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Suffering from episodes of insomnia. Taking cipralex10mg and xanax 1mg. Are these medicine safe in combination?

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I am 57 years old, female and have suffered from episodes of insomnia since my late teens. However, episodes used to be quite infrequent, and I would be prescribed a couple of sleeping pills to break the cycle. I would then be OK for several months. About 6 years ago, I moved to Dubai, and upon consulting a GP during a particularly bad spell of insomnia, I was put on Cipralex, 10mg. This was fine and did the trick, but earlier this year I decided to wean myself off it, as I was afraid of what it might do to my brain chemistry long term. I was OK for a few months, then was faced with a highly stressful hostile takeover at work, and back came the insomnia. The GP I saw would not put me back on Cipralex, but referred me to a psychiatrist who prescribed Cipralex 20 mg ( I only wanted 10) AND gave me 30 tabs of Xanax 1 mg. I tried to question this, as it seemed like overkill, but he wasn't going to take any questioning of his judgment from me. I have been taking Cipralex for 5 days now, and have yet to feel any difference, tho I realize it takes several weeks before it becomes effective. Meanwhile, I have to take Xanax to sleep. I have tried to sleep without it, but am literally awake, feeling 'wired ' all night. I don't much like what I have read about Xanax, as it appears to me highly addictive, and I would like to know whether these two drugs are really safe when in combination.
I am otherwise fit and healthy, slim and not on any other medication, but do have an insomniac mother and a brother who also does not sleep well.
Please advise. (I fear the doctor, an elderly Indian, trained in India, may not be at the cutting edge of psychiatric medicine. (I have no previous psychiatric history.)

XXXXXX, Sleepless not in Seattle, but in Dubai...

Posted Thu, 11 Oct 2012 in Mental Health
Answered by Dr. Ashish Mittal 2 hours later
Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     57 year old female
•     Known case of Insomnia
•     Worry related to current medical treatment.

You case is interesting and but difficult too. Even your attending physician is facing to solve it. I will try to give my best effort to help you in this problem.

Insomnia is caused by several reasons like poor sleep hygiene, chronic pain, stress, anxiety and depression etc.

In your case it may be anxiety or depression as physician and your psychiatrist had prescribed you cipralex which is effective in both condition and you also responded to treatment.

Good thing about cipralex: It is non addictive, safe and it can be used for years (even lifelong) without much difficulty under supervision of doctor. But it take 3-4 weeks to show its effects. Its effective dose is 10 to 20 mg per day.

Xanax is used for anxiety and insomnia. But it show effect immediately. Because of addiction potential it used only 1-2 month and then slowly tapered. Same time (3-4 weeks) other safe medicine like cipralex start showing its effect.

So, do not worry. Your treatment appear to fine to me. Also follow sleep hygiene.

For sleep difficulty follows below principles of sleep hygiene which will help you in long term:
•     Fix a bedtime and an awakening time. Do not be one of those people who allows bedtime and awakening time to drift. The body "gets used" to falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleeping habits.
•     Avoid napping during the day
•     Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate, so be careful.
•     Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime
•     Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep.
•     Use comfortable bedding.
•     Find a comfortable temperature setting for sleeping and keep the room well ventilated.
•     Block out all distracting noise, and eliminate as much light as possible.
•     Reserve the bed for sleep. Don't use the bed as an office, workroom or recreation room. Let your body "know" that the bed is associated with sleeping.
•     Practice relaxation techniques before bed. Relaxation techniques such as yoga, XXXXXXX breathing and others may help relieve anxiety and reduce muscle tension.
•     Don't take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a "worry period" during the evening or late afternoon to deal with these issues.
•     Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.
•     Getting Up in the Middle of the Night :Most people wake up one or two times a night for various reasons. If you find that you get up in the middle of night and cannot get back to sleep within 15-20 minutes, then do not remain in the bed "trying hard" to sleep. Get out of bed. Leave the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You will generally find that you can get back to sleep 20 minutes or so later. Do not perform challenging or engaging activity such as office work, housework, etc. Do not watch television.
•     A Word About Television: Many people fall asleep with the television on in their room. Watching television before bedtime is often a bad idea. Television is a very engaging medium that tends to keep people up. We generally recommend that the television not be in the bedroom. At the appropriate bedtime, the TV should be turned off and the patient should go to bed. Some people find that the radio helps them go to sleep. Since radio is a less engaging medium than TV, this is probably a good idea.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
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