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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4298
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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Hello I am having trouble sleeping. I have had OKMH103100

Resolved Question:

Hello I am having trouble sleeping. I have had trouble sleeping for about 3 weeks now and have had weeks of no sleep in the past. Can you provide a suggestion for getting to sleep? I do have hypothryroid and hypoganidism and am treated for both. I also have anxiety issues. I am not that comfortable with Melatonin. Is there anything that you can suggest to aide me to getting to sleep?

Submitted: 9 months ago.
Category: Mental Health
Expert:  Dr. Z replied 9 months ago.

Dr. Z :

Hello I believe I can help you with your concern

Dr. Z :

I am so sorry that you are having difficulty sleeping, I can imagine how that can distress you.

Customer:

Hello and thanks for taking my question

Dr. Z :

I understand that you would not like to take Melatonin, but are you willing to consider other possible medications to help you sleep or are you looking for non-medical interventions only?

Customer:

I am really not sure. I spoke with a primary physician before who suggested melatonin but I saw some negative comments about that on Dr Oz web page. Either will suffice

Dr. Z :

Well this is a good non-medication way of helping to get better sleep, but I think since this has been happening for 3 weeks, I will suggest some medical ones that can help too.

Dr. Z :

Benadryl is a good over the counter medication that can help. Although you mentioned that you may have anxiety, so I would suggest an over the counter supplement called St. Johns Wort that can lower your anxiety and may help you sleep more.

Dr. Z :

For prescription medications, I would recommend Trazadone, Gabapentin, or Seroquel. These can all be used to reduce anxiety and help cause a sedative effect to help you sleep at low doses, so there should be no major side effects for you

Customer:

Oh OK. Are these the mainstream meds to help with sleep as first line?

Dr. Z :

Well the Ambien is the first-line prescription medication to help with sleep, but it will not help with anxiety at all and I wanted to recommend one medication that can do both for you

Customer:

Question. Who gets prescribed sleeping pills like Ambien or Lunesta?

Dr. Z :

You can get prescribed those two medications for you sleep issues, but like I said it will not help with your anxiety and usually doctors would want you to try the over the counter medications first.

Customer:

OK is it worth it as a first line to go to the Dr and ask for Ambien?

Dr. Z :

Also Ambien and Lunesta can be addicting too. You can try going and asking the doctor for Ambien too

Customer:

OK so is Benadryl a much safer way to start?

Customer:

When you say addicting does that mean that I will want to pop them just "because" ?

Dr. Z :

I think it is definitely a safer way to start. You can use that and the St. Johns Wort too at the same time as well.

Customer:

Oh OK. What dosage ?

Dr. Z :

Addicting means that you cannot go off them abruptly after using them for a sustained period of time or you will suffer serious withdrawal effects (e.g. anxiety, delirium, shakes, etc..).

Dr. Z :

50mg to start should be good for you.

Customer:

It sounds like you are assuming that my primary physician will start me off with Benadryl

Customer:

I use the Androgel medicine that absorbs through the skin for testosterone. Is it true that Benadryl constricts capillaries? If that happens wont I absorb less androgel through the skin the next day? Is there a safe time until using androgel ?

Dr. Z :

Usually most doctors will start off with over the counter medications before the prescriptions, but some may go straight to the prescriptions if you are insisting.

Customer:

Also, Is melatonin one of your choices ? Is that safe?

Dr. Z :

I use melatonin and I think that is the safest actually because it is a natural supplement.

Customer:

I have gone 3 weeks without sleeping in the past. I have not had a full night sleep in months and have gone about 5 days so far with out any sleep at all.

Customer:

Since I have what they've called a lazy pituitary I worry that taking a hormone could be problematic. Does that make any sense from your point of view?

Dr. Z :

Well for that I would use a prescription medication to help you get some sleep. But like I said if it is related to anxiety, I would use Trazodone first.

Customer:

Oh OK. Are you using for sleep issues or just to get better sleep?

Dr. Z :

It does make sense, the melatonin should not have any major effects in that area because it is a small dose.

