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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by Quintal on April 28, 2008, at 14:38:36
I've run out of zopiclone again and my insomnia has come back with a vengence. Last night it took four hours to fall asleep, and that was with 4mg Periactin, 6mg melatonin and a bunch of herbal sleeping tablets. I've always been a night owl, even as a kid I'd be awake until 11:00 or 12:00, and later, in adolesence I'd stay up until 3:00 or 4:00 in the morning. It's just a wonderful time to be awake. It feels cosy, like being wrapped up in a warm blanket. No interference from other people.
Doctors in general don't seem to accept that some people are nocturnal, although when I was in hospital one of the pdocs agreed that some people are. When I worked I always preferred night shift. Day shift was hell - almost the opposite of your typical 'normal' person. If I could work permanent nights I would. I've heard about 'delayed sleep phase syndrome', but I doubt most doctors here would recognize it as a genuine medical condition. I may try taking a copy of the wiki article in to my next pdoc appointment and see what he says.
http://en.wikipedia.org/wiki/Delayed_sleep_phase_syndromeI have no trouble falling asleep during the day, or early morning, but at night my mind is active and my energy levels are at their highest. My mother always said 4:00Am is the body's lowest ebb, but I'm certain this isn't true for me. Morning is my lowest ebb. I'm about 4-6 hours behind the normal schedule. Zopiclone helps me fall asleep earlier, but my pdoc will only give me 14 a month. So far I've managed to get more by various means, but now I'm stuck. He doesn't appreciate how this affects my life. I can't just take it on alternate days because my sleep pattern goes out the window - I go back to sleeping at 4:00AM or later. At at my wits end trying to find a solution to this. It's the biggest factor affceting my quality of life right now.
Q
Posted by B2chica on April 28, 2008, at 14:46:55
In reply to Delayed Sleep Phase Syndrome, posted by Quintal on April 28, 2008, at 14:38:36
you know, i don't know anything about the zopiclone that your taking for sleep, but my last pdoc was SO adamant about sleep habits that every appointment we had we discussed how i was doing with sleep, and getting in a routine and exercise to help sleep etc.
i don't understand why your pdoc is only allowing you 14/mo if you are needing something on a regular basis to assist your sleeping habits? have you talked with him/her about this? i say either they need to adjust the Rx or they need to change the med...Something needs to change period. it's NOT working and your sleep habits effect SO much else its so important that you get good sleep. i dont understand your pdoc at all.and i do agree with you. although i've since changed abit ( i think cuz of my meds) i am typically TOTALLY nocturnal. always going to bed around 2 or 3. however i get my best restful sleep starting about 6am to 10am. i always thought if i could work from 11-7 shift i'd love it.
i think some people ARE just like that. for better or worse.anyway, sorry if i don't have much constructive to say.
best wishes though.
b2c.
Posted by bleauberry on April 28, 2008, at 17:19:00
In reply to Delayed Sleep Phase Syndrome, posted by Quintal on April 28, 2008, at 14:38:36
I guess if you and your pdoc have a good longstanding relationship then you'll have to go along with him. But from your description it does not sound like a cooperative teamship kind of relationship. I sounds like the paying customer is being badgered by the person he is paying for a service. Totally unacceptable in the business world, makes businesses go bankrupt, but I guess pretty common in the medical world.
You might consider being more stern asking for what you want.
You might consider seeing another doctor, GP or nurse practioner, for zopiclone. Just go in for insomnia treatment and leave the rest out of it.
Or to be completely honest, tell them your pdoc is doing a good job but he just doesn't agree with the importance of sleep and how helpful zopiclone is for you. Another doctor may well indeed be more on your side of things and be quite willing to prescribe the med for you.In any case, most of the psych meds the pdocs put in us are pretty darn heavy duty. Even plain ole ssris are heavy duty compared to zopiclone. I do not understand the pdoc's resistance to it and it makes me question his quality of care and the relationship you two have.
Posted by Sigismund on April 28, 2008, at 17:55:02
In reply to Re: Delayed Sleep Phase Syndrome, posted by bleauberry on April 28, 2008, at 17:19:00
14 a month? That's classic. Firm but fair etc etc.
