breaking the cycle---skipping sleep

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i have more than a little anxiety (with panic attacks) and it keeps me from falling asleep (and staying asleep) and the only medication that has ever helped me with anxiety/sleep (besides the tiny bit buspar does)---risperdal---was fucking me over so badly over the the past few years that writing this post would have become impossible if i had continued using it. and even on risperdal, id still be asking this question, which is: does anyone have a good way to break the pattern of sleeping only every other night?

optional background and clarification:

before risperdal it would take 3-8 hours to fall asleep every night, if i could fall asleep at all, and ive simply lost the patience for tossing and turning and wasting that enormous chunk of my time doing nothing but feeling anxious and shitty and obsessing, especially without the guarantee that id even be able to sleep. so, both on and now off the risperdal, when i am too anxious to sleep, i get up after an hour or two of not being able to sleep (or, more often, just never go to bed in the first place) and stay up until my bedtime the next day, at which point im usually able to fall asleep within a reasonable period of time. some days are good days to stay up and im not tired at all during my waking hours, but some days i feel tired and dont want to be awake, but im still too anxious to sleep. when these cycles persist for weeks at a time, its not usually preferable and because ive had sleeping disorders my entire life i covet sleep and just want to feel rested (which i virtually never, ever do). the cycle is habit forming after just one instance of skipped sleep, though i suppose one might infer its just a peak in ambient anxiety.

ive seen multiple pdocs, a naturopath (even though i dont believe in that shit), and have "good sleep hygiene." i guess im looking for more advice than "ask your pdoc to write you a script for something new" because most things apparently have no effect (or make me more awake, like trazodone). im about to give latuda a try once i get sick of life without an AAP, if my insurance will let me, but that probably wont solve this problem. thanks in advance.

[Guest]

Have you ever tried Restoril? It's different from the other sleep meds. It's a benzo. If you're trying everything, you might want to give this one a try as well.

Have you done the low dose Seroquel? Maybe 50mg? I know that low dose Seroquel is sometimes used for sleep. The higher doses aren't sedating like the lower doses.

I had to give up on sleep meds. Too many side effects. So now, I sleep the way that my body tells me to. Most week nights I get around 4 hrs of sleep. Maybe less. On the weekends I'll get more. So long as it isn't dangerous, and I'm not clearly sleep deprived, I let it go.

If things were the way I'd like it the days would be 36 hrs long. That seems to be what my body likes best.

Have you ever done a sleep study? I've done two and I was shocked by the results. It might be worth doing. I know it changed a lot of things for me.

[CrankyMe]

I was going to suggest the sleep study also. You just never really know what's going on when you are sleeping.

As for me, I'm much the same way when it comes to sleep meds. They seem to stimulate me rather than sedate me.OTC sleep meds are the WORST.

When I'm having trouble falling asleep, I take a prn benzo (xanax) and a beta blocker (propranolol) to try and calm my mind and body. It usually works within an hour or so.

When I have major insomnia, I generally just have to suffer through it. Seems like everything is either contraindicated for my meds/conditions or they just plain don't work for me.

I really need to buck up and do a sleep study. I just dread sleeping (or trying to) away from home.

[Indigo 'n dye]

If things were the way I'd like it the days would be 36 hrs long. That seems to be what my body likes best.

Mine would be about the same. Now, syl, all we have to do is convince the rest of the so-called civilized world!

I too have learned to listen to my body and sleep when it is best for me, rather than by the clock.

I wish everyone well who is having sleep difficulties.

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i hesitate to quote posts given the brevity of this thread. i think people can sort things out alright at this point.

sylvan, thanks for all the suggestions. ive tried the low dose of seroquel but ive never tried any benzos for any purpose. ive asked for them but never gotten them. i think my pdocs have been uncomfortable with prescribing them for long term conditions or something, i dont really know. my pdocs havent been all that great a lot of the time, but im trying to come to some point of conclusion with my current one before moving to a new one (that my new/notsonew insurance will cover). im a little apprehensive about benzos, but pretty much any psych med is something im ambivalent about. if i go on latuda and that doesnt straighten shit out relatively well (on multiple fronts), ill see what my pdoc says about restoril/benzos in general.

