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Is difficulty sleeping normal for BP patients?

B

BlueWater

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I first felt depressed when I was 18 then at the age of 19 couldn't nap again ever. I get about one to two naps per year. That's it. I am 45 now. My mind doesn't stop at night without a sedative, a benzo, an anti-convulsant, an antihistamine, a little Trazodone and sometimes a muscle relaxer. I know other OCD sufferers like me and they've told me they don't have insomnia unless something specific is bothering their mind or something about their environment has changed. But this sleep drama exists for me all the time. I have mood problems, too, and wonder how much of that is the cause of my sleep problems. A mood stabilizer gets me going in the morning and has made me nicer, but something deep inside tells me I need something to calm me down, too. Any insight would be appreciated. I'm going to try Lexapro in about two weeks. Hoping it will help the sleep aspect and calm my mind.
 
Wishbone

Wishbone

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I'm not sure about wording it as difficulty in sleeping but changes in sleep pattern certainly occur and we're supposed to have more of a natural 'night owl' pattern about us as well. In 'up' spells it can be feeling like you don't want or need as much sleep, or are simply doing too much that getting to bed at a sensible hour doesn't exist for a time. When depressed I know some people sleep more but for me I would say its more that my sleep is disturbed more, waking multiple times in the night and never getting into the deeper realms of sleep. In betweens episodes it can be fine or I can still have some spells where I'm struggling to sleep through. My sleep has been great for the last month or so and tonight, for some reason, is the only night in a while where I've woken in the night and can't get back to sleep.
Your mind shouldn't be continually on the go come night time so having trouble shutting off thoughts shouldn't be down to anything like Bipolar, again, that's the kind of thing that would come when in episode but not outside of them, so could just be down to life stress, events etc, and needing to find ways of relaxing.
P.S: I genuinely feel concerned that you sleep with multiple sedatives plus, each night. That doesn't sound good at all. I assume you practice sleep hygiene etc?
 
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SFGuy

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My pdoc tells me that sleep problems are universal among her bipolar patients. I take a combination the max dose of Trazodone (400 mg) and the muscle relaxer baclofen along with 2500 mg of Depakote ER. Benzos and Z drugs don't touch the insomnia.

I practice strict sleep hygiene, too.

I had morning grogginess/brain fog even before I was medicated for bipolar & sleep, but I know the meds make it worse. It's hard to get going. I wish I could be less sedated, but complex sedation is the only thing that works on the insomnia.

My pdoc says much of the problem comes from wacky Circadian rhythms caused by the disorder. My reading confirms it.
 
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BlueWater

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I'm not sure about wording it as difficulty in sleeping but changes in sleep pattern certainly occur and we're supposed to have more of a natural 'night owl' pattern about us as well. In 'up' spells it can be feeling like you don't want or need as much sleep, or are simply doing too much that getting to bed at a sensible hour doesn't exist for a time. When depressed I know some people sleep more but for me I would say its more that my sleep is disturbed more, waking multiple times in the night and never getting into the deeper realms of sleep. In betweens episodes it can be fine or I can still have some spells where I'm struggling to sleep through. My sleep has been great for the last month or so and tonight, for some reason, is the only night in a while where I've woken in the night and can't get back to sleep.
Your mind shouldn't be continually on the go come night time so having trouble shutting off thoughts shouldn't be down to anything like Bipolar, again, that's the kind of thing that would come when in episode but not outside of them, so could just be down to life stress, events etc, and needing to find ways of relaxing.
P.S: I genuinely feel concerned that you sleep with multiple sedatives plus, each night. That doesn't sound good at all. I assume you practice sleep hygiene etc?
I practice good sleep hygiene since beginning talk therapy a year ago. OCD and physical pain are the two contributors I know of to my insomnia. I phase my meds in at night so my body and mind will wind down, and I don't start projects before bed anymore. Despite all of that, it's hard to feel tired enough to sleep. Either my body tells me to do more or my mind tells me to be on alert for OCD triggers. Maybe I'm just hyper-vigilant. I know it's too much variety to sleep, too, and in a couple of months my doc wants to review my meds again.

