Not sleeping

[loubielou]

Hi all,

So I have now been awake for around 35 hours with a couple of short 'dozes' that have probably totalled about 3 hours. Usually I sleep more than I'm awake... it's been a long time since I couldn't sleep.

I'm currently changing meds - I'm tapering citalopram from 40mg to 30mg, and have added in Mirtazapine 15mg. I understand Mirt should have a sedative effect, and I take it at night. I've been on it for about a fortnight now.

The other thing that may be relevant is my anxiety levels, these were sky high a couple of weeks ago, settled over the last few days, and are now rising again over the last 48 hours. I have some lorazepam, perhaps I should take that tonight...

Just wondered if anyone has any tips or advice. I have an appt with the MH team on the 8th so will of course discuss this then. If I continue to barely sleep at all I'll arrange to see my GP in the meantime.

Last night between 3am and 7am I finished my first ever crochet blanket, so I suppose this lack of sleep problem is at least productive in some way!! I find the rhythmic nature of crocheting really helps calm me. But unfortunately it didn't quite send me to sleep.

It's a bit like I feel as though I could put my head down and drift off, but that makes me nervous for some reason and I know I'm almost fighting the sleepy feeling. Then after a few minutes it passes and I'm wide awake again. I'm now at the point where I feel a bit 'spaced' because I must be so tired, but I feel as though my eyes are pinned open.

So, I either sound like a complete loon, or, hopefully, someone is going to read this and say 'yes - I know that feeling' and make me feel like less of a weirdo.

Thanks for reading.

[Pip]

Sorry I can't be helping with regards to your medication as different meds / combinations work for different people.  I have taken citalopram which did work for a while for me but stopped it last year because it stopped helping and I've never taken Mirtazapine.  For years I've had problems with sleeping but I have taken Amitriptyline for one of my combination of meds for pain relief.  It's been upped to 50mg which helps me sleep.

[SteveW]

I replied to you about the CMHT and thought I'd reply about your sleep problems. It takes my mind of the horrendous contents of my own head for a bit.

Sleep problems are pretty much integral to depression. Early wakening is the classic symptom but loads of people have problems getting off to sleep as well. I wouldn't expect too much of your GP. He has done the classic thing of putting you on a sedative anti-depressant. There is only one thing that really could be  done in addition. That would be to put you on a sleeping pill for 4 weeks in the hope that this would settle you back into a regular pattern of sleeping. But this option is very rapidly disappearing from your average GP's set of options. Many GP's simply don't prescribe sleeping pills full stop.

Increasing your Mirtazepine wouldn't do much good. It is a very paradoxical drug. It is more sedative at lower doses than it is at higher ones. I think its peak for sedation is 7.5 mg, which isn't even anti-depressant dose level. Your best bet is probably to use the Lorazepam you have. There is treatment for anxiety that is separate from treatment for depression. You are most likely to get that from a CMHT psychiatrist.

My GP says something to me regularly that causes me to want to file his keyboard up his nose. This is "Insomnia isn't pleasant but nobody ever died of it". God that irritates me. If all goes well your sleep problems should disappear as your depression lifts. You found crochet. I tend to listen to my iPod.

[loubielou]

Pip, I was prescribed amitryptiline for pain a while back too, at that point I wasn't depressed or having trouble sleeping, and I actually had to stop taking it because I just couldn't get out of bed in the morning it made me so tired. Maybe I should take some left over ones if I carry on struggling, although my friend has removed all medications from my house (as a safety precaution) so I'll have to ask for that one back.

Steve, thanks for your reply, I'm glad that helping me is sort of helping you too, even if its only by diverting your attention briefly. I really appreciate it. The early wakening you mention really surprised me - a few weeks ago I was sleeping alright but waking really early, even when I still felt tired - that must have been in what it was.
I remember a few years ago a GP offered what you described, a two week course of sleeping tablets to try and create a positive sleep pattern... I actually paid for the prescription but was too scared to take them.
As you suggested in your post I did end up taking my lorazepam last night. It did the trick, I fell asleep about half an hour after taking it and actually slept for 12 hours solid, a huge relief.
Haha - I'm amazed someone hasn't filed anything up your GP's nose for comments like that before - how I sometimes wish they could try living our lives for a day.

[SteveW]

Just one last word, and then I'll stop bothering you. Don't try mixing amitryptilene and mirtazepine. I can't say that it is biochemically unsafe but you may experience rather more sedation than you planned on.

[Pip]

That's the only problem I find out times with amitryptiline particularly if I go to bed later than I intend.  This morning I had to be up early so I've been very tetchy all day.  Sometimes I drop it by 10mg for a few nights and my GP is fine with me regulating myself as I never take more than 50mg a night.

[loubielou]

Thanks again to everyone, and Steve, you're not bothering me at all!
I avoided the amit. and have managed to sleep okish the last couple of nights by listening to meditative music and deep breathing while I'm trying to drift off. Fingers crossed this continues to work.

[stewart]

i take 45mg mirt's and it dont have any sedative impact on me, its the 150 mg amy's that help me sleep.

the amys do tend to come back for a second kick in the afternoon and make me drowzy