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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by sunnydays on June 23, 2008, at 14:28:40
So, I took 1 mg Xanax for a week last week as a suggestion of my pdoc to get my sleep schedule back to normal. It didn't do all that much.
I did not take it on Thursday night and got to sleep relatively ok. Friday night, however, I was unable to get to sleep and got increasingly upset, finally falling asleep around 4 am.
Saturday night I could not fall asleep and, despite being sleepy and exhausted all day, was wide awake at night and couldn't sleep until I took a Xanax at 5am. Slept 5 hours, then had to get up to go somewhere.
Groggy and exhausted all yesterday, but then as night came, got very very anxious and was wide awake once again. Took a Xanax so could sleep well.
Today I am super super anxious - heart racing, dizzy, etc.. In addition, I'm worried about not being able to sleep again tonight. I don't want to keep taking the Xanax because I don't want to get addicted. I didn't take it two nights in a row and was relatively ok, so what's up now? I have an appt. with pdoc on Wednesday and can't get ahold of her before then (I just tried), so what do I do until Wednesday?
She also increased my Effexor XR from 150mg/day to 225 mg/day. Could that be causing the insomnia? I'm just having a difficult time and advice would be appreciated.
sunnydays
Posted by rskontos on June 23, 2008, at 15:51:36
In reply to desperately need advice - Xanax, anxiety, insomnia, posted by sunnydays on June 23, 2008, at 14:28:40
Sunnydays, have you considered trying Melatonin as a supplement. The pharmatistic helped me help my DH with sleep issues and he would not see a doctor. She said to get the 3 mg tablets and half them. You have to take them about 2-3 hours prior to wanting to go to sleep, they take a while to take effect. But overrall, she said they are quite effective with no residue effects the next am. He had done well with it. The melatonin might work better than the xanax. Less side effects I think too. Anyway, just a suggestion.
rsk
Posted by IAMtheWalrus on June 23, 2008, at 16:01:49
In reply to Re: desperately need advice - Xanax, anxiety, insomnia » sunnydays, posted by rskontos on June 23, 2008, at 15:51:36
I don't know what's causing the insomnia, my guess would be your elevated anxiety. Another option you could try is low dose Trazodone. It's an antidepressant that is very sedating, and not addictive like xanax...just a thought.
-W
Posted by Phillipa on June 23, 2008, at 16:18:30
In reply to Re: desperately need advice - Xanax, anxiety, insomnia » rskontos, posted by IAMtheWalrus on June 23, 2008, at 16:01:49
My feeling is it's the upped effexor and the start up side effects. Phillipa
Posted by dbc on June 23, 2008, at 16:28:56
In reply to Re: desperately need advice - Xanax, anxiety, insomnia, posted by Phillipa on June 23, 2008, at 16:18:30
Dont start the cycle of using benzos for sleep, you dont want to go down that road.
Try some melatonin and diphenahydramine (ie benadryl) its in every generic sleep aid you find at grocery stores.
Posted by bleauberry on June 23, 2008, at 18:01:17
In reply to desperately need advice - Xanax, anxiety, insomnia, posted by sunnydays on June 23, 2008, at 14:28:40
At the new dose of effexor, you are getting a bigger push on norepinephrine and dopamine than the old dose. In my guess that is a big player in what you are feeling. It should subside but may take a couple weeks.
I had withdrawals from 1mg xanax after just 2 weeks using it maybe once every 2 days. I had to do a taper to get off smoother, which was .5mg for a few nights, then .125 for a week, then .125 every other day. In the meantime, other tools were used for anxiety and sleep. The herb passionflower in tincture form was a lifesaver, as well as skullcap which I sometimes combined the two. Lemon balm is another one. Common calming herbs are chamomile and hops, in many herbal formulas, but they make me more depressed.
Melatonin helps people sleep, but for sure there have been many reports of it making people who are prone to depression more depressed. It did that to me.
Valerian root herb is a good one. For some people, like me, it works immediately. For others it takes a couple weeks to kick in. Good for anxiety or insomnia or both. With herbs, combos work better than any single herb.
Tiny bits of remeron (3mg-7.5mg) give a pretty good sleep while weaning off xanax or getting used to a new antidepressant dose.
So, I think the higher dose of effexor could be causing a lot of the problem, and xanax is fueling the fire even more. Tamer alternatives are listed above to manage the anxiety and insomnia until they subside. For me, that was about 3 weeks.