right now im on disability and, aside from general life responsibilities and plans, i can wake up and go to sleep whenever i want, so that helps me maximize the sleep i get from my common rhythm (sleeping roughly 6AM-6PM +/-3 hours, at least, when i was medicated enough to), but before risperdal i slept 0-5 hours a night and i had chronic sleep deprivation with aural, visual, and sometimes tactile hallucinations every day. and they all hated me except for the ones too caught up in their own world to notice me, so although i do miss them, some of them were creepy or violent. they start to come back when ive sustained a sleep skipping cycle for long enough. i need 10 hours of sleep minimum, probably, and now that ive discontinued the risperdal i will probably sleep less and less, unless i just trap myself into this cycle until it collapses and then eventually restarts.

ive never undergone a sleep study but that would be a completely horrible experience. i might have a go if you think it would somehow change my situation. it would involve a lot of panic attacks and i wouldnt be able to sleep in a foreign place unless i had already been awake like 36+ hours (and maybe not even then). i would figure staying awake for so long before i sleep would affect the results...would that matter/matter enough to not do it? what are the potential benefits? sleeping under monitored conditions is really just one of the worst situations i could ever find myself in. i think that tops eating in front of people. being there in the first place would ruin my entire month. but i dont want it to sound like im ruling it out before knowing the specifics; im enticed.

so, crankyspice, two votes for benzos, well thats something. if something has more or less enabled you to fall asleep, that sounds interesting. risperdal didnt help me fall asleep per se, i would just have to stay up into the morning until i felt like my tiredness somehow outweighed the lowest level of anxiety i could bring myself to aided by the risperdal/buspar. however, risperdal also helped me become less sensitive to noise and light that would give me panic attacks as i would try to fall asleep. im sorry to hear that youve also had no luck in treating the more severe manifestations of insomnia.

[confused]

Hi. I took restoril and it helped, but I think it's temazapam which you've taken before? I have a couple of questions. You sleep during the day about 12 hours? (6 am- 6 pm) . Were the hallucinations from sleep deprivation or is that a part of your illness?

Does anything help with the anxiety? I learned some things in therapy, cbt and relaxation that help some

I've never tried latuda. I hope it works for you

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well shit, i didnt even remember that was a benzo/those were the same drug. im sorry for my false reporting! that was so many years ago my medication history is kinda spotty from those years...i reconstructed it from memory a good while ago and i have amnesia from risperdal/aaps. i tried temazepam by itself and then also the combination of temazepam and ambien i think. the only thing temazepam ever did was give me a wicked hangover the first day or two of use, i had trouble walking around/using a ladder. none of the medications i listed like trazodone or temazepam or ambien ever helped me fall asleep, but ambien did help me stay asleep a little bit once i fell asleep.

while i was on risperdal i would sleep during the day roughly 6AM-6PM on days i wasnt skipping sleep, yeah. ive quit risperdal completely within the past week after tapering off and my schedule is now essentially in flux, though ive been adhereing to the 6-9AM-6-9PM sleep schedule on the every other day that i do sleep for the past 10 days. it is because i have stayed up 36+ hours that i am able to sleep 10-12 hours without the risperdal.

im pretty certain the hallucinations i commonly experience are from sleep deprivation, based on the information i have through observation/reading. i may have experienced some depression related hallucinations in the past, but thats not what im referring to when i discuss the bulk of my hallucinations in here. my pdocs never had a clue about my hallucinations and expected them to get better every time we upped the doses of whatever aap(s) i was taking at the time, but nothing has ever altered my experience of those hallucinations except sleep.

the only medications i can remember helping any reasonable amount with anxiety are risperdal (which helped a passable amount) and buspar (which helps a slight amount). mental techniques like meditation and relaxation can have a slight influence over my experience of the anxiety, but when im very anxious, which is most of the time, nothing like that can make any sort of difference. ive been a little interested in possibly seeing a cbt tdoc just to see if any progress could be made, but im highly skeptical of what sort of results i could realistically see. i already do tons of stuff that makes me anxious on a daily basis (and challenge the validity of the classifications my brain tends to use for objects/actions/situations), and the majority of my physical anxiety experience is "ambient anxiety"---anxiety that is just omnipresent regardless of thought life or setting. you say youve learned some helpful things, is there anything you feel would be potentially useful to me? or is it more personal learning that has to be done on the level of the unique individual?

latuda has some buzz, but most people say they get terrible akathisia, and right now im trying to revel in the glory of being aap free for the first time in 7 years. my life is descending into a shitstorm, but in many ways i feel better than i have since the advent of meds.

[confused]

My anxiety is more concerns about things that have already happened. Mistakes or things I could have done better. I learned this visualization to keep the past out of the present which helps. I try to think rationally through the thoughts now. I used to get suicidal ideations just to end the pain and to escape, but now I don't see that as an answer.

