxil in earlier years, then when I started the Trintellix I got bumped up to 1mg Klonopin.  That failed to work and that's when I got really freaked out.  I don't want to have to keep increasing my dose indefinitely (and know that it wouldn't be allowed, anyway).  So I told myself enough is enough.  It's time to start looking into a serious long-term solution to this, and I started researching CBT.

What's difficult about the CBT is that I know I need to tell myself it's no big deal if I only sleep maybe 4 hours a night and that I'll be fine the next day.  But being exhausted is, to me, very debilitating.  I think some/much of this debilitation is mental because I obsess over the sleep and worry that it's not enough.  That's why I'd love encouragement from others who have gone through getting such a small amount of sleep (at least temporarily) and had a decent quality of life.

Can I ask you:  how long has your combo of 3 anxiety/insomnia meds been working for you at their current doses?  I suppose this may be the answer for me - a sleep med.   I think I will ALWAYS need some sort of anxiety med (I have GAD like crazy too), but since I'm naturally a good sleeper I thought I could avoid dealing with sleep meds.  Perhaps not.

Thanks again - I really appreciate it!

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18 hours ago, nervousnellie said:

What's difficult about the CBT is that I know I need to tell myself it's no big deal if I only sleep maybe 4 hours a night and that I'll be fine the next day.  But being exhausted is, to me, very debilitating.  

Can I ask you:  how long has your combo of 3 anxiety/insomnia meds been working for you at their current doses?  I suppose this may be the answer for me - a sleep med.  

Thanks again - I really appreciate it!

No problem.....:)

Only 4 hours sleep a night, for a long period of time, is going to be very hard on your body and your mind.....That's what it did to me.....It was a vicious cycle of almost no sleep, worsening anxiety, then no sleep again, night after night.....I tried many natural sleep remedies without any real success.

Finally, I went to ER after a week of no sleep and hallucinating.....After the ER doc was very rude to me, they finally called in a psychiatrist that gave me some meds to sleep, and then got me a follow up appt with another psychiatrist, who is still treating me today.......That was 4 years ago in 2013.

Since then I've tried MANY sleep meds, some of which didn't work at all, some worked for a while then stopped working..........My current anxiety and sleep meds (Klonopin 2mg, Trazodone 200mg, and Thorazine 100mg), have been working pretty well for over a year now.

If you tell your pdoc you're only sleeping 4 hours a night, and say it's really affecting your level of functioning,  I'm reasonably sure your doc would be willing to let you try some sleep meds to find out what works best for you....You can look at my "Ex-meds" list below in my signature to see what I've tried over the years.

Hope this helped.....Sleep deprivation sucks big time.....I've been there.

Edited by CrazyRedhead

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Thank you so much once again, @CrazyRedhead.  One more (hopefully last) question:  what precipitated your insomnia?  We're you just a not-so-great sleeper or were you a great sleeper but became anxious about sleep (or something else) and THEN got insomnia?  The reason I ask is that I'm trying to figure out if I should ask to be treated primarily for anxiety (which I have) OR insomnia.  In the past treatment for anxiety had fixed (for about 10 years) my sleep anxiety=insomnia.  I'd rather not go on sleep meds forever if I don't have to but right now even 1.25mg Klonopin plus 12.5mg Seroquel didn't help me sleep much better last night.  So I'm freaked out that going from .5 to 1.25mg Klono pin isn't helping!! Never in my life would I have thought I'd need a sleep med; that how easy sleep was for me. But if anxiety meds don't cut it maybe I do.

THANK YOU SO MUCH!

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@nervousnellie, sorry I'm late in replying....

I am really not sure what triggered my insomnia and anxiety--it was pretty sudden.......I believe it was a combination of being in perimenopause (fluctuating hormones) and quitting cigarettes at the same time, but that's just my opinion, because nothing else had changed in my life--no traumatic events, accidents, etc.

The day after I had my last cig was the first day I experienced the extreme anxiety and insomnia.....So the anxiety and the insomnia came on together, not separately.......I tried hormone therapy for a while, hoping it might help, but no dice there, either.....Anxiety and insomnia were crippling until I got on the right combination of anti-anxiety and sleep meds.

