Q. I have had five major psychotic breakdowns, drug related. I have been diagnosed with such things as bipolar, obsessive compulsive disorder, schizophrenia, during my last breakdown I had extreme anxiety attacks . . . I've been on meds like prozac, lithium, Depakote, haldol, lorazepam and am currently on zyprexa and remeron. For a two month period during my last episode I had symptoms of PTSD. The remainder has left me an insomniac. I have tried over the counter medications, meditation, music, reading, occasionally I get a prescription for sleep aids, melatonin, things like that-- anyway, on average I get about three hours a day, sometimes less, after a period of five days, exhausted, I can sneak in five hours. I practice a methodic ritual, sleeping at sleep hours whether or not I am tired. It takes me two hours before I reach the breaking point between consciousness and sleep. I've been using sleep therapy, dream therapy, to analyze my dreams. On average I have a lucid dream every four weeks. At the time I had my last psychotic breakdown it was due to a large ingestion of crystal meth, combined with cocaine, heroin, and I had been unable to sleep for a period of three to four weeks . . . I was in the graduate department for literature at a University, but upon recovery in a hospital and follow-up in a medical facility for substance abuse and twelve step programs, I found my creative skills no longer possible. Certain emotions are also blocked off from me, such as the ability to cry. This could be related to my sleep pattern. Sadly, when I was younger and impressionable I experimented with sense depravation and hallucinogenics, inducing schizophrenic episodes. I had worked out a paper in abnormal psychology, about the ability to produce multiple personalities, false memories, create a trauma similar to children molested between the ages of 1 to 12 months . . . I was interested in metanormal human development and the evolution of the brain/mind. I got kind of whacked, reading about trance states, method acting, religious ecstasies, kundalini, kabblah, the templars, ritual mutilation, mediums and channeling, "past life" regression-- all this was going into research in a story about "identity," a sci-fi fiction piece I was developing into a screenplay. My ambitions are less grand now. Although I'm attending a film school.
Anyway, all this has lead me to where I am now. Sleepless.
A. There are a couple possibilities for your sleep problem. The first, and most likely, is that your underlying illness has not been treated successfully, and your sleep problem is one of the symptoms which remains. That would explain the use of Remeron, which is very sedating. Remeron is usually used in folks who cannot sleep. It does not seem to be working, which means you need more (if not already on 60 mg/day) or it just is the wrong medication for you.
Since you have a diagnosis of OCD comorbidly with your other symptoms, you would most likely benefit from a SRI (Prozac at 80 mg, Zoloft at 300 mg, Celexa at 60-80 mg, Luvox at 300-400 mg) or SNRI (Effexor XR at 300-600 mg/day). Lower dosages will not help with the kind of problem you have. There is no guarantee the aforementioned medications will help either, but they are definitely worth a try. It takes 4-6 weeks for your sleep pattern to change on the medications, and it may even get a bit worse before it gets better.
A second reason for your sleep problem is the drug abuse. Some argue that this "burns out" the sleep center in the brain. No good data to support this is in the literature. A third, and final reason, is that the sleep problem may be something you need to put up with for a while as the current medications on the market may not address this portion of your illness. You may also want to try 20 mg of either Sonata or Ambien for a few weeks. This may give you a respite if it works.