Posted by sunnydays on June 23, 2008, at 22:02:59
In reply to Re: desperately need advice - Xanax, anxiety, inso, posted by dbc on June 23, 2008, at 16:28:56
Are there any interaction problems between Effexor and OTC sleep aids? I just wonder because my pdoc never suggested trying those, just immediately prescribed Xanax (well, not immediately, it's a long story, but OTC stuff has never been suggested to me).
sunnydays
Posted by sunnydays on June 23, 2008, at 22:09:25
In reply to Re: desperately need advice - Xanax, anxiety, insomnia, posted by bleauberry on June 23, 2008, at 18:01:17
Thank you so much bleauberry! That was amazingly reassuring to hear. I had called my T and he called me back and missed me and was supposed to try back again, but I think he forgot, so I'm feeling really on my own here since pdoc only works 1 day a week (she might be available if I really needed her, but it's through a counseling center and I didn't ask because I started getting panicky talking on the phone to them).
But it's good to hear that it's probably going to go away, and that even if it is withdrawal from Xanax, that that can be dealt with. I am not one to take medications lightly, and in fact would prefer not to be taking any at all because they scare me in large part, so I'm so so so afraid of having any side effects at all because I get afraid that I'll be stuck with them for life or have to take something else to deal with them.
Thank you very much. Hearing your experience and having those suggestions was really helpful. I'm going to try to fall asleep on my own tonight, but if I can't, maybe trying 0.5mg of Xanax instead of the full 1 mg would work.
sunnydays
Posted by dbc on June 23, 2008, at 22:26:22
In reply to Re: desperately need advice - Xanax, anxiety, inso » dbc, posted by sunnydays on June 23, 2008, at 22:02:59
> Are there any interaction problems between Effexor and OTC sleep aids? I just wonder because my pdoc never suggested trying those, just immediately prescribed Xanax (well, not immediately, it's a long story, but OTC stuff has never been suggested to me).
>
> sunnydaysAs far as i can tell after a brief over view of the interactions i dont see anything about the OTC stuff. Why he went for the xanax...maybe he thought you were getting wound up by the NE reuptake kicking in with the effexor. Which also explains the insomnia, he was just being a nice guy.
If you're concerned about interactions just ask a pharmacist but i seriously doubt your doctor is going to continue to give you xanax after a week or two which isnt long enough to get strung out as far as im concerned, people blow it out of proportion on here sometimes.
Posted by sunnydays on June 24, 2008, at 1:42:13
In reply to Re: desperately need advice - Xanax, anxiety, inso, posted by dbc on June 23, 2008, at 22:26:22
Well, she gave me enough for a month, plus she knew I already had a week or two left (I had been using it as needed before that, which was maybe once a month)... But I do agree that she was just being nice.
sunnydays
Posted by Horned One on June 24, 2008, at 5:52:57
In reply to desperately need advice - Xanax, anxiety, insomnia, posted by sunnydays on June 23, 2008, at 14:28:40
Xanax isn't that great for sleep, and 1mg is a pretty big dose. A prescription for Lunesta or Ambien might be more effective as they have more hypnotic action than Xanax. They're also less likely to be addictive. Also, a normal starting dose of Ambien or Lunesta is equivalent to about 5mg Valium, while 1mg of Xanax is equivalent to about 20mg Valium according to reliable sources (not everyone agrees with these equivalencies). This means that you are much less likely to feel rebound anxiety when the drug wears off. In the case of Ambien, the drug is usually completely out of your system by morning (half-life 2 hours). With Xanax the anxiety comes back like a slap in the face, and with me it usually came on at night, making it very hard to sleep without the Xanax. It's easy to slip into a habit this way.
Rozerem is a different non-addictive sleep aid available on prescription. It works via melatonin receptors, much like melatonin. There are no trials comparing the efficacy of Rozerem to melatonin as yet. The manufacturers claim that melatonin is of no benefit as a sleep aid, but much anecdotal experience suggests this isn't true.
-Horny
Posted by sunnydays on June 24, 2008, at 11:50:22
In reply to Re: desperately need advice - Xanax, anxiety, inso, posted by Horned One on June 24, 2008, at 5:52:57
Thanks. I didn't take anything last night and got to sleep at 5 am.... not anxious, the anxiety went away, but just wide awake, like my eyes were glued open. 1mg Xanax does not give me rebound anxiety when taken as needed, so I disagree with it being a big dose - depends on the person I think. I have thought of Ambien and Lunesta, but pdoc never suggested those, so I am thinking that there is a reason there. I also don't want to risk those weird side effects you can get - sleep driving is not for me.
