Posted by survivin bpd on September 29, 2006, at 14:06:56
In reply to Re: sleep - melatonin, temazepam, bipolar management, posted by Fungalfoot on September 28, 2006, at 4:40:05
> > Hi
> >
> > I have biploar disorder and manage this by using just a small amount of chlorpromazine now and again if I get the first hint of a prodrome coming on. this seems to work well and I am pretty lucky that I don't get the sort of regular mood swings that makes this impossible, and has only happened 2 oe 3 times since my last illness. I have been well for 5 or 6 years. The only other meds I take are temazepam sometimes - 10mg or if really bad 20mg - as I seem to go through patches of insomnia that are really disabling. I then go through weaning myself off the temazepam after needing it for 3 or 4 nights to get my sleep back into a pattern. Last couple of weeks have been very stressful so ended up on the 20mg for a couple of nights, now down to 10mg. I am commuting an hour or so at the end of each day so just have to get that sleep - means I stay on the temazepam longer than I want to as I don't want to risk not sleeping and having to drive / work / manage to look after kids on no sleep.
> >
> > Sleep was better on carbamazepine which I had a few years ago, but couldn't concentrate - felt fogged and I have a big academic workload. Withdrew from carbamazepine about 4 years ago under advice of consultant who thought I could manage the illness without it. I am sort of wondering whether I am paying the price for choosing not to take a mood stabiliser by going through patches of bad insomnia. Put loads of weight on and felt really nauseous all the time on lithium (before the carbamazepine and a long time ago).
> >
> > I have just bought some melatonin. Took for the first time last night at around 10pm. Well - it is now 4.43am! my mouth tastes kind of milky, I have a banging headache which is not unusal when I can't sleep and it gets to this time in the morning. I dozed lightly for an hour or so and that is about it. I took 2 mg of melatonin- from reading other posts not sure at all whether that is too much, not enough, or it just plain didn't work, in which case I am pretty upset and feel like the thing I thought would save me from all of this is just plain useless.
> >
> > Could be a rebound insomnia cos I didn't take any temazepam last night after taking it for a week or so.
> >
> > I was worried about taking the temazepam together with the melatonin..... so thinking of either going to only 10mg of temazepam, withdrawing from it (usually have to reduce by a quarter of the dose at a time or I can't get off the stuff - a pain breaking up the tablets but the only way - if I go to fast the insomnia rebounds in full force) and at the same time starting the melatonin -no idea what dose to go for apart from the 1 or 2mg suggested on the packaging. other alternative is to keep taking the temazepam until this bad sleep patch goes away (though unlikely for a while I have too many stressors) and then getting going with the melatonin in the hope that it prevents the insomnia next time,
> >
> > now that's the background, here are the more specific questions
> >
> > 1 has anyone taken temazepam and melatonin in combination? cross tapered off the temazepam and replaced with melatonin? any effects?
> >
> > 2 has anyone had a hypermanic / manic episode that they believe to be triggered by taking melatonin and not other factors? if so, please could you tell me a bit more about it
> >
> > 3 would be great to get some advice / support on getting the melatonin dose right - any would be really appreciated.
> >
> > 4 would be great to hear from anyone who manages bpd without a mood stabiliser
> >
> > 5 any advice/ suggestions most welcome
> >
> > Thanks in advance
> >
> > Maria
>
>
> Hi Maria
>
> This is a bit off the tracks but have you considered a small dose of an anti-psychotic to get you to sleep? There may be a chance that you are hypomanic or even hypermanic and a bit of Olanzapine or maybe Seroquel could lower your mood and allow you to get some sleep.
>
> I am a manic depressive on Lithium for 30 years, no lies, and four years ago I had bad insomnia for which my pdoc gave me 2.5 mg or 5 mg, I can't remember which, Olanzapine (Zyprexa). Well the 5 mg gave me thirteen hours sleep and the 2.5 mg gave me eight. It was bliss. I carried on with 5 mg Olanzapine for four years - the last two years it was not working anymore. I was waking at 5.00 am and unable to get back to sleep again despite going to sleep at 11.00 pm. I am weaning myself off the Olanzapine now, with some difficulty - terrible insomnia, and now I am taking Seroquel (Quetiapine)100 mg at night.
>
> I don't know if you are hyper-manic. The fact that you take Chlorpromazine suggests that you
> you may get manic mood swings. Is it possible that a manic mood swing has crept up on you without giving the usual warning signs? For me the usual warning signs are extreme irritability, inability to sleep, racing thoughts, hyper-acitivity, grandiose ideas.
>
> You might want to try some Olanzapine or Quetiapine. You can read some comments about the latter at http://askapatient.com/viewrating.asp?drug=20639&name=SEROQUEL
>
> I suggest if you do take Seroquel or Olanzapine you take a small dose to start with or else try it out on a weekend when you can have a good lie in.
>
> I only mention this alternative as you stated you are bpd. I hope you beat the insomnia. Be aware that Olanzapine and Seroquel can make you put on weight and they are, in my opinion Olanzapine definitely, habit forming. Perhaps you could use it sparingly say only three or four times a week or else cut up into small doses, see askapatient on this.
>
> Good luck
>
> Alan
Hi AlanMany thanks for that. No change in mood whatsoever - I have tried using a small amount of chlorpromazine to help me to sleep, but have found that if I take it and there is nothing at all wrong with my mood, it simply makes me feel a bit flat and tearful - so basically if I can keep the sleep ok and don't rock the boat using antipsychotics unless I do actually have some warning of being hyper ( I take an antipsychotic at the level of one single altered thought or desire to do a little more for example - not needed for years), my mood doesn't shift at all.
Not sure if I would get the same effects from a newer antipsychotic. How low a dose of e.g. olanzapine do you think might produce a sedative effect? Do you think it would have a weight gain effect using a small dose at night in order to help sleep? Have you experienced any mood shift when using chlorpromazine or quetiapin to help you to sleep?
Last time I discussed with a doc he thought I was probably taking the most appropriate medication with the temazepam it is just so addictive!
Not had much luck with the melatonin. I found it made me feel calmer than usual - I don't get particularly anxious but if a few worries around I would say it destressed a bit. It made me feel sleepy at the right time of day when my sleep had been bad for a while, but didn't help at all with the mechanism of getting to sleep or staying asleep.
So back to the temazepam with a long long withdrawal....
Maria
poster:survivin bpd
thread:688575
URL: http://www.dr-bob.org/babble/20060927/msgs/690227.html