Posted by DL on September 9, 1998, at 22:18:15
In reply to Re: Much appreciation for your thoughts, posted by Toby on September 8, 1998, at 10:27:00
> Regarding the sleep study: it won't hurt to call the insurance company and find out if they will cover the testI will call and ask. I know they do them in Boston, but a little hospital near by does also. Is there a difference in where you have such a test done? I have heard that a number of such centers have sprung up in local hospitals but that they may not have really qualified personnel to interpret the info and make suggestions--that they are primarily looking for sleep apnea. I read once about studies done in people's homes with a special "hat" fitted to them connected to a recording device. Have you heard of this? Also, I have so much trouble sleeping here that I don't think I would sleep at all at a hospital. Even with the klonopin if stress level is high I sleep very little. And, without it I revert to just staying awake all night and feeling increasingly desperate.
> You said you'd tried Pamelor without much sleep relief; Imipramine in tiny doses has been tried with better results for sleep. Pamelor usually helps sleep in bigger doses which you may not tolerate.
How long does it take for the Imipramine to start to help? Is it the 4-8 wks often quoted when used for depression? And what are the side effects/toxicity?
> Regarding your experiment with the Klonopin: you are indeed exqusitely sensitive. Was the quality of your sleep any better with the extra Klonopin? And was the eye fatigue different from the usual sleepiness you feel in the evening and could you tell any difference in the sleepy feeling that day?
Sleep quality was not different that I remember. Just what I said about waking after a short time sleeping and feeling strange (sort of the way you feel before you get sick) I don't remember differences in the level of fatigue because I was trying to function with that strange "eye muscle/focusing problem" during the day and because I can't remember back to when I have not felt tired and exhausted.
> By "waffle in baseline mood" I mean small, frequent changes in your mood rather than the huge, longlasting changes that characterize full blown mania.
I don't think I fit that. I have been pretty much depressed and anxious for a long time. It is easy for the anxiety level to spike with any new stress because I think I have totally worn out my body's stress system. But, I WISH I could have even a tiny hypomanic minute or two just to see what it is like.
> Social phobia, on the other hand is the fear of being in a social or performance situation in which you could be exposed to unfamiliar people or to scrutiny by others and there is the fear that you will act in a way that will be humiliating or embarrassing (such as showing anxiety symptoms of shakiness, sweating, stuttering, or anything else like that).
As a child everything I did was scrutinized and criticized. Nothing I did was ever good enough for my dad. We learned to "act perfect" in front of other people and not to talk about anything that would lead others to think things were not perfect in our family. I guess I continued that early structure all through my life and lived with some pretty horrendous things while people around me thought things were "perfect" with me! It's only in the last few years I have started to learn that normal people are not perfect and it's OK. Perhaps when I met people and felt uncomfortable it was because I was fearing they would find out something that was not perfect about me...I feel comfortable with the friends I have made in the last few years--people I have opened up to and told about the pain in my life. But for years and years I dreaded parties and tried to find ways out of gatherings at my place.
>You asked about cognitive-behavioral therapy and it is very helpful for social phobia.
How does one go about finding the right person for cog. beh. therapy? There are a number of people who supposedly do it, but I don't have the money to experiment. Would the same person likely do EMDR also?
> In regard to the EMDR: The therapist has you think about a particular incident that is distressing to you, along with the negative thought about yourself that that memory causes and the negative physical feeling that occurs in your body (anything from pain to anxiety).
What if the feelings that come up are so deep and distressing that I become tied up in wrenching tears and feelings of loss/desertion? Because that's what happens. Right now as I am fighting off some memories there are tears running down my face. How would I be able to participate in the EMDR session?
> Then the therapist moves his fingers in front of your eyes (just so your eyes have something to track on) while you focus on those things listed above. This is related to REM sleep which is involved in memory and learning. By focusing on several distressing aspects of the memory at once and doing the REM movements, the brain is able to rapidly sort out what is important, what is no longer needed for your survival, and is able to let go of the physical sensations that are no longer needed in order to "catalog" the memory.
This is really interesting to me. The REM sleep part. I have trouble getting to sleep and waking up early, but during the night I frequently wake up every 90 min or so--especially if I am taking nothing to help me sleep. It's like I break through whenever I am coming into REM sleep. I seem not to dream. I can only remember dreaming once or twice in the last few years. But when I used to dream a common theme was that I had done some terrible thing like kill someone and I was trying to hide it from everyone. Some of my decreased concentration and memory is probably releated to no renewing REM sleep.
> In regard to which medication to try first, I'd think about Buspar first since it is pretty benign and doesn't interact with much else.
Would you suggest I take it with the klonopin
for a while? How long should I give it before I decide if it is helpful? Does it help with depression? Have you known it to be effective in people similar to me? Does it have side effects I should look out for? And does it help with sleep? Any guidelines on dose in case I get the psychiatrist to prescribe it? If he does not want to prescribe it with the klonopin, what else would you suggest for sleep for a while?> In regard to the Remeron, it takes about a week to get used to the daytime sedation, but if you tolerate it, I usually increase it from 15 mg to start with up to 30 mg at bedtime after the first 3 days which takes care of the sedation in most people.
Remember that I had drastic reactions to tiny doses of a number of other AD's. If the MD does not want to prescribe Buspar, what would your next suggestion be? You mentioned Serzone, Remeron, and Elavil or Imipramine. Or should i just search out Cog Beh Therapy?
Can you tell I am lost and pretty desperate? I feel like the mental health system has walked past me with hardly a turn of the head. Where can i find someone like you? (You can e-mail me directly if you want).
Thanks again for listening and keeping me going when I was ready to give up!
poster:DL
thread:511
URL: http://www.dr-bob.org/babble/19980901/msgs/584.html