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Dr. Andrew Rynne

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Suggest remedy for insomnia

Answered by
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Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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Posted on Wed, 21 Oct 2015 in Sleep Disorders
Question: I have gone now without sleep for 6 days straight. I feel like I'm losing my mind. Went to the E.R. and they did nothing. what can I do?
doctor
Answered by Dr. Chintan Solanki 46 minutes later
Brief Answer:
try sleep hygiene for a while and let me know more

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us.

You seem to be suffering from insomnia.

Insomnia (sleep disturbance) are of two types:

1. Primary: There is problem of only sleep disturbance and no other physical or psychological problem is there. In this case treatment for sleep problem is needed.

2. Secondary: There is some underlying physical or psychological problem which is responsible for sleep disturbance. In this main treatment is done for underlying problem.

First of all try to follow some measures called 'sleep hygiene' which would help in sleep. You can find the same in below link.

sleepfoundation.org/ask-the-expert/sleep-hygiene

Drinking a cup of warm milk before going to bed helps in 30-40% of patients and they do not need medicines as per my clinical experience.

To help you further I would like know more from you.

- How did problem begin is there any specific incidence?

- What was the schedule and duration of sleep before the problem started? How much reduction in sleep from previous?

- Which tablets have you tried for sleep?

- What are the sleep disturbances- initiation, fragmentation or early awakening?

- Do you have any stress in life?

- Do you have any physical illness?


Regards,

Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Chintan Solanki 12 minutes later
I have P.T.S.D., Lupus, High blood pressure, and Migraines. I've have gone one or two days without sleep, but nothing like this. I've seen a doctor for this problem and have tried almost every sleeping pill there is out there. Right now I'm on temazepam 2 pills every night 30 mg. The only incident I've had was an Upper Respiratory Infection about two weeks ago. I sleep about 6 hour a night until this past Tuesday. nothing traumatic has happened. Medications I'm taking are Klonopin, Plaquanil, Diovan,
doctor
Answered by Dr. Chintan Solanki 8 minutes later
Brief Answer:
dose of klonopin can be increased

Detailed Answer:
Hi,

Thanks for information.

Probably secondary insomnia is likely possibility.

Klonopin can be increased up to 2 mg with temzepam 30 mg. After sufficient improvement dose can be reduced gradually and stopped.

Amitryptiline (elavil) can be added if migraine is there it will help in sleep also.

There is need to monitor your blood pressure also.

Let me know if you have already tried 2 mg klonopin with temazepam.

take care.





Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Chintan Solanki 20 minutes later
Klonopin is at 2 MG 3 times a day, temazepam is at 60 mg, my blood pressure is under control at 128/82. I do have a cough that never went away from a Upper Respiratory Infection 2 weeks ago. I have seriously tried everything I can think of.
doctor
Answered by Dr. Chintan Solanki 11 minutes later
Brief Answer:
treatment for cough is must

Detailed Answer:
Hi,

Thanks for clarification for dose.

I have mentioned that you are suffering from secondary insomnia and main treatment for this insomnia is to treat underlying cause.

Cough is very bad symptom and it can affect sleep in many patients. You need benadryl and other antihistaminic drugs (chorpheniramine, cetrizine etc) in high dose which can suppress cough and give sedation. However do not use them with such high dose of klonopin as later on severe sedation and respiratory depression may occur.

At last if no improvement you can be given antipsychotic medicine like quetiapine or olanzapine for sedation.

If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback and rating so I can improve my service. In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki
by clicking on 'Ask me a question' on same page.

Wish you good health and early recovery.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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