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dealing with chronic sleep issues - suggestions?


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So prior to my current (former?) episode, I was dealing with sleep issues galore, but it led to an ideopathic hypersomnia diagnosis, meaning essentially we don't know why you're tired all the time, but you are. 

In my current (former?) episode, I've been dealing with variations on insomnia (and yet still being exhausted the next day) for approximately 60 days now.  The PHP program I'm in says that they are really good at sorting out sleep issues, but mine have not sorted.  Maybe they're getting better, but it's really hard to tell. 

Initially, the situation was that I'd try to sleep from about 8:30 or 9:00 until about 6:30.  I'd pull that off roughly, but I'd wake up 4-5 times during the night to do so.  Recently I pushed the hours back in an attempt to possibly have the first chunk of sleep (which was usually the longest) possibly last to a better hour and reduce the number of wakenings.  This past weekend was all over the board, but one of the days was probably because of me having caffeine too late in the day.  Sunday night, however, I went to bed at 10, was stuck wide open at 5:30, and woke up four times. 

At PHP pdoc's suggestion, I'm not tracking the specifics anymore, so I just put little check marks when I wake up and then try to go back to sleep and eventually get up if I can't.  Three out of the past four nights, though, I've woken up one time (usually a good thing), but when I wake up the second, I'm stuck awake for the day.  For example, Saturday morning I was stuck awake at 5:30, which at least isn't as awful as being stuck awake at 3:30 (currently).

To cover the usual - yes, I've had a sleep study.  I was too anxious in the lab for them to measure quality of sleep or hours slept, but they did rule out sleep apnea or any movement disorders.  However, I've gained about 40 pounds since then, so it's possible that's changed.  PHP pdoc mentioned having a sleep study done and I agreed, but I'm also partially hesitant because I'm getting a sleep study of me during my abnormal sleep state.  I still see it as a bipolar problem (it started when the bipolar episode started), but they're wondering if it's physical.  I was thinking if it was physical, it wouldn't change when the episode started and it would have been findable previously.

So...anyone else dealing with this chronic multiple awakenings or chronic getting stuck awake at a super early hour?  Any suggestions?

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I'm having a similar problem.

What helped me was first putting me on a heavy sedative and changing my mood stabilizer.

After those changes I could sleep and I made some changes to reduce some life stressors.

Unfortunately I was and still am struggling with getting back on a health sleep track and struggling with tiredness.

The mood stabilizer was once again changed and I could at least reduce the sedative because it wasn't helping the next day tiredness and I begun having problem with memory and focusing.

A thing that I did was fighting with every power that I had the need to sleep during the day, I used to set up 20/30 minutes to shut everything and lay down.

I don't know if that helped because most of the nights were still tough to sleep and everything, from awakenings to early awakening still happened.

After some time, I found out that my neighbors are making abruptly and loud noises and that's why I'm awakening.

What started as just stress and a possible secondary chronic insomnia (related to lamotrigine) is turning out that I was and I'm sleeping under a lot of noise.

The awakening on the middle of the night comes from the 'not so a child' upstairs that usually start a revolution around 00:00/01:00 and/or 02:00/3:30.

Same is happening to morning that dropped from my steady routine of 6:50/7:00 to 5:30/5:50, the time that the 'old fellow' there sets his alarm clock and goes to work.

If you're not noticing anything related to environment. (I'm sleeping on multiple places on my apartment to avoid it, since 'the system' isn't working to make they stop).

I would just try some meds adjustments.

Unfortunately I'm still struggling with some tiredness but is getting better as I avoid those noises and reduce the sleeping pills.

I can notice a big change when using a mild sedative, I don't feel as tired.

I'm improving, I'm still irritated and now doctors are just attributing my issues to a sleep related problem outside a mood disorder.

I hope this helps you and I hope things get better, I can see some improvements but I wish they were faster than those I'm experiencing. 

Edited by uncomfortable thoughts
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I was dealing with this for a long time.  And still do. 

I don't know how to get a full night's sleep, but I can empathize with you.  I know what it is like to wake up a bunch of times at night.  I have the hardest time staying asleep.  I can fall asleep, but then wake up a couple hours later. 

I hope you find a way to sleep through the night.  I know the frustration.

Looking for others suggestions on this thread as other people post.

Thanks for posting!

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It could definitely be a bipolar issue. Inability to sleep is one of my major symptoms, and it occurs during every episode type. The difference is that I'm not tired when I'm manic, but I am dead tired when depressed.  Mixed varies. Psychosis is much more likely to occur when I'm not sleeping, too, but I had a bad psychotic episode when I was sleeping quite well once. I hope you find a solution to your sleep woes. 

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I've been having good results using a free app made by the VA called CBT-i which is CBT for insomnia. There's a sleep diary to fill out once a day and it generates an "efficiency" rating, which gets used to generate a "sleep prescription" to help consolidate sleep. This means you spend a greater percent of time in bed actually sleeping. It has a lot of good information on it as well about what to do/not do during the day as well as night that contribute to better sleep.

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The times when I've been unable to sleep, it was because I couldn't turn my mind off. So I always redirected my mind to - believe it or not - replaying a TV show or movie I saw. I mean I replayed the show in my mind. That way my mind had something to focus on and eventually it got tired and I drifted off. That's what always worked for me.

Now that I take Remeron, the moment I hit the bed I doze off. 

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Thanks both of you also for ideas of things to try. 

What sucks is that for the past three days I got 6-7 hours in the first chunk of sleep.  Today, not so much.  I'm back to the 1.5 hours here, 3.5 hours there technique.  I'm currently taking a break because I couldn't fall back asleep and it's just shy of 3:00am.  I'm going to be really frustrated if this is how early I'm waking up, because my day is destined to be slow-going already. 

