So so tired. Caffeine has been utterly useless.

[Ambivalid]

@Spice_Weasel

That is some compelling imagery.

My anxiety is usually at its worst at night. At best, it’s just a general feeling of existential dread. But sometimes it manifests as imagining vivid horrible things or just me obsessing over my mother. I usually pop an Ativan before bed when I’m particularly het up, but it’s not the most effective thing ever. I do not typically drink caffeine but I swear sometimes I feel like a gallon of it has been dumped into my system. It’s so predictable I have a little mental mantra, something like, ‘‘I’m thinking about the Holocaust. It must be 10 o’ clock.’’ It reminds me it’s just anxiety. But anxiety sucks.

You sound a bit like my girlfriend. She suffers bad anxiety and it is definitely at it’s worst at nighttime. She always tells me she feels alone when it’s dark, even if I’m just one room away. Or that all her life decisions have been failures and dead ends. It’s always better the next day.

[RivkahChaya]

I have this vicious circle where I worry that I won’t sleep, and worrying about not getting any sleep keeps me awake. Even though I rarely take them, just having Ambien and clonazepam help me sleep, because I know if I’m wide awake in bed for 30 minutes, I can take something.

I have had a couple of sleep studies done, and I have some weird sleep patterns. When I enter REM sleep, I frequently startle awake. The seizure and antipsychotic meds together stop that from happening, so I get plenty of REM sleep, and the ADHD med, aside from preventing daytime drowsiness, so I’m ready to sleep at night, somehow makes my brain more effectively produce the “wake” hormone that brains produce when they are asleep. There’s also a psychological effect of knowing that I need to take it by a certain time making me keep to my sleep schedule.

Anyway, the meds I take are things that are off label for insomnia, but ARE meant to be taken, and remain effective long-term, as opposed to Ambien, which becomes ineffective if you take it every night for several weeks. As it is, I take it, at most, twice a month (my prescription is for ten a month, and I’ve filled it twice since November). I get 30 .5 clonazepam a month, and can take up to 4 at bedtime, but I also can take one during the day for anxiety. I fill that about every three months.

FWIW (just for full disclosure) about three times a year, I get a four - seven day bout of terrible insomnia when I take an Ambien along with the clonazepam, and sometimes a couple of Benadryl, and finally get to sleep. I have no idea why. Under normal circumstances, my three regular meds allow me to sleep very well.

You (Ambivalid, that is) might want to ask your doctor about long-term meds that are not sedatives or tranquilizers.

Also, for full disclosure, the first med I took for insomnia was a tricyclic antidepressant, which worked well, but it made me crave sugar, so I switched to another one, and it worked too, but it killed my appetite altogether. What I’m on now seems to have no effect on my appetite.

[Ambivalid]

@RivkahChaya

I have this vicious circle where I worry that I won’t sleep, and worrying about not getting any sleep keeps me awake. Even though I rarely take them, just having Ambien and clonazepam help me sleep, because I know if I’m wide awake in bed for 30 minutes, I can take something.

I have had a couple of sleep studies done, and I have some weird sleep patterns. When I enter REM sleep, I frequently startle awake. The seizure and antipsychotic meds together stop that from happening, so I get plenty of REM sleep, and the ADHD med, aside from preventing daytime drowsiness, so I’m ready to sleep at night, somehow makes my brain more effectively produce the “wake” hormone that brains produce when they are asleep. There’s also a psychological effect of knowing that I need to take it by a certain time making me keep to my sleep schedule.

Anyway, the meds I take are things that are off label for insomnia, but ARE meant to be taken, and remain effective long-term, as opposed to Ambien, which becomes ineffective if you take it every night for several weeks. As it is, I take it, at most, twice a month (my prescription is for ten a month, and I’ve filled it twice since November). I get 30 .5 clonazepam a month, and can take up to 4 at bedtime, but I also can take one during the day for anxiety. I fill that about every three months.

FWIW (just for full disclosure) about three times a year, I get a four - seven day bout of terrible insomnia when I take an Ambien along with the clonazepam, and sometimes a couple of Benadryl, and finally get to sleep. I have no idea why. Under normal circumstances, my three regular meds allow me to sleep very well.

You (Ambivalid, that is) might want to ask your doctor about long-term meds that are not sedatives or tranquilizers.

Also, for full disclosure, the first med I took for insomnia was a tricyclic antidepressant, which worked well, but it made me crave sugar, so I switched to another one, and it worked too, but it killed my appetite altogether. What I’m on now seems to have no effect on my appetite.

I will talk to my doctor (again, it’s a new one now) but as far as nortriptyline (bka Pamelor), which is a common TCA prescribed off label for insomnia is something I have been taking for the past 8+ years. I’ve also been prescribed it off-label but it was prescribed to me as part of my three-drug cocktail to prevent migraines. The Pamelor NEVER helped me sleep, aside from helping the migraines get under control, which didn’t help the insomnia, surprisingly.

I really have tried pretty much everything. Even acupuncture. I’ve tried Trazadone, Ambien, Xanax, Klonopin, Lunesta, strict sleep hygiene, NOTHING helps. So any options that I haven’t yet tried or heard of will be met with an open mind from me.

[Sunny_Daze]

@Ambivalid

I will talk to my doctor (again, it’s a new one now) but as far as nortriptyline (bka Pamelor), which is a common TCA prescribed off label for insomnia is something I have been taking for the past 8+ years. I’ve also been prescribed it off-label but it was prescribed to me as part of my three-drug cocktail to prevent migraines. The Pamelor NEVER helped me sleep, aside from helping the migraines get under control, which didn’t help the insomnia, surprisingly.

I really have tried pretty much everything. Even acupuncture. I’ve tried Trazadone, Ambien, Xanax, Klonopin, Lunesta, strict sleep hygiene, NOTHING helps. So any options that I haven’t yet tried or heard of will be met with an open mind from me.

Another chronic insomniac here. I don’t know if I have much to add on that front, other than I want to know who RivkahChaya’s doctor is.

I would really like to know about your migraine prevention plan, if you don’t mind sharing that. I’ve been fighting daily migraines for several years now. I’ve tried a lot of things, but like you and insomnia, I am always on the lookout for something else to try.

[Ambivalid]

I can commiserate with your problems. The year or two before I found the Michigan Head Pain and Neurological Institute in Ann Arbor, MI, my life was unliveable. Truly.

Im falling asleep as I write so ill briefly describe the meds now and tmrw ill discuss them, if wanted.

Current Meds (all prescribed off-label)

1. Nadolol (a beta-blocker)
2. Pamelor (tricyclic anti-depressant
3. Topamax (anti seizure med)

[Ambivalid]

These are all preventative meds. They are useless then if taken once you’ve gotten a headache. Then you need an abortive med (scary sounding way of saying painkiller)

[Sunny_Daze]

We overlap on topamax, but I’m using the new extended release form Trokendi (I like it, btw - it’s worth checking out - one pill a day, fewer side effects).

I will ask about the others. Thank you. Hope you get some rest.