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I hate complaining, but I have been plagued with insomnia now for over three years that is now starting to get me really down. My doctor believes it is caused by two of my HIV medications. Whatever the cause, I find that I rarely sleep more than two to three hours in a row at night, and I start waking up around 3 AM. On a good night I get 5 1/2 hours of broken sleep and on a bad night it is 2 to 3 hours. As a result my mood is getting darker, I am crankier with my partner, and I have trouble getting pleasure out of most activities. The only positive side effect is that my voice gets deeper and huskier when I am tired!

Do any RJ members have any pearls of wisdom that would help me get more sleep? I am not expecting 8-9 hours a night, I would be happy with 7 hours with few interruptions.

Just to let you know, I am taking 30 mgs. of an anti-depressant called Cipralex that my Doctor prescribed to help me sleep better and to cope with depression. At first it worked pretty well, but now it seems to be losing its' effectiveness. My doctor has given me the option of going on a stronger medication but he says it will cause drowsiness!

I am on 9 different drugs for HIV, cholesterol, tryglicerides, herpes, blood pressure and depression so I have been leery about taking on herbal medicines due to a fear of interactions. But I am getting to the point where I am open to anything.

Thanks
Jonathan

The chief neural chemical in the brain for sleeping is gamma-aminobutyric acid (GABA) which you may have seen me mention on the threads before. You can google gaba and sleep and read to your heart's content all the citations you will get.

You can try that. You can get it at any vitamin, health food, or organic food store.

This may seem odd to you now, but the natural state for the brain is asleep. The brain actually has to produce chemicals to override its GABA in order to wake up.

I don't know anything about the meds but since I started Yoga I've been sleeping WAY better!!!

I was going to say yoga too. Since I took up yoga in 1996, I sleep with ease and a lot. I was never a light or troubled sleeper, but since bringing yoga into my life I've only had trouble sleeping if there's some specific cause, such as a cold/flu type scenario.

My first yoga teacher taught us this GREAT 'white wall, black wall' yoga relaxation technique. It never fails me. Many of the older ladies in that class would fall asleep. Charlotte - the yogi - would have to wake them up.

Calson is right on with GABA. The one shown is even the one I take. When I take it it makes me drowsy within 30 minutes, and then I sleep really well. You can also take it with melatonin. My roommate who is an alcoholic cannot sleep when he stops drinking. He would take over the counter sleep-aids which only marginally help. When he took the GABA and melatonin combo he was amazed at how well he would sleep! Anyway, that is my testimonial

I know you said you were feeling leery about taking on herbal medication, but I fount that melatonin(sp?) really helped me. Now, it didn't help me fall asleep any faster, but it did help me stay asleep. I've also taken prescription medication. If you don't want to go with the pills, try some warm milk before bed.. after a hot shower. If that fails.. just pop 2 or 3 benedryl, it will knock you out,lol.

Have you tried meditation? I've been doing just ten minutes of meditation/breathing exercises on most days and it is very calming and good at stopping a racing mind (assuming that's part of your experience).

I found good meditation techniques after a quick search via Google.

Thanks guys for the suggestions, keep the coming please.

The only reason I mentioned I was concerned about herbal medicines was the potential for bad interactions with my HIV meds. I know that I can't take St. John's Worts for example. But I will take the ones mentioned and do more research before asking my Doctors in August.

I am starting to get worn out, one doesn't realize how important sleep is until one has a sleep shortfall of 15-20 hours per week, every week of the year. I just hope I don't "zone out" while driving at 80 mph!

I'm not a doctor by any means and not on any other medication than my prescribed sleep meds, so I have no idea.

I was diagnosed with chronic persistent insomnia, so I can feel for you - it's hell not getting any sleep.

Maybe a dump question, but have you asked your doctor if a prescription sleep aid would negatively interact with your current meds?

Ah man, insomnia sucks; sorry you've had to endure it for 3+ years. Just some thoughts (from a psych student ) :

It looks like a side effect of Cipralex is insomnia.

I wonder if your doctor might consult w/ a psychiatrist just to balance out and inform the options?

I'd be curious if anything corresponded to the increase in insomnia that started 3 years ago..? Did you start new meds then? Other transitions in life that might have some relation or resulted in increased anxiety or depression?

Do you wake up thinking/worried about things (anxiety)? If so, there are other SSRIs that could work for you very idiosyncratically. The med field still doesn't quite know how SSRIs work and why some work better for one individual over another w/ the same symptoms. Some SSRIs work well for both depression and anxiety, moreso than others.

Sedatives (alcohol, anti-anxiety meds) create short sleep cycles. Even though booze can make us sleepy, it prevents deep sleep and results in short periods of sleep.

My ex had a Rx for Trazadone, another anti-depressant, that he took at night to help him sleep, while taking Welbutrin during the day.

Although it might all be med-related, a lot of people benefit from talking to a counselor, too.

Thanks, I did not realize that Cipralex could worsen the insomnia. Sustiva (one of the HIV meds.) causes insomnia and/or depression. My doctor put me on the cipralex because I was depressed (not suicidal just depressed). I had lost my father, a friend and I was only sleeping 0-4 hours a night. Cipralex improved my mood and allowed me to fall asleep. But now I am having more trouble falling asleep (used to be 5 minutes now 20 minutes) and I start waking up as early as 1:30 AM.. I did add another HIV drug recently as part of a study. Of course one of the side effects is insomnia!

I try to limit any alcohol to 1 drink every second or third night. I also stop drinking caffeine by 12 noon. I work out in the morning not at night. I don't think I am anxious about anything, if I am it is buried deep. When I am desperate I take a gravol to knock me out. But the next day I feel groggy which I hate.

If things don't improve with less intrusive methods such as thoughs mentioned above, I may ask my doctor to prescribe a more powerful tranquilizer and try and cope with the drowsiness. I just can't see me coping effectively with life forever with this kind of problem (I am assuming the HIV meds are forever).

I may seek out counselling if I start getting really depressed, but hopefully it won't come to that. I just don't want to put a strain on my relationsip with my partner.

I am also an insominiac and eventually went to a Sleep study. I found out that during the night I would stop breathing and that is what was waking me up.

I now have a CPAP machine (Constant Positive Airway Pressure) that assists in getting that deep sleep I need. I don't use it everynight, but when I start feeling tired, irritable and dark I use it.

Meditation also is very helpful for me to get back to sleep.

Thanks for the suggestions about GABA. I will try that.

ChrisRo saidI am also an insominiac and eventually went to a Sleep study. I found out that during the night I would stop breathing and that is what was waking me up.

I now have a CPAP machine (Constant Positive Airway Pressure) that assists in getting that deep sleep I need. I don't use it everynight, but when I start feeling tired, irritable and dark I use it.

Meditation also is very helpful for me to get back to sleep.

Thanks for the suggestions about GABA. I will try that.

If you have a known problem for your sleeping problem, I am not sure I would recommend taking GABA. Your body is waking you up for a reason. You arent breathing. Knocking your brain out so it doesnt respond to the problem doesnt sound like a good idea. You could end up like Heath Ledger. Ask your doctor about it first.

I'm awake at 4AM at the moment. LOL. But I get enough sleep so I'm not worried.

Anyway, hope you get better sleep soon, JBE60.

Agree with Caslon, your body talks to you. Sleep studies can answer a lot of questions. If you're getting to sleep, but waking up throughout the night, your body isn't allowing yourself to get into RIM. (Sleep Apnea could be the cause.) I didn't have this problem, as I could never "get to" sleep. However, once I did, I was fine - it took two weeks in a sleep center to figure this out - but it worked.

I'm not an expert with HIV medication so I hesitate with saying, take this or try this. I would definitely check out a sleep center. And sometimes they even have equipment/tests you can take in your own home.

jaydub saidyour body isn't allowing yourself to get into RIM.

I think you meant REM (Rapid Eye Movement),
RIM is something completly different, but as long as they've made an effort to clean up before hand (I think zim recommend toothpaste) it's not too bad.

A couple of thoughts:
1) You could ask your doctor about a medication such as Ambien CR or Lunesta to take 2-3 times per week so that you will get some sleep although they are not recommended to take every night.
2) Rozerem which is a relatively newer drug that has shown some promise of alleviating insomnia although make sure your doc cross references it with your antiretrovirals as it does have some interactions
3) Sleep Apnea is a good thought to discuss with your doctor as well
4) It could be that your antidepressant is not working as insomnia is a huge symptom of depression and you may need to try another drug

Thanks northcarolina, it has crossed my mind that the depression is the underlying cause still. Depression runs in my family big time but I know the meds I am taking can have that side effect (especially Sustiva). I may check out the sleep clinic just in case I have sleep apnea. Although I don't snore anymore which is often a sign of it.

I just woke up from a nap on the couch so I feel a bit better. Boy was I sleepy.

ChrisRo saidI am also an insominiac and eventually went to a Sleep study. I found out that during the night I would stop breathing and that is what was waking me up.

I now have a CPAP machine (Constant Positive Airway Pressure) that assists in getting that deep sleep I need. I don't use it everynight, but when I start feeling tired, irritable and dark I use it.

Meditation also is very helpful for me to get back to sleep.

Thanks for the suggestions about GABA. I will try that.

Are you sure you do not have sleep apnea?

Establish a routine. Don't use your bed for anything other than sleep...or, well, one other things that should be done in a bed...but the point is don't read in bed, don't watch TV in bed, etc. Actually, if possible, do those things in another room entirely.

Listen to your body. If after half an hour to 45 minutes of lying there you're unable to fall asleep, get up and do something else for a while before trying again. You want to break the habit of lying in bed trying to fall asleep.

In the half hour before you go to bed, don't subject yourself to bright lights. That means no television, no computer screen, and when possible, task lights on dimmer switches. If you're not able to avoid bright lights due to others being around, put on a pair of sunglasses.

If you're a napper, you may need to break yourself of that. Insomniacs who take frequent naps have a harder time getting uninterrupted night time sleep than do those who avoid naps.

Finally, accept that 8 hours of sleep is not a universal requirement. I wake up after 6.5 hours without an alarm clock, even when I have no intention of being up early. I have a friend who basically can't function with less than 10 hours of sleep. There's a fairly broad range out there, and you may fall on the low end of the sleep spectrum.

one thing to try is making ur bedroom a place to only sleep. if u have a tv in there, remove it, if you work in there stop working in ur bedroom. if u read in the bedroom, stop reading there. besides sex, the only thing u should use that room for is to sleep. by making it a place to just rest, you might find that when u hit the pillow it will be easier to fall asleep and stay asleep.

exercise-unto-physical-exhaustion, or a glass of wine or some warm milk and honey always help me... that sux that u have been wrestling with insomnia though- i feel like living death if i have merely one night of fitful sleep- my heart goes out to you... good luck..

exercise-unto-physical-exhaustion, or a glass of wine or some warm milk and honey always help me... that sux that u have been wrestling with insomnia though- i feel like living death if i have merely one night of fitful sleep- my heart goes out to you... good luck..

Thanks guys once again for all the helpful advice. I forgot about not using the bed for reading or watching TV right before sleeping. I don't watch TV, but I do read right before I sleep. Maybe I will try and read in the living room until I am ready to sleep. I also will try warm milk, and maybe cutting my coffee down from 2 to 1 per day.

I have always been a fussy sleeper (at 6 months of age I spent the first night in our new house screaming because of the noise of the trains 1/2 a mile away). I must wear ear plugs, can't fall asleep if I am being held by my partner,I can't sleep while travelling, etc..

As long as I get 6 hours I am fine, but once it gets into 3-4 hours I am not functioning the way I should. I just want to avoid more drugs in my life, I hate the feeling of drowsiness I get the next day from tranquilizers or gravol.

Thanks for all you advice and support.

Warm milk (OK, hot chocolate) worked for me when I had sleep issues from medication I was taking.

Eventually, they added Ambien, after which I woke up refreshed, but I would be afraid of getting hooked on it.

Good luck, Surreal life!

I know how insomnia can make you feel lousy - both physically and psychologically. Also, I can not imagine that the lack of sleep is doing your immune system any good.

Because you are on so many other meds and you are managing HIV as well, I would recommend that you find a psycho-pharmacologist (a psychiatrist specializing in drug therapies) who can work with you in conjunction with your current doctor(s). You may also want to talk to your doctor about getting a sleep study at a teaching hospital to see if there are any underlying neurological, cardiac or respiratory issues affecting your sleep. Chances are very high that you will find relief.

Other people have mentioned these meds, but Trazadone is an older anti-depressant that is now used for sleep. Ambien CR is a new one that seems to help people stay asleep. For long term therapy some docs like a sedating atypical antipsychotic called Seroquel.

Best of luck.

