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Re: REM sleep/Prozac/PLMD?

Posted by Kenny Koala on January 24, 2005, at 11:16:28

In reply to REM sleep/Prozac/PLMD?, posted by shoebox on January 24, 2005, at 9:48:16

> For the past several months I have had trouble staying awake during the day. I averaged a 2-hour nap every day around the same time (early afternoon), even though I was getting my usual 8 hours overnight. I had no other symptoms that could account for such fatigue.
> I finally went to a sleep clinic and stayed overnight, hooked up to all manner of wires. They expected to find sleep apnea. The results: I woke up over 150 times. Approximatley 30 of those times, it was due to mild sleep apnea. Another 20 seemed to be caused by PLMD--Periodic Limb Movement Disorder--and that left 100 or so "wake-ups" unaccounted for. The real kicker: I never reached Stage 3 sleep, never mind stages 4 and 5, because of all the wake-ups, and was told I had experienced virtually no REM sleep.
> My insurance won't cover any additional evaluations (at least not any overnights at the clinic), because of the "mild" sleep apnea DX.
> The doctor at the sleep clinic was flummoxed as to the 100 "idiopathic" wake-ups, and I don't know what my next move is.
> [I'm BPII and was on 80mg Prozac, 300mg Lamictal prior to my most recent pdoc appt.]
> My pdoc decided to decrease my Prozac from 80mg to 60mg and add Wellbutrin SR 150 mg., figuring Prozac has a reputation for REM sleep spoilage. I've been on the new RX for about two weeks now, and can't say there's been any marked improvement, though I feel more "alert" thanks to the WB.
> What else could be causing the interruption of my sleep besides sleep apnea and PLMD? That's the question. Has anybody had to deal with this type of thing?

Reduced or nil Stage 4 sleep is a side effect of all SSRI's & Effexor, not just Prozac. Excess agonism of Serotonin 2A receptors(5-HT2A) by the increase in Serotonin levels is the cause. The cure is rather simple, take a low doseage of something that is a 5-HT2A antagonist. Amitriptyline, Doxepin, Remeron, Trazodone or Trimipramine would be my first choices. Most antimigraine & antipsychotic drugs are 5-HT2A antagonists too. 5-HT2A receptors also control other body functions such as temperature control, anxiety & orgasm.




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