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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by m1man on October 11, 2000, at 20:55:01
I have to take massive amounts of something to get some sleep. I am trying a 1/2 terezone w/melatonin tonight and see what happens. 40mgs of valium didn't phaze me at all last night. I used to have a chronic pain problem for about 5 years. Been gone about a year though. Could this create such a tolerance to sleep meds as well???
Posted by chdurie2 on October 11, 2000, at 22:20:19
In reply to Link to insomnia from going through chronic pain?, posted by m1man on October 11, 2000, at 20:55:01
> I have to take massive amounts of something to get some sleep. I am trying a 1/2 terezone w/melatonin tonight and see what happens. 40mgs of valium didn't phaze me at all last night. I used to have a chronic pain problem for about 5 years. Been gone about a year though. Could this create such a tolerance to sleep meds as well???
m1man:
I don't know what kind of chronic pain you've had
for the last five years, but my own experience tells me that chronic insomnia is self-perpetuating, and that you develop tolerance to some sleep meds. And yes, your chronic-pain problem, from what i know, could have given you a physiological sleeping problem.if you have good insurance or are close to a university with a good sleep lab, it might be worth it to have a sleep study done.
My experience is that i've had chronic fatigue syndrome since 1994, when i developed my sleeping problem. i've been through restoril, tranzene, klonopin, ativan, elavil, doxepin liquid, sinemet and a few others. although the combination of klonopin and doxepin liquid prescribed by my cfs-doc was the best, it was not refreshing sleep. i went to a good sleep lab, where i was diagnosed with a bad case of periodic leg movement syndrome (a cousin of restless legs, it means i move much too much when i sleep) and heavy alpha wave intrusion (means i don't get deep sleep-only light sleep.) My cfs-doc told me he could have told me that without the sleep study.
Result? the sleep center told me i'd be on sleep meds for the rest of my life. the chronic fatigue syndrome causes my PMLS and alpha-wave intrusion. So I would think (but I'm no doc) the chronic pain could have caused your insomnia and consequent reliance on sleep meds.
I have tried to go off sleep meds from time to time without any real success. when i was recently in the hospital for surgery, the docs there had some trouble knocking me out, and I woke up before surgery was over. But it was the best sleep i've had in six years.
so i related my hospital experience to my p-doc after suddenly ever-increasing amounts of klonopin/doxepin were doing nothing and told him i wanted to be able to knock myself out. i'm now doing 50 mgs of seroquel a night combined with .5-1.0 of klonopin, and it's a pleasure to get deep sleep at last! But, in answer to your question about sleep-med tolerance, klonopin is notoriously tolerance-developing, and i've taken it for six years without needing more than .5mg. only in the last two months did the amount start to ever-increase.
actually, i'm starting to yawn now without my med, an amazing thing for me. someday i hope to be off this stuff.
hope this helps. in summary, yes, i think there's a link between chronic pain and insomnia, but i'd explore it more with a good doc, sleep or otherwise.caroline
Posted by Racer on October 12, 2000, at 1:53:39
In reply to Re: Link to insomnia from going through chronic pain? » m1man, posted by chdurie2 on October 11, 2000, at 22:20:19
Many sleep drugs are habit forming, and many can be addictive in very small amounts. Tolerance can be caused by a lot of factors, too. At the worst of my depression and anorexia, when I weighed about 110#, I could take 80mg of valium on rare occasions and still walk and talk as though normal.
My experience is that valium will relax me, but not put me to sleep. Xanax will put me to sleep, but after a short time, like two weeks, I go through such awful withdrawal that it's not worth taking.
The drug that works for me, which I take rarely, is an anti-histimine. It makes me groggy the next day, but it puts me right to sleep.
