Doctors' Answers to "Frequently Asked Questions" - Sleeping Problems

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Hallucinations and bad dreams [posted 1/11/99]
Question: I had a ear surgery that didn't go the way we planned, and since then I have had balance and dizziness problems that are kept under control to give me a life that will enable me to do some of the things that I want to do. Otherwise, I would have bad days everyday. I still have problems, but not to the extent that they were before I was put on the histamine blocker Claritin. This does help me, but it also causes me tachycardia. So the doctor has had to put me on various beta blockers. I have tried about 3 kinds now. The first one was Normodyne, which worked for about a year or so, but then the tachycardia became a problem once again so I was put on Inderal 60, which worked, but I started having terrible nightmares. It then led to nightly hallucinations, so I asked the doctor to give me something that wouldn't affect the brain so much. He put me on Lopressor 25 mg bid, which keeps the heart rate within reason, but am still having trouble at night with the dreams and the shadows in the rooms turning into people or animals that are walking or floating in the air. It's not a very good feeling, as I know that I probably am not really seeing this, so I try to focus on the object until the hallucination goes away, which it usually does within a few minutes. Why do drugs do this to our brain? Is there a drug that won't do this, but help with tachycardia that is caused by a different drug?

Answer: Well, I would try Atenolol, but you will probably experience the same problems.

PTSD [posted 1/8/99]
Question: Desyril was prescribed for sleeping problems due to multiple anal/oral rapes of child. Would this be drug of choice to manage symptoms? Also please provide information as to contraindications for this medication and any efficacy studies that may have been done to date. I was unable to locate any information of possible side effects. This child has extensive history of gastric dysfunction due to birth defects, i.e. Born with intestinal organs outside of body cavity.

Answer: This belongs to a class of anti-depressants called tricyclics. They tend to produce dry mouth, constipation, and drowsiness. Long term side effects do not appreciably differ from short. As to whether this is the best drug, impossible to say here.

Sleeplessness After Diagnosis with Heart Condition [posted 11/13/98]
Question:I am 73 years old, and I was diagnosed, few weeks back, with an atrial fibrillation. However, my great problem is sleeplessness, and unless I take a Temazepan pill, I seem to remain awake for the whole night -sometimes 2 nights in a row, leaving me feeling ghastly. I have to take Digoxin 125mcg, but am told this should have no effect on sleeping patterns. Being of a somewhat nervous disposition, my belief is that I remain anxious about my condition, yet I cannot crack my sleeplessness problem - it's as if I have lost the ability to know how to fall asleep! Wonder if you might have any ideas about what's going on.

Answer:Did they check your thyroids, a possible link if elevated. The digoxin won't cause this problem.

Sleep & Nortriptyline [posted 11/10/98]
Question:Is nortriptyline ever given to someone because they have problems sleeping at night?

Answer:Often, causes drowsiness as a side effect which is very helpful in helping patients sleep without any addiction.

Sleep Disorder [posted 7/21/98]
Question: I am 30 years old. I have always been one to take evening naps since middle school. For the past 5 years I have had an extremely difficult time staying awake during the day. It doesn't matter if I go to bed and get 8 hours of sleep or 4 hours of sleep, I am still tired. For the past two years I have been getting at least 30 minutes of exercise daily. Usually walking 2 miles. Nothing seems to work. I have even had a glucose tolerance test and it was normal. What could be the problem?

Answer: Most likely a sleep disorder. Have your physician check your thyroid function. If it’s normal, see a sleep specialist and spend a night in a sleep lab. There are several common problems, usually easily corrected which will lead you to be tired all day. Most of the problems center on the lack of ability to get into deep or Stage IV sleep which is necessary to avoid the fatigue you describe. It also tends to be inherited in certain types and may relate to your children (or eventual children) and your siblings.

Difficulty Sleeping
Question: I stopped taking Redux and phenteramine about 9 months ago. I took it for over a year and had to take Zoloft and Unisom to counteract the side effects. However, since I've been off of it (I never lost any weight) I have had trouble sleeping and sometimes one Unisom is not enough. I've asked my doctors about it but they seem flummoxed. Could it be nerve damage or something?

Answer: Hard to know. Have you tried melatonin? You are currently using an antihistamine to achieve sleepiness which is all right, but doesn't indicate any nerve damage.

Tired
Question: I'm a 15 year old girl with a very pressured schedule. Lately, I have been finding it very hard to stay awake after 10 p.m. I thought it might be mononucleosis, but I don't have any appetite problems. Should I have a blood test done?

Answer: You fail to mention how much sleep you are receiving on an average night. Most 15 year olds will have sleep deprivation with any amount less than 8-9 hours. Usually a pressured schedule means that sleep is minimal. I’d recommend that you schedule your day to ensure 8-9 hours a night for a week or so. If fatigue continues, see your physician.

Snoring
Question: My husband snores in any given position: on his stomach, side, or back. His mouth is never open and he doesn't quit when he is moved into another position. He used to only do this occasionally, but now it happens every time he goes to sleep. He is 41 years old and in good health. Could his adenoids be the cause of this?

