![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Reggie BoStar on January 1, 2007, at 22:12:01
Hi Everyone,
I was wondering if any of the folks out there with severe and/or Bipolar depression had really bad sleeping patterns like me.I was severe unipolar for many years, am now diagnosed with bipolar II (the cycles are severe depression to hypomania). Sometime around the onset of the bipolar version, or maybe when I had ECT in 2005,I started having these bizarre sleeping patterns that I can't seem to work around with meds, exercise, therapy, whatever.
Here's a typical pattern: for 3 or 4 days, I'm doing a day shift more or less OK. By the end of that period, though, I start really winding down fast. Within hours, early in the evening, I'm nodding on and off all the time and my muscles feel like lead. I used to try to postpone the inevitable with caffeine, but now I now better.
Sometimes, just before I do collapse, I've got the chills and a mild sore throat. The MD has taken culture to check on that and they've all been negative.
Anyway, I finally collapse early in the evening (6-7pm) and sleep through that night, the next night, and lately through to the next morning around dawn. I get up for the bathroom but nothing else - no food, no meds (not even for one of my cats, who will have seizures if he goes too long). That's a total of about 48 hours, and it isn't even a struggle. There's a lot of disturbing dream activity, but getting up and staying up until that third day is impossible. I know, I've tried. I just wind up collapsing again after a shower.
I just woke up after one of those marathons. I got up about 6am, did the shower, meds (including the cat's!), etc, and seem to feel as though I'm headed into another few days of day shift. But the first few hours of being awake are pretty morbid. This is when suicide thoughts come and go, mixed in with the despair of all that time lost (this time it included New Year's Eve - all gone); then comes fear. What is happening to me? I seem to be less and less alive as time goes on. I spend almost all of that first day trying to shake off this mood, along with all the memories and emotions hanging around from those dreams.
They tested me for sleep apnea and found nothing. Lately they've upped my Wellbutrin and decreased my Cymbalta, on the theory that the Wellbutrin would energize me more and the reduced Cymbalta would be less likely to sedate me.
I see the pdoc next week. I just saw the therapist last week. In addition to the med changes they try to talk me out of this with suggestions, but nothing seems to work. There's just total exhaustion after only a few days' low-level activity (I walk for exercise) and then I'm off to coma world again.
What is this? Anyone else with severe depression going through this? I'm starting to get really worried, which I don't need. In fact, I'd better not worry too much. Who knows what'll happen next?
Well, Best Wishes for a Happy New Year; hope we all feel better this time around.
Reggie BoStar
Posted by Dinah on January 1, 2007, at 22:12:01
In reply to Morbid sleeping pattern, posted by Reggie BoStar on January 1, 2007, at 6:27:04
It sounds biological to me. Although I know it's hard to tease these things apart. How long has it been like this, and did it start with any of the meds?
Posted by Reggie BoStar on January 1, 2007, at 22:12:02
In reply to Re: Morbid sleeping pattern » Reggie BoStar, posted by Dinah on January 1, 2007, at 11:13:16
Hi Dinah,
It started getting really bad on 11/22/2006 (I've been keeping notes for my therapist).My MD noticed that my testosterone was really low, even for someone my age (56), so he's going to try to increase the level to see if that helps.
This week I start the prescription. I had to wait until after the first of the year because I was in that infamous "donut hole" in Medicare Plan D (after being covered for $2200.00 worth of meds, you have to pay the next $3600.00 out of pocket. When that's done, the coverage kicks in again, hence the "donut hole"). I'll have a deductible for the new year, but at least I'll be paying the money towards that instead of throwing it away.
Oh yeah, they've ruled out a thyroid problem too.
I'm scared. The morbid feeling that goes along with these sleep marathons gives me a sense of foreboding that I've never had before.
Needless to say, my pdoc is going to get an earful next Monday. I see the therapist on Thursday too.
I hope something happens in the next few weeks to turn this around.
Take care Dinah,
Reggie BoStar
Posted by med_empowered on January 1, 2007, at 22:16:52
In reply to Re: Morbid sleeping pattern » Dinah, posted by Reggie BoStar on January 1, 2007, at 15:56:28
when I'm very depressed, I do things somewhat similar...
you might want to try Provigil, although it is very expensive. I imagine many docs would also consider a trial run of Ritalin or one of the amphetamines (dexedrine, adderall, desoxyn) to see if that helps you out. You might be able to switch out one of the Antidepressants for a stimulant and get better results (or, if you're on a mood stabilizer, go for a mood stabilizer+stim combo). Stims are usually used for depression in older people and/or those w/ treatment-resistant depression. If you've had ECT and are still having mood issues, I would imagine you qualify as treatment-resistant.
Posted by Jimmyboy on January 1, 2007, at 22:37:56
In reply to Re: Morbid sleeping pattern, posted by med_empowered on January 1, 2007, at 22:16:52
How do you feel on the days that you work? Are you exhausted and tired on those days also?
