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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Mild Sleep Apnea

I am 31 years old and have extreme difficulty falling asleep. I work rotating swing shifts, so I'm never on a constant schedule. I took ambien for a couple years, but now in no way does it help me fall or stay asleep. I have tried melatonin, tylenol pm, benadryl, restoril, sonota, lunesta, trazadone, klonipin, and the list goes on. None of the previous medications make me the least bit sleepy, it's like I have taken nothing at all. It's hard to get up at 4 in the morning when I can't go to sleep until 12-1 or sometimes no sleep at all. Needless to say, most of the time I'm angry and very easily irritated which makes for bad days at work and home. I have talked with family physician, psychiatrist and had a sleep study (mild sleep apnea, but I can't use the cpap because I can't sleep). I was just wondering if there are any suggestions, or what type medication to maybe request from physician to try?
Fri, 8 Aug 2014
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Psychiatrist 's  Response
Hi, thanks for the query. Your problem is typical of those facing shift work duties & hence first & foremost; you need to get off your shift duty. The problem is your body rhythm (known as circadian rhythm) gets disturbed due to shift work & hence body regulatory axis gets confused as to decide what is the proper time to sleep & get up. This is somewhat similar to jet lag experienced by people. My suggestions are consult your doctor to try either of 2 new molecules Ramelteon, Agomelatin. Both of these act directly on body's circadian rhythm regulating axis & reset it to normalcy. Secondly, there is something called as phase advance therapy of sleep regulation where simply put you stay awake for 1 whole night; do daily routines very next day & get to bed in night (your expected sleeping time); then you try to get up 1 hour earlier than your usual sleeping hours (so on & so forth). There are drugs like modafinil, armodafinil which help to promote wakefulness & ward off lethargy particularly in shift workers having sleep difficulties. Also discuss about them with your doctor. Lastly, depression, anxiety disorders, parasomnia & narcolepsy are causes of sleeping difficulty which frequently get unnoticed. Hence, consult your Psychiatrist to rule out these causes. Hope this helps. Good Luck
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Suggest Treatment For Mild Sleep Apnea

Hi, thanks for the query. Your problem is typical of those facing shift work duties & hence first & foremost; you need to get off your shift duty. The problem is your body rhythm (known as circadian rhythm) gets disturbed due to shift work & hence body regulatory axis gets confused as to decide what is the proper time to sleep & get up. This is somewhat similar to jet lag experienced by people. My suggestions are consult your doctor to try either of 2 new molecules Ramelteon, Agomelatin. Both of these act directly on body s circadian rhythm regulating axis & reset it to normalcy. Secondly, there is something called as phase advance therapy of sleep regulation where simply put you stay awake for 1 whole night; do daily routines very next day & get to bed in night (your expected sleeping time); then you try to get up 1 hour earlier than your usual sleeping hours (so on & so forth). There are drugs like modafinil, armodafinil which help to promote wakefulness & ward off lethargy particularly in shift workers having sleep difficulties. Also discuss about them with your doctor. Lastly, depression, anxiety disorders, parasomnia & narcolepsy are causes of sleeping difficulty which frequently get unnoticed. Hence, consult your Psychiatrist to rule out these causes. Hope this helps. Good Luck