"I've always envied people who sleep easily. Their brains must be cleaner, the floorboards of the skull well swept, all the little monsters closed up in a steamer trunk at the foot of the bed." — David Benioff (City of Thieves)
You are lying there tucked up in your bed and the day’s images race through your mind like a never ending film strip. You begin to feel a familiar anxiety over all the things you have not done and goals unaccomplished. Your thoughts pummel you for your imperfections. Your worries take root and begin to sprout like weeds. You glance at the clock. A new worry appears. It is getting late and you still cannot sleep. If you don’t sleep soon you will be miserable the next day. But the more you “try” to sleep the more the thoughts in your head resemble monkeys frantically jumping from vine to vine. “Let go” you plead with yourself. Your body is so weary but your mind will not turn off. Does this sound like a familiar scenario to any of you? Sleep may be one of the first casualties of having a mood disorder and/or anxiety. In this post we are going to discuss sleep disturbance as related to mood disorder and possible remedies. I am also going to be using my personal experience to illustrate the quest to get a good night’s sleep.
It is well known that depression, bipolar disorder, and anxiety can contribute to disturbances in sleep. In fact, chronic insomnia is listed as a symptom of a major depressive episode. In addition, any medications you may be taking to treat your mood disorder and anxiety can affect the quality of your sleep. Are we having fun yet?
For me, my sleep problems truly kicked in when I was diagnosed with Multiple Sclerosis. You add my anxiety and bouts of depression and we have a recipe for insomnia and more. For all the parents and caregivers out there, sleep may also be disrupted because your day of work doesn’t necessarily end when you go to bed. As a parent, you may find yourself “on call” 24/7. When my son with autism would have trouble sleeping it had a domino effect upon the entire house in that we were not sleeping either. You can surmise from my real-life example that there can be a multitude of reasons why your sleep may be disturbed. And this is why it may be so difficult to remedy. Where do you begin to find a solution?
Personal Remedy # 1 for Sleep Problems: The natural route
My personal inclination is to try non-prescription methods to treat sleep problems as a first tier approach. I am not saying this is the way for everyone. This is simply my general philosophy and that is to not pull out the big guns unless you absolutely need them. Prescription medications may work wonderfully but they come with side effects. Supplements can also have side effects and interactions but usually they are not as extreme. Here are some of the natural remedies I have tried in an attempt to get better quality sleep.
• Exercise: You probably already know this but regular exercise can help not only with your sleep but also to improve your mood.
• Lifestyle changes: This is also a no-brainer but things like going to bed at the same time and getting up at a regular time can help with insomnia. Don’t drink caffeinated beverages before bedtime and turn off the computer and TV.
• Natural Supplements: Melatonin is one of the more popular natural sleep-aids. It doesn’t work for everybody but it has worked for both me and my son in getting us to sleep. Both of our neurologists recommended melatonin to help with our sleep problems. It has been my experience that melatonin will get me to sleep but quite often it doesn’t keep me there.
Check with your doctor first before taking melatonin to make sure there are no possible adverse interactions with any of the other supplements or medications you are taking.
My insomnia remedy #2 : I added an over-the-counter medication as a sleep-aid.
Disclaimer: I am not saying you should do what I have done in order to get a good night’s sleep. What I am describing is my personal quest to overcome my sleep problems. You need to consult with your doctor if you are having difficulty sleeping.
Over time I found that the melatonin was working okay but did not keep me asleep. I was waking up multiple times in the middle of the night. When I asked one of my doctors’ about an OTC sleep-aid, Benadryl was suggested. I had not realized at the time, that Benadryl could be used for this purpose. Benadryl is not without side effects. Dry mouth and feeling groggy the next day are just some of the possible reactions to taking this drug. You can find Benadryl dosing instructions on the Internet but do check with your doctor first if you decide you might use this medication as a sleep-aid.
I also asked my doctor if I could use melatonin and Benadryl at the same time. My doctor told me it was okay. In researching this, most drug sites report no known interactions between melatonin and Benadryl. What I tried to do was to only use these sleep-aids when necessary so that I did not build up a tolerance to them.
