How I got rid of my insomnia (long)

Hi all.

First, short introduction: bipolar II, on medication (antidepressant + mood stabiliser).

In April 2011 I was diagnosed with a major depressive episode and prescribed an antidepressant. It has worked. In fact, it has worked so well it sent me into what was a hypomanic state of my bipolar (which my doctor hasn't noticed and neither have I -- hypomanic state feels amazing, you don't go to a psychiatrist to complain about feeling really great). But there was a side effect: insomnia. I seemed to have lost the ability to sleep 8 hours per night, which as I later found out was also an effect of the hypomania. I slept 4 hours average, tossing and turning in bed until 3-4 am.

I was prescribed zopiclone 7.5 mg. I hated the idea of becoming addicted to sleeping pills, so I didn't want to take them every night. However, I also still couldn't sleep without zopiclone, so I quickly developed a "schedule": one night zopiclone, one night getting drunk, one night without sleep, repeat. This lasted until October when I crashed from my hypomanic phase into what's called an ultra-ultra-rapid-cycling mixed episode and started going up and down extremely fast. At this point I went to a psychiatrist whose evaluation resulted in rediagnosing me with bipolar disorder and whose advice was that I have to get my sleep every night even if it means taking zopiclone every night. So that's what I've done. I stuck to the dosage of 7.5 mg all the time, sometimes though I had to take another half a pill to finally fall asleep. Never exceeded 10.25 though. But also never managed to sleep without it.

One night I forgot my zopiclone. I was staying with my boyfriend and I just didn't have any pills left. The night was a nightmare. I was tired but sleep just wouldn't come. Finally around 5:30 am I fell into very bad quality sleep for 1.5 hour or so. I was a zombie the day after. I realised I was dependent on the pills and wouldn't be able to sleep without them. Raised that concern with my doctor, who said that's not a problem -- as long as I sleep. And so I swallowed the bitter pill (if you know what zopiclone tastes like, you know why I say that) and went on with them. Until they were removed from the market and replaced with a generic version which had one main flaw: it didn't work.

So we tried various solutions. Seroquel was great. Gave me amazing sleep. It also gave me tremors so bad I couldn't eat soup because my hands were shaking so badly. It was replaced with promethazine, which I had to take about 6 hours before sleep, then go to bed for two hours of fun with akathisia (imagine all your muscles itch so badly you involuntarily twitch, which stops the feeling for about a second, then you go back to being super-uncomfortable). This was replaced with zolpidem which made me sleep-order-stuff-from-Amazon, sleep-write-emails, then finally sleep-walk-around-the-house and fall on a metal chair, ruining the chair and giving me some nasty bruises and almost taking my eye out. At this point I decided I would never take zolpidem again.

I got prescribed temazepam with a warning it was very addictive so it's a short term solution while the docs scratch their head trying to come up with something else. I took it and slept very well for two nights. Then on night three one pill didn't work and I had to take two, which explained to me very well how addictive it was. I was desperate at that point -- I had some bad nights in a row which reactivated my illness and made me feel literally crazy. I was missing work -- I work with power tools and after a sleepless night last thing you want to do is handle an 18 kg grinder. My doctor suggested going back to zolpidem. I suggested he goes to hell. He made an appointment for me with a sleep specialist -- psychologist specialised in sleep issues -- and I said yes, even though I was already applying all the typical sleep hygiene advice.

I decided to try something I found on the internet. I went against my doctor's advice. Instead of taking temazepam every night (and being pissed off that one pill doesn't work and I have 14 pills for 14 nights) I used some of my emergency stash of zopiclon for two nights. Then two nights with temazepam. I read that those two meds work with different receptors in my brain and this is the way to get rid of dependence on one of them. Figured out I don't have much to lose at this point. And after doing this for 12 days I decided to try a night without pills. It was, predictably, a nightmare. Around 3:30 I got up to use the toilet, thinking that I won't fall asleep and I'm wasting time, then suddenly realised that unless there indeed was a talking kitten and a bunny in my bed, I must have been dreaming even though I felt awake.

The day after that I was a zombie again, but a very tired zombie. I went to bed at midnight, as usual, and... fell asleep around 1. It was poor quality sleep, I woke up all the time, but it was better than anything since April 2011. I woke up -- against all odds -- pretty rested. Then took a temazepam again next two nights, to make sure my bipolar doesn't get too upset, and then again slept without pills.

I am now two months into my "regimen". Ran out of zopiclon and haven't missed it. I use temazepam once-twice every 3-4 nights when I can't fall asleep for an hour or longer. Most nights, though, I sleep, and I sleep well. Lots of dreams, almost as if my brain is trying to catch up on the period it has "missed" them. I wake up rested and I feel great -- not just because I sleep, but also because I was so afraid I'd never sleep without meds again. Sleeping pill has become something that I indeed use "as needed" rather than something I am entirely dependent upon. I still take that antidepressant, but my body seems to be used to it now.

The story above is not intended as medical advice (obviously). I am not saying it will work for everyone either. But if you have long suffered insomnia related to medication or are finding yourself dependent on zopiclone or benzos (like temazepam), consider talking to your doctor about what I have done, as it might be useful. My long term goal is to stop using temazepam entirely and sleep completely without "help".

Sleep hygiene tips that work:
- meditation and prayer before sleep
- mantra -- very simple -- long, slow breathing in and out, and repeating in your head "help" on breathing in and "sleep" on breathing out
- only using bedroom for sleeping
- complete darkness
- going to bed roughly at the same time and getting up at most an hour later than your usual time (not sleeping in too long)
- avoiding smoking before bed (I smoke pipe, and found that if I smoke after 10pm it makes sleeping without a pill impossible)
- reducing caffeine, obviously (but I still have 1-2 coffees a day -- just never after 6)

Sleep hygiene tips that didn't work:
- avoiding activity in the evening -- don't see much difference
- avoiding using Internet/computer in the evening -- same
- calming music -- well, perhaps thrash metal won't lull me to sleep, but Enya doesn't either, sadly
- no alcohol -- I haven't had a drink for 9 months and counting, but it hasn't made a difference either way

Big hugs everyone and I hope your lives get easier.

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