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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4816
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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Hi, I am having tremendous difficulty OKMH(NNN) NNN-NNNN

Resolved Question:

Hi, I am having tremendous difficulty with my sleep. Most nights I fall asleep at 9pm only to wake at 1am then cannot go back to sleep until 5am. Then sleep for 3 hours and again off and on sleeping for 3 or 4 hours thru the day. Tonight is the worst. I haven't slept at all and it is 3am. My mind constantly spins with thoughts and wants to analyze every smallest details. I have had some problems my entire life - I am 55 - but lately has been the worst ever.
Submitted: 11 months ago.
Category: Mental Health
Expert:  Dr. Z replied 11 months ago.

DoctorZ :

Hello I believe I can help you with your concern

DoctorZ :

I am so sorry that you have been experiencing these sleep disturbances, I can imagine how that can distress you greatly

DoctorZ :

It sounds like that you probably have some anxiety related issues, may I ask do you experience any anxiety or stress during the day? Or have you ever been diagnosed with an anxiety or depressive disorder in the past?

DoctorZ :

And you also mentioned that you have been having some of the "worst ever" problems of your entire life, may I ask what those problems area?

DoctorZ :

Okay well I am going to go over a couple approaches for you, the non-medical approach and the medical approach. Both can be used together and both are pretty effective in helping you with your issues with insomnia.

DoctorZ :

Now the first approach is called Cognitive Behavioral Therapy (CBT). This therapeutic modality has a premise that your anxiety, stress, or depression, which is the most likely cause of your insomnia, is caused by negative thoughts. So if we retrain the brain and change that thought process to be more positive and objective, then your symptoms of insomnia will lessen.

DoctorZ :

In addition, symptoms of anxiety, stress, and depression commonly co-occur (around 60-65 percent of the time), so it would not be surprised if you have a mixture of these symptoms.

DoctorZ :

So this link may help you, it contains a technique I use with patients called a thought record. It will help you keep track of any negative thoughts you have. You put the negative thought on paper, the emotion accompanying, the evidence to support it, and the evidence against it. Then I want you to come up with an alternative thought for the situation (more objective and plausible). This will help you change your way of thinking to be able to think more positive and not automatically go to a negative type of thinking.

DoctorZ :

Also this worksheet can help alleviate symptoms of anxiety and stress by focusing on alternative explanations and methods for a particularly anxiety provoking situation

DoctorZ :

Many issues with depression, anxiety, and stress at night is because an individual may be worrying about the future, so this What if worksheet can help for you to focus on alternative positive solutions for future issues.

DoctorZ :

And also this problem solving sheet can help, if you are staying up at night analyzing a problem

DoctorZ :

In addition, this is a CBT worksheet that can has checklist for better sleep that can be beneficial

DoctorZ :

Also this book uses CBT principles to help tackle insomnia

DoctorZ :

In addition to the use of CBT techniques. CBT also advocates for the use of relaxation techniques that can help as well. The first link is for something called Progressive Muscle Relaxation that can help you create a long term calm by using muscle tension and release techniques, this can be used to prevent insomnia. The second link has basic relaxation techniques that can be used to calm you down and help you relax enough to fall back asleep.

DoctorZ :

Now the issue with these CBT and relaxation techniques is that it can take at least 2-3 months till you really start to see the benefits. So I think a medical intervention can be helpful for you as well.

DoctorZ :

Lets start with some non-prescription medications that can be effective in helping you sleep. The first would be melatonin, this is a natural hormone that your body produces and can be used to help realign your circadian rhythm to sleep at night and stay awake during the day time. This is a very effective natural non-prescription medication that can help with your insomnia. Another sleep aid medication would be Diphenhydramine, which is in your standard Benadryl allergy pills/tablets and most over the counter sleep aid medications. These antihistamines have sedative properties that can cause drowsiness to help you fall asleep.

DoctorZ :

Now because your insomnia may be caused by depression, anxiety, or stress, a natural supplement called St. Johns Wort or Omega-3 may be helpful because these medications have been shown in studies to improve your mood and hence lessen your insomnia.

