23 replies to this topic

[penisbreath]

I'm so desperate to sleep. It's been months since I've had anything resembling a peaceful night's rest. I constantly feel sick, look horrible, have yellow circles under my eyes.

I thought that the Riluzole was activating me, and that still might be true, but I've also worked out that I'm sensitive to antihistamine rebound. I was using doxylamine for weeks on end and would get horribly agitated and restless the ensuing afternoon. When I stopped it, the symptoms diminished. I've been trying cyproheptadine, but it seems to stimulate me after I take it and my sleep has been even worse the past few nights. I'm kind of trapped in a cycle now though where it's hard to get a decent picture of what the Riluzole's doing, but I also can't bear to not sleep.

I can't take:

benzos (rebound anxiety)
z-drugs (rebound anxiety)
antihistamines (rebound akathisia/irritability)
Seroquel (terrible akathisia, even at tiny doses)
clonidine (paradoxical anxiety)
mirtazapine/mianserin (anxiety/akathisia the next day)
amitriptyline (sleep poorly, anxiety the next day)

clonidine worked well for two nights, before I grew tolerant and only experienced stimulation on it. Dr Mariano (sp.) writes that clonidine simultaneously reduces and increases NE in areas of the brain/body, which is why the stimulating aspect sometimes overwhelms the sedation in certain patients.

My main problem is delayed sleep-phase, but also contextual hypervigilance -- we have a small dog who barks outside my window every morning and disturbs my sleep. Since my anxiety is already so high, I simply lie in bed trying to force myself to fall asleep and experiencing this horrible sense of inevitability over being woken up prematurely. I'm too physically fatigued to exercise in any meaningful way, no amount of sleep hygiene helps, melatonin does nothing. If I'm lucky, I eventually pass out at 4 or 5am and sleep for 5 hours. The one or two nights I've been able to spend away from home were a lot better, but unfortunately I'm stuck here.

I've wracked my brain and the only two options I can come up with are Lyrica (expensive, can supposedly cause rebound anxiety -- which I'm sensitive to -- and has a withdrawal syndrome) and Prazosin, which I thought could be a decent option -- is it a more selective alpha-blocker than clonidine? Neurontin also helped in the past, but it had a weird window where I had to dose almost exactly 40 minutes before sleep, or it would keep me up, and it also caused tremendous brain fog/apathy the next day.

[nowayout]

I feel your pain.

not that anything has helped me, but have yountried trazodone yet?

i asked my doc about lyrica but he said the sedation side effect wears off fast. I get immune to any gaba drug in about 2 days so I didn't push it.

Edited by nowayout, 12 September 2013 - 04:27 PM.

[Adaptogen]

bacopa, ashwagandha, high dose magnesium, taurine..one of those might help, although 3 of the 4 act on gaba I think, but I find them very different than most other relaxants. Can't you take naps?

Edited by Adaptogen, 12 September 2013 - 10:13 PM.

[penisbreath]

magnesium and taurine increase my anxiety for some reason these days. I tried bacopa years ago and I think it worked; ashwagandha never really helped.

I can't really nap at the moment, no .. either the antihistamine rebound or riluzole is leaving me quite wired during the day.

[stablemind]

What does your anxiety feel like? Adrenaline rushes? If so, cortisol may be one of the culprits. Have you tried taking phosphatidylserine? It greatly reduces cortisol levels and I've taken it a few times to help me sleep.

[penisbreath]

yes, adrenaline rushes, rumination, hyperarousal

[JBForrester]

Have you seen a doctor about this? I hope? I had a friend who went through hell with bad sleep, and it was only a year out that she found out her brain was having seizures during the middle of the night. Not saying that's happening, but there has to be a reason for this, and I don't think medication will solve the problem if you don't know what the problem is.

[penisbreath]

The problem is multivariate, unfortunately. I have:

1. Delayed-sleep phase syndrome, which is made worse by..
2. Contextual stress (dogs barking; a noisy household), meaning I get very little done during daylight hours, which is made worse by ..
3. Severe depression and anxiety, rendering me too fatigued and/or anxious to leave the house, which I am trying to treat with ..
4. Riluzole, which is (temporarily, I hope?) exacerbating my anxiety and insomnia.

