Question: yes...I have been suffering insomnia for about 18 months, over the last 6 months it's gotten terifying. I'd go 3 nights and 3 days without an iota of sleep (microsleep I'm not qualified to comment on and wouldn't know if I got any). It stretched to 4 nights and days, then five and recently I went 11 days and 10 nights, during that time I couldn't figure out how to drive home. I was terrified. I finally slept 6 hours one night, 15 hours the next and then 9 hours and then 3 days and nights without sleep. Right now I'm on my sixth day and tonight, God Forbid, would be six nights. I'm starting to feel mean, angry, crazy and have had blackouts. When I come to I see all the dumb stuff I did while my brain was not recording memories. I'm familiar with FFI, the prion disease, but that is so rare that I'm not worried though I have experienced severe weight loss. Today I have thought people were after me and I'm very confused at times. Any help?

Dear Doc: Just wanted to let you know that I have never been diagnosed as manic/depressive, now referred to as bi-polar. And I was once tried on resperidone with very negative results (agitation and inability to set still and relax at all). I was tried one other time on a neuroleptic/antipsychotic medication whose name I can not recall (when you went to rehab - in the old days - many facilities were dual diagnoses facilities so they like prescribing neuoleptics)...that particular medication made me have stiff muscle sensations in my face and neck if I recall very similar to my reaction to resperidone. I have never suffered any form of psychosis in my life. No auditory or visually manifested hallucinations. I also mentioned "thoughts of people being after me" which has only occurred after an extended period with literally no sleep at all (4 or 5 plus days). After being awake that long and longer, today is day seven, I start seeing shadows from my peripheral vision, sometimes when the phone rings I panic and I often go into a sort of blackout where to my friends I appear to be functioning normally, yet I will have no recall what I did for a period of time sometimes lasting several. I have never had a manic episode in my life, nor has it ever been suggested that I may have bi-polar disorder. My mental health problems have centered around extended periods of chronic depression. But this being awake for days on end is mentally exhausting, zaps my motivation, and when gone on long enough leads to mental confusion (days of the week become confused, tracking time, reading - and I normally read 4 to 6 books a week...recently I was reading an excellent book by XXXXXXX professor XXXXXXX Gelernter, THE TIDES OF MIND: Uncovering the Spectrum of Consciousness, but after 2 hours of reading I don't know if I read anything, just spaced out or the result was a combination of the two. It's really, at this point driving me all but crazy and the frustration level is off the charts. One other note since this insomnia first started about 18-20 months ago I've gone from a weight of 170 pounds (too heavy as I'm only 5'5") to now weighing 114 pounds and I lost the weight through no deliberate effort. I'm a 59 year old man (Widower, my wife died in 1996) with my only psychiatric issue that I have ever dealt with being depression. I have a fairly keen intellect (my FSIQ was tested at 142 using the Wechsler Adult Intelligence Scale - Revised along with accompanying appropriate tests. Testing was done about 15 years ago), and currently am not suffering any depressive symptoms. Please, any other thoughts or areas you could guide me to would be appreciated. Regards, XXXXX

Dear Dr. Sheppe: I have some serious concerns with regards to your advice of trying a neuroleptic/antipsychotic medication like the above mentioned olanzapine. Concluding (your words): "...an atypical neuroleptic such as olanzapine would be very helpful in getting you to sleep...I have no doubt it would help you." I have researched olanzapine extensively and do not see your opinion shared as to the likelihood of it's assisting my efforts to get some sleep in light of the variety of anti-depressants - currently used much more frequently than neuroleptics - due to there sedative qualities (Doxepin 25mg, Quetiapine 200mg, Mirtrazapine 30mg as well as 200mg of Quetiapine and 30mg Mirtrazapine. I got pemission from my Dr. to try this of course. I even, on a single occasion, after 5 days and 4 night without an iota of sleep tried the Quetiapine with the Mirtrazapine and 20 mg of diazepam the results being a negative for sleep.). I have read and digested numerous general 'search engine result' articles as well as a number of articles appearing in a variety of peer revue medical journals and found very little support for your conclusion that olanzapine..."would be very helpful in getting you to sleep... I have no doubt it would help you." I also researched risperidone and found this medication to at least mention the possibilty of drowsiness: "Alpha α1 adrenergic receptors: This action accounts for its orthostatic hypotensive effects and perhaps some of the sedating effects of risperidone." But I also read repeatedy: " It has actions at several 5-HT (serotonin) receptor subtypes. These are 5-HT2C, linked to weight gain." As I have mentioned previously risperidone is not 'on the table' due to bad side effects that I had hours after taking it one time previously. Another negative side aspect regarding the use of olanzapine, and this was almost always expressed as problematic..."The principal side effect of olanzapine is weight gain, which may be profound in some cases." As someone who spent most of his child wearing the fat tag as well as most of my adult years, I have been fortunate enough to reduce my weight from an average of 165lbs to 190lbs to within a pound or two of 115lbs., and I have kept it there for more than four years. For me it is the result of a lifestyle change and I will never go back to being a fatty. So I just don't see either typical or atypical neuroleptics being a viable solution for the reason just stated.
I have also done some research on the Ambien that I accidentally, took out in the trash the night after I picked up the script. From what I have been able to ascertain from my reading is that the Z-Drugs (the new kids on the insomnia treatment block) which include Belsomra, Sonata, Imovane and Lunesta, along with Ambien and a few others are facing a great deal of debate if they are any more effective than Benzodizepams. And when some time has passed there seems to be a general feeling that they will prove as addictive as the benzo's.
I am now on my ninth straight day without an iota of sleep and am feeling desperation setting in...very fast. My reading suggested that many Dr.'s have tried with success, over a very limited time frame, Barbiturates such as secobarbital and amobarbital, which in many cases have seen their better days now being replaced by prescriptions for benzodiazepams, due to less likelyhood of overdose. One could and for good reason claim that I am displaying drug seeking behavior. While I consider myself no better than the next guy, I am not a believer of the A.A. and rehab mantra, "once an addict, always an addict." "If you pick up you will never know if you'll make it back." My experience has been different. at 22 years of age I entered my first rehab after drinking and blacking out everyday for more than 18 months. I would swear daily that tomorrow I wouldn't drink. Of course I did and couldn't stop and when I was 22 I never heard of A.A., Detox, or Rehab. I thought I was dead within 5 years. By the grace of God something changed during the next 18 years and my final rehab stay some 18 years ago. I haven't had a drink since because it may kill me, that I freely admit. I'm now on SSDI for a degenerative disk disease and after spending two years at a pain clinic they started me on 100MG of MS Contin twice a day with morphine sulfate IR 50MG every 4 to 6 hours for breakthrough pain. Within six years I was taking 1200mg of MS Contin twice a day and the morphine sulfate had been tripled. Then the formulary required a new approach as the MS Contin was cut back to 120 a month. Now I have available to me Oxycontin 2 80MG tablets every 12 hours, as well as up to 12 Oxycodone 30MG tablets a day and up to 8 Dilaudid tablets a day. About 6 months ago I thought long and hard to what these opiates might be doing to my insides and I can report the last time I had anything for pain was six days ago when I took 2 dilaudids. And at the end of my addiction I was shooting a bundle of dope a day. Yet I am one of the very few that was able to walk away from heroin. My whole point is that with this incredible stretches of insomnia I feel like my sanity is in danger without a solution and soon. I simply don't see the point of trying this, that and the other thing...I don't have the time. So when I see my Dr. I was going to propose he prescribes a barbituate for me but at only 5 to 7 for the month so I only use them when times are darkest. And during that time I need to get a sleep study done or at minimum see a specialist. I would appreciate your giving this some thought as I really feel I need a solution now, preferably yesterday, and then there can be more investigative work done. Best regards, XXXX