stimulants and intolerable insomnia

[Anonymous]

I am currently taking Vyvanse. I take a booster dextroamphetamine for work, as I work 11-14 hour days (good thing that it is only 3 days a week). I had a little insomnia about the first week I started it in June this year, but that eventually faded. I have had insomnia problems my entire life and have taken sleeping medication every night for the last 4 years.

My insomnia exploded during the first week of September. I often get insomnia before the beginning of fall and spring related to my seasonal bipolar switches (bleh…much less pronounced with my medication). However, this insomnia is worse than usual. My doctor thinks that it is the Vyvanse. My thought is that I was ok in June, but the seasonal neuro circuit balance tipping plus the stimulant plus the stress of the 11+ hour days at work (ie the chaotic collapse of community health (people are losing access to interdisciplinary care, getting more ill, being a provider is naturally challenging, and I have taken on case management and medical assistant work) have exacerbated the problem. (vent- i paid for 8 hours and i get no benefits).

I have had multiple calls to my doctor in insomnia distress over this month. both times medications were never called in so I’ve made do with whatever random other pills I could find.

My doctor suggested that I go without the stimulants. I had been hoping to prevent this insomnia streak to prevent this consequence. and as you all understand this is a major problem. I sought out a diagnosis and meds for ADD because I could not keep up with this job, and this was before the system meltdown. I could only accomplish 6 hours of work and I was just falling behind related to time management, prioritization, concentration problems. The system was already on fire, but the last rash of Medicaid cuts are leading us to utter collapse and no one can complete their jobs anymore. I am already hanging on the thread of what I can do (meds are helpful, but do not put me at completely normal). It is intense. Even the most experienced and focused people take no breaks and usually shovel packed food while working. yay health care field. so that leaves me…..

also, I am frustrated that I lost my ability to get school work done in a timely way which allowed me to enjoy evening.

also, driving can be dangerous for me in the early morning and during long drives

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so ok point…….

I really really want to stay on stimulant ADD medication. so I am looking for others’ experiences with insomnia and stimulants.

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Any specific stimulants less likely to cause insomnia, but can be played with in a way to survive through an at least 12 hour work day? (I am not interested in strattera because I seriously do not want to damage another relationship due to lack of sex drive or which will make me tired during the day- i am very susceptible to fatigue side effects). I’ve been on wellbutrin before which had similar insomnia side effects which was ineffective for everything I wanted it to treat. any med with serotonin is disastrous for me as it can lead to mixed and rapid cycling bipolar mood swings.

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[Anonymous]

topic bump!

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[Cat Alberts]

I have noticed an influence on my sleep as well.

Regular methylfenidate made my sleep less deep, and dexamfetamine kept me awake longer, and I woke up earlier. So I tried Strattera and I felt and slept wonderfull! But it gave me more impulsiveness, so I went back to methylfenidate at a lower dose, which does give me clarity, but less trouble sleeping.

Have you tried Strattera yet? It works on the epinefrine system, not so much on the dopamine.

Have you tried cutting out sugar/coffee/alcohol to avoid the rollercoaster of high-low energy?

Michael Ellsberg wrote a piece about how he controls his bipolar II symptoms by staying away from those.

http://www.forbes.com/sites/michaelellsberg/2011/07/18/how-i-overcame-bipolar-ii/

I recently reintroduced coffee and yes, my thoughts are more scattered.

I should take the hint!

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[Anonymous]

I’m not really interested in strattera. If there is a possible sedation or sexual side effect, I get it. And the selective reuptake inhibitor mechanism kind of freaks me out (even if strattera is not serotonin). I had these nasty rapid, mixed cycling with SSRIs and SNRI. I was pretty terrified to ask for a stimulant of all things, but desperation makes one brave lol. i just really really don’t want to be tired and impotent .

Do you have any side effects from Strattera? how long did it take to work for you?

I am good about avoiding caffeine and alcohol. I rarely drink either. but I am a huge sugar fiend and might kill people who stood in my way to obtain it. lol. *kidding*.

interesting article. thank you.

my impression: Classic Bipolar I. I don’t really trust that he will not need medication in the future. Uncontrolled bipolar can get worse as years progress.

