Insomnia Blogger

Tolerance

Insomnia Blogger — Tue, 30 Jan 2007 23:00:00 -0800

I wrote previously about how I only seem to get 4.5 to 5 hours a night of good sleep before an uncomfortable period of intermittent waking/sleeping. This is, to a large part, a result of my having developing tolerance to my sleeping pills. I've been taking Zopiclone for a few years now - that's Lunesta in the U.S. When I started, I got a good 7 hours of sleep straight. I knew that if I had enough hours in bed, I was going to feel refreshed in the morning. But now all I get is that lousy 5 hours max on a single pill. When I wake up, it's a crap shot if I'll fall back asleep or not. In the last few days, I crapped out and as a result my days have been like walking through a fog.

Now, if I take another half a pill at 5 in the morning or whenever I wake up, that usually does the job. But I'm concerned about developing tolerance to that routine too. Plus my Zopiclone prescription is only for one a day and my doctor has already hinted that if I'm needing more pills, not less, then maybe he'll stop it all together, which totally terrifies me because then I'll be back where I was before all this, not sleeping at all.

This is getting to be a real bummer. Does anyone have any suggestions on how to cope with or even reverse sleeping pill tolerance?

Do Insomniacs Dream of Electric Sheep?

Insomnia Blogger — Sun, 14 Jan 2007 01:58:00 -0800

My sleep has been not terrible this last week thanks to a change my doctor made in my latest cocktail of sleeping, anti-depression and anti-anxiety pills. I've been able to fall asleep OK, but then I wake up about 4:00 AM and start a period of intermittent sleeping followed by waking followed by sleeping. This goes on for several hours, such that it seems I'm awake the whole time but I know I must be sleeping too. Because if I get into bed around midnight and can stay in bed until about 9:30 AM, I feel refreshed, like I've gotten a full night's sleep. My guess is I'm sleeping to waking ratio during these hours is about 50/50.

Obviously, this isn't the most productive way to start the day. I'm lucky that I work at home and I can flex my hours however I want. But if I had to get to a job - or when we go on vacation - it can be tough for me to get the sleep I need when I need so many hours in bed.

What's particularly weird, though, is the dreams I have during this sleeping-waking period! They all seem to be stressful someone's-coming-to-kill-me or I'm in a scary place and I want to get out or I'm with someone who's making me jittery. Imagine 4-5 hours of unpleasant quasi-nightmarish dreams and you've got my experience.

My doctor says he thinks I've still got left over anxiety and/or depression in the early morning hours after the half-life of my latest pills have worn off. He's suggested I pop another pill to see if that relieves the bad dream symptoms. I'll let you know.

Anyone else have this kind of semi-wakeful bad dream experience? I'll post later on how it's going.

-- Brian

Don't Take Pills Too Late at Night

Insomnia Blogger — Fri, 22 Dec 2006 12:00:00 -0800

The pill my doctor recommended to help cut the anxiety and hopefully temper the early morning bad dreams is Mobiclomede (brand name Mobimede). It's a very old fashioned anti-depressant from the 1950s and 60s, known as a MAO Inhibitor. Most people have since graduated to newer meds like SSRIs and SNRIs, but for me the side effects were too great and I stopped using the more modern concoctions. Going to an "old" drug like this is kind of like a last resort - when nothing else works.

So far, it seems to be doing OK. I'm certainly feeling less depressed during the day and after upping my dose as I mentioned in a previous post, my early morning nightmares seems to be less, though my pattern of wake/sleep/wake/sleep is still there (maybe that's just my natural pattern?)

Last night, we had a parent-teacher meeting for my son. I usually take my third Mobimede of the day around dinner time, but this night I forgot. We didn't get home until 10:00 PM and I wasn't sure what to do - take the pill anyway or skip a night. The reason to skip a night was that the pill *may* have an activating component to it that could keep me up. The doc wasn't sure but many anti-depressants act this way. On the other hand, skipping the pill might have meant a return to bad dreams in the morning, and I've been hoping to break that pattern.

So I took it. And guess what...I couldn't fall asleep until 3:30 AM. I tossed and turned and maybe fell asleep a little. But when I got out of bed for the fourth or fifth time to use the bathroom, I gave up and took another half a Zopiclone and that knocked me out until 7:00 AM. I then had another two hours of on and off again sleep but no really bad dreams.

