Any GPs / Psychiatrists about with sleeping pill/ psychosis experience?

[LemonSwan]

Posting for traffic.

I have postpartum insomnia. Baby started sleeping through a month ago and now I can’t get to sleep at a reasonable time. Stupidly got in the habit of staying up late so I only had to do a couple of night wakes before DP looked after babe in the morning and I got a full stretch then.

GP has been amazing and got back to me straight away and prescribed meds after a 5 minute phone chat. Problem is just picked up the prescription and it’s Zoplicone and says warning psychosis / schizonpehria risk in the leaflet.

I did have quite a bad psychotic episode about 3/4 years ago and was sectioned for a month. Was high risk for PP psychosis and under surveillance team but managed to get through without issue. Unsure whether Gp knows about that history but very nervous about this.

Is there an alternative medicine I can ask for or is this panic about nothing and going to be ok. The last thing I need right now is a psychotic episode. I was hoping I was one and done. Anymore and I have pretty much developed schizophrenia.

Any advice?

Thanks

Didn’t want to read and run. I think you are absolutely right to be cautious and to double check before you take them. Have you done all the sleep hygiene non medication stuff?

can you give the surveillance team a call for specialist advice?

Thankyou, sorry was just getting babe to bed.

Yes I have tried everything I can. Albeit I have only tried a month but nothing is actually shifting my sleep time forward, not even a small progress and I have run out of ideas. Its always 3-3.30 am and that’s not sustainable.

I don’t know actually. I was discharged from their care after the all clear at c. 4/5 months and was left with the crisis team number.

I would speak to your GP about the potential risks. Chronic insomnia is just as likely to precipitate a psychotic episode as the medication so it’s about balancing the risk…

Thanks, your right it is a risk factor for me. I do think I need to chat again to GP definitely.

Are there not any sleeping tablets which don’t have psychosis / schizophrenia as a side effect?

Absolutely right to call your GP to discuss risks BUT psychosis is a rare side effect of most psychoactive drugs. I'm a psychologist not a prescriber, I often see patients who take zopiclone occasionally but who always have other MHN inc a history of psychosis. I haven't seen anyone in whom it has triggered an episode of psychosis so I would suggest this is rare. It's also an adverse effect of most drugs used to treat bipolar, epilepsy etc.

The short course your GP has prescribed is intended to give you a few good nights sleep so you can start getting back into a good sleep routine. If it doesn't work don't keep taking them. Review.

Long-term sleep deprivation will also raise your risk for a psychosis relapse so there is an element of balancing risk here. many patients I see use sleeping pills occasionally after a night or two poor sleep to prevent that becoming a pattern which could trigger an episode of something more serious.

IF you are taking them make sure those around you know your prodromal symptoms and can help you get help quickly if worried. But I think the risk is small.

Hope you sleep well tonight. Insomnia sucks.

Just in case it helps, the book The Effortless Sleep Method cures my postnatal insomnia. Good luck.

MH nurse here.
The answer is, unfortunately, not really. Any drug which is powerful enough to sedate the brain is also powerful enough to trigger psychosis. It’s worth talking to your GP about it but I can see why you would be worried. I presume the dose is pretty small? It’s a very rare side effect and a small dose over a short period is unlikely to cause any problems.

It is definitely a good idea to discuss with the prescribing medic.

The extent of the risk depends on the dose to some extent.

Psychosis is not a very common side effect, but you are right that it may be slightly more risky due to your history.

But sleep deprivation is not without risk, and is also associated with triggering psychosis where there is a history.

There are other sleeping meds, but the choice will depend on if you are in sole care of a baby overnight. You could try Promethazine, though it may not help you sleep as well as Zopiclone would. I'd personally want to know that Melatonin had been considered.

(I am speaking from the pov of an experienced mental health nurse, not a doctor).

Thanks all for taking the time!

Yes it is a very short prescription - 7 days of 3.75g.

I won’t take tonight and ring tomorrow just to make sure they are aware of the history and happy with it.

My partner is very good with babe, and he’s night weaned so I wouldn’t need to attend to him.

@Stompythedinosaur I like the idea of this promethazine. I really don’t want to take this risk but I do really want to sleep so even if it’s less powerful might be a compromise worth taking; or atleast trying first.

We didn’t discuss melanin either. I just answered the questions, very short chat and didn’t even know what I was getting until I picked it up and panicked a bit when I read the leaflet.

Thank you, have just ordered it 😊

I didn't get on with zopiclone or promethazine, they didn't help as they came with a host of odd side effects including worse sleep and odd dreams.

I've now got Hydroxyzine (old style antihistamine) which is fab for a reset of sleep, although I'm not to take it all the time.

My GP tried prescribing them to me in that order. I've got a psychiatric illness that involves some symptoms of psychosis and needs me to sleep to avoid bad episodes.

I can only give you my experience. I did have post partum psychosis. At the time, I wasn’t prescribed zopiclone, but I have been prescribed it on and off since and I’ve not had any issues.

I didn’t actually know about the risk you’ve highlighted and completely understand your hesitation to take it. I wouldn’t wish it on anyone. But, insomnia is utterly destroying and it needs to be dealt with. You could try diphenhydramine hydrochloride (over the counter) until you discuss your zopliclone concerns with your doctor. Take it 12 hours before you you need to be up and fully alert so around 8pm.

Wish you better. It’s a lonely place to be.

(Just so you know with zopiclone, for me, there is absolutely no way I’d be able to get up in the night to care for a baby/child or even go to the loo, so make sure partner is aware).

I had the same problem and I have been taking 30mg amitriptyline since, it has really really helped with sleep and another separate health issue I have as well. May be worth asking about?

