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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Solstice on December 7, 2011, at 20:43:00
My daughter has bipolar. It's been pretty well controlled. The big problem we're having now is an escalation of chronic insomnia.
Here's what she takes:
MORNING
Geodon 60mg
Vyvanse 80mg
Intuniv 3mgBOOSTER
Adderall 15mgEVENING
Geodon 60 mg
Trazadone 150mg
The Trazadone was prescribed specifically to help with the insomnia. She was very sensitive to it initially, and in the beginning, for the longest, she only took 25mg and slept like a log. She has gone up and down on it since then - and her biggest complaint is she believes it makes her feel sleepy during the day. What I'm worried about, is that her sleepiness is not because of the Trazadone, but rather is because of how little sleep she gets. She frequently doesn't fall asleep until 5am - and is up an hour or two later to go to school. Sometimes she gets a few more hours, but not often. On weekends, though, she might sleep till 1pm.She just finished being in a lead role in a play at school.. where there were weeks of very late rehearsals, and she'd come home quite stimulated. Anyway, her insomnia is driving her, and me, nuts.
We saw her psychiatrist the other day, and the psychiatrist said there wasn't much she could prescribe for her at her age.
My daughter has heard about melatonin. Does anybody here think it's worth a try? Can anyone tell me whether Trazadone is likely to cause daytime sleepiness? Is there anything else about her med schedule that might be exacerbating her insomnia? Any ideas?
As a side-note - and I don't know whether it plays a role, but she was diagnosed with autonomic dysfunction several years ago. All her autonomic systems are affected.. including heart rate, digestion, sweating, internal thermostat, etc.It is controlled by taking salt tablets. A lot. About six a day. If she takes it, most of her symptoms are held at bay. If she misses the salt tabs for a day, her heart rate & blood pressure get erratic, she starts having frequent PVC's, sweats on one side and not the other, feels cold when it's hot and vice versa. So.. I can't help but wonder if whatever brain malfunction that's responsible for her autonomic dysfunction also plays a role in her insomnia. Any of you brilliant folks got any ideas?
Solstice
Posted by Phillipa on December 8, 2011, at 0:12:43
In reply to Bipolar and insomnia, posted by Solstice on December 7, 2011, at 20:43:00
I feel for your Daughter and you. I know you are getting the best of care for her. Not quite sure of this medical illness also but it it ups all her reflexes I might think a beta blocker could help? I don't know though. It sounds horrible. What docs have you seen a big medical center could that help? I feel this is something that the very best of docs need to consult on. Maybe let her stay home for a few days and see if she can calm down. Sounds like overstimulations causes all body processes to speed up. I'm so sorry for you both. Phillipa
Posted by Phillipa on December 8, 2011, at 0:15:15
In reply to Bipolar and insomnia, posted by Solstice on December 7, 2011, at 20:43:00
Makes me also think of Addison's and Cushings Disease from my own searches for me last week. Phillipa
Posted by Phillipa on December 8, 2011, at 0:21:19
In reply to Bipolar and insomnia, posted by Solstice on December 7, 2011, at 20:43:00
Might help might now here's hoping Phillipa
Posted by SLS on December 8, 2011, at 7:26:50
In reply to Bipolar and insomnia, posted by Solstice on December 7, 2011, at 20:43:00
> My daughter has bipolar. It's been pretty well controlled. The big problem we're having now is an escalation of chronic insomnia.
Geodon can produce insomnia. Does the emergence of insomnia coincide with Geodon treatment or dosage adjustments? Maybe she can take the second dose earlier in the day. Interesting thing - using salt for dysautonomia. I am guessing that bipolar disorder can aggravate dysautonomia via HPA axis activation.
Is the Geodon being used to prevent mania or as an antidepressant adjunct?
Have you tried low-dosage Seroquel yet?
- Scott
Posted by ed_uk2010 on December 8, 2011, at 9:18:04
In reply to Bipolar and insomnia, posted by Solstice on December 7, 2011, at 20:43:00
Hi there,
>Can anyone tell me whether Trazadone is likely to cause daytime sleepiness?
Trazodone often causes daytime drowsiness, but in your daughter's case I expect there is more than one cause.
>Is there anything else about her med schedule that might be exacerbating her insomnia?
It could be the amphetamines (Vyvanse and Adderall). Amphetamines disturb sleep and cause insomnia very frequently. It's certainly worth looking into.
