My medications are making my sleep lest restful. Help?

December 7, 2008 3:03 PM

My medications are making my sleep lest restful. Help?

I'm currently on 4 medications: Atarax (10mg), Seasonique, Cymbalta (30mg), and an antibiotic. Some background: I have interstitial cystitis, so the Atarax is meant as one part of treatment for that, and the antibiotic is meant as a preventative (as I am getting bladder instillations for the IC). I started taking the Seasonique about 3 weeks ago, and the rest of the medications later that week - so about 2.5 weeks ago.

Since starting the latter group of medications, I've noticed some sleep disturbances. I am waking up in the morning (my guess would be about 5 or 6am, though I've never been coherent enough to check my alarm clock), and then dozing until my alarm goes off (usually between 7 or 7:30). While dozing, I tend to have very vivid, active dreams. They tend to feel mentally tiring, and they are also often mildly stressful.

My sleep hygiene is fairly good, I think - I take my medications at about 10:30, read or play around on the computer for awhile, and I am usually asleep by midnight. I don't have any trouble falling asleep. I usually wake between 7 and 7:30 during the week, and I find the latest I usually sleep in on the weekends is about 9:30.

A few other pieces of information that may be useful:

(1) Last Monday, I had a late shift at work (this is very unusual). I didn't take my medications until about 12:45am that evening. I didn't notice any sleep disturbances for the next few days - they "came back" yesterday morning.

(2) I have talked about this with my doctor. (Rather, I had someone at the office put a note in my file. I don't see him again until January, and no, I can't see him earlier than that.)

(3) I have read some of the other threads about Cymbalta and sleep issues; it seems like Cymbalta's the most likely culprit, though I think the Atarax is a possibility, also.

It seems the most reasonable thing for me to do would be to try taking Cymbalta in the morning, instead. However, I have a concern about this - I'm notoriously bad at remembering to take my medications. I've been very good about taking my medications recently because I'm taking the 4 of them at the same time every evening. I'm concerned that if I had to move 1 of them to the morning, I might start forgetting to take that medication. (Can't take the Atarax in the morning, as it's got a sedative effect.)

So, what I'm looking for is:

(1) Advice on how to remember to take my meds (if you think changing the medication timing is the thing to do).

(2) Advice on something I could do with regard to my sleep habits - set my alarm for earlier? Set an alarm for peaceful music at that time? Learn lucid dreaming? Something like that.

(3) Any other relevant advice. :)

If you have any follow-up questions, you can send them to anonymeta [at] gmail.com. Thanks in advance!

posted by anonymous to health & fitness (6 comments total)

Cymbalta and similar drugs can cause sleep disturbances, in particular, vivid dreams are not uncommon. You could try asking your doctor about taking more Atarax before bed, as it has a sedative and anxiolytic effect that might help you stay asleep through the night and perhaps tone down the dreams a bit.

As for remembering to take your medication if you decide to try the Cymbalta in the morning instead, you need to make it a part of your morning routine. You don't forget to brush your teeth or put pants on in the morning, right? Set up a pill box and keep it front and center on your bathroom counter. Put a note on the mirror to remind yourself if need be. Tell yourself that you won't let yourself do X (shower, make breakfast, brush teeth, etc...) before you take your pills.

You say you can't talk to your doctor before January; could you perhaps set up a short phone consultation with him in the meantime to discuss this?

I am not a medical practitioner, your mileage may vary, etc...
posted by zachlipton at 3:35 PM on December 7, 2008

I remember to take my morning medications by keeping them in my makeup bag. I don't let myself start putting on makeup before taking the pills, and since wearing makeup is a habit that has become very deeply ingrained since I purchased my first Bonnie Bell blush in 1982, I always take it. If you link taking your meds to something you always do in the morning, you'll do it.

Oh, and I'm a pharmacist, and I think your idea of taking the Cymbalta in the morning is probably what your doctor would advise you to do. If it gets really problematic don't hesitate to call your doctor back (since I see you already called). Ask to talk to the nurse and tell him or her that it's interfering with your life. Not getting enough sleep can really mess you up and there is no reason to suffer for weeks.
posted by selfmedicating at 4:05 PM on December 7, 2008

I had to switch one of my medications to the morning for the same reason. I have underlying sleep issues, so complicating that with insomnia causing meds was making my life a living hell. The only way I could remember to take it every morning was to put the medication next to my tea, which I drink without fail every morning.

Also helpful: putting medication next to your toothbrush. Whatever it is that you ALWAYS use in the morning, put your meds in/next to it. It'll be a lot harder to forget.

If you really, really can't get enough sleep even after trying this, try taking a small dose of melatonin with your other meds, just to remind the brain that IT IS CAN BE SLEEPYTIMEZ NAO.
posted by grapefruitmoon at 5:12 PM on December 7, 2008

Maybe you can't "see" your doctor until January, but surely you can make contact with him/her? You really should make every effort to, and a worthwhile doctor will work with you or refer you to someone who can.
posted by mattholomew at 5:42 PM on December 7, 2008

The only problem with putting the medication next to your toothbrush (see above comment) is that it is not good to store certain meds in the bathroom. The humidity reduces their effectiveness. I would make a sign big enough to be embarrassing and stick it on the bathroom mirror so that you cannot miss it. But keep the medications in another room. Once you take it regularly a few times it will become part of your routine. I hope this helps. I am having sleep problems too, right now, with a beta blocker.
posted by artfann at 7:25 PM on December 7, 2008

Anon, two thoughts:

(1) If you are waking at 5:00 am, but your normal wakeup time is 7:30 am, have you thought about, instead of addressing the interruption to your sleep schedule, accommodating it? In other words, if the sleep time that "should" be is 12:00a-7:30a, but if you're waking up at 5:00a, making it 9:30p-5:00a -- or 10:00p-5:00a, etc.?

(2) As for the medication reminders, what did the trick for me in a similar circumstance (evening pills, used to taking them in the morning) was two-part: (a) to put the medication right by where I anticipated myself to be that evening, and (b) to have my computer spit out a big fat reminder that I had to properly click away at the proper time. Don't know what system you're using it, but if it's a Mac, check out the system I described at this comment -- it's such an obnoxiously large reminder that it's hard not to get up and do whatever it's reminding you to do.

(I am not overlooking the heavy irony of addressing a sleep hygiene problem while typing at a keyboard at 3:18 am in the morning.)
posted by WCityMike at 1:23 AM on December 8, 2008