Anxiety about sleep.

[DJW]

A bit of background. I rarely sleep through the night. For the last month or so the insomnia is back. During the day I have very little energy to walk or even think. I do some volunteer work and right now that is overwhelming.

Lately I've been fighting with my desire to work and the fact that walking everyday is a challenge. How can I possibly work when I don't feel up to anything.

Right now the thought of trying to get to sleep is stressing me out.

I don't even know that I'm looking for advice. Just rambling.

 

[Jennifer]

I know where you're coming from DJW as I suffer from insomnia as well. Reducing your stress or having it bother you less is easier said than done. Have you gone to a sleep disorder clinic to see what they recommend? I've had doctors suggest all kinds of things to me from meditation to sleeping pills to drinking wine before bed.

Sleeping pills worked for me for only about a month and then suddenly they just stopped working. I don't have the patience for meditation, I actually become irritated by it. Some things just don't work for everyone. Booze, well, enough of it will put me to sleep but I'll feel like crap the next day so I'll pass on that.

What has helped me though is treating my anxiety. I take Klonopin during the day and I take Restoril at night to help me sleep. Since I started Restoril about 6 months ago, I've only had 2-3 nights where I had difficulty falling asleep. If you haven't tried anxiety medication for bedtime, I highly recommend it. I did start with Klonopin before bed but it doesn't act fast enough. I then tried Xanax before bed but it started to not work just like sleep meds like Ambien. So far the Restoril has done it's job pretty well and I don't dread going to bed because of the insomnia anymore.

Hopefully you'll find something that works for you even if you don't go the medication route.

 

[DJW]

Thanks Jennifer.

I wrote that and fell asleep...then slept for 6 straight hours. I'm usually up every 3 hours.

I've got a GI appointment this month and will discuss it. The GI clinic has a psychiatrist on staff.

 

[baistuff]

(Copied from another thread- please read.)



Lollakins asks a very important question. I'd like to start an answer from a general perspective and then address the issue from the chronic disease perspective.

Insomnia is a symptom, not a diagnosis in and of itself. Anything from depression/anxiety to jet lag, diet, stress, medical conditions, medication, sleep environment, shift work, travel etc... can screw up sleep.

Obviously the first step is to find the cause and treat the underlying issue ( common medical conditions causing insomnia are thyroid problems, diabetes, sleep apnea, obesity, depression, anxiety.) then throw in meds- steroids, caffeine, nebulizers, cold meds.

Regardless of cause the first step is to ALWAYS address sleep "hygiene"
1) Go to bed and wake the same time EVERY day regardless of amount of sleep
2) room should be dark and cool
3) Bed is only used for sleep and sex. NO work, paying bills, watching movies.
4) Exercise daily, but NEVER less than 3 hours before bed- to fall asleep our bodies must drop 1 deg F from normal (thats why we use blankets.) Exercise raises body temp and it takes about 3 hours to normalize
5) No bright lights- TVs computers, smartphones etc.. for 1 hour prior to bed. relaxing activities only.
6) HIDE THE CLOCK. A study about 10 years ago said removing a clock was the single best aide for insomnia, because people check it every 10 minutes and get frustrated
7) If awake after 20 minutes or so get up and read in mild light until sleepy
8) avoid stress- write things bugging you down prior to going to bed and say "I'll review you in the AM."
9 NO CAFFEINE 8 hours before bed. NO ALCOHOL as a sleep aide, and PLEASE AVOID SLEEPING PILLS AS MUCH AS POSSIBLE!!!! Alcohol may make you fall asleep, but it fragments sleep and you will wake up quickly and groggy. Sleeping pills have VERY quick tolerance and then causes incredible rebound insomnia. my rule for ALL my patients. NEVER more than twice a week. And with Ambien NEVER more then 5mg per night.

Insomnia is also divided as trouble falling asleep or staying asleep. From a psychologic standpoint, anxiety usually causes trouble falling asleep, depression causes trouble staying asleep and getting back to sleep.

And now of course chronic illness throws a monkey wrench into everything. the wonders of IBD can certainly cause awakenings, discomfort, anxiety. And then of course meds- especially any steroid. However, any med can muck with our physiology in odd ways, so in theory ANY med can cause insomnia. TALK to your doctor. Change time of day of when you take meds. Change you meds. With IBD it's hard to know what may be causing the insomnia.

The best advice I can give is
1) Relax- everyone goes through very bad sleep from time to time
2) Get off the Sleeping pills. Wean down to a small dose and then on a night where you have nothing to do the next day (weekend? ) quit. You will be up all night in withdrawl, but then after that you will recover.
3) exercise daily in the morning
4) Change meds up
5) Treat underlying problems. Get labs to rule out other conditions
6) consider seeing a psychologist. Sleep disorders are so common now, it's half of what they see.
7) consider a SHORT early afternoon nap if possible (20-30 min.) we have a natural dip in our circadian rhythm in the early afternoon. A short nap then can actually help maintain our natural circadian rhythm.

Good luck.

 

[DJW]

Thanks biastuff.

I saw your post and have started to implement changes. The clock was the first change I implemented.

Thank you.

 

[Jennifer]

However, any med can muck with our physiology in odd ways, so in theory ANY med can cause insomnia. TALK to your doctor. Change time of day of when you take meds. Change you meds. With IBD it's hard to know what may be causing the insomnia.

2) Get off the Sleeping pills. Wean down to a small dose and then on a night where you have nothing to do the next day (weekend? ) quit. You will be up all night in withdrawl, but then after that you will recover.

Everything else you said I agree with but these two points depend on the individual. Not every patient is the same. Some things cannot be changed so it's important that they get the sleep they need in order to function.

Personally I'd never stop doing something that's working for you. Everyone is different and some meds are needed for treatment of other health conditions so it's not wise to stop medications and switch to something else hoping that you'll be able to sleep but exacerbate symptoms of an improperly treated illness. Sometimes we have to decide what's more important.

My GP hates Benzodiazepines and sleeping pills and refuses to prescribe them yet other doctors feel they are the best thing for some people. So it comes down to a personal preference with doctors and with patients. If you can eventually stop taking them (slowly rather than forcing yourself to deal with withdrawals) once the underlying cause is reduced or resolved then that's great.

Restoril is a Benzodiazepine used to treat insomnia and I've finally started sleeping (it's continued to work instead of stopping like other Benzodiazepines and sleep aids have). I have a lot going on at home that cannot be changed nor undone so if the Restoril gives me the sleep I desperately need then it's the best thing for me right now.

 

[baistuff]

Everything else you said I agree with but these two points depend on the individual. Not every patient is the same. Some things cannot be changed so it's important that they get the sleep they need in order to function.

Personally I'd never stop doing something that's working for you. Everyone is different and some meds are needed for treatment of other health conditions so it's not wise to stop medications and switch to something else hoping that you'll be able to sleep but exacerbate symptoms of an improperly treated illness. Sometimes we have to decide what's more important.

My GP hates Benzodiazepines and sleeping pills and refuses to prescribe them yet other doctors feel they are the best thing for some people. So it comes down to a personal preference with doctors and with patients. If you can eventually stop taking them (slowly rather than forcing yourself to deal with withdrawals) once the underlying cause is reduced or resolved then that's great.

Restoril is a Benzodiazepine used to treat insomnia and I've finally started sleeping (it's continued to work instead of stopping like other Benzodiazepines and sleep aids have). I have a lot going on at home that cannot be changed nor undone so if the Restoril gives me the sleep I desperately need then it's the best thing for me right now.

Well, there is no question that these meds can be helpful at times. However, for something than can, should, and in the past is a natural process, I don't believe medically inducing sleep should become a norm for a person. The minute your external stressors are under control I would highly suggest working with your doctor to wean them. Even if you are lucky not to develop tolerance, dependence is also a major issue with these meds. Please tread carefully.

 

[DJW]

Last night was better. I took a short nap in the late afternoon instead of a coffee. I dozed off easier.
Set the watch alarm for 7 and got up.

An improvement.

 

[UnXmas]

I posted on the other Sleep Issues thread too, I expect you probably saw my post or can find it, but anyway:

With a lot of sleep meds you build up tolerance very quickly - they don't keep having the same effect. They should only be prescribed if it's known the insomnia is going to be short-term - my GP gave me the example of someone who can't sleep due to going through a stressful situation where it's known it won't last. These meds are the ones classed as benzodiapines. (I think?)

When I first took prednisone, it gave me awful insomnia. I tried every over-the-counter type of sleeping pill I could find, plus a couple of prescription ones (but not benzodiapines), one of which had the opposite effect on me than it was supposed to, and I couldn't sleep at all.

Then my GP prescribed me Amitriptyline, first at a low dose, then increased it, and it worked like magic. I've been taking it for a couple of years now, and it still works.

Before taking prednisone I'd not often had much trouble sleeping before. I carried on taking Amitriptyline even when I came off prednisone though, because it works well for me as an anti-depressant. The only times Amitriptyline hasn't let me sleep have been a few nights when I've been extremely sick in hospital following surgeries, especially when in withdrawal for strong opiates following surgeries. Other than that, it pretty much guarantees me a very deep sleep, the deepness depending on how much I take.

When I was on prednisone, the tips on sleep "hygiene" never helped me.

When not on prednisone, or on prednisone plus Amitriptyline, I never need them. Light and noise don't bother me, I sleep through anything, and I can drink a lot of Coke with caffeine and fall asleep just fine.

But there are some things I do, I could probably sleep without them, but they seem to enhance sleep at night and help me feel more awake during the day: I always make myself get up early in the morning; I'm naturally a morning person anyway. I often nap in the afternoon, occasionally in the morning, but I don't let myself nap in the evening when it's too close to bedtime. I do find I'm much more ready to fall asleep when I'm a bit cold, I keep the room cool at night and wear light nightclothes. I don't go to bed during the day - daytime naps I have in a chair. And I always feel sleepy after eating (after lunch I desperately need my afternoon nap), so I eat supper last thing before going to bed. When I time it right, the Amitriptyline kicks in, sleepiness comes on following supper, I try to think of something calming and it all comes together and I fall right asleep.

I remember the anxiety part of insomnia very well. I dreaded bedtime, but dreaded waking up very early in the morning even more. I've naturally always been an early riser, anything after 5:00am is "morning" for me, though I prefer it around 7:00/7:30am. The first time I was on prednisone I'd be waking at more like 4:00am, having only gone to sleep well after midnight. I'd have the energy to get up at 4:00am, but I couldn't get up and do things at that time - I had nothing to do but count down the hours until the real morning! And prednisone made me far too restless to read, or concentrate on anything really. Once I was on the Amitriptyline and sleeping well again, if I woke up needing the loo in the early hours, I'd panic that the insomnia was back. I'd even take more Amitriptyline, when I wasn't fully awake enough to know what I was doing, to ensure I could get back to sleep again. It took me a while to get some confidence back in the fact that I would go back to sleep again.

I wouldn't give up on trying sleeping meds. Different meds, different doses, work for different people. I had quite a lot of trial and error until I found what worked for me.

 

[baistuff]

DJW- good to hear. Naps get a bad rap. they actually can help keep our natural rhythms in check. Also overtiredness can sometimes actually cause the brain to go into overdrive and actually keep you awake. In residency we all used to talk about getting home after a 36 hour shift, flopping into bed, but hearing the monitors and machines still in our heads. Overtiredness is not a good thing. Just keep the naps short.

