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Suggest Treatment For Sleeplessness In A Person With Bipolar Disorder
Question: This query is with regard to someone I’m very concerned about.
Roughly 8+ years ago his sleeping collapsed, which was followed by some manic episodes. He was diagnosed with Bipolar and was put on the following drugs:
In the morning: 100mg sodium valporate
In the evening: 200mg sodium valporate
15mg mirtazapine
3.75mg zopiclone
He’s constantly having chronic sleeping problems, is anxious and exhausted all the time. The doctors don’t want to give him the strong sleeping drugs he was on in hospital (which worked) as they say they’re addictive, so they just up the dose of his existing drugs for a while, but this isn't very effective.
Before the drugs he was confident, only had minor anxiety problems and was a good communicator. All of these things have been seriously impacted and last time I spoke to him he had trouble putting a sentence together…
He has the best sleep hygiene of anyone I know, but it doesn’t make a difference, he can go for weeks getting only 2 hours sleep a night, sometimes not even that.
Are there any better drugs available?
Roughly 8+ years ago his sleeping collapsed, which was followed by some manic episodes. He was diagnosed with Bipolar and was put on the following drugs:
In the morning: 100mg sodium valporate
In the evening: 200mg sodium valporate
15mg mirtazapine
3.75mg zopiclone
He’s constantly having chronic sleeping problems, is anxious and exhausted all the time. The doctors don’t want to give him the strong sleeping drugs he was on in hospital (which worked) as they say they’re addictive, so they just up the dose of his existing drugs for a while, but this isn't very effective.
Before the drugs he was confident, only had minor anxiety problems and was a good communicator. All of these things have been seriously impacted and last time I spoke to him he had trouble putting a sentence together…
He has the best sleep hygiene of anyone I know, but it doesn’t make a difference, he can go for weeks getting only 2 hours sleep a night, sometimes not even that.
Are there any better drugs available?
Brief Answer:
yes benzodiazepine group drugs are useful
Detailed Answer:
Hello XXXXXXX
Thanks for writing to us.
I can understand your concern for someone.
He is suffering from bipolar and not getting enough sleep with mirtazapine and ezopiclone.
Benzodiazepine group of drugs like clonazepam, lorazepam or diazepam are quite useful for sleep disturbance in this disorder. Doctor was right that drug may be addictive.But that is the case with alprazolam more which is also a benzo. Drugs mentioned above are not going to be addictive if used under doctor's guidance and supervision.
Quetipine is an also good option. It is useful as mood stabilizer as well as sedative.
In my opinion 300 mg total valproate in a day is also not sufficient dose. Please let me know age, wieght of your concerned one.
Discuss above aspects with his treating psychiatrist and change medicines accordingly.
Does he have any physical problem and medicine for the same?
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
yes benzodiazepine group drugs are useful
Detailed Answer:
Hello XXXXXXX
Thanks for writing to us.
I can understand your concern for someone.
He is suffering from bipolar and not getting enough sleep with mirtazapine and ezopiclone.
Benzodiazepine group of drugs like clonazepam, lorazepam or diazepam are quite useful for sleep disturbance in this disorder. Doctor was right that drug may be addictive.But that is the case with alprazolam more which is also a benzo. Drugs mentioned above are not going to be addictive if used under doctor's guidance and supervision.
Quetipine is an also good option. It is useful as mood stabilizer as well as sedative.
In my opinion 300 mg total valproate in a day is also not sufficient dose. Please let me know age, wieght of your concerned one.
Discuss above aspects with his treating psychiatrist and change medicines accordingly.
Does he have any physical problem and medicine for the same?
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your quick reply, it's much appreciated.
Lorazepamam is the drug they are hesitant to give him, even though it has worked well in the past.
He is also on a drug to reduce how many times he goes to the toilet.
His doctor (or it may have been his psychiatrist) did change his drugs slightly about 9 months ago, his confidence came back within a week, he even started driving again. Then his sleeping collapsed and his drugs were changed back to what they were before (listed here).
You mentioned Quetipine, is this as a replacement to one of the drugs he's on or in addition?
Lorazepamam is the drug they are hesitant to give him, even though it has worked well in the past.
He is also on a drug to reduce how many times he goes to the toilet.
His doctor (or it may have been his psychiatrist) did change his drugs slightly about 9 months ago, his confidence came back within a week, he even started driving again. Then his sleeping collapsed and his drugs were changed back to what they were before (listed here).
You mentioned Quetipine, is this as a replacement to one of the drugs he's on or in addition?
Brief Answer:
Quetiapine can be used as add on to current valproate dose
Detailed Answer:
Hello,
Thanks for follow up.
There is history of response to lorazepam. In my opinion lorazrepam can be given for sleep and gradually decreased and stopped.
Quetiapine is indicated for many psychiatric problems.It can be used as a mood stabilize in bipolar. It causes sedation which is useful in his case. Current dose of 300 mg of valproate is not sufficient as mood stabilizer in my opinion. Quetiapine can be added in his current profile if lorazepam is not used.
If Quetiapine is found useful in his case,later on valproate can be reduced and stopped and Quetiapine should be increased.However Quetiapine can cause weight gain so simultaneous weight control measures should be applied.
Hope this answers your concern.
Regards,
http://bit.ly/drchintansolanki
Quetiapine can be used as add on to current valproate dose
Detailed Answer:
Hello,
Thanks for follow up.
There is history of response to lorazepam. In my opinion lorazrepam can be given for sleep and gradually decreased and stopped.
Quetiapine is indicated for many psychiatric problems.It can be used as a mood stabilize in bipolar. It causes sedation which is useful in his case. Current dose of 300 mg of valproate is not sufficient as mood stabilizer in my opinion. Quetiapine can be added in his current profile if lorazepam is not used.
If Quetiapine is found useful in his case,later on valproate can be reduced and stopped and Quetiapine should be increased.However Quetiapine can cause weight gain so simultaneous weight control measures should be applied.
Hope this answers your concern.
Regards,
http://bit.ly/drchintansolanki
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
One final question please.
Have you ever tried Circadin (http://www.circadin.com) or light therapy for Bipolar patients who are experiencing extreme insomnia?
Have you ever tried Circadin (http://www.circadin.com) or light therapy for Bipolar patients who are experiencing extreme insomnia?
Brief Answer:
Circadin used for sleep and light therapy for seasonal disorder
Detailed Answer:
Hello,
Thanks for follow up.
Circadin is melatonin. It is used for sleep disturbance. It can be used for insomnia.It may help in bipolar disorder for sleep disturbance.It can be given under doctor's guidance.I have used only in 3 patients until now as benzo are almost effective in sleep disturbance.Yes it may help in case which we are discussing.But still I prefer benzo.
Light therapy is used for seasonal affective disorder. If biploar symptoms are specific to season , it may help otherwise it is not useful. And particularly for insomnia in bipolar no evidence of effectiveness.
Hope this answers yo is helpful.
If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback so I can improve service. In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki
Circadin used for sleep and light therapy for seasonal disorder
Detailed Answer:
Hello,
Thanks for follow up.
Circadin is melatonin. It is used for sleep disturbance. It can be used for insomnia.It may help in bipolar disorder for sleep disturbance.It can be given under doctor's guidance.I have used only in 3 patients until now as benzo are almost effective in sleep disturbance.Yes it may help in case which we are discussing.But still I prefer benzo.
Light therapy is used for seasonal affective disorder. If biploar symptoms are specific to season , it may help otherwise it is not useful. And particularly for insomnia in bipolar no evidence of effectiveness.
Hope this answers yo is helpful.
If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback so I can improve service. In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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