Pain-somnia (mini-post)

It's well past 5am & I have to get up at 7:25am, my pain induced insomnia (aka Pain-somnia) had kept me up all night, despite significant pharmacological treatment.  Unfortunately, with about two hours until I need to get up, there's nothing that I can take right now to help me sleep (even Zanaflex/tizanidine knocks me out  a bit longer than two hours). It is infuriating to feel so tired, but be unable to actually get any sleep.

I hope that you're all doing well, in minimal pain & getting plenty of sleep.

Steve

Insomnia

As I am sure most of you know, pain can interfere with sleep on a monumental scale. I had to get up pretty early this morning (actually, I've had to get up early for the past two weeks) and I have to get up early again tomorrow (or rather today), so I took my lorazepam 2mg (x2), tizanidine 4mg, and Rozerem (because I took the Rozerem, I had to skip the melatonin tonight per my PCP's orders). Unfortunately, the earlier of a morning, the worse my insomnia seems to be. I recently added two more tizanidine 4mg, which seems to be the most effective sleep aid in my extremely well stocked arsenal of insomnia remedies. In addition to the pain related insomnia, I have had insomnia since I was a toddler, AND the location of my tumor causes it to mess with my circadian rhythm.

I know that I'm not the only one who does it, but I frequently want to kick my own @$$ for repeatedly calculating how much time I would get to sleep if I fell asleep right now... or right now... or right, well you get the picture =P. This is one of the most self defeating habits of insomniacs, but, if you're anything like me, you simply can't help it!

Personally, I find this unpredictable sleep one of the most frustrating aspects of life with CP/IP because it makes it extremely difficult to schedule absolutely anything.

I feel like this post needs a conclusion, but I can't for the life of me figure out what that should be, so I'll simply wish you all happy slumber.

-Steve

Update/Insomnia

It's 10am my time and I'm officially giving up on sleep. I miss the days when I could sleep for more than 2-3 hours at a time, not that I've ever been able to sleep when I want. My insomnia started when I was still in a crib, it's my first memory. Of course, my insomnia only got worse as my pain worsened. I developed childhood Fibromyalgia and then brain cancer. The brain cancer caused severe migraine-like headaches and worsening pain... all of which has worsened my insomnia (which worsens pain) to the point where 4mg of lorazepam AND 8mg of Rozerem don't help me get to sleep without the additional help of 2-3 4mg tizanidine/Zanaflex. It shouldn't take six pills to get to sleep! Worse yet, it only gets me  a few hours.

Steve

I'm pissed...

I'm pissed! In an effort to minimize the use of controlled substances, especially in children, doctors like to prescribe powerful more stabilizers (Lamictal, risperidone/Risperdal, Seroquel, etcetera) for pain and sleep. I myself was a victim of this kind of inappropriate prescribing.

Now, I'm bombarded with reports that THESE MEDICATIONS (Risperdal/risperidone, Seroquel, Lyrica/pregabalin, and gabapentin/Neurontin/Gralise/Horizant) ACTUALLY CAUSE PAIN!!!

I've known for years that Risperdal/risperidone is responsible for the painful facial tics, but the idea that these medications are actually causing or exasperating the conditions that they treat. That's like prescribing high dose acetaminophen/paracetamol/Tylenol for the pain of liver failure!

Do I believe that Risperdal is responsible for 100% of my pain? No, but my doctors are constantly telling me that my tumor on it's own should not be causing the severe, crippling pain that I'm experiencing on a daily basis and there isn't a doubt in my mind that this illegally marketed drug is responsible.

Risperdal could have been replaced with the following safer, cheaper alternatives:
1) melatonin (OTC supplement)
2) Z-drugs- zolpidem/Ambien/Intermezzo, Sonata/zaleplon,eszopiclone/Lunesta, zopiclone/Imovane/Zimovane/Imrest (Rx, controlled substances)
3) benzodiazepines, like lorazepam/Ativan (Rx, C4)- ideal for stress induced insomnia where you can't quiet your brain (exactly what I experienced)

Rozerem (Rx, non-controlled substance) was not approved at the time, but is currently very useful.

So why was I given an antipsychotic? Because the manufacturer illegal advertised off-label use and bribed doctors into prescribing it.

That is why the anti-controlled substances environment that we are living in is so dangerous.

Steve

Sleep, or lack thereof

Recently, I have experienced a SEVERE increase in insomnia, despite multiple sleep aids. This inspired me to write a post on insomnia.

First, anyone experiencing insomnia should mention it to their doctor because undertreated pain can cause insomnia and insomnia worsens pain.

Talking to your doctor about your insomnia doesn't mean that you need to take medication, but they need to know. Plus, if you do need medication, they'll know that you've tried other things and that it's not a brief bout of insomnia. The doctor can discuss non-drug treatments with you including better sleep habits and

I don't believe in using dangerous psychiatric drugs, like antidepressants (especially trazadone) or antipsychotics (risperidone/Risperdal, Seroquel) for sleep. It's every patient's personal choice, but I developed permanent tardive dyskinesia from it low dose, short-term risperidone/Risperdal as a child. Seroquel caused night terrors

There are many treatments for insomnia that should be considered.

Melatonin
* Melatonin supplements
* Rozerem

Barbiturates- rarely used anymore

Benzodiazepines
* lorazepam/Ativan
* alprazolam/Xanax
* Valium/diazepam
* and countless others

OTC Medications
* diphenhydramine/Benadryl/Unisom- the generic Benadryl is IDENTICAL to Unisom, don't waste your money
* Tylenol PM- DO NOT TAKE FOR INSOMNIA, take diphenhydramine; this medication is intended for occasional treatment of pain & insomnia, but leads to the overuse of acetaminophen/paracetamol/Tylenol
* Advil PM- DO NOT TAKE FOR INSOMNIA, take diphenhydramine; this medication is intended for occasional treatment of pain & insomnia, but leads to the overuse of ibuprofen

Z-drugs
* Lunesta/eszopiclone - this is an overpriced waste of money and should only be used as a last resort, after cheaper, equally or more effective drugs have been tried; this is the left hands isomer of zopiclone (clinically the same drug)
* Ambien/zolpidem - this is a very useful medication, but some idiots took Ambien CR and drove less than six hours later, which caused the FDA to recommend limiting the dose to 5mg, especially in women; many doctors are unwilling to go to the more effective 10mg dose, even if you don't drive and the 5mg was worthless
* zopiclone/Imovane/Zimovane/Imrest
* zaleplon/Sonata

Steve

Update- October 3

I don't really have much to say, I'm still recovering from spending the day out on both Saturday and Monday. I'm still in pain. I'm trying to get by. I just want you all too know that I haven't forgotten about you.

It's 11:20am and I still haven't slept, which means I've recovered from the post-exertional malaise from the CFIDS, but now the insomnia has returned.

Steve