Sigh... here we go again Part II

[AJ]

I work at 8:30AM Went to bed at 12:15AM (off to a bad start right there). I got up around 4 A.M. Now what is that saying about one step forward... I should have taken the clonazepam.

I saw my P.doc on Thursday. She told me to drop my Clozaril dose by 25mg. (I don't tolerate 450mg a day well). The plan is for me to take clonazepam for 2 nights, then off for 1 night and repeat. We are in a holding pattern with Abilify dose.

I got my blood work done. I know you have all heard(read) me complain about getting poked a zillion times. The tech got it from my hand, as usual. I had to resist the urge to slap her. She pulled the needle out really fast, and it hurts way more than if it's pulled out slowly.

I guess I keep my fingers and my toes crossed that my blood work will be okay this time.

[paul m]

Hello AJ. Complain a few zillion more times, we'll listen. (it's way easier listening than doing). Poor humour aside that has really got to make you hate giving blood. If it was me I would need a large ativan just to show up in the office(probably several).

This may sound pretty obvious, but how much of your mania is being fed off of your anxieties about your medical conditions? Not that I know what to do about it. I was never very could at mediation or yoga as they never seemed to slow my mind. At one point you ( I think ) had talked about a sleep clinic.

Hang in there. Times are really tough for you right now, but you know they can get better. It would be nice if better could come a little faster for you. Take Care. paul m

[Woody]

I hate when that happens ... for me the clock turns 1 or so and then it clicks in that maybe I should have taken an extra dose that night

AJ, I am not sure this would apply to you or not, but one thing that I have noticed in the last little while with my sleep and medications is that if I do not go to bed or get to sleep within that normal 1~2 hours after I take my dosage, I really have a hard time.

[AJ]

I think you talked about the sleep clinic Paul. I've had some significant medical conditions for many years. One does affect the other, but it is only one part of the whole picture. I think my lack of sleep is feeding my anxieties Paul. Actually if I could get this sleeping thing sorted out, I think it would go along way to becoming stable. Probably more than any med will do.

Woody, the part about getting to bed an hr or so after taking my med, it seems to make sleeping more difficult. The other part of it, the part that I'm having the most trouble with, is staying asleep.

[paul m]

Hello AJ. and good luck, you need some for a change. Take Care. paul m

[leila63]

Is there a non psychiatric drug you can take for sleep? One sees the ads on tv for drugs that "help you sleep and stay asleep" I guess if there was your pdoc would have prescribed it. I have trouble sleeping sometimes but I've never tried these drugs for fear of sleep eating or, even worse, sleep driving.

Glad to hear your blood testing is over for now and wishing you an uninterrupted sleep tonight.

[AJ]

Thanks for the hugs Paul.

No phone call from MD office. I hope that means I passed my blood work. Cheerleader.gif

[uni]

Hoping so too AJ!

[paul m]

Hello AJ. No news is good news eh. Take Care. paul m p.s. I like the icon, I could have used in a post the other day.

Hello Leila63. Over the counter meds and alternative methods are a good idea. Docs do not always think to prescribe them and instead just reach for a prescription pad. Most are pretty safe. I have had major sleep problems at times and I find most are not strong enough for me.

A lot of cold/allergy/sleeping meds contain the antihistamine Diphenhydramine HCl , better known as Benadryl. It is marketed under such names as Tylenol sleep, Nytol and other common names. Sometimes it is combined with about 500 mg of acetaminophen per pill in the cold/allergy remedies.

I have used this sort of sleep aid before when I had too. Anyone who has bipolar may be at risk of using Diphenhydramine HCl as it has a mechanism of action similiar to an ssri anti-depressant it could cause problems.

If you use the ones with tylenol (acetaminophen) you are really increaing the load on your liver. The maximum daily amount of tylenol allowed is about 4000 mg before liver problems set it. Some extra strength tyenol to battle a tooth ache 3-4 times a day, another 2-3 tabs at night or for allergy control and all of a sudden your liver is going to start complaining.

Now you know more than you want about some of the sleep aids. Take Care. paul m

[Woody]

AJ

[AJ]

The over the counter sleep aids might shorten the time it takes to fall asleep by 20 minutes or so. My problem is staying asleep. Good thought though. Thanks Leila.

[AJ]

Maximum tylenol daily dose has now dropped to 3250mg/day.