I was a great sleeper until I quit smoking and was in perimenopause......For the past 4 years since this happened, I have had to take prescription meds to sleep every night, and also developed another anxiety disorder, OCD......Then the devastating depression developed as well.

So it has been sort of a domino effect over past 4 years--first the anxiety and insomnia, then the OCD, which has gotten progressively worse, then finally the horrible depression.

And I thought that quitting cigarettes would improve my life and health----LOL.....Maybe it did in the physical sense, but my mental health is so bad from all these things, that I am almost totally housebound and can't work.....I have to have help to even leave the house.

Would this have happened eventually, even if I had kept on smoking?.......Don't know for sure, and it's no use beating myself up over the question.......So I do the things I can to keep having hope that my situation might improve someday.

Edited by CrazyRedhead

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Wow @CrazyRedhead I'm so sorry you are dealing with SO much.  Your good attitude is extremely commendable.  I'm not there attitude-wise, that's for sure.   Good for you.  Keep it up- there's always hope for these illnesses.

I increased my Seroquel dose to 25mg and was still wide awake at 3:30am.  I may have dozed a bit after that but mainly that was it.  I'm having a horrible time and feel like I'll never be the same. 

I am post-menopausal (went thru early) and I do wonder if hormone fluctuations contribute to all of this.  The first time this happened was right after the birth of my first child.  I find it hard to believe that there isn't some hormonal causation here.  However, I'm hoping it's compound ed by possibly a bad reaction to the new Trintellix I started. 

I wish you the very best with your challenges.   Life can certainly throw some difficult punches sometimes.

And thx for your replies and for listening.

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Ask your pdoc about combining benadryl with your klonopin. This has been recommended to me in the past and it worked well to get me to relax long enough to slip into deep sleep. It's helpful for knocking things back a bit when needed (it is also marketed under other names as a sleep aid - same drug though). But ask first, always.

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FWIW ... IME, taking benadryl the first couple times helped, then stopped helping after that.

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Thank you both @jumpingrabbit and @melissaw72.   I am pretty freaked out the the 25mg seroquel plus the 1.25mg Klonopin still only gave me a handful of hours of sleep so I appreciate your info.  It seems like I should be knocked out by this combo.

I'll talk to my pdoc about Benadryl BUT there was a time I had a paradoxical reaction to it (took it as an antihistamine and got major restless leg from it.  It was quite weird.  This was decades ago though so worth a try.

I wish I knew if the Trintellix was causing this increase in anxiety/insomnia or if it's just getting worse on its own.  I am just at a loss about where to turn when fairly high levels of these meds (Klonopin and Seroquel) don't work.  CBT was the only thing I could think of but I don't know if I can find a positive or even a neutral spin to sleeping 4 hours a night (I'm not Trump after all....hahaha I attempted a joke.  Maybe I'm feeling better)

THANK YOU FOR YOUR INPUT!!!!

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Drugs such as Benadryl and Vistaril are anticholinergics. They have negative effects on memory, especially if you are over 50. There is a possible association with dementia. 

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8 hours ago, nervousnellie said:

I'll talk to my pdoc about Benadryl BUT there was a time I had a paradoxical reaction to it (took it as an antihistamine and got major restless leg from it.

I would let your pdoc know the reaction you had, so if you do take it and get the restless legs, you'll know it isn't from the seroquel or klonopin.  But like you said, sometimes things change years later.

About the klonopin, it does not work for me as an 'as needed' med.  I take it on a schedule, in AM and then in PM.  It works great for me like this.  Then for the breakthrough anxiety I have xanax for that.  YMMV though.

 

 

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4 hours ago, notloki said:

Drugs such as Benadryl and Vistaril are anticholinergics. They have negative effects on memory, especially if you are over 50. There is a possible association with dementia. 

Thanks @notlokiYes, I have heard that about the anticholinergic meds.  Not sure how familiar you are with this stuff but do you know if Lexapro is anticholinergic?   From reading it seems like that may be a good option if the Trintellix doesn't work out.  I know some of the older ADS are anticholinergic but I'm having a hard time finding this info specifically about Lexapro.  I don't think the SNRIS are but I'm worried they'd be too stimulating.

THANK YOU!

