fao squad and any advice....

[lcg]

i am fed up because i have not had a decent nights sleep for months. i go to bed at 9/10pm anf all asleep quickly, but always wake at 130am and 430am regardless of efforts at sleep hygiene/no caffeine/not sleeping during the day etc. i have mental health issues and take 600mg quetiapine xl and 75mg venlafaxine at night (8/9pm) and also have osteoarthritis which causes me constant pain and is sometimes the culprit of waking me, but not always. i have 75mcg fentanyl patches, meloxicam 15mg, pregabalin 75mg and cocodamol 60mg/1g four times a day also. i have tried various sleepers (short term only - temazepam, zopiclone and lorazepam) which do help a little but give me a 'hangover' feeling in the morning. my question is - have you got a suggestion for any other meds i could take longer-term which would stop me waking and keep my pain in check overnight as well? i am seeing my gp next week to discuss this issue and want to go armed with a little information. i was thinking amitriptyline......is there anything else? i have an appointment with the pain clinic in november, but can't wait that long or get seen more quickly. this is starting to drive me a little bit potty....and i am sooooooooo tired. mtia x

[Sqad]

Blimey Icg........not my field, but amitryptilline does come to mind.

The sleep pattern is that of an endogenous depressive (old terminology..sorry) and the osteo arthritis could well be a contributory factor.

Unfortunately amitryptilline may take 5 or 6 weeks to "kick in"

Sorry Icg....that is the best that i can do.

[lcg]

thanks, squad. yes i do think my waking is connected to my (psychotic) depression and my mood is pretty rubbish at the mo. when very unwell, waking becomes an extreme problem. i don't mind how long something takes to work and am willing to try anything at this point, but need to be careful of feeling over medicated as i work full time and that's hard enough at present. thanks again x

[LoftyLottie]

Let me know what your dog says icg. I have very similar problems. I am so, so tired every morning.

[LoftyLottie]

Ha, ha. I meant 'doc'!!!

[Eve]

I thought of amitripilyne as well, it makes me sleepy and I found it harder to get up in the mornings. Rhumo wanted me back on it but as I have a dry mouth and eyes they said it could make that worse so I went on citalopram to try and help with sleep instead.

I've just started on pregabalin 75mg twice a day and it's made me quite drugged up after the morning dose but easing off now I've got more used to it.

[LoftyLottie]

Jenna, what time of day do you take citolopram? I used to take it in the evening, but my GP advised to take it in the morning as it actually doesn't induce sleep, quite the reverse apparently. It is an anti anxiety drug which I have taken for years and probably for life!!!

[lcg]

i will let you know how i get on, lottie. i have a very good relationship with my doc - he knows i am a nurse, so we have really good, in depth consultations which are refreshingly open, honest and usually very productive! i really am getting to the end of my tether about my sleep and i have also started to fall asleep in random places during the day because i am so tired. it does not look cool when i start to snore in medical lectures by my colleagues!!! x

[Eve]

I've been taking it before I go to bed Lottie. Hmm, that's interesting! It was my GP I decided with rather than my rhumatologist. The latter suggested fluoxetine but when I looked it up I realised I'd been on it previously and it made me feel really sick so we went for citalopram as had been on that previously and it was good.

I might need to check up on that one.

[LoftyLottie]

Thank you. Your GP sounds like mine. So good to have a really informative and productive relationship with a GP. I have Osteo Arthritis, Hypermobility Syndrome and Fibromyalgia, plus anxiety problems. Tiredness is a big issue!!!

[lcg]

jenna - citalopram is not a drug used to help sleep. you usually come across mirtazipine, venlafaxine (which i take), trazodone or similar. typical ssri's do not help sleep, but mood or anxiety....

pregabalin is quite good used through the day, but does make me feel a bit 'high'. how bad is the hangover from amitriptyline and at what dose? sorry if i sound a bit nosey or picky, but i really want to explore something which will help me sleep better. i am running a salty bath as we speak because i am working later!! x

[Eve]

I have a brilliant GP now too, such a massive difference! I'm rhumatoid arthritis, fibro and hypermobile and other bits so with you all on the tiredness.

I was giving some poor guy shift looks on the bus the other day as I thought he kept nudging into me from the back (Lottie I'm sure you'll understand with the general pain thing) until I realised it was my muscles spasming...oops...

[lcg]

jenna....do not take ssri's at night!!! they should be used in the morning. mirtazipine is the only similar drug taken at night as it does make you feel quite drowsy. my son is on it as he is at uni, has depression and cannot sleep. it has helped him enormously x

[Eve]

Hmm, might need to query that one then! I found even on 10mg of amitriptilyne I found it hard to get going in the morning though my gastro wanted me on up to 50mg a day! I had been on that dose (GP pressed the wrong button by accident!) and I was like a zombie, thought I was losing it!

They do step it up though and definitely worth a try.

I'm hoping the pregabalin will help me. Need to faff about with when I take the doses I think as been taking one before bed (9/10pm ish) and one when I get up in the morning (5.20) or when I get to work (7am). Felt drunk the first morning (it was great!) but it's been wearing off about lunchtime and then OMG it's like a pain attack, I guess with the different from being so much more pain free earlier, I can feel it but it's more of a dull feeling and I'm not so bothered. Amazing difference when it's working!

I wanted the pre bed one to be able to get better more restful sleep though wondering if it's going to be more beneficial taking the doses in the day to be able to do more. It's definitely had an effect on my sharpness of thought, though hoping that will improve as my body gets used to it, but to be in so much less pain is amazing! Just wish it'd last for longer.

[lcg]

do query your ssri, jenna. sometimes gp's can be a little bit off when prescribing psych meds - i'm lucky because i see a shrink who takes care of that for me! i reckon mirtazipine will work well for you (and taken at night!). keep going with the pregabalin - i use 75 mg 3-4 times a day and it works well. hope it settles down for you . have replied to your email address x