But, it sounds like you have more free-floating anxiety and I imagine that is harder to deal with.

[Guest]

WRT sleep studies. The first one I had was several years ago. At the time, I was heavily medicated. I wasn't sleeping much at all and when I did, I'd wake up and not feel any better than I did before I went to bed. The sleep study showed that during the time I slept I got very little REM sleep. Evidently REM sleep is a very important part of your sleep cycle. As I recall, I got 10 minutes total of REM for the several hours I slept. It turns out that one of my meds reduced REM. I was able to lower the dosage and I finally started feeling rested when I woke up. Even if all I slept was 3 hours.

I had another sleep study done about a year ago. This time they found that I had pretty bad sleep apnea. I stopped breathing over 60 times/hour. I don't remember how long each spell was but they measured them and my O2 level. Usually they want your O2 in the high 90s. Mine was dropping down into the 60s. I was a stroke waiting to happen. From this sleep study I ended up with a CPAP machine. I can't tell you what a difference it has made in my life. Some people have trouble being compliant with the CPAP. Not me. I used it every single night and felt so much better that it's impossible to describe. For the first time in years, I was getting 6 hrs of sleep a night. Sometimes less but 6 hrs is good for me. I've lost a considerable amount of weight in the last year and the sleep apnea is a lot better. Actually, I need to go get another study done and I'm betting that I can do without the CPAP.

So, for me, the sleep studies made a huge difference in my life. If you're having as much trouble sleeping as you describe, a sleep study would at least rule out some of the more typical problems.

There is an extended release, Ambien CR. I believe it works by having an immediate release in the outer layer and an inner layer that is released later. So, essentially it helps you get to sleep and then helps keep you asleep. If you haven't tried it, it might be worth a shot. Oh, and I found this link that has a pretty good review of the newer sleep meds, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004925/ and http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0008716/.

I hope some of this info helps.

[enlightened_plutonian]

I would say that a lot of my sleep troubles are because of my anxiety. I used to be so frightened to sleep that I would force myself to stay awake so that I could defend myself if I needed to.

What helped me the most was a combination of treating my anxiety and being on a sedative med which I knew would knock me out eventually. Thankfully for me these were both the same med. But I am not going to pretend that I know enough about meds to give any suggestions, and you have already tried the med that helped me (Seroquel).

I hope at least some of this is relevant or helpful, and that I am not just rambling.

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confused - i definitely share that anxiety and a good portion of my thoughts while i am trying to sleep revolve around things i fucked up (that day, or any time previous, or things im going to fuck up in the future). i can never stop thinking enough to sleep, which is one aspect of the problem, (and i am always physically and mentally anxious/aroused independent of anything else which also keeps me from falling asleep). im usually a pretty rational person and even my rational interpretation of events and thoughts and emotions cause me anxiety. im suicidal merely by existing and anyone ever having conceived of my existence. i suppose i dont see suicidal ideation as an answer, but i feel weird when its not happening. sometimes (on light days) i have a certain amount of control over some of my thoughts insofar as where they are directed, but not whether or not they continue. im glad youve had some success in dealing with some of your anxiety, though.

sylvan - thanks for sharing your experience. i checked into local places that do sleep studies and found one that my insurance supposedly covers. if i can find out that it would be cost-free to me, i would consider going once i have some sort of stable medication and sleeping situation, so probably within the next month. i dont really think much will be revealed, but im piqued, and its good information to have.

ive tried regular ambien and it didnt help me fall asleep, but it did slightly help me wake up fewer times during the night. if i dont start on another ap, i might go back to trying sleep meds.

enlightened_plutonian - perfectly relevant. that combination of effects would do it for me, ive just never found anything capable. some medications do make me feel like going to sleep, they just dont make me able to sleep.

[Birdee]

Do you exercise? Sometimes it helps to get the body tired enough to shut the mind off.

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i try to exercise every day, but i dont get a LOT of exercise (only ~20 minute sessions usually), and there are many days/periods of time when i dont exercise because i am just too exhausted, depressed, and possibly hung over from medications. also, exercising is very complicated because it ruins my life to exercise where there are people, and there are people outside of my house and inside of my house, so that leads to a lot less exercising as well. exercising to most any extent doesnt really make me any less hyperaroused, generally. exercise is supposed to good for sleep and depression and anxiety, but i never notice a damn thing...but that doesnt really surprise me, nothing ever helps, usually.

