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Waking Up Is Destroying My Life — Need Help
An_248239 posted:

I apologise in advance for the lengthy post.

The Background:
I'm a twenty-two year old male. I do not have any sleep disorders per-se (no apnea, narcolepsy) and have been to a sleep clinic before when I was younger. Things there were inconclusive.

My mental health is not in perfect condition. Depending on whether we go with my old psych or my new psych I have Borderline Personality Disorder or Tempestuous Histrionic Personality Disorder (a mix of Borderline and Histrionic traits). Because of this condition, which has been ongoing since I was thirteen, I take psych medications. The brand names are in brackets. I take generics.

4mg clonazepam (Klonopin)
1mg lorazepam (Ativan)
60mg citalopram (Celexa)
20mg olanzapine (Zyprexa)

Bear in mind that I first started taking this combination of meds a long time ago — years, and have been ever since. I'm now fully tolerant to the benzodiazepines and I don't notice an effect from the antidepressant or the antipsychotic. I'm working with my new doctor to get off of the antipsychotic and antidepressant by slowly reducing the dose which I have been doing for about a year. We're going very slowly and decided to take out the benzodiazepines last, because as I'm sure you know, they are some of the hardest medications to "withdraw" off of.

The Problem:
I cannot wake up normally. If I am given free-reign I will wake up on my own eventually. Some days it is before 9AM but some days it takes me until 12PM to raise from bed on my own. This is not on purpose and I need someone to actually sit in my bedroom and talk to me until my "brain wakes up." I have entire conversations, according to the people I live with, that last sometimes ten minutes while I am trying to be woken in the morning. I never remember these.

The loudest alarms do not wake me. We discovered this when I was a teen in school. With two alarms (one close to my head and one further in the room to force me to stand) going off at a loud volume, I would sleep completely through them as if they weren't there. It would result in my mother having to come turn them off because they woke her up on the other side of the house and she would wake me herself. I hate this!

The Situation:
It seems to me that my brain has a special "partition" for the mornings. I've heard recordings of myself when people try to wake me up and I speak with eloquence saying "Yes, of course I'm awake — will you put the coffee on?" I talk as if I am awake and it sounds to me on the recording and everyone else in real life as completely true. Who could speak like that when they are asleep? Well, apparently, me. I'll fall back asleep seconds later. Like I mentioned before, the surefire way to wake me up that I've discovered is for someone to have a seat in my bedroom and talk to me for maybe fifteen minutes or until I start getting actively involved in the conversation. They ask me questions about language and I'm a linguistics major so I'm more than happy to talk.

This is great, but no one has time to spend fifteen minutes talking to me just so I can wake up in the morning every day. I'm about to head back to school and this is a huge problem — something I could never figure out living on my own during my freshman year of university. I missed class a lot. I've tried adjusting my med time earnestly over a year with my doc and this was no help. It seems almost random when I will be "ready to wake." I go to bed when I am tired and fall asleep quickly. The medication no longer makes me sleepy as I am so tolerant. I've tried melatonin and some other over-the-counter options.

This is destroying my life. How can I live on my own if I can't wake up? My doctor and my psych are stumped. I appreciate all help and insight.
Caprice_WebMD_Staff responded:
Hi and welcome to WebMD,

There are no experts on this forum but while you're waiting for others here to respond, do some reading of other discussions. There have been previous discussions on this issue though I don't think there's any one answer, but you may pick up on some ideas or at least realize you're not alone.

It's also possible it's time for another sleep study as the one done years ago when you were a teen (I'm guessing) was inconclusive and may be more conclusive now if it's a thorough one.
FundamentalGuy responded:
You should as a doctor about recently FDA approved Intermezzo. It is a low dose rapidly absorbed form of the active ingredient in Ambiem, and the first sleep medication approved for as needed.

If you wake up and way too soon dreading not being sleepy you take a dose as long as you can commit the next 4 yours to sleep. Take in bed, or wherever you normally sleep.

I am seeing a doctor next week to explore this

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