Certainly once things like steroids are introduced all bets are off, and then during those times, sleep aides may be needed. Heck, I give them to patients during times of acute grief, illness etc... but they need to be monitored, tapered ASAP and removed when possible. Some of these meds have nasty side effects, in addition to the tolerance, dependence, withdrawl.

Keep in mind something like sleepy time tea or tension tamer tea has a lot of herbal stuff to deal with the anxiety. Exercise (early in the day) is also really helpful.

Lucky for me, IBD has never really caused much nighttime problems (knock on colon.) For me, answering pages at 2AM, night shifts, never having a regular schedule was a sleep killer.

But now being older and set at work, I make sure the last hour of the evening is spent in combination of reading, helping the kids get ready for bed, and then talking one on one with each of them about anything but medicine or GI related. We read, do puzzles, play cards/games, laugh, make lunches for school, talk school, friends, the Rangers, whatever. No electronics allowed- Mrs. Baistuff deals with all of that

It is relaxing for the kids and for me and is what I look forward to most now every day. Then out like a light.

 

[DJW]

I'm going to talk to the doctor about a sleep study.

 

[UnXmas]

2) Get off the Sleeping pills. Wean down to a small dose and then on a night where you have nothing to do the next day (weekend? ) quit. You will be up all night in withdrawl, but then after that you will recover.

Everything else you said I agree with but these two points depend on the individual. Not every patient is the same. Some things cannot be changed so it's important that they get the sleep they need in order to function.

Personally I'd never stop doing something that's working for you. Everyone is different and some meds are needed for treatment of other health conditions so it's not wise to stop medications and switch to something else hoping that you'll be able to sleep but exacerbate symptoms of an improperly treated illness. Sometimes we have to decide what's more important.

My GP hates Benzodiazepines and sleeping pills and refuses to prescribe them yet other doctors feel they are the best thing for some people. So it comes down to a personal preference with doctors and with patients. If you can eventually stop taking them (slowly rather than forcing yourself to deal with withdrawals) once the underlying cause is reduced or resolved then that's great.

Restoril is a Benzodiazepine used to treat insomnia and I've finally started sleeping (it's continued to work instead of stopping like other Benzodiazepines and sleep aids have). I have a lot going on at home that cannot be changed nor undone so if the Restoril gives me the sleep I desperately need then it's the best thing for me right now.

I'd echo what Jennifer said. My GP made it very clear that she would not prescribe me addictive sleep meds that are known to only work for a short time, but the med she did end up prescribing me works, and isn't addictive. I believe it would cause me some physical withdrawal symptoms if I were to suddenly stop taking it, but I've no reason to stop taking it. As I said above, I'm taking it now main for its anti-depressant effects, but it's still extremely useful as a sleep aid on nights when I have physical discomfort (which would be the main cause of sleeping problems for me).

Well, there is no question that these meds can be helpful at times. However, for something than can, should, and in the past is a natural process, I don't believe medically inducing sleep should become a norm for a person. The minute your external stressors are under control I would highly suggest working with your doctor to wean them. Even if you are lucky not to develop tolerance, dependence is also a major issue with these meds. Please tread carefully.

It depends on the medication and the person, but I think taking medications to help sleep has a more negative reputation than it deserves. Isn't most of medicine about altering natural processes?

I realise that perhaps I would have a very different view if my doctor had prescribed me one of the addictive meds though - I do understand your warning, I'm just not sure it applies to all meds that are used to help with sleep.

 

[DJW]

My goal is to be able to sleep without any meds. About 13 years ago I started to develop serious performance anxiety after a business failure. I struggled with the simplest jobs. Afraid I'd screw up and get fired. Now I'm getting that same anxiety about sleep...of all things.

Now that I've started Remicade I'm anxiously anticipating getting on with life. Being realistic I think working from home is my best option. And yes, doing my own thing. So I don't sleep well and start feeling rotten for weeks; now a couple months.

If I can't manage sleep, how can Imanage work lol. More anxiety.

Welcome to the complex twisted jumbled mind of Dave. :ack: