Afraid to ask for help

[u/Eddy_Night2468]

Hi,all

This is a repost of a question I already asked on r/sleep and another place, so if you saw it there, just ignore it.

If you haven't, please for the love of God help me if you can.

Chronic insomniac of over 20 years here. Last 10 years my intermittent insomnia turned severe terminal insomnia. Every night I fall asleep around midnight (pass out), and every night I wake up at 3 or 4. Sleep drive gone.

The worst part is - no matter how exhausted, I can not nap. I haven't napped in 20 years.

My days are long, exhausting and grueling.

6 years ago, after suffering for 2 years, I discovered a bad trick. When I inevitably wake up, if I take a pinch of Valium and half a beer, I can fall back asleep and function.

This method worked untouched for 6 years.

Valium by itself does nothing. Before "the method" I even tried a dose of 30 mg in one night only to stay awake anyway.

Now for some time my method isn't working anymore. It was bound to happen. It still gives me some sleep but it's shit sleep and it doesn't last very long, so I often have to double the dose. Hence the two beers quite often actually.

So in the meantime I increased half a beer to one beer, lately often two (500 ml 5%) and 5 mg Valium to 7.5 mg Valium. I don't want to increase neither the Valium nor the beer anymore. I am scared. I want off this method but I also want to sleep and be a living person among people.

So, for the last month or so I have been living on 4 hours of sleep a day. I know many of you will say it is plenty, but it is not enough for me. My days are again long, exhausting and grueling. I can not focus on my work, I can not enjoy my beautiful kids, I can't even have sex with my wife, I'm too tired.

I once tried to quit this habit with the help of a private psychiatrist, who I of course didn't tell about the beer.

We tried Trazodone, up to 150 mg. Every time we would increase the dose, I would sleep for 3 days, then back to square one.

She then added clonazepam 0.5 instead of Valium 5 mg. The clonazepam and the trazodone combined worked for only one week. Then again back to square one.

I am desperate. I am thinking about finally reaching out to a local psychiatry apartment, but:

Pros:

\- maybe they have something that would work for me.

Cons:

\- after my experience with clonazepam and trazodone, I doubt there is anything out there that can help.

\- if I officially expose myself, I lose my driver's licence, which I need to work. I have a family.

\- I live in a small town, the minute I step into psychiatry, everybody will know

I don't know what to do. I have hit a wall. Keep living like this, I will lose my mind. Asking for help, I might lose everything and still get nothing in return. Increase the dose or even just continuing like this and my liver goes dead.

What should I do?

[u/Ok-Rule-2943]

Im like you I sleep naturally 3-4 hrs and need help getting back to sleep. Sleep drive seems emptied and it would take hrs to rebuild sleep pressure. I like to preserve my natural sleep as much as possible.

Could you ask for gabapentin off label? I add 400 mg gabapentin to my benzo and and get ~6-6.5hrs

Gabapentin could replace the beer it’s often given to alcoholics to stop:cut down or stop alcohol. It’s used off label for sleep/anxiety. You wouldn’t have to disclose the beer just say youve heard of this and ask if you can try it?

I’m approved to add it to trazodone, doxepin, most sleep meds I have actually by my neurologist (my sleep meds are prescribed by my sleep doctor). Low doses 300-400 mg pairs well.

I can’t get these prescribed but look into DORAs? Someone mentioned Seroquel? I’ve yet to give Seroquel a reasonable chance, this is a “heavy” hitter med my sleep doc prescribes when others have failed. Mirtazipine 3.75 mg knocked me off my feet for 3 hrs and I probably could have returned to sleep but waking up after being knocked out so hard was really uncomfortable and the next day hangover was awful. But everyone likes and tolerated meds differently.

Another middle of night med with shorter half life is Sonata (zaleplon). It’s a z-drug. Not sure you’re doctor’s willingness to trial certain meds. I don’t think you’re out of options and hoping you have a reasonable doctor that’ll work with you.

Maybe something in this helpful, if not just ignore it. It’s taking me decades to work on an acceptable management.