If I have this situation again, I think I'll skip the 10:00 PM shot though.

A History of My Sleeping Meds

Insomnia Blogger — Sat, 16 Dec 2006 12:09:00 -0800

I am not a walking poster boy for fast results of sleeping meds. I must have tried a dozen different pharmaceuticals so far over a period of 2-3 years, and nothing has really helped...or it helped a little but the side effects were so severe that I couldn't deal with them.

I started with just the occasional sleeping pill - my first was Zopidem (Ambien) though after a time I graduated to Zopiclone (known in the U.S. as Lunesta) which despite its bitter aftertaste, gave me an hour more of sleep a night. I tried some over the counter stuff like Sominex but it was never really strong enough.

I never wanted to stay on the sleeping pills and over time and with the consultation of more than a few doctors, I became convinced that my sleeping problems were probably the result of anxiety, depression or some combination (see my post on the roots of my sleeping problems in the midst of a war). Thus began my slippery slope with every anti-depressant on the market. Here's a brief summary of my history.

The first pill I think was Seroxat - or Paxil as it's known in the U.S. In the dosages I tried it, I didn't get much relief from depression, my sleeping got worse, and my sex life gave out. A well known side effect of SSRIs is that for many people it either kills your sex drive or creates temporary impotence. My sex life has always been an important part of my psychological well being, so I had a hard time giving up sex for sleep, especially when the sleep wasn't really coming on that fast.

We tried a couple different SSRIs (Zoloft and Cipramil, though not Prozac) all with the same effect. I also had feelings of nausea and terrible constipation.

We switched at one point to Trazadone and I stayed with that for almost 9 months. It's an anti-depressant but it's frequently used for sleeping issues. I guess I felt somewhat more stable on it, and the sexual effects were the opposite of impotence...which was kind of fun! But ultimately, it seemed like a waste: I was still on the sleeping pills and still waking up too early. From there it was on to Elatrol with mostly the same effect.

A friend recommended SAM-e, an over the counter natural supplement that has worked wonders for some people with depression. Only problem was it was way expensive. And to get to a therapeutic dose, you have to pay something like several dollars a pill. Nevertheless, I found a great deal at Costco and bought about a dozen boxes (the checkout girl didn't bat an eyelash). It seemed to work at first on the depression, with no nasty side effects, but no real impact on the sleep. Which got me depressed again.

(My wife by the way has been using a "research grade" St. John's Wort blend called Remotiv to help with night terrors which she has suffered from for 20 years since our apartment was broken into while we were sleeping. It seems to be helping a bit, but she doesn't have the same problems with chronic insomnia.)

I switched doctors who tried me out on something called Effexor. He said he'd had very good results. For me it was just ho-hum. Then I tried Cipramil. Then Edronax. Who nellie, stay away from that one. The effect on sex there was too painful to describe. Let me just say that a romantic get away my wife and I planned had moments of sheer unplanned torture.

I am now using a cocktail of Sulpiride (brand name Modal) and a very old med called Moclobemide (brand name Mobimede). The latter kind of freaked me out - it's a 1950s-era drug known as a MAO Inhibitor. These d days, it's a drug of last resort - when nothing else works. Which has been my case. Oh yeah, I'm still using the Zopiclone to get to sleep.

So far, it's going OK and I'm encouraged. I'll write shortly on what I need to do to get a good night's sleep with this cocktail.

I invite you to join this group blog and post your own experiences with meds so we can all benefit from the power of web knowledge!

-- Brian

A Reader's Shares Insomnia Meds Cocktail

Insomnia Blogger — Mon, 11 Dec 2006 07:09:00 -0800

I received a very helpful comment on my "This Normal Life" blog from a reader who shared his or her (the comment was anonymous) sleeping cocktail:

Hi Brian, I too have suffered for decades from the kind of insomnia you describe, including all the alternative medical treatments that didn't work.