Add to that some strange paradoxical reaction to GABA-eric compounds and, shy of adopting me, I don't see much that a medical professional can do. It's my terrible environment coupled with anxiety/depression that is proving very resistant to treatment.

[lammas2]

I see a noisy environment has a lot to do with your problems. So why not isolate yourself from the noise? Ear plugs at night; isolating in-ear earbuds with some relaxing music when you have some work to do.

[nowayout]

Agomelatine can be helpful for delayed sleep phase. It worked for me for a couple of months for sleep until it pooped out

Regarding noisy environment it.is the bane of my ecistence. The neighbors' bathroom fans or air conditioner whines drive me up the wall and no, earplugs don't help and moving is not an option given my finances.

What helps a bit for this is my own sources of white noise, namely my window fan, as well as my room AC. Either will drown out most external noise. I also asked the neighbors politely if they would mind not using their bathroom fsn after 10 pm. It soinds like a helicopter on my floor.

Maybe you can talk with the neigjbor eith the dogs and if tgat doesn't help, the landlord or eben the police.

[Adam90]

Try wearing blue light spectrum blocking safety glasses ~2 hours before you want to go to bed. It will normalize your melatonin production, much of modern day insomnia is caused by all these gadgets people use before going to bed.

http://www.amazon.co...g/dp/B000USRG90

[Tom_]

Sleeping pills have side effects. The short of it is, either don't use them or find the best and deal with it.

Also as I've mentioned before, sleep hygine is a must whether it seems to have any effect or not. Every single night, follow the same routine, I doubt you have practiced good sleep hygine for six plus weeks and even if you have effects paticualy with DSPS which in your case I would call a very dubious diagnosis may take significantly longer. Mindfulness and relaxation practice daily is important, bla bla bla, you know it all. Either you will do it or you won't - its likely the key to your recovery.

Trimipramine may be worth a trial
Melatonergic agonists +/- morning bright light therapy (to reset circadian rhythem disorder (in fact in the case if bright light therapy you should use it with or without sedative drugs))
another AAP
You won't ever get it prescribed but sodium oxybate will likely knock you to fuck out and then wake you up after 8 hours (nor should you)
Barbituates
Phenibut

All of these bar the melatonergic agonists carry lots of side effects, they are all sure to knock you out although with some you will reach a level of tolerance were increasing the dose that eventually the side effects outweigh the benefit of sleep. the final three are addictive in the true sense.

Edited by Tom_, 13 September 2013 - 07:45 PM.

[penisbreath]

lammas2: it's partly the noise and partly my response to it. Even when I use some kind of noise-aversion tactic, it's very difficult to stop the relentless hyperarousal and anxiety. Plus, while I have a set of decent earplugs, my noise-cancelling earphones broke some time ago and I can't afford to replace them. I'm trying to get my anxiety under control (the Riluzole), but otherwise there's little I can do at the moment.

nowayout: sorry to hear you're going through something similar. It's actually our family dog: we have two .. one's been outfitted with a citronella-spray collar and doesn't bark anymore, but it didn't work for the other. I've been trying to convince my parents to get him a vibrating collar, but they just never get around to it. And again, while white noise can be helpful, it still doesn't stop the mental/physical anxiety (which I can't control at all at the moment).

Tom: I've had DSPS for 10 years, even prior to moving into a noisy household, so there's nothing dubious about the diagnosis -- it's a pretty common comorbidity alongside ADD. I do implement sleep hygiene to the best of my ability -- I don't watch TV at night, bath in darkness and use Flux on my computer, but beyond that there's little else I can actually do.

All I'm really interested in finding out at present is whether Prazosin and/or Lyrica have benefited anyone. The former sounds safer, though maybe less effective for inducing sleep, while the latter seems to carry a risk of rebound anxiety and a possible withdrawal syndrome. Anyway, I'm seeing my doctor on Monday and will ask for one or the other.

I bought a Bacopa tincture from a health shop yesterday. I had had a bit to drink last night, so couldn't really assess its benefits. Anyway, I'll keep trying it until I can see my doctor in 2 days. Does anyone know what dose I should aim for? I took 1000mg last night, which actually sounds a bit high.

