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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by shoebox on January 24, 2005, at 9:48:16
For the past several months I have had trouble staying awake during the day. I averaged a 2-hour nap every day around the same time (early afternoon), even though I was getting my usual 8 hours overnight. I had no other symptoms that could account for such fatigue.
I finally went to a sleep clinic and stayed overnight, hooked up to all manner of wires. They expected to find sleep apnea. The results: I woke up over 150 times. Approximatley 30 of those times, it was due to mild sleep apnea. Another 20 seemed to be caused by PLMD--Periodic Limb Movement Disorder--and that left 100 or so "wake-ups" unaccounted for. The real kicker: I never reached Stage 3 sleep, never mind stages 4 and 5, because of all the wake-ups, and was told I had experienced virtually no REM sleep.
My insurance won't cover any additional evaluations (at least not any overnights at the clinic), because of the "mild" sleep apnea DX.
The doctor at the sleep clinic was flummoxed as to the 100 "idiopathic" wake-ups, and I don't know what my next move is.
[I'm BPII and was on 80mg Prozac, 300mg Lamictal prior to my most recent pdoc appt.]
My pdoc decided to decrease my Prozac from 80mg to 60mg and add Wellbutrin SR 150 mg., figuring Prozac has a reputation for REM sleep spoilage. I've been on the new RX for about two weeks now, and can't say there's been any marked improvement, though I feel more "alert" thanks to the WB.
What else could be causing the interruption of my sleep besides sleep apnea and PLMD? That's the question. Has anybody had to deal with this type of thing?
Posted by Kenny Koala on January 24, 2005, at 11:16:28
In reply to REM sleep/Prozac/PLMD?, posted by shoebox on January 24, 2005, at 9:48:16
> For the past several months I have had trouble staying awake during the day. I averaged a 2-hour nap every day around the same time (early afternoon), even though I was getting my usual 8 hours overnight. I had no other symptoms that could account for such fatigue.
>
> I finally went to a sleep clinic and stayed overnight, hooked up to all manner of wires. They expected to find sleep apnea. The results: I woke up over 150 times. Approximatley 30 of those times, it was due to mild sleep apnea. Another 20 seemed to be caused by PLMD--Periodic Limb Movement Disorder--and that left 100 or so "wake-ups" unaccounted for. The real kicker: I never reached Stage 3 sleep, never mind stages 4 and 5, because of all the wake-ups, and was told I had experienced virtually no REM sleep.
>
> My insurance won't cover any additional evaluations (at least not any overnights at the clinic), because of the "mild" sleep apnea DX.
>
> The doctor at the sleep clinic was flummoxed as to the 100 "idiopathic" wake-ups, and I don't know what my next move is.
>
> [I'm BPII and was on 80mg Prozac, 300mg Lamictal prior to my most recent pdoc appt.]
>
> My pdoc decided to decrease my Prozac from 80mg to 60mg and add Wellbutrin SR 150 mg., figuring Prozac has a reputation for REM sleep spoilage. I've been on the new RX for about two weeks now, and can't say there's been any marked improvement, though I feel more "alert" thanks to the WB.
>
> What else could be causing the interruption of my sleep besides sleep apnea and PLMD? That's the question. Has anybody had to deal with this type of thing?
>
>
Reduced or nil Stage 4 sleep is a side effect of all SSRI's & Effexor, not just Prozac. Excess agonism of Serotonin 2A receptors(5-HT2A) by the increase in Serotonin levels is the cause. The cure is rather simple, take a low doseage of something that is a 5-HT2A antagonist. Amitriptyline, Doxepin, Remeron, Trazodone or Trimipramine would be my first choices. Most antimigraine & antipsychotic drugs are 5-HT2A antagonists too. 5-HT2A receptors also control other body functions such as temperature control, anxiety & orgasm.
Posted by shoebox on January 24, 2005, at 11:57:41
In reply to Re: REM sleep/Prozac/PLMD?, posted by Kenny Koala on January 24, 2005, at 11:16:28
> Reduced or nil Stage 4 sleep is a side effect of all SSRI's & Effexor, not just Prozac. Excess agonism of Serotonin 2A receptors(5-HT2A) by the increase in Serotonin levels is the cause. The cure is rather simple, take a low doseage of something that is a 5-HT2A antagonist. Amitriptyline, Doxepin, Remeron, Trazodone or Trimipramine would be my first choices. Most antimigraine & antipsychotic drugs are 5-HT2A antagonists too. 5-HT2A receptors also control other body functions such as temperature control, anxiety & orgasm. [Yeah, tell me about it!! :-/]Thanks for responding, Kenny. Interesting stuff. Now I wonder why:
a. the sleep clinic doc would be unaware of SSRIs' effects on REM sleep (he was no dummy). He didn't even seem to factor it in at all, much less point to it as the main culprit.
b. am I suddenly having this sleep problem now, after everything was running so smoothly for so long? (I know, I know...strictly rhetorical)
Elavil and trazodone make me dopey, so those are out. I've never tried the others. Arrrgghh. And here I was down to only TWO meds! I don't want to start throwing things at the problem and messing with my current combination, which is the best I've ever had after 12 years drug-hopping. No way am I giving that up.
Anybody had success with something *other than* klonopin for PLMD or Restless Leg?
Posted by Kenny Koala on January 24, 2005, at 12:41:29
In reply to Re: REM sleep/Prozac/PLMD?, posted by shoebox on January 24, 2005, at 11:57:41
>
> > Reduced or nil Stage 4 sleep is a side effect of all SSRI's & Effexor, not just Prozac. Excess agonism of Serotonin 2A receptors(5-HT2A) by the increase in Serotonin levels is the cause. The cure is rather simple, take a low doseage of something that is a 5-HT2A antagonist. Amitriptyline, Doxepin, Remeron, Trazodone or Trimipramine would be my first choices. Most antimigraine & antipsychotic drugs are 5-HT2A antagonists too. 5-HT2A receptors also control other body functions such as temperature control, anxiety & orgasm. [Yeah, tell me about it!! :-/]
>
> Thanks for responding, Kenny. Interesting stuff. Now I wonder why:
>
> a. the sleep clinic doc would be unaware of SSRIs' effects on REM sleep (he was no dummy). He didn't even seem to factor it in at all, much less point to it as the main culprit.
>
> b. am I suddenly having this sleep problem now, after everything was running so smoothly for so long? (I know, I know...strictly rhetorical)
>
> Elavil and trazodone make me dopey, so those are out. I've never tried the others. Arrrgghh. And here I was down to only TWO meds! I don't want to start throwing things at the problem and messing with my current combination, which is the best I've ever had after 12 years drug-hopping. No way am I giving that up.
>
> Anybody had success with something *other than* klonopin for PLMD or Restless Leg?
>Actually, I seemed to have answered your question rather poorly, due to me reading it wrong. Stage 4 sleep is deep sleep, this is what is controlled by 5-HT2A receptors. Amitriptyline(Elavil), etc, are noted for improving this part of sleep. I don't know of any drugs that affect stage 5/REM sleep in a positive way, but getting good stage 4 sleep would be a step in the right direction. You might like to try Trazodone or Amitriptyline again at a very low dosage, all 5-HT2A antagonists have a zombiefying effect initally, but it does go away when a little tolerance builds.
This is the end of the thread.
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