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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 6020
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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Im in a vicious cycle of insomnia. Ive always had trouble

Resolved Question:

I'm in a vicious cycle of insomnia. I've always had trouble falling asleep, but now if I know I have to work the next day, I don't fall asleep at all anymore. I know lack of sleep affects me very badly and now that I know that worry alone can keep me up all night it is only getting worse. I am really panicked about this, because without sleep I cannot function.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.

DoctorZ :

Hello I believe I can help you with your concern

DoctorZ :

I am so sorry that you are going through this cycle of insomnia, I can understand how distressing this is for you.

DoctorZ :

May I ask you, for how long have you been in this cycle of insomnia that you described?

Customer:

Thank you so much! It's been going on for years but has been getting worse progressively.

Customer:

I've always been a night person - tired in the morning and fit at night. This started giving me stress already in my teenage years, because I'd always go to bed too late and then regret it in the morning when I felt the effects of lack of sleep at school.

DoctorZ :

I understand your difficulties, it sounds like you have trained your circadian rhythm in a paradoxical way where you are awake at night and tired in the daytime. And it seems like you have tried many sleep medications as well

DoctorZ :

Have you considered trying behavioral therapy or biofeedback therapy?

Customer:

Yes, they worked for a while but they all stop working after a while. I don't think I really "trained" my system, it's always been that way (meaning, it's always an effort for me to go to bed early and get up early - does not come naturally).

DoctorZ :

Oh really, have you ever been inducted into a sleep clinic before?

Customer:

I tried everything. Cognitive restructuring therapy does not help, because I cannot fool myself into thinking that it's not a big deal when I don't sleep!

Customer:

Yes I have (been to a sleep clinic)

Customer:

Never did Bio Feedback though

DoctorZ :

Biofeedback therapy is a type of therapy that helps you gain control of your more involuntary bodily functions and gain insight more of the needs and wants of your body.

Customer:

I want to make sure this consult is the $22,- it said it was going to be. I can't afford anything right now, that's why I want to make sure :)

DoctorZ :

No worries, I am going to try to give you as many options that are possible.

Customer:

Sound like maybe good for me?

Customer:

:)

DoctorZ :

Insomnia is a very tough disorder to treat, especially chronic insomnia, so I want to help you the best that I can.

Customer:

Sometimes I get short of breath when I think about not being able to fall asleep, and then for sure it doesn't work anymore. It might work for that?

Customer:

Thank you, XXXXX XXXXX hell right now.

DoctorZ :

I think Biofeedback is an option that you should try. It has worked wonders for people who have tried nearly everything like you are trying.

Customer:

My life sucks when I don't sleep, and I can't work and pay the bills!

Customer:

Oh really?

DoctorZ :

So you get anxiety as well that increases your insomnia?

Customer:

So where do I go and how much does it cost? I'm a little skeptical it will help me, would be great though!

Customer:

Yes lots of anxiety! About not sleeping!

Customer:

I have OCD.

Customer:

So yes you could say I'm the worrying type, which does not help.

DoctorZ :

Well a number of therapists can help you with biofeedback, I can look in your area to see if any specialize in biofeedback for you.

DoctorZ :

You have a diagnosis of OCD, I can understand why this may make your insomnia worse, but I notice that you are not on any medication for OCD, why is that?

Customer:

That's OK, I can probably find out myself. At least tell me - is it a psychiatrist who works with those machines?

Customer:

I tried Prozac (triple dose), then Zoloft and Paxil. Did not do anything for me. Paxil interfered with my sleep, and I think Zoloft gave me upset stomach.

DoctorZ :

More often it is a psychologists or Master's level therapist, but I am sure there are some psychiatrists that may practice biofeedback

DoctorZ :

Okay, and the Cognitive Behavioral Therapy (CBT) did not help with your anxiety or OCD symptoms?

Customer:

Oh yes and Selexa?

DoctorZ :

Well I do want to tell you that the best medicine for treating OCD is clomipramine

DoctorZ :

Not sure if you have ever been on that medication before

Customer:

Wow really? The very first one I tried was a tri-how do you call that? Not sure the name, if you say it I will know.

Customer:

Anyway the OCD is not too bad, but it does indicate I'm the worrier type.

DoctorZ :

Tricylcic antidepressants?

Customer:

Yes, one of those.

DoctorZ :

Well clomipramine is a tricylcic as well, but it has been proven in many studies to help with OCD, I just wanted to mention it to you

Customer:

Nothing really helped for the OCD though, but I did also do a cognitive-behavioral thing a couple times. Was very expensive though.

DoctorZ :

I want to give your money's worth here and provide all the options to you

Customer:

So now I'm not sure if that was the one, I think it was called something else though.

Customer:

:)

Customer:

So you think if I bring my OCD down it might help my insomnia?

Customer:

I'm still gonna think it sucks though if I don't get any sleep, because experience has shown me that.

DoctorZ :

I understand that it is expensive, I can show you some CBT techniques or recommend a self-help book for you that is cheaper than a therapist too

Customer:

Yes I got all of those, thanks though. Did the CBT.