I'm not looking for another diagnosis per se. I know that ultimately managing symptoms is key, and a diagnosis can change years later. But lately, finding people to relate to has been paramount. After having these meds pieced together one at a time to ease various symptoms I see that I'm patched together and something is missing. This other situation of feeling mixed up on Lamotrigine and going both higher with energy and motivation yet lower with irritability and depression during a stressful period was according to my GP not normal. I see my counselor next week and am going to tell her what he said. Thanks for replying.
 
B

BlueWater

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My pdoc tells me that sleep problems are universal among her bipolar patients. I take a combination the max dose of Trazodone (400 mg) and the muscle relaxer baclofen along with 2500 mg of Depakote ER. Benzos and Z drugs don't touch the insomnia.

I practice strict sleep hygiene, too.

I had morning grogginess/brain fog even before I was medicated for bipolar & sleep, but I know the meds make it worse. It's hard to get going. I wish I could be less sedated, but complex sedation is the only thing that works on the insomnia.

My pdoc says much of the problem comes from wacky Circadian rhythms caused by the disorder. My reading confirms it.
My benzo and sedative won't touch my insomnia without Lyrica, an antihistamine and a little Trazodone. I reserve the muscle relaxers for nights when muscle tension is too much. I take a little extra of my benzo or sedative and usually a little more Trazodone on nights when sleep is still elusive. And I alternate in a different antihistamine on nights when my usual antihistamine doesn't help. Too much Trazodone, which would be 50-75mg, and I fade into a fog the next day and can feel even more depressed. I'm now taking Progesterone almost every night to ease the perimenopausal symptoms which include excessive hunger and insomnia. My obgyn recently threw up her hands with me and deferred to my GP because I have too many moving pieces for her to be able to help. My GP mentioned Depakote last year but said I can't try it until menopause. He hopes Lexapro will lift my general depression and even my daily moods because I've maxed out on my Lamotrigine benefits. If I take any more while stressed, I go up close to what resembles a mixed state. If I increase while depressed, I just become too flat. Ah, enough. Time to get off this forum and do things. Thanks for the info. I thank you and Wishbone for the useful info.
 
Amazingly

Amazingly

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To simplify things, yes sleep problems are commonly seen in bipolar patients.
 
Gigirez

Gigirez

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I've had sleep issues as long as I can remember. They come and go. I've experienced chronic nightmares, night terrors, insomnia (days without sleep), sleep paralysis, and on the other end of the spectrum, sleeping for 12+ hours at a time.
 
I

InnovatingProfessor

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Having sleep issues with this disorder is very normal. This night I slept only 3 hours due racing thoughts and much energy... :mad:

I have the "nap" issue also, there are years ((little) hypomania <-> manic psychotic) I couldn't even feel tired - always feeling too ... during the day. I also noticied: I also don't yawn when my mood is higher. When switching to depression, I start yawning like hell.

When I am more depressed I fall a sleep like a baby and I sleep then +during daytime...

Meditation with muscles excercises seems to improve. I will yawn.
 
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keith74

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Sleep issues during a mood swing is extremely common.

When my wife is manic, she doesn't want to sleep because her mind is too busy and she wants to stay up.

When my wife is in a depressive episode, she desperately wants to sleep but cannot because her mind has all these negative thoughts that fuel her anxiety and keep her up all night worrying about everything.

When she is at baseline, she can sleep like a rock. Fortunately she is classic bipolar 1 with long stretches at baseline.
 
