Insomnia [posted 10/1/98]
Question: In the past month or so I have had Chronic Insomnia ( I sleep no more thatn 3 or 4 hours a night ). I usually need at least 8 . I have both ADD and Bi-Polar II and am now on four different meds. I originally started taking the Klonopin to help me sleep but it really never did. In fact my Dr. told me to increase my evening dose to 2.5 or 3 mgs. I know that would knock most people our for days but it has had no effect. As a matter a fact, any drug I have taken that says it may cause drowsiness never does. I am seeing him again on Tuesday and my insomia is a big problem. My main problem is I just can't get to sleep: I am up until 4 or 5 most nights and get up around nine.

Answer: First, ensure you don't have a new problem like hyperthyroidism. Second, I'll need to know the other drugs to help.

Insomnia Treatment with Paxil and Trazadone [posted 8/10/98]
Question: What do you know about the use of Paxil and Trazadone for people who have trouble sleeping, but show no other signs of depression or anxiety? I'm wondering if these drugs are effective in just dealing with sleeplessness and if in lower doses the side-effects won't be as severe?

Answer: Paxil is generally not helpful for sleep, trazadone often is. I would not use Paxil in patients with difficulty sleeping, but often use trazadone. Side effects are drowsiness the next day, constipation and dry mouth. These are usually dose dependent and you should try for the smallest dosage that accomplishes the sleep goal.

Insomnia [posted 8/7/98]
Question: I have chronic insomnia. For over four years, I have been getting no sleep, or about three hours/night, three weeks of every month. That means I am severely sleep deprived. It is truly ruining my life. I am extremely bi-polar, have manic attacks at least five times/week, and have been on Prozac in the past. At this point, I am unsure of whether my insomnia is causing mania, or my mania is causing insomnia. What are your thoughts on this? I've contacted numerous sleep clinics and have either gotten no response at all, or a negative one since I have no health insurance.

Answer: 1) avoid any caffeine, chocolate, alcohol - all known to interfere with sleep cycles. 2) Try an antihistamine about 1 hour before bed - benadryl is good take 50 mg (available in 25 mg capsules in any pharmacy). 3) If you cannot tolerate the drowsiness you may see during the day with benadryl try melatonin - some patients get major improvements with this drug. 4) Ensure your thyroid functions have been checked - an over active thyroid will give sleep disturbances, about the only significant medical problem that will.

Chronic Insomnia
Question: My average 14 1/2 yr. old daughter has terrible insomnia. She is not depressed / drug user / stressed. She eats well and exercises. What can I do to help her. She goes to sleep fine, then wakes up approx. 2am and cannot get back to sleep until around 5a. She goes to bed around 10'ish most nights.

Answer: Is this new or has she had it her whole life? If new it definitely needs to be brought up with her pediatrician. If lifelong, I doubt that it will change. A sleep lab could be helpful to determine if she has any condition which is causing this.

Klonopin
Question: I have problems sleeping. I occasionally take klonopin to help me sleep. Lately I take it every night. I am finally able to wake up and feel good. I am able to sleep through the night. Is taking this bad for me? Can I just stop taking it?

Answer: Klonopin belongs to a class of drugs called benzodiazepines. In general, they are used for sedation and treatment of anxiety. They are usually effective as sleep inducing agents;but, tend to lose their effectiveness if used on a nightly basis. Antihistamines(Benadryl, etc.) are not addicting and do not tend to lose effectiveness. I would take these types and use Klonopin as a back-up if there is no effect. If you have taken them for a long period, I would not stop them cold. Rather taper them over a week. However, if you only take one a day you could probably taper fairly quickly.

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