rebound insomnia

[Hea83ther]

I am experiencing rebound insomnia after being taken off elavil. Prior to elavil, it took me an hour to fall asleep at night. I was on it for four years, and my new doctor said even though it's making me fall asleep, it's negatively affecting my sleep architecture. He warned me it would be hard to fall asleep after going off of it, but I had no idea it would be this bad. I'm sleeping about four hours per night for the past week and a half. He told me I could use benadryl sparingly, so I tried it last night. It did nothing.

I've tried everything I can think of to do-going to bed early, going to bed late, cutting back on caffeine, and nothing is working. I also have a seizure disorder (controlled by meds), and I'm afraid the stress of so little sleep could cause a breakthrough seizure if it doesn't get resolved. I'm starting to fall asleep at work while trying to do paperwork and getting really sleepy while driving.

And, I haven't even started CPAP yet (this Friday I'm getting my machine), so I'm scared that it will make the insomnia even worse when I start it.

Any ideas would be appreciated.

[ThirdOutOfFive]

I don't have any real answers for you, darn it. But, I can understand where you are coming from. I have fibromyalgia, and have been on anti-depressants for sleep for 17 years. (I also get to juggle diabetes, ventricular tachycardia and chronic depression.) I'm still taking the sleep meds, even though I am using PAPpy. I took my pills before both the sleep test and the titration night. No one mentioned any unusual finding with my sleep architecture. I still have trouble falling asleep -- sometimes PAPpy adds to that because it is another thing for me to concentrate on.

I wonder if you should call your doc and let him (her) know about your concerns re your epilepsy? Seems to me that altered sleep architecture is not as serious as seizures. . . .

I so wish that I had the answer for you. What I do have is an ear (eye, since we are online?). Post or PM me if you want.

[idamtnboy]

I am experiencing rebound insomnia after being taken off elavil.

Any ideas would be appreciated.

How about melatonin? It's an OTC natural hormone that induces sleepiness. I used it several years ago to advance my bedtime by 6 hours over one week prior to going to Europe. Worked good.

Here's one article about its use for insomnia. http://web.mit.edu/newsoffice/2001/melatonin-1017.html Google will bring up dozens more pages.

[Rustyolddude]

You might also ask your doctor about Remeron aka. Mirtazapine (generic). It's used effectively as a sleep aid, no withdrawal issues, lower doses work better than higher doses. Most common side effect is craving carbs. As my doc says, "it's great for underweight little old ladies with anxiety." Low cost generic works just as well. It of course will depend on compatibility with your other meds. No issues with long term use other than potential weight gain. Far safer than the benzo's like the devil Ambien etc.

One other thing that was suggested to me here, gosh been probably 2 years now, was to take a MP3 player and load Dr. Thompsons Delta Sleep System on it, pop the ear buds in, toss the player in the pillow case. That was the best bit of advice that I was ever given. I actually use two 80 minute meditation music tracts now. It works great because the "stimulus" gives your brain something to do instead of lying there focusing on trying to sleep, the ear buds block out other noises and they fall out on their own during the night. I route the wire down from the top of my pillow with my hose, I've never had an issue getting tangled up.

[chunkyfrog]

There is another activity which helps younger folks fall asleep--sometimes some of us old farts, too.

[robysue]

I am experiencing rebound insomnia after being taken off elavil. Prior to elavil, it took me an hour to fall asleep at night. I was on it for four years, and my new doctor said even though it's making me fall asleep, it's negatively affecting my sleep architecture. He warned me it would be hard to fall asleep after going off of it, but I had no idea it would be this bad. I'm sleeping about four hours per night for the past week and a half. He told me I could use benadryl sparingly, so I tried it last night. It did nothing.

I'd suggest calling the doc back and letting him know just how difficult things are getting now that you're not taking the elavil. It may be that a strategy to wean you off the med is needed---in other words, maybe the doc would ok you going back to a half-dose of elavil for a while and then a quater dose and then off of it entirely.

I've tried everything I can think of to do-going to bed early, going to bed late, cutting back on caffeine, and nothing is working.

As hard as it sounds, you may need to cut the caffeine out completely instead of just cutting back on it.

A few other self-help tips that might be useful, although some of them may be difficult to implement:

1) Make sure you get at least a bit of exercise everyday, but not too close to bedtime. If you can force yourself to take a 15--30 minute walk after lunch or supper that might help with the insomnia.

2) If possible try to get outside some during the daytime every day. If you can manage to take that 15--30 minute walk after breakfast---outside and in the morning light---that might help more than just a walk after supper (in the dark). A SAD light can give you some simulated sunlight in the morning, but the good ones are not cheap.

3) If at all possible, try to maintain a consistent WAKE UP time---even on the weekends and even when you don't feel like getting up. Sleeping in on a morning following a bad insomnia night or sleeping in on the weekends tends to mess up my ability to fall asleep on time for several days, and that of course, has the tendency to become a bad feedback loop that makes the insomnia get worse, not better.

4) No naps during the daytime no matter how tired you are. Yes, you'll drag along during the afternoon or evening. But until the insomnia is under conrol, napping usually messes up the ability to get to sleep and stay asleep at night.

5) Do some reading on sleep hygiene. See if some of the suggested practices for good sleep hygiene are missing. Two of the most important in my opinion are:

• Go to bed only when you are sleepy enough to get to sleep and learn to tell the difference between being tired or exhausted and sleepy. Feeling exhausted is not the same as feeling sleepy. And no matter how exhausted you are, it's difficult to fall asleep when you are not actually sleepy.
• Reserve the bedroom for sleeping and sex and make the bedroom inviting for sleep. Kick the tv and computer out of the bedroom. If you find that reading in bed doesn't make you sleepy in a few minutes, don't read in bed. (I can't read in bed because I tend to stay awake turning the pages---even when what I'm reading is not all that interesting; but if I read in my recliner in the living room, I will get sleepy enough to then go to bed.)

6) Find a book called Sound Sleep, Sound Mind by Dr. Barry Krakow. Most of this book focuses on cognitive behavior approaches to dealing with insomnia. He's also got plenty of things to say about just how and why insomnia gets started in the first place and he also has a long section on the connections between sleep apnea and insomnia and unrestful sleep.

And, I haven't even started CPAP yet (this Friday I'm getting my machine), so I'm scared that it will make the insomnia even worse when I start it.

There's a chance that CPAP will actually help with the insomnia. For some folks, all those mini-arousals triggered by the apneas and hypopneas turn into full wakes often enough where they feel as though they're getting little or no sleep at night. And once the apneas and hypopneas disappear, so do those arousals triggered by the apneas and hypopneas and they sleep better.

Of course, there's also the chance that starting CPAP will aggravate the insomnia. Alas, I know far more about that problem that I'd ever wish on anybody. If you find yourself fighting the machine and fighting for sleep night after night in the early going, you'll want to check out my blog entry Taming the CPAP-Induced Insomnia Monster.

And I sincerely hope that the CPAP helps your insomnia rather than feeding it.

[Hea83ther]

Thanks for all of the advice!