With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. This week, we focus the spotlight on medications that can help you sleep.
Before we crack open the medicine cabinet, I’d like to say a few words about bipolar disorder and sleep. Sleep is a biggie. Too much could trigger or be symptomatic of depression. Too little could trigger or be symptomatic of a manic episode. At least one study shows that changes in sleep patterns can be an early predictor of a manic episode. Sleep plays a major role in mood disorders and recovery, so if you’re having trouble sleeping, you and your doctor need to do something about it.
That something could consist of many strategies, ranging from very simple (such as going to bed the same time every night) to more involved – medication, avoiding caffeine and other stimulants, maintaining a strict sleep schedule, and convincing other family members to stop banging around in the kitchen till two in the morning. In stubborn cases, you may benefit from a sleep study to identify factors that may be contributing to the sleep disturbances.
Assuming your doctor and you decide that sleep medication is necessary, your doctor may prescribe one or both of the following:
A little-known fact is that the active ingredient in many over-the-counter sleeping pills is diphenhydramine – the generic form of Benadryl!
Several effective sleeping pills are available, which vary in terms of safety, side effects, and other considerations. The following list provides a quick rundown of some of the more common prescription sleep medications currently in use:
Some older sleep aids include Restoril (temazepam), Halcion (triazolam), and ProSom or Eurodin (estazolam). These are not used frequently anymore – and have a history of being addicting and causing a number of side effects. Halcion has been withdrawn form the market in several countries. If your doctor recommends one of these medications, question the reasoning for using an older drug.
Some medications that are not bona fide sedatives are often used for this purpose. Following are a few of the more common and effective medications in this group:
What about melatonin?
Melatonin is a natural hormone, released by the brain when it gets dark. It is available over the counter. It is an effective sleep aid and is well studied even in children. The safety profile is quite good. Doses range from 1-5 mg per night, and it comes in pills and spray forms.
All medications have side effects. Prior to taking any prescription or over-the-counter sleep aid, consult your doctor let her know all the medications you are currently taking, including over-the-counter medications and “all natural” or herbal remedies. In addition, be aware that any sleep aid can cause drowsiness, so avoid driving or operating machinery while taking these medications, especially when you first start taking them and are unsure of the effect they may have on you. Additional side effects may include the following:
I recommend or provide sleep aids frequently, because sleep problems are so commonly associated with mood disorders and other psychiatric conditions. I encourage people to practice good “sleep hygiene” as a primary intervention:
If we do need to use a sleep aid, I will often start with melatonin before proceeding to prescription interventions. We try hard to use medications for brief periods of time. Getting enough sleep is important in recovery from mood disorders, so treating aggressively is important.
If you have bipolar and accompanying sleep-related issues, please share your experiences and insights and any helpful suggestions. This goes for you doctors and therapists out there, too!
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Becky at 7:45 pm on
November 6th, 2009I have bipolar with sleep issues. I have been seesawing back and forth between Ambien CR and Lunesta, mostly due to which one insurance will cover on any given year. For example, I just had to switch from Lunesta to Ambien CR last month.
I don’t really notice a difference. Usually, they help, but if I’m too revved, I still have trouble. Too much stimulation can be due to a late movie or dinner, or anxiety producing situations during the day or evening. So this stuff is not fool-proof. I have had trouble sleeping for many years even before I was diagnosed.
On rare occasions (thankfully) I have been up all night despite being on 3 psych. meds, one of which is very sedative. I do wish that science could unravel this serious problem . Why do people like me have insomnia and others don’t.? I can’t even nap anymore.
