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Dr. Andrew Rynne

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Suggest treatment for insomnia

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Dr. Kaushal Bhavsar

Pulmonologist

Practicing since :2008

Answered : 14052 Questions

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Posted on Wed, 22 Mar 2017 in Sleep Disorders
Question: I have been suffering from extreme insomnia for the past 15 years. I have great difficulty going to sleep and staying asleep. I will go for 4-5 days without any sleep, not even a 10 min nap, then sometimes I will "crash" and sleep 48 or more hours or more only awakening to use the bathroom. I suffer from sleep apnea and have a cpac machine but rarely use it because I don't sleep.
I have been under the care of a sleep specialist during this period of time and he has conducted sleep apnea sleep studies, prescribed every sleep and off label sleep medication without success. He first diagnosed my insomnia as being secondary to my major depression and stated that when my psychiatrist had stabilized my depression he would try prescribing 2 or more each sleep medications each working on a different area of the brain that controls sleep. The depression was stabilized over two months ago, however instead of following his plan he changed his mind and then stated he thought the insomnia was being caused by my severe back pain. Normally I would agree with him, however, I am under the care of a pain management specialist and have an implanted pain pump that delivers a dose of hydromorphone hourly. I don't think back pain is the cause of my insomnia but I don't know what is, do you have any ideas or any form of treatment you might suggest? The city I live in has approximately 5-6 sleep specialist and the one I am seeing is considered the best so I don't know if seeing a different doctor with perhaps different ideas would help. What do you think?
I would be willing to travel anywhere in the country if you know of a doctor or perhaps a teaching hospital that is highly regarded for insomnia treatment. Do you know of any?
What questions should I ask my doctor?
One idea I thought of is the cause may be a traumatic head injury with an unknown time of unconsciousness that I suffered in 1991. The impact was sufficient enough to cause damage to the pituitary gland and suffer significant short-term memory loss and cognitive ability. Could this head injury be the cause and if so what type of tests would need to be performed? My sleep doctor knows of this injury but may have forgotten it?
Do you think this theory is worth exploring and, if so, how?
Also my psychiatrist prescribed Dexedrine 15mg ER three times a day for AADD, refractory depression and daytime sleepiness, after trying Ritalin and Adderall without success. I have to take this plus a significant amount of caffeine throughout the day to stay awake and be able to function. Thinking the Dexedrine might be the cause of the insomnia I have reduced the dose from 45mg to 30mg taken before noon and cease all caffeine intake at 4:00 p.m. By the way I have tried Provigil and another medication without success. I have also tried all the home remedies, i.e. sleeping in a cool dark room, not using the bed for anything except sleep and sex, etc.
I would appreciate any advice you can give.
XXXX

I have tried all of the home remedies without success.
doctor
Answered by Dr. Kaushal Bhavsar 2 hours later
Brief Answer:
Yes, you should should consult another sleep specialist.

Detailed Answer:
Thanks for your question on Healthcare Magic.
I can understand your concern.
I have gone through the detailed history you have given.

Answer to your 1st question.

This kind of chronic insomnia is mostly psychosomatic in nature. So I still feel that you should consult other psychiatrist and sleep specialist.

Answer to your 2nd question.

Mayo clinic and XXXXXXX clinic are known for research work on unexplained diseases. So you can visit any of these institute for diagnosis.

Answer to your 3rd question.

Old head injury can sometimes cause delayed symptoms. So you should definitely look into this. You can should get done detailed MRI brain for this.

Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Kampana
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