Insomnia


#1

Hello, everyone, I am new here. I am 53 and was only diagnosed about 10 years ago. I tried Ritalin and initially had an amazing response (and it actually really helped me sleep at night), but I developed tolerance very, very quickly. I have since tried buprion, which does help but greatly increases my anxiety so I had to stop. Now I am not on meds.

My main issue at this point is insomnia, which is a long-standing issue. Under normal circumstances, I am able to deal with it using sleep hygiene/relaxation techniques, but right now I am under two MAJOR stressors (long story ;-), which have just overwhelmed these methods. I can’t function if I can’t sleep, and I just can’t sleep. And I absolutely need to function at quite a high level right now to resolve the major stressors.

I currently have a psychiatrist who doesn’t seem to really understand ADHD, and is inclined to think I am actually bipolar (“rapid cycling”) and is pushing me to take an antipsychotic. I think it’s a terrible idea because I know all my symptoms (and history) are covered completely by ADHD, and the last thing I need is a bunch of side effects from an atypical antipsychotic.

Does anyone have any personal experience to share that could help me figure out how to work with this doctor, and especially what sleep medication is best for insomnia related to ADHD?


#2

Hello, I’ve just started getting much better quality sleep after stopping Quetiapine, I would agree, best to avoid such drugs if possible.

I don’t have much advice, sorry, just make sure you take care of yourself with diet and mental health. Try to increase exercise if possible.

I have taken Zopiclone in the past, it works but has addictive tendency, only available short term in the UK.

Have you tried hypnotism? I have not myself, just a suggestion from way out of left field.

I hope you find sleep tonight and wake up feeling refreshed.


#3

Thanks for your response Neil.

I actually am taking Zopiclone right now, but as a very short-term prescription (literally just a couple of pills). This is in part because I have a past history of sedative abuse.

In terms of quetiapine, that is the one the psychiatrist is pushing (although it is also a sedative, so not sure why they would trust me with a full prescription of that but not zopiclone). They seem to want to prescribe quetiapine for everything. Wikipedia says it is not recommended for insomnia, so I don’t understand why this doctor wants to prescribe it.

I am 53 and definitely have never been hypomanic or manic. I just talk fast so they think my thoughts are racing or whatever. And I go off on a zillion tangents. And when I haven’t slept well I experience emotional dysregulation and major inability to concentrate. And my mood is “labile”. That is just ADHD, but they don’t seem to want to accept it, although I have a very firm ADHD diagnosis at this point.

I have not tried hypnotism for insomnia. I am into all those types of relaxation methods (and have tried a lot of different things with quite good results) but the level of stress on me now is just way off the charts. It’s not just me feeling stressed for normal things. The doctors recognize that I am dealing with several very major stressors at once. That is why I need to figure out what medication to ask for until these stressors resolve, given that she is very unlikely to prescribe more Zopiclone.

Are there medications specific to ADHD (stimulants) that also help some people with sleep? Ritalin definitely helped me sleep great at night during the short period it worked for me (I grew tolerant to it in just a few weeks–such a major disappointment that was, because at first, the effect was life-changing).


#4

Do you have any idea how long this high stress period is likely to last? Just to get some idea of how long you need to maintain the current situation for.

The quetiapine did have a sedative effect initially and on increasing dose, this only lasted for a few days, maybe a week each time, and then made insomnia much worse. It also came with whole raft of other negative side effects and I’m still experiencing some weeks after stopping. Obviously everyone is affected differently but this is one medication that I would advise extreme caution regarding use.

The hypnotism suggestion was a bit out of the blue but worth considering in your situation I think? Depends if you can afford the treatment I suppose, but otherwise not much to lose. Some people rate CBD oil highly for relaxing effects, obviously quality can vary between brands, bit of a bandwagon to be jumped on right now, legal status also varies by location too.

Is it worth trying an amphetamine ADHD med? There is also Strattera which is a non-stimulant SNRI, it’s known not to increase levels of anxiety, I don’t think it is classed as anxiety reducing though.


#5

Hi Neil. The stress is due to a repossession of my housing. I am a single mom with two boys, one of whom is very severely developmentally disabled with a complex profile. I live in Montreal which is in the process of gentrifying, so the real estate prices are skyrocketing and people are selling their duplexes/triplexes to rich people who want to throw all the tenants out to make large homes. The stress of this ended me in psych emerge for four days (adjustment disorder with anxious and depressed mood), but then the depressed mood (suicidal thinking) resolved and I got a great treatment program and my ex covered for me completely with me for my kids, which was excellent. However child services got involved, and where I live they are allowed to dig through people’s old files. So they found information from literally as far back as 10 years (and even before) so they decided to attack me very aggressively and unfairly so they can charge me with endangerment, with the purpose of providing me with “assistance” for one year, which is basically just a year of funding for them and a year of harassment for me, because they cannot do anything to help me find stable housing in this city. I wanted to leave Montreal, but my disabled son is 11 so he needs very specialized schooling, which is only available here. So now I am preparing for two different hearings (youth court and the housing board) and facing a search for affordable housing in an extremely, extremely competitive rental market, where no landlords want to rent to me. And even if I find something, I am at great risk of having it repossessed again, because the whole city is gentrifying very quickly now. This is the second year in a row I will have gone before a rental board judge to fight to keep my home.

Sorry for the long story–just venting. My idea for the sleeping pills is until the youth court hearing is resolved, but I don’t know yet when it will be. There is no date set yet. About 10 days ago I had a date and had thought it would be resolved then, but my legal-aid mandate lawyer refused to help me submit my documents (I have a huge pile of documents that refute their mountain of bullshit) and call my witnesses (from the intensive treatment program I did) to explain that I don’t have a serious mental health diagnosis (the only diagnosis now is ADHD) and who are competent to testify as to my psychological stability, which is extraordinary given everything that is going on!

But as you can see, at this point not being able to function is really, REALLY, not an option, and when I can’t sleep I can barely function at all.

IIn the past I was unable to try other ADHD meds because it’s not covered on our government insurance unless regular Ritalin has been shown not to work, but when I tried it and grew tolerant to it I was on private insurance because I had a good job, so the government doesn’t have it in their system. But now maybe I could get them to try again, given what is going on and the fact that my only firm diagnosis is ADHD.


#6

With all of that going on I’m not surprised you are struggling to sleep. No problem about the long story, it’s good to vent.

I think it’s worth trying Ritalin again, if there is no other option available. Your tolerance should have been reset to zero after some time not taking it. In theory you will get a few weeks benefit and better sleep before needing to change meds, at that point it will be on your health records enabling you to move on and try something else. It seems unlikely that you will get a strong sleep med for any amount of time and then you have potential tolerance issues there too. Hopefully the Ritalin will give you some help with both ADHD issues and sleep problems.

How about finding a psychiatrist who has more experience with ADHD? It might help to feel like you have one less battle to fight, or like an extra job that you really don’t need right now.


#7

Thanks for the ideas Neil. I think asking to try Ritalin again is actually a very good idea. I had been thinking “what’s the point” because I know I will develop the tolerance again, but you are right–a few weeks of functioning well is a few weeks of functioning well, which sounds great to me right now!

I do think I could request that my current psychiatrist request a consult with the specialized team that diagnosed the ADHD ten years ago. At that time it was called “sub-threshold” ADHD, because it was a research study and I missed their cut-off by literally just one point, and so I was not admitted to their treatment protocol. But since now the ADHD has been confirmed by neuropsychological testing, I think we could at least ask for one consultation with their specialized team.

