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dmer 09-04-2008 09:22 AM

Need advice on sleeplessness and extreme drowsiness
 
About 10 months ago, I received the HBP diagnosis and subsequent blood tests revealed various lipid issues as well.

Initially, I was prescribed a 10 / 40, CCB / ACE combination. After about 3 months, that dose was reduced to 5/20 which I presently maintain. Since that initial diagnosis, I've lost a little more than 60 lbs, altered my diet and have a 6 day exercise program. Overall, I feel much better and think my general health reflects it.

What is perplexing me at the moment is something that began about 3 months ago and has gotten worse, mainly, difficulty getting to sleep and staying asleep, coupled with extreme drowsiness during the day. Last night, I went to bed around 10:30PM and fell asleep around 11PM, then woke up at 12:30AM, before falling back asleep at 3AM, to re-awaken again to the alarm at 5am. I was groggy going out the door for my exercise, but quickly woke up and felt good on the way back.

When I get back, I take my CCB / ACE combo around 6:30AM. Around 9AM, I get an overwhelming urge to fall asleep, which might return around noon and again between 4 and 5PM. If I can take a 30 minute nap, it solves the problem but probaly interferes with getting to sleep at night.

Sunday is a no exercise day and I've noticed that when I go to bed that night, rest comes more easily and lasts a little longer.

My question is, how much might my CCB / ACE dose be contributing to this sleep disruption and, would it make sense to titrate the CCB dose down to 2.5MG?

Thanks in advance for comments and help.

bethsheba 09-04-2008 09:42 AM

Re: Need advice on sleeplessness and extreme drowsiness
 
Dmer,

What you describe sounds very similar to what I experienced when I was taking norvasc, a ccb. When I took it in the am, I couldn't keep my eyes open by lunch time (and yet I couldn't sleep if I laid/layed (oh gosh the grammar) down to sleep. If I took the dose at suppertime or bedtime, despite my fatigue I was up between midnight and 3 every am.

I don't know which ccb or ace you are on...I would suggest checking the side effects of both meds because many of our bp meds can cause sleep disturbances.

Last but not least, congratulations on the weight loss and the lifestyle changes that made that weight loss possible!!!

Funny, I thought of you last night as I poured a bottle (less one glass) of very good wine down the drain.

Take care!

Bethsheba

PS Re the norvasc...I was on 5-10 mg and I simply stopped taking the 5 mg when I slept well after missing a dose. It did take me up to 6 weeks to sleep normally, though. I found out after the fact that one should not go "cold turkey" with a ccb....so don't know what to suggest regarding dosage.

dmer 09-04-2008 10:07 AM

Re: Need advice on sleeplessness and extreme drowsiness
 
[QUOTE=bethsheba;3715823]h ccb or ace you are on...I would suggest checking the side effects of both meds because many of our bp meds can cause sleep disturbances.

Last but not least, congratulations on the weight loss and the lifestyle changes that made that weight loss possible!!!

Funny, I thought of you last night as I poured a bottle (less one glass) of very good wine down the drain.

Take care!

Bethsheba

PS Re the norvasc...I was on 5-10 mg and I simply stopped taking the 5 mg when I slept well after missing a dose. It did take me up to 6 weeks to sleep normally, though. I found out after the fact that one should not go "cold turkey" with a ccb....so don't know what to suggest regarding dosage.[/QUOTE]

Bethseba,

Thanks for the reply - it would pain me to pour 3/4 of a bottle of wine down the drain! White, as I'm sure you know, keeps well for a few days in the fridge after opening. Unfortunately, to preserve the majority of reds beyond a few hours requires intervention with additional technology. Any decent cask reds?

I'm fortunate in that I work from home, otherwise, if I was in an office, people might think I had narcolepsy. I take the generic equivalent of norvasc and the container, along with the ACE container, advise against drowsiness.

I've heard about the problems with abrupt withdrawal from CCB's and thank you for repeating them! At the risk of practicing on myself, I think I'm going to start dropping my CCB dose to 2.5mg and check the effects for about a month before scheduling another Dr's visit.

I think it is a vicious circle though because nodding off during the day really sets you up for a disrupted night time sleeping pattern.

Glad to hear you are well!

bethsheba 09-04-2008 11:40 AM

Re: Need advice on sleeplessness and extreme drowsiness
 
Dmer,

I didn't know that the whites kept a few days in the fridge, thank you for that bit of information!...alas, I happened to have a dry red last night. ( What do you deem decent? I"m far from an expert but I do enjoy a good glass with salad or a well prepared meal, :)). Usually I would save it for stew but I forego red meats as much as possible in the hope that someday I will become a vegetarian....but in the meantime, there are additional health/hypertension benefits with my "madness".

[QUOTE=dmer;3715863]... At the risk of practicing on myself, I think I'm going to start dropping my CCB dose to 2.5mg and check the effects for about a month before scheduling another Dr's visit.[/QUOTE]

I don't think that is a bad idea...although you might want to give it at least 6 weeks. I slept all night the first nights I disco'd but I think it was because I was so very sleep deprived. I'm repeating myself, but I think it was a full 6 weeks before I was back to normal.

