SSRI, Sleep Med, or Other?

All,

Thanks to everyone, I'm working at this treatment. However, I'm having a spell of anxiety or perhaps insomnia of both types from sleep deprevation. I really think the OSA has fried my brain in some way. I simply can't turn off my brain to sleep or for anything else. I'm pretty sure it's anxiety because when I quit looking at my numbers every morning I had a really good spell. Yet, I missed some things in my treatment and got sick again as I was having a lot of cluster apneas.

I have a drawer full of pills that my PC gave me when I first starting having OSA symptoms. They never worked probably because I didn't yet know I had OSA. Now, I have the Apap and don't go to bed without it, but I think I might need some help from something.

I have the SSRI Lexapro, Ambien, traxadone(?), melatonin, and maybe some others. Does anyone have a positive experience with any of these helping you work through the first year of therapy. I know there are lots of posts on this, but my fried brain can't make it through at the moment. You guys are always so helpful. I really don't know where else to turn. I really never had any issue sleeping until I got sick. Now, I can't even lay in bed with my machine for a nap without staring at the wall.

Best,

Mike

For immediate help, try the lowest dosage of Ambien that you have (or cut pills) and see how that works, but do try Melatonin (only 1 mg - if that - at least 1/2 hr before bed). It works, but can be funny in that ... once you take it for a few nights it starts backfiring - e.g. you'll go to sleep, but then awaken maybe a couple of hrs later... so while I don't take it routinely in any case (better to stop caffeine much earlier in the day), I only take it for 1-2 nites at a time, then skip 1-2 and try again so I don't run into that glitch. But it's the least harmful of anything else I know... not like any of the other things you mentioned. And try Valerian tea - it can also help.

Thanks. I've played around with melatonin. Sometimes it helps a little. I should mention that I also have Elavil as well.

With the ambien, I have 10mg. I'm assuming to split that in half like a lot of the posts I see and maybe take the other half if waking again early in the night? I have to admitt I've stared at that bottle a lot over the last 6 months but never gave in. Maybe I'm a dummy in that regard.

Mike

What strength Elavil?

Ambien is mainly for help in getting to sleep and might not last through the night and if you take it in the middle of the night you may experience significant left over morning grogginess. It depends on how your body responds.
There is a controlled release version of Ambien that is supposed to last longer.

Elavil..amitryptiline... in low doses might do the trick. Again it depends on how the body responds or metabolizes it.
Low dose meaning around 10 mg or so. Big doses will likely cause significant morning/daytime grogginess though.

Ambien isn't something I would want to use night after night for prolonged periods of time though...certainly not for a year.

Pugsy wrote:What strength Elavil?

Ambien is mainly for help in getting to sleep and might not last through the night and if you take it in the middle of the night you may experience significant left over morning grogginess. It depends on how your body responds.
There is a controlled release version of Ambien that is supposed to last longer.

Elavil..amitryptiline... in low doses might do the trick. Again it depends on how the body responds or metabolizes it.
Low dose meaning around 10 mg or so. Big doses will likely cause significant morning/daytime grogginess though.

Ambien isn't something I would want to use night after night for prolonged periods of time though...certainly not for a year.

Yes, the elavil is 10mg not sure I remember how they told me to use it. I've resisted the ambien for now. Do some of those here use it just to break up a series of bad nights? if so, how?

Thanks,

Mike

Amitriptyline 10 mg is a relatively low dose and I use it (and have used it for probably 5 years) to help me sleep just a little deeper/better. I have some arthritis issues that cause pain and thus multiple wake ups due to the discomfort.
I don't normally have issues getting back to sleep though but 30 wake ups a night if I don't take it will pretty much trash any sleep quality I might hope to have.
It doesn't have the potentially "habit forming" qualities that Ambien or Trazadone might have....though I do admit to taking an Ambien every now and then. Mainly when I have been unable to take the Amitriptyline when I need to take it.

If I take Amitriptyline (mine is also 10 mg) after 10 PM I am pretty groggy the next morning but sometimes I forget to take it or I am away from home. Last night I forgot until bedtime at 11:30...so I took an Ambien instead. I should have cut the Ambien in half and taken 5 mg...it took me a little bit to get a clear head this morning. Not a huge problem because I didn't have anywhere to go or anything I had to do early.

My Amitriptyline instructions say to take 1 or 2 or the 10 mg tablets at bedtime but I have found that it works best for me if I take about 2 hours prior to anticipated bedtime which for me is usually around 11 PM give or take a little.
Usually 1 tablet is all that I need. While I might wake up a couple of times (usually when I roll over onto my back and that causes back pain) I normally just roll back over onto my side and go back to sleep.

Of the RX meds you listed...if you haven't tried the Amitriptyline at bedtime you might give it a shot to see if it helps or not.
It would be the one I would think would have less chance of causing problems long term (of the choices you have available) though I would also advise that you keep your doctor in the loop.
Melatonin...helps some and doesn't help others and can't really be put in the same class as the RX meds so I can't really compare or comment on it. I had some nasty side effects to it when I tried it (everything has a potential to have side effects).

Amitriptyline is also a type of anti depressant/ anti anxiety med...in low doses it is used for pain management too with good success and that is why it was given to me.
If your insomnia is stress related...maybe that little bit would help in that area also.
Lexapro is much more beefed up class of SSRI meds and thus it also has the potential to mess with sleep architecture (insomnia which you don't want to make worse)...yes, it is supposed to cause drowsiness but it is normally prescribed in bigger doses and if it is going to mess with sleep then the chance is greater with the larger dose.
So that's why I lean towards the small dose of amitryptiline as being the lesser of the potential evils as a potential sleep aid.

