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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 Dinah on August 30, 2004, at 9:42:33
My sleep study showed a couple of things, like central apnea and very little stage 3-4 sleep, that can be caused by my use of the Klonopin that was prescribed for an anxiety disorder. A large part of that disorder was night-time panic attacks related to my OCD, usually between 3 am and 6 am, 4 am and 6:30 am daylight savings time, at a time (while I'm asleep) when it really isn't as feasible to use CBT techniques to deal with anxiety.
It doesn't seem to make a huge difference what time I go to sleep. The anxiety attacks occur at the same 3 hour or so time period.
When I got the sleep test results, I decided to reduce my Klonopin from 1 mg to 1/2 mg, and I'm back to the same problem. Last night I woke up several times and talked to my dog or husband about work. Once I woke up to find myself halfway across the room, heart pounding, talking about something I needed to do for work. If the issue had been something I wasn't able to readily settle, that's where the panic attacks would occur. Obviously I think or dream about work a lot while I'm asleep. What I wake up saying is usually correct. But what I can't figure out is why those specific hours? What is going on in the sleep cycle that makes it happen in that 3 hour space of time? During the three hours, I always say I'll get up first thing in the morning. But once the three hours pass, I generally sleep to my normal waking time (or later) because it *only* is an issue in those three or so hours.
What is so special about 3 am - 6 am? That's my real question. I can't see anything in my research on sleep structure that account for such a specific timing of anxiety.
My sleep study also showed signs of narcolepsy but wasn't conclusive for narcolepsy.
Posted by gardenergirl on August 30, 2004, at 10:11:22
In reply to Klonopin and sleep and 3 am to 6 am, posted by Dinah on August 30, 2004, at 9:42:33
Dinah,
I wish I knew what was so special. I seem to wake up around 3:30 a.m. without fail. Progress for me is that I can now get back to sleep eventually. But I still don't know why I keep waking up.Good luck to you. I hope we both eventually get solid and restful sleep very soon.
gg
Posted by Dinah on August 30, 2004, at 11:36:24
In reply to Re: Klonopin and sleep and 3 am to 6 am » Dinah, posted by gardenergirl on August 30, 2004, at 10:11:22
I have noticed some pretty late postings from you. :( I figured we might be sisters of the three am awakenings.
I just spent the morning on largely unprofitable google searches. The best I can figure out is that the earlier cycles of sleep have less REM and are deeper than the later cycles of sleep. And that our sleep cycles are based partly on our circadian rhythms, which would explain why it doesn't really matter when I get to bed - 3 am is still the magic number.
I also read something I don't fully understand about cortisol being in high levels in that time, but I can't draw any conclusions about it, since I didn't understand it. :)
I also found out that my sleep study may not have been valid due the meds I was on at the time. Sigh.
Posted by Dinah on August 30, 2004, at 11:37:06
In reply to Re: Klonopin and sleep and 3 am to 6 am » Dinah, posted by gardenergirl on August 30, 2004, at 10:11:22
Posted by gardenergirl on August 30, 2004, at 21:50:18
In reply to Re: Klonopin and sleep and 3 am to 6 am, posted by Dinah on August 30, 2004, at 11:36:24
> I have noticed some pretty late postings from you. :( I figured we might be sisters of the three am awakenings.
Yeah, sometimes I just bag it and get up and go online. But it's been better lately. I hope it gets better for you!
>
> I just spent the morning on largely unprofitable google searches. The best I can figure out is that the earlier cycles of sleep have less REM and are deeper than the later cycles of sleep.Nardil suppresses REM sleep, so this kind of makes sense to me.
>And that our sleep cycles are based partly on our circadian rhythms, which would explain why it doesn't really matter when I get to bed - 3 am is still the magic number.
That makes sense, too. Although one night I went to bed earlier...about 10:00. And I woke up at 1:30 instead. My body seems to not allow me to sleep more than 4 hours at a time. Even when I am dog-tired and nap...4 hours max. (I know, that's not really a nap...that's sleeping in the middle of the day...but still. 4 hours...)
>
> I also read something I don't fully understand about cortisol being in high levels in that time, but I can't draw any conclusions about it, since I didn't understand it. :)Maybe Racer can jump in on this. She's been researching cortisol and also gave me some info about insomnia recently, I think. Or maybe I dreamed that? ;) (I miss my dreams...they are gone again at 67.5 mg of Nardil.)
>
> I also found out that my sleep study may not have been valid due the meds I was on at the time. Sigh.Bummer. I actually called today about an advertisement for a sleep study for a new med targetting early awakening. I'm not eligible due to the Nardil. Dang. Making money, getting free sleep study results, and maybe taking a med that might help....wish I was eligible....
Take care and sleep well.
gg
Posted by Racer on August 31, 2004, at 3:20:08
In reply to Re: Klonopin and sleep and 3 am to 6 am:Racer??? » Dinah, posted by gardenergirl on August 30, 2004, at 21:50:18
What I do know -- besides the fact that I'm not in bed, asleep, right now -- is that cortisol levels peak sometime between about 4 and 5 AM. Those peak times seem to be pretty consistent, even for people working odd shifts. That peak is a big part of the reason that, if you're up all night, you'll get that cold phase around that time, too. (I've never been good at the all-nighters, but have done a few. Of course, after getting most of the way through school without doing it, most of mine were work related. Go figure.) Cortisol is the infamous stress hormone, and the rise at those hours is probably the body preparing to wake up and face the wolves while hunting the mammoth.
