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Suggest Treatment For Sleep Disturbance
Question: I have beeen hypertensive for last 8 years and diabetic about a year before . I get my all check ups done regular;y and all test are ok .
For last about a year I have been suffering from lack of sleep / mild anxiety . I have lot of travelling ( some times in different time zones ) . To take care of sleep I used to take of alcohal ( 2 to 3 large pegs ) .Gradually it was not enough then I started Alprex 0.25 ( some times 0.5 mg also ) . I took it almost for six months . Last six months I agian had lack of sleep and as a result some enxiety . I do not get deep sleep .Morning the moment I have to go in deep in sleep i get up at around 5 AM and find my heat beat is high .I consulted doctor ( MD) he advised to take Nexito plus . After two weeks I realzed its not suiting me and I stopped it . Of my own I started using Nitrest 5 mg + Clonazapam 0.5 mg .With this I was rlaxed for some time but did not solve my problem . My alchoal of 2 to 3 pega also continued . I realized that when ever I had 3 pegs my sleep is distubed .So about a month before I consulted doctor and he advised to start Etilaam 0.5 mg . It gave me little bit of sleep . I also stopped Alcohal and felt sleep is bit better but again anxiety . So I have been on this for about 25 days .I again consulted doctor and he advised me to stop etilaam and start " Lorazepam 1 mg ". I have not yet started it . Please advise right medication for me .Would apprciate to suggest me few options to try .
( About 7 years before I had extream of anxiety and I remeber doctor treated me with Nitrest + Zapeez + XXXXXXX .This treatment was continued for about 6 months )
Suggest me few alternates so that I can try what suits .
For last about a year I have been suffering from lack of sleep / mild anxiety . I have lot of travelling ( some times in different time zones ) . To take care of sleep I used to take of alcohal ( 2 to 3 large pegs ) .Gradually it was not enough then I started Alprex 0.25 ( some times 0.5 mg also ) . I took it almost for six months . Last six months I agian had lack of sleep and as a result some enxiety . I do not get deep sleep .Morning the moment I have to go in deep in sleep i get up at around 5 AM and find my heat beat is high .I consulted doctor ( MD) he advised to take Nexito plus . After two weeks I realzed its not suiting me and I stopped it . Of my own I started using Nitrest 5 mg + Clonazapam 0.5 mg .With this I was rlaxed for some time but did not solve my problem . My alchoal of 2 to 3 pega also continued . I realized that when ever I had 3 pegs my sleep is distubed .So about a month before I consulted doctor and he advised to start Etilaam 0.5 mg . It gave me little bit of sleep . I also stopped Alcohal and felt sleep is bit better but again anxiety . So I have been on this for about 25 days .I again consulted doctor and he advised me to stop etilaam and start " Lorazepam 1 mg ". I have not yet started it . Please advise right medication for me .Would apprciate to suggest me few options to try .
( About 7 years before I had extream of anxiety and I remeber doctor treated me with Nitrest + Zapeez + XXXXXXX .This treatment was continued for about 6 months )
Suggest me few alternates so that I can try what suits .
Brief Answer:
There is need of enough dose of the drug, do not self-medicate please
Detailed Answer:
Hello Mr. XXXXXXX
Thanks for writing to us.
I have read your query and understood what problems you are facing.
Your main current problem is sleep disturbance.
You have tried alprazolam, Nexito plus(Escitalopram + clonazepam), Nitrazepam, clonazepam, etizolam and alcohol.
From your history I feel that you have not been given enough doses of the medicines. You might have self-medicated and that is also not good thing.
Clonazepam should be given up to 2 mg or nitrazepam up to 20 mg for sleep disturbance.
Another part is your use of alcohol. Initially alcohol may help in sleep but later on person gets tolerance and does not get same effects as with routine quantity and needs to take more. Same has happened in your case. And stopping alcohol after regular intake itself can cause sleep disturbance as withdrawal symptoms. However it is good decision that you have stopped alcohol.
Etizolam is not effective in sleep disturbance it is less sedative and more anti-anxiety benzodiazepine.If you have day time anxiety I would like to use etizolam in daytime for the same.
Please remember that alprazolam, clonazepam, nitrazepam and lorazepam are benzodiazepine drugs. They cause dependence and must be used with medical supervision and as per doctor’s advice.
If I were your treating doctor I would like to use clonazepam 2 mg or lorazepam 2 mg for your sleep problem.We can reduce/increase the dose according to response. As well as also want to counsel for avoiding alcohol until you come out of sleep disturbance completely and you can sleep without any medicines.
Also follow some steps called, ‘Sleep Hygiene’ to get good sleep without help of medicines or to reduce need of medicines. You can find the same in this link: http://sleepfoundation.org/ask-the-expert/sleep-hygiene
In conclusion,
- Consult a psychiatrist – Psychiatrist is the doctor who treats insomnia as well
as help in deaddiction.
- Take prescription of clonazepam or lorazepam of appropriate dose after
discussing with psychiatrist. You can change dose according to response of the
drug.
- Say no to alcohol
- Please do not do self-medication without doctor’s advice
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
There is need of enough dose of the drug, do not self-medicate please
Detailed Answer:
Hello Mr. XXXXXXX
Thanks for writing to us.