Every year, I hope/contemplate that the bipolar is a figment of my imagination or just me being crappy at coping or just being a moody hyperactive person (hyperactive and anxious is my natural state so it gets murky when I try to analyze when those traits are exacerbated by hypomania). taking my meds contemplation of course . and then every year, i get disappointed again with that feeling like my brain does not feel right and it is cycle time again. with meds, I can cope with cycling using support network and coping skills. being that this is now 4 months after I started taking the ADHD meds daily, I think it is just my seasonal cycle + some aggravation from the stimulants.

but I do not want to stop them. I finished a big project in 2 days. would have taken me close to week before. I learned before that I literally only have the ability to concentrate on something for one hour until I absolutely cannot go on and need at least 30min of goofing off.. then just get about 45min…then goof off.. rinse repeat and major time wasting.

anyhow, I hope the medical assistant doesn’t let my doctor listen to the angry message I left on her machine >_<. (long story). I am taking way too much ambien and have been begging for a second med for a month now so I can decrease the ambien and not insomnia myself into a full blown mania. seroquel should be waiting for me at the pharmacy soon. more sleep + able to decrease ambien + some extra mood stabilization= awesome. as long as I’m not dragging all day. I am not concerned about the weight gain because I am underweight (i don’t know why as I’m so obsessed with sweets lol). got to get the thyroid checked again! and sleep study is still on my list of things to ask for.

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[Cat Alberts]

All the stimulant medication are reuptake inhibiting, so you are already taking it, just for a different neurotransmitter, dopamine. Strattera would influence the reuptake of norepinephrine (sorry forgot the nor- in previous writing). Maybe you have used it- it is a NRI, not a SNRI- I just read the wikipedia page. http://en.wikipedia.org/wiki/Strattera

The stimulants have had a more negative effect on my libido than strattera. Wellbutrin is known for enhancing libido, but that is an anti-depressant, so I guess it works on serotonin as well. It just made me feel high and spacey.

Strattera had no physical side effects for me as far as I can remember. I can’t find the notebook I used to record my symptoms, but other than more impulsiveness, I can’t remember. I started making stupid decisions in traffic, like crossing the street after thinking: no that car is going too fast for me to cross now, and then crossing the street anyway. That was my reason to go back to methylfenidate.

I hope you get through this okay. The amount of different meds is staggering for me, living in Europe and a reasonably healthy person.

As for the sugar, maybe up the protein and fat and slowly reduce the sugar? That insulin roller-coaster had me completely out of whack, and I only have to cope with ADD.

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[Anonymous]

Hi sugargremlin,

Just popping in to see how you are faring in getting in to have a sleep study? I had my sleep study followup on Thursday, doc confirmed the diagnosis of narcolepsy, but it was interesting to see my results as I had 168 spontaneous arousals (without cause like PLM or apnea, basically off the charts statistically), and only about a 65% sleep efficiency index (amt of time asleep during the night – normal is over 85%). When I did some searching on the internet about the side effects of severely fragmented sleep, severe memory issues jumped right out for me. I have the complete results and graphs and my arousals were so frequent it looks like a very long and dense bar code throughout the night.

I am now on modafinil, see the doc again in 5 weeks for another followup before being turned over to my “useless” family doc. Sleep doc says Ritalin is still an option but we’ll see how the modafinil works for me. So far I like it, it’s not as “raw” as ritalin and it’s definitely helping with the daytime sleepiness. The night time is still insomnia-like in nature, but I am feeling as though I am rested in the morning before taking my modafinil.

Just thought this might be of interest since I had no clue about the insomnia aspect. The doc confirmed narcolepsy because really poor sleep is one marker, as well as the family & clinical history and my successful ritalin trial. ADD assessment is still on, but sleep doc doesn’t think it’s a concern, the narcolepsy is definitely front and center for me.

I am also really happy to be able to DRIVE again. He did say NOT if I am sleepy, but otherwise I’m ok to drive. Big relief!

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[Anonymous]

Thank you so much for the update!!! 168 awakenings wow. And i feel a crappy sleep when i look at the clock every hour. Have they talked to you about xyram? It is the GHB narcolepsy drug. Approved only for narcolepsy because it is technically the 1980sto date rape drug lol. I see my doc on the 26thto so i need to start printing and filling out some referral info for her to sign for a sleep study.

I did get the seroquel which has been really helpful and i am back to normal ambien dosages and can stop calling the doc and feeling like a drug addict. 7 full hours of sleep yesterday felt soooooo good. Still no improvement in sleep graph. Gave the bf an ultimatum that he needs to actually help me get to bed on time or not to come over. He appears motivated. So sort of back to where i started but gladthat it is no longer spiraling. I think i am going to be ok now . I stopped taking the meds on the weekends which seems to help. Maybe it lessens the build up?

