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Diagnosed with insomnia, have Bipolar, ADHD and anxiety with sleeping disorder. Suggest?

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General & Family Physician
Practicing since : 2009
Answered : 9400 Questions
Yes, I was diagnosed with insomnia over 5 yrs ago. I also have Bipolar II Disorder, ADHD, and panic/ generalized anxiety. I studied psychology and while I was having one of my 18-24 hr sleep episodes I remembered learning about KLS/ Sleeping Beauty Syndrome. I thought at first that my meds may have something to do with my sleeping disorder- whatever it may be, but I've had problems sleeping since I was a little girl... including sleep-walking and talking. The walking stopped at about 14 but I still sometimes wake myself up to myself talking out loud. When I fall asleep for these unexpected, (I don't exactly feel normal tiredness before falling asleep), long bouts of sleep no one can wake me, and I only wake to use the bathroom or eat. I think I have even slept for longer than 24 hrs in a row without waking at all. Please give me your opinion on what may b wrong w me. It's also hard to not get irritated at everyone and everything during these phases and after about 1-2 wks. my sleep may regulate again, at least to proper hrs of sleep, but I still have trouble falling asleep at appropriate times- close to XXXXXXX is a common sleepy time for me when I'm sleeping "normal". Please ask for more info if you need it or just help me understand how I can figure out what is going on because it has effected my life negatively in many ways since I was very young... but I am 30 now and it seems to have gotten worse.
Thank You,
Posted Mon, 23 Sep 2013 in Sleep Disorders
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer:
Possibly due to current conditions+medication

Detailed Answer:
Hello ma'am and welcome.

Thank you for writing in.

I can understand how this can be really frustrating and restricting. I also understand that doctor's would struggle to understand the exact cause for such a peculiar presentation. But based on some studies which I read about recently, the causes for such a presentation are few and mostly quite straight-forward.

Let me first say that you have been on quite a few medications, which can either be the sole cause for your excess sleep or can be an add-on to the existing problem. Let me now list the conditions which were found to cause such a presentation.
-Other psychiatric problems (which is positive in your history)
-Thyroid abnormalities (especially hypothyroidism, which is a less actively functioning thyroid, will require a blood check called thyroid profile)
-Sleep disorders (especially sleep apnea)
-Medication that can induce sleep (many of the medications from your treatment regimen can induce sleep)
-Personality traits (eg. introverts tend to sleep more, in order to escape society)
-Stress (some individuals can sleep for long hours when they are stressed)

Based on your information and medical history, I would say that the excess sleep is a symptom that has occurred due to the current conditions along with the medication you are on. But it would also be wise to rule out other causes from the above list. Treatment is usually cause-related, which is why I would advice finding the exact cause for your presentation.

I hope you found my response helpful. Please feel free to write back to me for any further clarifications. Hope and pray you are soon relieved of your symptoms.

Best of luck and god bless.
Above answer was peer-reviewed by
Follow-up: Diagnosed with insomnia, have Bipolar, ADHD and anxiety with sleeping disorder. Suggest? 33 minutes later
I thought it was the meds as well, but I've gone off of them several times as I guess is suggested to prevent dependency and tolerance. I had no contact w my psychiatrist for about 6 months at one point bc I couldn't pay for the visits/ meds. I actually have these sleep episodes when I haven't take my sedatives, and Pristiq doesn't make me drowsy... Naturally people find me quite hyper and lively when my sleep is regulated. I just know that it's scary to think i took my meds and that's why I slept o long then look in y weekly pill box and see that I haven't taken any. Besides, the sedatives don't really help me sleep, they do help w anxiety, but since I've been treated for it so long I don't really get drowsy, if anything I get kind of hyper or more energetic. Adderall used to make me calm down but also made me apathetic and not myself. I am not a hypochondriac I swear, I just feel like I need a sleep study bc when I gave my mother an article on KLS she actually said she thinks I'm onto something. She's a health freak and would be the first one to blame it on depression, my meds or no getting enough excersize, but she looked at those symptoms and realized that it wasn't bc sometimes I wake up to eat it go to the bathroom and fall back asleep... I don't really take 3 clonazepm at night... That would put me in a lil coma, I just gave you my meds as written bc my dr can't figure out why nothing can put me down either! I swear the strongest sleep inducer that effects my body is diphenhydramine. That knocks me out. Everything else, it just calms me but doesn't quite make me feel tired at all, plus I only take as needed...
What would be the most important questions to answer (you or my dr) and changes in routine to rule out meds and or a neurological disorder? I took 1/4 of an adderall I had left today and I'm awake, calm and clear headed for the first time in 3 days. I slept 3 days straight basically and I forgot to take my meds...??
Answered by Dr. Shoaib Khan 13 minutes later
Brief Answer:
KLS can be considered; but rule out others also

Detailed Answer:
Hello once again XXXXXXX

Kleine-Levin syndrome is extremely rare and I have only read about it in text books. You need to know that because this syndrome is so rare, there exist no definite diagnostic methods or treatment for the same. It would be most unfortunate if you were right, so as a doctor, I really hope you are wrong; but that doesn't mean we can rule this out. It is quite possible and admire your will and need to find the cause for your problems.

Also, you will have to rule out/diagnose the conditions I have mentioned in my previous response, it would only be fair, and it would also help in proving to your doctors that there is nothing else wrong with you, and they might even consider KLS. So medication can be ruled out to a certain extent, not completely, because the medication you are on can stay in your system for hours and even days, during that period it can still cause the required effect.

You can also request your doctor to conduct a polysomnographic study to learn more about your sleep cycle. Usually in patients suspected to have KLS, the slow wave sleep is significantly reduced at first, but returns to normal. This finding along with others should help put KLS on top of the list. Although, no definitive diagnostic tests exist, a CSF analysis and EEG would also help rule out other conditions and put KLS in the spotlight.

I hope I have provided you with information that can really help you. Please write back to me anytime, I am always here to help.

Best wishes XXXXXXX
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