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Suggest Treatment For Severe Insomnia

Posted on Wed, 8 Feb 2017

Question: Hello, I am a 54 year old female who has had severe insomnia for the past 8 weeks. In November 2016, missed my cycle and have not had one return. My family physician has prescribed bioidentical progesterone starting at 60 mg cream and now at 100 mg pill form. I am experiencing hot flashes as well. The insomnia started out where I would sleep three to four hours per night. Now, I am only sleeping 1 to 2 hours and last night, zero. My family physician prescribed Ambien 10mg and I could not take it. Still woke up but felt absolutely horrible the next day. Next, Lunesta 1 mg. I took that for three weeks and could only sleep three to four hours taking two at bedtime another when I woke up around 1 am. This past week, my family physician prescribed Buspar and we stopped the Lunesta. 7 1/2 mg morning and evening. Have had brain zaps (feeling of electric shocks) and jumping (feeling startled) as I try to go to sleep. Help, I certainly need rest and one love a second opinion. Thank you

Forgot to add blood work was good. Hormone levels a little low but nothing too low.

Answered by Dr. Seikhoo Bishnoi (3 hours later)

Brief Answer:
Benzodiazepines can be tried for insomnia

Detailed Answer:
Hi, thanks for asking from HCM for your health related doubts

I can understand your concern. You are not able to sleep properly and since last few days it has become more severe. Ambien is Zolpidem and is given commonly for early insomnia but it didn't work. Lunesta also failed to work. Buspar or Buspirone is even not a sleep medicine. The drug is an anti anxiety drug which helps to relieve anxiety symptoms and indirectly improves the sleep. This is also not resulting in sleep.

In such case in my opinion there is need to add some benzodiazepine drug for short term. Clonazepam or Diazepam can be added to your prescription. The drugs will help in sound sleep and will also help to maintain sleep. These are safe drugs and have no serious side effect except increased risk of dependence if taken regularly for more than 4 weeks without supervision. But in your case the drugs will help in sleep and then these can be tapered.

Olanzapine or Quetiapine can be tried if Benzodiazepines fail to work. The drugs in low doses can be utilised for sleep. You can discuss with your doctor for the drugs Ive mentioned.

Most likely cause of your poor sleep is hormonal changed related to age. This results in anxiety and worsening of insomnia. The drugs will help in sleep and will thus reduce anxiety and symptoms like hot flashes.

Thanks. Take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar