tryp Posted February 21, 2009 Share Posted February 21, 2009 Back in mid-2008, I was having PTSD-related insomnia issues, pdoc gave me mirtazapine at 15 mg then upped it to 30. It's no longer a sleep dose at 30, but I was still sleeping because my PTSD was better controlled, and the decent sleep I got at 15 seemed to let me break the cycle of insomnia. Then I had to go home for Christmas, which drove me so loony that I ended up on quetiapine 150 mg to make me sleep (lower doses didn't work). I was having such bad daytime anxiety a couple weeks ago that pdoc swapped the quetiapine for Ativan (1 mg in divided doses during the day and a whole 1 mg at night) but apparently Ativan makes me suicidal (whouda thunk it?), so now I'm off of that (haven't had any in 4 days) and on a baby dose of clonazepam (0.25 mg in the morning) as well as mirtazapine at 45 mg. I thought that since the acute stressor that made me need the extra sleep aid is gone, I'd be able to sleep again, especially with the Klon in my system, but I can't. I tried smaller doses of quetiapine (50 and 100) over the past couple of days and it doesn't help. I wake up all the time and it takes me hours to fall asleep (I also have trippy dreams, but that's another story ). Pdoc offered me Imovane when I saw her on Thursday, but I said no and so she gave me more quetiapine instead. I would really, really like to not be on sleep meds. I've never really needed them before, and I think a lot of what's going on is rebound insomnia from the various meds I've been on but I'm not exactly sure how to break the cycle. Any ideas? Should I humor my insomnia and go back to higher dose quetiapine? I've tried to taper the dose from 150 before with no luck - anything lower just tanks my sleep entirely, but I could try tapering it more slowly. Should I try to wait it out? Should I try an OTC sleep aid? I've tried diphenhydramine before, and it doesn't seem to help. Pdoc's gone for a couple weeks, so I'm stuck with the meds I've got, and I really don't want Imovane anyway. I apologize if this is incoherent/makes no sense. I've been a little bit boggled recently. Link to comment Share on other sites More sharing options...
Thomas Posted February 21, 2009 Share Posted February 21, 2009 I have been on Restoril (tomazepam?) for several years now as a sleep aid and it seems to help. I still have bouts of imsomnia every two to three weeks, but on the other hand, I don't need to take my Restoril every night -- if I'm really tired, I will fall asleep pretty fast. I am always in bed by 9 or 9:30 because I have to get up at six for work. On days off, I manage to sleep until 7:00. Tommy Link to comment Share on other sites More sharing options...
tryp Posted February 21, 2009 Author Share Posted February 21, 2009 Thanks, but I'm not really in the market for a new med. If I do try another med, it'll be Imovane - after what happened with the Ativan, I really don't want another benzo, especially with the Klon already running around in my system. Link to comment Share on other sites More sharing options...
BPCharlotte Posted February 21, 2009 Share Posted February 21, 2009 I hope you don't mind me saying this, but if I were you, considering all the other stuff you've been dealing with, I'd leave the issue of coming off sleep meds for a while. I understand why you want to do something about it now, given the med issues you've had, but sleep is really important. Well, durr, you know that already, but what I'm saying is that I'd tackle just one little thing at a time. I know it's tempting to say "well I'm changing meds so I may as well do it now" but IMHO you should look at simply stabilising your sleep patterns with meds for now. Sorry I can't be of more use, but I really do think it'd be best left alone, at least for a little while until other things in your life are more settled. And for the record, I'm stuck on Zopiclone. Maybe not every night, but enough to be a right royal PITA. All the best with working out your meds. Link to comment Share on other sites More sharing options...
tryp Posted February 21, 2009 Author Share Posted February 21, 2009 Thanks mrsmaz - you're probably right. I think I'm going to go back up to a higher dose until I'm sleeping normally and then try a REALLY slow taper. Link to comment Share on other sites More sharing options...
scatty Posted February 21, 2009 Share Posted February 21, 2009 If it helps you sleep- take it! I agree to worry about going off the med later when you have been stable for a while. You don't want your treatment to go backwards, so to speak. Link to comment Share on other sites More sharing options...
tryp Posted February 21, 2009 Author Share Posted February 21, 2009 I really wouldn't rather Imovane - that's why I refused it and asked for more Seroquel instead. I guess I should just keep the Seroquel - I guess I want off because I really don't think it's necessary if I can find a way to sleep without it. I tried taking it in divided doses for anxiety and it didn't help, which leads me to believe that it's not doing any anxiety stuff (I could be wrong, though). It worries me, taking an AAP, though. I mean, those are hardcore meds. I know it's a low dose, but I'm nervous about it. And I guess it's maybe that I'm feeling a little bit triggered - I'm having problems with my asthma and medical stuff triggers me, and I know I'm not explaining this right, but sometimes my reaction to having medical issues or having to deal with medically-related triggers is to think "All of my problems are a lie and I'm taking meds I don't need which makes me a horrible person". This may be behind my sudden desire to get off of the quetiapine. Now that I think of it, I think that part of what's behind this is that my brain is telling me that my pdoc thinks I'm on more meds than I need to be on, therefore pdoc must think I'm a hypochondriac and a liar, so I'll dump the seroquel and then she'll be pleased with me and won't hate me. Pdoc, of course, has said nothing of the sort, ever. Damn, that's really twisted. God, that's twisted, but now that I think of it, I think that's a big part of it. Damn, I must be more triggered than I realized. Y'all are right, I need to tell my PTSD to STFU and keep taking the meds that are working for my condition. Back to 150, then, and I guess I'll see where it goes from there. Link to comment Share on other sites More sharing options...
AnneMarie Posted February 21, 2009 Share Posted February 21, 2009 Susan makes a lot of good points. My first thought was if after you started Seroquel your symptoms in general improved, then perhaps Seroquel partially contributed in addition to helping with sleep. Actually, just getting consistent sleep helps improve health. (That's not to imply the med is responsible for all the progress you've made!!!) I find that even at a low dose Seroquel has an anti-anxiety effect the next day. I also found that when I reduced from 150mg to 75mg I felt some depression for a little while. For me, I think a little of that antidepressant property starts working at a lower dose than typically thought. Meds are funny like that, effecting different people differently. But, enough about me. If Seroquel helps you sleep and especially if it allows you to get by with less benzo, I'd go back on it. And, as others commented, you are dealing with a lot right now. It might not be the best time to ween off a med. Real stability will happen and you'll know when you get there. Link to comment Share on other sites More sharing options...
liveoak Posted February 21, 2009 Share Posted February 21, 2009 What Susan said. Your goal is to get stable, not to get off meds. Right? Link to comment Share on other sites More sharing options...
SunshineOutside Posted February 21, 2009 Share Posted February 21, 2009 I agree with everyone that says stay on the med. Sleep is so important especially if you're still changes meds. I still take my Trazodone faithfully. Sunshine Outside Link to comment Share on other sites More sharing options...
tryp Posted February 21, 2009 Author Share Posted February 21, 2009 Yes, everyone's right. I'm a dumbass. I'll go back up on the Seroquel and see if I can fix my sleep. Link to comment Share on other sites More sharing options...
Velvet Elvis Posted February 21, 2009 Share Posted February 21, 2009 FWIW both seroqeul and mirtazapine (Remeron) are more sedating at lower doses. At 45 mgs the mirtazapine isn't likely going to be doing much for sleep. If you increase the seroquel much beyond 300 mgs it will stop helping with sleep as well so taking something additional for sleep rather than raising the Seroquel too high is logical. Link to comment Share on other sites More sharing options...
tryp Posted February 21, 2009 Author Share Posted February 21, 2009 I find my sleep dose of Seroquel tends to be 150 mg. Pdoc says I can go up to 200. I'm taking less at the moment because pdoc and I were doing a bit of a med juggle, but I'm only going to go back up to the dose that helped me sleep before. The Quel is for the sleep issues, so I can keep it at a sleep dose just fine. As for the mirtazapine, it's my AD and not really a sleep med anymore. I was just hoping that with my depression/PTSD stabilized, I wouldn't have the kind of sleep problem that needed supplemental medication. Of course, I'm nowhere near stable anyway. Link to comment Share on other sites More sharing options...
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