Belsomra

I’ve been dealing with some sleep issues for a few years now. Initially began speaking with a LCSW due to what I was told were some anxiety issues (which have crept back recently). My issue has always been staying asleep. I used to be able to depend on 4 hours straight before waking, but that is now too often only 1 1/2-2 hours. I’ve tried all the sleep hygiene suggestions but they have not helped.

I had a, at home sleep study done and there is no sleep apnea. The doctor suggested the sleep medicine Belsomra. I understand you guys are not my doctor, but is this something you guys would prescribe in certain situations? And how could/would this impact my training?

It sounds like you may have sleep maintenance insomnia.

Belsomra (Suvorexant) is a relatively new medication, and I do not have any experience prescribing it myself. It may provide short-term benefit compared to placebo, though it has not been directly compared with other sleep medications like Ambien (zolpidem).

The main way this could impact your training is due to a continued sedation effect lingering into the next day after taking it.

Have you looked into Cognitive Behavioral Therapy for Insomnia (CBT-i)? This is actually the first line treatment, preferred over the use of medications that are potentially habit-forming and have significant side effect concerns. There are a number of web-based CBT-i options that I’ve referred a number of patients to over the years.

Please suggest a couple of your favorites.

Thanks Austin. I thought by seeing the LCSW, we were working in some CBT, but I guess that was more specific to the anxiety than sleeping. I had a look at some CBT-I online quickly yesterday. If it is in the scope of what you can do in the forum, is there one in particular you can recommend?

I took the medicine the past two weekend nights. I woke up like I normally do (multiple times)but was able to go back to sleep. I’m not sure if I will take it tonight as I have work tomorrow.

On a side note, I am considering the possibility that I may need a little anti anxiety/anti depression medication. I can’t believe I am at this place, and really have no idea how. I really don’t want to, but I don’t want this ‘funk’ I’ve been in to get worse. Are there any concerns training wise, and health wise gernerally I should be aware of. No particulars of medicine have been discussed, except she said she prefers the non addictive combo anti anxiety/anti depressants. Obviously as an LCSW she herself can’t prescribe. Thanks.

I also have sleep maintenance insomnia. Some nights I wake up every 1.5 hours or so (make for rough next days), some are more like every 3-4 hours. My dr prescribed trazodone, which tends to noticeably improve my sleep. I try not to rely on it though. I only take it if the two prior nights were bad, so it’s probably about once per week.

My sleep hygiene efforts did very little, but Sleep Restriction CBT actually did move the needle in the right direction. Coming from 7.5 hours per night (prior to insomnia), I decided to only be in bed for 6 hours (same wake-up time) and slowly do a linear progression (;)) to about 7 hours in bed. Not perfect, but improved for sure!

Keep at it.

I don’t have personal experience with any of them to tell you my favorites, but have provided links to sources like Sleepio, SHUTi, etc. to patients.

Sounds like you should get evaluated by a physician (either primary care or psychiatry).