Dr. Z :

I use it for better sleep, but I dont have the sleep issues that you are having currently.

Customer:

OK so should I start with Benadryl ? Or, should go to the Dr office and ask for Amien?

Dr. Z :

You can start with the benadryl, but I do not think it will be that effective for you since your lack of sleep is considered moderate-severe.

Dr. Z :

Ambien will help you sleep, but will do nothing for anxiety

Customer:

OK but both will assist with getting me back on a sleep schedule I assume?

Customer:

Thanks for your patience

Customer:

I will need to leave work tomorrow to see the Dr and am wondering if I should. I never feel confident that I will fall asleep and the weekend is starting tomorrow

Dr. Z :

Yes they should both help you getting back to sleep.

Dr. Z :

I am so sorry, I think seeing the doctor would be best or at least saying that your sleep is very moderate-severe and that a prescription may help more than an over the counter.

Customer:

Is there any time frame that you would consider dangerous for lack of sleep?

Dr. Z :

Well if you literally got no amount of sleep in the last 5 days, then you are at risk for psychosis.

Dr. Z :

But I assume that you got some cat-naps to help you get some sleep here and there, but not enough for a full rest.

Customer:

OK I believe I experienced that in the past. I went over 2 weeks with no sleep at all.

Dr. Z :

I think the longest someone has gone without sleep is around 15-17 days

Dr. Z :

Really, then yes psychosis would be present, anxiety, high blood pressure, etc...

Customer:

I went to the hospital and they said no one ever died from insomnia and I left. My dr prescribed Seroquel and I did not take since I did not like what I read about it.

Dr. Z :

If you have had these issues with insomnia in the past, then I definitely think that a prescription medication is right for you.

Customer:

OK but in the mean time if I can not get to the Dr office I should try Benadryl?

Customer:

I just called the Dr office and they said I will have to be seen

Dr. Z :

I understand your reluctance about the Seroquel, but it would be at a low dose and the major side effects are very rare.

Dr. Z :

Yes try the Benadryl

Customer:

I do have severe OCD and GAD. I was advised by a Psych to try Luvox days ago. I am still not sure about it since I experienced side effects on it as well as others

Dr. Z :

The side effects for most SSRI antidepressants are temporary as your body adjusts to the medication, they usually only last 4-6 weeks on average.

Customer:

OK. Could the Benadryls action interfere with absorption of Androgel through the skin because of how it shrinks the capillaries?

Customer:

What deters me with luvox is the apparent increase in Prolactin. I was told that it increases serotonin which decreases dopamine which increases prolactin.

Dr. Z :

I doubt it will because it is such a low dose. And here is a good link showing that there are no major interactions between the two.

Customer:

Oh that is good to know

Dr. Z :

Well the choice of the medication is up to you, if you want to take it or not. Have you tried Cognitive Behavioral Therapy (CBT) instead for your symptoms of GAD and OCD?

Customer:

I do want to take something. I need to. I have tried CBT twice.

Customer:

The last CBT Therapist no longer took my insurance and I discontinued.

Customer:

The psych dr that I just spoke with said that CBT does not work very often with OCS

Customer:

OCD

Dr. Z :

I understand, you can also use the CBT techniques at home through books and a website I know.

Dr. Z :

It works very well for OCD actually, CBT is the mainstream treatment for OCD.

Dr. Z :

Here are some good CBT books as well that can help you with OCD and GAD

Customer:

OK. I will go ahead and look for a new therapist as I need this but I immediately would like to get real sleep. I forget what sleep feels like

Dr. Z :

Try the Benadryl, but I think a prescription is going to be best for you.

Customer:

Thanks for that.

Dr. Z :

Anytime, I am always happy to help.

Customer:

So I should go to the appointment tomorrow ? Should I ask for Ambien?

Dr. Z :

I think the an anti-anxiety medication with sedative effects would be better for you. I would recommend the Trazodone or Gabapentin. But the Ambien will help you sleep though

Customer:

So I should try the Benadryl and if it does not work I should go to the appointment ? If Benadryl works should I continue taking it each night?

Customer:

You also mention St Johns Wort

Dr. Z :

If it does not work go for an appointment, and if it does you can safely use it each night.

Customer:

So tonight I should try Benadryl alone or both?

Customer:

OK. I am thinking of starting with 25 MG

Customer:

of Benadryl

Dr. Z :

St. Johns Wort can be used together with the Benadryl, the only side effects may be increased dizziness, drowsiness, and difficulty concentrating, but these are usually minor and most likely will not happen at a low dosage.

Customer:

OK and lastly. Melatonin

Customer:

Is melatonin that safe in your view?

Dr. Z :

You can try the 25mg, but I would go no higher than 100mg a night

Customer:

Is melatonin safe with Benadryl?

Dr. Z :

Yes it is safe in my opinion

Customer:

What dose would you recommend for someone like me? it says 3 mg

Customer:

Could Benadryl 25 and Melatonin 3mg be taken together?

Dr. Z :

3mg is fine for melatonin to start with and you can use it with the Benadryl, but it may cause excessive drowsiness.

Customer:

Great hopefully that will knock me out

Customer:

In your view would that be a safer route for the body than something like Ambien?

Dr. Z :

I think it would be safer, yes

Customer:

Also I have done exercising at night. Is that a bad Idea for sleep issues?

Dr. Z :

I would not exercise 2 hours before planning on going to sleep

Customer:

OK so I should not expect any hormonal interruptions with melatonin and Benadryl. I have enough of that

Dr. Z :

With such small doses, I do not believe you will have any hormonal issues at all

Customer:

so 3mg is a small dose?

Customer:

from what I hear melatonin is meant to be taken daily for best results over time

Dr. Z :

3mg is a standard dose, but it is low in the way melatonin effects the body's hormones.

Customer:

That sounds like committment

Customer:

I just get worried that I will suppress my bodies ability to produce it

Dr. Z :

No you do not have to take it daily, it is fast acting and does not accumulate much in the body

Dr. Z :

No that will not be a problem with the melatonin, there are no physical addictive elements to melatonin

Customer:

I see that you are a Psychologist. Are you able to prescribe medicine or do you focus more on research?

Dr. Z :

I have a post-graduate degree in Psychopharmacology, so I am only able to prescribe medications in 2 states currently. Only Nurse practitioners, Medical doctors, and Psychiatrists can prescribe medications in all 50 states.

Customer:

Thanks. People with OCD like myself need reassurance that something is safe enough. And you are saying that melatonin does not accumulate and will not be harmful. Also that it can be taken along side Benadryl. Is this a combination that people use with success?

Dr. Z :

Most individuals will try one or the other for the sleep aids, not both together, but there are no major issues taking it together. You can see on this link there are no major issues

Dr. Z :

Also melatonin has a half-life of 35-50 minutes, so that means within 8 hours the melatonin supplement has completely been excreted through your urine.

Dr. Z :

I see that you are offline right now, but if you would like to discuss this question further please feel free to respond in the chat box and I will be sure to get back to you as soon as possible. If I answered your question satisfactorily I would very much appreciate if you could rate my performance in helping you so that I can get credit for this question. Thank you very much

Dr. Z :

I see that you are back online, did you have any other questions or concerns?

Customer: Hi yes. Tonight if I were to try benadryl 25 mg and 3 mg melatonin does that seem doable? I am hoping that I am not the first
Dr. Z :

Yes it is doable and safe as well for you

Dr. Z :

Try that first and if it does not help then go to your doctor and ask for a prescription

Customer: also is there anything about ambien that I should consider dangerous? Seems like drs never even bring up the subject. I am getting used to no sleep and am not sure how aggressive to be. If I do get sleep I guess I can go to work and cancel my dr appointment?
Dr. Z :

Well it can cause sleep walking, talking, and other sleep related behavior (e.g. chatting on email, etc...) I have seen people use it and report doing all of these things while they sleep.

Dr. Z :

And like I said the withdrawal effects after extended use can be bad, so you must wean off it carefully

Dr. Z :

Here a list of common and rare side effects associated with Ambien

Customer: I see that makes sense. Ok so it is nothing to play with. So can u give me a gameplay? I really would appreciate since if I try to decide I will do nothing. When it comes to health issues I can never decide. With all the bad information out there.
Dr. Z :

Most rare side effects only happen in less than 1 percent, so I think Ambien is very safe and very effective in helping you sleep. If you wanted to try other sleep aids that may be more safe than ask for Trazodone. This is used in all hospitals and is not addictive as well, unlike the Ambien

Dr. Z :

Try the Benadryl and Melatonin first then go on to the prescritption medications. Your choices are Ambien or Lunesta, or Trazodone, Gabapentin, or Seroquel.

Dr. Z :

This is your best gameplan.

Customer: Ok thanks. What if melatonin and benadryl work?
Dr. Z :

Then stick with that

Dr. Z :

You will not need prescriptions

Dr. Z :

Okay, I will have to go to a meeting now. Did you have any last question or we can continue this chat at a later time if you like?

Customer: Ok and melatonin sounds like it is safe. There is a lot of bad information out there.
Dr. Z :

It is very safe, you should not be worried about it

Customer: Thanks! I will ping u later if I have any questions. U were a huge help
Dr. Z :

Anytime, happy to help. Best of luck to you and I hope your sleep issues resolve swiftly. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.


 

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4298
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
Dr. Z and other Mental Health Specialists are ready to help you
Customer: replied 9 months ago.
Hello Dr Z. I just went to vitamin shoppe and got St. John's wort and melatonin. I also got 5 http for kicks and also something called vitamin shoppe advanced sleep formula sleep solutions. Would you recommend the St. John's wort tonight with benadryl or would you recommend melatonin with benadryl? Also, should I throw I the 5 htp as well?

Thanks!
Expert:  Dr. Z replied 9 months ago.
I would not use the 5-HTP and the St. Johns Wort together, it can cause something called Serotonin Syndrome, although the condition is rare with those two supplements together I still would not use them combined. You can use the St. Johns Wort in the morning or in the afternoon if you like and then the Benadryl and Melatonin at night. The St. Johns Wort is good for anxiety and improving your mood and the Benadryl and Melatonin are meant as a sleep aid.
Customer: replied 9 months ago.


Dr. Z. OK I am all set. I am going to use 25 mg Benadryl and Some Melatonin. Should I use half the melatonin to be safe? Also, is 5HTP a good option for me in place of St Johns Wort? I really don't know enough about the two.

Expert:  Dr. Z replied 9 months ago.
Well St. Johns Wort is usually considered more effective than the 5-HTP, so use the St. Johns Wort for a few weeks to see how you feel. Also I think the 25mg of Benadryl and the full melatonin pill are going to be fine, but if you want to take half of the melatonin that is your choice and there is no problem with splitting the pill. You should not worry about any major side effects with this combination and remember the melatonin does not accumulate in your system, it has a half-life of 35-50 minutes. Best of luck to you and I hope you sleep well tonight :)
Customer: replied 9 months ago.


OK. I am really focusing on this issue but I do have another question. lf I had just asked you for your program of sleep aids getting to sleep without mentioning any of my preference could you tell me what that would be? Would Melatonin be first on your list?

Also should any of this have any kind of effect on testosterone. I get that tested regularly as I am treated for low testosterone. Lastly does it make sense to go speak with the GP tomorrow anyway ?

Expert:  Dr. Z replied 9 months ago.
For medications, Melatonin would be the first on my list, then the benadryl. After that I would recommend the prescription medications I listed above depending on what is the possible cause for their insomnia, and if the individual is currently taking medications. There should be no effect at all on your testosterone levels with these over the counter medications, you will be fine. Sleep well :)
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4298
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
Dr. Z and other Mental Health Specialists are ready to help you

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