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3 hours ago, melissaw72 said:

I would let your pdoc know the reaction you had, so if you do take it and get the restless legs, you'll know it isn't from the seroquel or klonopin.  But like you said, sometimes things change years later.

About the klonopin, it does not work for me as an 'as needed' med.  I take it on a schedule, in AM and then in PM.  It works great for me like this.  Then for the breakthrough anxiety I have xanax for that.  YMMV though.

 

 

Thanks @melissaw72.  That's actually exactly what my pdoc thinks about Klonopin -- that it's not really meant for an as needed basis.  I was taking .5mg each night (never just 'as needed')  then when I started Trintellix I bumped up to 1.25 (per pdoc instructions).  I was fine for a couple nights but then the anxiety came roaring back which really, really freaked me out (the fact that I could go from .5 to 1.25 and it didn't work).  I'm wondering if I have just built up a tolerance to even higher doses.  The night the anxiety came back I then also took .5 Xanax (again, okay with my pdoc) and no effect.  Very, very disconcerting for me.

May I ask what your Xanax dose is on an as needed basis?

I'm hoping I can chalk all this up to Trintellix but I'm not sure.  I built it up really slowly in 2.5 mg increments, increasing every 4 days.  Have been at 10mg for almost 2 weeks. 

I just hope I can get over the insomnia/anxiety.  At this point the dementia that @notloki describes doesn't even sound bad, which I know means my anxiery is bad.

Thank you so much for your time!!

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1 hour ago, nervousnellie said:

Thanks @melissaw72.  That's actually exactly what my pdoc thinks about Klonopin -- that it's not really meant for an as needed basis.  I was taking .5mg each night (never just 'as needed')  then when I started Trintellix I bumped up to 1.25 (per pdoc instructions).  I was fine for a couple nights but then the anxiety came roaring back which really, really freaked me out (the fact that I could go from .5 to 1.25 and it didn't work).  I'm wondering if I have just built up a tolerance to even higher doses.  The night the anxiety came back I then also took .5 Xanax (again, okay with my pdoc) and no effect.  Very, very disconcerting for me.

May I ask what your Xanax dose is on an as needed basis?

I'm hoping I can chalk all this up to Trintellix but I'm not sure.  I built it up really slowly in 2.5 mg increments, increasing every 4 days.  Have been at 10mg for almost 2 weeks. 

I just hope I can get over the insomnia/anxiety.  At this point the dementia that @notloki describes doesn't even sound bad, which I know means my anxiery is bad.

Thank you so much for your time!!

When I am on the 0.5 mg in AM and 0.5 in PM ... I still can get bad anxiety even though of the as needed klonopin.  That amount I take keeps me in a steady state, while for the breakthrough anxiety uses the xanax.  My point is that my pdoc doesn't keep upping the klonopin, he will increase the xanax if it needed.  I take 0.5 mg/day if I need it.  I find that I don't need it often, but it is there when I need it.

The insomnia and anxiety suck.  What does your pdoc say about it? ... Maybe talk to your pdoc about getting something to help that?  Or maybe a med tweak?

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1 hour ago, nervousnellie said:

I know some of the older ADS are anticholinergic but I'm having a hard time finding this info specifically about Lexapro. 

Here is a list:

https://www.peoplespharmacy.com/2015/02/01/where-can-i-find-a-list-of-anticholinergic-drugs/

Lexapro is not on this list.

 

http://www.empr.com/clinical-charts/medications-with-significant-anticholinergic-properties/article/123667/

Lexapro isn't on this list either.

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1 hour ago, nervousnellie said:

Thanks @notlokiYes, I have heard that about the anticholinergic meds.  Not sure how familiar you are with this stuff but do you know if Lexapro is anticholinergic?   From reading it seems like that may be a good option if the Trintellix doesn't work out.  I know some of the older ADS are anticholinergic but I'm having a hard time finding this info specifically about Lexapro.  I don't think the SNRIS are but I'm worried they'd be too stimulating.

THANK YOU!

No, it is not.

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14 hours ago, nervousnellie said:

I am pretty freaked out the the 25mg seroquel plus the 1.25mg Klonopin still only gave me a handful of hours of sleep so I appreciate your info.  It seems like I should be knocked out by this combo.

I take 2mg Klonopin twice a day, used to take it three times a day, and it has never helped with sleep. It just helps with my sort of constant anxiety throughout the day. I don't get drowsy from it at all.