Also , Anafranil can be ordered as a supplement and is supposedly alot like Provigil and a hell of a lot cheaper.
I paid $75 for 5 pills of provigil!!!
I too suffer from extreme exhaustion , but nothing like sleeping for 48 hrs striaght , wow, thats horrible, I hope you find some relief soon.
JB
Posted by Jimmyboy on January 1, 2007, at 22:39:28
In reply to Morbid sleeping pattern, posted by Reggie BoStar on January 1, 2007, at 6:27:04
maybe you are not getting deep sleep on those days you go to work?? I have always gotten chills when I am severely sleep deprived..
Posted by Reggie BoStar on January 2, 2007, at 9:36:32
In reply to Re: Morbid sleeping pattern, posted by Jimmyboy on January 1, 2007, at 22:39:28
Hi JimmyBoy,
I actually don't work. I'm out on a mental health disability (I shudder to think what was in the letters my pdocs and MDs sent to the SSDI). This is why the exhaustion is so worrisome and frustrating. Three days in a row of easy walking, 1 mile per day, and I'm down for the count.Right now I'm trying to conserve energy for a 6:00pm support group meeting tomorrow night. It's a good meeting, and it's run at the same facility where my pdoc and therapist practice; so there's some visibility for them about what goes down in those meetings.
That's the stage it's all at. I have to plan a few days ahead not to get overtired so I can hack an early evening meeting.
Last night was a typical sign of things to come. Around 8:00, I became really muscle-fatigued and drowsy all of a sudden. I was just sitting watching TV. Within a half hour, my throat was sore, I had trouble swallowing, and had a case of the chills. I went to bed and was asleep in minutes.
I slept from about 9:00pm to 10:00am today. That's 13 hours, and that's not too bad for me. That means I'll have enough waking hours today to get things done.
I never go less than 10-12 hours a night, so I can't imagine that I'm sleep deprived in any way.
Reggie BoStar
Posted by Phillipa on January 2, 2007, at 10:29:44
In reply to Re: Morbid sleeping pattern » Jimmyboy, posted by Reggie BoStar on January 2, 2007, at 9:36:32
Could it be chronic fatigue syndrome? Love Phillipa
Posted by Jimmyboy on January 2, 2007, at 10:51:02
In reply to Re: Morbid sleeping pattern » Reggie BoStar, posted by Phillipa on January 2, 2007, at 10:29:44
Yeah, it could be chronic fatigue, the chronic sore throat, exhaustion, oversleeping, etc. are all signs of that. Have you looked into treatments for CFS? There is a lot of crossover with depression/psychiatric , but the doc's I have seen , do tend to look at other things like hormones, etc. ( Wait.. I think you said you were getting testosterone..so.. ) But they may recommend an antiviral or increase in glutathione, or on ething you could try on your own, which is supposedly good for CFS is stuff that maximize the mitochondria like Co Q 10 , Fish oil and large amts of Ribose powder ( 5 mg 3 times a day)
Good luck,
JB
Posted by Reggie BoStar on January 2, 2007, at 13:28:12
In reply to Re: Morbid sleeping pattern » Reggie BoStar, posted by Phillipa on January 2, 2007, at 10:29:44
Hi Phillipa,
I've thought of CFS, but I haven't suggested it to my MD yet. When I see him I just give him a detailed list of the symptoms, he checks me over, and then he suggests something else we can try. I trust him implicitly (have known him since he was in med school!), so if this were really CFS he'd know.He did give me that 19(?) point test (I think that's what it's called) for fybromyalgia, which came up negative.
What I've been doing on my own is eliminating as many variables as possible. I now take only my prescribed drugs and a multivitamin recommended by the MD. All other over-the-counter supplements are on hold.
I was worried about those supplements because I had been taking high doses of fat-soluble supplements such as Lecithin, Omega-3, and Flax Oil. It's not a good idea to overload on those things, since some of the ingredients can build up to toxic levels if you can't metabolize them faster than you're taking them in. This is particularly true of Lecithin. Too much of that or the Choline that's part of the supplement can produce some bizarre symptoms and be very dangerous.
The last few days I had been feeling some abdominal cramps and nausea. If they were caused by Lecithin, I was really pushing my luck.
We'll see how it goes now. I just walked my second mile in two days and feel refreshed for a change. I only hope I don't cave in all of a sudden around 6:00.
Reggie BoStar
Posted by Reggie BoStar on January 2, 2007, at 13:42:42
In reply to Re: Morbid sleeping pattern, posted by Jimmyboy on January 2, 2007, at 10:51:02
Hi JB,
My MD's approach in this case is to try one thing at a time, so that we can identify the treatments that work and toss out the ones that don't. This makes for a slow process, but at least I won't haver to worry about unnecessary side effects if we ever do find anything.I told him that I was a little uncomfortable fooling around with hormones such as testosterone. He told me that my levels were so low that the increase he's prescribing won't even get me past the bottom of the bell-shaped curve. He said that if it did start working we could worry about getting the level into the norm. He's being very careful, which calms me down a little, anyway.
I'm on a roll, at least for now. This is only the second day after hibernation. The crisis will be tomorrow evening. If I'm still in trouble, that's about when I'll sink back into oblivion for a few days.
BTW my record was sleeping from 5am Dec 24 to 11pm dec 26. That's over 60 hours.
Not fun.
Reggie BoStar
Posted by Reggie BoStar on January 15, 2007, at 19:47:31
Hi Everyone,
I posted a thread here a few weeks back about a "morbid sleeping pattern" that's been making me more or less completely dysfunctional.I was sleeping in marathons of 50 - 60 hrs, then staying awake 5 or 6 hrs per day for 2 or 3 days, then back to oblivion again.
I'm Bipolar II. The depression cycles last about a month, then "hypomania" (i.e. just not as depressed) kicks in a for few days. This occurs during only one of the waking sessions per month; the rest are basically walking wounded days.
My pdoc has added Lamictal to my meds to try to even out the mood swings, but after two weeks it's not helping at all with anything. I still struggle to be active when I'm awake but am totally exhausted after 5 hrs and again when I wake up 18 - 19 hrs later.
I went in for one of those sleep tests and came out negative for any signs of apnea or other disturbances.
It also seems to be making it very difficult to urinate. I had this problem before when I was taking too much Buspar. I had to be catheterized in the ER twice - UGH! My pdoc lowered the Buspar dose and it went away.
Here it is again, this time on a low starter dose of Lamictal. Last time around a urologist did a detailed endoscope exam of my bladder and gave me the green light, and agreed that it was probably meds.
So here I am. Still out of my mind with depression, and now fear for my life, when I'm awake, asleep at least 18 hrs per day, and then every week asleep for a marathon of 2-3 days.
I have NO problems sleeping during those hibernations, either. I get up to go to the john, drink a bottle of Ensure ("complete nutrition"), give my lucky-a** cat his phenobarbitol, and go back to bed.
And now my urethra is starting to close shut as tight as a vise.
I'm taking:
Depression - Cymbalta, Lamictal, Wellbutrin
Migraines - Neurontin, Gabitril, maxalt, Axert
Alcohol cravings - NaltrexoneI gotta say that the Naltrexone is the only one that works great. The others, I don't know.
Hey, I'm getting sh*t scared. I keep thinking now that I'm either going to drop in my tracks or die in my sleep any time now. I have a really strong fear of death.
I had to post this, don't know what else to do..
Thanks for the ear and for reading through this encyclopedia my friends,
Reggie BoStar
Posted by Phillipa on January 15, 2007, at 20:51:43
In reply to Still can't stay awake, Lamictal added, new probs, posted by Reggie BoStar on January 15, 2007, at 19:47:31
Well I couldn't take lamictal either at 50mg excess salivation so stopped. I'd call my pdoc and get another med ASAP love Phillipa
Posted by blueberry1 on January 16, 2007, at 5:16:03
In reply to Still can't stay awake, Lamictal added, new probs, posted by Reggie BoStar on January 15, 2007, at 19:47:31
I have no idea what to do. Just off the top of my head I would think get rid of two of the migraine meds and replace them with something else. Depakote maybe. I don't know, it just seems like there are some very sedating meds in that cocktail. Not to mention a lot of meds period. There is no telling what kind of interaction is going on. I mean, I don't know which meds affect which liver enzymes. But there is the possibility that one or more of them are inhibiting, slowing down, certain enzymes that break down other meds, so that you end up with massive amounts of the other meds in your system, far higher than the doses you think you are taking. Beyond what we think these meds do, they do lots of other stuff in the body as well. So who knows. Best bet is to figure a way to cut that cocktail down to 3 meds so you can monitor them better. Besides, with all the problems you are having, they obviously aren't doing a great job, so why continue with them? Still get depressed? Then what good is cymbalta and wellbutrin? Scrap them. Do something else.
I can't help but think the med cocktail is to blame. Exactly how, why, or which ones I do not know.
Of course you could always add yet one more med to the mix. Either Provigil or Adderall. Maybe a heavy duty dose of a stimulant would get you going. Still though, my gut instinct tells me that cocktail is just too many meds for anyone to monitor. And no one on this planet could guess what the combination is doing to you.
I am disturbed when doctors don't admit a drug is not working that well, so instead of switching it to a more talented idea they add another on top of it, and another, and another, and another. You know, you would have to be one of the most mentally ill people on this planet to justify taking that many meds. I don't think you are.
Sorry. I know this isn't much help. Those are just my thoughts.
Posted by Quintal on January 16, 2007, at 8:47:41
In reply to Still can't stay awake, Lamictal added, new probs, posted by Reggie BoStar on January 15, 2007, at 19:47:31
Reggie Bo, have you ever tried lithium? When I was first diagnosed with Bipolar II my pdoc said it was a dysfunction of the body clock that controls the circadian rhythm and responses to seasonal changes. Lithium allegedly helps with this:
http://www.psycheducation.org/mechanism/Clock.htm
Q
Posted by Reggie BoStar on January 16, 2007, at 21:24:39
In reply to Re: Still can't stay awake, Lamictal added, new probs » Reggie BoStar, posted by Phillipa on January 15, 2007, at 20:51:43
Hi Phillipa,
I'm still at least a week away from 50mg (now at 25). I'm not sure I'm going to make it that far though. Not if these sleeping wars keep happening.So far my mouth is actually too try, but that could be one or more of the other meds I'm taking. Another poster in this thread suggested that maybe the mix contains too many meds, and one or more of those in combination is doing this. Needless to say, I'm open to suggestion.
I'll keep that salivation thing in mind if it happens to me - then I'll know which med is causing it.
One thing I do monitor very carefully is any sign of that deadly rash that can occur on Lamictal. It's very rare and even then responds to early treatment. It's just that it sounds so gross it has me on the alert.
That rash, BTW, is why the dose changes in the starter set are so gradual. They're just playing it safe so they can catch the rash at a low dose before it gets too far.
Take care,
Reggie BoStar
Posted by Reggie BoStar on January 16, 2007, at 21:37:27
In reply to Re: Still can't stay awake, Lamictal added, new probs, posted by blueberry1 on January 16, 2007, at 5:16:03
Hey Blueberry1,
Thanks for the input.Although it looks like a complicated mess, the only two meds that remain constant are the Cymbalta at 60mg and the Neurontin at 1800mg. The others have all completely replaced previous meds (or none) in the last year.
We found out that even though the Cymbalta doesn't make me entirely functional, I'm even worse without it. Before Cymbalta I had to have ECT just to keep me on my feet.
However, we also found that upping the dose to 90mg doesn't help much at all. Hence the 60mg dose for the foreseeable future. Most likely Cymbalta would be the last AD to go if my pdoc and I felt it was worth the risk of having to go through ECT again.
Neurontin is essential in preventing migraines. Some others in that category, Maxalt, Imitrex, and Axert, are only taken one-at-a-time "as needed". These days that's very rare, since the Neurontin works so well.
Buspar is there to control social anxiety and GAD. It doesn't seem to be related to how any of the others function. I'm not sure it's essential, but life is a lot easier with it than without it.
That leaves Wellbutrin, Lamictal, and Gabitril. I have no idea what they might or might not be contributing to this situation.
You're right - no matter how I slice it, that's a mess. I go to a "Dual Diagnosis" meeting in the same facility as my pdoc tomorrow, and a visit in the same place with my therapist next week. I just had another long day in the sack. I think I'm going to recommend trying your minimalist approach.
I think I could go as far as being on Cymbalta and Neurontin only for the sake of experiment. At this stage I'm willing to try anything.
BTW, my pharmacy is one of those that keeps computerized tabs on interactions and augmentations of various meds. They've successfully flagged other bad mixes in the past. This time around, for some reason, they're quiet about the mix. In the past I've trusted them, but..
Thanks for your input, it gave me a lot to think about.
Have to go now and keep a log of this week's sack time.
Take care,
Reggie BoStar
Posted by Reggie BoStar on January 16, 2007, at 21:43:17
In reply to Re: Still can't stay awake, Lamictal added, new probs » Reggie BoStar, posted by Quintal on January 16, 2007, at 8:47:41
Hi Quintal,
I remember trying Lithium a few years ago with some pretty bizarre (as in unpleasant) results.But that was with a far different mix of meds than I have now. That's an interesting idea; I'll bring it up during my meetings this week and next.
I do remember my MD saying that Lithium was the type of drug that only worked if you really needed it, i.e. it didn't work for me because I didn't need it.
That sounds pretty anecdotal though. I'll ask the pdoc and see what he has to say.
I think somewhere in this thread I made brief reference to the time I had to go through ECT to become at least functional.
Too much sleep is one thing, but I'm really so afraid of needing ECT again that I'm not too comfortable even thinking about it.
There.
Now I can concentrate on the fact that I'll be having all four wisdom teeth out on the 31st.
AAAAAIIIIIIIIIEEEEEEEEEE!!!!!!
(they hurt when I scream)
Take care,
Reggie BoStarPS: maybe I should find a board to post about those teeth, too. Seems like these days I need half a dozen BBS forums to take care of everything that's going on.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.