Seeking input on Rx Sleep meds, SSRIs, insomnia treatment

I've got a followup appointment with my sleep doc. next week. Prior to the sleep doc refereal, I got a clean bill of health from my PCP, bloodwork, EKG, spirometry etc. I've been thru 2 sleep studies, Ambien was used in both.

In both study graphs, my wake/sleep cycle looks like a bar code. First study no REM, second study 30 minutes total combined REM, very fragmented over the course of the night. Moderate severe alpha intrusions, %50 sleep efficiency in both studies, UARS, REAS was around 38, lowest 02 was %88. My actual AHI was low, around 1 both times which is the norm when I don't sleep well.

I go to sleep and the moment that I drift off, I wake, often breathing harder and with a racing pulse. Pulse rate graphs indicated this and coincident with the wakings. I repeat this cycle all night. It has been the norm for me for a long time. If/when I actually get a somewhat decent nights sleep my AHI runs around 5-7 at 10cm. Got the go-ahead to bump it up to 11cm.

I systematically eliminated all meds, OTC, suppliments etc. as the cause, I only take lisinopril & nasonex so there wasn't much to eliminate. Only other foreign substance was aspartame. I eliminated it from my diet, no change in sleep quality. Only one morning cup of coffee. No other stimulants. I don't snack after dinner. No alcohol. I don't watch any evening TV that gets gets me worked up, actions movies, politics etc. I generally try to read an hour before bed.

My sleep hygiene is about as perfect as it gets. I've been very structured and disciplined since addressing the whole sleep issue. I could elaborate more here but I won't. I've adjusted to CPAP like a duck to water.

I was given an Rx for Ambien 10mg. It worked fairly well getting me to sleep but I still had issues with poor quality of sleep, still tired during the day. The only side effects I was having were a very high level of irritability, and swings to euphoria. I couldn't deal with the emotional swings and I quit the Ambien. The rebound insomnia was rough but I got thru it. Now I'm back to the ping-pong sleep-wake cycle I'm used to. I've been using the brainwave entrainment music but it's hasn't been any more effective than white noise.

I'm wondering if anyone here has experienced long term insomnia or symptoms similar to those that I describe. If so, what meds were you prescribed and what worked and what caused you problems? In reading up on insomnia, I've run across trazadone, mirtazapine, amitriptyline that have commonly been used to treat insomnia. A few others that I can't recall. I'm not really keen on taking any meds that have withdrawl issues like SSRI's. I have taken Paxil many years ago and I hope I never have to take a similar med again. Mirtazapine did help get me off the Paxil with no side effects. Benadryl doesn't do much to promote sleep for me, I've tried Tylenol with benadryl, tried Sominex (bad hang over from it). Tried Dr. Falcon's recommendation of Claratin for the UARS, didn't have any effect but I had been on Claratin for years for allergies so it may have lost some effectiveness.

I'm not expressly looking for an Rx solution, I don't like the thought of having to take anything other than occassionaly, but if it comes to that during the upcoming doc vist, I want to be prepared and educated for the best possible option(s). I don't know if CBT will be an option or if it's coverend by my ins. I've also read a little on on SR (Sleep Restriction). I'm not ruling out non-drug optons either, increased exercise. I more or less work 7 days a week, a portion doing physical labor in a farming job.

Sorry about the long read, I get into details. Looking for any suggestions, links, personal experiences, good or bad. I just want to get back to someting resembling a normal sleep pattern. I think CPAP has addressed one half of my sleep issue, now it's time to get after the other half. Thanks!

you could try melatonin which helps some but not me, get some high dose good quality tablets and take for a few months

Paxil is the wrost antidepressant medicine you can ever take, the reason is it has the worst withdrawal symptoms of all. so don't guage the rest of antidepressants based on your experience with Paxil

long term insomnia shouldn't be treated by direct sleep aids because rest assured your brain will get used to it over few days or weeks and it will no longer be as effective which will lead to a cycle of increasing the dose and dependance- sleeping aids are for short term or occasional nights only. long term insomnia should be treated from the cause but not by direct sleeping aid

number 1 reason for long time insomnia is depression - SSRI like Lexapro is very nice one to try, no serious side effect and ro withdrawals
(that if you don't want to check other symptoms of depression or think you don't have it, then you might just try the med.)

Rusty - I'm so sorry that you're continuing to have this problem. I know how miserable it is.

Trazadone is bad for inducing Stage I sleep for large parts of the night - you know, that "I'm not awake but I'm not really asleep either" stage. It wouldn't be my first choice if it were me. Mitrazapine (Remeron) is being used more and more as a sleep aid and is pretty effective for alot of people. Remember that low doses of it tend to be more sedating than higher doses.

I expect you're beyond this advice, but chamomile tea can be helpful.

millich wrote: but chamomile tea can be helpful.

I agree with Chamomile tea. Very relaxing & sedating, with no ill effects, upon waking. Also a half tablet of Melatonin worked really well, from Acupuncurist, Melatonin made me feel a bit groggy upon waking, but it did knock me out !!!! And the grogginess, didn't last.

Thanks for the input. I've tried the melatonin, valerian and Tilo. I need to go back and try a low dose of melatonin. What I've been reading regarding melatonin study data is a low dose is better than the standard OTC dose. I'll give Chamomile tea a try too. How is it cold as an iced tea?