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That post was from my old account, so all the meds and stuff is off.  I didn't realize I logged into it. 

 

I got another two hours of sleep, but I'm feeling fairly stuck awake now.  Well, it's still about 7.5 hours...it was just in three chunks of time.  Sigh. 

 

As one very trying to see things positively side benefit - grocery shopping at 5:30 goes much more quickly than going at a normal hour when other people are up and doing chores. 

Edited by dancesintherain
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On 8/16/2016 at 9:05 AM, melissaw72 said:

I was dealing with this for a long time.  And still do. 

I don't know how to get a full night's sleep, but I can empathize with you.  I know what it is like to wake up a bunch of times at night.  I have the hardest time staying asleep.  I can fall asleep, but then wake up a couple hours later. 

I hope you find a way to sleep through the night.  I know the frustration.

Looking for others suggestions on this thread as other people post.

Thanks for posting!

It's funny (not funny haha but funny weird). I can't fall asleep at night for the life of me. My body will be begging for my brain to let me sleep, but my brain just buzzes along. I toss and turn and go from recliner to couch to bed back to couch - then it starts to get light out and I'm out... I could sleep for 10-12 hours straight. Maybe I'm a vampire and my teeth just haven't come in yet? LOL 

Great topic. Thanks for the posts everyone!

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Do you have any medications that help you fall asleep?  I've currently kind of got a few (gabapentin somewhat w/ slight benefit from tizanidine; seroquel was until it made me eat my house,so now I'm fortunately coming off; ativan helps a tiny bit, but seeing as I take the same dose in the morning, I doubt it does much). 

Disclaimer that, given that I started the post on the issues and they haven't gone away, the medication and/or my body has been inconsistent in keeping me asleep...well more realistically, it's been consistently not keeping me asleep for the entire night, but how many times I wake up and how much sleep I get in each interval is up in the air. 

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Perhaps good for @Chronicles of Insanity, but sadly not for me @HAL9000...when I took Ambien, I sleep-walked, sleep-ate, sleep-prepared-food (fortunately all cold), sleep-talked, sleep-argued, and sleep-had-a-tea-party-with-my-dog.  Fortunately the lovely ex was still dating me at the time, so she clued me into all the above happening.  She didn't know if I didn't know until the next morning, where I'd have no recollection of it.  

I always assumed the stories about people doing weird things in their sleep were fabricated, but I question no more. ;-)

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You are not taking enough Ativan for it to be a hypnotic. Dosages for Ativan, when used for sleep are 3-4 mg as a single dose according to the Prescribing Information. Have you tired any of the true benzo hypnotics (ie not the Z drugs) ? Dalmane, Restoril, Prosom are some off the top of my head. I have the devil of a time with early morning waking and sometimes getting to sleep. The latter is solved by a small dose of a benzo to shut my brain down. This happens infrequently. Early morning waking happens all the time. My pdoc and I discovered I need a larger dose than most take and that once I find the right dose I don't get tolerant to it, I have been on Lunesta for 12 years.

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I've taken triazolam which I think is a benzo hypnotic.  It helped for some time and I can't really remember why I stopped.  I haven't gone past that and the current program's pdoc doesn't seem convinced that the sleep issues are bipolar related anymore.  I beg to differ.  I've been told I'm on enough sedating medications that they don't want to give me anything else.  Well, if they want me to sleep through the night, as opposed to in three or four chunks at a time, they may want to change their mind. 

That said, I did recently have three straight nights of six+ hours in a row.  The fact that that's noticeable over the past two months is a problem, though. 

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Whatever the reason for your insomnia, bipolar or not, I find it rather callous that they "don't want to give" you anything more because obviously your sleep issue is not adequately being treated. I'm not sure that there is any solution for early awakening except pharmaceutical. There are tricks to getting asleep as I posted and there is sleep hygiene but waking up early is a special torture that doesn't really yield to those methods.

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Thanks jt.  Right now, the program is a bit--rollercoaster-y in its thoughts and actions--so perhaps the not giving any additional medication will change come Monday.  Particularly with going back to work.  There was talk of a sleep study--which I find strange b/c I don't consider myself to be at my baseline when it comes to sleep yet, so it seems strange to make my insurance pay for a second study when the first was inconclusive because of anxiety. 

Right now, the falling asleep part is going okay without too much effort...it's the staying asleep.  I can take an extra 100mg of gabapentin if I want to, but seeing as 400mg is part of the cocktail that knocks me out, expecting 100mg to keep me out is strange.  And going past that--why isn't our goal keeping me knocked out to begin with?  If I have a PRN medication that I take to assist me with falling back asleep every single night, wouldn't that suggest that the regular sleep meds need to change?

 

add on - she's similarly commented on the number of CNS depressants.  Perhaps now that we're withdrawing the seroquel (which was at 400mg) it'll be less of a concern, but I doubt it. 

Edited by dancesintherain
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These are just some random observations about myself that might be informative as to why they want a sleep study. I find that the phase of sleep I wake up in plays a large part in how I feel when I do wake up. I'm medicated now with Remeron so under no circumstances do I have a problem getting back to sleep if I wake up. But there are times when I do wake up and I'm ready to go. I mean, I feel well rested and could get up and start my day. This is even true after only a couple of hours of sleep which clearly is not enough. Other times, I have a hard time to wake up to my alarm after sleeping 10 hours. So I think a lot of it has to do with sleep phases. One thing they do measure in a sleep study is sleep phases, Perhaps you are waking up when you are entering a new phase of sleep. I don't know. But the sleep study could help you get to the bottom of it. Also, you probably should take your anti-anxiety meds so that you can get to sleep.

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