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    Old 06-14-2006, 02:21 PM   #1
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    How do I combat Daytime Sleepness?

    I am on a lot of pain medication for pain and it makes me very tired during the day any advice on how to combat this?

    I'm on Oxycotin 40mgs 3 x's a day
    Hydrocodone 7.5/325 3 x's a day or as needed for pain
    flexiril 3 x's a day
    Topamax 100 mgs 1 at night
    Ambien 5mgs-10mgs at night
    Effexor 75mgs - 1 at night
    Doxepin 25 mgs as needed to help with sleep problems

    I take the meds for a failed lumbar spinal fusion l5-s1 with screws displaced and fibromyalgia. I am in an extreme amount of pain. Even with the meds I am still in pain at a level of 6-7 sometimes higher. I go for another fusion surgery in October this time a 360 fusion with cages and hardware. Until then I have to deal with where I'm at - any advice?

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    Old 06-14-2006, 07:42 PM   #2
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    Re: How do I combat Daytime Sleepness?

    I will throw you an idea - this is how I have in the past tried to figure out which med of my regimine is causing a particular side effect, especially when the problem I am having is common (sleepiness, dopiness, headahce, stomach problems). If I am unable to figure it doing what I am going to explain to you, then I complain to my doc, if I think I have it figured out then I talk to my doc too, usually about a dosage change or a med drop or med change.

    First, I look at the list of meds I am on and usually there are a some I have been on for a while and I know how they have impacted me in the past so I can rule them out and if I know that they don't make me drowsy for example, I mentally cross them off the list. The other thing I take a look at is, for each medication is if that particular side effect is listed near the top as being a very common side effect where lots of people experience it I do this by reading the info that comes from the pharmacy on the drug and then the internet. So even if all my meds were new I would hopefully have an idea of what side effects are more common for each drug, but keep in mind that I am an individual and may or may not experience a common side effect.

    The other thing I take a look at is the side effect I am bothered by, and try to classify either when it starts or when it is at is worse, helping me to possibly determine which meds taken at a particular time might be at play. From there I play detective and I might drop back a bit on the med that I suspect that is causing a problem - I am not suggesting that you or anyone not follow docs orders, but for example on the opiate pain meds I am guessing in your case there is nothing that says you have to take the max dose everyday, probably same for some of the other. If you drop back (not stop, we don't want any withdrawals occurring) I realize you might experience more pain as a result, but then you will know the trade off (sleepy during the day or pain during the day) and then you can talk to your doc about an alternate medication that maybe doesn't make you so drowsy. As for the topamax, maybe try 50 mg just one night and see if there is a difference the next day - dropping to half one night to me it is no different than if you forget to take it all together and actually taking half a dose is better than not taking it all (believe me if you have never made this mistake after having it successfully control pain). However, do not cut back on your topamax if you are taking it for anything other than pain control (if you have seizures or some other serious disorder that topamax is used for then you must talk to your doctor if you suspect it is the culprit of your drowsiness.)

    Now the effexor I also can not suggest you not take one day either because although I know kind of what it is and used for I do not know enough and actually I suspect missing a day of it is probbaly not such a good idea. Again if you get to the point you think effexor is the problem - talk to the doc. The Doxepin you state you take as needed for sleep problems, easy enough to not take it and see if you are less drowsy easily rule it in or out as a problem maker - same for Ambien, although my guess would be if the Ambien is giving you trouble it would be short lived and in the morning if anything - but again, easy enough to find out.

    I have looked at you list of meds and am farmiliar with all but the Effexor and Doxepin in regards to their use for pain and in general more common side effects - now everyone is different and you could be experiencing a reaction that is a combination of 2 og the meds you are on - but there are 2 things I saw right away that make me say wonder if they aer causing you this trouble. My #1 suspect is the flexiril which you are taking 3 times a day - I know they are small pills but try cutting those in half for a day or talk to the doc about trying to stop them for a few days and see if that helps the drowsiness and see how much they are or aren't helping your pain. Secondly, the topamax. I do not know how long you have been on it or if you tirated up to the 100mg's and how fast. Topamax varies greatly from person to person and does NOT have a huge daytime drowsiness side effect but it can make you really, really out of it which you may be thinking is daytime drowsiness. So if you have just started the topamax and they started you right at 100mgs you could be feeling like you just want to sleep, but if you have been on it a while and given that you take it all at night, I am thinking it is not causing your problem.

    I hope this helps. Also there are a couple of people on this board that really know the pain meds, and they will be able to chime in as to what they think about your list. Please, please consider my advice carefully before trying anything and understand I am not saying to stop taking meds without doc approval - that would be bad, I am just saying experiment a little within the range of how you are prescribed to use your meds, combine it with some knowledge about the side effects and then try to figure out when your side effects occur in relation to when you take your meds. Again, my guess is the flexiril - especially if the drowsiness seems to carry on all day, every day (then again I don't know about the effexor). Also, I don't know if flexiril is one of those medications that eventually your body will get used too, but some of the senior members could help you with that.

    Good luck to you in your journey and I would love to hear if you are able to figure something out and work it out with your doctor so you can get to a place where you can function - after all what good is controlling the pain if you can't keep your eyes open.

    Old 06-14-2006, 10:52 PM   #3
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    Re: How do I combat Daytime Sleepness?

