Of all of the effects of the stroke - learning to walk, the inability to run, losing the ability to swim (for now, I hope), difficulty talking, and difficulty swallowing water, the most frustrating of the bunch is insomnia. This is not the run-of-the-mill "I only got four hours of sleep last night" kind of insomnia, but the "I don't think I got any sleep at all last night" kind, which went on for over two years.
When this first started in the hospital, they tried to give me all kinds of different sleeping meds. Unfortunately, as it turned out, the only one that seemed to work for me was lorazepam - more commonly known as Ativan. The doctor in charge of the rehab unit at the hospital was really reluctant to put me on Ativan long term (more than a few days in a row), but I asked him for a prescription when I left in January 2010 for a seven day script - and he grudgingly obliged.
Once I was out of "the big house" (we don't use the "H" word anymore) and seeing my regular GP, he figured that it was far better to get on to Ativan, and it's addictive properties, than to lose sleep - we could handle the Ativan dependence at a later time. The drug worked well for a time - a couple of months - but then it stopped being effective. I had to supplement it with a drug called mirtazapine (or Remeron). This went on for several more months, until I figured it was time to get off both of them. The mirtazapine taper was easy - I just took a smaller dose every few days for a couple of weeks and I was done. The lorazepam proved much more stubborn.
I attempted to taper and get off lorazepam three different times. The drug is a potent benzodiazapine, and as such you have to taper off it really slowly - a matter of months, not days or weeks. The first time, after three months of taper, I found that I couldn't get past a very small dose (0.25mg - this is strong stuff) - the insomnia returned worse than ever. The next time I tried, I went even slower, and put up with the consequential extreme insomnia when I got to the really small doses. My sleep blog has a post specifically about the taper.
There is so much controversy over the use of lorazepam (and others) that there is a well established benzodiazapine withdrawl program, and even several web-based support groups to help you through the physical dependency. Note that these encompass all of the benzo type drugs - Xanax, Valium, Mogadon, Klonopin, Ativan and others. The sad part is that most doctors in North America would sooner write you a prescription than provide some counselling.
If a doctor had provided me some counselling at the outset, I'm hoping that this is what he/she would have told me (this is the take-away from this entire essay):
"Lorazepam or Ativan becomes physically addictive when taken for more than a few days at a time. This addiction is horrific to get off of - it will take you months. On top of that, the drug is effective for only a short time, after which you'll have to either increase the dose or find some other drug to help you sleep. The best thing to do is to understand that you will sleep the amount that your body finds absolutely necessary - you probably won't know that you've slept, but you will. It will be far better and easier for you to try and resolve this issue without any drugs whatsoever. Begin some meditation, try some isochronic tones, and make sure you're practicing all the sleep hygiene tips we have. This, in the long run, will be something you'll have to do anyways - the lorazepam just postpones the process, it doesn't cure it - the same could be said of any sleep medication; they just mask the problem, not resolve it.".
If you want to read more about my struggle with sleep - check out my BuildBetterSleep blog. I started this site and still write in it three times a week because sleep became all-consuming for me...