When I speak to doctors about my sleep they always say that it doesn't matter.
When I say I disagree, they shift in their chairs and say that of course I am entitled to my opinion.
Posted by Quintal on April 28, 2008, at 18:02:11
In reply to Re: Delayed Sleep Phase Syndrome » Quintal, posted by B2chica on April 28, 2008, at 14:46:55
Thank you B2. My pdoc only gives me 14/month because I was addicted to Klonopin for years, and he says he doesn't want me to become addicted to zopiclone in the same way I was addicted to Klonopin. He would be delighted if I would take Zyprexa, Seroquel or trazodone for sleep because they have no addictive properties, but I can't tolerate any of them. Anyway, it's good to hear from someone else that has nocturnal sleeping patterns. I'm so sick of people making me feel like a freak for wanting to sleep during the day. My aunt calls me 'Dracula' because I used to go to bed at sunrise.
I once did work a 12 hour night shift at a nursing home from 8:00PM-8:00AM and was in seventh heaven. You also get paid more for doing night work :-)
Q
Posted by Quintal on April 28, 2008, at 18:25:25
In reply to Re: Delayed Sleep Phase Syndrome, posted by bleauberry on April 28, 2008, at 17:19:00
If I was paying for my treatment there's no way I would have hung around with this guy for so long. To get started on it would turn into a rant, but he really is a nasty peice of work. Completely arrogant, invalidating, petulant, incapable of empathy. Many times I've wondered if he isn't one of those professional psychopaths that worm their way into medicine just to get off on controlling people. A compete Hannibal Lecter in the offing.
It's actually my GP that prescribes the zopiclone - I have an appointment with her in the morning. Pdoc wants only one person to prescribe the zopiclone so that I can't get scripts from two people, so he left that job to my GP.
Health care is free where I live so I don't pay for appointments, but there's this tacit agreement that you get what you're given, and you have to put up with that. Stiff upper lip and all that sort of thing. My social worker agrees with my views on this particular pdoc, and we were planning to see a different consulant I saw in hospital who agreed to the zopiclone in the first place. She backed down after this pdoc started to 'play ball' as she put it, but I don't think that is going to last for long. She's off for a week right now, otherwise I'd ask her to do something about it.
Q
Posted by Quintal on April 28, 2008, at 18:38:25
In reply to Re: Delayed Sleep Phase Syndrome, posted by Sigismund on April 28, 2008, at 17:55:02
Getting enough sleep does matter. I was thinking a few nights ago about where you said ordinary people have always known that sleep is critical for good health, but doctors aren't much bothered. It's obvious that lack of sleep makes you feel awful. There's so many repair processes that go on while we sleep that surely the body can't function properly without it. On days where I've had little sleep my eyelids and guts feel raw. I once read that epithelial cells are shed and replaced during sleep, and that's what I've always associated it with.
I found this a few weeks ago. Looks to be an American Heather Ashton wannabe:
http://www.darksideofsleepingpills.com/all.htmlApparently we should rest assured that having a night of poor sleep won't kill us, or harm us in any way. I often want to know if these people sleep soundly at night.
Q
Posted by clipper40 on April 28, 2008, at 20:01:24
In reply to Delayed Sleep Phase Syndrome, posted by Quintal on April 28, 2008, at 14:38:36
I'm in the same boat as you. I'm a total night owl and have been going to sleep when the sun starts coming up. I want to change this so badly but haven't been able to. Whenever I've worked the normal work schedule, I've been completely exhausted by the end of the week and I'd sleep away most of the weekend just to recuperate. It's horrible.
Have you ever tried a tricyclic like doxepin for sleep? Not addictive so your doctors shouldn't be too concerned about it. I still had trouble getting to sleep on it sometimes but it always did a great job of keeping me asleep. I took a small amount of this for over 20 years but recently stopped it because I started sleeping through all of my alarms. So now I'm trying to find something else. I'm going to be experimenting with some natural things (melatonin, valerian, tryptophan, niacinamide). I may end up needing to take Ambien or Lunesta (eszopiclone - our version of zoplicone) but I just can't afford it.