I am afraid that the current psychiatrist won’t go for it though, because she seems very inclined to want to label me bipolar and prescribe an atypical antipsychotic. I am certain 100% certain that I am not bipolar, but at this point, I have to make a very concerted effort to s.p.e.a.k…v.e.r.y…s.l.o.w.l.y… for the benefit of these slow, non-ADHD brains who are evaluating me ;-))))


#8

Considering all that you have going on, and the emotional issues that come with ADHD, (Assumption on my part this affects you too.) it’s not surprising that you would be showing some large variations in mood. Maybe go into see the psychiatrist armed with notes or a list of points, it may help to focus your argument and give you something to pace yourself with.

Misdiagnosis is a massive problem for the patient, not so much the doctor, and carries many potential problems too, I’ve been bouncing around the MH services for 10 years. I think bi-polar has a additional degree of stigma attached to it, and this could be an extra problem if that lands on your records. Best wishes from me, stay strong and, as you said above, make sure to appear calm and patient.

My experience with Quetiapine, it did literally turn me into a zombie, barely able to concentrate and keep a thought in my head. I could not get any help to taper off of it so just had to stop, I still have blurred vision, visual disturbances and excess sweating 2 weeks after last dose. One thing it will, almost certainly, do for you is to make you …speak…very…very…s…l…o…w…l…y.


#9

If the doctor isn’t listening to you (and doesn’t seem to know what s/he is doing) then my only advice is to get a new doctor. There are plenty of psychiatrics in the world and sometimes biases or misinformation gets in the way of them doing their job.


#10

Thanks for your thoughts. Unfortunately, I cannot get a new psychiatrist. I am in Quebec (Canada). Most people cannot easily access any psychiatric services at all. They would have to go through a GP, and then end up on an endless waitlist. I have this doctor only because I ended up in psych emerg. I am lucky to have this doctor. I have to figure out how to work with her, one way or another. If she pushes hard for quetiapine, my plan is to just tell her, OK give me the script and I will think about it, and then just muddle through without any meds as usual :wink:


#11

Oh, I’m sorry. It’s probably a bit easier to find a psychiatric in the US… I didn’t even think about other countries accessibility. I’m sorry for just assuming.


#12

No worries! In truth, in the past, I have refused a psychiatric follow-up when I was able to access it because I did not agree with the treatment approach, but then I was left with nothing. Here in Quebec, we cannot “shop around” for doctors, especially specialists. I said in my prior comment that I would “muddle through” as usual if I did not agree with the treatment recommendation, but at this point–given the major stressor of the housing repossession, which ended me in psych emerge and now with child services on me–that is not an option.

So I am going to prepare really well before talking to her. I figure I will tell her I have two ideas:

1 - Another month of Zopiclone and a request for a consult from the ADHD specialist who diagnosed me

2 - Another trial of Ritalin (which helped me sleep) and a request for a consult with the ADHD specialist

The problem is–based on how she has been talking in our prior conversation–I am fairly certain she is going to say: “I really think extended-release Seroquel (quetiapine) would be really helpful to you, let’s try that”.

So, I guess that’s my big question: what am I going to say to that in the context I am in (cannot shop around for another doctor, cannot afford to lose this doctor, and cannot afford to have on my record that I am refusing to follow treatment advice)?

If I say “OK, I’ll think about trying it” that will actually be dishonest, and I hate that (it’s actually extremely difficult for me because I always say exactly what I think). These antipsychotic meds are pushed on disabled kids all the time (my son is developmentally disabled) so I am extremely well aware of all the side effects and I just do not want to go there.


#13

Hello, I have not been on here for a few days.

Just wondering if you have had any success yet with figuring this out?


#14

Hi Neil,

Thanks for checking back. The appointment with the psychiatrist went very well, actually. She accepted to continue the Zopiclone for the time being. She did not want to consider a retry of Ritalin or other ADHD meds, but she is going to ask for a consultation from an ADHD specialist. She also wants to ask for a sleep study given the long-standing and worsening insomnia.

So a good result, except that I already am developing a tolerance to the Zopiclone. I had to take a double dose last night in order to get any sleep (after only 10 or so nights on it). I have this tendency to develop a quick tolerance to medications, so of course, I put in a call and we’ll see if she wants to double the dose or add something else, or what.

How are you Neil?


