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Suggest Treatment For Sleeplessness

Posted on Mon, 4 Jul 2016

Question: I am the mother of the following person. He can not get up in the morning whether he takes his sleeping medication or not. But if he doesn't take his sleeping medication he is up and down all night. He says melatonin doesn't work. We have tried Unisom and other over the counter sleeping aids. Any suggestions?

Answered by Dr. Chintan Solanki (25 minutes later)

Brief Answer:
provide more details

Detailed Answer:
Hello,

Thanks for writing to us. I can understand your concern for your son.

He is suffering from insomnia. I want to inform you about insomnia and form that I need some relevant information about him.

Insomnia (sleep disturbance) is of two types:

Primary: There is problem of only sleep disturbance and no other physical or psychological problem is there. In this case treatment for sleep problem is needed.

Secondary: There is some underlying physical or psychological problem which is responsible for sleep disturbance. In this, main treatment is done for underlying problem.

Ask him to follow some measures called 'sleep hygiene' which would help in sleep. You can find the same in below link.

sleepfoundation.org/ask-the-expert/sleep-hygiene

Drinking a cup of warm milk before going to bed helps in 30-40 of patients and they do not need medicines as per my clinical experience.

Let me know,

- Since when is he suffering from sleep disturbance?

- Is there difficulty in sleep onset, fragmentation of sleep or early morning awakening?

- What was the schedule (timing) and duration of sleep before the problem started? How much reduction in sleep from previous?

- Does he have any stress in life (it can be social, economical, relationship, study/work or emotional)?

- Does he have any physical psychological illness?

- Which medicines have been tried until now and in what dose?

- Any other relevant information?

I will be happy to help further after your response.
Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Naveen Kumar

Follow up: Dr. Chintan Solanki (21 minutes later)

I guess I didn't give you enough information and I do apologize for that. He just graduated high school 5/19 and is finishing his training for fire fighter 1 to get on with a paid department. When his girlfriend broke up with him back in October, he just went down hill. I know he has A LOT on his plate. When I took him to the doctor, he was diagnosed with Bipolar and put on Seroquel and Zoloft. Seroquel made him too sleepy and was hard to get up in the morning. Even cutting the 25mg in half was too much. Ambien was NOT a good idea. Trazodone seems to make him too groggy in the am to get up as well. He currently takes Zoloft 100 mg and Latuda 40 mg at night before bed. Could the Latuda be causing the drowsiness as well?

Answered by Dr. Chintan Solanki (7 hours later)

Brief Answer:
yes latuda causes drowsiness,I need more info about diagnosis

Detailed Answer:
Hi,

Thanks for information.

Latuda is long acting and half life of its 18 hours. Somnolence is common side effect of it. At 40 mg it is possible that latuda is responsible for his drowsiness.

I am little bit surprised that patients with bipolar disorder generally have no very less sedation with drugs. Can you tell me about his hypo-manic or manic episode so I can confirm the diagnosis of Bipolar.

- What are other symptoms he has currently apart from sleep disturbance on these medicines?

If I were his treating doctor I would like to give low dose benzodiazepine like ativan or klonopin for sleep problem apart from application of sleep hygiene.

I would like to comment further about his treatment after your response.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee