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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by IsoM on February 2, 2002, at 2:18:03
Tim, I remember what else I wanted to ask you. Reading over another post today triggered my memory.
You've been on modafinil/adrafinil longer (at least continuous) than I have been. In one of your posts, you mentioned that too much sleep made your depression worse - did you tend to dream more when you slept more? The studies I've read before linked excessive dreaming with increased depression. I know it certainly lessens deep sleep.
Here's my question: Has modafinil decreased the amount you dream at all? Or do you remember dreams much?
I don't know if you've ever shown symptoms of narcolepsy or how your dreams even are, but frequent dreaming seems to be part of my make-up. As soon as I'm dropping off, my dreaming starts. At this point, sounds & interuptions can easily awaken me again & I ALWAYS remember the dreaming starting & what it's about.
Maybe someone who can't remember their dreams would love to have more dreams, but I seem to spend so much time in REM sleep. I can be easily awoken anytime of night, it seems. Hence, my curiousity on whether modafinil increases the deep sleep cycle & lessen REM sleep. Maybe you haven't been on it long enough to tell either.
Posted by Elizabeth on February 2, 2002, at 14:08:59
In reply to Got Another Question for You, Manowar, posted by IsoM on February 2, 2002, at 2:18:03
> Here's my question: Has modafinil decreased the amount you dream at all? Or do you remember dreams much?
Provigil really is just a wakefulness-promoting drug and isn't the most effective treatment for narcolepsy since it doesn't help with other narcolepsy symptoms. The most effective antinarcolepsy drugs are REM suppressors.
> I don't know if you've ever shown symptoms of narcolepsy or how your dreams even are, but frequent dreaming seems to be part of my make-up. As soon as I'm dropping off, my dreaming starts.
That's often seen in narcolepsy; it's called sleep-onset REM sleep (SOREMS) -- REM sleep beginning within 20 minutes of sleep onset. In some people with depression REM latency is decreased, but not nearly to the degree that it is in people with narcolepsy.
> Maybe someone who can't remember their dreams would love to have more dreams, but I seem to spend so much time in REM sleep.
MAOIs and some tricyclics (amitriptyline, protriptyline) can help with this, as can amphetamine.
-elizabeth
Posted by IsoM on February 2, 2002, at 20:52:42
In reply to Re: REM sleep in depression and other disorders, posted by Elizabeth on February 2, 2002, at 14:08:59
Thanks Elizabeth for the post. I wasn't aware there were REM suppressors & will look into that. For me adrafinil looks after the constant struggle with trying to maintain alertness. The all-day struggle with staying awake is to me, the most disabilitating feature of narcolepsy.
I started TCAs 15 years ago for migraines (which never did help) but it did stop the sleep paralysis & the hypnogogic/hynopomic halluications but never dealt with the sleepiness. The cataplexy is infrequent & fairly mild (if I'm laughing or crying when it happens, I just collapse with weak muscles).
TCAs were too constipating for me & my heart rate was always around 120, so tried SSRIs & they stop the same symptoms TCAs did. It's not like I have bad dreams but it seems like most of my sleep is in that stage, meaning less for deep sleep which may account for my excessive sleeping & not feeling like I'm well rested. Just my feeling abut it.
I'm off to check what sort of REM suppressors are out there.
Posted by Chloe on February 3, 2002, at 20:12:31
In reply to Re: REM sleep in depression and other disorders, posted by Elizabeth on February 2, 2002, at 14:08:59
> > Maybe someone who can't remember their dreams would love to have more dreams, but I seem to spend so much time in REM sleep.
>
> MAOIs and some tricyclics (amitriptyline, protriptyline) can help with this, as can amphetamine.
>
Hi Elizabeth
I wonder if you know anything about Depakote affecting REM sleep. I started amitriptyline for neuropathic pain and sleep about a month ago.For the first time in years I was sleeping 8 hours without interuption. It was so great! But my days were filled with agitation and rage (too much AD, caused rapid cycling)..So depakote was added. Since the second dose of dep, I have had this dreamy, very light sleep. I sleep for an hour or so and then wake up and have trouble falling back. AND I am still taking the amitrip., but only 10 mgs...
