Has anyone given up day-time meds?/opiates/sleepiness

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Helen518
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Has anyone given up day-time meds?/opiates/sleepiness

Postby Helen518 » Thu Jun 11, 2009 2:19 pm

Does anyone with daytime symptoms just resolve to suck it up during the day because all meds just make them too sleepy to function? Just wondering what that is like if anyone out there is doing that.

If I take enough methadone to cover my symptoms I am becoming way too sleepy and my driving is risky. If I don't take enough, then my legs are crazy with creepy crawlies. Today I am beginning the gradual switch over to vicodin during the day and methadone at night to see if it reduced my day time sleepiness, but I am afraid that the vicodin will make me too sleepy too.

If that is the case, I may just have to suffer during the day . . . maybe take benzos to stay calm during the day when my legs are acting up. The benzos don't seem to make me sleepy enough to cause a problem. They only make me tired if I am already tired.

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Postby Sojourner » Thu Jun 11, 2009 2:24 pm

H, I can definitely say the Vicodin does not make me sleepy but then nothing does. Sometime, unfortunately, "sucking it up" may be all that is left but I would hope that is not in your future. I would like to feel optimistic that if you keep working with your doc you will be able to find a happy medium. I'm sure others with more similar experience to yours will be more helpful. Best wishes, my friend. M.
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Neco
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Postby Neco » Thu Jun 11, 2009 6:00 pm

I don't know what your daily dose of Vicodin is, and this does vary in some people, but back when I was knee-deep in overmedicating myself, I would often end up with Paradoxical Insomnia as a side effect, even if I was tired enough to pass out one minute and be up the next.

Usually this starts happening as the dose goes up, but I am a little different in that I can push myself to stay up and then the meds take over as I redosed and it would just go on for 2 or 3 days until I finally made myself go to bed to at least watch some TV and finally pass out, or something like that.

I could not identify a specific dose trigger with Vicodin, other than the combination of events, but with Methadone if I start to go above 20 - 25mg sustained for more than 2 days I will end up the same way. I know 20- 25mg of Vicodin was nothing to me though and it usually took a lot more than that to start the cycle.

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Postby ViewsAskew » Thu Jun 11, 2009 6:19 pm

It's tough when you're taking multiple things....you may have to experiment more and find something that doesn't prevent you from staying awake. Sounds like you're already doing that...
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Helen518
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Postby Helen518 » Thu Jun 11, 2009 7:48 pm

It's weird. I can handle insomnia. It's this panic that I can't stand. For months I've handled an occaisional night with difficulty sleeping with no anxiety. I just handled it. Then all of a sudden I started waking up in the middle of the night, terrified. NOthing I did would calm me down, not even a long walk, until I finally would cave in and take a benzo or mirapex or now, mirtazapine. I thought it was caused by the hyosciamine I was taking for my bladder, but when I stopped that, I continued to wake up terrified. It's much harder for me to calm myself down in teh middle of the night than it is in teh day time. When this continued to happen night after night, I thought it was time to take mirtazapine again. I was so grateful to sleep. But now I am falling asleep during the day at the drop of a hat. I don't even see it coming. I'll think I am totally awake, then BAM! My eyes close and I am asleep. I wake up when my car runs over those grooves on the shoulder of the road! Very bad. It was only happening on teh highway, but then today it happened on a regular road and I rear ended someone in my new car. I have enough provigil to get me to Tuesday. My husband is afraid to let me drive my son in the son in the car. My neurologist is out of town and my Psych is also on vac. I made an appt with my GP for tomorrow. I just need enough provigil to hold me over until my methadone dose gets down to 10 mg, I think.

To be honest, I think I would sacrifice my day-time comfort if it meant I wouldn't have this terrible dark feeling off and on and if I could sleep thru the night without waking up in a panic. I really do. Honestly, I was happier on requip and lorazepam than I am now. It is a shame because the methadone seemed to work so well for a while.

Of course, it could turn out that the methadone is not causing the panic. I could get my dose down and still experience it. It is truly maddening. It makes me very angry inside. :x Maybe I am just angry that I have to deal with this at all. I have many fears and much anger that I have no outlet for. I've been reading about how suppressed rage *can* cause all kinds of disorders. Surprisingly, they don't list RLS. I would have thought that many folks would assume that it was psychosomatic. The things that are on the list are back pain, carpal tunnel, tennis elbow, GERD, IBS, Urinary tract problems and prostatitis, fibromyalgia. Not to say that everyone who has these disorders is experiencing psychosomatic symptoms, just some subset.

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Postby Wayne » Thu Jun 11, 2009 8:19 pm

Yes. That's what I had been doing. Up until a few weeks ago when I was put on Neurontin for neuropathy.

I had been taking Xanax .5mg only at night to get to sleep. I don't know if it made me drowsy or not, but it definitely allowed me to relax. And since I was already sleep deprived I would get sleepy and be asleep shortly thereafter.

I was not willing to take the Xanax at any time during working days because I was afraid of falling asleep at the wheel. I have a 30 mile, 45 min drive to/from work and a very comfortable, smooth riding car.

My RLS (now neuropathy) was not presenting until late afternoon, so it wasn't so bad to just endure it for 4-5 hours.

Maybe you could find someone to share your ride with? I've tried that for years, to save gas also, but no one from work lives close enough to me to make it practical.

Don't know if this helps, but that's my experience.

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Aiken
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Postby Aiken » Thu Jun 11, 2009 11:51 pm

Helen--

When do your symptoms peak?

Mine peak maybe 8pm through 1am. The rest of the day they're pretty stable and, thank goodness, minimal.

That's why I sort of do the opposite of what you're doing. Methadone has such a long half-life that what you take today is still half-there tomorrow. That makes it good for covering the non-peak hours. If you graphed my methadone content over a few days, it'd be nearly a straight line. A little wobbly, but mostly straight. Then, if you added in my hydrocodone, you'd see a hydrocodone-colored peak in the evenings, layered on top of the straight methadone line. That's what I use the hydrocodone for.

Here, lemme see if I can draw my day, from midnight to midnight.

Okay, the blue lines are methadone, and the red ones are hydrocodone. Note that today's blue methadone line sits on top of a couple of previous days' doses, since the half-life is so long. Likewise, the second and third hydrocodone doses sit on top of the dwindling first.

Image

Note that I get up around 11am, so that's why the blue methadone bump is near midday, instead of more like 8am for a normal person. :)

If I didn't do it this way, and just took methadone, I'd need to take a big dose of methadone to cover my evening peaks. Unfortunately, that would look like this, and you can see why I got drowsy during the day, because I've got about twice as much methadone on board while I'm at work from noon 'til 8pm.

Image

Does that make any sense?
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.

Johnny2
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Postby Johnny2 » Fri Jun 12, 2009 6:03 pm

Hey there!If you have an open minded doctor (it sounds like you may)
(thank god I do!!!) you may ask for a stimulant. I take a combo of
methadone, oxycontin for my refractory rls/plmd and a small dose of adderrall to kick start my day. It's almost playing polypharmacy
but none of asked for this, and this is the best combo I have found so far.
Is it nap time yet ?

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Postby Maria » Sat Jun 13, 2009 4:45 am

The red-line/blue-line drawings make a bit of sense, but I’m not a graphic organizer thinker so much as a verbal thinker.

I started methadone in January and have been taking 10 mg late evening. I have been awakening around midnight - without symptoms – since about March or April. Now I’m awakening with symptoms at midnight – 1 a.m. I take another 2.5 mg methadone, go back to bed after about a half hour or less and sleep fairly well through the night.

I have always been an early riser – 5 a.m. and usually go to bed around 9 – 9:30. Now I can’t seem to make myself go to bed before 10:30 or eleven; I’m up at midnight, and sleep until 6:30 or 8:00.

My doctor suggested I supplement with Lyrica as I am having back pain and thigh pain (from total hip replacement). I can’t tell much difference, but it may be helping the thigh pain. His idea was that perhaps the Lyrica may relieve the thigh pain as well aspossibly enable me to cut down the methadone dose (although he isn’t worried about it).

Aiken, if you don’t mind weighing in on this, what would your experience with methadone and sleepiness suggest? I am so unaccustomedly drowsy in the day time now. Driving does worry me although I’ve been really careful. What would be the best times to take medication to avoid drowsiness? How does supplementing with hydrocodone ameliorate this symptom?

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Helen518
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Postby Helen518 » Sun Jun 14, 2009 5:41 pm

Everyone's posts are quite interesting.

