If you’ve read even two or three of my blog posts in the recent past, you’ve probably witnessed me complaining that I can’t sleep. Insomnia isn’t a new problem for me, but it’s been much worse over the past year or so.
Last week I went back to see Tabitha again. “I’m feeling desperate,” I texted her ahead of time, requesting an appointment. “It can take me more than two hours to fall asleep, sometimes even longer. I sleep at best an hour or so at a time, then I wake up. Sometimes I go back to sleep quickly, but other times I’ll be awake again for ages. Most nights lately I’m sleeping only four to five hours, with interruptions. I’m frustrated, discouraged, and immensely exhausted…”
Tabitha is incredibly responsive. She was fully booked during the week, but she had me meet her at her office at 9am on Saturday. (No, she doesn’t usually see clients on the weekend.)
Not only that, but I’m sure she was one of those conscientious, straight-A students. When I got there, she’d already been researching options. We have tried a lot of medications over the past 12 months, trying to find something that will help me sleep. Mostly she tries some additional anti-depressant that has sleepiness as a common side effect. Unfortunately, I haven’t been able to tolerate hardly anything, or not for very long. Most commonly I get tingliness that builds and builds, getting worse each day until I feel like I want to rip my skin off. Sometimes it makes the sleeping worse. Other times it sends me straight to the bottom of Depression Swamp. I’ve tried sometimes to keep taking things for a couple of weeks to see if I’ll adjust, but every time I’ve reached a point where I can’t tolerate the side effects any more.
The only exception to that has been gabapentin, which I started taking in August. It did seem to help for a while. It even eliminated the pain I typically have in my feet in the morning. Since early January, however, I have feel worse within an hour of taking it each evening (tinglier, more depressed). And meanwhile, my sleep has deteriorated.
Given this history, I’m pretty nervous to try anything new. “But I’m also nervous not to try something,” I tell her on Saturday. “I’m supposed to fly to DC on Wednesday, and then on Thursday I have an all-day work meeting starting at 8am east-coast time (which will be 5am for my west-coast body). Friday will be another early start. I’m afraid I won’t be able to think straight if I can’t get some sleep.”
Tabitha suggests we try Abilify to augment the anti-depressants I already take (Effexor and Wellbutrin). I actually have a little bit of experience with this medication, not for myself, but for my son with autism. He went through a very difficult period right after high school. I think the demands of the “real world” were so overwhelming for him that he kind of fell apart. Abilify is actually an antipsychotic that seems to serve a lot of different purposes, including taming some of the anxious anger my son was experiencing. I hadn’t heard of it for depression, though, and I especially hadn’t thought of it as a sleep aid.
Part of me wants to protest, “Not another drug! Maybe let’s get rid of what I have.” Another part of me, remembering my last effort to taper off Effexor, decides to trust Tabitha.
“Anyway, you aren’t traveling for a few days,” she tells me. “You have time to try it and see if it works for you.”
She writes me a prescription specifically for the brand-name drug, not the generic. She’s okay with some generics, but not for everything. And she gives me a coupon from the company to get the prescription for $5.
I trot off dutifully to the pharmacy and give in the prescription, saying I’ll pick it up a bit later; I live just around the corner. But it turns out they won’t be able to fill it until Monday, so I spend the weekend, not sleeping much, as usual. The fact that I’m able to take a two-hour nap on Sunday afternoon, however, makes me wonder again if it’s the gabapentin I take at night that is bothering me. Maybe it’s easier to sleep when my body hasn’t had any for 18 hours?
On Monday, I go to pick up the Abilify. The pharmacist tells me my insurance won’t pay fr the brand-name drug. “No problem,” I say, whipping out the magic coupon. Mysteriously, the coupon will not work with the pharmacy’s computer.
“Okay, how much is it without the coupon?” I ask.
“It’s expensive,” the pharmacist says. “$1459.”
I’m not missing a decimal point there. It literally costs one thousand, four hundred and fifty nine dollars for a one-month supply.
Never mind that then. I text Tabitha and tell her Abilify is not going to be an option. She suggests a prescription for clonazepam, something I can have with me “just in case.” I waver. I used to take clonazepam for several years and painstakingly weaned myself off in the summer and fall of 2016, convinced it was contributing to my low energy and worried about negative things I’d heard about benzos.
But sleep, the promise of sleep…
I accept the prescription and take it for the first time on the night before my trip to DC. I fall asleep ten minutes after I crawl into bed and don’t wake up for five hours. Even after that, I fall back to sleep until my alarm goes off. It’s the best I’ve slept in at least six weeks.
I bring the clonazepam along on my trip and sleep well, despite the time difference. (The fabulously comfortable bed at the Marriott may have helped a little, too.) I get home late Friday night and even back in my own less luxurious bed, I sleep well again.
I try to remember why I worked so hard to get off clonazepam. I tell myself that it is an addictive substance and even at therapeutic doses, it can be a problem taking it for a long time, as I did before. And yet, I’m so relieved to get some sleep at last. I don’t know what to do, longer term, but tonight I’ll swallow another tablet, welcoming the knowledge that brain and body will get to rest.
Image: Modified from Creative Commons.