Anxiety and Insomnia.

[fluxandflow]

Hello all,

I posted a few months ago prior to getting my new family doctor. She's wonderful, by the way.

So, her and I discussed the diagnosis I was given by CAMH in Toronto a few years ago and she decided we would try Lamotrigine first as she considers Lithium "old fashioned". I was given a referral to CAMH again to meet with a psychiatrist for evaluation.

I had my first appointment with him a few days ago. I can't say I particularly like him, he was very impersonal. Anyway, after my evaluation he settled on Bipolar II, as we'd thought.

Now, I really liked the Lamotrigine. It helped me sleep, although I had more nightmares than usual, some so horrific I'd wake up crying. It didn't seem to have any other negative effects other than slight dizziness in the first weeks. The dosage was too low to have any therapeutic effects though.

The psychiatrist decided to add Lithium on top of the Lamotrigine, 300 mg of Lithium and 150 of Lamotrigine. Now, in the last two days since adding in the Lithium I have been utterly unable to sleep, which isn't usually a problem. I typically fall asleep easily and sleep lightly, but I sleep. Now I just lay awake all night, on top of feeling far more neurotic, anxious and paranoid. Now, I'm not sure what's going on since the Lithium dosage is low and recently started. Maybe it's the Lamotrigine being upped. Regardless, this not sleeping thing is driving me nuts and I'm pretty sure my boyfriend is getting pretty unimpressed with the recent paranoia added on top of the usual mood swings.

Does anybody have any advice or input, either on the medication or the sleeping...(or my boyfriend. -.-?

[astronaut]

I have been on lamotrigine before and was up to 100mg twice a day. I took it for over two years but it didn't seem to help me at
all and it caused no side effects. I have never been on lithium.

Some drugs can cause disturbances in mood or sleep when you first start taking them. Sometimes these side effects go away
within the first week or so. I suggest keeping a detailed log of your mood, hours of sleep and rate your anxiety and irritability
everyday from 0-3. Keep this log while also recording what meds you took that day and what the dosage was. Over time, you
can look at your log and see if the side effects are lessening or worsening and see if your mood is improving on the med as you
raise the dose. There are mood charts that you can print off online that will help you log these things. It doesn't take long at all.

I would also suggest that you raise the dose of one med at a time. If you start a new med and raise the dose of an old med, then
you can't know which one is affecting you. The pdoc should have been thinking about this when he adjusted your meds, I'm
sure you were just doing what you were told.

As for not sleeping, if it is the meds causing the insomnia, then it might go away as you get used to the drug. Or the side effect
might not go away and you may have to try a different drug. Either way, keep a log of how many hours you sleep per night and
share this with your pdoc. I always thought that Lithium tended to make people sleepy not more awake but drugs affect
everyone differently so I can't say for sure how it is affecting you. For now, you can try taking your meds in the morning instead
of at night (if you do take them at night, that is). If the meds are keeping you awake then best to take them in the morning when
you have the whole day ahead of you to be awake for.

And for insomnia, the old rule of thumb is to never just lie in bed awake. If you have been lying there for over 15 minutes or so,
get up and do something quiet like read. Try to avoid looking at computer screens or TV screens before bed. Don't exercise close
to bedtime, keep the bedroom dark, eat a big turkey dinner...

I hope you get some sleep soon,
astronaut

[Sweetest1]

I would have to agree with everything our wonderful space friend said. Especially about only switching one med at a time, that's so key!

Also, some people I know take benedryl at bedtime on a short term basis when a med change is affecting their sleep, may be worth a try.

[melissacalhoun]

I have used prescription, non prescrition and homoepathic medications for sleeping, some being more effective then others. I have a prescription right now for Zopiclone (immovane) which i find very effective and is also less addictive then Benzoes. If your Doc doesnt want to write you a presciption drug there are a few pharmacy options such as Benadryl or Gravol (both shouldnt be used daily or for an extended period of time). There are also some good homeopathic ones such as Melatonin (particularly effective for shift workers or >45yrs as the pineal gland that creates melatonin begins to calcify as we age), also Tryptophan (sleepy stuff in turkey), or 5-HTP. Valerian root or Chammomile teas can also help. Most of these are safe on most meds, just ask your pharmacist about possible drug interactions. I hope this information helps.