lisa at 12:16 am on
November 8th, 2009this is such a big deal for me i cannot tell you how happy i was to find it. why? it’s just so overlooked i think. people do not realize how horrible it is when you don’t sleep well. it’s beyond just a bad night here and there. i can count on one hand the times i’ve enjoyed REAL sleep in the past 3 years. i am so used to it i joke that i won’t know what to do if i ever wake up feeling rested! I’ve tried most meds you mentioned. nothing works! nothing! OTC stuff is total crapola. i tried trazodone but it does NOT sedate at all so i’m sick of people saying it’s just oh so sedative. HOGWASH! for me it didn’t help at all. i got laidoff 7-31. i still have no job. i have no insurance so ihave to go to a clinic where the psych doc tries but just keeps trying stuff on me which makes me feel like a guinea pig. then she wonders why i am so tired and angry and manic. DUH! i have tried Rozeram too but the only good thing about it is the cute TV commercials with the man and the talking Abe Lincoln and talking chipmunk thing. nothing’s hurt me but it doesn’t help either. i am DESPERATE for help with a sleep study. i’m willing to be a case study if needed but someone has GOT to help me get into a sleep study program. i am a lost cause at this point. and it’s horrible not being able to sleep well. also, to make it worse, we battled bedbugs for over a year so we have been sleeping on airbeds for a year. not good either for sleep quality. so anyone feel my pain? i am not a bad person. i am usually very energetic and happy but really, this lack of good sleep is getting chronic to say the least. something has to give. i now feel cynical when i read any warning on a bottle that “this product may cause drowsiness” i wanna scream OH YEAH? I DARE YA!
I had insomnia off and on my entire life, prior to starting on medications with a sedative side-effect about 10 years ago. I don’t recall thinking of the insomnia as such a terrible thing (except for the nights I couldn’t get my brain to slow down), but it certainly contributed to pushing me in to mania and depression.
I tried Ambien, Lunesta, Sonata, Klonopin, and Trazadone, over the years. I developed a nasty dependency on Ambien and abused as my tolerance levels increased (this was prior to accepting treatment for bipolar disorder). The only thing that’s worked well for me has been Seroquel, which I’ve taken for about 8 years, now. I don’t seem to build up any tolerance to it, and it reliably knocks me out every night.
The flip side of this is that I haven’t been able to sleep without it since I started taking it.
I’m surprised you didn’t include Seroquel in your article. In low dosages, it has begun to be commonly prescribed as a sleep aid, even for people without a diagnosed mental illness. It’s been a Godsend for me.
Waco
Hi, Waco–
As Dr. Fink mentions near the beginning of her post, atypical antipsychotics and anxiolytics are sometimes used to help with sleep issues related to mood disorders, but this post focuses on meds designed specifically to act as sedatives.
You’re right about Seroquel (an atypical antipsychotic). A Dr. I met in Slovenia told me she often prescribes Klonipin (an anxiolytic) to help with sleep issues, because she finds that it’s not prone to be abused. According to her, at high doses, Klonopin causes the tongue to swell, which isn’t a very pleasant side effect.
Kazz at 9:37 am on
November 10th, 2009Im starting to get a little desperate I can be dead tired but unable to sleep and if I do sleep its a broken nights sleep where I wake up several times per night – I take 400mg SR Seroquel, 2 Alodorm (sleeping tablet) and if that doesnt work I add 2 Valium and still I wake through the night when I finally get to sleep – I then wake in the morning feeling hung over and I might be able to sleep an hour or so during the day but thats it I have bipolar and the Seroquel seems to be helping all the mania etc but not the sleep side of things my psych recently told me to take 800mg of Seroquel for a few days to try to set off a sleeping pattern but it didnt work – well its 1.35am I took 400mg Seroquel and 2 Alodorm at 9pm Im about to take a couple of Valium as I am tired but cant fall to sleep – Im wondering where I go to from here??
chris at 5:31 am on
November 22nd, 2009A typical week of sleep for me averages 10-14 hours, most of those on my days off laying around all day getting an hour here an hour there. This has been going on for 9 years. I work shift work, 5/12 hour days, 3 days/2 nites. It is common for me to only sleep 1-3 hours combined for all 3 days. I do better for nite shifts. Ambien will give me 1 1/2 – 2 hours sleep, but makes me sick and extremely tired the next day. My doctor prescribed Temazapan with little affect. My life is complete missery, I feel like shit all the time and have no energy. My job is physical and pays well, I dont have another option to make that kind of money. The only thing that has got me a full nites sleep in years was marijuana, since my job requires random drug test, that is not an option. I need sleep! My body doesnt feel like it can make it much longer.
maggie at 11:25 pm on
November 24th, 2009I am bipolar.
This article helped me plan a new schedule for my life.
THANK YOU!!!! Excited to try it out.
THE KEYS TO HAPPINESS:
- WRITING IN A JOURNAL (right before bed)
- VITAMINS
- DAILY MEDS
- RUNNING 4 TIMES A WEEK
- MELATONIN FOR SLEEP
* Regular bed time and wake up times. It doesn’t matter what times I go to sleep, but it needs to be REGULAR.
