[nothings]

Hi all, this is my first post on the forum. I know the topic of insomnia and anxiety comes up a lot (I ran a search for old posts) but just wanted some insight into my own situation.

I have a history of pre-existing anxiety (no medication) and have always been a light sleeper. I sustained what I thought was a mild concussion on 2/28/14 by tripping and slamming the center back of my head into a steel door at work. ER performed a physical assessment and diagnosed me with a concussion and gave me a referral to a concussion clinic in my area. A week later I ended up back in the ER for what turned out to be panic attacks, had a normal CT scan, but was then diagnosed with post concussion disorder and/or an acute stress reaction.

The past 5 days have been a complete blur. I did not sleep more than 2 hours per night from Sunday to today. During the day many of my symptoms are mild, but my anxiety is high. It's manageable as long as I have something to distract myself. But I rarely feel drowsy and when I lay down, I feel my heart rate increase and my mind begins racing. If I can manage to fall asleep, I wake up intermittently every thirty minutes or so in a sweat or for no reason at all. I do not take naps during the day (though I occasionally doze off for 15 minutes at a stretch) and try to go to sleep at the same time every night. I have no appetite whatsoever, nausea throughout the morning and late evening, and am probably averaging about 500 calories a day. I try to perform light exercise (mostly walking) every day.

It's now the start of week 3 after my concussion and I've been to the concussion clinic four times, seeing a neuropsychologist who is helping me cope with anxiety using meditation and mindfulness techniques. I have also been seeing a physiatrist at the same clinic, who doesn't seem to do much besides prescribe me a lot of medications that I feel wary of taking (had a bad history with anti-depressants when in college). Among these are Trazodone, Xanax, Ambien, and a few OTC supplements (melatonin, gingko biloba). The Trazodone worked by itself the first night but has not been effective since. The Xanax I try to reserve for emergencies but often end up taking 1 or 2 pills in the middle of the night as I grow more and more anxious about sleeplessness. I have not tried the Ambien yet as I'm afraid of the side effects.

I know that these things take time, but I'm a 24 year old who just got accepted to grad school and am trying to do whatever I can to recover before I start in August. I have a supportive family around me (my boyfriend's family, actually) and they are letting me stay with them so there's always someone at home with me. Unfortunately they can't help me fall asleep at night.

So I guess my questions.... What else can I be doing to sleep? Is it worth trying the Ambien? (My own physiatrist called after he prescribed it to say he had reconsidered, since it might exacerbate my anxiety.) Can anyone provide any insight?

[Mark in Idaho]

nothings,

Welcome to NeuroTalk. Sorry to hear you are struggling so with anxiety.

I think you need to be working on the anxiety as your primary problem. You could try taking L-Tryptophan and L-Theanine plus the vitamin regimen in the Vitamins sticky at the top to help your brain get settled. It may help to get a full hormone assessment. Hormone imbalances can be the cause of your anxiety.

What anti-depressants did you try and what were you problems with them ? I had extreme anxiety issues after an event last summer and the doc put me on Celexa with good results.

If you can try sleeping while watching TV, it may help. Put on a program or DVD that is interesting but slow and not overly exciting. Turn the volume down. Watch it and let your eyes close. It may be able to fill your conscious thoughts enough to prevent anxious thoughts. I used to do this with a DVD of Celtic Women. I was usually asleep watching 'the girls' within 10 to 20 minutes. I know of others who use this same system to occupy their thoughts until they fall asleep.

I hope this helps. My best to you.

[brokenbrilliant]

Sorry to hear you're having issues. Sounds like the concussion came at the worst possible time - though it's never a good time to have one.

I've had issues with anxiety for years, and the thing that helps me most is sitting and doing controlled breathing, where I slowly breathe in for 5 counts, pause a second, then breathe out for 5 counts. Nice and slow. Focusing on my breathing keeps my mind from going wild, and it also trains me to pay attention to one thing at a time. It also physically calms me, and it helps with fatigue. It also balances out my sleeping.

For falling asleep, I have a heck of a time just going to bed and falling asleep, even when I am exhausted. I tend to lie down on the couch while my spouse is watching television, and the background noise seems to help me fall asleep. Then I wake up after a few hours and go to bed, and I can sleep.

But getting to sleep is the challenge. Especially when I'm exhausted.

I cannot take a lot of medications, because I am so sensitive to them, and they make matters worse.

Good luck with school - hope you find a solution for your sleep and anxiety. I have a feeling that improving either one will help the other.

[Lightrail11]

Originally Posted by nothings

It's now the start of week 3 after my concussion and I've been to the concussion clinic four times, seeing a neuropsychologist who is helping me cope with anxiety using meditation and mindfulness techniques. I have also been seeing a physiatrist at the same clinic, who doesn't seem to do much besides prescribe me a lot of medications that I feel wary of taking (had a bad history with anti-depressants when in college). Among these are Trazodone, Xanax, Ambien, and a few OTC supplements (melatonin, gingko biloba). The Trazodone worked by itself the first night but has not been effective since. The Xanax I try to reserve for emergencies but often end up taking 1 or 2 pills in the middle of the night as I grow more and more anxious about sleeplessness. I have not tried the Ambien yet as I'm afraid of the side effects.

I know that these things take time, but I'm a 24 year old who just got accepted to grad school and am trying to do whatever I can to recover before I start in August. I have a supportive family around me (my boyfriend's family, actually) and they are letting me stay with them so there's always someone at home with me. Unfortunately they can't help me fall asleep at night.

So I guess my questions.... What else can I be doing to sleep? Is it worth trying the Ambien? (My own physiatrist called after he prescribed it to say he had reconsidered, since it might exacerbate my anxiety.) Can anyone provide any insight?

Hi and welcome to NeuroTalk.

To put some perspective around this, your concussion was very recent when compared to typical mTBI recovery times. School starts in August so you have some time on your side.

My first question would be how is the mindfulness meditation working? I have found this effective for reducing anxiety, and I have no trouble sleeping. Like other things this may take some time, and in order for it to work you have to practice consistently. Another practice I find useful is yoga, so if you don't have physical limitations from your injury you may wan to give that a try.

Personally I'd see the Ambien as a last resort, I'd keep practicing the meditation, and the mindfulness breathing as brokenbrillaint suggests prior to starting on that.

Recovery from mTBI isn't an exact science but you do have a some time to get better before school starts.

Best to you on this journey.

[nothings]

Thanks everyone. I ended up trying the Ambien with extremely bad results (never actually fell into a deep sleep, just hallucinated all night and woke up every few minutes). I think my body eventually gave out as I managed to fall asleep without medication last night besides the OTC melatonin I've been taking. I slept fitfully and woke up every hour or so, but got in about 7-8 hours for the first time in a week.

The mindfulness and breathing exercises are normally very helpful. Unfortunately I felt so exhausted, sleep-deprived and depressed towards the end of the week that I was totally unable to concentrate long enough to perform them. I did some this morning and found them helpful.

[LauraM]

Ambien did not help me sleep at all.

just as a suggestion I have been listening to audio books.

If you lay down to sleep turn on a relaxing......no horror....book and just listen. Even if I do not fall asleep I am still and totally relaxed in bed.

Some nights I do sleep some and do not realize it until I figure out I missed something important in the book. Or it could be soft music, but I found the books to keep my interest more thus occupying my mind from thinking too much.

I also take Melatonin 5mg. as prescribed by my physical med/rehab doc.
A warm cup of Camille tea never hurts.
Good luck!