![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by utopizen on June 26, 2003, at 13:23:47
I just entered the ER two days ago after not being able to sleep for two days. I have no history of depression, and my only history is with social anxiety disorder and inattentive ADD.
I've had chronic insomnia for at least a year now, but have been able to ignore it because college let me take classes at 10:30 or 11am and nap when necessary.
Now that I've started my summer internship, and I must wake up to get ready at 7:30 each morning, I can't afford to be feeling terrible about how I won't function in the day when it's 4:30AM and I've either had no sleep or slept from 9PM to noon and couldn't go back to sleep.
I'm also out-of-state, making matters worse. I had a polysomnograph, but don't know the results yet because I won't be back to review the results with my pulmonary specialist (I guess my neurologist wanted me to rule out apnea?) until September when I'm back in state.
I thought I could keep things under control until them symptomatically. My psychopharmacologist said he'd be fine calling in and mailing in scripts as needed over the three months I'll be out of state. Well, it turns out he's a space cadet about doing this.
He's given me Trazodone, but that left me with really high blood pressure and heart palpatations, plus morning groginess that made me feel terrible in the morning (the first hour of the day is the only time I ever feel energetic-- I'm a morning person!)
I've called him, repeatedly, and finally got him on the phone last thursday, and he said he'd review my records and phone in a script to my pharmacy here. Well it's Thursday, and I've left messages, E-Mails, even pages to him, and he hasn't responded. And my pharmacy knows me by name now because I've called so many times asking if he called anything in.
I'm also waiting for him to mail me a script for Desoxyn, which he promised last Thursday as well. And I don't appreciate having to go to the ER two days ago and take a day off from work just to get a two-week supply of Ambien when he could have easily called that in way before then. It was embarassing to have to admit to the kids I'm staying with I went to the ER over insomnia
(I've since scheduled an appt. with a GP in case anything comes up again like that... but I'm also just very open about why I do things, so people don't think I'm "sketchy")
It's sad to see the ER doctor look so concerned over my problem, and realize it's something my regular doctor neglects to even call me over the phone about. I mean, I have no abuse history, or anything, it's not like he's avoiding some drug seeker! I didn't even ask him for a particular drug, I just told him I had chronic insomnia and the Trazodone wasn't helping.
So now I'm hoping this random GP I see will prescribe more Ambien for the remainder that I stay here (rebound insomnia is to me like rebound thirst from taking water-- yeah, you'll be thirsty if you stop drinking water, but you'll stay thirsty if you don't drink it too!)
Oh, I'm concerned my co-workers think I take drugs during the day. Some have told me they think this (even though we're friends) and are concerned about me. It's because I am so tired and exausted. Even with the Ambien, and Desoxyn during the day, I get so tired I can't function. Getting 8-9 hrs. of sleep just ensures I will be articulate enough (I had a sleep impediment when I was younger, comes out when I'm tired) to talk.
Has anyone had success with Provigil for their fatigue? I've never experienced depression before, but the fatigue is so painful I feel down all the time now.
I've read recent reports have found insomnia itself can induce depression, which is annoying because I have to tell doctors this after they've been lectured over and over about how depression causes insomnia and never thought the opposite could happen. If I continue like this, my jolly natural self, which I pride myself on for being happy all the time, won't be so myself still. I can't even do work, it exaccerabates ADD. And I think I'll need to switch stimulants, feels like the Desoxyn I've taken for the last few months has run its course and drained out a little too much adrenaline or something and needs a little break. I don't think it's tolerance, just sleep debt and EDS interfering with its efficacy.
Posted by utopizen on June 26, 2003, at 13:56:42
In reply to Help! Tired, Insomniac, EDS, ADD, posted by utopizen on June 26, 2003, at 13:23:47
Oh yeah, and about this random GP- I'm hoping 1) he'll script me for the enxt two months I'm out-of-state for Provigil and Ambien and 2) the two will work and I can feel less like hell during the day.
If he says no, and doesn't care how chronic this problem is with me, I'm likely to fly home for a week and see my doctor to review my sleep study results.
My ER doctor wanted me to see a sleep disorders specialist in the same hospital. Problem is, my appt. is for Aug. 21. Some good that'll do, I already have a sleep doc. appt. for 9/2!
My pulmonary specialist is now really confused, I thought I told him when I first met with him I would be out-of-state for three months, and would see him in September. And this is of course all just to rule out the possibility of apnea and so forth in a 19 yr. old 170 lb. 6'3'' healthy male!
But he seems very concerned and accomodating, cc'd emails to his two nurse practioners, and will meet with them to review my case "asap this AM". He also said he will fit me in to see me if I had a chance to get back home before September (big accomodation for someone who's at a research hospital with a 6 mon. waiting list).
Basically, all this because my psychopharmacologis is ignoring my countless messages. I even paged him two days ago. What a jerk! I thought he would be fine before this happened.
Posted by Ritch on June 26, 2003, at 23:28:02
In reply to Help! Tired, Insomniac, EDS, ADD, posted by utopizen on June 26, 2003, at 13:23:47
> I've read recent reports have found insomnia itself can induce depression, which is annoying because I have to tell doctors this after they've been lectured over and over about how depression causes insomnia and never thought the opposite could happen. If I continue like this, my jolly natural self, which I pride myself on for being happy all the time, won't be so myself still. I can't even do work, it exaccerabates ADD. And I think I'll need to switch stimulants, feels like the Desoxyn I've taken for the last few months has run its course and drained out a little too much adrenaline or something and needs a little break. I don't think it's tolerance, just sleep debt and EDS interfering with its efficacy.
