Table of Contents (hide)
- 1. Insomnia and Hyposomnia
- 2. Pick Your Poison
- 3. Dyssomnia & Hypersomnia - Sleep, Interrupted.
- 4. Parasomnia - Disturbed Sleep
- 5. Bibliography
The sleep disorders covered here, and the methods to treat them, fall into three broad categories.
The most common sleep disorder of the group is insomnia, which is technically not being able to sleep at all, and hyposomnia, which is getting too little sleep. Most people complaining of insomnia actually have hyposomnia because insomnia means “not enough sleep” to 99% of everyone who isn’t a doctor, or they manage to sleep at least a couple hours without being aware of it. The latter is one of the reasons why I have the ‘radio’1 on when I sleep. As I would wake up every thirty minutes to three hours anyway, the radio lets me know that I was asleep, and for longer than it may have seemed. The deception that you didn’t sleep when you actually have messes with you, and contributes to feeling more tired in the morning than you should. Hyposomnia and occasional insomnia can be treated with all sorts of things before you need to see a doctor, and there are thousands of websites that deal with non-medicine treatments for them. As this is Crazy Meds I’m going to assume you’ve already tried everything else, or at least some of the non-drug therapies which, honestly, you should. Just don’t ask me which is best because leaving the radio on, or the TV if a radio isn’t available, so the news2 is on all night, is the only non-drug treatment that has ever helped me sleep. Exercising in the morning vs. exercising later in the day vs. not exercising at all: no difference. I can get an A+ in sleep hygiene, but without the news on I’ll be lucky to get five hours of sleep.
So if you do need to use medications, hyposomnia and insomnia are primarily treated with hypnotics, benzodiazepines and other sedatives, and off-label by a few other drugs. How does your doctor determine which group of med to prescribe out of? That depends on factors such as:
- how old your doctor is
- what their specialty is
- what your HMO’s formulary is like
- if you’re lucky something actually meaningful:
- is your problem primarily psychological in nature?
- what other conditions you have and medications you might be taking to treat them
Younger doctors are far more likely to prescribe hypnotics, while older doctors are apt to prescribe sedatives of one kind or another. Benzodiazepines and other sedatives are usually more effective for psychological insomnia psychological (i.e. “in your head”), while hypnotics are usually better for insomnia with an underlying physical problem in your head. Each class of medication has its pros and cons. With benzodiazepines you’re essentially exploiting a side effect, so taking one on a nightly basis often causes you to rapidly build up a tolerance. I don’t think it’s a great idea for the bipolar to take the prescription hypnotics (Ambien, Lunesta, Rozerem, or Sonata). At least not very often. Most of what you find in the literature shows them as safe to take when crazy, and there are few case reports of high weirdness (e.g. Ambien + Depakote + bipolar = sleepwalking), but I’ve collected far too many stories of the bipolar frequently going way overboard with Ambien-induced sleep-what-the-fuckery. Who else remembers Representative Patrick Kennedy’s Ambien Adventure? That was nothing compared with the stories of first-time full-on psychoses, various items going missing only to be found in the freezer3, laundry being washed and hung up inside to dry instead of using the dryer (and hang drying was not required), and complete destabilization that took months to recover from. These were rare events, even in the context of the bipolar population taking hypnotics, but if are bipolar and you’re reading this site the odds are you’re taking more than one medication to manage your bipolar symptoms, have tried at least several other meds before getting your symptoms under control, if they are under control, and have experienced a few nasty side effects from various medications at some time in your life. So while the ‘average’ person with bipolar disorder may have nothing to worry about, the sort of people I’ve dealt with over the years are another story.
- Ambien (zolpidem tartrate)
- Benadryl (diphenhydramine HCl) - as well as numerous other brand names: Unisom, Compoz, Sominex, Nytol, and every OTC pain reliever with PM after its name.