I have read your query and understood what problems you are facing.
Your main current problem is sleep disturbance.
You have tried alprazolam, Nexito plus(Escitalopram + clonazepam), Nitrazepam, clonazepam, etizolam and alcohol.
From your history I feel that you have not been given enough doses of the medicines. You might have self-medicated and that is also not good thing.
Clonazepam should be given up to 2 mg or nitrazepam up to 20 mg for sleep disturbance.
Another part is your use of alcohol. Initially alcohol may help in sleep but later on person gets tolerance and does not get same effects as with routine quantity and needs to take more. Same has happened in your case. And stopping alcohol after regular intake itself can cause sleep disturbance as withdrawal symptoms. However it is good decision that you have stopped alcohol.
Etizolam is not effective in sleep disturbance it is less sedative and more anti-anxiety benzodiazepine.If you have day time anxiety I would like to use etizolam in daytime for the same.
Please remember that alprazolam, clonazepam, nitrazepam and lorazepam are benzodiazepine drugs. They cause dependence and must be used with medical supervision and as per doctor’s advice.
If I were your treating doctor I would like to use clonazepam 2 mg or lorazepam 2 mg for your sleep problem.We can reduce/increase the dose according to response. As well as also want to counsel for avoiding alcohol until you come out of sleep disturbance completely and you can sleep without any medicines.
Also follow some steps called, ‘Sleep Hygiene’ to get good sleep without help of medicines or to reduce need of medicines. You can find the same in this link: http://sleepfoundation.org/ask-the-expert/sleep-hygiene
In conclusion,
- Consult a psychiatrist – Psychiatrist is the doctor who treats insomnia as well
as help in deaddiction.
- Take prescription of clonazepam or lorazepam of appropriate dose after
discussing with psychiatrist. You can change dose according to response of the
drug.
- Say no to alcohol
- Please do not do self-medication without doctor’s advice
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr XXXXXXX , thanks fir reply and guidance .
I missed to mention that apart from sleep disturbance I also have anxiety .During night I find my heart is running fast and I get up .specially after taking etilaam 0,5 mg I have reasonable sleep but morning around 5 when I m just start going to deep sleep I get up . Day time I will have headache , not able to concentrate on work .can not sit for long time so take a small walk .
Since I saw your response late so last two nights I increased dose of Etilaam from 0.5 to 1 mg with this I had excellent sleep now I need your guidance to choose option
1. Can I try and continue 1 mg Etilaam for few more days and see response .?
I want to give try as last 25 days I have been on this ie 0.5 mg
2. Do not try above and just switch to clonazapam 2 mg
3.whatever medicine I try it gives head ache . Which medicine to take care of it
4 . I m traveling to US again so different time zone so should I add on some new medicine or increase the dose please advise when I m there to regularized sleep .
With best regards
I missed to mention that apart from sleep disturbance I also have anxiety .During night I find my heart is running fast and I get up .specially after taking etilaam 0,5 mg I have reasonable sleep but morning around 5 when I m just start going to deep sleep I get up . Day time I will have headache , not able to concentrate on work .can not sit for long time so take a small walk .
Since I saw your response late so last two nights I increased dose of Etilaam from 0.5 to 1 mg with this I had excellent sleep now I need your guidance to choose option
1. Can I try and continue 1 mg Etilaam for few more days and see response .?
I want to give try as last 25 days I have been on this ie 0.5 mg
2. Do not try above and just switch to clonazapam 2 mg
3.whatever medicine I try it gives head ache . Which medicine to take care of it
4 . I m traveling to US again so different time zone so should I add on some new medicine or increase the dose please advise when I m there to regularized sleep .
With best regards
Brief Answer:
Yes you can continue etizolam,add amitryptiline for headache or propranolol
Detailed Answer:
Hi,
Thanks for follow up.
Ans 1: Yes you can continue etilaam 1 mg for few more days. After 1 month you can reduce back to 0.5 mg. Just inform your doctor also about the same.
Ans 2: Wait if etizolam is working.No need to stat of clonazepam.
Ans 3: For headache tow options are there according to me. Amitryptiline at night which will help in headache as well as in sleep. It will decrease the need of medicines for sleep. Other option is propranolol in morning. It is without sedation and it will help in reduction of anxiety also.You can ask your doctor about choice.
Ans 4: No need to add or change the medicines if you find stability here with the same. You just need to change the schedule according to timezone.
Hope this answer is helpful. Feel free to ask if you have any query.
Take care.
Yes you can continue etizolam,add amitryptiline for headache or propranolol
Detailed Answer:
Hi,
Thanks for follow up.
Ans 1: Yes you can continue etilaam 1 mg for few more days. After 1 month you can reduce back to 0.5 mg. Just inform your doctor also about the same.
Ans 2: Wait if etizolam is working.No need to stat of clonazepam.
Ans 3: For headache tow options are there according to me. Amitryptiline at night which will help in headache as well as in sleep. It will decrease the need of medicines for sleep. Other option is propranolol in morning. It is without sedation and it will help in reduction of anxiety also.You can ask your doctor about choice.
Ans 4: No need to add or change the medicines if you find stability here with the same. You just need to change the schedule according to timezone.
Hope this answer is helpful. Feel free to ask if you have any query.
Take care.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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