Posted by Sigismund on April 28, 2008, at 21:09:12
In reply to Re: Delayed Sleep Phase Syndrome » Sigismund, posted by Quintal on April 28, 2008, at 18:38:25
So the melatonin I take will whiten my fur and make me obese?
Cool.I know why my docs say that insomnia is not a problem.
It's because they think that what they have to help will prove to be more of a problem than the insomnia.
And I expect they are right.But for you it is different.
Your feeling that insomnia is a risk factor for going manic deserves serious consideration.It is not our fault that the only hypnotics some want to take are habituating.
My mother had agitated depression. In spite of 9 months in hospital and full time complaint she never got treated for insomnia.
ECT? Yes.
But they only ever gave her Valium (5mg) for her insomnia.
Once I was looking after her and gave her a couple of Normison (temazepam).
Next morning she told me with gratitude that it was the best sleep she'd had in many months.
Posted by Phillipa on April 28, 2008, at 21:09:15
In reply to Re: Delayed Sleep Phase Syndrome » Quintal, posted by clipper40 on April 28, 2008, at 20:01:24
Q my life I've always liked to sleep late hence to go bed late. Now it is l0pm here and just getting ready to do my work which is an online business now so I do it when I feel like it. Bad at 2am irreguardless of what meds I take and wake in four hours repeat doseage and sleep till ll am. Suits me fine. When nursing did 3-ll shift so that is my sleep schedule and I like it. Phillipa
Posted by Molybdenum on April 29, 2008, at 1:38:13
In reply to Delayed Sleep Phase Syndrome, posted by Quintal on April 28, 2008, at 14:38:36
Hi,
I've always had trouble sleeping too. Stress seems to make it worse of course. I've had trouble falling asleep, then staying asleep & my latest is waking up pre-dawn. Sometimes I just get up then but I'm super tired all day if I do that.
I was only zopiclone but it used to give me a bit of a hangover the next day. Then I switched to zolpidem (Stilnox). I have been taking it every night for at least 5 years and I've never built up a tolerance. I have central sleep apnoea (stop breathing, then hyperventilate which stops me going into deep sleep phases). So I have a sleep doc I see. He claims that because the zolpidem is more or less out of my bloodstream by the morning, I don't develop a tolerance.
I have mentioned that I've been on one a night for years to several local general practitioners (docs) and they always raise their eyebrows but don't argue with the sleep doc prescribing me 365 tabs a year. The data sheets say "short term use", but it's never caused me any problems completely defying that.
So maybe you should see a sleep specialist...?
The only change in dose has been that in the early days I was on 10mg, then they brought out the 12.5mg slow release, which for some odd reason is actually cheaper here (Aust.) Other than that, they always work & I've never had to have a break from them at all. Some nights I've not taken one and sometimes I've slept normally, sometimes not but I've never had what I would consider withdrawals.
Re the melatonin, I was a bit like you in that I would not feel sleepy til really late & then never wanted to wake up. Forcing myself out of bed early just made me tired - it never helped me to fall asleep at a reasonable hour. So the sleep doc got me onto the slow release melatonin (6mg) which I take at 6pm. That's really helped reset / keep my drifting body clock in sync with the humans ;)
Lastly, mirtazapine (Remeron) in small doses is also very effective for helping you fall asleep. Within an hour of taking it, you'll likely have great trouble keeping your eyes open. The good thing is that it doesn't interfere with your natural sleep stages very much - unlike Mogadon for instance. I told my sleep doc I got some Mogadon from the GP when I ran out of zolpidem. He said "throw them out, you might as well have a general anaesthetic".
Good Luck ;)
Posted by undopaminergic on April 29, 2008, at 2:45:37
In reply to Delayed Sleep Phase Syndrome, posted by Quintal on April 28, 2008, at 14:38:36
Back when I was trying to fit my sleep-wake patterns into little 24 h segments, I was consistently nocturnal, always wanting to stay up in the night and sleep until noon or later.
