I’m up, may as well try to explain it

[stephbg]

As I make the decision to start writing this post it’s just after 4 am and I’m awake. Again. Since there are possibly Reasons for this I thought I’d try and knock out some kind of medical update post. It’s rambly. tl;dr I’m messed up and take a lot of meds.

About a month ago I started taking my tiny Cymbalta dose at night (about 10 mg), hoping that the woozy side effects would help me to sleep, rather than wiping out a few hours of mid morning after taking it first thing. My dosage is approximate because the smallest capsule is 60 mg and I’m stupidly sensitive to drugs and had to start small. Remember that: Stupidly Sensitive.

The plan was always to try to increase the dose because I’m taking it for pain management, so a week or so ago I started doing that at night.

It has not gone well.

One of the biggest issues I had with morning Cymbalta was that it would act like a catalyst for any other kind of woozy-making drug I may have taken recently (i.e. even the night before). It effectively doubled the life of a dose of Stilnox, giving it an extra boost that would keep me sleepy or simply asleep for the rest of the following day. This rather defeated the purpose of taking occasional Stilnox, which is to try to make me diurnal once in a while. It also boosted the woozy factors of codeine (still needed because the Cymbalta wasn’t dealing with the pain) and amitriptyline (Endep), also taken for pain and to still jumpy muscles.

I’m up now because of ridiculously intense muscle jerks, spasms and tremors in arms and legs, an extreme form of Restless Legs syndrome, and it gets particularly bad in my hands, feet, and quads. If I relax, I move. If I try to stay still I get a couple of seconds of suspension (who needs to breathe?) followed by an almighty spine jerk just to make up for lost time. (This used to happen a lot during massages.) Earlier this morning at around 2:30 am I caved and took 20 mg of Endep. I usually try to take only 5-10 mg at once but this was extreme. Tried to do the yoga-y things that usually help to settle the twitches but no luck and I gave in at around 3:30 am and here we are.

As a side note I’ve overdone the yoga-y stretches and poses and will pay an additional penalty for that in the form of additional muscle pain from micro tears. Oh how I could go on about micro tears, muscle development, and the critical role of restful sleep after exercise. One is tempted – after all, one is awake with no signs of anything else on the horizon – but one will exercise restraint. Lucky you.

I’ve had the restless legs (ha, if only) for a long time, but unfortunately the Valdoxan (agomelatine) I take at night to help (ha!) regulate my sleep sometimes exacerbates the condition. When this happens I usually drop or even skip the dose for the next night or two. Can’t do this permanently, or I’d never get to sleep at all. Not that I *stay* unconscious under any circumstances other than with the help heavy pharmaceuticals designed to do that and only that, but I’m better off with Valdoxan than without it. Slightly. (Note: unconscious =/= asleep.)

What I think I’m seeing here tonight is the interaction between my natural tendency to jerk and thrash about multiplied by the Valdoxan, and given an extra fun boost by the Cymbalta which I’ve been taking at 15-20 mg or so nightly.

(It’s difficult to be precise about the Cymbalta dosage because I have to crack open a capsule and take a small fraction of the granules within. I’ve described this method elsewhere, but the point is it’s easy to be consistent with a certain dose, but a bit messier to specify numbers when dealing with “a bit more”.)

So here we are. At 4:40 am-ish my legs are protesting that they’ve been squashed in the seated position for OMG half an hour, which really I wouldn’t expect after 20 mg of Endep. I have leave to take much more and it looks like I’m going to have to do that. Good bye any thoughts of productivity tomorrow :-( .

As of tomorrow I drop the Cymbalta back to the smaller 10 mg or so starting dose, and cut the Valdoxen back until I can relax my muscles in prone position without looking like I’m having some kind of intense seizure. It would also be nice if I didn’t feel the urge to whimper when I’m trying to rest. The jerking happens when I’m awake and stay still for too long, but it’s no trouble really compared to what happens when I just want to get some f%kin sleep.

No, I would *not* be better off without them, because that’s worse.

ETA: The shakes didn't go away so took another 10 mg Endep at about 6 am.