My Neuro called me on Friday night around 5:30- his typical time. THe result is that he recommended that I stop the remeron, as it is highly sedative. He recommended I cover any panic attacks with benzo's. SO, I've been taking .25 mg of Klonopin at bed time the last 2 nights and have not woken up with panic. I also took .5 mg lorazepam in the morning yesterday because I felt mildly panicky. TOday I took it again because my anxiety was pumping up. However, today I resolved to not take anymore in the day unless I had tried at least two other methods of calming my body or legs without success. I'm not sure if my day time sleepiness is better. I think it is just as bad. I've felt the beginning of sleepiness yesterday afternoon and I totally fell asleep when my husband drove us to Philly (about 1 hr) for an evening out, and on the way home too.
I did experiment two days switching one of my doses to vicodin. However, since I also took provigil and remeron that day, I can't be sure hwo well it worked. My legs were awful in the evening. the nextg day they were 10 x better when I had not taken remeron or provigil and went back gto taking methadone, per neuro's instructions.

Bottom line is, back on methadone for a few days and dropped remeron to see if my sleepiness is tolerable. He wants me to have a sleep study. I never did one (he thought I had). I have to sleep at his lab in Baltimore. My husband and son will book a hotel and drive down with me and spend the evenign, then drop me off at 9 pm on a friday night. I hope I can fall asleep in a lab! It sounds unpleasant! My husband had to do a sleep study near our home 2 times and he hated it. (he has sleep apnea but refuses to wear the mask).

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Neco
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Postby Neco » Sun Jun 14, 2009 6:28 pm

I hope it all works out for you.

The benzos may also be contributing to your sleepiness, so any time you can cut them out, or perhaps if you try taking them earlier, you might get better results?

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Postby ViewsAskew » Sun Jun 14, 2009 9:35 pm

The last line of your post scared me to death....he has apnea but won't wear the mask.

There are potentially other options, depending on the type of apnea he has. But, to be untreated is downright dangerous. My hubby's best friend did that....he now has heart damage because of it and become diabetic. They lay both at the feet of the unresolved apnea. His apnea requires a mask, so he now just has to deal with it.

Per the sleep study, I won't say it was the happiest night of my life, but I've been through worse, too. Take reading material or whatever you do when you can't sleep.

One thing you can ask the to do is to connect everything to your body, but not connect it until you are ready to sleep. If you are restless and you have to call them to unconnect you, it's a pain.

Sleep hours at most labs are 10 PM to 6 AM. I normally sleep about 2 or 3 AM until about 11 AM (or later), so that is also a potential problem. Just make them aware of it if your hours are different so they know what to expect. I was able to get one lab to let me sleep from 2 AM until 10 AM.
Ann - Take what you need, leave the rest



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Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Johnny2
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Postby Johnny2 » Mon Jun 15, 2009 4:23 pm

Helen I just had one more thought about your anxiety/daytime sleepyness
you could discuss catapres (clonodine) with your doctor, it is normally
used for blood pressure and some times to help with withdrawl syndrome
its an alpha blocker that slows your body's extreme reactions to stress and such, and really should'nt cause any daytime sleepyness but may help
both of your conditions instead of taking sedatives :) John
Is it nap time yet ?

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Helen518
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Postby Helen518 » Mon Jun 15, 2009 6:10 pm

Thanks for all your advice, John, Ann, and Zach.

I just called and left a message at the Neuro's office to make the appt for sleep study. Three nights with no remeron and doing fine. Taking .25 - .375 mg Klonopin at bed and sleeping thru until 5 or 6, but waking with a somewhat tight chest. Can't complain, though, hope eventually to be off the klonopin.

Still a bit sleepy when driving but not nearly the hazard that I was before. I think I was falling asleep for up to 5 seconds at a time, now I just do a quick head bob. I'm supposed to evaluate my level of sleepiness without the remeron, so I'm not taking the provigil (besides, more than 2 consecutive days on that stuff destroys my stomach).

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Postby ViewsAskew » Mon Jun 15, 2009 7:59 pm

Sounds like an improvement...this is good.

I wonder if a shorter half life benzo would help you and you'd have even less daytime sleepiness? Klonopin is forever in your system (like 36 plus hour half-life).
Ann - Take what you need, leave the rest



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