Nowadays I no longer let Earth's rotations around its axis dictate the length of my sleep-wake cycle. I just stay up until I'm really tired, and sleep until I wake up naturally. Sometimes I wake up in the morning, and sometimes around midnight.
Posted by Sigismund on April 29, 2008, at 2:58:02
In reply to Re: Delayed Sleep Phase Syndrome, posted by undopaminergic on April 29, 2008, at 2:45:37
The bloke who ran the life Extension Forum rejigged his sleep cycle into a 28 hours/day, making 6 days a week.
Posted by Quintal on April 29, 2008, at 4:09:30
In reply to Delayed Sleep Phase Syndrome, posted by Quintal on April 28, 2008, at 14:38:36
I just got back from the doctor. She saw the letter where pdoc's understudy gave me an extra seven, and would only give me another seven. To last a month. Pdoc only gave me the extra seven becaue I'd been slightly manic and he thought I needed plenty of sleep to calm me down.
Last night I had no sleep at all. Just tossed and turned, then lay awake looking at the patterns on the curtains. Today I feel rotten, sore & aching all over. I can't go on like this. I ordered some zolpidem from an online pharmacy, but the first shipemnt didn't turn up, then the next one got seized by customs, so I'm just hoping this one turns up. I don't think I could bear the dissapointment if it doesn't.
Q
Posted by undopaminergic on April 29, 2008, at 5:59:58
In reply to Delayed Sleep Phase Syndrome, posted by Quintal on April 28, 2008, at 14:38:36
> I've run out of zopiclone again and my insomnia has come back with a vengence. Last night it took four hours to fall asleep, and that was with 4mg Periactin, 6mg melatonin and a bunch of herbal sleeping tablets.
>Zopiclone was useless for me, as it had no hypnotic effect; I gave the remains of it to my brother.
4 mg cyproheptadine only works sometimes for me, but 8 mg has worked every time so far, so why not try a higher dose?
Also, maybe a drink (whisky, etc.) would interact synergistically with the medications?
Posted by Quintal on April 29, 2008, at 12:53:15
In reply to Re: Delayed Sleep Phase Syndrome, posted by undopaminergic on April 29, 2008, at 5:59:58
Did you take it after a heavy or fatty meal? I've found that zopiclone has almost no effect if I take it after a meal. I always take it on an empty stomach now, wait until I feel it starting to kick in, then eat my supper and go to bed. I remember on RemedyFind they used to warn that the effect of zopiclone and zolpidem may be reduced if taken after fatty meals.
I've been taking 8mg Periactin the last few nights, bar last night, but it leaves me in a stupor well into the afternoon. Definately has a half-life longer than 4 hours in me. I find it doesn't do a lot for sleep latency on its own, but that could be due to rebound insomnia from stopping zopiclone.
Q
Posted by Quintal on April 29, 2008, at 13:14:41
In reply to Re: Delayed Sleep Phase Syndrome » Quintal, posted by clipper40 on April 28, 2008, at 20:01:24
I've never tried doxepin, but I have used dothiepin (another sedating TCA) and I think it did help with sleep. I was asking him to add an antidepressant to my Lamictal at the last appointment, but he wanted to wait and see what effect Lamictal was having on its own. I was considering asking for lofepramine, but I might ask for doxepin instead. What's the half-life like? I don't want to be groggy all morning like with Periactin.
Q
Posted by Sigismund on April 29, 2008, at 14:54:40
In reply to Re: Delayed Sleep Phase Syndrome » undopaminergic, posted by Quintal on April 29, 2008, at 12:53:15
>I've been taking 8mg Periactin the last few nights, bar last night, but it leaves me in a stupor well into the afternoon. Definately has a half-life longer than 4 hours in me.
Yes, it did with me.
Seemed like mirtazepine.
One is supposed to have a half life of 40 to 60 hours, and one a half life of 4 hours.
Posted by cumulative on April 30, 2008, at 6:26:22
In reply to Re: Delayed Sleep Phase Syndrome, posted by undopaminergic on April 29, 2008, at 2:45:37
>Nowadays I no longer let Earth's rotations around its axis dictate the length of my sleep-wake cycle. I just stay up until I'm really tired, and sleep until I wake up naturally. Sometimes I wake up in the morning, and sometimes around midnight.
