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Treatment Resistant Chronic Insomnia - Disability

Posted by EastC on August 13, 2010, at 15:04:32

After many years of suffering from treatment resistant chronic insomnia I went to my health care provider to file for short term disability (about 1 month) in order to go see sleep specialists at the world renowned Johns Hopkins Medical Center.

I have been on so many medications and gone through so many tests. I know that my insomnia is due to a neurological condition and not a physiological one (such as sleep apnea, RLS, etc). I have had an MRI, EEG, and had two sleep studies done all of which were inconclusive. I have been on all of the benzos and am currently on Lexapro and Strattera in the morning and a combination of Xanax, Seroquel and Neurontin at bedtime (and removing the strattera from my regimen has not helped my sleep and only makes my depression worse). Also, Xanax is the benzo that has the lowest negative impact on my depression - all of the other ones make it significantly worse. Unfortunately, even on these medications I cannot get a full 7 to 8 hours of sleep during a normal block of time between 10:00 pm and 7:30 am because it takes me too long to fall asleep initially and I wake up throughout the night with trouble falling back asleep. It used to be that the combination of Neurontin and Seroquel at bedtime solved my sleep issue and gave me a consistent 8 hours of sleep every night of the week - after a period of years that benefit was lost. In the past I have been on the non-benzos Trazodone, Remeron, Serzone and the hypnotics Lunesta and Ambien (all of which worsened my depression). The only things that I haven't tried are the barbiturates, tricyclics and Xyrem (I have heard that Xyrem is the most effective for treatment resistant insomnia but I don't know if any doctor would be willing to prescribe it).

My only option now is to sleep in late - essentially waking up and going back to sleep repeatedly until I have hit my 7 to 8 hours of sleep sometime around noon (at which point I feel great for the rest of the day since this combination of meds completely fixes the depression side). I am hoping that others who have had a similar experience can share with me what medication or combination of medications solved their insomnia problem. My gut tells me that no medication(s) will allow me to get that 7 to 8 hours of sleep within that 10 pm to 7:30 am block of time any longer and that the ultimate solution will be to resign from my job and either become self-employed or find a line of work that starts in the afternoon.

I have a theory that from the time that the insomnia originally starts (in my case from childhood) it can in some cases progressively worsen due to an area of the brain that is responsible for producing and regulating GABA. I remember as a child having problems with falling asleep and waking up too early, but once I hit age 21 the insomnia became severe enough to require medication. This area most likely has a store of neurons that permanently decrease with age, causing a worsening of insomnia and eventually causing certain insomnia medications to loose their efficacy. Either that, or the medications themselves cause a semi-permanent down regulation of said neurons.




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