K

keith74

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I practice good sleep hygiene since beginning talk therapy a year ago. OCD and physical pain are the two contributors I know of to my insomnia. I phase my meds in at night so my body and mind will wind down, and I don't start projects before bed anymore. Despite all of that, it's hard to feel tired enough to sleep. Either my body tells me to do more or my mind tells me to be on alert for OCD triggers. Maybe I'm just hyper-vigilant. I know it's too much variety to sleep, too, and in a couple of months my doc wants to review my meds again.

When my wife had severe insomnia a few months ago (during an acute depressive/anxious state), the meds were not enough. She was put on quetiapine, benzos, z-class meds, etc but they all had limited effectiveness. She then started to really work on her sleep hygiene and that seemed to help a bit. This included really strict sleep schedule (10 to 7), an early AM walk to catch some morning sun, afternoon exercise (always before 4PM), no caffiene after 12PM, minimal sugar and alcohol, evening meditation to prepare for sleep (you can listen to guided meditation like calm.com), and "droney" sleep music when going to sleep (I like SleepTube on youtube: https://www.youtube.com/channel/UCJkWqlhR1-tJpygPdylMl8A). It was a good habit that she still practices now even though she sleeps well now.
 
C

CabbageMama

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Absolutely, for me. In periods of high stress, I have struggled to get 3-5 hours of sleep a night. Sleeping tablets were ineffective when I was high. Currently, some stressors have been removed, and with sleeping pills, I can get 9-10 hours of sleep. I am generally functioning much better and feel that I need it. I always try and practice good sleep hygiene to try and make it a habit.
 
Wishbone

Wishbone

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This other situation of feeling mixed up on Lamotrigine and going both higher with energy and motivation yet lower with irritability and depression during a stressful period was according to my GP not normal. I see my counselor next week and am going to tell her what he said. Thanks for replying.

Things like Benzos etc don't help this though, that's one of the problems with taking so many different meds. Knowing how effective one medication really is when there are so many other 'ingredients' in the cocktail is nigh on impossible to decipher or separate. Benzos are also linked to depressive moods so if you take them at night you're effectively bringing your mood down and then in the morning taking a medication that's supposed to be bringing it up: a constant rollercoaster. If you take a benzo and an antidepressant what do you think your mood is going to be like come morning? An internal wrestling match, that's what.
The Americans do it very differently to us 😕
 
B

BlueWater

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When my wife had severe insomnia a few months ago (during an acute depressive/anxious state), the meds were not enough. She was put on quetiapine, benzos, z-class meds, etc but they all had limited effectiveness. She then started to really work on her sleep hygiene and that seemed to help a bit. This included really strict sleep schedule (10 to 7), an early AM walk to catch some morning sun, afternoon exercise (always before 4PM), no caffiene after 12PM, minimal sugar and alcohol, evening meditation to prepare for sleep (you can listen to guided meditation like calm.com), and "droney" sleep music when going to sleep (I like SleepTube on youtube: https://www.youtube.com/channel/UCJkWqlhR1-tJpygPdylMl8A). It was a good habit that she still practices now even though she sleeps well now.
Thanks for the meditation and sleep music tips. I've been keeping my sleep routine. I like how you say your wife takes medication to prepare for sleep. That's me to a T. I've been staying home more and not running as many errands when I do go out. That helps, too. Not so great for the depression that comes from looking at the same four walls too often but it does cut down on stress from outside the home.

What does your wife take for her BP 1? My doc said of all the mood stabilizers he would only let me try Lamotrigine for now. I'm still of childbearing years so he won't prescribe Depakote. Lamotrigine has been good for evening my moods and lifting a bit of the depression but if a new stressor comes I go up to a mixed-like state which just adds to my stress and fight for sleep. I hope I haven't asked you this before. I know I've discussed this with two others on this forum. As each med has been added to patch me together the last 14 months, I see something new about myself so I'm trying to learn. OCD is my biggest culprit so avoiding anything that will trigger new compulsions is important for me. I'd like to avoid this spring's mixed-up state again but I also know what to look out for now and to go see my doc ASAP if that happens again when I try an SSRI that I have awaiting me.
 
