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What Causes Sleeplessness When Treating CHF, Intracerebral Hemorrhage And Hip Fracture?

Posted on Thu, 5 Mar 2015

Question: My 85 yr old mother was diagnosed with CHF 15 years ago for which she has been prescribed Digoxin, Carvidolol, Lisinopril, Furosemide , and, of course, potassium. She also suffered a severe intracerebral hemorrhage 7 years ago followed by a hip fracture. She takes 200mg phenytoin to avoid petit mal seizures since the stroke which has been effective. She is currently wheelchair bound. As a result of the deterioration to her autonomic nervous system, her blood pressure is somewhat erratic and she now only takes the furosemide and carvidolol depending on her blood pressure and fluid retention. Still on digoxin. She also takes celebrex 40mg for depression. Given her age and lack of mobility, she naps throughout the day, although we try to keep her mentally alert as much as possible. She began awakening throughout the night and could not sleep despite obvious signs she was tired. We've tried diphenhydramine but the effects wear off in 3-4 hours. Her primary physician prescribed clonazepam 1mg initially. Now she is taking 1.5mg and still not sleeping at night. Of course, she, then, wants to sleep all day and we end up in a vicious cycle. What else might be helpful that will allow her (and my family) to sleep at night?

Answered by Dr. Kathy Robinson (2 hours later)

Brief Answer:
trial of trazodone

Detailed Answer:
Hello and thank you for your question. First I just want to clarify something. You said that she takes celebrex for depression. Celebrex is an antiinflammatory drug usually dosed at 200 mg a day, can cause sodium retention and should never be used in patients with CHF due to sodium retention. Make sure she is not taking any celebrex. Secondly if you meant celexa for depression, the maximum safe dose for patients over 60 years old is 20 mg daily so you may need to speak to her doctor about lowering that dose. Klonopin can be used very short term for sleep but taken long term it can actually disrupt the normal sleep cycle. It also increases the fall risk in elderly patients. A much safer drug for sleep in the elderly is trazodone. Unfortunately she will need to be tapered off the klonopin very slowly. Then her doctor can give her a trial of trazodone, starting at a very low dose and tapering up. You may also want to ask the doctor to check an overnight pulse oximetry to make sure that she is not lowering her oxygen levels during her sleep.
Good luck to you and I hope she is able to sleep at night soon.
Dr. Robinson

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Kathy Robinson (45 hours later)

You're right. I did mean celexa. Since she is wheelchair bound, the chance of a fall is minimal. But I will discuss trazodone with the physician. Thank you.

Answered by Dr. Kathy Robinson (4 hours later)

Brief Answer:
good idea

Detailed Answer:
Thank you for your follow up and please let me know if you have further questions.
Dr. Robinson

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj