Bernerbits' ongoing CPAP/meds/insomnia saga

[49er]

I am perplexed on the med changes the psychiatrist made as I thought things were going well. What am I missing?

49er

[bernerbits]

Well, treatment has improved as has the overall number of sleepless nights, but: I haven't had a full night of sleep in weeks but rather 5-6 hours a night and am starting to feel the cumulative effects of sleep deprivation. I had a couple recent episodes of the Ambien not inducing sleep as expected, especially after dropping/lowering the Melatonin dose (which at 3mg was causing me severe hangovers), and I also mentioned still having a baseline of low-to-medium level anxiety. She wanted to see if we could take care of some of the lingering anxiety with the Zoloft in the longer term and use the small Lorazepam dose to try and help improve my sleep in the short term. There was an understanding that I would still taper Ambien (and the Ativan) as planned.

[49er]

Berner Bits,

Thanks for the clarification and I am sorry about your sleepless nights.

Not to sound like a broken record but I am really concerned about the cumulative effect of all these rapid med changes. Obviously, you know your situation the best but I would proceed very carefully.

49er

[bernerbits]

So, hopefully to address some concerns here: other than tweaking my Melatonin, there hasn't been a med change since 15 (edit: 15, not 11, misread my sleep journal) days ago when I went up to 50 on Zoloft.

Lorazepam on an as needed basis was already part of my med regimen, and I'm already authorized to go as high as 1mg per day; she just clarified that I could use .5 nightly as part of my sleep aid regimen. I've used it for years on and off, tolerate it well and am familiar with its effects.

The Zoloft increase is new; I've never been as high as 100mg before, but I am treading carefully. I'm tracking my symptoms every few hours now, and if I notice anomalies or subjective issues tolerating it, I'll alert my psychiatrist.

[49er]

Thanks Bernerbits, I understand what you're saying.

I think the Zoloft increase concerns me the most. I am glad you are carefully watching it.

49er

[bernerbits]

By the way, AHI 1.8. Gonna stay at the new pressure for a little bit and then bump up to 9.

[bernerbits]

Ativan and Ambien together are potent as hell. Best sleep I've had in weeks but feeling groggy the day after -- though it's not as rough as when I was taking too much melatonin. I've decided to stick with it since I'm tapering down Ambien anyway.

The taper is going fine so far. I've been on 10mg of Ambien a night for 3 days, with the dose split across the night 7.5/2.5. On one night I didn't even wake up to take the second dose. Certainly the Ativan is helping with the weaning, at the cost of taking a little bit longer to taper off Ativan after that.

Last night was weird. I explicitly remember lying awake in bed for 90 minutes as I was falling asleep, but SleepyHead shows regular breathing like I was asleep for most of that time, with a few very brief awakenings.

[bernerbits]

Since beginning the taper last week, I'm not konked out all night and all next day like I was.

I'm down to .5mg Lorazepam and 7.5mg Ambien a night. I'm supposed to be taking 10mg Ambien, according to the original taper plan, splitting the dose across the night and taking the second, smaller dose when I wake up. But since I've been sleeping from about 10:30-4, I wake up too late to take the second dose and instead sleep very lightly for an hour before waking up at 5.

This at least gives me enough sleep to function. It's good that I can sleep that long on just 7.5mg of instant release Ambien. Since my next step down is supposed to be Friday, I'm just going to stay the course for two more days, and then drop my Ambien schedule to 5/2.5. While not technically a step down, I am expecting a similar effect, sleeping longer and longer until I wake too late to take the second dose. If not, I'll simply step down again after a week. If I have difficulty with any step-downs, I will return to the previous week's dosage and try again the following week.

Biggest side effect from the Zoloft increase is bad stomach cramps and gas, but that seems to be getting better. Jury still out on whether it's helping my anxiety any more, but it's only been 5 days since the increase.

[bernerbits]

Still here. Interesting development last night...

I'm down to .5mg Lorazepam and 5mg Ambien on my taper plan. Things have been pretty stable, but last night I had some trouble sleeping. I was suddenly wide awake around 11:25 and I just lay in bed for 15 minutes before getting up to read for half an hour. Get back in bed and sleep through until 5 when my alarm goes off. Get up blearily, check SleepyHead and see that I got about 5 1/2 hours of sleep, find the coffee pot empty, and get on with my morning while I curse the Ambien for being inconsistent and my pill cutter for not giving me perfect fractions, and start worrying about needing to slow down the taper.

Later, I'm freshening up for work and I see a half of an Ambien pill sitting there on the bathroom counter. I take it downstairs to line up with the other half of the pill I cut last night, and it's a perfect match. I can't help but laugh; I forgot to take my Ambien. As I have always done, I had put it out the night before with a glass of water, then gone to the guest bedroom to read for half an hour. At bedtime I had brushed, flossed and relieved myself as normal, then filled my humidifier, hooked up my mask and gone to sleep.

This means I got my "core" five and a half hours of sleep on CPAP with a single Lorazepam pill and no Ambien. When I originally went on Ambien, it was because I couldn't sleep at all on the CPAP with three Lorazepam.

So, yay for the placebo effect accidentally getting me a successful night off Ambien far earlier than planned. Roundabout way of saying good news, the taper is going better than expected.

[bernerbits]

I am OFF the Ambien and sleeping well! Next is coming off the nightly Lorazepam which will be a longer, more difficult taper, but it's also a much gentler sedative effect than the Ambien.

Anxiety is down to pre-cpap levels.

Daytime energy is also up to pre-cpap levels, which is progress but I still have some ways to go on that front. CPAP numbers are good but room for improvement - AHI hovering steady in the 2-3 range so I may raise minimum pressure soon now that I know Ambien isn't interfering with my numbers.