What drug?

[dancesintherain]

I’m dead to the world tired.  Falling asleep on the train despite getting enough sleep.  I’m curious which drug to you seems to be the culprit.  Options below:

morning:

-fanapt (not likely because have me horrible insomnia)

- lithium 150

-lamictal 250

 

even’ing:

lithium 600

zyoreza 15

prazosin 2

klonopin - 0.75

 

i also take B-12, folate, and D supplements but I started them after this was already a problem.  Same thing with xanax.

Edited August 13, 2019 by dancesintherain

[Unstrung Harp]

I suspect the Lamictal is making me tired, though I'm only on 50mg. But since I got out of the hospital I sleep 11 or 12 hours a night and still take naps. Though that may be one of those side effects that is supposed to go away in time.

[Wonderful.Cheese]

@dancesintherain

I’m confused sorry. Are you taking Xanax and klonopin too? I don’t see when you take the Xanax on your list? Maybe I misread though. Just wondering if that could be an issue? As in, if taking two benzos plus zyprexa at bedtime is sedating you throughout the day?

And I take my lamictal at bedtime. I remember it reduced some sleepiness for me. I was really tired and now practically all of my meds are taken at bedtime. I don’t know if that’s helpful or not. Something to chew on and discuss with your pdoc. 

[dancesintherain]

Thanks—I take 0.75mg of klonopin at night.

the Xanax is during the day (0.25mg twice daily) and not likely the cause as it was only just added.  It’s possible but I’m fairly sure they predate the symptoms.

thanks harp—that’s two votes for lamictal at night.  I’ll see where it goes.

[Wonderful.Cheese]

@dancesintherain

I know I always mention this. But it doesn’t hurt to look for physical causes too. 

I know you have hashimotos like me. Have your thyroid levels been checked like the full panel recently? (I think they were?)

Have you ever had a sleep study night or daytime one done? I’ve had both. I wasn’t even snoring but my GP saw I had a small some kind of throat opening (I really don’t recall the technical word she used lol) and suggested I get a sleep study plus husband said I sometimes breathed weird on my back?). So I did one and I had barely enough “episodes” of it and now I use a CPAP machine and take nuvigil for speculated narcolepsy too and sleep apnea tiredness. If you have any questions about either of those just let me know. 

[dancesintherain]

Thanks Cheese.  Thyroid levels are fine as of about three weeks ago.  did sleep study about three years ago and it came back fine.  Vitamin D, B-12, folate are all in the process of getting fixed.

[notloki]

The only problem here is that Lamictal is not sedating. 50 mg is nothing, folks with seizures start at 600 mg and don't experience sedation. You list a number of sedating meds you say you take, look there.

[dancesintherain]

I take 250, not 50.

 

i tend to have the opposite reaction (fanapt is traditionally sedating and it gives me insomnia).  I’m curious where to start.

[Wonderful.Cheese]

@dancesintherain

Personally, I’ve always taken lamictal at bedtime. My pdoc has said it should make me a little drowsy. That was my first pdoc though. I honestly do believe that it does have this effect on me IME. Ymmv of course. We all react differently to meds. I take 300 mg at bedtime along with others and they all help me sleep. 

Edited August 13, 2019 by Wonderful.Cheese

[dancesintherain]

Thanks Cheese.  I left my pdoc a message and explained that it’s largely when I’m sitting idle (the 45 min train ride is the worst, but I also had some when sitting in her office for an appointment).  I do okay when I have to do things, though still tired.

[DammitJanet]

Lamictal is confusing. Side effects say it can cause sleepiness OR insomnia. I’m gonna try it one in the am and one in the early evening to see how that goes. I’d hate to try it all at night and be wide awake all night! Thanks for this thread!

[Iceberg]

6 hours ago, dancesintherain said:

I’m dead to the world tired.  Falling asleep on the train despite getting enough sleep.  I’m curious which drug to you seems to be the culprit.  Options below:

morning:

-fanapt (not likely because have me horrible insomnia)

- lithium 150

-lamictal 250

 

even’ing:

lithium 600

zyoreza 15

prazosin 2

klonopin - 0.75

 

i also take B-12, folate, and D supplements but I started them after this was already a problem.  Same thing with xanax.

Zyprexa? 

[dancesintherain]

As a hangover?  Could be.  I take it pretty early (7ish).

 

o realized from talking with pdocs receptionist that it also comes on when I have to sit and do nothing for a while (like waiting two hours for an appointment with her—which was at 12).  So maybe it’s not an immediately after taking them issue.