Answer: Snoring usually indicates some partial blockage of the airway while sleeping. In severe cases this can cause sleep apnea, which is potentially very serious. I'd discuss this with his physician. He may need a visit to a sleep lab, especially if you see him stop breathing or if he is getting sleepy during the day. Large adenoids are a possible cause of this problem as is a short jaw.

Sleeping problems
Question: I am 48 years old and I don’t sleep very well. I go to bed about 11:00 p.m., sleep deeply for about half an hour and then get awaken for 2 to 3 hours. Even when I go to sleep early I wake up too early (about 3:00 or 4:00 a.m.). I feel I am not getting enough sleep because in the afternoon I get very tired at work around 2 p.m. I started taking 1 mg of Melatonin every night just before bed and that improved my sleeping somewhat, but still not very much.
Please advise me if I need any other medication.

Answer: Common culprits in disturbing sleep are alcohol and caffeine. In many people, as little as one drink will decrease the deep stage IV sleep substantially. Caffeine, tea, or chocolate are also possible causes. If eliminating alcohol does not help, a small dose of a drug like Elavil (usually used in depression) will usually fix this problem with no risk of rebound or addiction.

Sleeping on one side
Question: I am a 50-year old male. I can only get to sleep lying on my right side. I always wake lying on my right side and my bed partner says I spend the whole night on my right side. Is this normal or harmful.

Answer: This is very normal and not harmful.

Sleeping Problems
Question: Please recommend a prescription to make me sleep very hard for 8-10 hours. I have tried Temezepam, Ambien. I work odd shifts and MUST sleep unusual hours during some weeks.

Answer: Shift work is difficult to work because of the impact on sleep. Trying to shift the sleep cycle is difficult. Benzodiazepines like you have tried are the usual method. Taking higher doses may help, but continued use will blunt their effectiveness. Several people have tried melatonin with some success.

Sleeping Pattern
Question: I would like to know if there's any treatment for my condition. I am only 17 years old and for the last 3 years I have been sleeping for more than 9 hours each night. I exercise, eat a balanced diet and I am not depressed. I would like to know if there's a treatment or anything that would help since this is getting in the way of my studying.

Answer: If your thyroid and blood counts are OK, there probably is nothing medically wrong. Many 17 year olds will sleep this amount. Other medical causes would include different sleep disorder. These are usually marked by marked snoring, leg movement while asleep or jerking of muscles while asleep.

Thyroid & Insomnia
Question: My doctor tested my thyroid and increased my dose from .025 mg Synthroid to .075 Synthroid about three weeks ago. I am also taking Phen/fen (have been doing this since May, 1996 with NO insomnia). Over the past two and one half weeks I have been plagued by insomnia. I go days at a time without sleep. On one hand my psychiatrist (who prescribed sleeping meds) feels strongly that the Synthroid increased dose could well be causing the sudden onset of insomnia. On the other, the doctor who prescribes the phen/fen (30 mg Ionamin 1 x day and 20 mg fenfluramine bid, although I usually only take it once) says it surely can't be the Synthroid and must be the Phentermine. This makes no sense to me given that I've been taking it for well over a year with no side effects and all of the sudden (coincidental with the increased thyroid meds dose) I have begun to experience insomnia that is even resistant to sleeping pills. I have an appointment with the doctor who prescribes the phen/fen next Thursday however, he believes the p/f is causing the insomnia and is threatening to discontinue prescribing it. I have lost 75 lbs in the past 14 months and have NO INTENTION of going off the p/f, with or without this doctor's consent. There are pill mills on every street corner in my area, and I do not believe the p/f is responsible, and neither does my psychiatrist. I need an additional medical opinion before I go for my appointment with the p/f doctor on Thursday so that I can intelligently discuss this matter with him. Any advice you can offer (or any opinion) would be greatly appreciated.

Answer: Stop the phen/fen for a week or so to test which one is the culprit. Also, long term damage is being increasingly reported concerning patients who are on these drugs over a year. If you desire to continue phen/fen insure that you get a cardiac echo to check the valves and the pulmonary pressures.

Temazepamum
Question: I would like to know what brand name this sleeping pill is known as. " Temazepamum".

Answer: Brand name is Restoril.

Trouble Getting Up
Question: I am a 20-year old male with no prior major medical disorders. My question regards a problem I have with sleeping. For about a year or two, I have had trouble waking up in the morning. No matter how long I sleep, I still never feel like I am completely rested. Furthermore, the more that I sleep, the worse I feel. I sometimes wake up with headaches, and it is very difficult to wake up completely. Once I have gotten up, I am not usually tired for the rest of the day, it's just waking up that is so difficult. Is there something medically wrong with me? I have read about disorders such as sleep apnea, etc., and I was wondering if I could have such a thing. Or, if not, what can I do to end this problem?

Answer: First, how many hours a night are you sleeping. A 20 year old will need 8-9 hours a night. If you are getting less this is the most likely culprit. Secondly, avoid any alcohol and caffeine-both of whom change the level of sleep. One to two drinks will block some patients from reaching Stage IV sleep-necessary to avoid feeling tired. Thirdly, if this doesn't fix the problem you will need to see a physician to check your thyroid function. If normal, a sleep lab is the next step.

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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