Thanks for your input. I'm getting really overwhelmed because can't get in touch with T or pdoc - T will try back again, but he keeps calling too early in the morning for someone who can't sleep to be awake, so I haven't gotten to talk to him yet. And pdoc won't be there until tomorrow. It's really frustrating.
sunnydays
Posted by sunnydays on June 24, 2008, at 23:44:00
In reply to desperately need advice - Xanax, anxiety, insomnia, posted by sunnydays on June 23, 2008, at 14:28:40
So I finally got to talk to my T. He encouraged me to make sure I give my pdoc all the information (I tend to get really scared when I'm there and despite however confident I was suddenly start hiding stuff). He also asked if I was feeling manic-y? I said I don't think so. But he said, "Well, I know you don't want to [long story], but I think you're probably on the continuum at least if you truly don't feel like you need sleep at all."
Do you guys agree? He may be right - my brother has bipolar I and so I probably have some predisposition as I have a serious family history of mental illness. Anyway, see pdoc tomorrow, so hopefully I can get off this Effexor.
sunnydays
Posted by sunnydays on June 25, 2008, at 20:34:12
In reply to mania???, posted by sunnydays on June 24, 2008, at 23:44:00
I'm frustrated - my pdoc seemed really frustrated with me today - the conversation ended with "I don't want you to think I'm yelling at you." I just feel very let down. I thought we were working well together and I thought I was doing exactly what she told me to do.
I guess I'm more difficult than I thought. Everything stays the same for now, and she basically said I have to take the Xanax every night until further notice.
I wish I could see someone else. But that's what you get when it's free, I guess.
sunnydays
Posted by rskontos on June 26, 2008, at 13:24:23
In reply to pdoc frustrated, I'm frustrated, posted by sunnydays on June 25, 2008, at 20:34:12
Suunydays, how much xanax did she prescribe (sorry if you already posted that I did not see it). How little of it have you tried to take to get to sleep? I use only .25 (sometimes I need two but rarely two nights or days in a row) and I go to sleep and I am anxious as hell. I am prescribe up to .75 at a time. I would never start out at 1 mg. or more. I think to start at a lower dosage is an ok thing to do if you are worried. Then you are taking it everynight like she wants. If a smaller dosage works and you go to sleep then all is well and she would be happier and so would you.
So how much is the least you have tried to see it works?
Now we are different in that my p-doc did not prescribe it for an sleep aid nor to counter the effects of an ad.
But if she insists and you are so frustrated just try and half the tablet if it is 1 mg. or even 1/4 of one.
I think this is a viable trial to try and get relief with a lower chance of addiction which I believe is your biggest worry.
rsk
Posted by kowaligirl on June 27, 2008, at 7:39:26
In reply to desperately need advice - Xanax, anxiety, insomnia, posted by sunnydays on June 23, 2008, at 14:28:40
I have taken Xanax for 10 years now. I am not addicted even though someone may think one would be after 10 years. I only take it when I need it. I have rx for 1 mg 3 times a day but a script of it last for 4-5 months. I usually take .5 mg at night if I am feeling the burn from anxiety which I have battled long enough to recognize my symptoms. Xanax is a quick acting but works only short term so even though it may help me to go to sleep I usually end up awake after 4 or so hours. Some sleep is better than none. But I do not take it every night and after a couple of nights of taking it, I usually have a few nights of not needing it to sleep. The Wellbutrin I take adds to the insomnia so I am aware I will have insomnia to deal with. My dr. tried Lyrica, but I will not deal with the hangover effects I feel from meds like that and Ambien and that group of hypnotics. I recommend you try the xanax for 2-3 nights and get all the sleep you can from that. Then if you are still tired and know you need more sleep to cope, try a OTC Tylenol PM. Check with your dr. first b/c any other meds you are on may change what is right for you.
Posted by blueboy on June 28, 2008, at 11:25:42
In reply to mania???, posted by sunnydays on June 24, 2008, at 23:44:00
> So I finally got to talk to my T. He encouraged me to make sure I give my pdoc all the information (I tend to get really scared when I'm there and despite however confident I was suddenly start hiding stuff). He also asked if I was feeling manic-y? I said I don't think so. But he said, "Well, I know you don't want to [long story], but I think you're probably on the continuum at least if you truly don't feel like you need sleep at all."
>
> Do you guys agree? He may be right - my brother has bipolar I and so I probably have some predisposition as I have a serious family history of mental illness. Anyway, see pdoc tomorrow, so hopefully I can get off this Effexor.
>If you are bipolar and taking Effexor, there is a high likelihood of bad reactions.
I tried Effexor, prior to the time I was diagnosed BP, and I had a horrible experience at higher dosage, ending in seizures/convulsions. And, it did no good.
Your extreme insomnia is a symptom I share. Yes, it could easily be hypomania induced or aggravated by Effexor. I am especially reminded of my own problems by the lack of response to "normal" doses of Xanax.
If you are in fact bipolar, you need to get off Effexor and the last thing in the world you need is to take Xanax every day. Bipolar patients are especially susceptible to getting addicted to depressants. I had a horrible time with alcohol.
The one thing I have really been successful with is Use of a benzo for hypomanic or mixed-state insomnia. (In my personal lexicon, if it feels good, I call it hypomania; if it feels bad, I call it "mixed state".)
I have a high body weight (225-230 pounds) but for mixed state insomnia, or when I feel agitated and unpleasant in the evening, I take 2.5 to 3 times the "normal" dosage of clonazepam (Klonopin). I think Klonopin is better than Xanax for hypomanic relief. (Xanax is great for fast-acting relief from primary anxiety.)
However, I limit myself to two doses of Klonopin a week and, after four years, I have no habituation or craving for the drug.
Ambien and Lunesta are effective for sleeplessness but if you are having a mixed-state episode, you might wake up still having the episode and will possibly have some very weird and unpleasant dreams. Or at least, I do. Again, I need 2.5 to 3 times the suggested dose of Ambien/Lunesta to get me to sleep if the insomnia is bipolar related. (And it is difficult to tell the difference sometimes, although it gets easier over time.)
I occasionally use both Klonopin or Ambien to reduce simple anxiety: Klonopin primarily for social anxiety, i.e. I want to stay awake and go to, say, a dinner party; Ambien if I am having anxiety or feel okay but just can't get to sleep. In those cases, the normal dose of 10mg Ambien to sleep or 1mg Klonopin when I'm going out for the evening works great.
Ambien (available in generic) is really good for waking up in the middle of the night, since it only lasts about five hours. On occasion, when I have gotten to sleep but wake up at 2 or 3 a.m., 10mg of Ambien works very well.
If your pdoc is prescribing daily Xanax along with high doses of Effexor, without taking a total history and making an informed decision about the possibility of bipolar disorder, you need to either confront him with the possibility or see someone else. This is a very bad drug combination for someone with Axis I Bipolar. It probably wouldn't help the condition at all and would leave the patient worse off than before.
Since you have difficulty describing your symptoms in person (and let me tell you, I have symptoms I find extremely embarrassing to tell even a psychiatrist in a private setting protected by legal privilege), here is my suggestion:
Write them down and let him read them. I did two such documents. First, a life history (which is very helpful in seeing longer cycles in bipolar type disorders, especially if you have periods of success in school or work followed by periods of inexplicable breakdown). Second, a description of symptoms broken down by type.
If you have embarrassing symptoms (sexual obsession or conduct, eating disorders, self-mutilation, etc.) and don't want to put them in writing, you might characterize it generally. Say, for example, you are bulemic and eat a lot of food, then vomit it up. Yeah, I can sympathize, you might find it just to embarrassing to tell even a doctor. But maybe you can write down "an eating disorder" and tell the doctor that it is too embarrassing for you to give details. Or if you spent hours obsessively looking at men's penises on the internet, you might write down "problem with a sexual obsession that goes on for hours" or, if that is too much for you, just "an obsession that takes up hours of time".
I realize these may not be problems you have, I just want to say that your doctor needs some clue about your symptoms. Even if you generalize them beyond recognition, it's better than leaving him clueless.
Also, caveat: I am not qualified to diagnose mental problems in person, much less from an internet post! I just hope I can give you some help from my own experiences and perhaps a bit of perspective about one possible problem. That said, my own opinion would definitely be influenced by your brother's condition. Have you thought about talking to him, if possible?
This is the end of the thread.
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