Regardless of all my neuropathy meds (gabapentin 4500 mg, fentanyl 125mcg/2 days, effexor 225mg, tramadol 50mg as needed) and various sleeping medications, I cannot sleep more than 2 hrs a night.

Usually my pain is under control, I am tired or exhausted, and have no problems falling asleep. I wake up all of a sudden and am fully awake and unable to go back to sleep so I just get up.

This pattern has been going on about a year even before my husband died 5 months ago. No matter if I take a nap or not (again for only 2 hrs at a time) I still cannot sleep at night.

I also take enbrel 50mg/week and leflumonide 20 mg/day for my RA which is currently in remission.

Please help.

im sorry to hear about your loss.
I also taking tramadol and gabapentin. My pain is under control too but just like yours, my sleep is disturbed.
I have difficult to fall asleep, somedays i can sleep for more than 10 hours. It is very confuse, i have no time settled.
The last 6 months, i've notice the hours of sleep is decreasing, and i am now waiting for an appointment at Pain Management clinic, when i hope to get a solution for the problem. I will write to you about the outcome of this.
I would like to try a different medicine.
Tramadol and Gabapentin works for me in the last 4 years, but i always feel tired and restless, amongst with other side effects.
thank you for your post.

I would try some Melatonin, to see if that helps.

Taking SSRI drugs like Effexor, reduces the availability of serotonin for conversion to Melatonin in the brain.

Melatonin is our sleep hormone. When it is low we don't sleep or or sleep cycles become disturbed.

If you get up during the night and put the lights on, this automatically shuts off the melatonin in your brain, so you will become erratic in sleeping. Use only yellow type night lights.

If a person is low in B12, then they do not have enough to convert to methylB12 in the brain, which is the cofactor for making melatonin from serotonin. Taking methyl B12 orally as a supplement may help as well.
More here:
http://en.wikipedia.org/wiki/Melatonin

The blue blocking sunglasses mentioned are called BluBlockers.
There is also another one, more expensive called Eagle Eyes.

If you decide to try melatonin, start with 3mg 1 hr before bed.
This is a gentle type intervention, and not like a "drug" treatment. It will take a few days for your body to get used to it.

Thank you, Mrs.D, as a matter of fact, I did try using melatonin when I started using vitamin supplements: Methyl B12, D3, benfotiamine, magnesium, ALA & omega3.

The melatonin did not help me at all. I gave it a fare shot and used up the bottle. My night lights are 4 watt yellows. Should I just stay in bed wide awake and try to go back to sleep even if it takes hours? I have always kept my room dark for sleep. Should I stop using the effexor? My neurologist is also certified in pain management so he also handles all my drugs for me.

Well, Effexor is a mixed acting anti-depressant, and those have shown better effects centrally for chronic pain. Effexor is less toxic to the liver than Cymbalta. But it has norepi effects which are stimulating and even may raise blood pressures.

Some ideas:

1) change or lower the dose of Effexor slightly. The norepi effects may be stimulating you too much. Change to immediate release over long acting, since Effexor has a short half life in the blood.
Don't take it before bedtime.

2) Switch to amitriptyline... this drug has shown usefulness too, and also shows nerve growth potential peripherally.

If you don't sleep, you don't heal, and things get worse over time painwise.

So you need to discuss with your doctor what can be done.

Thank you mrsD. My effexor is the regular one and not the XL. My neuro did prescribe me amitriptyline for sleep (in addition to my effexor) but it did not work. I gave it 60 days. Also I am medicare disabled so medicare is my only insurance now that my husband is gone. Why does medicare not cover amitriptyline? I realize it is only about $15 for a month supply, but with the amount of drugs I have to take and the very large copays I have to pay, sometimes that extra $15 is too much. Also, I just found out that effective Jan 2011 that medicare made fentanyl a tier 2 drug. Can you believe that?

Amitriptyline should be covered by every insurance. I don't understand that. It is a very inexpensive drug and used by many seniors.

Some places like Target and Kroger's (where I live) and WalMart which is everywhere have a $4.00 cash/month deal or $8.00 for 90 days on most generics. Amitriptyline should be on that list.

It might be that you will need up to 50mg at night of the Amitrip.
Sedation and better sleep are very common side effects that many patients welcome. If you try it again, you may have to discontinue (taper off ) the Effexor. The fact that you took them together and got no sedation implicates the Effexor as the culprit.

Also some people get jazzed on narcotics too. And on Tramadol.
Not everyone, but some.

Its not medicare that is not covering amitriptylene its your particular plan. other plans are covering it. you can get amitriptylene for $4 a month at a few places as Mrs. D said. Again it isnt medicare that is changing the tier for fentanyl its your particular plan that is doing that. some i looked at just now have it as a tier 3 drug. it depends on the plan. they are suppossed to give you 60 days notice of the change. you may have to change your part D drug plan if they dont cover the drugs you need.

Thank you, mrsD. I will look into the amitriptylene on my plan (just going by what lady at the pharmacy told me) and discuss the effexor with my neuro on my next visit.

Hi, echoes and thank you. I was told by the lady at the pharmacy that is was medicare who did that. I will try to research for another plan, but isn't it true I cannot change plans until the next enrollment period? I am having a hard time with all this medicare stuff. I was effective on it 12/1/10.