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How to get rid of Amitriptyline dependency for sleeping. Afraid of developing insomnia if stopped. Suggest?

Jun 2013
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Practicing since : 2005
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Hi Doc.

I need advice on getting rid of Amitriptyline dependency for sleeping. I have halved the dose to 5mg. But I am afraid of developing insomnia again if I completely cut it.

Posted Thu, 11 Jul 2013 in Mental Health
Answered by Dr. Sushil Kumar Sompur 25 hours later
Hi there ~

I understand your concerns. It seems like you are having problem with insomnia and you think that it is being treated with amitriptyline. Although, the medication amitriptyline is drowsiness producing as a side effect, it is not in itself a treatment for insomnia or any other sleep disorder. It is a tricyclic antidepressant. However, it can be used as a sleep aid, although not a sedative hypnotic (sleep agent), to help with sleep induction. It does not maintain sleep. Moreover it is not habit forming, i.e. you will not get dependent on the medication. I believe you have been on this medication for a long time which is making you feel like you are dependent on it while you are not in fact. No matter what your age, insomnia usually is treatable. The key often lies in changes to your routine during the day and when you go to bed. Try these tips:

~ Stick to a sleep schedule. Keep your bedtime and wake time consistent from day to day, including on weekends.
~ Get out of bed when you're not sleeping. Sleep as much as needed to feel rested, and then get out of bed. If you can't sleep, get out of bed after 20 minutes and do something relaxing, such as reading.
~ Avoid trying to sleep. The harder you try, the more awake you'll become. Read or watch television in another room until you become very drowsy, then go to bed to sleep.
~ Use your bed and bedroom only for sleeping or sex. Don't read, watch TV, work or eat in bed.
~ Find ways to relax. A warm bath before bedtime can help prepare you for sleep. ~ Having your partner give you a massage also may help relax you. Create a relaxing bedtime ritual, such as reading, soft music, breathing exercises, yoga or prayer.
~ Avoid or limit naps. Naps can make it harder to fall asleep at night. If you can't get by without one, try to limit a nap to no more than 30 minutes and don't nap after 3 p.m.
~ Make your bedroom comfortable for sleep. Close your bedroom door or create a subtle background noise, such as a running fan, to help drown out other noises.
~ Keep your bedroom temperature comfortable, usually cooler than during the day, and dark. Don't keep a computer or TV in your bedroom.
~ Exercise and stay active. Get at least 20 to 30 minutes of vigorous exercise daily at least five to six hours before bedtime.
~ Avoid or limit caffeine, alcohol and nicotine. Caffeine after lunchtime and using nicotine can keep you from falling asleep at night. Alcohol, while it may initially make you feel sleepy, can cause unrestful sleep and frequent awakenings.
~ Avoid large meals and beverages before bed. A light snack is fine, but eating too much late in the evening can interfere with sleep. Drink less before bedtime so that you won't have to urinate as often.
~ Check your medications. If you take medications regularly, check with your doctor to see if they may be contributing to your insomnia. Also check the labels of over-the-counter products to see if they contain caffeine or other stimulants, such as pseudoephedrine.
~ Don't put up with pain. If a painful condition bothers you, make sure the pain reliever you take is effective enough to control your pain while you're sleeping.
Hide the bedroom clocks. Set your alarm so that you know when to get up, but then hide all clocks in your bedroom, including your wristwatch and cell phone. The less you know what time it is at night, the better you'll sleep.

Getting to know what it is that is making you sleepless is one of the biggest factors that could change the way you sleep. CBT has been helpful for insomnia and if you find a good psychologist who can walk you through the process of finding your niche in sleeping, it would be better than taking medications, as you believe that medications can be habit forming, while most medications are not.

I hope this helps. I wish you the very best in health and sleep hygiene!

Take care and have a lovely day!
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