    Hey Gal,

    How long have you been on these meds? The reason I ask, is because if you have been taking the opiates for some time, I doubt the opiates (Hydro, Oxy) has too much to do with the daytime sedation. If you were taking Morphine or Methadone, then yes, but the semi-synthetics like Oxy, are actually a little more stimulating.

    By looking at your list, my guess would be Doxepin and Flexiril. Doxepin being a tricyclic anti-depressant. TCA's are known for drowsiness. Amitriptyline being probably one of the more prominent ones for sedation. But many times, and as you mentioned, Doxepin is used for sleep and can carry over.

    Flexiril is a muscle relaxer but with some anti-depressant properties. Flexiril has been known for sedation and relaxation.

    The ambien can definantely cause sedation, this is what it is made for. However, Ambien is a short acting drug. Unless you are taking it during the day, I doubt it has too much of a carry over effect.

    Topamax can make you feel pretty spacey, especially at higher doses.

    Now if you add all those together, it is a good probability that you will experience daytime drowsiness. Other than asking for a change of meds, I'm not sure how to combat the drowsiness. Some of it will go away with time. But I have found that the TCA's can take a long time.

    There are alternatives. For instance, there are other muscle relaxers like Skelaxin that do not cause as much sedation as Flexiril. And if you were able to get by with just the Ambien at night, then maybe you could cut out the Doxepin.

    Of course talk with your doc and see what he has to say. But maybe he can make a temporary adjustment in your meds to see what works for you without causing the daytime sedation.

    Take Care

    Old 06-15-2006, 08:39 AM   #4
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    Re: How do I combat Daytime Sleepness?

    Flexeril is a heavy drug. if I take a 10mg I am out for 16 hours. I could NEVER take it during the day and function. I bet that is what is causing your day time sleepiness. if I take it at night I am still out of it the next day. it is sooooo powerful. see if your Dr can reccomend something else. i take Robaxin and it works well for me and is a muscle relaxer that does not make you tired.

    Old 06-15-2006, 10:16 AM   #5
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    Re: How do I combat Daytime Sleepness?

    Because each person reacts differently to medication it's hard to say exactly what medication or combination of medication could cause the excess drowsiness. For example, Flexeril doesn't even phase me in the sense of being drowsy where as you can see it does affect others and I can't take Skelaxin because it does a number on me. Ambien on the other hand causes extreme drowsiness beyond the 8 hours that it is supposed to.

    The biggest offender on your list is the Doxepin, it is similiar to that of Elavil and it does somewhat build up over time causing the excessive drowsiness.

    I would definately talk to your doctor and or your pharmacist about your current regimine. You may need to lower doses on some medications or make changes. If the doxepin is used to maintain sleep them Sonota would be a better choice to actually get to sleep as it is the shortest acting sleep aid in that it only lasts 4 hours and then is completely out of your sytem. The doctor could add a new medication to combat the daytime drowsiness but then it could set off an entirely new set of side effects that are unwanted, it's best to find the offender instead and deal with it.

    Old 06-15-2006, 12:55 PM   #6
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    Re: How do I combat Daytime Sleepness?

    Thanks for all the replies! I wanted to clarify a few things for those who asked. I have been on Oxy for almost a year. Hydro for almost 2 years.

    I take the flexiril mainly at night. I rarely take during the day and only when absolulty when needed as it does tend to make me sleepy. I would say on average I take the flexiril maybe once every two weeks during the day.

    As for the doxepin I rarely take that as well. I have mostly phased that out and replaced with Ambien at night-time. The only time I take the doxepin is when I can't sleep due to the pain being so bad then I will take in conjuction with the Ambien as I find that the two together helps me sleep better but again I do this very rarely. I included it in on the list because I do sometimes take it.

    At this time it is not possible for me to cut back on my Oxy as I am severe pain everyday in fact with the oxy it only brings my pain down to a seven without it I can't move or get out of bed because the pain is so bad :-( I would rather deal with the sleepiness -

    I guess the short of it is I just have to deal with the sleepiness. I know fatigue is a main symptom of fibromyalgia so I suspect this could be playing a role in this as well.

    I am 30 years old and most times I feel like i'm 80 - but such as life it could be so much worse at least I have my life and God!

    Old 06-20-2006, 12:40 PM   #7
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    Lightbulb Re: How do I combat Daytime Sleepness?

    Recently I complained to my Doctor about the same thing.

    I am being treated for Rheumatoid Arthritis, Chronic Myofacial Pain, Fibromyalgia, TMJ, and Bulging Disks in my neck.

    Currently I am taking MS Contin, Percocet, Cymbalta, Flexeril, Nuerontin and Trazadone (for sleep) daily. I also take Valium (for tension headache) and Midrin (for migraines) as needed.

    I was exhausted and yet I still had some trouble sleeping, since I am still working full time (against my Doctors advice but we need the money) I cannot afford to be sleepy all of the time. She prescribed Provigil, a narcolepsy drug. It has made a big difference. Before I was afraid to drive home after work because I was so tired.

    The pain meds have never made me feel altered so that hasn't been a problem. Now with this medication I feel awake for most of the day without that buzzy feeling that I would get from too much caffeine. I am not sure that all insurance companies cover it but it is worth a try.

    I thought that I was the only one in her 30's that felt like 80. I am sorry that you have to deal with this, just know that you are not alone.


    Old 08-18-2006, 01:11 AM   #8
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    Re: How do I combat Daytime Sleepness?

    its the flex try to take it only at night good luck

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