>the psychiatrist said there wasn't much she could prescribe for her at her age
Night sedatives such as temazepam can be used on a very short-term basis in young people, but in the long term I think her medication regimen needs to be reviewed. Trazodone causes too much 'hangover' and its long term effectiveness is probably not very good. In fact, most sleep meds are not that great for chronic insomnia. The most successful treatment is usually to eliminate aggravating factors (often other medication) and to improve sleep hygiene. I think you should discuss making changes to your daughter's regular daytime medication in order to improve sleep.
Posted by mellow on December 8, 2011, at 9:56:16
In reply to Bipolar and insomnia, posted by Solstice on December 7, 2011, at 20:43:00
The stimulants seem like the red flag to me.
Posted by linkadge on December 8, 2011, at 16:26:39
In reply to Bipolar and insomnia, posted by Solstice on December 7, 2011, at 20:43:00
On too much.
Consolidate.
Linkadge
Posted by Christ_empowered on December 8, 2011, at 20:05:18
In reply to Re: Bipolar and insomnia, posted by linkadge on December 8, 2011, at 16:26:39
I dunno...this situation sounds hard. Maybe switch out Geodon for seroquel or seroquel xr? Eliminate the booster Adderall?
Posted by Solstice on December 8, 2011, at 23:38:32
In reply to Re: Bipolar and insomnia » Solstice, posted by SLS on December 8, 2011, at 7:26:50
> > My daughter has bipolar. It's been pretty well controlled. The big problem we're having now is an escalation of chronic insomnia.
>
> Geodon can produce insomnia. Does the emergence of insomnia coincide with Geodon treatment or dosage adjustments? Maybe she can take the second dose earlier in the day. Interesting thing - using salt for dysautonomia. I am guessing that bipolar disorder can aggravate dysautonomia via HPA axis activation.
>Hi Scott - Thanks for responding.
I didn't know Geodon could cause insomnia! When she first started taking it, and when her dose has been adjusted, she has about two weeks of pretty serious sleepiness. And since she takes an equal dose in the morning and the evening, I just don't know if it makes a difference. As for the salt.. yeah, when the cardiologist said for her to take salt and drink high quantities of water, I was bewildered - couldn't imagine how that would help all the problems she was having.They had done a couple of holter monitors on her, with and without her psychotropics. On both, she had 700 PVC's (premature ventricular beats) every single hour, 24 hours a day. She had runs of two to three in a row fairly frequently. So she starts taking the salt, and would you believe that all the symptoms go away! Including the PVC's, erratic heart rate, erratic blood pressure, internal thermostat dysregulation, etc. And there's nothing that upsets her more than for me to let her get low on those salt tabs :-)
> Is the Geodon being used to prevent mania or as an antidepressant adjunct?The Geodon has been crucial to moderating her hypomania. Depression hasn't seemed to be a problem so far. Her psychiatrist has told us that preventing hypomania as much as possible is key... because the more episodes she has of hypomania, the more likely she is to develop full blown mania, along with its depression counterpart.
>
> Have you tried low-dosage Seroquel yet?
No.. haven't tried Seroquel. The Geodon has really worked well for her... and the psychiatrist seems to attribute the insomnia to bipolar itself. My daughter has had a long history of difficulty sleeping - since toddlerhood.Solstice
Posted by Solstice on December 8, 2011, at 23:44:20
In reply to Re: Bipolar and insomnia, posted by ed_uk2010 on December 8, 2011, at 9:18:04
> Hi there,
>
> >Can anyone tell me whether Trazadone is likely to cause daytime sleepiness?
>
> Trazodone often causes daytime drowsiness, but in your daughter's case I expect there is more than one cause.Yeah.. it's the chicken/egg thing. My daughter thinks the trazadone makes her sleepy during the day (but if that's true - then why won't it make her sleepy at night??). But I think her insomnia is making her sleepy during the day. I just don't know enough about how trazadone works, though, to really know. It's so tough to figure out.
> >Is there anything else about her med schedule that might be exacerbating her insomnia?
>
> It could be the amphetamines (Vyvanse and Adderall). Amphetamines disturb sleep and cause insomnia very frequently. It's certainly worth looking into.
You've got a point on that one. She takes a booster dose of Adderall when she gets home from school. Problem is that she tends to get home late, and is taking a booster at 5pm or so. Maybe she needs a much shorter acting thing as a booster.