[Iceberg]

1 hour ago, dancesintherain said:

As a hangover?  Could be.  I take it pretty early (7ish).

 

o realized from talking with pdocs receptionist that it also comes on when I have to sit and do nothing for a while (like waiting two hours for an appointment with her—which was at 12).  So maybe it’s not an immediately after taking them issue.

Yeah the sitting around gets me too

[dancesintherain]

I’m not sure what to do with that.  Because I’m always going to be sitting for the train. And I can’t run the risk of dozing off and missing my station/having my stuff stolen.

 

i also don’t have the same problem in the 430pm train.  It’s weird.

 

for now I’m going to hope it’s an easy drug fix.  We will see what my pdoc does/says.

Edited August 13, 2019 by dancesintherain

[dancesintherain]

I heard from her receptionist and was told that “it’s okay to dial it back a bit and keep 1/2 a pill as needed.”  I asked to clarify what “it” was and she said Xanax...isn’t that what you were asking about.  (I talked to a different person earlier today and this person apparently didn’t read the note.)

i told her I thought it was least likely to be xanax because of when I take it, namely after the sleepiness, and he short half life. She asked what I wanted then and I said I didn’t know.  I hoped that my pdoc would have an idea.  I didn’t know whether to split a dose, change when something’s taken, etc. but I could tell her that I don’t think Xanax needed to be changed.  And that if it did, definitely not from 0.5 to .125 with no substitution.

we will see what happens with round two.

 

Now I am doubting myself on when this started and wondering if I'm having a paradoxical reaction to one of the supplements.  All say to take in the morning because of risk of insomnia (they're liquid form).  But maybe they're the culprit rather than my meds?  I wish I paid better sense of this stuff before it hit the point of needing a change.  I sent her the timing info related to supplements in case she wanted to go down that path.

Edited August 14, 2019 by dancesintherain

[dancesintherain]

So round 2 version makes more sense from my perspective.  I'm cutting the klonopin evening dose back from 0.75 to 0.5.  If that doesn't work by my next appointment (two weeks out), we'll think about decreasing zyprexa from 15mg to 12.5mg.  I mentioned the supplement situation but said we can talk about it later.

[Wonderful.Cheese]

11 hours ago, dancesintherain said:

So round 2 version makes more sense from my perspective.  I'm cutting the klonopin evening dose back from 0.75 to 0.5.  If that doesn't work by my next appointment (two weeks out), we'll think about decreasing zyprexa from 15mg to 12.5mg.  I mentioned the supplement situation but said we can talk about it later.

Sounds reasonable, dances! Good luck! I hope it helps you. Sitting idle usually makes me sleepy or fall asleep too, and that’s with nuvigil on board for me (but I have sleep disorders, mind you).

That’s hard. I can see how it would be very problematic on a train ride! Yikes! I’d be worried too!

ETA: would anything like having a coffee or soda help on the train ride? Or don’t you drink caffeine?

Edited August 14, 2019 by Wonderful.Cheese

[mikl_pls]

@dancesintherain, prazosin may also be contributing to it. In addition to what has been said about Zyprexa, I'd also say that lithium may also be contributing.

I've been meaning to ask you about Fanapt, btw. I guess it's confounded by taking Zyprexa with it, but did you notice any antidepressant effect of Fanapt? Also, has it caused any weight gain? My pdoc said it isn't associated with weight gain, but everyone's different I suppose.

[dancesintherain]

thanks Cheese.  I've been trying to pull back on caffeine, but maybe this particular train ride isn't the time to  make that lifestyle change ;-) I hope her change helps.  If it doesn't, I do think it's time to play around with the supplements.  the sitting idle portion isn't helping though.

thanks mikl_pls - it sounds like the summary is that anything I take could be causing it.  I'm not going on the train in the am today (a friend is driving me to a doctor), so I won't get to test out the new theory.

Re: Fanapt - I'm not sure I noticed AD one way or the other.  I needed a new AAP that was weight-neutral and it was one of few that I hadn't tried.  We were also primarily looking for something that was anti-psychotic, so it won the day on that one.  we joked about not knowing what it was doing when I switched back to zyprexa for sleep assistance...and then I went hypomanic.  So it was definitely doing something, but probably in the mania squashing land.

[Unstrung Harp]

On 8/13/2019 at 11:24 AM, notloki said:

The only problem here is that Lamictal is not sedating. 50 mg is nothing, folks with seizures start at 600 mg and don't experience sedation. You list a number of sedating meds you say you take, look there.