[Babychris]

Smoking a good indica is always a good way haha.

More seriously (or legally) you should try a combo of high dose of ashwaganda like 750 mg, some gotu kola at same dosage, a bit of bacopa (not too much or it loss the desired effect) before bed

You can add something slightly stimulating some hours before bed, like piracetam, the comedown will make you exhausted more easily.

The best Rx drugs for sleep are agomelatine and mirtazapine for the powerness of the knocking out, but mirtazapine is AWFUL for the next day so fu** it
Oh and of course Melatonin.. I think anyone could fall asleep after a good dose of that ( not more than 2mg please)

Edited by Babychris, 14 September 2013 - 11:03 AM.

[Tom_]

How was the diagnosis made because I'm pretty sure almost no sleep specialist actually has enough brains between there head to mix actigraphy, hourly temprature, quaterly cortisol swabs and a polysomnogram + MSLTs which is the only way to make the diagnosis firmly (the first two and a polysomnogram + MSLTs are absoutly required).

DSPS is rare as fuck ((1-2000+) and the vast majority of ADHD sufferes do in fact not suffer with it. Although about half the sufferers of DSPS have some kind of attentional decifict, which may or may not be sleep depervation induced. If you do have DSPS you certainly don't seem to do much to treat it.

I.e. morning & if possible 12pm bright light therapy, proper sleep hygine (I'm not sure how bathing in the dark is related), using a computer 1-3 hours before bed isn't helpful, your room should be as comfortable as possible and preferably there shouldn't be any electronics in the room. If you can't sleep within half an hour of going to bed you should get up and do something (non-stimulating - something like a book) until you feel tired/are possibly ready for sleep or half and hour comes by and you should try again, rince and repeate. Nor are you supplementing with Melatonin/agonist following a dosing structure to replicate normal release. As a side not light restriction at about the same time it gets dark outside is suggested. If you remain treatment resistant chronotherapy is an option. Avoidance of stimulants at least in the late afternoon onwards is required and you could always trial supplementation with b12 despite probable lack of efficacy. L-Tryptophan might be helpful three to four hours before bed.

Pregabalin isn't a sedative, its an anxiolytic. It might help with your anxiety but it will screw with your sleep architecture. Rebound anxiety is unlikely, if you aren't taking three doses a day a RETURN of your anxiety is possible. Its only been shown to be effective for GAD & possibly PTSD. Not for OCD. It may help you sleep.

In regards to Prazosin I'm sure you can guess my views - poorly evidenced and certainly not a sedative. Its main use in psychiatry is to reduce physiological anxiety (which it likely doesn't do well) and reduce nightmares in sleep.

Do look into Trimipramine.

[penisbreath]

I remember trying ashwaganda a few years ago and being stimulated by it, though it might have been a low-ish dose. Does it become more sedating at higher doses? Again, I have this Bacopa tincture (the cheapest option I could afford), but I'm uncertain about dosing .. it's a 1:1 distillation, but I have no idea if that's less/more/equally potent to a powdered extract.

I'm hesitant about Agomelatine because I've heard the effects take a little while to show up and I don't want to add another variable into the mix while on Riluzole.

I take 2mg of Melatonin (time-release) and it has very little discernible effect.

[Tom_]

Its AD effects do, not its sedative effects.

You should be using instant release with a dose of 0.3-1mg 5 hours before planned bed time and a further 1-20mg about an hour to two before bed.

[penisbreath]

How was the diagnosis made because I'm pretty sure almost no sleep specialist actually has enough brains between there head to mix actigraphy, hourly temprature, quaterly cortisol swabs and a polysomnogram + MSLTs which is the only way to make the diagnosis firmly (the first two and a polysomnogram + MSLTs are absoutly required).

DSPS is rare as fuck ((1-2000+) and the vast majority of ADHD sufferes do in fact not suffer with it. Although about half the sufferers of DSPS have some kind of attentional decifict, which may or may not be sleep depervation induced. If you do have DSPS you certainly don't seem to do much to treat it.

