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Thursday, October 2, 2014
Inability to sleep
Recently (about 7 months ago), I started to find that i couldnt sleep until 3-4 hrs after laying in bed. I told a doctor, who prescribed a medicine called "Clonidine" which says "Take 1-2 hrs before bedtime as needed for insomnia." I don`t seem to show symptoms of insomnia, but here goes.. I took the medicine, it worked fine, but... I started to drink caffiene, and the effect made it so much worse.. Now(with the medicine, I have become dependant) i cannot sleep until as late as 4AM, and wake up with a horrible taste in my mouth. I feel as if i weigh 4 times my weight, and getting out of bed is extremely difficult.)
But I don`t seem to have insomnia, my symptoms don`t go with it.
Here are my symptoms:
Nighttime: Inability to feel "sleepy" I haven`t felt that in almost a year. I will feel completely awake, but still.. completely out of energy.. I find myself collapsing when i walk,a nd when i use a muscle to move something it gives in and i collapse. I will try to sleep, but i will not feel able to sleep, and wotn fall asleep, so i find soemething to do. I will fall asleep after losing all energy and eventually falling to the floor and unable to rise.
MORNING: When I wake, I have a dry mouth. I taste a horrible taste (of dirty water), and I feel 10 times my weight. I`ll try to rise out of bed, but it is almost impossible. After an hour, I resume feeling normal. Then at night it repeats.
The word “insomnia” may have a different meaning for different people. Describing the symptoms is always a better way to define a problem. I am glad you gave detailed narrative of your problem, so that I am sure to consider all aspects:
About one third of the population in the US experience difficulty falling asleep at some time during their life, and 10% of the people have this kind of problem all the time. The best way to treat problems falling asleep is to find the initial situation that started it, and also to counter the perpetuating behaviors that makes it worse (such as worrying about lack of sleep).
Conditions that cause difficulty falling sleep or maintaining sleep include:
- General medical disorders
- Heart disease
- Lung disease such as emphysema and asthma
- Acid reflux disease
- Pain syndromes
- Acquired immunodeficiency syndromes (AIDS)
- Chronic fatigue syndrome
- Neurological disorders
- Psychiatric disorders
- Drugs and alcohol
- Primary sleep disorders
- Psychophysiologic insomnia
- Circadian rhythm disorders
- Sleep state misperception
- Restless legs syndrome
- Inadequate sleep hygiene
- Sleep apnea
We do have minimum daily requirements for sleep. Once a situation develops and someone can’t sleep at night, they end up compensating by attempting to sleep during the day or having difficulty getting out of bed in the morning. This will lead to an imbalance between their biological clock and the clock of the environment around them. This is called circadian rhythm disorder. Sleep medications and substances for wakefulness (like coffee), work only temporarily and stop being effective in a few weeks. This may explain the problems you are having with Clonidine and with caffeine.
In some situations feeling weak and feeling sleepy may coexist. In narcolepsy with cataplexy, for example, there is loss of power and difficulty staying awake during exciting situations. In other medical situations, such as rheumatoid arthritis, the time to getting out of bed in the morning may be prolonged. But the list of possible causes of weakness is lengthy and may be better left for you to discuss face to face with your physician or with a sleep specialist.
The treatment of your problem will obviously depend on finding and fixing the cause, and may also include behavioral therapy and certain short-term medication use. I urge you to discuss your problem with a sleep specialist in your area. In the meanwhile, here are a few rules that may be of benefit for you:
- Avoid caffeinated beverages, alcohol, and tobacco in the evening (alcohol may help you fall asleep but will cause your sleep to be fragmented)
- Avoid intense mental activities and vigorous exercise up to 3 hours of bedtime
- Adhere to a regular sleep-wake schedule even on weekends and non-working days
- Avoid naps, and resist the urge to catch up on sleep during the day
- Avoid excessive time spent in bed (if not asleep in 20 minutes, get out of bed and don’t return until sleepy)
If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need be. Good luck and sleep well.
Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University