Posted by Rick on November 12, 2002, at 15:28:25
In reply to Sleep Cycles and Depression, posted by Alara on November 11, 2002, at 23:43:02
Just a few random thoughts about what you're dealing with...
There are SOOO many factors that could be contributing here (and I don't claim to know which are the most likely). This obviously includes some basic psychiatric components, but could also relate to meds, physical or hormonal issues ranging from obstructive sleep apnea to periodic limb movements to eating habits/nutritional deficiencies to blood sugar abnormalities and on and on.
If you haven't been to a sleep clinic, this is clearly an advisable first step. Also, if your antidepressant treatment was prescribed by a GP, you should see a psychiatrist -- preferably one who does a lot of work in sleep disorders. And if you haven't already done so, do a net search to find one of the many, highly active, sleep disorder info+discussion sites on the web. They really have a lot of info, ideas and shared experiences relating to both physical and psychiatric causes (including depression and anxiety).
It could be that whatever meds you're taking and/or the dosages/dosing schedules are making the sleep-related problem worse.
Before I started taking Klonopin (1 mg, all in the a.m.) and dropped from 220 to 180 pounds, my sleep pattern had a lot in common with yours, although to a lesser degree. I would also experience spontaneous multi-week "holidays" where the symptoms would improve temporarily. And I also had a hell of a time getting to sleep when anticipating a next-day stressor like an interview or a presentation. (Daily morning Klonopin has been a godsend in getting rid of most of this kind of insomnia-inducing anticipatory anxiety.) I don't know what proportion of my sleep improvement is due to the long-lasting effects of the Klonopin and how much is due to the weight loss that seems to have resolved my sleep apnea. (But again, I'm sure the Klonopin is a major contributor. The fact that it allowed me to get to sleep MUCH faster and sleep better even before I started losing weight is further evidence.)
While lots of people seem to relish their dreams, I find that the more I dream, and the more intense they are, the more tired I'll feel the next day, and the more prone to feeling mentally down or more susceptible to anxiety (athough still nowhere as bad as before I started taking Klonopin). That sounds at least somewhat similar to your experence. I've long found that the worst sleep and the "noisiest" and weirdest dreaming usually happens if I wake up, say, 90 minutes before the alarm is set to go off, and then go back to sleep. This is especially true if the early-awakening lasts for more than just a few minutes. Even though I know it's important to get enough sleep, I truly feel better the rest of the day by just hopping out of bed after waking up an hour or two early, rather than going back to sleep and waiting for the alarm.
Although it *did* cause insomnia, I always seemed to wake up refreshed when I was on Nardil. I'm guessing that's because it completely surpressed any dreaming (or perhaps more acurately, *recall* of any dreaming).
Re the daytime sleepiness, have you considered a stimulant? I'm partial to Provigil because it's gentler than the traditional stims, few side effects, virtual lack of abuse potential, and surprisingly doesn't affect the ability to sleep when you WANT to (after the first 2-7 days, anyway).
Again, I don't know what AD you're using, but if you do use a daytime stim maybe you could switch to a more sedating AD like Serzone or Remeron, which would help you get to sleep at night after the Provigil or other stim wears off. That, along with Klonopin, could help you get to sleep quicker, thus allowing you to get up earlier without as much difficulty.
Fyi, I'm now taking 1 mg Klonopin, 300 mg Serzone, and 100 mg Provigil, all first thing in the a.m. (although in the early weeks/months it might be better to take the former two in divided doses, especially Serzone). I've also been on Klonopin alone, and Klonopin & Provigil without the Serzone (but I have non-depressive social anxiety). With all three regimens, getting to sleep is so much easier than it was for me "pre-meds," 90% of the time. The difference is that on K alone, I'm more prone to waking early, but am almost always bright and alert when I *do* get up (might be a different story with nighttime dosing of K, which isn't recommended for more than a few weeks duration). When I add the other meds, I still get to sleep easily, but rarely wake up early. The flip side, though, is that it's harder - sometimes *a lot* -- to get up, and when I do, I'm pretty groggy. But that half-asleep feeling goes away pretty quickly, especially after I take my morning meds. The other difference is that, with the K alone, *sometimes* I'll suddenly start getting kind of fatigued, especially late afternoon. When I'm taking Provigil with it, that happens only once or twice a month.
Rick
>
> Manowar, sorry to dredge this post up again but the findings of this study are very interesting.
>
> I have always had problems with my sleep cycle. Even when I was a child, I'd experienced a delayed sleep gateway (tossing and turning for hours before finally getting to sleep) and would then fall into a very intense sleep state. Once asleep, I could sleep through an earthquake! When I'd wake up I'd often recall a lot of dreams and would often feel as though the dreams had exhausted me,making sleep a far from refreshing experience. Even then, I struggled with getting out of bed to go to school and would always sleep in until lunchtime on the weekends (until my father forced me out of bed)! On one or two occasions my father caught me asleep in another room after sleepwalking to the bathroom. lol.
>
> As an adult my sleeping crisis has become progressively worse. Upon entering the workforce I would toss and turn for weeks without sleeping and then suddenly the insomnia pattern would be broken and I'd get some reprieve for a few weeks or so. This on-off-on-off sleeping pattern continued for many years until the age of 26, when I got glandular fever and all the problems with depression started.
>
> At 32, all I want to do is sleep. This has been going on for a couple of years and is getting ridiculous. As I am not working at the moment, I have the luxury of sleeping as much as I want. I wake up many times during the night, usually after dreaming and often can not go back to sleep until the alarm goes off. (Of course I just throw a pillow at the stupid alarm and go back into the land of the nod. It's almost as though there's a series of dreams which must be completed before I can surface into the day. Know what I mean??) I am getting very close to getting a full-time job and need to think about an antidepressant medication which may help with my sleep cycle. Sleep really seems to be the key with my mood, anxiety levels, and ability to tolerate stress in life.
>
> I can never sleep the night before work or an interview because of the anxiety and this really undermines my performance and confidence the next day. Paradoxically, I sleep like a log (as a way of turning off the anxiety) once I have `escaped' from the stressful situation, knowing that I have nothing on the next day.
>
> I cannot tolerate the typical 8 hours a night sleep regime as it leaves me feeling tired and drained. I suspect that this is because i am waking up from a lot of dreams..Currently I need 13 hours a night in order to feel refreshed. I currently get a lot of this sleep during the day as I find it harder to sleep at night. Obviously I cannot cope with a full-time job with these sleep requirements so I must do something about it!
>
> Sorry, this is a long post and I don't know whether anyone can help. Just thought that it didn't hurt to ask. :-)
>
> Alara
poster:Rick
thread:89412
URL: http://www.dr-bob.org/babble/20021108/msgs/127403.html