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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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i am having memory and sleep problems; poor concentration, problems

Answered by
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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 3129 Questions

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Posted on Mon, 18 Feb 2019 in Mental Health
Question: i am having memory and sleep problems; poor concentration, problems thinking correctly, difficulty reading and remembering what i read, asking for information over and over, trouble finding right words to say, trouble thinking right words to think loss of balance. forgetting important dates, where i put things, people i care about, what others tell me, and what read. i get anxious and worry about what needs done in my home. cleaning laundry cooking. I do not eat meals like i usually do(breakfast, lunch, and dinner. i get so anxious about what i think about that i worry way too much and forget what i was thinking about in the first place. then i remember much later. i jump to conclusions fast and mess up. I worry so much that i feel i need help right away. Right now. I. I do not sleep I ave not slept for a very long time. Not since december. My blood pressure has been hypertensive for weeks now. Very hypertensive. very high readings on my home meter. I have been to emergency room three times in last two months. I am afraid sleep problem may kill me very soon. i lie down and try to sleep but just cannot. I take melatonin, benadryl, sometimes over the counter sleeping pills, but nothing works. I need help sir.
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Answered by Dr. Bonnie Berger-Durnbaugh 1 hour later
Brief Answer:
Recommendations

Detailed Answer:
Hello and welcome,

I've experienced severe sleep problems at times and have patients who also have experienced this.

I think, from what you described, your sleep problems need more than melatonin and Benadryl. There is hope though. The thing to address is the anxiety and hypervigiliance. Then sleep will come and once sleep is restored, your memory, concentration, and ability to function well will improve as well.

I recommend that you see a psychiatrist for medications for the anxiety, and if that is not possible, then to see your primary care doctor.

Medications that can help would be an SSRI antidepressant/antianxiety medicine such as Lexapro (escitalopram). But that can take several weeks to kick in. So in addition, since Trazadone did not work for you, you can talk with your doctor about one of the atypical antipsychotic medications such as Seroquel or Zyprexa. These work quickly, are sedating, and also give the SSRI medication a boost.

Now I know what people think when they hear "antidepressant" and "atypical antipsychotic" medications. You may think "but I'm not depressed or psychotic". I am not assuming you are. That is just the name of the class of these meds because that is what they were first used for. But the SSRI antidepressants also work for anxiety and hypervigilance (where a person keeps worrying about getting something done, etc). And the atypical antipsychotics are used for a number of things other than psychoses, including severe insomnia.

A 3rd medication, to have on hand for episodes of panic attacks, is either alprazolam or lorazepam. But, after a couple of weeks on escitalopram and either seroquel or olanzapine, you may no longer need to take the benzodiazepine (alprazolam or lorazepam).

In addition to these medications, I recommend you also see a psychologist/counselor to help you with skills to control the anxiety too.

Now about the hypertension. If you never had that before, it may be related to the anxiety. But if it is a regular problem, then you should see your primary doctor for a medication to control this on a daily basis.

So - there is hope that you will recover from the sleep problems, but the way to address it is to treat the anxiety.

In summary:
See your doctor and start
1. An SSRI (escitalopram works faster than some of the others but still takes about 2 weeks to really start seeing effects).
2. An atypical antipsychotic (Seroquel is often used for insomnia, so is olanzapine).
3. A benzodiazepine for break thru episodes of panic (alprazolam or lorazepam).

In addition, see a counselor for help with training your mind to not go off on anxious thoughts.

Please let me know if I can help further.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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