DoctorZ :

Now for prescription medication, there is Ambien that is a very effective sleep aid medication, but since I think that your issues are a result from anxiety, depression, or stress, you may have more benefits from a psychotropic medication.

DoctorZ :

One of these psychotropic medications is called Oxazepam, that is a benzodiazepine and helps lower anxiety/stress, as well as have a sedative effect to help you sleep. It is also frequently prescribed for anxiety and insomnia, so that can be very effective for you

DoctorZ :

Another anti-anxiety medication that has good sedation effects is called Gabapentin, but it is not as strong as the Oxazepam

DoctorZ :

Rozerem is also a medication that has been prescribed for insomnia and has some anti-anxiety effects too

DoctorZ :

Laslty Buspar, Seroquel, and Trazadone are also prescription medications with an off label use as a sleep aid and have anti-anxiety and anti-depressive effects too

DoctorZ :

I see that you entered the chat, so I will give you some time to read over what I wrote and then you can ask any questions or concerns that you have.

DoctorZ :

So the medications are usually pretty fast acting in helping you sleep giving you immediate relief, but they should not be used indefinitely. So the best plan of action for you would be to use the medication (starting with the non-prescription medication first and then if that does not work, asking your physician for a prescription medication that fits your needs) and the CBT techniques at the same time. Then after some time, usually around 6 months, you can slowly wean off the medication and see if the CBT techniques have done an acceptable job at lowering your anxiety, depression, or stress to the point where you are no longer experiencing insomnia.

DoctorZ :

So I believe that for the medications that you can take to give you immediate relief of your insomnia is numerous and you do have a lot of choices, which is a good thing.

DoctorZ :

I see that you are offline right now, but when you get back online I would be very interested in continuing this discussion with you and talking about anything further you would like to share regarding your concern, so if you respond in the chat box I will be able to get back to you as soon as possible, although I should be available starting around 730AM Pacific Standard Time.

Customer:

Wow, you nailed it DocZ. Yes I am going thru a rough stretch with anxiety and stress. And yes I have been diagnosed with mild depression/anxiety in the past. I was taking effexor but stopped a year ago due to horrible side effects. Now I am on lamictal.

Customer:

Up early?

Customer:

Hi?

DoctorZ :

Yeah I did get up early, hello

DoctorZ :

Lamictal is really good for depression, but not for anxiety in most cases

Customer:

My ex-wife (we reconciled) has clonipan and I do take them from time to time but my doc doesnt want me to take it too much

DoctorZ :

I understand that is one reason whey I mentioned the Oxazepam, as that is a benzodiazepine, like Klonopin, specifically for insomnia

Customer:

You see my job (in IT) was outsourced 5 years ago and then the economy imploded in 2009. Since I am in my 50s it has been difficult finding another job - especially my wife works so I take care of our young daughter

Customer:

I am fighting my old employer in court for age discrimination and of course lawyers are expensive so I am trying to go it alone - Pro Se - is the legal term.

DoctorZ :

I am so sorry to hear about your job status and difficulty finding another job, I can imagine how stressful that must be for you

Customer:

That is what my mind spins on - even though it always spins as I am an analytical type. From what I researched ir could be an ADD thing as well - where my mind jumps from thought to thought.

DoctorZ :

I do not think it is ADD, it sounds more like anxiety/depression because you are worried about your future and this is causing you to be stressed and think about everything all at once because of your worries

Customer:

Sorry I have to get my daughter out to school.... I apologize for having to leave now but perhaps we can pick up later if that is OK with you?

DoctorZ :

Sure, no problem. I will be here :)

Customer:

Bless you :)

DoctorZ :

Happy to help, talk to you soon

Customer:

Hi, feeling a little better today.... cause as you said, most of my stress and anxiety stems from worrying about the future. I feel a little less worried because I have tried to avoid dwelling on negative thoughts as mentioned in the CBT. I guess I feel somewhat hopeful because I still have control over my future. Even though right now the road ahead seems bumpy and with a cliff or two - if I handle things right and have a little luck then all should be well. I guess either way I have alot to be thankful for as compared to alot of other poor souls who are going through much suffering.

