Suggest Treatment For Severe Insomnia While On Benedryl And Ativan

Question : I have had insomnia for the last 10 years. I have paradoxical reactions to virtually all sleep medications whether over-the-counter or prescription. Even ABH (a mixture of ativan, benedryl, and haldol) kept me awake and made the insomnia worse. After 10 years, I am getting desperate. Is there any chance that a stimulant might put me to sleep? I have asked a number of doctors before, but they look at me like I'm crazy. Couldn't someone prescribe say, three nights worth to give it a try?

Dr. Solanki,

-- I tried Ambien, Lunesta, ABH (a combination of ativan, benedryl, and haldol), Klonopin, Xanax, and perhaps XXXXXXX (?). There were others that I cannot remember. I have no idea what the dosages were. Benadryl can either make me sleep or keep me up, so I do not take it for sleep. 10 mg of cyclobenzaprine makes me uncontrollably sleepy, but it is a tense, drugged sleep that is not restful at all, and I wake up feeling even more exhausted. I tried magnesium, valerian, B6, melatonin, and GABA, separately and in combination. The combination kept me up all night and I never slept at all.

-- I sleep anywhere from zero to five hours each night. If I fall asleep during the day out of sheer exhaustion, I actually sleep a little better, but then it is even harder to get to sleep that night.

-- I have all three types of sleep disturbance. Difficult onset, fragmented sleep (sometimes waking every hour), and if I cannot get back to sleep, it is essentially the same as early awakening.

-- I have tried sleep hygiene under the supervision of a sleep specialist, but it did not work. I have tried keeping to a schedule, eliminating caffeine, massage, acupuncture, chiropractic, cranial-sacral therapy, physical therapy, sitting in the dark all evening, hypnosis, ambient music, ambient noise, XXXXXXX sleep recordings, meditation before going to bed, baths, showers, earplugs, blindfolds, fasting three hours or more before bedtime, setting intentions, praying, asking management to deal with noisy neighbors -- you name it. Nothing works. One strange thing of note: my Chinese M.D./Accupuncturist told me that I am one of the one-tenth of one percent of people who are energetically wired backwards, so that acupuncture will not work on us and will actually make us sick. I sometimes wonder whether that is related to my paradoxical reactions.

-- I do have physical illness, pain, and stress from fibromyalgia, psoriatic arthritis, migraines, the resulting disability, and the severe financial stress that comes from not being able to work. Other than suppressed anxiety (with not much conscious worrying), I have no psychological illness. I suspect that anxiety may be at the root of my sleep problem but have no idea what to do about it. I tried years of therapy without any sleep improvement. Xanax helps me fall asleep, but gives me amnesia and adds to my chemo brain and fibro fog. I recently tried EFT, and it does seem to relieve the anxiety somewhat.

-- I have undergone three sleep studies. I had the first sleep study in 2003 because even though I slept eight hours a night straight through with no interruptions, I awoke as tired as when I went to bed. The first study showed sleep apnea (holding the breath for forty seconds and breathing for twenty seconds, almost every minute, almost all night long). I failed CPAP, had a UPPP in 2004, got significant relief, and felt great.

Then, in late 2005, prednisone prescribed during cancer treatment disrupted my sleep pattern. I was wired and slept very little. I worked with a psychopharmacologist who tried everything she could, but every sleep medication wired me even more and I couldn't sleep at all. She even had me try a combination of ativan, benedryl, and haldol (ABH), with the same results. I had a second sleep study in 2006 and they found nothing wrong except that I only slept four hours and got almost no XXXXXXX sleep. The sleep specialist did not know why and had no helpful answers. I gave up at that point, but over time, I started getting five to six hours of sleep each night, although it was never restful. I got fibromyalgia suddenly a year later (after an infusion of IVig) and the doctors had no explanation as to why.

A few years after that (probably around 2012), my rheumatologist prescribed prednisone again, this time for psoriatic arthritis that had become severe and added to my disability. After nine months, I had built up to 20 mg of methotrexate and the doctor weaned me off of the prednisone. I have since cut down to 10 mg of methotrexate once a week and I control the arthritis primarily through diet. Needless to say, I hardly slept at all for those nine months and I never regulated my sleep again after that. I had the third sleep study that showed almost the same result as the second: four hours of sleep with one interruption, and only five minutes of XXXXXXX sleep. Again, the doctor could not tell me why. He suggested better sleep hygiene. I followed his suggestions carefully and with discipline, but they did not work.

Thank you for your time and patience. I look forward to your response and any suggestions you might have.

K

P.S. When my energy was waning from fibro and I needed help to keep working, my doctor prescribed Ritalin and then Provigil. Ritalin drove me crazy as I cycled on and off it between doses. It seemed like I was always on the way up or the way down, and never stable. I did much better on Provigil because it had once a day, morning dosing and kept me more stable, calm, and concentrated. However, I don't remember it helping me sleep. It helped me keep going, but I would periodically "crash" from having done too much for my body to handle. I stopped taking Provigil when I retired early because I could not fight the pain, fatigue, and cognitive impairment any more. Ritalin and Provigil are the only stimulants I ever tried. P.P.S. I also asked my doctors about possible hormone imbalances that might effect my endocrine system and ability to sleep. No one ordered tests or even seemed interested in the possibility. Is this something I should insist upon or are hormones truly irrelevant? Thanks, K

Dr. Solanki,

Thank you for your time, attention, and advice. After being awake for nearly 48 hours I finally crashed and slept most of the day yesterday. I was also very distracted by recent news events. I apologize for taking so long to get back to you.

Your reply was very informative. I have never taken Mirtazapine before, so that suggestion is definitely worth trying. Your response reminded me that I have tried amitriptyline (Elavil) and quetiapine (Seroquel) at very low doses before. They might be worth revisiting. Would you recommend full or low dosing this time around?

I have had thyroid levels checked in the past (but no other hormones that I can remember). The levels were "low normal." My family physician suggested we try natural thyroid and it seemed to help, but then it stopped being available. I did not do well on synthetic hormone (racing heart) and stopped the treatment. I will ask to be tested again if natural T4 has become available again.

Thank you,

K