[Nimrodgal]

I’m just wondering if it’s OK to do SRT whilst still taking some form of prescription sleep aid? I’ve had insomnia for just over a month and think the main reason it’s persisted so long is due to sleep anxiety and hyperarousal. I’ve been on some form of sleep medication most nights since onset and my medication has changed a few times. I’m currently on 10mg of Ambien and have been taking this since April 1st. With this I have around 5ish hours sleep. Is it OK to Base my SRT around this or do you need to be off sleep aids before SRT? Thanks – Nimrodgal

[Aiva]

Hi there, I am in that situation too.  I’ve been using Imovane, a sleeping pill, a couple of times a week since February.  It’s been my ‘backstop’ for when I had too many bad nights in a row.  But I have only in the past few days started to delay my bedtime, but I’m finding I am using Imovane too frequently and I don’t want to get a dependence.  I have thought of going back on Valium (Diazepam) which I was prescribed last year, used for 3 months.  It got me over the worst anxiety that I developed after a bad reaction to a new insomnia medication Belsomra that saw me hospitalised with heart arrhythmia.  It totally freaked me out and of course the anxiety that resulted completely wrecked my sleep.

My sleep specialist at the time prescribed Valium at bedtime for anxiety about sleeping and Mirtazepine (an anti-depressant that at low doses can help with sleep).  I was on both these for 3 – 4 months only.  I didn’t want to stay on them as my sleep did not improve that greatly – I still had a big gap in the middle of the night – and I don’t really like the side effects of the stuff.  So I tapered off both around the start of this year.  Now trying other methods to train myself to get back to sleep, or create the ideal conditions so that sleep will flow!

Maybe this is a question for your Dr. though?  I’m certainly going to ask my Dr on Tuesday if I can start back on low dose Valium, just to ease the anxiety around bedtime.  I know I can taper off this fairly easily, and I’d like to think that I could gradually ease off it week by week once I gain confidence in my sleep and start to build it up.  Slowly and steadily I will improve my sleep.

[Nimrodgal]

Thanks for the reply Aiva, I’m finding it can be almost like chicken and egg with the anxiety and sleep cycle. Reducing/getting rid of the anxiety will improve sleep and, simulataneously, once we start sleeping better the anxiety around it should reduce too. I guess tackling and reigning in that anxiety really is the key to getting better and sometimes we may need a little help with this in the short-term with medication, just whilst we get back to something a little more normal sleeping-pattern wise. I don’t see the harm in doing this if you feel it will be beneficial.

Like yourself,  I was an imovane for a very short period – I found it worked relatively well to get me to sleep but not to stay asleep. I had such awful nausea whilst on it that I only took it for a few days before my Dr prescribed me something else. I was also given diazepam for two days in the hope it would chill me out enough to kick me back into a more normal sleeping pattern. Though it didn’t get me back to my old self, it did really help with the anxiety but they wouldn’t give me anything more than two day’s worth as they don’t seem to like prescribing it long term over here in the UK. They did try me on duloxetine for a week but it gave me palpitations and can be stimulating, rather than aiding sleep so I’m not on anything for my anxiety at the moment. I might ask again for something, just whilst I recover. I mentioned doing SRT to my Dr when I saw her last week but I didn’t directly ask her if it was ok to do it whilst on the tablets, so will call to check.

 

Wishing you all the best.

[RoyN]

One problem for taking a pill for anxiety right before bedtime is creating an association that you can only sleep with the aid of the pill.    I have found that it is almost as important to alleviate your anxiety during the run-up to bedtime as it is right during bedtime.  What has worked for me in the past is to take a Xanax  for sleep anxiety at 4pm or so in the afternoon.  This helps calm the anxiety throughout the evening and allows me to fall asleep easier without directly associating the pill to bedtime.

[Nimrodgal]

That’s a very good point about taking anti-anxiety so close to bedtime and building an association that you need that pill to be able to sleep. I think this association builds for many people using sleep aids too and that’s why they can be hard to stop, especially the longer you’re on them for. I want to be able to sleep without any medication but part of me is anxious about stopping or tapering it down and how this could lead to things to get worse for a while.

[Martin Reed]

CBT-I techniques such as sleep restriction are effective if you are taking sleeping pills and they are effective if you aren’t taking sleeping pills:

https://www.youtube.com/watch?v=pnOZ8BrYeno

You should not change your medication regimen without talking to your prescribing physician first. Similarly, if you have concerns about medication or sleep restriction, it’s best to talk to your doctor.

I hope this helps!

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[Nimrodgal]

Thank you Martin, the video and your reply have helped to put my mind at ease about this. I’ll keep practising the CBTi techniques and look to come off the medication, with my Dr’s help, when I feel ready.

[Author]

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