Cannot sleep

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After the 2nd follow-up appoint, mum needed to take the extra dose of olanzapine (sometimes once, sometimes twice a day i.e. the maximum) and it was working in dampening her self-hurt urge. Her sleeping pattern, though, fluctuated i.e. sometimes she had little sleep.

However, just less than a week to her 3rd follow-up appointment, her sleeplessness was so bad that she started shaking due to anxiety. Once again she hurt herself using a peeler :( This despite having taken the max presribed dosage of olanzapine. According to my family (I wasn't there), this self-hurt urge emerged when she felt very restless but manageable if she had sufficient sleep at night. Another important fact was that it was not driven by "voices".

Since it was post-election public holiday (next two days were declared as holiday by the incoming ruling coalition after the 14th general election), my family brought my mum to the A&E department at Penang GH. In the end, the on-call doctor prescribed clonazepam 0.5mg (an anti-convulsant/anti-epileptic drug that is also used to treat panic attacks) to be taken as and when needed, to the max dosage of twice a day (morning and night). If mum's condition didn't improve i.e. restless, couldn't sleep and wanted to hurt herself, then she would be warded once again.

That night, at 1am+, my mum had to take one because she couldn't sleep and half an hour later she managed to sleep for more than 8 hours. Subsequent nights, things were ok until the night before the appointment: once again, she couldn't sleep (after getting up to go to toilet) and started shaking intermittently. Despite taking clonazepam, she still couldn't sleep. She managed to hurt her hand once by using a drawer but my dad managed to stop her from doing it any more. Took the maximum additional dosage of olanzapine. Her blood pressure was 159 but luckily she managed to fall asleep at around 2.45am. There was much anger in her because she felt she was a burden to her family.

I managed to piece some information together: the shaking and the urge to self-hurt occurred when she couldn't sleep.

The 3rd follow-up appointment summarised as follows:
  • We informed the doctor about her symptoms appearing only if she couldn't sleep
  • She was giddy all the time, with varying intensity. This was since the time in ward. All the doctors, so far, appeared to be at a lost to explain this, especially since her blood pressure was ok most of the time
  • Voices now included her own voice but it they were all "inside" (rather than verbally spoken)
  • Maintained olanzapine 5mg day 10mg night, benzhoxol 2mg day plus ad hoc 2.5mg twice a day. Instead of ad hoc, clonazepam 0.25mg is taken every night and additional 0.25mg if needed but try not to. Introduce anti-depressant sertraline 25mg day
  • If there was no improvement, then she would be warded and undergo ECT
  • We were advised to bring her to A&E if we couldn't manage her condition

Comments

Twilight Man said…
Your mum's condition is quite rare and unusual that even such strong medications could not help her to sleep at times. The doctors were baffled themselves too.
May 21, 2018 at 2:19 PM
Anonymous said…
Your Mom is having the same meds as my brother did. He was on olanzapine, benztropine (to control the side effects of olanzapine), clonazepam, and fluvoxamine (anti-depressant). He had lower dosages because he had anxiety and aggression, but he did not hurt himself. Hopefully, now that an anti-depressant is added, your Mom can sleep better (not being able to sleep it the biggest trigger factor for mental illness), and can respond more positively to her other meds. SR
May 22, 2018 at 1:21 PM
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