Add a new medical problem and medication to the mix:
One of the major symptoms of Multiple Sclerosis is extreme fatigue. I was finally sleeping well but I was still experiencing daytime fatigue related to my MS. My neurologist suggested taking Provigil, which is a stimulant prescribed for individuals who have narcolepsy or MS. I am not so keen on taking prescription medications so it took me many months before I agreed to try it. I have to say that it works wonderfully to cure my fatigue but one of the big side effects is…can you guess? That’s right. Provigil may cause problems getting to sleep. *Sigh* Back to square one for me. When I take Provigil, my usual sleep-aids do not work as effectively.
My Attempt at Getting to Sleep #3:
I am in the process of trying different prescription sleep-aids. How did we get here? I know many of you are in the same boat. You are taking medications to treat one ailment and end up needing a second medication to treat the side effects of the first medication. It feels as though you are forced into making crazy choices. Do I get a good night’s sleep or do I experience MS fatigue? For some of you the compromise may be sleeping excessively due to your antidepressant or anti-anxiety medications or sleeping less but feeling mentally unwell.
During my most recent visit with my neurologist I explained that I was having difficulties both going to sleep and staying asleep most likely compounded by the use of Provigil. We jointly decided upon two options: Klonopin (clonazepam) or Ambien (zolpidem) My neurologist felt that Ambien was the better choice because there was less of a risk of becoming dependent upon it. Yet I was leery of Ambien because of the stories you hear about people doing some wacky things when they take it such as sleep walking and leaving peanut butter sandwiches on the stairs and not remembering they did so.
In fact, the information about Ambien on MySleepCentral states that: “Rarely, after taking this drug, people have gotten out of bed and driven vehicles while not fully awake ("sleep-driving"). People have also sleepwalked, prepared/eaten food, made phone calls, or had sex while not fully awake. Often, these people do not remember these events.”
Oh is that all? No there is more. It seems Ambien can also cause depression, anxiety, aggression, memory loss and confusion. Wonderful.
So I chose the Klonopin.
I had been taking Klonopin for sleep (1 mg) each night for about three weeks when I began to notice that I was waking up anxious. I was also experiencing more depression symptoms than usual. I was getting a good night’s sleep however. So now I was sleeping well and had energy during the day but was anxiety ridden and feeling depressed. It is quite a combination. It is one of those things, if you already suffer from depression and anxiety, how can one determine what is causing it? Is it the meds or just me?
If you read the literature about Klonopin one of the potential side effects can be depression.
In addition Klonopin can cause:
• weakness on one side of the body
• slurred speech
How very interesting. These also happen to be Multiple Sclerosis symptoms. How would I know what is causing what? I have to tell you that this whole process is crazy-making. I called my neurologist and explained that my depression and anxiety seemed to be worsening while taking Klonopin. So I picked up a prescription for Ambien. I have only taken a half a pill once. I was so frightened by the potential side effects that I kept myself up in fear that I was going to be doing crazy things in my sleep. This would all be amusing for a sitcom episode but unfortunately this is my real life with no laugh track.
So now I may need a third or fourth medication to counteract the possible depression and anxiety symptoms caused by prescription sleep-aids. Where do I get off this bus?
I wrote this post to show the human side to being treated for mental and medical symptoms through pharmacology. There are no easy answers. It can be complicated. There will be compromises. My story has no clear ending. I am still seeking balance in maintaining my physical and mental health. The two are absolutely intertwined. Getting good restful sleep is important to our wellness. But how to achieve this can be difficult at best especially if you suffer from depression and/or other conditions.
We would love to hear from you. Care to share your experiences in trying to get a good night’s sleep? What works for you? What has not worked? Your story could help someone else who is facing these same challenges.
For additional information about sleep problems and disorder the following Health Central resources can help:
• Health Central’s MySleepCentral
Published On: September 12, 2011