I finally have made headway with a combination of:
- trazodone (which you have to take with food, so I have a bit of a snack before I go to bed)
- lamictal (new drug for a variety of anxiety-related syndromes, ADD, depression.... gives me more "slack," more control over my tendency to ruminate and catastrophize)
- temazepam as a backup for nights when the others don't work and REALLY need to get up the next morning. (But I get habituated to benzodiazipines very fast so I never use it more than 3 nights in a row.)
- valerian, an herb which really does relax you. It's very subtle but it helps.
- L-theanine, an amino acid which also helps relax, it's very popular in Japan)

I don't know if you can get this in Israel, but there is a sleep formula I get in health-food stores called "Fatigued to Fantastic: Revitalizing Sleep Formula." Everything in it is benign and it helps relax me.

I take some of these right when I get into bed and then I read a bit and then fall asleep.

My psych says to combat depression (which is usually a component of insomnia) get outside for for at least 1/2 hour before 2 PM, 30 min. brisk walk every day, increase Omega-3 fatty acids to 1200 mg/day (these help your brain process stuff), avoid aspartame (a non-caloric sweetener found in zero-calorie sodas.

Crazymeds.org is a great community site about psychoactive medical drugs. Irreverent, lots of personal anecdotes, and distills medical knowledge about the drugs.

It's true that insomnia is often linked with depression, that's certainly what I found and am working on as well (I'll write about this in an upcoming post). I was using Trazodone for awhile, but found it didn't make a huge difference in either sleep or depression symptoms. But everyone's experience is different. Valerian helped too, but for me it wasn't strong enough. Perhaps as part of a cocktail, my results may have been different.

Dear anonymous commenter - if you'd like to be part of this group blog, please write me directly and I'll set you up as a blog author. My email is insomniablogger@bloggerce.com. This blog will really work if readers like you get involved on a regular basis. I hope to welcome you soon!

-- Brian

The Price of a Night's Sleep

Insomnia Blogger — Tue, 05 Dec 2006 01:09:00 -0800

You know the old saying “time is money?” Well, how much would you say time spent sleeping is worth? As I found out on a recent family vacation: exactly $119 plus tax.

We were driving down the California coast from San Francisco to San Diego, stopping for the night at inexpensive motels. Our first night was in Monterey and I had picked a shabby but inexpensive Days Inn not far from the city’s fabled Fisherman’s Wharf and its lively restaurant and entertainment district. We picked up the key from the dour clerk in the motel’s perfunctory lobby.

In order to keep our costs low, we all cramped into a single room with two queen beds and a rollaway. How do you fit five people into three beds? Boys with boys, girls with girls. That meant that instead of my wife Jody and I sharing a bed, Jody shared with thirteen-year-old Merav while I had a choice between either fifteen-year-old Amir or eight-year-old Aviv.

Given that Amir is over six feet tall, I opted for the much shorter and (I thought) manageable little Aviv.

Unfortunately, as I soon discovered, Aviv is also a night kicker and a squirmer and a won’t-stay-on-his-side-of-the-bed kind of restless sleeper. Not long after I had crawled into bed (several hours after Aviv had already fallen asleep) then – ouch! – Aviv whacked me in the face with his arm as he flailed in deep REM. A few minutes later and – yow! – his leg was in my groin.

He was also, by this point, hogging at least two-thirds of the bed. I tried to move him back to “his side” but he kept squirming his way towards me.

Now, I’m not a good sleeper to start with. I've written previously about my ongoing battle against chronic insomnia. In that post I reported that I was starting to lick my sleeping difficulties with a cocktail of sleeping pills and behavioral techniques. Many meds later, that’s still mostly true, but I’m very finicky about my sleeping conditions. And getting whacked in the face very three minutes simply wasn’t very conducive.

I knew I had to somehow separate myself from Aviv. But how? First I pulled the bedspread and the blanket off of the two of us and wrapped one around Aviv and the other around my own body, creating a sort of double cocoon. No luck: he quickly kicked that free.

Next, I went into the bathroom and took out all of the towels there in an attempt to create a fence between us. He got through that too.

I briefly considered putting Aviv on the floor on the pillow cushion from the big armchair that sat n the corner. But that seemed too cruel – after all, he wasn’t doing anything on purpose. And he’d probably fall off, wake up and cry and as a result I’d wind up staying awake worrying about when he’d be falling off.

