Need reassurance about sleep....

[nervousnellie]

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  

[CrazyRedhead]

@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 February 16, 2017 by CrazyRedhead

[nervousnellie]

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!

[CrazyRedhead]

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 February 17, 2017 by CrazyRedhead

[nervousnellie]

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!

[CrazyRedhead]

@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 February 19, 2017 by CrazyRedhead

[nervousnellie]

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.

[Jumping Rabbit]

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.

[melissaw72]

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

[nervousnellie]

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!!!!

[notloki]

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. 

[melissaw72]

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.

 

 

[nervousnellie]

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!

[nervousnellie]

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!!

[melissaw72]

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?

[melissaw72]

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.

[notloki]

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.

[heilmania]

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.

[melissaw72]

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. 

[CrazyRedhead]

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

And thx for your replies and for listening.

 No problem........