Could the depakote be increasing REM, causing this wakeful sleep? Do you have any idea if this decreases over time? Most people report sound sleep with depakote. Am I just having a bizarre reaction to depakote? I am so disappointed to lose that sound sleep! There must be a way back!
I hope this isn't too off the topic.
Take care
Chloe
Posted by manowar on February 4, 2002, at 21:27:58
In reply to Got Another Question for You, Manowar, posted by IsoM on February 2, 2002, at 2:18:03
Hello again IsoM,
I'll just answer your questions individually instead of rambling like I normally do!> Tim, I remember what else I wanted to ask you. Reading over another post today triggered my memory.
>
> You've been on modafinil/adrafinil longer (at least continuous) than I have been. In one of your posts, you mentioned that too much sleep made your depression worseI had to cut you off mid sentence, because I may have said that, but in reality I don't think it's the too much sleep that makes my depressions worse. I think it's the boredom and complete lack of interest in anything that causes me to oversleep. In other words, when I'm depressed, I oversleep for the simple fact that I just don't want to face life, and sleep is not as painful as being awake--big bummer:(
>- did you tend to dream more when you slept more? The studies I've read before linked excessive dreaming with increased depression. I know it certainly lessens deep sleep.
I can't tell you, because it seems that my dreams are normally so abstract and out of this world that I never can remember them. But really I just don't know why I very rarely remember my dreams.
I've read that people with depression have more REM sleep than healthy subjects.
> Here's my question: Has modafinil decreased the amount you dream at all? Or do you remember dreams much?
Don't know. I don't really think that the *finil drugs affect my sleep cycle at all, but they certainly affect my waking cycle. Now I know for a fact that they affect the GABA levels, because the *finil drugs have a calming effect for me much like the Klonipin. Paradoxically, I also get a stimulating effect from the *finil drugs. Of course the Klonipin makes me sleepy, and has no stimulating properties for me.
> I don't know if you've ever shown symptoms of narcolepsy or how your dreams even are, but frequent dreaming seems to be part of my make-up. As soon as I'm dropping off, my dreaming starts. At this point, sounds & interuptions can easily awaken me again & I ALWAYS remember the dreaming starting & what it's about.
Not me, but I normally go to sleep very easily when I'm in my depressed cycle. However, I don't go to sleep easily without drugs when I'm in my normal stage of Cyclothymia, but I don't suffer from insomnia. It's just harder for me to go to sleep.
>
> Maybe someone who can't remember their dreams would love to have more dreams, but I seem to spend so much time in REM sleep. I can be easily awoken anytime of night, it seems. Hence, my curiousity on whether modafinil increases the deep sleep cycle & lessen REM sleep. Maybe you haven't been on it long enough to tell either.Again, I really don't think it affects my sleep at all.
I don't think that strange sleeping patterns cause depression; I think they are a symptom of depression. Again--pure speculation on my part.
You may have read my Yin-Yang theory in a previous post. It's probably total nonsense, but who knows, there might be some truth to it. So it goes like this: For me it seems that when I take Klonipin at night, it tells my brain to shut up and sleep. When I get up in the morning, I feel wonderful. I feel even better within 15 minutes or so, when I take my pstims-Wellbutrin, *finil, and Concerta along with my coffee.
The point is that there are two clear delineations in my circadian cycle thanks to the use of medications. I think this may have something to do with my wellness, but who the hell knows?
Hope you're doing well. Don't eat the yellow snow!
Tim
Posted by IsoM on February 5, 2002, at 0:45:17
In reply to Re: Got Another Question for You, Manowar » IsoM, posted by manowar on February 4, 2002, at 21:27:58
Always glad to read your posts & to know you're feeling good now. Ignore my question about sleep in my post about new meds.
Yeah, I did read your post about ying/yang & although I don't call it that, I feel it's a good analogy. I think most things in life need balance to function properly especially ourselves. I know a good night's sleep makes me feel so much better in the day. And conversely, if I've had a active, satisfying day, I tend to sleep better most times.
So it sounds like *finil helps your ADD. It certainly does with me, but also helps improve a myriad of other annoying problems I have. Some might happen from a chain reaction - improve one thing & others will fall into place too.
I react to depression & anxiety like you in that I sleep far, far more but it's still the light, restless unsatisfying sleep. These last few nights, I've been sleeping like a log & for 10-11 hours too. Perhaps just catching up on 'real' sleep for a change. I'd like to get by with 8, preferrably.
Tim, I never think of you as rambling. I think of myself as 'blithering' but maybe not all think I do. Couldn't eat yellow snow even if I wanted to :-)
We don't have any! This is the Banana Belt of Canada, I live in, after all.
Posted by Elizabeth on February 7, 2002, at 14:58:23
In reply to REM Sleep Narcolepsy » Elizabeth, posted by IsoM on February 2, 2002, at 20:52:42
> Thanks Elizabeth for the post. I wasn't aware there were REM suppressors & will look into that.
Oh yes! Those daytime sleep attacks in narcolepsy are REM sleep attacks. Similarly, at night you probably spend a disproportionate amount of your sleeping time in REM sleep. Modafinil (and, I'm guessing, adrafinil) only prevents the sleep attacks, not the cataplexy. Everyone loses skeletal muscle tone during REM sleep, BTW, not just narcoleptics. Although there's a disorder -- which I have had spells of since I was a kid -- called REM sleep behavior disorder [silly name] where you act out your dreams physically because your muscle tone is sustained. People with narcolepsy and some other neurological disorders often get this.
> For me adrafinil looks after the constant struggle with trying to maintain alertness. The all-day struggle with staying awake is to me, the most disabilitating feature of narcolepsy.
Of course it would be. Cataplexy, I imagine, is mostly just embarrassing. :-}
> I started TCAs 15 years ago for migraines (which never did help) but it did stop the sleep paralysis & the hypnogogic/hynopomic halluications but never dealt with the sleepiness.
TCAs often make people more tired. I think if you're going to use ADs for narcolepsy, MAOIs are a better choice. Which TCA(s) did you try?
> The cataplexy is infrequent & fairly mild (if I'm laughing or crying when it happens, I just collapse with weak muscles).
Interestingly, it's often triggered by strong emotions (of the sort that would cause you to laugh or cry).
> TCAs were too constipating for me & my heart rate was always around 120, so tried SSRIs & they stop the same symptoms TCAs did.
I had similar problems with TCAs (not the tachycardia so much, but the constipation was pretty bad) -- turned out I didn't metabolize them normally. I hadn't heard that SSRIs were being used for narcolepsy. They do suppress REM sleep to some degree, not as much as TCAs and certainly less than MAOIs.
> It's not like I have bad dreams but it seems like most of my sleep is in that stage, meaning less for deep sleep which may account for my excessive sleeping & not feeling like I'm well rested. Just my feeling abut it.
"Just?"
Yes, an increase in REM sleep can lead to not feeling rested. (But it could be good for your memory! :-) )
> I'm off to check what sort of REM suppressors are out there.
Lots. Amphetamine. Benzos. TCAs (any anticholinergic, really). SSRIs and Effexor, but less so, as I said. MAOIs are probably the strongest ones.
BTW, the main link between REM sleep and depression is that some people with depression tend to go into REM sleep earlier than normals do (around 70 minutes REM latency instead of 90). REM latency is much shorter in narcolepsy, though. Also, this feature isn't found in the sleep of all depressives -- many have normal REM latency.
-elizabeth
Posted by Elizabeth on February 7, 2002, at 16:02:35
In reply to Re: REM sleep-off topic? » Elizabeth, posted by Chloe on February 3, 2002, at 20:12:31
> I wonder if you know anything about Depakote affecting REM sleep. I started amitriptyline for neuropathic pain and sleep about a month ago.
Yeah, lots of people say amitriptyline helps with sleep, including sleep continuity.
> For the first time in years I was sleeping 8 hours without interuption. It was so great! But my days were filled with agitation and rage (too much AD, caused rapid cycling)..
Unfortunately, TCAs are among the worst ADs for bipolar folks (usually)! They tend to cause a lot of rapid-cycling dysphoric mania or hypomania, not the happy kind.