#15

It’s good to know it went well, sorry to hear you are already growing tolerant, hopefully you will get more help with this. Do you think you have a specific sleep issue, like Apnoea or something else, that’s treatable?

I feel that i’m just about surviving at the moment, my head is sore and the wall is dented!
ADHD meeting went poorly this week so treatment is on hold again now. Next week I have a disability assessment, which will probably be refused, and seeing a new doctor for other issues. Been waiting 6 months for this appointment and optimistic it could be useful but also considering the possibility she will suggest I go back to taking another anti-psychotic, which will be a big fat ‘no, thank you’ from me.


#16

You had an ADHD treatment meeting? Why did they put your treatment on hold? When you say disability assessment, is that in terms of work? I am unable to work but it’s because my son is developmentally disabled and there is no after-school daycare. Before I had kids I difficulties working but I did manage, but not consistently. I did not pick the right career. I so wish I had known before that I had ADHD!


#17

I find the ADHD consultant quite hard to deal with, he seems to get basic facts wrong consistently and gives me conflicting advice and seems to have a problem when I try to clarify what I’m being told. This kicks off my anxiety so my blood pressure readings are too high and then he refuses to prescribe stimulant medication.

I’ve worked hard most of my life and not much to show for it but can’t hold down a job right now, been struggling with this for a few years. Mild autism, severe ADHD, major depression/anxiety and back injury are my issues, just trying to get some help until I can back on my feet.


#18

I have a great Psychiatrist who also has ADHD and really understands the struggle. She only deals with my mental health and my GP deals with everything else. I strongly believe you need a mental health provider who specializes in ADHD.

I take methylphenidate for the ADHD symptoms. I also take Sertraline for anxiety. Also, amitriptyline at bedtime to help me sleep. Obviously, talk to your doctor before starting anything since many medications interact with each other and not in a good way. The three I mention above all have risks associated with interaction but I’ve been taking them for several years and both my doctor and I feel the benefits outweigh the risks.

On nights when I still struggle with falling asleep I will take a melatonin. It is natural, I only take it occasionally and I don’t wake up with a “hangover” (mental fog that doesn’t clear for a while) like I do if I take Benedryl.

I still have nights that I don’t sleep well or at all. It can get frustrating. Some insomnia can actually be caused by natural aging processes. :slightly_frowning_face: and that can be tricky to figure out when you also have ADHD.

Good Luck,


#19

Hello @Anjikun. First, I respect & appreciate your honesty/transparency. My heart goes out to you for the difficult situation you’re in. It’s also refreshing to see how you do appreciate the little bit of help you’re getting, even though things could be/need to be better (I often overlook the blessings & many times just get bitter).

I’m not sure how much help it may be, but I’ve included a link from a website I frequent, hoping it may help with common misdiagnosis issues doctors have with ADHD. Only thing, you’ll need to submit your email address to the website, but it’s a free download:
https://www.additudemag.com/download/adhd-misdiagnosis/?src=embed_link

You may want to familiarize yourself with it (instead of printing it and taking it with you), because I’m sure that most doctors would either get their feelings hurt, or get offended that you’re trying to tell them how to do their job (depending on the “humanness” of your doctor). Even in the US, my experience is that many physicians aren’t experienced or educated enough to provide a solid ADHD diagnosis (I am grateful for the ones that do).

I am praying for the best for you & your family. Please keep us posted on how you are doing.


#20

So sorry to hear you are struggling, with ADHD and also health problems. My son has autism (although his primary diagnosis Fragile X syndrome). I know that many individuals/families who are dealing with the mild end of the autism spectrum have a much harder time because of the lack of resources/understanding. My son is in an excellent specialized school, so there is no lack of recognition and the level of resources is good.

In terms of high blood pressure, my ex has that and it goes up when he is under stress, which worries me a lot. He is able to get the readings down by resting. I have also read that vegan eating can do that. For right now my ADHD medication is coffee. If someone tried to take away my coffee I would go ballistic!