As for long term, have you tried behavior modification? That's worked great for me. I was a chronic insomniac, sleeping a couple of hours per night, after tossing and turning for hours and hours. It's hard to remember what happened or how I did it, but I know that part of it was only getting into bed to sleep. Any other time of the day, any time I wanted to stretch out and relax, I'd choose the sofa rather than the bed. Then, getting into bed, I'd read for a few minutes, to relax myself. Then, if I wasn't getting sleepy, I'd tell myself a pleasant story. In the midst of depression, that's damn hard to do -- but it's possible if you force yourself. Let's see, some I remember were giving riding lessons to the cast of the X-Files, teaching them the real way to ride, not just the sit here, hold this that actors usually get. Another was being swept off my feet at a dance by a tall, dark and gorgeous hunka man. (That one was particularly nice: he heard me discussing favorite slow dance songs with a group of friends, and had the dj play them all, so that he could dance to them with me. By the time they got to Miracles by the Jefferson Airplane, I was melting. Couldn't stay awake for the denoument!) Some of the stories got to be so familiar that I'd drift off before I got through to the end.
Oh, and the most important part of all this: I get that wild thinking, where you list compulsively all the things wrong with you, everything you've ever done wrong in your life, and how awful and worthless you are. That will keep you up, days on end! I had to learn to breathe, to stop the train of thought, and to force my mind onto another track. That was the hardest part for me.
Good luck, and may your pain stay far away.
Posted by chdurie2 on October 12, 2000, at 20:19:19
In reply to Re: Link to insomnia from going through chronic pain?, posted by Racer on October 12, 2000, at 1:53:39
> Many sleep drugs are habit forming, and many can be addictive in very small amounts. Tolerance can be caused by a lot of factors, too. At the worst of my depression and anorexia, when I weighed about 110#, I could take 80mg of valium on rare occasions and still walk and talk as though normal.
>
> My experience is that valium will relax me, but not put me to sleep. Xanax will put me to sleep, but after a short time, like two weeks, I go through such awful withdrawal that it's not worth taking.
>
> The drug that works for me, which I take rarely, is an anti-histimine. It makes me groggy the next day, but it puts me right to sleep.
>
> As for long term, have you tried behavior modification? That's worked great for me. I was a chronic insomniac, sleeping a couple of hours per night, after tossing and turning for hours and hours. It's hard to remember what happened or how I did it, but I know that part of it was only getting into bed to sleep. Any other time of the day, any time I wanted to stretch out and relax, I'd choose the sofa rather than the bed. Then, getting into bed, I'd read for a few minutes, to relax myself. Then, if I wasn't getting sleepy, I'd tell myself a pleasant story. In the midst of depression, that's damn hard to do -- but it's possible if you force yourself. Let's see, some I remember were giving riding lessons to the cast of the X-Files, teaching them the real way to ride, not just the sit here, hold this that actors usually get. Another was being swept off my feet at a dance by a tall, dark and gorgeous hunka man. (That one was particularly nice: he heard me discussing favorite slow dance songs with a group of friends, and had the dj play them all, so that he could dance to them with me. By the time they got to Miracles by the Jefferson Airplane, I was melting. Couldn't stay awake for the denoument!) Some of the stories got to be so familiar that I'd drift off before I got through to the end.
>
> Oh, and the most important part of all this: I get that wild thinking, where you list compulsively all the things wrong with you, everything you've ever done wrong in your life, and how awful and worthless you are. That will keep you up, days on end! I had to learn to breathe, to stop the train of thought, and to force my mind onto another track. That was the hardest part for me.
>
> Good luck, and may your pain stay far away.Racer: Thanks for this. i know what you're saying about the difficulty of weaning off even small amounts of sleep meds. for a while, a long time ago, i could do .25 of klonopin and be okay but i couldn't ditch it altogether. then i had to give it up for my sleep study, and i practically went berzerk, but decided to use the chance to try to stay off. for a couple of weeks while waiting for results, i could go without about half the time. then i listened to the doc who said forget about even trying.