> So depakote was added. Since the second dose of dep, I have had this dreamy, very light sleep. I sleep for an hour or so and then wake up and have trouble falling back. AND I am still taking the amitrip., but only 10 mgs...
I don't know why Depakote would do that to you. I don't think it's a REM sleep enhancer, and many people find it sedating. Since it's a GABAergic drug, I would expect it to suppress REM sleep if anything. There are many other possible causes of sleep disruptions and fragmented sleep. Unless you're recalling vivid dreams, I doubt that REM increase is to blame.
It sounds to me like you need a different sleep aid, I'm sorry to say! Rapid-cycling and dysphoria are serious side effects, and there are plenty of options for sleep besides amitriptyline.
best,
-elizabeth
Posted by Chloe on February 7, 2002, at 18:52:44
In reply to Re: Depakote, amitriptyline, and sleep » Chloe, posted by Elizabeth on February 7, 2002, at 16:02:35
> > I wonder if you know anything about Depakote affecting REM sleep. I started amitriptyline for neuropathic pain and sleep about a month ago.
>
> Yeah, lots of people say amitriptyline helps with sleep, including sleep continuity.
>
> > For the first time in years I was sleeping 8 hours without interuption. It was so great! But my days were filled with agitation and rage (too much AD, caused rapid cycling)..
>
> Unfortunately, TCAs are among the worst ADs for bipolar folks (usually)! They tend to cause a lot of rapid-cycling dysphoric mania or hypomania, not the happy kind.
>
> > So depakote was added. Since the second dose of dep, I have had this dreamy, very light sleep. I sleep for an hour or so and then wake up and have trouble falling back. AND I am still taking the amitrip., but only 10 mgs...
>
> I don't know why Depakote would do that to you. I don't think it's a REM sleep enhancer, and many people find it sedating. Since it's a GABAergic drug, I would expect it to suppress REM sleep if anything. There are many other possible causes of sleep disruptions and fragmented sleep. Unless you're recalling vivid dreams, I doubt that REM increase is to blame.
>
> It sounds to me like you need a different sleep aid, I'm sorry to say! Rapid-cycling and dysphoria are serious side effects, and there are plenty of options for sleep besides amitriptyline.
>
> best,
> -elizabethHi Elizabeth,
Thanks for responding. Normally I would never continue on a TCA, as I have found that extremely small doses are extremely destabilizing to me. But the *primary* reason I was put on amitriptyline was to help with a neuropathic scalp burning. I have developed this while continuely being on mood stabilizers (mainly lithium, trileptal, perhaps neurontin) that have severely dried out my skin and hair. Now my skin and hair gets upset with any mood stabilizer I put in me. Even one's like depakote, where I never had any skin problems with when I took it in the past. I have this constant burning, mostly on my scalp where my hair follicles feel like they are on fire. It is very distracting...And of course I hardly ever brush my hair now, and it hurts to lie down on a pillow. So the added sleep benefit of amitrip was so nice. Because my "aching hair" wouldn't wake me up!Anyway, my question is, is there any other class of meds, or a "better" AD that can help with neuropathic pain and sleep?
Many thanks
Chloe
Posted by Ritch on February 8, 2002, at 0:11:31
In reply to About Sleep and Such » manowar, posted by IsoM on February 5, 2002, at 0:45:17
Hi IsoM,
I recall previously that you were wanting a few more links about ADHD, etc. Well, I found this one and you might really like it, from the feds.
Mitch
Posted by Elizabeth on February 8, 2002, at 0:22:58
In reply to Re: Depakote, amitriptyline, pain and sleep » Elizabeth, posted by Chloe on February 7, 2002, at 18:52:44
Hi Chloe. I don't really know about neuropathic pain. Neurontin is a newer option. The SSRIs and Effexor are also used, I think. You might also look at ways to alleviate the dryness. I don't know how to go about moisturizing one's scalp -- leave-in conditioner maybe? Ask a hairstylist, I'd say.
I'm sorry I can't help more. I hope you find something that works for you.