Lamictal is not sedating for most people. Note that I didn't tell dances that it was the likely culprit given her various meds, but that I have experienced recent sedation that tracks timing-wise with my time on Lamictal, and which I cannot easily attribute to anything else. Cheese has said that in her experience it has some sedation for her. My psychiatrist and I have discussed the possibilities, and he is not willing to dismiss the idea that Lamictal is having a sedating effect on me as one of the possibilities, even though "50mg is nothing."  Many people here have mentioned Abilify as an activating drug, but Abilify knocked me out consistently within a half hour of taking it for months, on not particularly high a dose. And I could go on about drugs people take here that supposedly do one thing but have had a different effect on me. And I don't think I'm particularly special. Psychiatric drugs in particular affect us differently, so I think you can talk about the relative likelihood of different drugs at different dosages doing different things, but it doesn't make a lot of sense to proclaim things like "Lamictal is not sedating" across the board. I'll give you the benefit of the doubt that you didn't intend for your tone to be as dismissive as it sounded.

Edited August 14, 2019 by Unstrung Harp

[argh]

Lamotrigine is mildly sedating for me.

[dancesintherain]

Thanks, I might put it on my list of things to suggest.  At a minimum we could try splitting the dose and seeing if it does anything.  I just took a Xanax before getting into the train in the afternoon and I’m fine, so it’s at least not the xanax by itself.  It may be a contributing factor in the morning, but I usually wait until post train ride.

and then there’s the why now factor.  That’s what raises the supplement question to me.

[dancesintherain]

so it's not the klonopin.  We tried cutting it back (from 1mg to 0.5mg) and all it did was mess with my sleep and anxiety.  No impact on the train (maybe actually a bit worse because of the poorer quality sleep).  Also, I took 1mg extra a few nights ago and there was no difference.  So we can safely rule that one out.

I told her I'd rather play with supplements first than try another med change.  So I'm stopping all and then adding them back in one at a time.  If it makes it worse in the morning for two days, take it at night and see if that works.  If it doesn't make it worse in the morning, leave it be and add the next one.  And so on and so forth. 

Only downside is that during my two days without any supplements I haven't had any noticeable impact on the drowsiness.  My tdoc suggested that it could be boredom in combination with sleepiness.  I'm going to try podcasts, since they require concentration and thought.  I have one more day without them (tomorrow) and then an extended weekend where I won't be able to tell.  I also wonder if it's some minor level of depression setting in and manifesting as a sleep disturbance first.

[dancesintherain]

I'm thinking it's an Rx pill I swallow because I took my morning medication and now I want to go back to sleep.  And I remember it being that way on the train.

i guess I'll still do the trial runs with the supplements just to mak sure none of them are making it worse, but I'm going to have to take a guess at something most likely.  I know we discussed- lamictal as being a possibility.  I can split that dose (w/ my pdoc permission).

[Blahblah]

@dancesintherain Looking at the other meds you are on (Zyprexa, Lithium, Xanax, Klon) I would say it's one of those (or possibly a supplement, like Magnesium or Omega3). Also...Trains make me INCREDIBLY drowsy.

Literally everything makes me tired or drowsy: SSRIs, SNRIs (particularly A/Ps those knock me out). Even Ritalin sometimes after taking my afternoon dose, i just want to lay in bed. I've stayed on Lamictal so long because it is literally the only thing that does not seem to make me tired or stimulated...Initial titration is wonky but not since I've been taking regular dose. I know everyone's wired differently though

Edited August 31, 2019 by Blahblah

[dancesintherain]

thanks for the thoughts.  the problem is I need something I take in the mmorning.  zyprexa and klonopin are at night, xanax I haven't taken yet today (it's two PRN, but I don't take it first thing).

Restricting it to  morning leaves the 150mg lithium, 250mg lamictal, and 6mg fanapt (which I know gives me insomnia, unless that side effect has gone away).  I haven't taken the supplements for three days, so it's not likely to be them.  That said, I may still try (I take B12, Folate, and Vitamin D, so none of those seem likely either b/c they all come with insomnia warnings).

So not that many possibilities given timing.  When i thought it was just train after 8ish hours of sleep, I was willing to think it was a night time med hangover.  But this morning was 30 minutes after I took morning meds (and not at all before) after waking up without an alarm clock. 

any ideas/thoughts given that?

 

ETA - it could just be timing (train ride in the morning).  but given that I saw the same thing this morning, makes me wonder if not. and given that I can do the entire ride home w/o a problem, I think less likely.  It's also weird because I've been taking this med combination since at least May, which is what made me think supplements.

Edited August 31, 2019 by dancesintherain