I think you are on the right track about sleep deficits accumulating and causing trouble. I'm in that pickle right now and trying to correct it. Switching stims sounds like a good idea. The easiest thing to do would be to switch from the Desoxyn (with long half-life which could be sleep disruptive), and go with some IR Dexedrine through the day so you can sleep later on.
Posted by utopizen on June 27, 2003, at 1:26:56
In reply to Re: Help! Tired, Insomniac, EDS, ADD » utopizen, posted by Ritch on June 26, 2003, at 23:28:02
Ritch,
I think I've been able to rule out the Desoxyn for insomnia because I don't take it on the weekends. Also, if it makes me crash like 2 hours after taking it, how long could the half life be (for my metabolism)?
Anyway, when I do crash, I feel so tired and depressed, it's terrible. And the problem is, it only lasts for two hours really. I need a new med. But now I'll have to wait another week I guess for my p-doc to mail one over (I'm out of state). Just found out in the mail today the Ambien he promised was mailed, not called in like he promised, along with another script for Desoxyn I'd rather do many other things before filling and crashing on the stuff again. And the co-pay's $30 anyway, versus $5 for any other stim.
As for the Ambien, I'll take it at 10:OOAM and be awake at 1:AM, generally hungry. If I tell this to a doc, he'll just be "oh, you need to eat more during the day" and not prescribe me anything to help me sleep longer. But the reality is my metabolism is very, very fast (I'm 170 lbs., 6'3'', 19 yr. old male).
I'm on 10mg of Ambien at bedtime. Maybe 20mg will help knock me out for long enough. Ambien MR (modified release) won't be out until at least 2005.
Posted by Ritch on June 27, 2003, at 9:57:55
In reply to Re: Help! Tired, Insomniac, EDS, ADD, posted by utopizen on June 27, 2003, at 1:26:56
> I think I've been able to rule out the Desoxyn for insomnia because I don't take it on the weekends. Also, if it makes me crash like 2 hours after taking it, how long could the half life be (for my metabolism)?
>
> Anyway, when I do crash, I feel so tired and depressed, it's terrible. And the problem is, it only lasts for two hours really. I need a new med. But now I'll have to wait another week I guess for my p-doc to mail one over (I'm out of state). Just found out in the mail today the Ambien he promised was mailed, not called in like he promised, along with another script for Desoxyn I'd rather do many other things before filling and crashing on the stuff again. And the co-pay's $30 anyway, versus $5 for any other stim.When you skip the Desoxyn on the weekends, does this 2-hr. post-dosing crash phenomena not happen?
Posted by utopizen on June 27, 2003, at 16:16:49
In reply to Re: Help! Tired, Insomniac, EDS, ADD » utopizen, posted by Ritch on June 27, 2003, at 9:57:55
>
> When you skip the Desoxyn on the weekends, does this 2-hr. post-dosing crash phenomena not happen?
>Um, of course, if I don't take Desoxyn, I won't crash, because I never launched. It's not such a phenomenal, it's typical... although I don't remember getting it when I started it a few months ago during school, I did get it this summer (same thing happened last summer with Adderall- got crashes all of a sudden after months of not getting them).
I think my brain just needs to switch to a different stim every few months. Ritalin got pretty dsyphoric for me after a few months too.
I met with a GP nearby the place I'm interning out of state at for the first time. I told him if I couldn't resolve my insomnia and somnolence problems I'd have to fly back home, and sort of begged him to up my Ambien from 10mg to 15 or 20mg (the ER gave me a two week's supply of 10mg, but it only puts me to sleep for 3 hours). I also asked him if he could put me on Provigil.
I went over all my stuff with him, the 1mg 3x/day Klonopin, the Desoxyn for ADD, the history of sleeping/fatigue problems, and he said "well you've got a lot of problems" in a nice way, allayed my concerned about having to go back home to see my specialists, and said he'd call me back with names of "doctors who deal with psychotropics" (he asked me what kind of doctor my psychopharmacologist was earlier, but he's otherwise a pretty smart guy. I lucked out, at least he will give me good contacts.
He said he couldn't prescribe me more than 10mg Ambien, which I understood... obviously we both knew he could, but he didn't want to risk audit troubles. But he said like "I can't stop you from taking more though" in an almost wink-wink sort of way. Yeah, right. wink, wink means having to deal with 2 different pharmacies with two different scripts from 2 different doctors on a medicine that's $30/month. That's $60/month just so I can get an appropriate dose of Ambien (20mg/night). Keep in mind I am in an internship situation, and starve myself half the time and the other half the time struggle as it is to pay for my meds that cost $15 or $5 in co-pays. Oh, and Provigil is $30/month if I want that, so we're talking $90 month just to keep me asleep and awake. Definitely time to avoid $30 to paying for Desoxyn, which really doesn't work at all basically now. Use to do wonders, sure it will again if I give it a month or two break.
It's gotten too complicated to rely on my spacey and over-booked p-doc to not EVER return my messages, and now and then mail me scripts a week after I ask him to PHONE them in. Like if I add Provigil, I don't want to worry about having to leave messages he won't return if I get crazy side effects or need a different dose.
I can understand not returning messages now and then, but he hasn't returned a single message I left for over a week now, including a page several E-Mails. Which is a shame, because he's an otherwise great doctor (when you're seeing him in person).
And I told him I can have my sleep study report mailed out to him, and he dismissed the idea and said, "no, I don't need that, I'll just phone in the sleep aid." I wouldn't mind that attititude if he actually phoned it in instead of mailing it in!
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.