Beyond that, I don't know much. The whole system is controlled by the hypothalamus, and some studies have shown hypothalamic changes in anorexics, as well as speed addicts. Cortisol is produced in the adrenal glands, which are part of the limbic-hypothalamic-pituitary-adrenal feedback loop, which can go out of whack in funny ways. Cushing's results in overproduction of cortisol, because the system either doesn't send or doesn't respond to the "Turn Off" signal, while Addison's is (I think I'm remembering this correctly) an insufficiency. The whole system is pretty delicate, and I still haven't been able to find out about whether or not it heals after an insult, nor how long it keeps pouting. If I had it together to look it up, I'd check what I've got on it, but I know adrenaline is involved in this whole little dance routine, too. That's something someone else can probably answer, though...
I hope that helps, somehow. The only things I know for sure about it are that it's a pretty delicate feedback system, and the belly fat from excess cortisol that I've seen came with muscle wasting and weird joint and tendon stuff. (Actually, Cushing's can improve osteoarthritis quite a bit. Kinda like getting a cortisone shot every day. I'd bet that it might also, like cortisone, reduce bone mass.)
Posted by Sad Panda on August 31, 2004, at 8:47:31
In reply to Klonopin and sleep and 3 am to 6 am, posted by Dinah on August 30, 2004, at 9:42:33
I highly recommend taking a 5-HT2A antagonist which will give you good stage 4 sleep. TCA's at low doseages are probably the chepest & best way. Amitriptyline, Trimipramine & Doxepin will do it. Remeron is very good once you get use to it too. If your doctor wants to spend lots of money on an atypical AP, then I would say Zyprexa or Risperdal.
Cheers,
Panda.
Posted by Dinah on August 31, 2004, at 9:44:13
In reply to Re: Klonopin and sleep and 3 am to 6 am » Dinah, posted by Sad Panda on August 31, 2004, at 8:47:31
I didn't have much luck with tricyclics. Too much effect on norepinephrine. :( And I never made it past a weekend test on Remeron, because I slept all weekend. :)
I take the occasional Risperdal as needed. But I think I'm just going to play around with the Provigil and Klonopin doses, cut back on my diet coke, and try to change my lifetime practice of only going to bed when I'm sleepy.
I'm surprised about TCA's and sleep. When I was on nortrip(? - one of those) I hardly slept at all. But I have an extreme reaction to NE.
Posted by Dinah on August 31, 2004, at 9:47:22
In reply to Dunno much... (chemist??), posted by Racer on August 31, 2004, at 3:20:08
Looks like you know a fair amount. :)
That does confirm what I thought I read yesterday. That cortisol is at it's highest about two hours before wakening, which would bring it in a bit later than my 3 am wakenings. Perhaps all those generations of agricultural workers in my background has my cortisol system mistakenly thinking my wake time is 5 am rather than 8 am. :)
Posted by Sad Panda on August 31, 2004, at 9:50:38
In reply to Re: Klonopin and sleep and 3 am to 6 am » Sad Panda, posted by Dinah on August 31, 2004, at 9:44:13
> I didn't have much luck with tricyclics. Too much effect on norepinephrine. :( And I never made it past a weekend test on Remeron, because I slept all weekend. :)
>
> I take the occasional Risperdal as needed. But I think I'm just going to play around with the Provigil and Klonopin doses, cut back on my diet coke, and try to change my lifetime practice of only going to bed when I'm sleepy.
>
> I'm surprised about TCA's and sleep. When I was on nortrip(? - one of those) I hardly slept at all. But I have an extreme reaction to NE.
>
>I would try Remeron again at very low doseages & creep up slowly. Another TCA worth trying is Surmontil(Trimipramine) it has very little to no effect as an NRI & no effect as an SRI, but is the most potent of 5-HT2A antagonists as far as TCA's go. 5-HT2A antagonist improve sleep overall, while benzos cause it to deteriorate.
Cheers,
Panda.
Posted by sb417 on August 31, 2004, at 19:59:36
In reply to Klonopin and sleep and 3 am to 6 am, posted by Dinah on August 30, 2004, at 9:42:33
Hello Dinah. I am interested to know whether you had to be off of all medicines for an extended period before your sleep study. I've never had a sleep study, but I would like to have one. I have had SPECT scans and PET scans, and I had to be off ALL medicines for many weeks before those tests. On the morning of the scans, I was not allowed to exercise or have any caffeine! Ugh! Quite frankly, I don't know how I ever got myself to the imaging center.
Posted by Dinah on August 31, 2004, at 20:24:32
In reply to Dinah. . . a question, posted by sb417 on August 31, 2004, at 19:59:36
I thought I would have to be off medications, and it now looks like an accurate sleep study would have required me to be off medications. But my neurologist, who is apparently the specialist for sleep at a respected teaching facility, didn't think it was necessary and the facility where I had the test done didn't think it was necessary.
So I'm not even sure what validity my test results have. :( I guess they accurately depict my sleep while on medications.
So my answer is: I don't know. I'd check out the credentials of your sleep doctor and facility before having the test done though. I'd feel better if mine had been accredited specifically for sleep disorders, since it was apparently unusual that he didn't require me to be off meds.
http://www.absm.org/Diplomates/listing.htm
Posted by sb417 on August 31, 2004, at 20:37:19
In reply to Re: Dinah. . . a question » sb417, posted by Dinah on August 31, 2004, at 20:24:32
This is the end of the thread.
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