Hello,

Thanks for the query.

You have been recently prescribed with cymbalta or Duloxetine 60 mg per day for Fibromyalgia of 30 years. Previously you were on Elevil or Amitriptylline. You were switched to Cymbalts because of weight gain associated with amitryptilline.
Yes, the current difficulty to sleep may be due to cymbalta. My explanation is as follows:

Amitriptylline is a TCA (tricyclic antidepressant) and it causes sedation. As you were on this drug for long time your body becames tolerant to its side effect of sedation. However when you were switched to Duloxetine which don't cause sedation, rebound insomnia usually occurs without amitriptylline.
Besides that, duloxetine is a SNRI drug and is approved for use in Fibromyalgia. It is very effective in fibromyalgia with promising results. It don't cause sedation, instead insomnia is reported in a number of patients taking duloxetine.

Therefore the insomnia (difficulty to sleep) is due to duloxetine and also due to absence of amitriptylline. The problem will improve with time by own. Patients on duloxetine usually face this problem.

For problem of insomnia now you can do-

- Improve sleep hygiene like fix your time to go to bed; never take tea/coffee/aerated drink in evening, even avoid alcohol in evening; don't watch TV while on bed; don't read on bed, use your bedroom only for sleeping. Take warm water bath in evening. You can have a glass of plain milk in evening as it will also help in getting sleep.
- If you are taking duloxetine in evening start taking in morning after discussing with your physician.
- You can visit a Psychiatrist and take opinion regarding insomnia. Medicines as Ramelteon or Melatonin which are non addicting and cause improvement in sleep by improving melatonin (sleep hormone) in brain may be used.
- Other medicines like Zolpidem, zopiclone for few week will also help in getting early sleep.

Hope I cleared your doubt. Let me know if you have other concerns.
If you are satisfied with answer kindly rate. I will be happy to answer your doubt again.

Regards
Dr. Seikhoo Bishnoi MD
(Consultant Psychiatrist)

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Hello,

Thanks for writing back.

Temazepam is a newer benzodiazepine drug that has very low dependence potential. It can be taken for sleep but still risk of dependence is there as when you will stop it in future then chances of rebound insomnia are there.

-Try to control sleep by your own.
-Shift the Cymbalta to morning instead in evening if possible it will definitely improve the condition.
-It will take at least 8-12 weeks to bring sleep at base line level.

Hope, I cleared your doubt.
If you are satisfied then kindly review. Please ask, if you have more doubts.

Dr. Seikhoo Bishnoi MD
(Consultant Psychiatrist)

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