Posted by Toby on September 10, 1998, at 16:14:21
In reply to Response to Toby, posted by DL on September 9, 1998, at 22:18:15
You want to be sure the doctor reading the sleep study is Board Certified in Sleep Medicine and will interview you both before and after the study so that you can discuss your problems and then the recommendations. The study in the home is primarily for sleep apnea if I am not mistaken and is usually for people who are homebound and also to follow up every year on people with sleep apnea to make sure their treatment machines are working right. If you do have a test in the hospital or clinic, it's OK if you don't sleep well all night. That's what you are there for: the EEG will still be able to pick up many clues as to why you don't sleep. Also, if you get less than a certain amount of sleep, the lab will recommend a second night to negate that "first night effect."
Should imipramine become a choice for you, the sleep effects should be fairly quick acting (like a week) and the doctor may give you leeway in adjusting your dose yourself up to a certain amount so you can judge what the benefits and side effects are at different doses without having to labor through a long period on one particular dose, then returning to see the doctor for another dose change.
It does sound as though social phobia is high on the diagnostic list. To find a good therapist (never foolproof but narrows the chances of finding a good one) for cog-beh therapy, you should be able to call and get a brief telephone consult. Things to ask: how many years experience do they have (somewhere between 2 and 10 is the best because you can be better assured that they are pretty much up to date on new techniques, etc), were they TRAINED in school in cog-beh therapy and what is their degree (anything with a bachelors or higher is best, you don't want a "certificate in therapy" only), about how many patients have they treated with social phobia and depression and (probable) PTSD (the more the better), do they use groups plus individual (better if they do but not an absolute requirement), what is the length of the usual course of treatment and how often are the sessions (less frequently than every 2 weeks is generally useless and once weekly for individual therapy and every 2 weeks for group is generally the best option).
For the EMDR (which I'm recommending to you before searching out a cog-beh therapist) I found 4 therapists listed in Mass but my list is a little old so there may be more now (one in Boston/Cape Cod/Nantucket, one in Cambridge, one in Needham/Newton/Winchester and one in Gardner who is my personal favorite). The worry about getting "tied up in tears and loss/esertion" is valid, but the EMDR will prevent you from getting "tied up" in that. Many people do cry and experience some powerful emotions but, whereas ordinarily those feelings would be overwhelming and you would want to escape them quickly by squelching them, the EMDR allows these emotions to occur but to become quickly tolerable and lose their "power" over you. It is highly difficult to explain on paper in a few sentences, but so far I have not had a single person be unable to continue with the procedure. It's as though suddenly the event "dries up" and it doesn't make sense anymore that it should have a place in your life. Most people describe something along the lines that the pictures get smaller, more distant, less distinct and usually they have trouble even getting the image anymore, at which point the emotions just evaporate. All that in less than 2 hours.
Regarding the Buspar, there's no reason why you shouldn't be able to start the Buspar while you are still taking the Klonopin and the usual starting dose is 7.5 mg twice daily for 1 week then up to 15 mg twice daily. Usually that is continued for 2-3 weeks and if symptoms aren't gone, increase to 22.5 mg twice daily for a few weeks then max out at 30 mg twice daily. Even if you must remain on the Klonopin for sleep, your functioning during the day should improve with the Buspar. I've found Buspar to be more effective than I originally thought it was when it was introduced about 6 years ago. It can be effective by itself and certainly is a good augmenting agent for antidepressants. Regarding the Remeron, remember you get paradoxically FEWER side effects as you increase the dose, so if you try it and you are too sleepy at 15 mg each night, INcreasing it should reverse the sleepiness. Other sleep meds to consider in place of Klonopin are doxepin and trazodone although they may give you a hangover because you are sensitive and you can't get it in really small doses, imipramine, or Serzone (the only problem there is possible nausea but you can get it now in very small doses).Let me be clear though since we have discussed so many different options. Look into the EMDR first because it has the greatest chance of quickly clearing up many of your symptoms without meds (there are some insurance companies that will pay for it now because it is so quick). Then try cog-beh therapy. If EMDR isn't an option and you are trying cog-beh therapy, then proceed with Buspar, then Remeron, then Serzone along with the cog-beh stuff. Keep Depakote in mind if the antidepressants poop out as it is a pretty good antianxiety medication (125 mg per day to start and slowly increase up to as high as you can tolerate). You can look into the sleep study as a sideline while you are doing these other things; the sleep study may not be as profitable to you as the EMDR and/or cog-beh therapy now that I have more info about you, because it sounds as though the sleep problems are rooted in your depression and anxiety (which doesn't mean you are hysterical, just traumatized and trained to not sleep) and a sleep study would probably just confirm that via the EEG results of your brain waves being hyperaroused and simultaneously clinically depressed.
Just because I'm suggesting these meds doesn't mean you need to fight with your doctor if he feels there is another, better option. Just keep these things in mind to continue to look into. After all, unfortunately there's no test to see which med will definitely do the trick and even the ones I mentioned have the potential to fail in any particular person. As always, good luck.
poster:Toby
thread:511
URL: http://www.dr-bob.org/babble/19980901/msgs/592.html