Posted by zatar on August 17, 2009, at 10:29:47
In reply to New pdoc, new meds (anxiety, trouble sleeping, ..), posted by Sunbath on August 10, 2009, at 11:22:59
I have the same problem of disrupted sleep, constant muscle tension and suffer from anxiety and panic attacks. I have Fibromyalgia so sleep is definitely an issue, especially sleep maintenance. Low dose doxepin (10mg) kept me asleep through the night until recently when some issues increased my anxiety and I was unable to fall asleep (never a problem until now) and I started waking up 10-15 times a night.
Per my pdoc's recommendation, melatonin 3mg helps me fall asleep and raising doxepin to 40mg keeps me asleep. My pdoc is very good about writing prescriptions for flexible dosing, so I tried increasing the doxepin until I found a dose that worked.
Sleep hygiene is very important. When my anxiety and sleep issues act up, I must avoid ALL caffeine (even decaf coffee,which still contains some caffeine), alcohol and chocolate. These prevent me from falling asleep and/or cause me to wake up in the wee hours when anxiety is rearing it's ugly head. I also avoid anything containing aspartame, MSG and other excitotoxins.
Exercising past dinner also tends to disrupt my sleep, so I make sure to do it in the morning. When my anxiety and panic attacks settle down, I find that I can go back to decaf coffee and have a drink and a chocolate muffin once in awhile.
My pdoc says that usually doxepin has an anti-anxiety effect starting at around 75mg and he is a big proponent of doxepin for sleep. But I am extremely sensitive to medications and cannot tolerate higher doses of many meds, so I don't take enought to get an anti-anxiety effect. Raising the doxepin dose increases my daytime fatigue and "spaciness", so I stick to the lower dose to help my sleep.
Years ago I took trazodone (50-100mg) for sleep maintenance issues and it worked for many years until I started getting these darn panic attacks (triggered by a trial of another medication). I was switched to 10mg doxepin and slept through the night. Doxepin causes increased appetite, however, so I eventually gave trazodone another trial. This time it didn't work at all, so I'm back to doxepin and intend to stick with it. I must be constantly aware to avoid snacking and watch portion control because doxepin definitely increases appetite. I am willing to pay the price because I find doxepin to be the best med I've tried for sleep.
SSRIs and benzos all disrupted my sleep. Since sleep is so precious to me and lack of it flares up my Fibro, I'm going to stick with doxepin.
I believe the trick for any medication is to find a dose that works for you. Start low, and titrate up slow.
Good luck to you. And may you find the sleep that you need.