Sleeping in the armchair myself was out of the question: I can’t sleep on planes, why would it be any better in a shabby motel in Monterey?

Mind you, that all of this maneuvering, both mental and physical, was being undertaken under the influence of a very strong sleeping pill, which, while not enough to allow me to sleep between beatings, still put me into an extra irritable haze.

I resolved not to sleep at all. I’d pull an all nighter and finish my book. It was now 2:00 AM. Only four hours until the sun came up and I could go for a run to pump a little much needed adrenaline into my system. But that plan ultimately seemed foolish. We had a busy day planned with a trip to the Monterey Aquarium made famous in the Sharon Stone/Albert Brooks film “The Muse,” followed by a three hour drive down the coast to our next stop near Hearst Castle.

My groggy mind raced through alternatives. Maybe we could cram another rollaway bed into the already tight room. Or maybe I could bed down in a spare room in the motel. Yes, that was the ticket. I pulled on my jeans and a sweatshirt and headed to the lobby.

It was locked. A sign said to call the following number for help. As I imagined waking up the proprietor of this dingy place in the middle of the night, I thought better of this approach.

Earlier in the evening, I had taken a stroll with the kids downtown and we had stopped in at another hotel to ask directions. The desk staff at the Casa Munras was positively chipper and told me that they prided themselves on their excellent customer service.

I got in the car. The light in the lobby of this second hotel was thankfully still on. I explained my plight to the man at the desk and asked as plaintively as I could that, as it was now 2:30 AM, could he possibly sell me a room for just a few hours at a discounted rate? To the desk man’s credit, he took me at my word rather than making the obvious assumption that I was up to some nefarious nighttime activity.

His cheapest room with a single bed ran $119 for the night plus various taxes, leading to a grand total of $139. While he wouldn’t give me a break on the price, he graciously offered to upgrade me to a king at no extra cost. It was an awful lot of money for so little time. I considered sleeping in my car, or maybe heading down to the beach.

In the end I took it. The bed in the new room was downy and delicious. I was ready to crash immediately. But first, I wrote a note out for Jody telling her where I was, drove back to the Days Inn and slipped the note under the door, before returning to the Casa Munras. It was now 3:00 AM. I took another sleeping pill and gratefully climbed into bed....alone.

I awoke at 8:30 AM with no idea where I was but feeling remarkably refreshed. As soon as I remembered the night’s events, I called Jody on the phone. She assumed I’d gone out for an early morning run…a long time one but not impossibly so. She hadn’t even seen my note! I ate the continental breakfast at the new hotel – why not it was paid for – then came “home” to pack up for the day’s drive.

I felt calm and rested, my decision seemed validated, a bargain even. Because at the end of the day – or in the middle of the night – there’s no price on a good night’s sleep.

Welcome to Insomnia Blogger

Insomnia Blogger — Tue, 05 Dec 2006 00:59:00 -0800

Insomnia Blogger was founded by Brian Blum, a long-time insomniac, who wanted to start blogging about his experiences - not only as a diary of sleepless nights, but to provide insight into various treatments and medications that can help turn the tide of chronic sleeplessness.

Insomnia Blogger is intended to be a group blog for people who suffer from insomnia. We are looking for other bloggers to share their experiences. If you'd like to be an insomnia blogger, please contact us at insomniablogger@bloggerce.com and we'll set you up with a login and password.

We hope this blog can be of some assistance and comfort to those people who must live with long term sleeping problems.

-- Brian Blum

Sleeping Pills and Sleep Medications for Insomnia Treatment

Insomnia Blogger — Sun, 03 Dec 2006 06:55:00 -0800

Here's a good site with a lot of links to articles, research and resources on the subject of sleeping pills and sleep medications to treat insomnia. The link is:
http://www.helpguide.org/life/sleep_aids_medication_insomnia_treatment.htm

Insomaniac

Insomnia Blogger — Sat, 02 Dec 2006 01:20:00 -0800

If you’ve never experienced it, it’s hard to describe just how disabling insomnia can be. Most people have had a few sleepless nights here and there. It’s a pain and the next day you’re zonked, but it’s usually temporary. And if you put the time to good use, all-nighters can be quite fun, sometimes even profitable.