[QUOTE]...I think it is a vicious circle though because nodding off during the day really sets you up for a disrupted night time sleeping pattern....[/QUOTE]

Yes, it is a viscious cycle...and perhaps more importantly than a disrupted sleeping pattern, the sleep disruptions can elevate the pressures. I came across some info (government site) that said that studies of children with hypertension suggest that lack of sleep impacts blood pressure more than obesity. There is a growing amount of literature addressing the importance of sleep in the role of bp regulation...and I'm not referring to sleep disorders here...simply people who just don't get enough sleep.

Well dmer, I wish you well, and I thank you again for the feedback you have given me these past months. I'm doing much better with my sugar intake (although I don't document it, I haven't purchased sweets (including the cold kinds) very often these past months.

Take care, dmer. Will be in touch.

Bethsheba

Machaon 09-04-2008 03:54 PM

Re: Need advice on sleeplessness and extreme drowsiness
 
[QUOTE=dmer;3715787] ... My question is, how much might my CCB / ACE dose be contributing to this sleep disruption ... [/QUOTE]

I took an AceI and a CCB for many years and never had sleep problems from either, or from the combination of the two meds. But I did have other types of problems, especially when I took my CCB within two hours of consuming too much calcium thru food or drink, and problems with my AceI when consuming too much potassium.

Diet can impact how medications behave in our systems. At least it is something that you can test, to see if your diet is interacting with your medication.

flowergirl2day 09-04-2008 06:59 PM

Re: Need advice on sleeplessness and extreme drowsiness
 
I also take both of these drugs. I have had the effects you describe but cannot attribute them to just these two drugs alone. Some of my other medications, or their combinations, could be contributing to the insomnia and feeling tired.

Machaon suggested dietary causes. Sounds like a very good possibility. I just visited a library and brought home several interesting books. One of them is titled "The New Glucose Revolution - a guide to the Glycemic index" by Jennie Brand-Miller and Thomas M.S. Wolever. I think that glucose fluctuations can cause extreme tiredness. I have yet to read anything from that book.

Another possibility you might consider are the disruptions our drugs cause to the circadian rhythm.

In hypertensive patients, morning versus evening dosing of antihypertensives was investigated in crossover studies. Interestingly, the only consistencies in altered patterns were noted in ACE inhibitors and calcium channel blockers.

In dippers, ACE inhibitors taken at night had a super-dipping effect. The BP lowering effects on the 24 hour blood pressure remained unchanged with evening or morning dosing.

In hypertensive dippers, antihypertensive drugs should be taken in the morning.
Non-dippers may have to add an evening dose, or take the entire daily dose of medication in the evening. This will help with the reduction of blood pressure during the night and improve the disrupted non-dipping 24 hour blood pressure pattern.
Interestingly, CCBs amlodipine and isradipine, when taken by non-dippers at night, transformed the non-dippers into dippers. I questioned the reason for my doctor's instructions to take my CCB (Norvasc) at night, instead of in the morning, not so long ago. Becoming a "dipper" must have been the reason for the switch in the dosing times. I must say that it has worked. My blood pressure tends to dip now at night-too much sometimes. A circadian phase dependency in pharmacokinetics has been shown for beta blockers, CCBs, oral nitrates and ACE ihibitors.

High blood pressure and many other health conditions cause our sleep patterns to change. Our bladder's holding capacity shrinks as we age, necessitating trips to the bathroom. There are a number of possible reasons why we aren't getting a good nights' sleep. Many medications cause fatigue and insomnia. ACE inhibitors have fatigue, insomnia, drowsiness and weakness listed as side effects. Calcium channel blockers and other cardiovascular drugs (and other classes of drugs) can make it difficult for us to fall asleep and stay asleep. Diuretics cause restlessness, insomnia and anxiety.

When drugs are combined, this often results in unintended additive or decreased effects. For obvious reasons, decreased effectiveness is not desirable. The additive effects can sometimes work in our favor. The combination of ACE Is and CCBs is not too bad in this regard. There are additive effects. Watch for an excessive bp reduction on occassion.

I think you should experiment with the dosing times. That is something that you can easily do. Perhaps a change in meds is on the horizon - e.g. a very low dose of just one of the two drugs and a diuretic. Another thing I would suggest is a complete blood workup. You should have all of the electrolytes, CBC, ferritin & B12 level checked. Low iron stores (ferritin is a good indicator) will leave you pretty tired all the time.

Congrats on your very healthy lifestyle! :)

flowergirl

dmer 09-08-2008 07:00 AM

Re: Need advice on sleeplessness and extreme drowsiness
 
Thanks to each of you for the thoughtful and uplifting comments.

I cut my CCB dose from 5mg to 2.5mg and noticed an almost immediate change - the fatigue didn't appear during the day with the same intensity and I felt more enervated during exercise. Unfortunately, I haven't slept much better at night.

The other issue I have is possibly with the statin I take which may be the cause of some intense athritic like symptoms. Then again, there may just be a confluence in my life of age related things which vanity keeps me from fully accepting. My diet is pretty good at the moment and I continue to lose weight because of the calorie restriction. If it's at all possible, I'd like to become med free, even if only for a little while.

But the feedback here is invaluable - it offers the possibility of changing / modifying protocols in a rational manner.

Thanks!


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