This Is MS Multiple Sclerosis Community: Knowledge & Support

Depression and insomnia are 2 of the wonderful side effects of my MS. Last night i couldnt sleep, so i take a little ambien to get me down. . i get a good 8 (waking up once or twice) - ambien does give me a side effect of making me a little more grouchy and depressed (not as bad as if i didnt get any sleep - lesser of 2 evils). I need to shake this today, i have to be in a good mood for a birthday celebration. i am going to try and get a yoga class in and i have had 2 cups of coffee - can anyone think if anything that had worked for them? im just so negative about everything when i am like this.

Hi Lizzy-

I might be able to return the favor after receiving the supportive words from you in the recent past. There are treatment options outside of sleep medications. Behavioral changes and cognitive interventions can be quite helpful with this sort of thing. The research has shown that they are actually as effective as the meds, without the next day side effects. I don't know what part of the world you live in, but in the US, there are a growing number of sleep disorder centers and many of them have physcians/psychologists specifically trained in these treatments.

If you don't have access to these services, there are several good books written by specialists with insomnia specifically in mind. Here are a few:

The Insomnia Answer written by Art Spielman
Say Goodnight To Insomnia by Gregg Jacobs
No More Sleepless Nights written by Peter Hauri

If you have anymore questions about this, feel free to let me know.

good luck with everything,

ThinkingOutloud

thank for your suggestions - i often say that sleep is my most sought after activity. my insomnia can have such an effect on so many parts of my life, esp the emotional side. . i can go from a negative nancy to tears in 5 mins - very confusing for some people close to me.

thanks.

Lizzy;

You don't say whether your problem is GETTING to sleep or STAYING asleep. Its rather important to know which it is.

_________________
Carpe Diem

I had sleep issues, way before I had MS symptoms. I found that it improved after I cut out ALL caffiene. Including cola drinks etc. A cola before midday, affects my sleep at night time, over 12 hour later.

Also, for the depression you may wish to try prozac. Now, it has some research which has implicated it can possibly attributed to nuerogenesis in MS (as well as in mice).

I would consider myself far from Depressed, however I tried prozac. It has some amphetamine type effects (take it in the morning to stop it affecting sleep). I seemed to possibly improve my physical results.

Personally I was concerned it would turn me into some kind of emotionless zombie. However, I didnt notice any mood changes at all. If I was clinically depressed, I would be concerned if this was the best they had to offer. I was on 20mg/day (normal dose is 20-40mg/day). But it may help your mood with a possible added bonus.

Hi Lizzy-

A few more thoughts. One...WebMD has an article on some sleep management for individuals with MS. They've listed a number of items used to treat insomnia for the general population. The link is:

http://www.webmd.com/content/article/57/66143.htm

Also, in addition to eliminating the caffeine (good idea!), it can help to tease apart when the insomnia started as well as any changes in your bedtime routine. For some people (regardless of having MS or not), they develop a pattern where their body/mind become more aroused at bedtime, which makes it harder to fall asleep. In a sense, it becomes learned. If you find that your mind is racing at bedtime, writing your worries down before bedtime can be a way of reducing them. Also, a white noise machine or something else that distracts your thoughts can also be helpful. Lastly, our body temperature naturally rises and falls throughout the day. During our deepest sleep, our body temperature is at its lowest. Thus, it can be helpful to exercise in the late afternoon/early evening (which, as all of us with MS know raises our body temp) and take advantage of the natural lowering of the body temp in the later evening as we cool down.

ThinkingOutLoud

I too am one of those ones up til 3 or 4am, mind (& bladder) abuzz. I've been trying Melatonin off/on. It seems to have helped others with winding down. Most beneficial has been the LDN. I found it helped calm the jitters or cramps (& even the bathroom visits). Hope you find some relief. It's so hard to 'handle the day' when one is tired, crabby and achey.

What works for me.....
Depresssion: Celexa 40mg daily...dont really give a sh!t about anything, but I am always positive and happy.
Sleep: 2mg of xanax, 1 benadryl, and several beers.. I sleep like a baby.

_________________
w/m 44
The problem comes with the decision of weighing the unknown with the unknown.

My husband was helped by the Prozac, and I would say he was clinically depressed (also anxious and could not sleep at all, which made the first 2 worse). I really feel the prozac contributed to his recovery, BUT at the same time he had some cognitive behavioural therapy and was using some hypnotherapy tapes, so it all helped together. He's off the prozac now.