I.e. morning & if possible 12pm bright light therapy, proper sleep hygine (I'm not sure how bathing in the dark is related), using a computer 1-3 hours before bed isn't helpful, your room should be as comfortable as possible and preferably there shouldn't be any electronics in the room. If you can't sleep within half an hour of going to bed you should get up and do something (non-stimulating - something like a book) until you feel tired/are possibly ready for sleep or half and hour comes by and you should try again, rince and repeate. Nor are you supplementing with Melatonin/agonist following a dosing structure to replicate normal release. As a side not light restriction at about the same time it gets dark outside is suggested. If you remain treatment resistant chronotherapy is an option. Avoidance of stimulants at least in the late afternoon onwards is required and you could always trial supplementation with b12 despite probable lack of efficacy. L-Tryptophan might be helpful three to four hours before bed.

Pregabalin isn't a sedative, its an anxiolytic. It might help with your anxiety but it will screw with your sleep architecture. Rebound anxiety is unlikely, if you aren't taking three doses a day a RETURN of your anxiety is possible. Its only been shown to be effective for GAD & possibly PTSD. Not for OCD. It may help you sleep.

In regards to Prazosin I'm sure you can guess my views - poorly evidenced and certainly not a sedative. Its main use in psychiatry is to reduce physiological anxiety (which it likely doesn't do well) and reduce nightmares in sleep.

Do look into Trimipramine.

I'm not familiar with the exact medical dx. of DSPS. Maybe it has bled into popular (scientific) culture and become bastardized, but I have had a tendency to want to stay up late and sleep in late since adolescence. Whatever the case, my circadian rhythm has always been off.

You're right that I'm not doing anything to help it because, as I've stated, I am cripplingly non-functional. Any slight concentration or energy I can muster during the day is ruined by endless noise, either from our idiotic toy dogs yapping outside my window (and setting off the 4 or so other dogs that surround us) or my family yelling at each other throughout our shoebox house. That leaves me with about 3 hours wherein I can actually do anything, after they go to bed around 11pm, at which point I'm usually too frazzled and exhausted to concentrate. I will use a computer during those hours, and having f.lux activated is the best I can manage in terms of sleep hygiene. Then, regardless of what time I get to sleep, I'm awoken at 8.30 anyway by the dogs. I've lived like this for 3 years now. have no income, no access to social services and can't actually envision survivng much longer, because it seems like an utterly cruel form of torture (above and beyond dealing with severe depression and OCD, which I've tried almost every conventional option to treat and don't really feel like re-addressing).

[nowayout]

If anyone at all ever found a solution to noise induced anxiety/hypervigilance, I would really really like to know it also.

[JBForrester]

Sorry to ask, but can you give your dogs up for adoption? That would be the first thing to go if I were in your shoes.

[nowayout]

Sorry to ask, but can you give your dogs up for adoption? That would be the first thing to go if I were in your shoes.

I agree. Are your family's dogs really more important to them than the mental health of their own son?

[chemicalambrosia]

How was the diagnosis made because I'm pretty sure almost no sleep specialist actually has enough brains between there head to mix actigraphy, hourly temprature, quaterly cortisol swabs and a polysomnogram + MSLTs which is the only way to make the diagnosis firmly (the first two and a polysomnogram + MSLTs are absoutly required).

DSPS is rare as fuck ((1-2000+) and the vast majority of ADHD sufferes do in fact not suffer with it. Although about half the sufferers of DSPS have some kind of attentional decifict, which may or may not be sleep depervation induced. If you do have DSPS you certainly don't seem to do much to treat it.

I.e. morning & if possible 12pm bright light therapy, proper sleep hygine (I'm not sure how bathing in the dark is related), using a computer 1-3 hours before bed isn't helpful, your room should be as comfortable as possible and preferably there shouldn't be any electronics in the room. If you can't sleep within half an hour of going to bed you should get up and do something (non-stimulating - something like a book) until you feel tired/are possibly ready for sleep or half and hour comes by and you should try again, rince and repeate. Nor are you supplementing with Melatonin/agonist following a dosing structure to replicate normal release. As a side not light restriction at about the same time it gets dark outside is suggested. If you remain treatment resistant chronotherapy is an option. Avoidance of stimulants at least in the late afternoon onwards is required and you could always trial supplementation with b12 despite probable lack of efficacy. L-Tryptophan might be helpful three to four hours before bed.

