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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 42837
Experience:  Board Certified Physician
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I had a baby 5 months ago and since coming of warfarin for

Customer Question

I had a baby 5 months ago and since coming of warfarin for DVD I've suddenly got into a cycle of insomnia. My problem is lack of sleep causes severe reactions in me. I have extreme migraines, vomitting, total lack of appetite and very black moods when I have anything less than 7 1/2 hours. When I sleep I'm absolutely fine. No depression or health issues. My doctor gave me doxepin which appears to work but I take it sporadically because I don't want to become addicted or for it to lose its affect. My fear of never getting out of the cycle is fuelling everything, I'm scared of not coping with my 4 kids ie falling asleep in the day and baby therefore doing something dangerous, I'm scared of the long term effects on my health and im worried about relying on pills to sleep.

My sleep at the moment is falling asleep at 3/4 in morning at then having to get up with my kids at 3 or going to sleep at 10 ish and waking up at 3/4.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. David replied 3 years ago.

Dr. David :

This is Dr. David

Dr. David :

I am sorry you are having poor sleep.

Dr. David :

you can try other non habit forming sleep aids such as tylenol pm or melatonin to help your sleep.

Dr. David :

talk to your doctor about these options as well

Dr. David :

also exercise during the day can help you sleep better at night.

Dr. David :

sounds like you have a lot of worries and anxieties about your kids and family as well.

Dr. David :

you could also be suffering from some post partum depression.

Dr. David :

you should speak to a counselor about this

Customer : I've spoke to a counsellor before and I know I've got insomnia phobia but because of the extreme effects and I mean to the point of vomiting everything I'm struggling to overcome it. If I was suffering post partum depression wouldn't I be down all the time regardless of how I've slept.?
Customer : I'm a ballet dancer so exercise regularly anyway
Customer : Isn't trle
Dr. David :

I see.

Dr. David :

you need some stronger treatments for your phobias.

Customer : isnt Tylenol not recommended for long term use. Is sleep deprivation dangerous and why do I have such an extreme reaction
Dr. David :

no, you could be down only if you don't get enough sleep.

Dr. David :

sounds like your phobia is out of control

Dr. David :

you need better therapy for your anxiety and phobia

Dr. David :

you might need more than just counseling.

Dr. David :

have you been on an SSRI before?

Customer : I thought doxepin was
Customer : ive also been on amitriptoline but had bad reaction ie. kept me awake
Dr. David :

no, it is a tricyclic antidepressants.

Dr. David :

I see

Dr. David :

I think you need to go back to see a psychiatrist or psychologist about your phobias and your medications.

Dr. David :

it doesn't sound like your phobias and anxiety symptoms are being well controlled.

Customer : My husband is a psychologist and for the last two years ie when pregnant and breast feeding I've been absolutely fine . Soon as hormones go it starts. Is there anyway I can control the effects of sleep deprivation as the vomitting and not eating is a real problem. I'm trying really are to eat but the nausea is making it impossible.
Dr. David :

you might need a stomach acid blocking agent to decrease stomach acid

Customer : Why does it happen everyone else just appears to feel tired
Dr. David :

everyone is different.

Dr. David :

some people have more issues than others.

Customer : Is it dangerous to have little amounts of sleeps for weeks at a time I feel like I'm doing permanent damage and can I use doxepin more regularly
Dr. David :

yes, you should be using the doxepine regularly.

Dr. David :

you need to get sleep.

Dr. David :

the body heals when it sleeps.

Dr. David :

you need to get your insomnia phobia under control

Customer : Will it lose its sedative effect if I use it regularly
Customer : Is 25mg the usual amount for sleep
Dr. David :

it shouldn't loose its effect if you use it regularly.

Dr. David :

it is a medication meant to be used regularly.

Dr. David :

did your doctor prescribe it for you to use it regularly?

Dr. David :

does your husband recommend for you to use it regularly?

Customer : The doc said I can use it when I need it as its not for depression. She said the sedative effect can have less of an effect after a while.
Dr. David :

since you are having problems with insomnia now, I would use it now.

Customer : i am using it but not entirely sure what the normal amount for sleep is. I
Customer : iIn have 25mg tablets
Dr. David :

you need 7.5 hours or more of sleep per night

Dr. David :

do you exercise?

Dr. David :

you are dancing which is good.

Dr. David :

25mg dose is fine.

Dr. David :

the dosing is either 25 or 50 for sleep

Dr. David :

here is a study on it.

Dr. David :

http://www.ncbi.nlm.nih.gov/pubmed/11465523

Dr. David :

BACKGROUND:

Over recent years, the use of antidepressants for the symptomatic treatment of insomnia has grown substantially, but controlled studies are still lacking. Our study is the first investigation to prove objective efficacy and tolerability of low doses of a sedating antidepressant in a randomized, double-blind, and placebo-controlled manner in patients with primary insomnia.

METHOD:

Forty-seven drug-free patients meeting DSM-IV criteria for primary insomnia (mean +/- SD duration of complaints = 11.2+/-9.7 years) received either 25-50 mg of the tricyclic antidepressant doxepin or placebo for 4 weeks followed by 2 weeks of placebo withdrawal. Sleep was measured by polysomnography at baseline and the first night of application, at 4 weeks of treatment and the first to third night of withdrawal, and after 2 weeks of withdrawal.

RESULTS:

In the doxepin-treated patients who completed the study (N = 20, 47.6+/-11.3), medication significantly increased sleep efficiency after acute (night 1, p < or = .001) and subchronic (night 28, p < or = .05) intake compared with the patients who received placebo (N = 20, 47.4+/-16.8 years of age). Latency to sleep onset was not affected since the patients had normal baseline sleep latencies. Investigators found doxepin to cause significantly (p < or = .05) better global improvement at the first day of treatment. Patients rated sleep quality (p < or = .001) and working ability (p < or = .005) to be significantly improved by doxepin during the whole treatment period. Overall rebound in sleep parameters was not observed, but patients with severe rebound insomnia were significantly more frequent in the doxepin group (night 29, p < .01, night 30, p < or = .01; night 31, p < or = .05). No significant group differences in side effects were found, but 2 doxepin-treated patients dropped out of the study due to specific side effects (increased liver enzymes, leukopenia, and thrombopenia).

CONCLUSION:

The results support the effectiveness of low doses of doxepin to improve sleep and working ability in chronic primary insomniacs, although subjective effects were light to moderate, and in some patients, rebound insomnia and specific side effects have to be considered.

Customer : I walk miles and I have 4 active kids.
Dr. David :

I see.

Dr. David :

that is good.

Dr. David :

patients in the study used doxepine daily for 4 weeks in the study safely.

Customer : Would you say this is better than usual drugs like sominex mythology or ambien
Dr. David :

yes.

Customer : And is it different from amtripline as this worked for a few nights then caused insomnia
Dr. David :

yes, it is a different class of drug than amitriptiline.

Dr. David :

do you have any other questions?

Dr. David :

let me know if you have other questions.

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