Thanks guys. I have not noticed one trend that may explain things. When I am at home I do not sleep well. When I am away on vacation (e.g. at our summer cottage in New Brunswick or in Italy) I sleep like a log. I think it could be sub-consciously that work is affecting me. Perhaps it is causing my brain to be over stimulated and I have trouble turning it off at night. The next time I visit my doctor I might ask him for some ideas.

Your observation about different sleep patterns when your away from your main home (and your work) may hold important information and it certainly indicates that your insomnia is not entirely (or probably even mostly) organic in nature. This may seem obvious, but see if you can tease out what you do differently at home versus away. A few things to consider:

1) do you tend to work in your bedroom at home or work near bedtime?

2) do you watch or listen to news, read email, etc near bedtime at home but not when away?

3) is your diet different? your alcohol consumption?

4) do you have sex more or less often at home versus away?

5) are noise levels different in your bedroom at home versus away?

6) is your bedroom away cooler than at home?

7) is your pre-bedtime routine different in the two settings?

do you exercise more or less, in different ways or in different ways in the two places?

9) do you share your bed (or bedroom) with the same people or pets in the two places?

Best of luck.

I have a CD of a Thundering Rainstorm I play every night. Gets me to sleep within 10 minutes and I keep it on repeat. Just a thought, as it works for me. Good luck!

SurrealLife saidThanks northcarolina, it has crossed my mind that the depression is the underlying cause still. Depression runs in my family big time but I know the meds I am taking can have that side effect (especially Sustiva). I may check out the sleep clinic just in case I have sleep apnea. Although I don't snore anymore which is often a sign of it.

I just woke up from a nap on the couch so I feel a bit better. Boy was I sleepy.

Sorry to hear about all the trouble you are having trying to get a good night of sleep! I think one of the difficult things with treating insomnia is that the treatment philosophy between many providers can be drastically different. From my interactions with psychiatrists I have found that many believe that you need to get a patient sleeping before the treatment of depression can begin. There are many options available that have different advantages depending on your specific symptoms:

1. Ambien (generic zolpidem) -- great choice if falling alseep is your only complaint.

2. Ambien CR / Lunesta -- for patients who have difficulty falling asleep and maintaining sleep throughout the night.
Lunesta has poor taste as a significant side effect which commonly seen by well over 30% of patients.
Ambien CR at this point in time has the best safety and efficacy data extending out 6 months.

3. Rozerem -- may offer some help to select patients who have trouble falling asleep.
If this is your problem zolpidem would be the better (and cheaper) choice of the two. Also since Rozerem is pretty much synthetic melatonin it can create some havoc with a person's hormone balance. Any drug that could potentially cause men to start lactating isn't something I would want to be taking!

4. Trazadone -- is often prescribed off-label to help patients sleep due to it's sedative-like side effects.
Keep in mind this drug is an antidepressant that is not indicated for insomnia and has never been clinically studied for such use and/or approved by the FDA to be used as treatment for insomnia.
Another disadvantage is that it takes a few hours for the drug to work and therefore it becomes necessary for patients to take it everynight. On the contrary, patients can attempt to fall asleep on their own first and after a set time (usually 30 min) if not asleep they can use a fast acting agent like Ambien(CR) or lunesta and be asleep within 15 minutes. The benefit here is that patients can try to fall asleep on their own first.

I know Ambien has been in the media a ton, but when taken correctly the risk of side effects (sleep eating, driving, etc) occur very infrequently. That being said I do not want to take anything away from those who have experienced it because unfortunately it can happen and is a potential risk of therapy.

Wow, sorry that got a little long! I think sleep/insomnia is very interesting and seems to be increasing at an alarming rate, which in my own opinion is not helped by the fast paced world we live in and many people's poor lifestyle choices!

Sleeping trouble is awful - it can really take a toll on your mood and health. I used to have a bad problem with insomnia. I tried changing my schedule around, creating new routines, prescriptions and over the counter medications, meditation, more yoga - everything I could think of, and none of it seemed to have any lasting effect. The best thing I found was swimming. I would hit the pool first thing in the morning, right out of bed, at the same time every morning, and get in 1-1.5km. There were two benefits I found from this. Firstly, there's nothing like jumping into a cold pool to wake you up in the morning! I found that I was less tired for the rest of the day, even if I hadn't slept well. I also found myself getting naturally tired earlier and earlier the more I stuck with it. My big problem with sleeping was that most days I wouldn't be able to sleep before four or five AM! I also found that it was easier for me to fall asleep at night and I woke up less during the night. Give it a try!