the last two or three years i have been so sleep deprived and screwed up my circadian rhythms so badly that i'd be afraid now to try to go without. (although i did unsuccessfully try last nite after reading this when sleepy - but i forgot to tell myself the stories.) the last few weeks on seroquel have been a blessing. but while driving today, i found myself thinking about your dj story and how nice that sounded. and i just reminded myself not to get obcessed about everything i've ever done wrong in my life. i need to remind myself and get reminders of that all the time, night or day.
but when my sleep is stable enuf, i think i'm going to try your "fairy tale" mode of going to sleep. giving myself something to have sweet dreams about would probably do me good.thanks again.
caroline
Posted by Racer on October 13, 2000, at 12:26:00
In reply to Re: Link to insomnia from going through chronic pain? » Racer, posted by chdurie2 on October 12, 2000, at 20:19:19
Thank you, Caroline! It's nice to know that someone liked my suggestions.
Be careful, though, about your fairy tales! Mine have led to such lucious dreams I couldn't stand waking from them! Just think about running your tongue around "----"'s ear, or running your fingernails up "----"'s sides... Or, in my case, getting your idiot horse around a nice hunter course without chipping once! (My big, beautiful mare can pretty much take her 12.5 foot stride, and compact it to 3 feet if it gives her a chance to chip spectacularly!)
To stop myself from the self-recriminations, I do two things: I breathe while counting, "in-two-three-four; out-two-three-four" over and over again. This is like counting sheep, it takes up part of the brain power that would otherwise be used to beat myself up. Also, it forces my body out of the high tension that comes from the bad thoughts, so I relax more physically. The other thing I do is to make up a mantra about whatever is setting me off right then. It's usually something like: "I can't fix it tonight, so I'll worry about it tomorrow. I'll be able to fix it tomorrow, if I sleep tonight, so I'll stop worrying about it tonight so I can sleep and fix it tomorrow." Long, but I remind myself of this over and over again, and eventually, I get so bored I fall asleep!
The fairy tales are the most pleasurable, though!
Posted by coral on October 14, 2000, at 16:20:18
In reply to Re: Link to insomnia from going through chronic pain? » chdurie2, posted by Racer on October 13, 2000, at 12:26:00
Oh, Racer! An fellow equestrian!!! Due to a variety of circumstances, after I put my last TB down due to crippling arthritis, I haven't been riding. Riding and writing are the only two things in life that could so completely absorb me that I was transported. The longing for riding is especially acute this time of year - the wrap-up of the show season and beginning of the hunter trials. The surging of a healthy, strong horse, feeling great in the crisp fall . . . that special one-to-one communication between horse and rider. Best therapy I've ever had and I so miss it.
Love your ideas for insomnia, too. You have a very creative, imaginative mind....
Coral
Posted by Racer on October 14, 2000, at 21:34:02
In reply to Re: Link to insomnia from going through chronic pain?, posted by coral on October 14, 2000, at 16:20:18
My TB mare is aged, and not doing well right now. This is probably one of the last winters I'll have her, and it's bittersweet. She's a dreadful old beast, nothing to recommend her: only the good die young, and she's about 24 now...
All that? It's only because I love her more than anything, and she's not much more than a very large, very expensive pet these days. I still get on her a few times a week, which she likes -- except for the work part! She's never liked being lunged or turned out, would rather be ridden. On the other hand, I'm out of shape, and she's not in great shape, so it's a struggle for me to decide to ask her to haul my big butt around much anymore.
But for all that, and for all that her career as a hunter really only started when she was 18, she was champion of her division the last time we showed. The judge loved her, and that's as it should be. She'd have gone even higher if not for her wretched Mom on top of her.
Loveliest mover, big, bouncy stride even now. If you were in Northern CA, I'd say "c'mon to my house and meet my love!" She's always happy to show off for an appreciative audience!
Posted by coral on October 15, 2000, at 7:38:10
In reply to Re: Link to insomnia from going through chronic pain? » coral, posted by Racer on October 14, 2000, at 21:34:02
Dear Racer,
Thank you for the offer but I'm on the other side of the country. Your mare sounds like a grand, ole dame!
Coral
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