Are my medicines really affecting my REM/deep sleep THAT much?
June 9, 2010 9:16 AM   Subscribe

Are my medicines really affecting my REM/deep sleep THAT much?

This is very much a play doctor for me scenario, BUT I do have two differing opinions from my ENT and my psychiatrist on my ENT's proposed medicine changes to help my sleep. So therefore, you are authorized to play my 3rd doctor, so please no IANAD posts. I come seeking simply advice as well as recapping the stances of two doctors so far.

Now on to my grand tale which will consist of several paragraphs most likely.

I've had insomnia for about 4-5 years now and at this point and this posting, I've learned to cope with it but it's still far from ideal in terms of that I need my 2 cups of coffee to get through the morning/day. A more positive attitude has helped me deal with it as well. Yet, I still hold out hope that my insomnia can actually be remedied fairly well one day.

So a year and a half ago, I had two sleep studies from the same sleep lab. One without a CPAP (first study) and one with a CPAP (second study). We came to the conclusion that I had severe obstructive sleep apnea (my ass). So we tried CPAP for a while and I hated it. I also now have a $2400 TAP appliance that is collecting dust because it doesn't work. I slept like pure shit both times, but they claimed when I was on their CPAP machine that my sleep was better (It was like 230, 240 mins of total """sleep"""). In short, I deemed them utterly incompetent after 5-6 months of going to appointments etc. More info on them and in general here:

So that's all the long backdrop. Now for my actual scenario.

I recently had another sleep study with a different sleep lab that my ENT recommended (the previous two studies were with a sleep lab that my psychiatrist recommended). The results came back and it turns out I don't have sleep apnea according to this study. That was thrilling to hear and so I was like well that's good. My ENT said that I definitely didn't sleep well though because my REM/deep sleep is virtually non-existent.

So he proposed a few medicine changes that sounded good in his office, but I got to thinking about them and this is where I come to this site for advice.

Currently my morning medicines consist of Cymbalta (120 mg) and Adderall (20 mg). My bedtime/sleep medicine is Melatonin (10 mg) + Klonopin (1 mg) + Edluar (20 mg, sublingual version of Ambien).

My ENT is a great doctor and I trust him as much as you can trust any doctor, but he's essentially recommending that I change all my medicines but Adderall XR (since I told him it really helped me). I have an issue with this that I didn't bring up at the appointment (but plan to fax him a letter about it).

The proposed changes are

Cymbalta (120 mg) ---> Wellbutrin XL (150 mg)
Edluar (20 mg) ---> Rozerem (8 mg, but likely 16 mg)
Klonopin (1 mg) ---> nothing (useless herbal teas I guess, lol)

I finally started to research this a bit today and I couldn't find anything conclusive on Cymbalta and REM/deep sleep. I get some info from these moronic sites like "" and "cymbaltasurvivors" saying yeah of course it affects REM sleep, it's the devil DUUUDDDE! Whereas the half-reputable sites didn't help much more just saying that affecting sleep could be a possibility but that tolerance/getting used to Cymbalta after a while would less the REM/deep sleep inhibiting effect.

The thing is since this recent sleep study (2 weeks ago) said I didn't have sleep apnea which would confirm my thoughts about the previous incompetent sleep clinic, we're trying to focus on the drugs that I'm taking and general sleep hygiene. I've been on Cymbalta for about a year and a half. It's helped me, it doesn't fix everything but I like it. According to him, Cymbalta is among the worst of the REM/deep sleep affecting drugs. As is apparently everything else I'm taking (which I don't know about all of that). However, I like Cymbalta. I'm stable on it, it's affordable, and it seems to help. If push came to shove, I could switch to another anti-depressant (I'd been on like 80 of them before cymbalta) but I'm worried about losing the anti-anxiety effects of Cymbalta by switching to Welbutrin XL. I "think" (I'd have to call her up again to make sure) that when this change was proposed on a prior ENT visit months ago, my psychiatrist cautioned me saying that Cymbalta was better for generalized anxiety, so I left it at that.

That being said, that leaves my nightime medicines as medicines that could possibly change. The dropping Klonopin I don't like at all because none of the herbal teas, kava kava, etc have NEVER NEVER NEVER done me much good as a relaxant before bed. So where would that leave me? Yeah it might be a big bad evil REM sleep inhibiting drug, but what would I replace it with a bunch of flowers at night? lol

The Edluar to Rozerem switch I wouldn't mind at all if it weren't for the fact that Rozerem at double the dose (16 mg) was ineffective for me when I tried it months ago. Edluar has the active ingredient of Ambien and thus is supposed to have the same deep sleep inhibiting possibility as Ambien.

The thing with all this is it's a am I damned if I do and damned if I don't scenario in my opinion. I'm stable on Cymbalta, yet it's supposed to not be good for REM sleep (then again what anti-depressant is? lol). I like my klonopin/edluar combo (but am much more open to changing it than my anti-depressant), but my ENT's proposed changes leave me without a night time anxiety drug and then on top of that Rozerem which costs 3 times as much as Edluar, AND doesn't work! Get a load of that huh?

I guess the information I'm looking for is what do you guys think? I know, you're not doctors (although some could be :) ) but I love this place and trust it when I have a situation that concerns my long-term well being.