DoctorZ :

Yes if you can control your anxiety and OCD symptoms I believe it will lessen the impact of your insomna

DoctorZ :

*insomnia

Customer:

Was OK, did reduce it for a while (not the insomnia though)

Customer:

Yes maybe

DoctorZ :

You also mentioned that you are afraid to take a higher dosage of the Ativan in your question because of fear of dependence, is that correct?

Customer:

Still, when I don't sleep I can't work. Also gotta finish my Masters program, did most of it on sleeping pills.

Customer:

Yes, right (about the Ativan)

Customer:

Everyone keeps warning me it's so bad for me.

Customer:

I mean so addictive. So I'm afraid to increase it.

Customer:

Seroquel worked great for me. I only needed about 65 mg to make my whole body heavy. I just HAD to sleep. But now I'm worried about getting a (serious) job, and I cannot do that when I don't sleep. That's where it got worse (so even worse), just recently.

Customer:

I mean that my mind just overrides the Seroquel.

Customer:

Because I need the sleep so badly I'm afraid I won't get it (and so on, well you know the cycle).

DoctorZ :

So with the Ativan, you are right it is physically addicting to many people, but do not believe the horror stories so much, only around 20-25 percent of individuals have moderate to severe withdrawal effects associated with it. Also if you are under the supervision of a doctor there are usually never any longterm effects and if you do an appropriate wean of schedule of the Ativan as instructed by your doctor there are usually never any withdrawal effects, so the horror stories associated with Ativan and other benzodiazepines are usually those of people who abuse the medication or do not follow a doctor's instructions.

DoctorZ :

You are right Seroquel is a good medication for sleep as it has a lot of sedation properties.

DoctorZ :

I would also recommend a medication called Gabapentin, it is a hypnotic that also helps with anxiety, and early studies have shown that it may benefit individuals diagnosed with OCD too.

DoctorZ :

And speaking of hypnotics, I have seen studies where hypnotherapy can be beneficial for insomnia, especially well all other avenues have been explored.

DoctorZ :

*when not well

Customer:

So happy to hear that about Ativan! Everyone gives me so much stress about it. Also I can increase the Seroquel right? I hear it's normally for Bipolar, and they take much higher dosages!

Customer:

Gabapentin sounds great.

DoctorZ :

Seroquel is used for individuals with Schizophrenia and Bipolar, but has been used for individuals with insomnia many times. Actually normally 100mg is what is used to help with insomnia, so you are definitely taking a very low therapeutic dose at 65mg

Customer:

Good to hear. I also never heard of Gabapentin, will definitely try. Take for sleep in evening or everyday dose for anxiety.

Customer:

You have been very useful! I will give you an "excellent".

DoctorZ :

Gabapentin's secondary use if for anxiety, and I would take it at night as the hypnotic effect can make you tired which is what you want. You can take that medication as needed for your insomnia

DoctorZ :

Thank you for the compliment, I appreciate it and I am glad that I am able to help you

Customer:

I will try Biofeedback and Hypnotherapy. Heard more often that that could be good.

Customer:

Wait, let me ask you. Does Gabapentin work like Ambien?

DoctorZ :

They are both classified similarly as a hypnotic, but work differently in your brain. In my opinion Gabapentin is more effective because it also increases a neurotransmitter that calms you down to decrease your anxiety in addition to making you tired and helping you sleep, this is why I mentioned it as an option to you.

DoctorZ :

The ambien only makes you tired, does nothing for anxiety

Customer:

That sounds great! And you say I can alternate them, right? (my brain gets used to very quickly)

DoctorZ :

There should be no issues with alternating the medications, but follow your physician's instructions on that. The gabapentin, seroquel, and the Ativan can all be increased to pretty high dosages, so I do not believe that even your body will be able to adapt to the higher dosages.

Customer:

OK good! Makes me feel less stressed out now (people around me are so against sleeping pills - I say well you try not sleeping and trying to function!)

DoctorZ :

Exactly, those are people that do not understand the stress involved with chronic insomnia because they have never experienced it.

DoctorZ :

The medications will work quickly, and the therapy will take a while to be effective as therapy is a gradual process.

Customer:

Thanks for understanding!

DoctorZ :

I have been there, I had my own problems with insomnia after college, so I know what you are going through to a degree

Customer:

REally?

Customer:

Glad because people who've been there take you more seriously. Should I try Biofeedback or Hypnosis first?

Customer:

I think Biofeedback right?

Customer:

OK thanks for all your advice!

DoctorZ :

I would try Biofeedback first, then try the hypnotherapy.

DoctorZ :

Anytime, I am always happy to help

Customer:

Happy about the Clomipramine and Gabapentin. At least I'm not out of options!

Customer:

Thanks for the consult!

DoctorZ :

No you are definitely not out of options, there are always options to help you

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 6020
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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Dr. Z
Dr. Z
Psychologist
5411 Satisfied Customers
Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.