Posted by Rick on November 13, 2002, at 21:15:35
In reply to Re: Sleep Apnea and Stims » Rick, posted by Alara on November 12, 2002, at 19:46:12
>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 think if it were apnea he'd notice you briefly gasping for air. But I'm by *no* means sure about this. Check the web for info on apnea symptoms.
>>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.
Maybe allergies are involved here, to indoor irritants like invisible dust mites (they're everywhere, unless you clean like Martha Stewart).
If you haven't already, you should mention the stuffy nose to your GP.> 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.)
I use Xanax once every couple months when I just can't get to sleep. Everyone's different, but for me low-dose Klonopin has great, smooth, long-lasting anti-anxiety effects, while Xanax just puts me to sleep. I tried it for social anxiety before Klonopin, and it only helped a little, just by making me feel doped up. When I tried Klonopin, it was a world of difference both in daytime tolerability and most importantly in fighting social anxiety. And yes, the longer half-life is a big advantage over Xanax as well...Klonopin is so smooth, I usually don't feel *anything* physically (after the first week or two). And mentally I feel like myself, but with most of the horrendous social anxiety gone.
(I should point out that I was taking Xanax on an as-needed basis, while I've always taken Klonopin daily.)Getting back to sleep apnea or other respiratory disorders, note that benzos and SSRI's can actually worsen this. That's one reason I set a rule for myself when I started Klonopin: Avoid taking any after 4 p.m. -- although, of course, there will be some in my body 24/7 due to the long half-life. Early on, I did sometimes feel the need to take a little extra before nighttime social events. I guess the reason that this no longer seems necessary is that -- as at least one discontinuation study documents -- some of the social anxiety benefits of Klonopin tend to become ingrained after awhile. I assume that also explains why I only need half as much K as I used to take.
> > 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.
Yes, I don't know how I managed to begin my first successful diet since sixth grade while I was taking Nardil! The weight gain may be an issue for most people (and women seem extra-susceptible for some reason), but it's not a given -- at least judging from the posts of other Babblers. Of course, I only took Nardil for about four weeks, and had just about every other side efect imaginable, although some might have gone away eventually with continued use. In fact, maybe Nardil helped me lose weight because it produced such severe orthostatic hypotension that I would fall down before I could make it to the refrigerator.
>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.
Yes, the stims all work through the CNS, but that translates to effects in other parts of the body too (e.g., increased heart rate). The traditional, amphetamine-based stimulants like Ritalin, Dexedrine,and Adderall do have a tendency to increase anxiety, although for people with ADD they may have a calming effect. Provigil works differently, and has a far lower incidence of anxiety or nervousness, especially at lower doses. Taken in tandem with Klonopin (or Klonopin+Serzone), in proper doses, I find Provigil actually enhances the anti-anxiety benefits by increasing assertiveness, enthusiasm and sociability. Unfortunately, Provigil is extremely pricey (although I think they have some financial assistance programs -- see www.provigil.com). As for the caffeine, I'd wager that taking Klonopin would counter caffeines's undesirable anxiety effect more than it would counter the desired wakefulness effect.
> >>>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?I've never taken Remeron. Serzone has had mixed reviews (from high praise to "zero benefit") for social anxiety, but anecdotal evidence and open studies show more usefulness for Serzone than for Remeron. It's definitely helpful for me, but the effects took a good 12 weeks to really take hold (which was OK, because I was already taking my key social anxiety med -- Klonopin). Without a stimulant, you *might* find either of these AD's to be too sedating, especially if taken with a benzo like Klonopin. But after the first few weeks, you could take all of the S or R at night. They really help people sleep, although I'm not sure if the potential respiritory effects seen with SSRI's or beta blockers figure in with S&R. Nighttime-only Serzone works very well for many people (although it sometimes paradoxically causes sleeplessness intil the body gets used to it), who sleep soundly on it but aren't hit by its sedating effects the next day. And note that some people find Serzone has no effects on daytime wakefulness one way or the other. It's a weird med in a way -- some people find it so much more benign than other AD's side-effect wise (including a welcome lack of sexual dysfunction in most cases), while others consider it to be among the *least* tolerable (especially if they give up on it too soon). Regardless, on thw whole it is considered especially suited for anxiety. On the nighttime sleep-aid front, you might also want to look into trazodone, which is inexpensive, and can help augment the antianxiety or antidepressant effects of other meds.
Rick
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URL: http://www.dr-bob.org/babble/20021108/msgs/127535.html