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i saw my new gp and told him i have insomnia (2 hours of sleep a night and/or weeks of 36+ hour waking periods), while providing him a list of my extant medical conditions, and he immediately dismissed it as ocd and refused to consider a sleep study as potentially beneficial. especially considering he made this diagnostic deduction without even hearing a single bit of information about my experience---what keeps me up, etc---his assessment is pretty useless to me, not that i really expected any degree of nuance in the understanding of MI from a hurried, lower quality facility gp. thats not to say i dont think ocd plays a role, but that is a very rudimentary and incomplete understanding, and does not, to me, preclude the potential for something else to be awry that a sleep study may at the very least quantify.

the sleep lab im interested in does not require a physicians recommendation, but my insurance does. do you guys think its worth "going behind my gps back" and trying to get a recommendation from my psychiatrist? honestly, i dont think theyd really find anything useful, just perhaps interesting. id like to make progress on this in some direction, though...ive spent years hallucinating every day and being perpetually exhausted and, now that my half-vacation has come to an end, i dont want to go years more before something happens to improve my life situation.

[melissaw72]

i saw my new gp and told him i have insomnia (2 hours of sleep a night and/or weeks of 36+ hour waking periods), while providing him a list of my extant medical conditions, and he immediately dismissed it as ocd and refused to consider a sleep study as potentially beneficial. especially considering he made this diagnostic deduction without even hearing a single bit of information about my experience---what keeps me up, etc---his assessment is pretty useless to me, not that i really expected any degree of nuance in the understanding of MI from a hurried, lower quality facility gp. thats not to say i dont think ocd plays a role, but that is a very rudimentary and incomplete understanding, and does not, to me, preclude the potential for something else to be awry that a sleep study may at the very least quantify.

the sleep lab im interested in does not require a physicians recommendation, but my insurance does. do you guys think its worth "going behind my gps back" and trying to get a recommendation from my psychiatrist? honestly, i dont think theyd really find anything useful, just perhaps interesting. id like to make progress on this in some direction, though...ive spent years hallucinating every day and being perpetually exhausted and, now that my half-vacation has come to an end, i dont want to go years more before something happens to improve my life situation.

Yes, IMO going against your GPs back would be ok. If your pdoc wants one done, then s/he can ask for one. Just like the GP said No, the psych can say Yes.

[Cetkat]

First, yes, I believe a sleep study would be helpful.

As far as being able to sleep during the study, it really doesn't take much time spent being asleep to analyze the results. It's basically an incidence per hour tally. The amount of hours isn't an issue because it's a relative figure. I have also heard that those on sleep medications are supposed to take them when doing their study, so I do not believe they influence the results. That would be something to confirm with the study people though.

They'll look at oxygen stats for sleep apnea. The way an event is counted is a combination of length of time and percent drop from what they determine to be your normal oxygen level. Sleep events that meet this criteria are then examined for meeting the quota per hour. They also check other things during the test, like sleep stages.. but I'm not very familiar with those aspects.

A sleep study can be ordered by any doctor. ENT's are some of the more prevalent referrers. There is absolutely nothing wrong with doing a little doctor shopping for a referral if you believe it is warranted.

Ideally, since you identify anxiety as being the main reason for being unable to sleep - that would seem like it would take priority in trying to treat this rather than sedating medication.

You can also try melatonin (rozerem is the rx form of that) to help regulate your sleep cycles. It's pretty hit-and-miss, but some people find it helpful and sedating, in a regulatory "it's now time to sleep" fashion.

Another idea, and please take this with a grain of salt as it's personal conjecture... would be to take something to increase your dopamine levels. This would be an absolutely bad idea if you suffer from any type of psychosis not connected with sleep deprivation - as it would inhibit the ability of an anti-psychotic med to work and increase possible events. I have sleep issues as well, and have found that it can help me get to sleep and stay asleep. The getting to sleep part probably has to do with other elements of my personal condition, but the staying asleep (that you mentioned as a problem) may be a more general reaction due to the importance that dopamine plays in the sleep process. I highly suggest against attempting to mess with any of this on your own, but it could be a possible conversation to have with your pdoc to see if he/she believes a trial could be beneficial and risk-free.

[Wooster]

Based on what you are describing, you might have luck looking in the direction of circadian rhythm disorders like delayed phase sleep or something... can't remember the name at the moment... that's indicating your circadian rhythm lasts longer than 24 hours.

Not particularly helpful, but I also second, third or thirty-second the sleep study recommendation. It probably won't be earth shattering, but may give you some good rule-outs or rule-ins.