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Another world


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A relative gave me the February edition of the Journal of the American Medical Association because it had an article on insomnia. I felt like I had stepped into another world due to the lovely drug adds that support everything.

 

As expected, I didn't learn anything knew as it was the same old, same old, with drugs and CBTI being the treatment of choice. It was a clinician' corner article about a 51 year old woman who had had insomnia since she was 35 as things changed when her daughter had a very erratic sleeping schedule. The physician discussant was Dr. Daniel J. Buysee, a psychiatrist with drug company associations galore.

 

Anyway, this woman had pretty much tried all the standard sleep medications and was currently on neurontin. I found this statement by her interesting, "It has been very effective in helping her get more sleep but I would not say my sleep is reliable".

 

She, like sadly, many sleep physicians, is falling to the common misconception that the effectiveness of a drug is judged by the number of hours slept when it is the quality that should be the number one criteria. And then of course when she says her sleep isn't reliable, that proves on again, that any sleep medication can only be counted on as a short term solution and nothing more.

 

Dr. Buyse indirectedly suggested that her medical history be explored for the possibility of other sleep disorders but didn't really seem to emphasize that strongly. Contrast that with Barry Krakow, who no doubt upon reviewing her history, would have suggested that she be tested for apnea since his studies have shown a strong link between apnea and insomnia. Also, apparently developing apnea during pregnancy is quite common.

 

Dr. Buyse also seemed to have no problems keeping some patients on medications for long term even though Dr. Krakow has specifically said that if they aren't working, something is being missed and the patient should be reevaluated. But he seems to be a lone wolf in that area sad to say.

 

The article goes on to review various drugs and horrifyingly seems to favor the short acting benzos although they do acknowledge the risks that we are all familiar with and even mention the withdrawal issues and note that it can take several months for some people to get off meds. Hmm, doesn't seem like a great deal to me even if the drugs are initially effective.

 

One drug (and I can't find which one) was mentioned as improving sleep quality in short term trials. That seems to me to be the ultimate in oxymorons as I just would find that hard to believe knowing what these medications do. I would love to know the criteria that was used to decide that a medication improved sleep quality. Probably the same one that used to judge antidepressant effectiveness and we know how that turned out right?

 

Under the recommendations sections for this woman, they decide she should be given a trial of Doxepin because of her sleep/maintenance issues and also take middle of the night ambien as needed. Hmm, she said she had tried ambien for one night and hated it.

 

And they also suggested CBTI strategies which they did mention throughout the article. The advice on sleep hygiene and relaxation techniques that we all are familiar with.

 

In other words, nothing has changed regarding insomnia and it is the same story regarding playing "chase the right med". It also seems to continue to blame the patient for their plight by stressing they are too anxious about sleep, have misperceptions, and so on and so on. I pretty much figured that and the relative warned me but still, it was interesting to see it confirmed.

 

What would be an ideal article that will never happen? Discuss the various reasons why this woman might be experiencing insomnia. Possible reasons - apnea, thyroid, hormones and or diabetes and then discuss the likelihood of these issues being a factor. But nah, alot easier to just find the latest, greatest drug.

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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CS,

 

It does seem like "Another World" to see how ubiquitous (not sure that's the right word..?) drugs still are while we are in this *parallel universe* trying to undo the damage of same drugs. This clash occurs everyday in my real life. Husband gets medical journals in mail, works from home advising other docs on med strategies (chart reviews). Tiny house, i hear it all.

 

Point being... i don't think drug use is slowing at all despite all of the dangers we know and are living.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Hi Barb,

 

Trying get drug use to slow down would be like trying to change English as the language of the US. It is that ingrained in this culture in my opinion.

 

That must be mind blowing to constantly hear your husband talk about meds.

 

CS

 

CS,

 

It does seem like "Another World" to see how ubiquitous (not sure that's the right word..?) drugs still are while we are in this *parallel universe* trying to undo the damage of same drugs. This clash occurs everyday in my real life. Husband gets medical journals in mail, works from home advising other docs on med strategies (chart reviews). Tiny house, i hear it all.

 

Point being... i don't think drug use is slowing at all despite all of the dangers we know and are living.

 

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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