> >the psychiatrist said there wasn't much she could prescribe for her at her age
>
> Night sedatives such as temazepam can be used on a very short-term basis in young people, but in the long term I think her medication regimen needs to be reviewed. Trazodone causes too much 'hangover' and its long term effectiveness is probably not very good. In fact, most sleep meds are not that great for chronic insomnia. The most successful treatment is usually to eliminate aggravating factors (often other medication) and to improve sleep hygiene. I think you should discuss making changes to your daughter's regular daytime medication in order to improve sleep.It's all so frustrating. She really needs the booster to get through all the homework - but the booster might be causing her the biggest problem.
Solstice
Posted by challenged on December 9, 2011, at 2:21:31
In reply to Re: Bipolar and insomnia, posted by mellow on December 8, 2011, at 9:56:16
Seems linkaege has it right ...On too much! OMG! ONE PILL FOR THIS AND ONE PILL FOR THAT. If she wasn't Bipolar before she is now. This is why I am so afraid of multiple medications and went off SSRI's years ago for my deep depression it was making me worse. I was actually becoming bipolar.Just saying. Good Luck and take care.
Posted by ed_uk2010 on December 9, 2011, at 6:51:01
In reply to Re: Bipolar and insomnia, posted by Solstice on December 8, 2011, at 23:44:20
>My daughter thinks the trazadone makes her sleepy during the day (but if that's true - then why won't it make her sleepy at night??)
Trazodone has a long duration of action. Even if it is not causing sleepiness as such, it might produce a degree of impairment.
>She really needs the booster to get through all the homework
But if she was sleeping better at night and felt more alert during the day, would she still need a booster?
Posted by Solstice on December 9, 2011, at 8:36:45
In reply to Re: Bipolar and insomnia » Solstice, posted by ed_uk2010 on December 9, 2011, at 6:51:01
> >My daughter thinks the trazadone makes her sleepy during the day (but if that's true - then why won't it make her sleepy at night??)
>
> Trazodone has a long duration of action. Even if it is not causing sleepiness as such, it might produce a degree of impairment.
>
> >She really needs the booster to get through all the homework
>
> But if she was sleeping better at night and felt more alert during the day, would she still need a booster?I think you're right, ed_uk. I think she's got a vicious cycle going... and the first thing we need to do is eliminate the afternoon booster.
Solstice
Posted by Phidippus on December 11, 2011, at 18:15:25
In reply to Bipolar and insomnia, posted by Solstice on December 7, 2011, at 20:43:00
How old is your daughter? Is she also diagnosed with ADHD?
I don't see her prescribed a mood stabilizer, which is kind of essential in treating bipolar disorder. Lithium would be a good choice for her as it can help regulate sleep.
Geodon can be activating. Not only is it an antipsychotic, but it is an SNRI and norepinephrine reuptake can cause activation. Have you ever considered switching to Seroquel? Seroquel is a strong sedative and will help her sleep.
> The Trazadone was prescribed specifically to >help with the insomnia. her biggest complaint is >she believes it makes her feel sleepy during the >day.Trazadone can cause daytime sedation, however at a 25 mg dose there shouldn't be that much of an issue.
>She frequently doesn't fall asleep until 5am - >and is up an hour or two later to go to school.
This is unnacceptable, especially for someone with bipolar disorder. Sleep is essential for those with bipolar disorder and helps stabilize mood. What I wonder is if she may be hypomanic and that her insomnia is a manifestation of mania.
> We saw her psychiatrist the other day, and the psychiatrist said there wasn't much she could prescribe for her at her age.
Bah!
First of all, I think a mood stabilizer will help a lot.
Second, I think a switch to Seroquel would also benefit her.
> My daughter has heard about melatonin. Does anybody here think it's worth a try?I don't think it will help and you'll pay a lot out of pocket.
>Is there anything else about her med schedule >that might be exacerbating her insomnia? Any >ideas?
She's on an awful lot of stimulant. That may be working against her.
>I can't help but wonder if whatever brain >malfunction that's responsible for her autonomic >dysfunction also plays a role in her insomnia. >Any of you brilliant folks got any ideas?
Absolutely. But it doesn't change how the insomnia should be treated.
Here are some sleep meds you can bring up with your doctor. All have been studied as treatments for innsomnia.
Gabitril
Cyproheptadine
Clonidine
Rozerem
Atarax
Clonazepam
Oxazepam
Restoril
Lunesta
SeroquelPlease, take that list to your doctor and see what they say.
Eric
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