Hi Lizzy
I was always a sleep chaser, even years before my diagnosis. Nerve pain, bladder frequency, and twitching all combined to make sleep my elusive obsession. I suffered 15 years of insomnia before I really tackled it. I now take 25mg amitriptyline at night (about 5 hours before bed) and I sleep, generally, very well. Occasionally I do have a breakthrough insomnia night but mostly I sleep well again.
My Dad is a hypnotherapist and despite relaxation tapes, yoga, vitamins, hypnotherapy etc. nothing every really worked for long on my insomnia, all except tackling the nerve pain I had - I hadn't really acknowledged or realised how bad the nerve pain had become until it stopped once I took amitriptyline.
Hope you find your own solution to the insomnia, it can be true hell.
Ami does make me 'dopey' in the morning but a strong mug of coffee helps.
Best of luck

_________________
~~~~~~~~~~~~~~~
Concussus Resurgo
~~~~~~~~~~~~~~~
RR-MS dx 1998 and Coeliac dx 2003
~~~~~~~~~~~~~~~
Copaxone, Cymbalta. EPO, Fish Oils, Vitamin D3 2000 IU daily, Cal/Mag/Zinc, Multivitamin/mineral, Co-Enzyme Q10, Probiotics, Milk Thistle.

hi lizzy if you did want to try a nutritional approach it would depend if you're already taking any vitamins/minerals and if so how much and what timing.

b vitamins, vitamin D, minerals, and essential fatty acids are key players.

B COMPLEX VITAMINS

http://depression.about.com/cs/diet/a/vitamin.htm

a daily b-50 or b-100 complex is a good starting point. people who take high doses of b12 (as in 2000mcg) in the morning may experience trouble sleeping. best to take higher doses of b12 in the afternoon or evening.

VITAMIN D3

low vitamin D3 levels can affect mood. ms patients tend to be low in vit D3. aim for serum levels of at least 100 nmol/L. up to around 150 nmol/L. no higher than 250 nmol/L. the appropriate test is 25(OH)D3. a daily maintenance dose is 4000IU.

MINERALS: CALCIUM, MAGNESIUM, ZINC

it is important to balance D3 intake with minerals like calcium, magnesium, and zinc.
calcium intakes around 1000mg per day are adequate.
magnesium - try for intakes in the neighbourhood of at least 400mg elemental magnesium per day. a good source would be from albion chelated magnesium glycinate. other forms are hard to absorb and may give you unwanted GI side effects. ms patients tend to be lower in mg, not to mention that anxiety and depression are associated with low magnesium levels. magnesium serum levels should be at least 0.91 mmol/L. in order to achieve that serum level you will have to take some magnesium at the same time as vit D3, but also another dose at a different time of day.
zinc intake requirements depend on your current status. 25-50mg per day would be good but make sure levels don't go too high. target serum values are 18.2-18.4 umol/L. i don't have good research on the top end of the safe range, but to be on the safe side i'd say don't go over 20??

POLYUNSATURATED FATTY ACIDS

essential fatty acids are also important. ms patients have more omega-6 in their systems than healthy controls. improve omega-3 / omega 6 balance.
fatty acids are also key in depression..
http://www.springerlink.com/content/u028h00453272554/
Arachidonic acid to eicosapentaenoic acid ratio in blood correlates positively with clinical symptoms of depression

fatty fish like albacore tuna or salmon can be very effective at improving O3 status.
ergo baked chinook salmon twice per week could help sort out your essential fatty acid balance:

http://www.ajcn.org/cgi/content/abstract/86/6/1621
Comparison of the effects of fish and fish-oil capsules on the n–3 fatty acid content of blood cells and plasma phospholipids

from a supplement perspective, it appears that EPA is more important the DHA for treating depression. my fish oil supplement contains 400mg EPA and 200mg DHA per softgel.

EXERCISE

finally, if you do not have an exercise regimen in place, getting moving in some personally EDSS-appropriate way, may help lift depression and improve sleep.

hope that helps. if you have any questions fire away

_________________
my approach: no meds so far - just balanced whole foods (partial 'paleo', much less outright elimination), science, supplements, & bloodwork
my regimen - www.thisisms.com/ftopict-2489.html
www.whfoods.com, www.nutritiondata.com

Great info as always, Jimmylegs! Thanks!

I can't even remember what 8 hours of sleep is like! I've had sleeping issues for about 10 years now. Once I get up to go to the bathroom at night, I can't get back to sleep. I usually have "to go" a couple of times at night I've tried several prescription sleep aids over the years, and none of them have worked. I've tried Valerian and natural sleep supplements too.

Believe it or not, the only things that can get me back to sleep so I can get close to six hours of shut-eye, are over the counter sleep aids--which are essentially benadryl (diphenhydramine.) I'm going to take a good look at your supplement suggestion list, JL! I'm not as diligent about taking supplements as I should be, so I need to get on the ball!

no probs k - hope you see some benefit keep us posted!

_________________
my approach: no meds so far - just balanced whole foods (partial 'paleo', much less outright elimination), science, supplements, & bloodwork
my regimen - www.thisisms.com/ftopict-2489.html
www.whfoods.com, www.nutritiondata.com

What sort of work out do you do?