Posted by yxibow on October 5, 2009, at 1:10:59
In reply to Need advice for treatment resistant insomnia, posted by Dave954 on October 4, 2009, at 16:39:08
I hate to say it but your psychiatrist is right to be worried about his license with Xyrem.
The DEA has clamped down on licenses and people have had them yanked for appearing to distribute too many controlled substances.
A psychiatrist that has special training in "addiction medicine" is usually more open to substances that are normally red flags than a regular psychiatrist because of their training.
Xyrem, what ever people want to say or not about GHB, can be lethal.
Chloral hydrate, which is an incredibly old medication is also somewhat lethal.Barbiturates have to be carefully considered.
The thing is, its possible you've become somewhat resistant to GABA-nergic medication, in terms of their use for sleep.Its like trying to drive a nail through hardwood with a rubber mallet. The transmitter ignores it.
Maybe I'm projecting because I've become fairly resistant to GABA medications, although they still work, I don't really feel it... I have catch-22s with the Valium I still need to take, etc. No pseudobenzodiazepine or benzodiazepine hypnotic works for me.
But then I stand a good chance of having sleep apnea, and you went through a study, which I am going to have soon, and there was nothing found.
Unfortunately sometimes with treatment resistant insomnia, if it involves the GABA receptors, the best thing is a washout. Yes, sleepless nights really suck, I know. I've had signs of insomnia probably as early as 8.
An EEG will only show something significant if you aren't on too many benzodiazepines (or Neurontin). Its harder to see things through the fog -- I mean, a good neurologist probably can, I'm just pointing that out.
If you've been through all of those I would say that amitriptyline (10mg) is worth a try. It would have a longer period of usefulness.Otherwise doxylamine succinate (Unisom doxylamine formation) 25-75mg (less is better if you can).
I'd still say with the combination of medications you're on you need a psychiatrist or psychopharmacologist to manage them, but I appreciate that costs are a concern. I'm just concerned because GPs while they know about these medications havent gone through a psychiatric rotation.
Stronger medications don't necessarily mean better results -- just quick and dirty solutions, and ones that may have serious consequences.
I'd try the two I mentioned if you want to go through a few more trials.I'm not quite sure how fast these changes were made in all your medications -- that can affect things too.
I think there are other possibilities -- one, your circadian clock may be offset. And the only way really to change this unfortunately is to go through sometimes a good two weeks of changing it.Which means, avoiding naps at all cost, caffeine, etc, staying awake (not to a dangerous point) during the day and allowing your body to have a chance to reset itself.
I'm not saying that it may work for you (and I know that its really hard for me to avoid naps and the like), but it could be a longer term solution for some.
I would try first with the TCA I mentioned though. It might work -- who knows, it also might give a little antidepressant lift.
-- best wishes
poster:yxibow
thread:919704
URL: http://www.dr-bob.org/babble/20091001/msgs/919749.html