[Vitality]

Interesting to hear about limotrigine as I may be going on it. Hope to find out tomorrow. I don't know how long you've been in your relationship, but I hope he understands your struggle. It is difficult for the partners, and if he hasn't already done so, I'd get him some info on it. I did this for my husband. He's not like me where a search out everything on the web, so I simply did it for him. There is info specifically for the families of people with bipolar. That might help.
Hope you can get some rest and sweet dreams!

[fluxandflow]

Thanks for the advice! I haven't found melatonin or valerian particularily effective in the past, unfortunately.

So, just an update...

I went to my pdoc last week. He seemed skeptical about my insomnia for some reason, saying that the lamotrigine and lithium should have me sedated. Regardless, he prescribed me zopiclone for the insomnia at the highest dosage. It's hit and miss. The second something disturbs my sleep I slip into this chaotic half thought/half dream state that I've fought with since I was a child. It's frustrating that even a sleeping pill can't make my brain shut off enough to rest. I've also upped my lithium to 450 and the lamotrigine is still at 150 and my last lithium blood test had me at .2, so a while to go yet as my doctor says I should be between .6 and 1.6.

I've been experiencing some moments of forgetfulness and balance issues, as well as a slight tremor. I drop things pretty frequently now. I'm also waiting on a call from the CAMH Bipolar Group. My pdoc gave them a referral for me, so hopefully they'll call soon.

[dave]

I used to take seroquel (Quetiapine) and i also have great difficulty sleeping. i stopped taking it because of side effects but i understand it is a frequently prescribed med for bipolar. you may want to search this forum for more info from others. there is a search tool near the top of the page. paul m. recently posted about it and its sedating effects. Seroquel used to be very effective in helping me sleep though this was not the primary reason it was prescribed to me but only an added bonus. because of dependence potential and safety concerns my pdoc will no longer prescribe me sleeping pills but i dont think these are issues with seroquel. also i quickly built up a tolerance to immovane when i took it before i had to no longer keep them for safety reasons.

I dont know about other pdocs but mine is very accomodating and not rigid or self absorbed so i can actually talk to him without him making me feel like he is the expert and i am the uneducated patient

if your meds are causing you problems and your pdoc wont listen to your concerns then you may need to be more insistent with him. i would ask him his thoughts on seroquel.

[dave]

I was searching for posts about something else and came across a post by "ladyswan" (i think) that said magnesium relaxed her and helped her sleep

[astronaut]

Hmm... I've been on lamotrigine and I don't think that your pdoc is right about it sedating you. I was never sedated or even mildly tired on the lamotrigine and I don't think that is a very common side effect of that drug.
I have been having racing thoughts too lately and haven't been sleeping too well. Like you said, if the slightest thing bothers me, I sort of wake up into this half-sleep and I can't get back into a deeper sleep again. I've been wearing earplugs at night and that sometimes helps. I also can't sleep during the day so it is harder for me to sleep because it gets so light so early in the morning and stays light so late at night now. Keeping your bedroom as dark as possible can also help your brain know that it is time to sleep.
good luck,
astronaut

[paul m]

Hello Everyone. I'm not an expert on sleep matters but I have learned a few things. One is that sleeping pills, especially Zopliclone helpful or it can be bad news. The following is the warning from one of the makers of Zopliclone:

"Treatment with APO-ZOPICLONE should usually not exceed 7- 10 consecutive days. Use for
more than 2-3 consecutive weeks requires complete re-evaluation of the patient. Prescriptions for APO-ZOPICLONE should be written for short-term use (7 - 10 days) and it should not be prescribed in quantities exceeding a 1-month supply".