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2 hours ago, heilmania said:

I take 2mg Klonopin twice a day, used to take it three times a day, and it has never helped with sleep. It just helps with my sort of constant anxiety throughout the day. I don't get drowsy from it at all.

Same with me.  I don't get drowsy with it either. 

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On 2/19/2017 at 10:03 PM, nervousnellie said:

And thx for your replies and for listening.

 No problem....:)....

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Hi Nervous Nellie, Yes you will be okay temporarily but obviously you will not be at your best. I have two suggestions. Try Melotonin, an OTC nuerotransmitter that signals the body it's time to sleep when it get dark. The other is prescription. You can talk to your dr, about. It's actually a blood pressure med that they use for anxiety. Good additions to have if you don't want to load up on more medicine. Also try not to take Benadryl unless it's an allergic reaction. Research has linked it to Alzheimers

Oops I forgot to say it's brand name is Inderal the generic is propranolol

Edited by on-the-verge
spelling
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FWIW, melatonin doesn't work at all for me.  It makes things so much worse.  But YMMV.

I have heard though (I think reading on CB) that the less you take the better.  So taking 0.5 mg might give you more of an effect than say, 5 mg.

Propranolol kind of worked for me (the first dose I could feel a difference), but I wasn't on a very high dose at all.  Others though find it to work really well for them. YMMV

Edited by melissaw72

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Some ideas (just ideas, I only have a Wikipedia doctors degree

What about a different benzo? Valium is good for mantaining sleep and kicks in pretty fast. Also, I need 2mg of Xanax or 2mg of klonipin for sleep. 

Trazodone- old antidepressant mainly a hypnotic now  that helped me sleep for a while 

also, did you say your seroquel is 25 mg? You might need more than that

Edited by Iceberg

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Seroquel only became sedating to me at 300mg of the instant release. 

I now take 100mg in the morning, and 600mg at bedtime. The 600mg at bedtime knocks me out.

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I agree instant release= nighty night 