DoctorZ :

Hello again, welcome back

DoctorZ :

I am glad that you are feeling a little better today and that some of the CBT techniques are working for you

Customer:

Oh, hi docZ! Really great help you have provided! Here is one other thing that has helped is that when I have a helpful thought while in bed , I write it down - otherwise I stay up worrying about if I will remember the helpful thought in the morning.... I hate when that happens and I forget good ideas that way.

DoctorZ :

That is a good technique, it is very similar to journaling. So that is good that you are implementing your own techniques to help yourself.

DoctorZ :

Now have you considered any of the medical approaches I mentioned as well?

DoctorZ :

Because while CBT is very effective, it can take time to see the benefits, and I would not want you to suffer through insomnia during that in-between time.

Customer:

Yes, I will try some of the medical approaches. For now I will try the herbal remedies as that is all that is available in short order (melatoin, herbal teas, etc). You know, my mother was the most anxiety ridden person I have ever known. Often when I called her on the phone she would most often greet me with `what`s wrong?`

DoctorZ :

The melatonin is very effective, I actually use that every night as well. Also for anxiety you may want to try St. Johns Wort as this has been proven in studies to lower anxiety too. That is interesting that your mother would greet you that way. My mother used to greet when I was a teenager with "What did you do this time?" :)

DoctorZ :

If you like I can also recommend a good CBT therapist in your area, if you the self-help techniques do not work

Customer:

lol...that is hilarious. mischievous were you?

DoctorZ :

Well I was a rambunctious one in my youth lets say :)

Customer:

I wish I could see a therapist. My income is barely getting me by. I dont have health insurance since our divorce last year. And even though we reconciled and live together, her company doesnt allow `significant others` to be added to a plan. I get really upset at the way our country treats its citizens. I heard one guy say `America isn`t a country - it`s a business`. Sorry to get political.

DoctorZ :

I am sorry, I do agree that health care in this country, especially mental health care, is not very well done in this country.

DoctorZ :

Still those self-help techniques should help and I can also recommend a couple anxiety books for you as well, if you want to try those.

Customer:

....sorry my laptop battery died. Which Anxiety book would you recommend?

DoctorZ :

No worries, that happens. I think these two books are excellent. You can get both of them or one of them, they are both really good.

DoctorZ :

They both follow the same premise as CBT, these are just more in depth.

Customer:

Thanks. So now my issue is to try to get back to a normal sleep pattern. Having been awake nights and sleeping days has added to my anxiety wondering if I can get back to a normal pattern.

Customer:

It sucks cause I am full of energy at night and sleepy during the day.

DoctorZ :

It will be tough, especially the first couple days because I recommend that you cannot sleep during the day, I mean no naps at all. So the first day will be the hardest, but after you pull through that you will be so exhausted at night you will fall right to sleep. The melatonin and the St. Johns Wort should help as well for your anxiety and helping you sleep.

Customer:

Awesome doc! I always fall into that trap of saying I will take a short 2 hour nap and 8 hours later the day is over. Last question.. How much melatonin to take? I am about 240 pounds if that matters. And also if one takes double do they fall asleep twice as fast?

DoctorZ :

Well the medication does not quite work like that, melatonin is a natural hormone, so if you take two it will not double your chance for sleep. I would take one melatonin tablet, which are at 3mg, and if after a hour your are not tired then you can take another one, but no more than 2 tablets a night.

Customer:

OK, thanks for all your help, insight, and simply being there for me during a rough stretch. Too bad the ratings are only `ok` `good` and `excellent` - I would like to have given you a rating of `incredible`!

DoctorZ :

Thank you so much, that is much appreciated. I am just happy that I was able to help you. If you ever need anything else, or if you just want to discuss some anxiety issues you are having, you are more than welcome to contact me at anytime.

DoctorZ :

I wish you the best of luck with everything and I hope your insomnia goes away fast

Customer:

Thanks!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4816
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
Dr. Z and 2 other Mental Health Specialists are ready to help you

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