What a tough ride you’ve had.

I remember well the sleep deprivation horror post partum… the frustration of lying awake unable to settle because you know you’ll have to wake up again v v soon 🥴

I’m a prescriber (GP) and echo all the sensible thoughts shared so far.

Sleep deprivation is a much higher psychosis risk post partum than anything else/ any medication for sleep.

I haven’t ever seen a case of Z drug (eg zopiclone) triggered psychosis- psych regularly use Z drugs to help regulate sleep (for short sharp bursts) in vulnerable people… that’s not to say it’s hasn’t be reported but in 20+ years (including a stint working in general mental health) I personally haven’t seen it.

The dose is small and sensible. Your GP has (imo) prescribed very rationally balancing risk against benefit.

You could consider something like promethazine as an alternative? Defo worth asking your GP about this as an option- have a google.

The medication choice and what’s right in this situation will depend on lots of factors that we aren’t privy to but your GP will/ should be.

Sending you sleepy vibes x

I've been an inpatient on a long term ward and lots of people were taking zopiclone and I don't know anyone that it caused psychosis. However, sleep deprivation did give me psychosis. Zopiclone didn't help me sleep, though, I needed lorazapam.

I'm not sure what you mean about schizophrenia? There's a lot more to schizophrenia than psychosis and just because you get psychosis does not mean you have schizophrenia.

I'm not sure if this is what it means... but I'm banned from sleeping tablets as I react to them by psychosis like symptoms. When I take them they do make me so drowsy, but don't quite put me to sleep so I end up hallucinating and talking gibberish 😬 once they are out my system and by next day I'm fine again. It got discovered when I got taken into hospital due to behaviour on them and the doctors were confused if I was having an episode, but by morning I was fine so they wrote it down to a side effect of zoplicone. Could this be what they mean on the side effects?

This is a well-documented side effect of z drugs, some people use them recreationally for this purpose. There are lawyers in the states who specialise in z-drug-induced sleep walking/driving/cooking and blackouts. I have used zolpidem in the past and experienced this… if I didn’t go to sleep within 15 minutes of taking it I would start talking nonsense and remember nothing about it the next day. Then packages would start arriving from my z-drug-induced shopping

I avoid z drug now since hypnotics have been associated with an increased risk of cancer:

www.ncbi.nlm.nih.gov/pmc/articles/PMC7601941/

link.springer.com/article/10.1007/s40268-017-0207-7

Thank you everyone again. So much experience on MN and so kind of you to share.

My doctor is lovely and very good so I am sure she has this right and has balanced the risk.

It’s put me at ease a bit; but I am sure those who have experienced psychosis will know why I am quite terrified by the idea. It was literally the worst experience of my entire life and I feel so lucky that I have managed to stay well.

I am going to sit on it for a few days, talk to GP. Am sure a couple of days more sleep deprivation won’t matter after nearly a year 😭

@UndertheCedartree I was told that Schizophrenia is just a chronic condition characterised by recurrent psychotic episodes. My first episode was so severe I was told she thinks it might be schizophrenia but she’s going to give me a chance and write acute psychosis (as schizophrenia is not a good thing to have on a health record - can even make you ineligible for organ transplant); but that if I have another episode, she’s very sorry it would most definitely be changed.

@Hope551 No I am talking about full blown losing your marbles for days/ weeks / potentially forever. 😬

Order melatonin from an american site to be shipped over here. English doctors are always so hesitant to give it out and they only prescribe it to over 60s in extreme circumstances. It’s stupid since melatonin is natural, and most sleeping tablets that are prescribed from the NHS are medications which cause more symptoms and problems. Just don’t take loads of it and you’ll be fine. I don’t take it every night, just when I’m noticing my sleeping schedule is starting to slip out of control.

You can also order it from an online doctor in the UK as “jet lag therapy”.

No there is a lot more to schizophrenia than that. It has negative symptoms and positive symptoms. Negative symptoms are very difficult to treat. Full recovery from positive symptoms may not happen either (in between full on psychotic episodes).

Acute psychosis can have it's root in a number of different issues. For example sleep deprivation as a very common one.

I hope you get some sleep tonight, whether you take the pill or not.

I'm a 40 year old with lifelong insomnia. Due to this and a few other things, I experience frequent episodes of borderline psychosis. It's something I've had to learn to live with and luckily I'm very introspective and can figure myself out.

I have my own brand of "sleep hygiene" (hate hate hate that term) which includes milk, low lighting, sometimes I play certain natural white noise tracks on repeat, the window is always open a crack and I read. I do this for a few hours following taking my melatonin (I have adhd and need the melatonin for the foreseeable).

All that warm milk lavender pillow baths shot is absolute bollocks for proper insomnia. But there might be a way you can work things out for yourself. It takes me a couple of hours to wind down, for my heart rate to slow, for my muscles to untense, and stop twitching, but after a few hours of reading under the right circumstances my body starts turning to putty. I use a kindle paperwhite with a dimmer back-light. Once my eyes start glazing, I'm in the right place.

I can't take zopiclone anymore, I'm a sleep walker/ talker/ texter and asked the GPs to note down some of the adverse behaviours I apparently get upto when taking it 😳

@UndertheCedartree

Thanks for explaining. Been reading about that and now understand the prodygmal stage which was mentioned above.

I do certainly recognise myself in those negative symptoms 😬 but in my defence I would say my partner can be as lazy and antisocial as I so hopefully that’s just personality and not actual schizophrenia. Fingers crossed anyway! 😭

And thank you for the sleep wishes, I did actually go to bed earlier and fall asleep last night so the good vibes did work. Although I had a nightmare (very rare for me) and was up again awake again by midnight 😔