Pregabalin isn't a sedative, its an anxiolytic. It might help with your anxiety but it will screw with your sleep architecture. Rebound anxiety is unlikely, if you aren't taking three doses a day a RETURN of your anxiety is possible. Its only been shown to be effective for GAD & possibly PTSD. Not for OCD. It may help you sleep.

In regards to Prazosin I'm sure you can guess my views - poorly evidenced and certainly not a sedative. Its main use in psychiatry is to reduce physiological anxiety (which it likely doesn't do well) and reduce nightmares in sleep.

Do look into Trimipramine.

I'm not familiar with the exact medical dx. of DSPS. Maybe it has bled into popular (scientific) culture and become bastardized, but I have had a tendency to want to stay up late and sleep in late since adolescence. Whatever the case, my circadian rhythm has always been off.

You're right that I'm not doing anything to help it because, as I've stated, I am cripplingly non-functional. Any slight concentration or energy I can muster during the day is ruined by endless noise, either from our idiotic toy dogs yapping outside my window (and setting off the 4 or so other dogs that surround us) or my family yelling at each other throughout our shoebox house. That leaves me with about 3 hours wherein I can actually do anything, after they go to bed around 11pm, at which point I'm usually too frazzled and exhausted to concentrate. I will use a computer during those hours, and having f.lux activated is the best I can manage in terms of sleep hygiene. Then, regardless of what time I get to sleep, I'm awoken at 8.30 anyway by the dogs. I've lived like this for 3 years now. have no income, no access to social services and can't actually envision survivng much longer, because it seems like an utterly cruel form of torture (above and beyond dealing with severe depression and OCD, which I've tried almost every conventional option to treat and don't really feel like re-addressing).

(I bolded the quote)

I don't know if this is an option for you, but if you let the people you live with know how miserable you are due to the barking of those dogs, and how hopeless you are because of it, they may be more inclined to deal with the barking problem. A couple shocking no bark collars could make a big difference in your quality of life...

[Heh]

Have you tried the basics? 5-HTP, Melatonin, Niacin (taper up to 3g instant release Niacin, 3g Vitamin C, 1g Vitamin B5)? Give it at least 10 days, so start taking them while you continue your search. Maybe they'll help.

Edited by Joel, 14 September 2013 - 08:43 PM.

[penisbreath]

Sorry to ask, but can you give your dogs up for adoption? That would be the first thing to go if I were in your shoes.

Sorry to ask, but can you give your dogs up for adoption? That would be the first thing to go if I were in your shoes.

I agree. Are your family's dogs really more important to them than the mental health of their own son?

(I bolded the quote)

I don't know if this is an option for you, but if you let the people you live with know how miserable you are due to the barking of those dogs, and how hopeless you are because of it, they may be more inclined to deal with the barking problem. A couple shocking no bark collars could make a big difference in your quality of life...

If they were my dogs, then sure, I would leave the front door open, tie a little food-sack to their collar and bid "Adieu". But giving them away isn't an option and my relationship with my family is already quite strained -- I've asked repeatedly for something to be done about it and they're like "yeah, okay" and never get around to it.

I was mostly put off the idea when I posted on a pet forum asking about collar options and incited a mob of angry pet-lovers who assured me that collars/muzzles of all variety (I'm not talking shock here, just vibrating, or possibly an elasticized muzzle) are inordinately cruel. So now I'm not so sure; I guess the psychological anguish they inflict is far more cruel (and I imagine a human's wellbeing > pets, in philosophical terms).

Have you tried the basics? 5-HTP, Melatonin, Niacin (taper up to 3g instant release Niacin, 3g Vitamin C, 1g Vitamin B5)? Give it at least 10 days, so start taking them while you continue your search. Maybe they'll help.

I take Melatonin, yes .. Vitamin C stimulates me if taken at night, never tried 5-htp, Niacin used to be help so I should probably look into that again.

Edited by lucky.pierre, 15 September 2013 - 06:04 AM.