- Imovane (zopiclone) - not available in the US
- Lunesta (eszopiclone)
- Rozerem (ramelteon)
- Sonata (zaleplon)
2.2 Benzodiazepines with FDA approval to treat insomnia
- flurazepam hydrochloride
- Halcion (triazolam)
2.3 Benzodiazepines used off-label to treat insomnia
- Ativan (lorazepam)
- Klonopin (clonazepam)
- Valium (diazepam)
- Xanax (alprazolam)
- amobarbital sodium
- butabarbital sodium
- methohexital sodium
- pentobarbital & pentobarbital sodium
- secobarbital sodium
- Good luck getting prescriptions for these:
- chloral hydrate
- hydrochlorides of opium alkaloids (Pantopon)
- Other medications:
- Xyrem (sodium oxybate) - good luck with this one as well, even for its approved usage
The flip side is sleeping when you need to be awake, from narcolepsy to the newly
invented discovered shift work sleep disorder (SWSD). Those ailments are usually, but not always, treated with a stimulant of some form. There may be non-drug therapies to treat narcolepsy, but none that I’m aware of that do any good4. SWSD is a controversial diagnosis, one I’m conflicted about. As an actual sleep disorder I consider it to be total bullshit. Either you can work the graveyard shift or you can’t; just as some people can get up at five or six in the morning while some people are ready to go to sleep at that time. On the other hand, the only job available for you might be one where the hours are exactly the same as when your body and brain would rather be asleep no matter how much coffee you drink. Assuming you can drink coffee in the first place. So if it takes getting diagnosed with bullshit sleep disorder (BSD)in order to keep the only job available5, then you’re much better off getting diagnosed with SWSD and getting a prescription for modafinil or Nuvigil (armodafinil) - depending on which one is covered by your graveyard-shift health insurance. I would do the same thing in those circumstances.
- Adderall (dextroamphetamine and amphetamine) - immediate release, not Adderall XR6
- Dexedrine (dextroamphetamine sulfate)
- Nuvigil (armodafinil)
- Provigil (modafinil)
- Ritalin (methylphenidate)
- Xyrem (sodium oxybate)
- Nuvigil (armodafinil)
- Provigil (modafinil)
Finally there’s doing weird stuff when you’re asleep, like sleep binge eating or sleep driving. The latter is most often associated with being a side effect of hypnotics like Ambien (zolpidem), where the treatment is simply to stop taking Ambien. In other cases the causes range from epilepsy to they don’t have a freaking clue, but either way the first treatment tried is usually an antiepileptic drug (AED). Parasomnia also includes things like restless leg syndrome (RLS) and periodic limb movement disorder (PLMD), probably because RLS & PLMD are both neurological disorders and can also be caused by things like a specific form of iron deficiency (anemia), postpolio syndrome, and the catch-all who the hell knows (idiopathic). So many things are in this category that non-drug treatments include talk therapy and, except for RLS & PLMD, all the treatments are off-label.
- Mirapex (pramipexole)
- Requip (ropinirole)
- Topamax - Sleep eating, especially sleep binge eating.
If you have any questions about sleep disorders and their treatments that weren’t answered here, check out our forum on epilepsy, migraines, sleep disorders and other neurological conditions.
Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition by Stephen M. Stahl © 2008 Published by Cambridge University Press.
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2 Not talk radio or pundit TV, but actual news. I have no idea why, but ever since I was nine or ten I've been like this.
3 Putting important stuff in the freezer is a common trait of the part-time somnambulist. Why so many of them consider the freezer to be a safe place to store something is understandable, as are some of the items consigned there: keys, wallets, TV remotes, photographs. It's when things like underwear, junk mail, and unwashed dishes show up in the freezer that you have to wonder if Lunesta makes you a sleep hoarder.
4 That doesn't mean reliable non-drug therapies to treat narcolepsy don't exist, I just don't know of any. If I learn of any I'll list them here.
5 Or the only job available with decent health insurance, and that pays enough to keep you and your kids from having to move into a studio apartment and live off of food bank donations.
6 For all I know Adderall XR may work for narcolepsy, it just doesn't have FDA approval to treat it the way the older immediate-release form has.
Treatment Options for Insomnia/Hyposomnia and other Sleep Disorders by Jerod Poore is copyright © 2012
Author: Jerod Poore. Date created: 24 May 2012 Last edited by: Jerod Poore on: June 12, 2013, at 04:45 PM
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]
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