But when it goes on for days and weeks and months on end, that’s a whole different ballgame. One in which, unfortunately, I’ve been forced to play designated hitter, pitcher and shortstop all at once and unasked.

I’ve never been a great sleeper. But things took a turn for the intolerable three years ago. It was not long after the violence in Israel, where I live, broke out in September 2000. As I lay in bed trying to fall asleep, I would hear the sound of helicopters. They seemed like they were just over my house. In reality, they were all of a few miles away, looking for terrorists who had been shooting every night at the southern Jerusalem neighborhood of Gilo from nearby Bet Jalla and Bethlehem.

The sound of helicopters and machine guns got me so riled that I lay in bed wide awake wondering what the hell am I doing here? Is this insomnia or insanity? Indeed, the question is one that I have asked on a number of occasions since then:

What do you do when your ideological commitment to a place is literally making you sick?

Not willing to give up, I started my search for a cure. I’ve never been one for strong medicine, always preferring alternative, more natural remedies. First stop on the tour was a Chinese herbalist named Aliza.

Our first appointment lasted nearly two hours. Aliza spoke at breakneck speed, downing multiple cups of not-very-Chinese looking tea and asking me questions about everything from my food habits to whether my sideburns itch (apparently itchy sideburns indicate bladder problems). She checked my tongue repeatedly. Then she gave me seven bottles of smelly liquid and told me to be in touch. I took my tonic for half a year.

It didn’t work.

Next I tried homeopathy. Then acupuncture. Over the course of the last three years, I must have tried it all: aromatherapy, reflexology, even magnets. I exercised regularly and cut out all caffeine. I visited a sleep clinic where I was told they couldn’t help me unless I have sleep apnea. That’s where you stop breathing and wake up repeatedly during the night.

Too bad I don’t have that, I thought. At least it would be something.

Friends were not always compassionate. There is an unspoken subtext with insomnia that the victim is somehow to blame. “If only he could just relax,” people think. And “how hard is it to sleep anyway?”

Most eventually came around and suggested their favorite practitioners: chiropractors, massage therapists, energy healers. I resisted the temptation to visit the doctor with the special machine that detects parasites. If there are parasites in me, they’re probably exhausted from not sleeping either.

For a brief moment I thought I had stumbled on something I’ll call "The Peanut Butter Cure." Magnesium, a key element in peanut butter, is supposed to have calming properties. But after two weeks of peanut butter pita sandwiches before bed, all I gained was weight.

Eventually, my regular family doctor sent me to a shrink. “Drugs...” I mouthed in my best mock-horrified Homer Simpson impression. But maybe it was finally time.

Dr. Robinson is a tiny man with jet white hair and the kind of oversized glasses I wore in high school. He used to be head of psychiatry at a private hospital in the Talbiyeh neighborhood of Jerusalem. I never heard of it, but I’m pretty sure there was an institution for lepers there.

A coincidence?

Dr. Robinson prescribed some bitter pills which made me nauseous. Which obviously didn’t help me sleep either. He then tried a different cocktail which totally killed my sex drive. Now if you can’t sleep and you can’t…well, what’s life worth living for anyway?

“These pills are making me crazy,” I complained.

“A bit obsessive-compulsive are we?” Dr. Robinson responded.

“Did I say crazy? Ha, I meant they’re not working. Um, yet.”

Finally, I hit up the sleep forums on the Internet. These discussion groups are very active. When you can't sleep spend you have extra time to post messages and share in the collective misery. There was some talk of light therapy and several special “sleep” diets recommended. But mostly more drugs.

As I dug deeper and deeper I found that one particular combination of meds kept coming up. I googled my discovery and read as much as I could. They had none of the side effects that had plagued me. They seemed to be working for a lot of people. I rang up Dr. Robinson and self-diagnosed myself. To my surprise, he agreed.

My new meds are not perfect. I still have too many bad nights and I can’t say I’m out of the woods just yet. But the good is beginning to slowly outweigh the delirious. For the first time in years, I have a glimmer of hope.

The repercussions of my experience still rattle me when I think too hard, though. Is it really possible that, in order to make it in Israel, you have to be seriously drugged, crazy...or both?

Well, it’s something to think about on a sleepless night.