PEF wrote:I would like to comment here because I have really bad insomnia, have had it all my life. I have a very dangerous kind. I have gone as much as 9 days and nights with only about 1 to 2 house of sleep per night, but laying in bed the whole time.
Two comments:
1) If you can't sleep, there's often no point in lying in bed
fighting for sleep. Sometimes it's best to get up and go into a different room and see if you can calm your mind and encourage it to get sleepy enough to try to go to bed again.
2) Many people who lie in bed for hours thinking they're not sleeping actually do get more sleep than they think they do. Has your insomina been evaluated in a PSG? How much sleep was documented on the sleep test and how did that compare to how much sleep you thought you got during the night?
You write:
When I was 38, the death of my 32 year old husband caused a spell of it that landed me in the hospital for 3 weeks. After that, they had me on a small dose of a combination of Amitriptiline and Perphenazine(2mg). This worked like a miracle for 20 years. Then, because I got older, I could no longer tolerate the Perphanazine , so I just kept taking the 25 Amitriptiline. So then I had trouble getting to sleep, but I was able to stay asleep. My doctor substituted Ambien for the Perphenazine. The Ambien does not work as well. I only take about 3mg per night because, if it does not work in the first hour, it is useless and I never take more.
You are right: If the Ambien doesn't kick in very soon after taking it, it's not going to do much good. But the usual dose for Ambien for sleep-onset insomnia is 5mg. And it's not uncommon for docs to prescribe up to 10mg. That 3mg dose at the beginning of the night may simply not be a big enough dose to help you fall asleep. Have you considered talking to the doctor about increasing the dosage?
Or have you considered switching to a different sleep medication entirely. Sonata and Lunesta may be worth a trial. I think both are now available in generic forms that don't cost an arm and a leg. There is also a much newer sleeping pill on the market called Belsomra. It works in a different way from Ambien, Sonata, and Lunesta. Most sleeping pills like Ambien work by "turning up drowsiness"---often they became "sleep medication" because "excessive sleepiness" was a very common side affect when they were in clinical trials for other conditions. Belsomra works by "turning down wakefulness". There's some controversy about whether the doses that were approved by the FDA are large enough for Belsomra to be effective. And since it's brand new, it's still under patent, and hence expensive. Still, it may be worth a try. Belsomra comes in 5mg, 10mg, 15mg, and 20mg doses. You might want to talk to your doctor about the possibility of trying Belsomra to see if it works any better for you than the Ambien does.
You also write:
I have tried everything imaginable to get rid of insomnia including mindfullness meditation, all kinds of tapes, sleep hygiene, you name it. They would all work for a few night and then the insomnia would come back.
So you've done some cognitive behavior stuff on your own. But have you ever worked with a professional CBT therapist on designing a full fledged cognitive behavior program to help
manage the insomnia? In other words, have you worked with someone who has started out asking you questions about what you think a
good night's sleep is supposed to look like? And who can teach you strategies for learning how to
manage the insomnia rather than trying to simply "get rid" of it altogether?
I ask this question because one of the most critical things that helped me get through an incredibly difficult CPAP-adjustment period was the fact that a PA in my first sleep doc's office met with me about 1-2 a month for several months while directing a CBT-I program for me. It did me a lot of good in learning how to manage the worst parts of my insomnia. The goal was never to completely eliminate my insomnia; rather the goal was to help me teach myself what I needed to do long term in order to get a decent night's sleep on
most nights and to not freak out about the nights when my sleep was far less than decent.
If anyone has any ideas, I would be happy to hear them.
To come up with ideas that you may not have tried, I'd need to know some information about your usual sleep habits:
1) What time do you go to bed?
2) What time do you get up each day?
3) Do you take naps during the day? If so, how many and how long do they last?
4) How long does it take you to get to sleep at night? Do you get frustrated or angry when you can't get to sleep?
5) What happens when you first wake up in the middle of the night? Are you angry?
6) Do you look at the clock multiple times during the night trying to figure out how much you may have slept? And how much time there is before you have to get up? Do you get angry at yourself when you realize that it seems like you've only gotten 1-2 hours of sleep and there's only 2 or 3 hours before you have to get up?
7) Do you watch tv in your bedroom? Do you browse the internet while in bed? Do you send a lot of text messages on your phone when you are in bed? Do you commonly read in bed? And if so, do you find yourself getting so interested in what you are reading that you don't
want to turn out the light and try to go to sleep?
Do you get outside for more than just a few minutes during the daytime? Do you get any regular exercise?