* It is bad when my body sleeps more than necessary and will cause fatigue.
* Extra sleep will cause depression.
* No coffee after 12 noon
* No vigorous exercise in the evening
* Turn off screens and phones, one hour before bedtime
* Try to keep the bed for only sleeping – no work or other activities
* No TV in the bedroom
HEALTHY LIFE BEHAVIORS:
- Apartment with lots of natural light or “light therapy” style fake lights
- Having some living plants in my house to take care of. If the plants are doing good, it shows that I am doing good.
I’m going to post it on my fridge and bed stand and see how I do. Wish me luck….
Vanessa at 7:30 am on
December 10th, 2009Again, I have been on every sleep drug there is. The worse was Trazodone. It gave me severe nightmares and would make me feel drugged for hours after waking. I am taking Ambien now. It is ok, but I still get the medicated feeling sometimes when I awake and it I don’t always sleep through the night. In fact since being diagnosed with Bipolar I hardly sleep at all and usually have my nights and days mixed up. I think I am going to try Melatonin, and see if that may work for me. I use to use it many years ago before being diagnosed. My dad swears by it, but he isn’t BiPolar.
angelina at 3:45 am on
January 20th, 2010seroquel is great but the weight gain is life changing…i to cant fall asleep without it..when i dont have any i have to take like 300mg of the over the counter sleep aid..and that doesnt really work i stay upp all night and sleep alll day like 12-14 hours and everything i do wont change it….
Colin at 7:20 pm on
March 11th, 2010I have been trying to deal with bi-polar and insomnia on my own for many years now, and finally got professional help just a few days ago. For a mood stabilizer I am trying lamotragine, and for sleep I was prescribed Trazadone and Clonidine to experiment with (maybe expiriment is a bad choice of words).
Trazadone didn’t help me much and I awoke with a start early in the morning after four hours of broken sleep with some very major aggression and scary thoughts. A clonidine helped me relax and put me back to sleep. I discontinued the Trazadone and tried .1 mg of Clonidine last night, it made me a little drowsy, then another one and I got about six hours of sleep, only waking a few times. This was pretty amazing for me.
Biggest downside so far is severe dry mouth and a little grogginess. We’ll see.
supriya at 5:33 pm on
March 12th, 2010i need medicine for avoiding sleeping that are available generally in india with doses and i don’t want doctor prescreption on it.just suggest that one that would be healthier and no bad effect.
Can you buy Halcion or generic anywhere with ou a script?
Can you ourchase Generic halcion without a script anywhere?
i have spent hours on research containg no real intelligent ino on sleeping aids only the expert opion.i have tried ambien/restoril/xanax.i have narrowed my search for a sleep aid with minimum side effects to gabitril and remeron.of course all the info i read counterdicks side effects so i dont know what to believe
i would like a answer to my question concerning remeron or gabitril
Vicki at 6:05 pm on
August 4th, 2010I have been having insomnia for 10 weeks…just right out of the blue. I was on Geodon and it knocked me out at bedtime it just quit working. I ended up in the hospital and they put me on Depakote er, and the sedating effects are killing my life, but still no sleep. Tried Trazadone, Ambian, Serquol, Zyprexa…nothing puts me to sleep. Need Help!
i have tried all the benzos and useless sleeping pills and they all stop working,currently on gabitril which my doctor said is safe for non-epilectics to use as sleep aid/what is your feeling on gabitril
sassy at 4:56 pm on
October 19th, 2010I have recently been diagnosed with bi polar, I’m extremely angitated and get angry quick and have lots of anxiety. I have been taking celexa 40 mg and its working great. I have had sleep problems for about 20 yrs. I have found that walsom, which is walgreens generic sleep med works good. I took it for about 7 yrs, then went 2 prescription halcion .25n its the higest dose but knocks me out EVERY night 4 the last 8 months. I do not feel bad next day. Its an old drug that is not prescribed a lot, but works great!
Jennifer at 4:11 pm on
December 24th, 2010I’ve tried most of the usual bipolar meds; however, I have problems with the idea that I could gain so much weight I could get secondary health issues, or taking drugs that make me feel like a total zombie. Having facial twitches and other symptoms aren’t much fun either. I have been without meds and trying to go to school. I am not the type to abuse drugs and I will have an occasional drink now and then.
During finals and test times I have terrible insomnia due to manics. I have had issues with finding a Doctor that is willing to treat the insomnia issue.