When it was first prescribed to me the doc said to start with 10 mg and do that for about a month and then go to 20 mg a night...I did that for several months (probably a year) and then he gave me 20 mg so I only had to take one tablet but I found that 10 mg does just as good of a job in my situation. So now my RX says take 1 or 2 of the 10 mg tabs.

One thing I like about it is that if I decide to not take it for a period of time or just one night...there is no withdrawal that I could tell. Last summer I experimented to see how my sleep would be without it and I didn't really have any withdrawal symptoms that I could see. I went 3 months without it and about all I noticed was the pain woke me up a LOT more often and in general my hours of sleep were lessened due to "can't lay in bed any longer because it hurts" thing.

I don't use the Ambien more than 2 or 3 times a week and sometimes will go a month and not take one...so I have never really used it long term enough to develop any sort of "physical" need for it to the point if I don't take it there are withdrawal issues.

Of course my pain issues aren't the same as your insomnia (because the brain won't shut off) and you may or may not see any positive results but since you have the Amitriptyline...you might try it.
Either than or the Ambien but with the understanding that Ambien is strictly short term sort of emergency only meds.

Macpage wrote:got sick again as I was having a lot of cluster apneas

It's unclear to me how well your current CPAP therapy is working. If you want to do this right, here is mandatory list.

1. Optimize CPAP therapy
2. Learn and practice excellent sleep hygiene every day
3. Regular moderate exercise program
4. Good diet - real foods in reasonable amounts

Drugs are a band-aid and a poor band-aid at best and sometimes a disastrous band-aid.

You seem to understand that the root of your problems is sleep deprivation and sleep apnea.

You won't be able to solve sleep deprivation until you have a good CPAP therapy.

I think you can be successful with everything.

Maybe I can get my husband this weekend to tell you how bad a mess he let himself get in before he got a CPAP. He made it, you can too.

Pugsy wrote:Amitryptiline 10 mg is a relatively low dose and I use it (and have used it for probably 5 years) to help me sleep just a little deeper/better. I have some arthritis issues that cause pain and thus multiple wake ups due to the discomfort.
I don't normally have issues getting back to sleep though but 30 wake ups a night if I don't take it will pretty much trash any sleep quality I might hope to have.
It doesn't have the potentially "habit forming" qualities that Ambien or Trazadone might have....though I do admit to taking an Ambien every now and then. Mainly when I have been unable to take the amitryptiline when I need to take it.

If I take amitryptiline (mine is also 10 mg) after 10 PM I am pretty groggy the next morning but sometimes I forget to take it or I am away from home. Last night I forgot until bedtime at 11:30...so I took an Ambien instead. I should have cut the Ambien in half and taken 5 mg...it took me a little bit to get a clear head this morning. Not a huge problem because I didn't have anywhere to go or anything I had to do early.

My amitryptiline instructions say to take 1 or 2 or the 10 mg tablets at bedtime but I have found that it works best for me if I take about 2 hours prior to anticipated bedtime which for me is usually around 11 PM give or take a little.
Usually 1 tablet is all that I need. While I might wake up a couple of times (usually when I roll over onto my back and that causes back pain) I normally just roll back over onto my side and go back to sleep.

Of the RX meds you listed...if you haven't tried the amitryptiline at bedtime you might give it a shot to see if it helps or not.
It would be the one I would think would have less chance of causing problems long term (of the choices you have available) though I would also advise that you keep your doctor in the loop.
Melatonin...helps some and doesn't help others and can't really be put in the same class as the RX meds so I can't really compare or comment on it. I had some nasty side effects to it when I tried it (everything has a potential to have side effects).

Amitryptiline is also a type of anti depressant/ anti anxiety med...in low doses it is used for pain management too with good success and that is why it was given to me.
If your insomnia is stress related...maybe that little bit would help in that area also.
Lexapro is much more beefed up class of SSRI meds and thus it also has the potential to mess with sleep architecture (insomnia which you don't want to make worse)...yes, it is supposed to cause drowsiness but it is normally prescribed in bigger doses and if it is going to mess with sleep then the chance is greater with the larger dose.
So that's why I lean towards the small dose of amitryptiline as being the lesser of the potential evils as a potential sleep aid.

When it was first prescribed to me the doc said to start with 10 mg and do that for about a month and then go to 20 mg a night...I did that for several months (probably a year) and then he gave me 20 mg so I only had to take one tablet but I found that 10 mg does just as good of a job in my situation. So now my RX says take 1 or 2 of the 10 mg tabs.

One thing I like about it is that if I decide to not take it for a period of time or just one night...there is no withdrawal that I could tell. Last summer I experimented to see how my sleep would be without it and I didn't really have any withdrawal symptoms that I could see. I went 3 months without it and about all I noticed was the pain woke me up a LOT more often and in general my hours of sleep were lessened due to "can't lay in bed any longer because it hurts" thing.

I don't use the Ambien more than 2 or 3 times a week and sometimes will go a month and not take one...so I have never really used it long term enough to develop any sort of "physical" need for it to the point if I don't take it there are withdrawal issues.

Of course my pain issues aren't the same as your insomnia (because the brain won't shut off) and you may or may not see any positive results but since you have the amitryptiline...you might try it.
Either than or the Ambien but with the understanding that Ambien is strictly short term sort of emergency only meds.

Thanks so much. I will give it a try. As you say it's here and I don't have anything to lose. The GI doc prescribed mine for pain as well. He's also the guy who pointed me towards the OSA when he couldn't find anything wrong with me. He said they use the medicine for a lot of GI pain issues that don't have definitive causes. I'll hold off on the ambien until things get really desperate and even then I'll do it as little as possible. I did take the SSRI in low dose for a while, but I could never tell anything from taking it that helped with the sleep. Thanks again for taking the time to explain it to me.

All the best,

Mike