Unfortunately many doctors ignore that warning. Most sleeping pills are meant only to take on an intermident basis. When taken regularily they usually lose effectiveness and sometimes they actually cause you to lose sleep in the long run. They also can be addictive as any street drug and very hard to quit taking.

It used to be thought that zopliclone was far less addictive than lorazepam(ativan) this has proven not to be true.(although ativan can be addictive, it usually takes longer)

In regards to seroquel, as a general rule of thumb, does of less than 50mg act simply as a sleeping agent and not as an anti-psychotic. I get my doctor to give me 25 mg of regular release seroquel and then I split that down to about 12.5 mg and it doesn't leave me sedated the next day. Seroquel is not usually thought to be addictive.

Lithium made me extremely tired when I was first on a theraputic dose. However I quickly adjusted and I know notice no difference. At .2 blood level I don't think that would make anyone tired.

In regards to lamotrigine. I never found that it made me tired either. The maker indicates that in trails it made about 14% of the takers sleepy. The trails also show that about 6% of the takers suffered from insomnia(3x's the rate of the palcebo) so like most meds it has a different effect on different people. Take Care. paul m

[paul m]

Hello Astronaut. My wife has the same problem, the slighest thing awakes her. Once awake she has a very hard time getting back to sleep. She tried everything from ear plugs to soothing background music. Nothing worked(she would lie awake listening to the music). We finally hit upon the cure by accident. Having a fan turned up fairly high and placed close to the bed drowns out the other occasional noise and is regualer enough that it doesn't bother her as she is used to hearing it.

She also takes sleeping pills about once or twice a month. Never for more than 3 days in a row and only when ever she is having trouble with her sleep patterns. Ocassionally one of the reason why she can't sleep is racing thoughts(living with me would cause anyones thoughts to race once in a while). Two or three days of sleeping pills seems to restore her proper sleep patterns. Take Care. paul m

[astronaut]

Hey Paul,

I actually do the fan thing. I have had a fan by my bed turned on every single night since the end of last August. I think it works great; however, lately my housemates have been staying up later than usual and my one house mate is really noisy and it is easy to hear her smashing plates around in the kitchen and stomping all over the house, so during these times I have to wear earplugs too. She doesn't wake me so easily when I'm in a good sleeping pattern but these days I've been stressed and angry so it has been harder to calm my thoughts.

astronaut

[paul m]

Hello Astronaut. I guess that the old rubber lined room would do the trick. Not for you but for your noisey house mate. Then she/he could stomp all that they like.

Fortunately I never had to live with room mates. I don't think that I could have stood it(and they probably couldn't of stood me). I had enough problems living in apts. Mind you when I was in university and going through my first really large major depressive episodes I would continually hit the snooze button on my very loud alarm. Sometimes 10 times or more in a row as I just couldn't get out of bed. This used to irritate the people in the apt next door to no end and I didn't blame them for being upset. (paper thin walls)

I hope that you soon find a solution, being woke up and unable to get a good nights sleep makes getting well tough. Take Care. paul m

[fluxandflow]

Hello again!

So, the Zopiclone started to kinda do its job at helping me sleep. It was hit or miss though. If I was even a little bit anxious before sleeping, I was up all night. If I was relatively calm, I was dead to the world. The ratio of awake to sleepiness was still a bit high for me, so I mentioned this to my pdoc at our last appointment. He then suggested Tryptophan, which is beyond expensive, by the way.

I'm on my third sleepless night.

We raised my Lamotrigine since my doctor said it helps lift depression better than Lithium, apparently. The insomnia is still apparently very alive and well under the Zopiclone and Tryptophan. I'm going crazy here trying to work out what to do. Do you guys think it'd be okay to take my Lamotrigine in the morning and my Lithium, Tryptophan and B12 supplements at night?

I need to sleep.

[dave]

This does not completely answer the question at the end of your post but the max dose for lamotrigine is 400mg daily. i take this dose and my pdoc told me my dose is at the max dose. currently i take all of mine @ night but i used to take half in the morning and half before bed. If your pdoc isnt easily accessable then your pharmacy may be able to answer this question for you.