If you can find a doc who is willing to treat the issue of sleep alone, that is a good thing. I wish I could.
:-C
happy bp at 2:35 pm on
March 26th, 2011Lunesta works for me, if there is no anxiety involved. If I have anxiety, I need to take a xanax. Unfortunately, I can only get about 14 lunestas for every 2 months. It makes me feel like a drug addict. I don’t abuse, and I’m a hight-functioning bipolar. Any suggestions?
I wake up three or four times a night because my left leg and knee are aching. I have not had an injury to that leg so I don’t know what is causing this. I walk for exercise about 20-30 minutes at least five times a week with no problem. My leg does not bother me except at night when I am in bed (when I have checked the clock it is usually 4 or 5 o’clock am). This puzzles me but do not want to take a sleeping medication.
Nice post! would like to see how this game plan pans out over time please keep us posted
Dana at 1:54 pm on
October 8th, 2011I am Bipolar and am struggling with sleep and a drug that controls my bipolar freakouts during the day. I have tried seroquel, lithium, risperdal and now my pyschiatrist is trying to figure out what next. any suggestioins? I’m going crazy and the lack of sleep does not help. thankz
I have had trouble sleeping for year — before I started seeing a pychiatrist would take cocktails of melatonin, nyquil, benedryl (up to 14-15 benedryl a day.) Yes, I agree with the person who said when it says, “causes drowsiness” I say, “I wish!” Bipolar runs in my family and we tend to be manic about 95% of the time and antidepressants of any kind cause us to have our head spinning — tarazadone threw me manic and I started shaking, not getting sleepy. Seroquel knocked me out so hard I couldn’t wake myself up from the horrible nightmares it caused – all my hidden fears came out and I had hand tremors for two days. I have been on Ambien (take 900 mg lithium daily, 1mg klonopin daily plus “causes drowsiness – NOT allergy meds) and it worked for 2 months, but kept taking me longer and longer to get to sleep until I finally couldn’t. Doc switched me to Ambien CR along with .5mg Klonopin which worked a few times, but now still I have to “jazz it up” with benedryl, melatonin and nyquil and sleep in a quiet room away from my husband as even his sneeze or cough wakes me up – which is no fun. Any thoughts? I’m 48 and going through the change and in the fall I get more manic, summers usually more depressed.
This is Becky again — I was taking 10MG Ambien (5mg didn’t do a thing); now on 12.5 MG Amien CR with .5MG Klonopin together – still trouble sleeping. WHen I mixed the two together I was knocked out great but doctor advised against it.
Jason at 1:43 pm on
October 25th, 2011I’m diagnosed Bipolar I. I have experienced insomnia now for about 3 or 4 years. I’m currently on Lamictal and Ambien. I used to take Seroquel but the weight gain and blood pressure was becoming a major issue. Ambien seems to be the only thing that works. Thing is when I stop taking it I can’t get to sleep again and insomnia continues where it left off. I’m getting much more stable on 200 mg of Lamictal but the insomnia will not go away! Even when I take 2 Benedryl it will not make me sleepy. I have to take about 4 or 5 to knock me out and that leaves me with a hangover the next day. Without medication my brain won’t shutoff at all. I don’t seem to dream but only think wild thoughts in this sort of restless half awake half asleep state. When this happens I wake up and feel as if I never went to sleep. My eyes burn and my head hurts. Melatonin really wacks my brain. It creates an sort of unpleasant buzz in my brain. I’m afraid of getting addicted to Ambien but nothing else I’ve tried works. Like other peoples experiences I don’t find Trazidone sedating at all.
nicole at 11:27 pm on
November 14th, 2011I am 27 years old. fiancee of 3 years made love to me last night very passionately, after taking a sleeping pill. He is bipolar as well. When he woke up in the morning, he didn’t remember a thing. Is that because of the sleeping pill? He sais he remembers the first part of the night, but that he was sure we fell asleep afterwards.Everything else that happened is blank. He also fell asleep while driving for a few seconds next morning.
E at 12:11 pm on
January 26th, 2012I have PTSD and have found a very small dose of Seroquel to be very effective when my insomnia and nightmares were at their worst.
Now that I have integrated the trauma I have been weaning down on it, and will use herbal sleep aids as needed. The Seroquel under 100mgs at the time was a life saver though.
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