Article; Canadian Pharmacist's Letter; July 2009; Vol: 16

Introduction
You'll hear debate about changing acetaminophen products and doses...to reduce the risk of overdosing and liver toxicity.
People don't realize that acetaminophen is a narrow therapeutic index drug. The toxic dose is not much higher than the therapeutic dose.
Just 6 g/day for 2 days can cause liver toxicity in some patients.
It's easy for a patient to get too much due to multiple prescribers or ailments...Excedrin for a headache, Sinutab for allergies, Tylenol Cold for cold symptoms, Percocet for pain, etc. Hospitalized patients get acetaminophen in many standing orders.
In fact, half of acute liver failures due to acetaminophen are due to UNintentional overdoses.
You'll hear talk about lowering the maximum recommended dose to 650 mg/dose and 3250 mg/day...down from 1000 mg/dose and 4000 mg/day.
3250 mg/day works out to be 650 mg 5 times a day. Explain that 650 mg works almost as well as 1000 mg for pain...and it's safer.
Experts will debate an even lower dose for people who have three or more alcoholic drinks per day or have liver disease.
Regulators will also clarify pediatric dosing and consider new warnings about not using multiple products that contain acetaminophen.
Discourage using combos with high doses of acetaminophen...Tylenol Ultra Relief, Triatec-8 Fort, etc. Explain that these contain 500 mg acetaminophen in each tablet.
When appropriate, suggest a formulation with 325 mg/tab or less...such as Tylenol No. 3 or one of the oxycodone and acetaminophen combos.
Help patients recognize and limit the total they get from ALL their Rxs and OTCs. Don't use "APAP" on labels...people don't know what it is.
Advise heavy drinkers to keep acetaminophen well below 3250 mg/day.
Symptoms of acetaminophen toxicity can resemble flu-like symptoms. So people take more acetaminophen...until it's too late.
Contact the prescriber or poison centre if someone takes over 10 g or 200 mg/kg in one day...or 6 g/day or 150 mg/kg for 2 or more days.
Tell people they may need their acetaminophen level checked ASAP to see if they need to start treatment to prevent liver toxicity. View Detail-Document #250701

[paul m]

Thx AJ. That put's it better. It's amazing the number of products that acetaminophen is in. Especially frightening is there is no clear warning that your liver will fail if you regularly take to much or even for 2-3 days in a row.

A lot of kids misuse drugs like oxycodone and it is exceedingly easy to ruin your liver in a hurry doing that. (also tylenol 3's etc)

If I use my OTC allergy meds twice in a day(total 2000mg) and I have a tooth ache and I use 2 extra strength tylenol(500 mg each) every 6 hrs. The total is 6000mg for the day(I never actually do that). Thats without taking Nytol or anything else. It's easy to get 7-8000mg without noticing. None of these are prescription either, so there is no pharmacists to warn you.

Nowhere on any bottle does it say "watch for cumlative totals". Perhaps it does in the box, but I am fairly typical, who reads the really fine print on the box. Its seems like an increasing # of this type of product is making to to the shelves without aquetate info going to the consumer. Anyways thx again AJ. My soapbox was getting dusty and I needed to use it. Take Care. paul m

[AJ]

I saw my P.doc today. Confirmed that my lab work was okay. It''s never great, but bottom of the normal range is good for me.

Still sleeping 4 to 6 hrs a night. Working 5 days this week hasn't helped.
I'm supposed to stay on the same dose of Clozaril and Abilify and increase clonazepam on the nights before a day off.... which will be Friday. Sigh.

It's either get more sleep, or be in the hospital and get a drug induced sleep. Neither my P.doc nor I like that option, but this hypomania is getting old!

So, will see how that works out after Friday. (She tried to talk me into taking the next 2 days off, but we're so short staffed at work).

[paul m]

Hello AJ. I'm sorry that you are still having so many sleep problems. It is tough to decide what to do in life when one is normal and not sleep deprived.

I know your in a tough position but the last time I said that the company showed it's gratitude by firing me once they got more help. They used my poor performance as an excuse. I've used all of the excuses too, my friends needed me, now's not a good time, I cannot let my co-workers down, I won't rest at home, the guilt will make me feel worse etc.

if you need to take 2 lousy days off to try and get better, well do it. Take Monday and Tuesday off instead of Thursday, Friday if it works better. Take Care. paul m