Xr doesn't have the same kick 

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      nortriptyline (Pamelor) 50-150 mg: this wasn't prescribed to me for sleep, actually, but I listed it because I know it's used sometimes for sleep, and I wanted to say that it didn't sedate me even one bit... trazodone (Desyrel) 50-200 mg: at first this worked like a charm (and gave me auditory and visual hallucinations), but 50 mg soon became insufficient, so I went up to 100 mg, then 150 mg, then 200 mg, and it just quit working. I took 300 mg one night just to see if it would help, and it helped me sleep for 3 hours, but I woke up with my heart beating rapidly and pounding in my chest—scary experience, would not repeat... Antipsychotics:
      chlorpromazine (Thorazine) 100 mg: this makes me sleep for 15+ hours and when I wake up I feel like hell. The first time I took it, I had an acute dystonic reaction, which scared the piss out of me. I'm surprised I was brave enough to take it again (I guess I was just desperate). It also makes me gain weight, but not as bad as Zyprexa. olanzapine (Zyprexa) 5-10 mg: also made me sleep for about 12-15+ hours, and when I wake up I would feel like hell, plus it made me gain weight like crazy without altering my diet, and it made my fasting blood sugar skyrocket into the 200's. quetiapine (Seroquel) 100-300 mg: at 100 mg, no help with sleep; 200 mg, I get help with sleep but I feel like hell the next day and gain weight; 300 mg is even worse than 200 mg and has no antidepressant effect for me despite what is purported by all the psychopharmacology textbooks out there.  Saphris (asenapine) 5-10 mg: works perfectly for sleep—helps me get just the right amount of sleep, and it's weight neutral; however, despite an initial antidepressant effect when first taking it after not taking it for a while, I always end up feeling very dysphoric and depressed the morning after I take it after taking it for a few weeks, and end up having to stop taking it. It also has started to exacerbate the akathisia that is being caused by another one of my medicines, Vraylar. α2-adrenergic agonists:
      clonidine (Catapres) 0.1 mg: made me sleep alright, but made me sleep forever, and when I woke up, I felt super teary, dysphoric, depressed, and miserable, and couldn't get out of bed all day Orexin receptor antagonists:
      Belsomra (suvorexant) 20 mg: this was hit or miss. It would work like a charm sometimes, and sometimes I would just toss and turn all night, unable to get to sleep. But it doesn't matter because my insurance gave me the middle finger last year with a nice little letter saying that they would no longer pay for it anymore. Melatonin receptor agonists:
      Rozerem (ramelteon) 8 mg: did absolutely nothing for me Natural remedies:
      Melatonin 1-10 mg: I've heard using a sustained release plus an immediate release sublingual tablet is the way to do it, and use the lowest dose possible for each one, so I wound up using 3 mg SR + 1 mg IR SL, and it seemed to work pretty well for about a week, but its benefits started to wear off, and I started feeling depressed more during the day. When I stopped the melatonin, the depression eased up. Valerian root: this actually stimulates me. Lemon balm: anything with lemon balm actually does help me sleep somewhat okay, but I have to watch out for what else is in it Lavender tea: this actually helps quite a bit, but it's hard to find where I live L-Theanine 200-400 mg: supposed to help relax you and help your quality of sleep, but I didn't get any benefits from it. I don't even feel the relaxation effects from it. Ashwagandha 500 mg: didn't help me sleep, but did help ease the nightmares I was having while going through Effexor withdrawal Scullcap 1275 mg: didn't help me sleep, but like Ashwagandha, it helped ease the nightmares I was having while going through Effexor withdrawal Chamomile: just helps me feel relaxed, doesn't help me sleep (probably more I can't think of off the top of my head...) *****************************************************************************************
      Here is a list of meds that I haven't tried.
      Benzodiazepines:
      flurazepam (Dalmane): my pdoc refuses to prescribe this one to me and given how long its half-life is, I don't think I'd want to take it anyway midazolam (Versed): I somehow feel like this would work, but it's so short-acting, and I doubt my pdoc would prescribe it to me Onfi (clobazam): not sure if this would benefit me for sleep, I think it's indicated for Lennox-Gastaut syndrome triazolam (Halcion): Very short-acting, not sure if it would benefit me through the whole night Nonbenzodiazepines:
      Edular (zolpidem sublingual): I was interested in trying this, but it's not covered by my insurance... bummer. zaleplon (Sonata): another short-acting sleep med, which I doubt would be helpful at sleep maintenance ZolpiMist (zolpidem oral mist): I was also interested in this one, but my insurance doesn't cover it either...  T__T Barbiturates:
      Butisol (butabarbital): seriously doubt my pdoc would prescribe this, but I wonder if I'm really to the point where I need a barbiturate... Seconal (secobarbital): see above... Antidepressants:
      amitriptyline (Elavil): I've heard of this one being prescribed for sleep, but I'm afraid of the weight gain. doxepin (Sineqan/Silenor): I've been curious about this one, but afraid of it because of weight gain. My pdoc at one point acted like she was going to prescribe it for me, but it was just not on my prescription sheet, like maybe she forgot? Or decided it was best for me not to be on it? imipramine (Tofranil): I've heard of this one being prescribed for sleep too, but I think it's contraindicated with MAOIs. (certain TCAs can actually be taken with MAOIs) Antipsychotics:
      risperdal (Risperidone): I've heard of this one being prescribed for sleep, but not too commonly... I'd be afraid of the hyperprolactinemia associated with it. Plus I would really rather take just one antipsychotic if I can help it... I don't want to be on one for mood and one for sleep... Other
      Xyrem (sodium oxybate): I feel like this would really help me what with my fragmented sleep and poor sleep quality, but my pdoc won't prescribe it (maybe she isn't licensed to?) I may need to find a sleep doctor for that if I want to pursue that. The only problem is I don't have narcolepsy, and I've heard it's next to impossible to get your insurance to pay for Xyrem if you don't have a diagnosis of narcolepsy, but I have heard of it being used off-label for idiopathic hypersomnia-associated insomnia as well as insomnia itself. *****************************************************************************************
      Can anyone give me any insight into what I could possibly do for sleep? I feel like I've kind of hit a wall here.
      I've also tried relaxation exercises, guided meditation, binaural beats, and that kind of stuff, none of which worked for me.
      I know I gave a lot of info to sift through, sorry for the super long post... But any feedback would be appreciated. Thanks!