B

BlueWater

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Things like Benzos etc don't help this though, that's one of the problems with taking so many different meds. Knowing how effective one medication really is when there are so many other 'ingredients' in the cocktail is nigh on impossible to decipher or separate. Benzos are also linked to depressive moods so if you take them at night you're effectively bringing your mood down and then in the morning taking a medication that's supposed to be bringing it up: a constant rollercoaster. If you take a benzo and an antidepressant what do you think your mood is going to be like come morning? An internal wrestling match, that's what.
The Americans do it very differently to us 😕
You're absolutely right about the ups and downs, but I started my benzo in May of last year because of panic, insomnia and weight loss from a traumatic injury and surgery with a year-long recovery. I'd just had a bad run with a normal dosage of Trazodone causing a feminine drying-out problem. Couple that feminine problem with chemical allergies and interstitial cystitis and I was in a painful situation requiring Tramadol and Hydrocodone. My doc wouldn't venture near an SSRI or tricyclic because they all can deplete estrogen which would've caused more side effects than I could bear at that time (my interstitial cystitis and vulvodynia were a 10 on the pain scale and both have to have normal estrogen levels for me to feel well). So my GP pulled me off of everything but Hydroxyzine HCL for bladder pain, then added Klonopin. He tried to make me a blank slate that would sleep and eat so he could look for mental illness diagnoses. I stayed on Klonopin daily for a few weeks so I could eat without stomach pain and not have a panic attack when I saw my bed. I told him I could see how depression would set in then I began rotating Klonopin and Lunesta every few nights for insomnia from OCD and trauma. After a few months, we added Lyrica because of nerve pain due to back surgery. It helped my anxiety and I still was only taking Klonopin about three nights per week. My moods were bad and had been since I was about 22 so six months later he added Lamotrigine. The depression has been there for years, long before Klonopin, but you're right about the daily roller coaster being more common and obvious now which is why he wants me to try Lexapro, come back in two months and see if we can decrease Klonopin or Lyrica or both.

Going all in with an SSRI, SNRI or anti-psychotic would've been more than I could've handled a year ago. I needed to separate the fibromyalgia from the interstitial cystitis from pain of back surgery from the vulvodynia to then see what was wrong with my mind. I'd been hit by a tornado. What else could I have done?
 
K

keith74

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Thanks for the meditation and sleep music tips. I've been keeping my sleep routine. I like how you say your wife takes medication to prepare for sleep. That's me to a T. I've been staying home more and not running as many errands when I do go out. That helps, too. Not so great for the depression that comes from looking at the same four walls too often but it does cut down on stress from outside the home.

What does your wife take for her BP 1? My doc said of all the mood stabilizers he would only let me try Lamotrigine for now. I'm still of childbearing years so he won't prescribe Depakote. Lamotrigine has been good for evening my moods and lifting a bit of the depression but if a new stressor comes I go up to a mixed-like state which just adds to my stress and fight for sleep. I hope I haven't asked you this before. I know I've discussed this with two others on this forum. As each med has been added to patch me together the last 14 months, I see something new about myself so I'm trying to learn. OCD is my biggest culprit so avoiding anything that will trigger new compulsions is important for me. I'd like to avoid this spring's mixed-up state again but I also know what to look out for now and to go see my doc ASAP if that happens again when I try an SSRI that I have awaiting me.

My wife currently takes Epival (a.k.a Depakote) and quetiapine. The Epival is her usual mood stabilizer that guards against mania while the quetiapine was used to treat her depressive episode earlier this year.

Yes you will want to stay away from Depakote if you plan on having children anytime in the near future. My wife and I don't plan on having children so this is not an issue for us. Lamotrigine is a good mood stabilizer also, but mostly guards against depression.

SSRIs are risky since they can trigger mania. You will need to take something with it that will guard against mania (like an antupsychotic)
 
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