Epival and Insomnia

[MooDee]

Has anyone experienced insomnia with Epival. - Can fall asleep but wake up 2 hours later could easily get up and feel totally rested. If I stay in bed I don't get into a deep sleep for rest of night. I am wide awake for long periods but not worrying or anything just not sleepy. I am also not sleepy the next day just wired. It seemed like it started when I increased to 1000mg/daily dose. I was sleeping ok on pervious dose of 875mg daily.

[paul m]

Hello MooDee. I'm sorry but I don't have that much experience with epival. The two times that I tried it, I got some really rare side effects and I had to be taken of of it, which was a shame, because it really worked well for me. I don't know what format that you are taking (immediate release or delayed or extended release) . For some of my meds I prefer to take the immediate release several times a day than the extended release once a day as I have better control over how much is entering my system when.

Your pharmacist should be able to answer your question, but you should also report it to your doctor(I know over Christmas it's not easy) . You can also look at drugs.com and you will see that epival (valproic acid same thing) has a long list of side effects https://www.drugs.com/sfx/valproic-a...e-effects.html

Another website. Crazy meds , whose motto is " Finding the Treatment Options that suck the Least" ofyten has some logical things to say about just about any med, but by no means is the guy who runs it a medical expert. https://www.crazymeds.us/pmwiki/pmwiki.php/Meds/Depacon did mention that insomnia was a possible side effect. Good Luck and Take Care. paul m

[quack424]

Hi MooDee,

I've been taking Epival for 4 months now at 1000mg/day. I have insomnia now and then. Is it a side effect? Possible. Is insomnia a symptom of bipolar? Quite often it is. What I might put as drug-related insomnia -- for myself -- is when I want to sleep but can't, or when 5 hours leaves me tired the next day. What I put as symptom is when I get 2-5 hours of sleep and am quite wide awake - sometimes /really/ awake. But I have found that this latter case is rare since going up to 1000 on the Epival.
Can you take your entire dose in the morning? (I do half in the morning, half at dinner.) Taking it in the morning might help, so the side effect might wear off by the time you want to sleep. Or take it right before you go to bed, so that the full dose is not metabolized until well into your sleep. Might be worth trying if it's a persistent problem.

[markm]

Hey MooDee, I've been on Epival (generic divalproex form) for several years. Lots of experience tweaking with it. Took a while for me to find the right dosage. I have a great PDoc and GP who I see as much as needed. Even now, I adjust according to my mood and environment. Here's a couple tips I've found...do with them what you see fit. I'm not sure sure what's causing your insomnia, could be a function of your BP...or ineffective/ insufficient levels of your med. Epival/Divalproex at the incorrect dose can mess with your sleep, yeah, a reported side-effect. Bunch of other stuff too.

The thing to keep in mind that to act as a mood stabilizer for BP, the dosage needs to be high enough so that it eventually metabolizes to 50-125 µg/mL of blood. That's therapautic range - your doc should know that. Lower than that, it's essentially useless and ineffectual to stabilize mood. Higher, and it's toxic. Everyone's got a custom level hat might work for them if valproic does in fact work for them.

For me: I get my blood tested every 3 months because I cycle rather rapidly. Plus that stuff is hard on the liver function, so you're supposed to get full liver work done at least once a year. OK..but here's the thing...about three years ago, when I finally got my level dialed in to about 50 µg/mL, that was with a 750 mg dose. (That level was where I actually felt pretty good - I didn't want to take more than I thot I needed...but some need a higher blood level, and maybe if I took more, I'd feel better too, who knows; I'd have to try.) Anyway, Then my blood levels went down (why??), so we bumped up to 1000mg, just to keep it at 50µg/mL. OK, so good, but then they came back up with a higher dose. But then they dropped again, below therapeutic range. So bump up the dose, to get up to 50µg/mL minimum. But we couldn't get it up to 50µg/mL, except this summer it spiked to 60 for a few weeks, then dropped again. Now I'm at 2000mg! So, by tracking carefully with my docs, I observed these things:

It's a really noticeable drop in the winter (it's pretty dark where I live in the north). My blood levels go down to 25µg/mL, so we bump my valproic up to 2000mg. My 2 busy (read: stressful) quarters of the year at work cause fluctuation, and I generally need a tweaking up. Summer, I can actually back off. As the sunny summer season happens, my need for valproic decreases, but for a short time. Guess I'm a bit seasonal affective and it influences how my brain is utilizing all its happy chemical (natural or artificial).

Point is, as long as I keep my 50µg/mL, I sleep pretty well. When my sleep pattern is off, I take that as a signal to get in to the doc's to get tweaked. For me, stay at 50µg/mL. If my blood levels aren't stable, I'm not going to be. Environmental stress and seasons really affect me. Oh yeah, exercise really really helps you be sleepy. I just feel "good". I go for a walk. Or do stuff. Don't fight the insomnia if it happens, just anxiety. Got to be me.

Also, if I'm having a really hard time sleeping, I combine quetiapine (seroquel) to aid sleep. Just a little, like 25-50 mg. That puts me down. That's a WAY different dose than for mania when they commonly combine Epival and like 250-500mg of quetiapine.

Also, make sure you're getting the ER form (extended release). Makes a difference. Blood levels stay more stable throughout the day, messes less with your circadian rhythm.

Also, when and how do you take your dose? Like quack424 related... After some thought and metabolic calculation, my doc gave me 1500mg to take at noon (my most wakeful alert time), and 500 at 11:00pm when I go to bed. Generally they say Epival causes drowsiness, but I've never had a problem with it that way. Also he calculated it that way so I wouldn't feel groggy in the morning if I took it all at night. Anyway, I don't have sleep issues.

Also, valproic acid, valproate sodium, or divalproex... all very similar drugs, in that they metabolize in the liver into valproic acid, but they all act differently during metabolism for a patient (verified by my pharmicist)- Once I was inadvertently switched over to valproic acid...threw me off like crazy. It's actually a different drug in the sense of how it will produce results.

Anyway, that's my experience with it. Hope you figure it out soon. Going without good sleep is not fun.

[MooDee]

Thank you everyone for your replies. It is very helpful to hear about other's experiences. I will get my blood levels tested next week and find out where they are at. I am armed with lots of information now that I can use to try to get things sorted. Thanks for taking the time to reply.

[Stenacron Man]

Epival "Divalproex" is only an antimanic medication with and FDA approval for off label usage for migraine headaches. It on its own is not a true mood stabilizer it only locks down mania it is typically used with other drugs that are mood stabilizers like "Quetiapine". Divalproex is normally only used when a patient has chronic manic episodes being like 4 per year. When I was rapid cycling then I took Divalproex but I have never used it as a primary medication and it was never designed for that purpose. Also never take it with lithium as both are sodium bicarbonate based. Having your kidneys check every 3 months is a very good thing to do. I suffer Hypersomnia which is opposite but still take a sleeping med called Zopiclone and it will put you to sleep.


Buddy Mack.

[AJ]

Welcome to the forum Stenacom man.

[Stenacron Man]

Thanks AJ it was Paul's idea I join and glad I did.

[justken]

This thread is old, but I will give my experiences. Sodium Valproate in the right dose at night makes me sleepy, which is good because if I need it and I don't take enough I will be wide away at 2am and thinking about interesting things to do. If I take too much my brain ends up in this state where I'm not hypomanic but I just can't go to sleep. It would seem that valproate slows down part of the brain that is needed for sleep.

Why I would this thread was that I had insomnia last night. What I think happened was that I managed to take my evening does twice, although I'm not certain it may be that my bipolar is shifting towards depressed. I took something else to counteract the insomnia and woke at midday.

[AJ]

Welcome to the forum justken.