-elizabeth
Posted by IsoM on February 8, 2002, at 14:55:21
In reply to ADHD link for You » IsoM, posted by Ritch on February 8, 2002, at 0:11:31
Thanks, Mitch, but I have read a lot on ADHD. I have been diagnosed as having it, but was curious about how bipolar II & ADD overlapped. Reading more on bipolar II, I can see that I definitely don't have it - mine is straightforward ADHD.
In many ways, I've managed well with it. Most people are surprised that I have it. My weaknesses is distractibility (I'll switch topics midsentence when something else catches my eye without even be aware I've done it & then switch just as fast back to original topic) & organisation. I work so hard at keeping things organised.
Talking with others who have ADD, most (like me) are very good at organising. We can organise anything or anybody, but ourselves. Anything I organise, I can disorganise in a matter of seconds. I keep any important notes or papers on a special folder in the computer. I've yet to misplace my computer & be unable to find it. One reason a palm pilot wouldn't be good for me. It's the distractibility - I carry away & put things down all the time, completely unaware of what I'm doing as my mind's working on so many other things too.
Yet, it's organisation that gives me structure more than anything else. I'm hoping adrafinil may help make me more aware of what I'm doing so I won't get so mixed-up in my everday doings.
Posted by Ritch on February 9, 2002, at 0:09:39
In reply to Re: ADHD link for You » Ritch, posted by IsoM on February 8, 2002, at 14:55:21
> Thanks, Mitch, but I have read a lot on ADHD. I have been diagnosed as having it, but was curious about how bipolar II & ADD overlapped. Reading more on bipolar II, I can see that I definitely don't have it - mine is straightforward ADHD.
>
> In many ways, I've managed well with it. Most people are surprised that I have it. My weaknesses is distractibility (I'll switch topics midsentence when something else catches my eye without even be aware I've done it & then switch just as fast back to original topic) & organisation. I work so hard at keeping things organised.
>
> Talking with others who have ADD, most (like me) are very good at organising. We can organise anything or anybody, but ourselves. Anything I organise, I can disorganise in a matter of seconds. I keep any important notes or papers on a special folder in the computer. I've yet to misplace my computer & be unable to find it. One reason a palm pilot wouldn't be good for me. It's the distractibility - I carry away & put things down all the time, completely unaware of what I'm doing as my mind's working on so many other things too.
>
> Yet, it's organisation that gives me structure more than anything else. I'm hoping adrafinil may help make me more aware of what I'm doing so I won't get so mixed-up in my everday doings.
Hi,I was just reading through that NIMH article in its entirety and combined with other stuff I have read about ADHD and I am more convinced than ever that bipolar disorder is just a subset of an ADHD "umbrella". The *most* conservative estimates are 3% of children with ADHD, and the most conservative estimate of that bunch that "keep" ADHD into adulthood is 50%. Well that still leaves 1.5% min. of the general population of adult ADHD'ers. Bipolar has been well studied and is estimated at (middle of the road) 1.0%. My opinion is that bipolar folks are just ADHD with prominent emotional lability or psychosis (as with BPI). Gee, what if it was just ADHD with temporal lobe instability(seizures)??
The sheet about coping with ADHD, and the "50 tips" thing I brought out define EXACTLY how I have been learning to self-manage a problem for 25 years. All the lists, sticky notes, color-coding, what am I going to do today-scheduling stuff. It all fits to a tee.
Perhaps bipolars have a combo of frontal lobe hypoactivity (ADHD) with temporal lobe instability?
If you tried 5mg/day of Adderall for the first time and didn't suffer a major seasonal(wintertime) depressive episode (without AD's) that normally occurs otherwise, and I can work in a room full of distractions without any problem-doesn't that sound a little indicative?
I still have a bipolar *component*. But, with the seasonal major depressions gone, I am left with hypomania. Interestingly, when I stopped AD's my cycling *settled down*. SSRi's seem to trigger cycling(hypomania)-but help with anxiety. So how do I get the anxiety relief of SSri's (without taking them) and get the bipolar/ADHD relief of a pstim without causing anxiety (or having worsened anxiety as a result of withdrawing an AD)??
Mitch
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