Review Questions

1) Is Cymbalta really that bad for REM/deep sleep? Anyone else have experience with this?
2) For my sleep combination, is there a less REM/deep sleep inhibiting combination than Klonopin and Edluar?
3) What do y'all think about my master's thesis I wrote in general? Ideally I'd be on no medicines, but it hasn't worked like that so far. Medicines have helped me. Where does one draw the line with consequences and benefits from medicines?
posted by isoman2kx to Health & Fitness (11 answers total)
Response by poster: Before the exercise suggestion comes in, I do exercise. I still seem to wake up multiple times a night regardless.
posted by isoman2kx at 9:16 AM on June 9, 2010

Have you tried stopping the Adderall? Sleep issues are a well-known side effect, and I'm surprised the doctor never brought that up (but changed the rest of your regimen). IIRC, 20mg's a pretty heavy dose too.
posted by schmod at 10:03 AM on June 9, 2010

I too have a problem with achieving REM sleep/waking up constantly. After trying literally every single sleep aid, (and for what it's worth, Rozerem was the most useless of the bunch), I discovered that 2mg of Ativan a little while before going to sleep sorted things right out. Have you considered upping the Klonopin dose?
posted by crankylex at 10:20 AM on June 9, 2010

answering an unasked question about sleep apnea:

* has a sleep specialist compared the reports from your two sleep studies? perhaps the first sleep study was incorrect, but it's also possible the second one was. the fact that the CPAP seemed not to help is not proof of the former
* in my case, the CPAP resolved my sleep apnea, but I still had other sleep issues that prevented restorative sleep
* a different mask can make a CPAP device more user-friendly
* untreated sleep apnea can be fatal
* we minimize the seriousness of sleep apnea because we are unconscious when we experience it. if we stopped breathing for long stretches of time, gasping or coughing for breath, when we were awake, we would seek an immediate remedy
posted by QuakerMel at 10:21 AM on June 9, 2010

Were the Klonopin and Edluar more effective in the past than they are now? I ask because my psych won't prescribe that type of medication for sleep, because he says they become less effective over time and require higher & higher doses.

I used to take Trazodone for sleep - it was great when my sleep was worse, but my sleep is a little better now, and it actually makes me sleep for too long (12 hours a night) so I stopped taking it. I'm not sure how it affects REM sleep.

Now I'm taking Neurontin (Gabapentin), is supposedly a non-addictive anti-anxiety med that your body does not get used to/ does not require higher doses over time. It definitely helps me fall asleep, but I do tend to wake up in the early morning hours. I'm not sure if my dose is currently too low, or if it's just not the right med for me. I have an appointment with my psych to discuss this week. Oh, and I definitely go in to REM sleep on Neurontin - I have quite vivid dreams. Maybe this one is worth discussing with your doctor.
posted by insectosaurus at 11:34 AM on June 9, 2010

I did some research on this myself. I have been on an adderall like drug for a while, and noticed that it seemed to "build up". If I didn't skip a day a week, I was a basket case.

Well, I had a rough couple of months, and didn't skip any days. And my sleep quality was terrible. Just endless, tired trashing. I cut it out for a weekend and slept all weekend.

In doing some research, I found that amphetamine is metabolized by the liver enzyme cyp2d6, which it turns out, many people have varying levels of. I cut my dose in half and I'm all better now.

As you can see by the link, there are a TON of drugs that effect or affected by that enzyme, and is a big cause of a lot of drug interactions. You might try getting tested for your level of activity and see if it might be a cause of the issues.
posted by gjc at 12:25 PM on June 9, 2010

I have been under a lot of stress and the only thing that have helped is a combination of:
1. Melatonin (3 drops)
2. Valerian (3 drops)
3. Hops (3 drops)
4. GABA (1/8 tsp)

I couldn't take them in tablets because they are too strong for me. I have found out that the drops work much better. I put then in some water 2 hours before going to sleep. For the first time in my life I yawn and feel sleepy.

I hope this helps. I am afraid of Ativan, Ambien and all those medicines and wouldn't recommend them.
posted by dupedyestafada at 1:30 PM on June 9, 2010

So we tried CPAP for a while and I hated it.

What's "a while"? Yes, it sucks. It's a huge pain in the ass. I totally agree with you there. However, you can't really tell if it will help you without using it faithfully for six months or so. You will learn to fall asleep and stay asleep with it on, but it takes time and persistence.

Also, why are you seeing an ENT and not a sleep specialist?
posted by desjardins at 1:59 PM on June 9, 2010

Insomnia is a side-effect of Wellbutrin too. You could switch the Klonopin to a different benzodiazepine but that stuff is not good for you. Could you try going without Adderall? And give up coffee? Maybe use something like guarana to give you morning energy. It contains caffeine, but different plants have different effects on different people. Try chocolate (not the sort with sugar).

Crankylex, 2mg Ativan is diazepam-equivalent to 1mg Klonopin.

Also, if these things cost you money, get generic formulations.
posted by westerly at 3:24 PM on June 9, 2010

I can't get any decent sleep when taking any SSRI. Even with meds that otherwise help me sleep (trazodone, at this time). They're trying all kinds of things for the fibromyalgia, but Cymbalta (most recent attempt) and the like completely deprive me of decent sleep. Maybe it's not the culprit in your case, but it certainly can inhibit sleep/good sleep.

FWIW, my husband didn't sleep for two days when he started on Adderall, but eventually he got used to it enough that it didn't seem to bother his sleep at all. He's now on Vyvanse and seems to do well on it also.

In case it's helpful, I *like* trazodone for helping me get decent sleep. I fall asleep reasonably quickly, I sleep through the night, and I usually am more awake in the morning. All of this is new since I started the trazodone.
posted by galadriel at 7:57 PM on June 9, 2010

Response by poster: Thanks to all who replied. I will analyze these comments and disperse emails to you guys. I want to get this sorted.
posted by isoman2kx at 8:27 PM on June 15, 2010

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