Difficult to sleep

So now it's becoming difficult to get a good night's sleep. It always was - even before GPN - but now it's worse. Lying down always results in pain. I have to lie only on my right side, and either not swallow or swallow without moving my mouth until I sleep. But then I sometimes wake up early with the stabbing, pulsating or electric shock pain. After that, I generally can't get back to sleep. I often take a couple of Tylenol before bedtime, but nothing stronger.

Once I get out of bed and have a hot drink I may feel fine until I eat or brush my teeth. For the rest of the day the pain is either random or linked to movements of the mouth. I'm still waiting for a period of no pain.

Hi Nomad, Its awful when you can't sleep - I find if I look at Farmville and Marjong long enough I become catatonic, even if I don't sleep - lulls the brain to a comatose state :) Have you asked your neuro about shifting the timing or your meds etc? May help a bit.

I'm not taking any meds for GPN. Afternoon exercise and reading before bed works pretty well. The main problem during recent weeks is waking up early because of the pain caused by shifting position while asleep.

I've unfortunately suffered from chronic insomnia and also sleep apnea. The usual course of action is to first talk to your primary care doctor. They may prescribe medications that get you back to a regular sleep cycle. If the medication works, you will be able to get a good night’s sleep, say 8 hours a night, without waking up too many times throughout the night.

Doctors might first suggest taking melatonin, a supplement you can buy over-the-counter. If melatonin does not work they might prescribe sleep medications like Ambien, Lunesta, etc... The doctor will try and get the patient back to a normal sleep pattern for say a few months, then slowly take the patient off the sleep medication(s). If the medications don’t work, then the doctor may prescribe a sleep study and/or recommend a patient see a sleep specialist.

I see you are from Thailand. I live in the U.S. Medical schools in the United States don’t usually allow a medical student to specialize in sleep disorders. So a doctor will typically specialize in another area before becoming a sleep specialist after further education. The doctor could specialize in almost any area before becoming a sleep specialist. For example, I’ve seen sleep specialists that are also neurologists. I’ve even seen a sleep specialist that is also a psychiatrist. I’m not sure how your system works in Thailand. If you do get to a point where you need to see a sleep specialist, you are likely better off seeing a sleep specialist that also specializes in neurology and/or pain management. They would have greater insight into how your sleep problems relates to your pain disorder.

For me, ultimately taking the medication called amitriptyline was the best solution. Amitriptyline (Elavil) is an old antidepressant developed in the 1950s. It is technically called a tricyclic antidepressant (TCA). TCAs were the standard treatment for depression before the introduction of Selective Serotonin Reuptake Inhibitors (SSRIs). Therefore amitriptyline is not typically used anymore as an antidepressant. It is now widely used for neuropathic pain disorders. So this medication may help your neuropathic pain and also your sleep. One of the major side-effects of amitriptyline is that is causes drowsiness, which is the reason I along with other people take it to fall asleep and stay asleep. From my own experience it takes anywhere from 45 minutes to several hours to make you drowsy and fall asleep. It has been highly effective for me. Some other side-effects are dry mouth and drowsiness when you wake up. This medication also has bad interactions with other medications that can cause cardiac events. So if you are considering taking amitriptyline, make sure your doctor is highly experienced and knowledgeable.

How this helps,


Hi Gipp. Thanks for the info. I did try Melatonin some years ago. It seemed to help at first, but not after a few months. I'm trying to avoid any drugs for as long as I can.

I use an employee insurance scheme run by the government and, frankly, it isn't very good. "Expensive" medications aren't prescribed and I can use only one hospital in the area where I live. The specialists typically work at other hospitals and are only available for a day or half a day each week.

The best specialists are concentrated in the big private hospitals in Bangkok and a few other places where foreigners live - the same hospitals that promote "medical tourism" - so they are quite expensive. I don't think the concept of a primary care doctor even exists here. Those who have the money go to the private hospitals and see a specialist that has probably been recommended to them by word of mouth. Whenever I go about something like a virus, they send me to a different GP, some good, some not so good. The first GP I saw about facial pain just didn't have a clue and didn't send me to any specialist. All in all, it's a bit frustrating not having a GP you can trust to help you make decisions about your health.