Heh, you must be self-employed.
Your method is what I have felt would be my optimal state for some time. Hopefully in the next few years I will be able to maneuver myself into a position where doing that is more possible -- and then I am quite sure that the quality of my activity will rise substantially.
In the general interest of this thread, the careful control of light cannot is critical. No bright light anywhere near, probably within 2-4 hours within, the times you want to sleep. Some form of light therapy in the morning. I've also recently wondered if some of those sunglasses which specifically block blue light (which has been isolated as the frequency of light to which your body's circadian rhythms are most responsive) would be helpful during the night-times.
Posted by Quintal on May 1, 2008, at 12:08:19
In reply to Re: Delayed Sleep Phase Syndrome » clipper40, posted by Quintal on April 29, 2008, at 13:14:41
My aunt just came and begged a zopiclone tablet off me in exchange for some eggs (that I don't want and won't use). She then leafed through a pile of books I've just bought and said "What a strange choice of reading material ["The Double Cross System", "Strong Poison", "Inferno", "Bury My Heart at Wounded Knee"]. Are you sure you're normal?" then swanned off. Now I'm angry. Not only am I now even depleated of the drug I so badly need more of, she went and insulted the books I'd bought to take my mind off it. I hate my family. They ruin everything for me.
Q
Posted by Sigismund on May 1, 2008, at 16:42:59
In reply to Re: Delayed Sleep Phase Syndrome, posted by Quintal on May 1, 2008, at 12:08:19
When I read this it struck me as like something out of Oscar Wilde, as in
'Do you smoke?'
'Well yes, I must admit I smoke.'
'I am glad to hear it. A man should always have an occupation of some kind. There are far too many idle men in London as it is.'or, (I think it was Lord Curzon)
'Gentlemen in London never wear brown'.I know it's different when it's your family.
A little detachment though might perhaps enable you to see more of the relentless absurdity of family life and feel less the impinging painfulness of it.Maybe you should have shown her "How to Make People Like You"?
Posted by Phillipa on May 1, 2008, at 20:02:15
In reply to Re: Delayed Sleep Phase Syndrome » Quintal, posted by Sigismund on May 1, 2008, at 16:42:59
Q sorry and you were so generous. Love Phillipa
Posted by clipper40 on May 4, 2008, at 5:02:04
In reply to Re: Delayed Sleep Phase Syndrome » clipper40, posted by Quintal on April 29, 2008, at 13:14:41
I would stay away from the lofepramine as that metabolizes to desipramine which would be energizing, rather than sleep promoting.
Not sure of the half-life of doxepin but I didn't have much of a problem with grogginess the next day as long as I was taking a low dose and I had been on it awhile so I was adjusted to that dosage. Also, it's better to take it earlier in the evening and then you also have less chance of any grogginess the next morning. When you first start on it, it will definitely make you very groggy until your body adjusts.
It won't guarantee to knock you out each night (I would sometimes need to take something else with it) but it did, on the whole, make it much easier to fall asleep. The best part was that it kept me asleep throughout the night.
I would stay away from the lofepramine as that metabolizes to desipramine which would be energizing, rather than sleep promoting.
Here's some info on doxepin and how low doses of it are being made into a new sleeping aid which will be called Silenor when it comes to market:
http://en.wikipedia.org/wiki/Doxepin
Posted by undopaminergic on May 4, 2008, at 21:42:33
In reply to Re: Delayed Sleep Phase Syndrome » Quintal, posted by clipper40 on May 4, 2008, at 5:02:04
It seems to me that doxepin as a sleep aid has few, if any, advantages over other antihistamines.
Posted by clipper40 on May 5, 2008, at 0:25:52
In reply to Re: Delayed Sleep Phase Syndrome, posted by undopaminergic on May 4, 2008, at 21:42:33
For me, even a small dose increases my mood. Also, it lasts longer than an antihistamine. It has a continuous effect.
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