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[Anonymous]

Hi sugargremlin,

I’m on a narcolepsy support forum on Yahoo groups and the people there who have taken Xyrem say it was the worst experience of their lives! Also learned that you need to take periodic drug holidays from the stimulants as one’s tolerance builds up – but talk to your doctor about this. I remember my mom taking drug holidays (she was on ritalin or dexedrine). Met someone just diagnosed with narcolepsy with similar day/nighttime issues as mine and who just started taking modafinil a day after me, which is really useful as we will now compare our progress, keeping in mind that we are all different and the drugs react differently for each of us.

My daytime alertness is good on the modafinil (provigil) but sleep at night is still an issue. I have kept a log for the past 3 weeks to objectively record what I can. After 1 week I will increase the doseage and see if it helps.

The thing about the spontaneous arousals is that many of them were so short in duration that I would not have recognized that I was awake. But it’s just as impairing. So a sleep study was really vital to see what was going on, I would never have known what was happening, nor would my GP. Soooo glad I did the ritalin experiment as it would have been challenging to diagnose without that and the family/clinical history. Not that I’m suggesting people go out and borrow other people’s meds, but I was truly desperate for the daytime ADD symptoms, and found to my complete surprise that it instantly helped my sleep issues.

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[Anonymous]

I suppose the sleep doc’s description of xyrem being the greatest hypnotic in existence was a little biased ( ie was drug dinner). I would think it would be ok if people were fully informed about what to expect? What are they doing for your sleep? Wakefullness is super important but 168it awakenings is bad for your health!

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[Anonymous]

Hi sugargremlin,

I’m keeping a careful log as I do this new trial with modafinil. Sunday night was not a great night’s sleep and I decided to start taking a second dose on Monday (1 pm is the latest they recommend taking it in order to avoid affecting nighttime sleep) to see if it would help. It did. I still woke up several times in the night, but they were much further apart than my usual (which could be 20 minutes to 2 hours), and I didn’t feel sleepy when I got up. Today is day 4 on the drug and I’m going to stay at this new level (100mg x 2) and see how it helps.

I loaned my Philips wake-up light to my husband last night so he could try it – I really like it – it is helpful as it cues the body with light – it was $147 CAD including tax at Costco online). I also went out and bought an Obus Forme relaxation machine, not expensive ($32 CAD), it has 6 sounds, I used the rain sound last night to help cover environmental noises that might otherwise disturb me, and I didn’t use my industrial strength earplugs at all. So I’m starting to fine tune now. I drove back and forth to Toronto yesterday and was fully alert (coming back in the evening). Finally I am seeing progress!

Someone on the narcolepsy forum I belong to just posted about a truly awful experience she just had with Xyrem. I am glad I know about it.

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[Anonymous]

yay progress!!!!

I would still research the medication. medication reactions can be so unique depending on individual. but I could totally see someone totally unsuspecting that he/she is technically taking GHB (in a small FDA approved dose of course) and having a wacky experience.

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[Anonymous]

I haven’t heard anything good about xyrem, just horror stories. But I am learning that meds are a personal thing, they work for some people and don’t for others. I just want to get the meds settled as much as possible with the sleep doc before he turns me over to my GP, since she’s been very judgemental about stimulant meds, and I fear she won’t work with me to find what I need for my particular condition. I don’t want a sedative.

I stayed overnight at my dad’s last night and normally I wouldn’t have slept well at all but I had a good night’s sleep – I only woke up once during the night. I think I have found the level of meds that keeps me alert during the day but also improves the length of sleep at night. I am waking up early in the morning but I am getting to bed earlier in the evening so it’s not too bad. Someone who also takes modafinil told me I might try taking the second dose a bit earlier so I “burn” it off earlier in the evening and it won’t disturb my sleep. The nice thing about this med is that it’s much more gentle than ritalin.

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[Anonymous]

Is the modafinil as effective for ADD as the ritalin was? Is modafinil generic over there. Over here i thinkhave people are still forking it out for provigil brand.

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[Anonymous]

Hi all. I am following this thread with interest, as sleep is a nightmare for me. I am pretty sure that it is just the cumulative effect of years of night shift, rather than a sleep disorder, but insomnia in any form is stressful.

I am already being treated for fairly severe restless legs syndrome, so now I can lie in bed without tossing and turning, but I still have endless difficulties getting to sleep and staying asleep (at any time of day – I don’t even dose off anywhere, unless it is 3am at work after being awake all day or getting poor daytime sleep). I am terrified that stimulant use would make things worse, though my son seems to sleep like a log once he gets to sleep.

I would return to day shift just so I can improve my sleep, but I have OA in my knees, and I would never cope with the amount of time I’d have to spend on my feet. The only real thing I can do in that regard is to find a management position (Ick!!!) or retrain.

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[Anonymous]

I lasted only a few months on nightshift! Only slept a few hours a night.

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[Author]

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