I cannot sleep in the night - #9734

Hi Sanghamitra, I understand you’re facing difficulty with sleep, especially when your sleep time shifts beyond your usual pattern. It’s good that you’re aware of your medications and seeking help for this. Sleep issues can sometimes persist even when other symptoms are under control. From what you’ve shared, here are a few things we can consider: 1. Sleep hygiene measures (these can help train the body to sleep more naturally): - Keep a fixed wake-up time every day, even on weekends. This sets your body clock. - Avoid using phones, TV, or any screen at least 30-60 minutes before bed. - Reduce caffeine or tea intake after 5 PM. - Avoid daytime naps or limit them to 20-30 minutes if really needed. - Ensure your sleep environment is dark, quiet, and comfortable. - Use your bed only for sleep—not for watching TV or using the phone. - Try relaxation techniques before bed like gentle breathing, soft music, or warm showers. 2. Regarding medications: You’re currently on Admenta, Nexito (10 and 20 mg), and Sulpitac 400. These are significant medications. Some of them can influence your sleep—positively or occasionally by causing restlessness if doses are mismatched or not timed well. 3. A detailed evaluation would be useful to guide next steps: - Since you’ve been treated for depression before, understanding how your mood is currently would help. - Sleep diary for 1–2 weeks: noting what time you go to bed, when you fall asleep, number of awakenings, and wake-up time. - Understanding if there are any current stressors, worries at night, or changes in energy during the day. - Checking for any signs of other conditions like thyroid changes, pain, or hormonal shifts (especially around age 40) that may affect sleep. We can slowly work on this without adding too many medicines if we understand the full picture. Let me know if you’d like to take this ahead, and I can guide you step by step. Dr Aman Shaba Consultant Psychiatrist 7992489808

Hello Sanghamitra, I’m sorry to hear about your sleep difficulties. Your medications—Nexito (escitalopram), Admenta (memantine), and Sulpitac (amisulpride)—can influence sleep patterns. • Nexito (Escitalopram): This antidepressant can cause insomnia in some individuals. Taking it in the morning may help reduce this side effect.  • Admenta (Memantine): Primarily used for cognitive symptoms, memantine has been associated with sleep disturbances, including insomnia.  • Sulpitac (Amisulpride): This antipsychotic can cause both drowsiness and insomnia, depending on the individual.  Recommendations: • Consult Your Doctor: Discuss the timing of your medications with your healthcare provider. Adjusting when you take them might help improve your sleep. • Sleep Hygiene: Maintain a consistent sleep schedule, avoid caffeine and electronic devices before bedtime, and create a relaxing bedtime routine. • Monitor Side Effects: Keep track of any new or worsening symptoms and inform your healthcare provider. It’s essential to work closely with your doctor to address these issues. They may consider adjusting your medication regimen or exploring other treatments to help improve your sleep.

Hi Ms. Sanghamitra, I agree with what other doctors suggested for sleep. It would also be helpful if you can mention what's keeping you awake. I assume that you continue to have depression which keeps you awake till late midnight. And I understand that you are taking treatment for depression but the treatment is not justified by the medications you are taking and it seems that the current medications are not working for you. It's quite difficult to understand the rationale of taking Escitalopram 30mg unless you also happen to have OCD. Please let us know what were the other medications trials you have been tried for depression. There can be a possibility of treatment resistant depression when you fail to respond to atleast 2 adequate trials of anti-depressants. You need to undergo proper evaluation and medications need to be rationalised. If it is established that you failed the trial of Escitalopram, then the anti-depressant drug needs to be changed. I hope this answers your question in addition to the above answers. Regards, Dr. Charan, MD Psychiatry (NIMHANS), email - dr.charankumar.p@proton.me

Patient Name: Sanghamitra Age/Sex: 40 / Female Date: 12-04-2025 Chief Complaint: Difficulty sleeping at night, irregular sleep pattern, history of depression, currently on psychiatric medications. Assessment and Diagnosis: Sanghamitra is experiencing difficulty falling asleep and maintaining a consistent sleep pattern, with irregular sleep times ranging from 11 PM to as late as 2 AM. This could be linked to her current medications and the history of depression. She is on a combination of Admenta 5 mg, Nexito 10 mg and 20 mg, and Sulpitac 400 mg, which are primarily used for cognitive support and mood stabilization. While these medications help manage depression, they may also influence sleep, either by causing insomnia or by affecting sleep architecture. Her irregular sleep pattern suggests that insomnia could be a side effect of her medications or a lingering issue from her depression. Treatment Plan and Recommendations: To improve Sanghamitra’s sleep quality, a combination of lifestyle changes and careful management of her medications is suggested. First, focusing on sleep hygiene is essential. Sanghamitra should aim to go to bed and wake up at the same time every day, even on weekends, to help her body establish a natural rhythm. Engaging in relaxing activities such as reading or practicing relaxation exercises before bed can also ease the transition to sleep. It's important that she avoids screen time 1-2 hours before bedtime, as the blue light emitted by phones and tablets can disrupt melatonin production, making it harder to fall asleep. Another important step is optimizing her sleep environment. Keeping the room cool, dark, and quiet will encourage restful sleep. If possible, a white noise machine or earplugs can help block out disruptive sounds. Additionally, incorporating regular physical activity during the day, while avoiding strenuous exercise close to bedtime, can improve sleep quality. Since Sanghamitra is already on medications for depression and mental health, it's important to review her medication regimen. Admenta and Nexito may affect her sleep, so a consultation with her psychiatrist to assess the dosage and consider any potential adjustments is important. Nexito (Escitalopram), being an SSRI, may cause either insomnia or excessive sedation, depending on the individual. If sleep continues to be a significant issue, her psychiatrist might consider adjusting the dosage or trying a different class of medication. Sulpitac (Amisulpride), an antipsychotic, may cause sedation, which is helpful for sleep but should be monitored to avoid daytime drowsiness. Lastly, considering cognitive-behavioral therapy for insomnia (CBT-I) could be beneficial in addressing the root causes of insomnia, especially if stress or anxiety are contributing to the problem. CBT-I is a highly effective therapy that helps individuals with chronic insomnia by focusing on behavioral and cognitive changes to improve sleep quality. Follow-Up Plan: Sanghamitra should follow up with her psychiatrist in 2-4 weeks to reassess her sleep issues and adjust her treatment if necessary. If her sleep problems persist despite lifestyle changes and medication adjustments, further evaluation for other underlying causes may be required. Problem is with the medicine you are taking . You can take Nexiforte instead of nexito. Dr Shayeque Reza MD 9800280276