Lexapro side effects/withdrawl listed are similar to other SSRI's. I guess symptoms would be similar to GAD which shares some symptoms with depression. I'll see what the doc has to say, be my luck it goes in a totally different direction and I'm caught off guard.

Rustyolddude,

I’ve got plenty of co-miseration for you but, unfortunately no practical advice. I have pretty severe insomnia in addition to OSA. I’ve tried to explain to my sleep doc that they are separate issues and she responds by continuing to tweak my CPAP therapy, as if that were the whole solution. The OSA is a relatively easy thing to deal with compared to insomnia and depression. I’m being fitted for a full face mask soon and as soon as I get that resolved I am going to explore the mental health part of this. I have a bad history with anti-depressants but am willing to try anything that will help me sleep.

Rusty

Here is a nice comparison of the various meds used for sleep:
http://www.emedexpert.com/compare/sleeping-pills.shtml

I've used Lunesta for my insomnia which tends to be more of a cyclical nature (months on, months off). It works like a charm and then I'm able to wean off easily when I no longer need it. It is supposed to be one of the easier ones to get off of and I have found that to be true.

OTOH, with your long history of crappy sleep, you may have to accept the idea of long-term meds. Accepting that idea lets you worry less about the difficulty of withdrawal effects (like from the SSRIs). So you stay on something from now on. So what? You get years of good sleep. How awful would that be?

I just want you to entertain the possibility before your doctors appointment. Let us know what you and the doc decide, okay?

millich wrote:Rusty

OTOH, with your long history of crappy sleep, you may have to accept the idea of long-term meds. Accepting that idea lets you worry less about the difficulty of withdrawal effects (like from the SSRIs). So you stay on something from now on. So what? You get years of good sleep. How awful would that be?

I just want you to entertain the possibility before your doctors appointment. Let us know what you and the doc decide, okay?

Thanks for the link. Mind you, I'm not dead set against having to take something long term as long as it's recommended for long term use by the maker and the side effects are managable. Just trying to one-up the doc. in case he recommends a med that others have had a bad experience with.

Please do some checking on the ssris before you take them. Lexapro is a horrible drug. Read up on it before you take it. It's been 20 months of horrible side effects for me. I know that some probably take it and love it and have no problems with it. Good for them. http://www.drugs.com/forum/featured-con ... 24681.html

RustyDude -

With your determination and attitude, I feel confident that you'll find a solution soon! You asked about CBT. I haven't tried it myself, but I have read they have a fairly high success rate in treating insomnia. If your insurance will cover it, I think it's worth a try. Given your crappy sleep architecture, If It Were Me, I'd probably go with meds AND CBT instead of CBT alone. But that's me.

If you don't like hot tea - make your camomile tea, let it cool almost to room temp, and then jug it. I hope the tea helps!!!

Crickette wrote:I have learned that Ambien is one of thos medications that effects apnea. It causes more events.

That's odd.. My sleep doctor says that Ambien won't make OSA worse and is quite comfortable prescribing it for sleep related issues. I take it off and on and my data (I have the software) is pretty consistent with or without the Ambien.

I go to sleep and the moment that I drift off, I wake, often breathing harder and with a racing pulse. Pulse rate graphs indicated this and coincident with the wakings.

It may take your sleeping brain a few months to trust that you won't die while asleep. For years this action has been keeping you alive, now it is a bad habit you have to break.

Don't be afraid to move to the "dark side" - alternative therapies. Be sure you check out the practitioner before dropping a load of cash.
You might find various biofeedback , relaxation methods or hypnotherapy might help retrain your brain. They won't work over night and they take time to practice. Some peoples insomnia responds well to this kind of thing others don't. Remember alternative therapies work with YOUR body/mind/spirit not on your symptoms so what helped your friend will not always help you. The practitioner will always be 100% sure they can help but that is their job - to inspire hope and attitude change.

I went this route many years ago to deal with my migraines and allergies - it helped tremendously when I had to deal with OSA. I know my mind, I can make it do things and I know when I need help I know what kind of person to turn to and how to make it work fast.

BlackSpinner wrote:

I go to sleep and the moment that I drift off, I wake, often breathing harder and with a racing pulse. Pulse rate graphs indicated this and coincident with the wakings.

It may take your sleeping brain a few months to trust that you won't die while asleep. For years this action has been keeping you alive, now it is a bad habit you have to break.

Don't be afraid to move to the "dark side" - alternative therapies. Be sure you check out the practitioner before dropping a load of cash.
You might find various biofeedback , relaxation methods or hypnotherapy might help retrain your brain. They won't work over night and they take time to practice. Some peoples insomnia responds well to this kind of thing others don't. Remember alternative therapies work with YOUR body/mind/spirit not on your symptoms so what helped your friend will not always help you. The practitioner will always be 100% sure they can help but that is their job - to inspire hope and attitude change.

I won't rule anything out, I generally research it whether it's medication or an alternative therapy, as long as I see it's helped someone, I'm willing to give it a try. I'm pretty self aware, and have been successful modifying my behavoir when neccessary. Problem is, this sleep issue isn't something I have direct control over, it's a subconscious, autonomic thing. I've removed & modified everything I've got control over. Maybe it is like you suggest, a result of years of apnea events and and my brain & body being afraid of going to sleep. I know I experienced that as a teenager, multiple full awakenings every night. I didn't get in this state overnight and I know I won't be cured overnight but I'm on a mission now to find a cure instead of continuing to just deal with it.