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Re: Sleep Apnea and Stims » Rick

Posted by Alara on November 12, 2002, at 19:46:12

In reply to Re: Sleep Cycles and Depression » Alara, posted by Rick on November 12, 2002, at 15:28:25

> 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).
>

>>>>Thanks Rick. I'm afraid that I need to rely on my own research and a GP at this point as I can't afford a psychiatrist or sleep clinic. (Am hoping to be able to afford medical insurance once I secure a job, so I'll be able to follow this advice further down the track.)


> 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.)
>


>>>>>Re Sleep Apnea: Actually I have been wondering about the possibility of sleep apnea more and more lately. My boyfriend says that I snore and I sometimes wake myself up with a single, loud snore. I also feel very groggy (almost as though there has been a lack of oxygen to the brain) upon waking and it takes me a long time to surface. I usually wake up with a stuffy nose too. I am about 10-15 lbs overweight and am going to try losing the excess pounds in case this is the problem. The sleeping problems have definitely got worse since I put on the weight.


>>>>Rick, do you have any experience with Xanax? It seems to help me to fall asleep initially but I wake up later, drifting in and out of the exhausting dream cycle. I have social anxiety too and will ask my GP about Klonopin. (Maybe Klonopin has a longer half life and so promotes more restful sleep??? It would be interesting to find out.)

> 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.
>

>>>>Interesting! Your `noisy' dreaming sounds just like mine. The more `noisy' or `active' my dreams, the more emotionally drained (and hence physically tired) I feel the next day. This always makes me emotionally fragile and prone to anxiety and stress.


> 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).
>

Mmmm...You didn't find that Nardil caused weight gain? This is the main complaint re this AD that I've noticed in the forums.


> 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).
>

>>>The only stimulant I've tried is caffeine. lol. I seriously need to drink 2 cups of coffee before leaving the house and then another two once arriving at work. (This, of course, raises the eyebrows of colleagues, who can't help wondering about the chain coffee drinking but I can't seem to get myself into gear without the extra norepinephrine...) Unfortunately the coffee makes me highly anxious and I can't drink it after midday due to the insomnia it causes. I don't understand anything about stimulants. Do they act directly on the CNS, thereby making anxiety worse? I'm in a bit of a bind because I need to stay awake during the day and yet I can't cope with anxiety.


> 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.
>
>>>I have been taking St Johns Wort for around 1 month and my energy levels have improved slightly since coming off Effexor. Am still undecided about whether or not to give it another month or to switch to a prescription AD. Do you prefer Serzone or Remeron? Which do you feel is more effective against your social anxiety?


> 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
>
>>>>Rick, thanks for your post. Sorry about the thousand questions!!!

Alara


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