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jerseyben · Feb 23, 2013

Medical question for Crispin:

Ok so I take a large dose of propranolol once daily. About 2 years ago I started having a "sleep disorder". I wake up in the night and I am convinced it is time to go to work. I will often stare at the clock for up to 5 minutes before I finally realize it is time to go back to bed. Sometimes I wake up my wife and tell her it is time to get up or ask her when she is planning on getting up. Sometimes I remember this happening but sometimes I dont. Usually she tells me it is only 11pm and then I go immediately back to sleep.

I noticed that about 9 months ago it got worse. I really think it is stress induced as it seems to happen almost daily when I am stressed out or very busy at work. I typically wake up shortly after going to bed (like 1030 or 11). I read that it could be a side effect of the propranolol. Sometimes I wonder if the propranolol even does anything positive for me.

Crispin, what are your thoughts about this? Any suggestions or helpful comments?

Peyton Manning · Feb 23, 2013

can I ask what propranolol is for?

jerseyben · Feb 23, 2013

Migraine prevention.

Peyton Manning · Feb 23, 2013

ok then, siince Crispin is apparently getting his botox injection. I (not having any medical training) wonder, have you tried a lower dose?

Crispin · Feb 23, 2013

jerseyben said:
Medical question for Crispin:

Ok so I take a large dose of propranolol once daily. About 2 years ago I started having a "sleep disorder". I wake up in the night and I am convinced it is time to go to work. I will often stare at the clock for up to 5 minutes before I finally realize it is time to go back to bed. Sometimes I wake up my wife and tell her it is time to get up or ask her when she is planning on getting up. Sometimes I remember this happening but sometimes I dont. Usually she tells me it is only 11pm and then I go immediately back to sleep.

I noticed that about 9 months ago it got worse. I really think it is stress induced as it seems to happen almost daily when I am stressed out or very busy at work. I typically wake up shortly after going to bed (like 1030 or 11). I read that it could be a side effect of the propranolol. Sometimes I wonder if the propranolol even does anything positive for me.

Crispin, what are your thoughts about this? Any suggestions or helpful comments?

I am not establishing a doctor-patient relationship. This question is being answered theoretically. No changes should be made without first contacting your physician.

Great Question! To start off, propranolol is a blood pressure medication. What dose is one taking? It is unlikely that it is causing the problems at night. It sounds like one is having a REM sleep disorder. More specifically, one is having difficulty coming out of REM. When the brain sleeps there is a paralyzation that occurs that prevents somebody from acting out their dreams. In some people, this can be overridden. Hence, talking in one's sleep or striking out in one's sleep. Stress plays a huge role in sleep and dreams. The more stress one is under the more latent emotion in the subconscious. Dreams are the subconscious manifestations of emotion. When I have a rough week at work I am all over the place in my dreams. REM is the last stage of sleep. When this is over the brain wakes up and the paralyzation dissipates. Some people have a disorder when they wake up but it takes a couple of minutes for the paralyzation to go away. I have heard that it is quite terrifying. You have the opposite problem, your paralyzation circuit is cutting off but you are not completely coming out of the sleep cycle...most likely you are in theta, delta, or REM wavelength.

Alcohol, other medications, and stress are three examples of things that will make this worse. Most sleep medications are addictive and should be avoided. Over the counter melatonin can be helpful for some people. Any OTC drug that does not use melatonin has Benadryl in it. Benadryl is addictive and can be very problematic, it should also be avoided. Trazodone is a good sleep medication that I would consider for this problem. It is not addictive and one cannot develop a tolerance to it. Elavil is a good treatment for migraines and causes sedation, it could be a two-in-one package.

All medications can have side effects and interactions. If it does not bother one that much then my best advice would be to live with it.

Concluding thoughts. Highly unlikely it is the propranolol. Doubtful that propranolol is helpful for ones migraines. Most likely stress. Could be a side effect of some medications, I would need to see a complete list.

Good luck,

Doc Crispy

Ps. Sign up for Crispy's Critters today!

Peyton Manning · Feb 23, 2013

Crispin, my doc is retiring and being replaced by a doogie houser. you sound like you know your stuff. If you move to indy I would like to be our patient

jerseyben · Feb 23, 2013

120 mg

onfire · Feb 23, 2013

jerseyben said:
Medical question for Crispin:

Ok so I take a large dose of propranolol once daily. About 2 years ago I started having a "sleep disorder". I wake up in the night and I am convinced it is time to go to work. I will often stare at the clock for up to 5 minutes before I finally realize it is time to go back to bed. Sometimes I wake up my wife and tell her it is time to get up or ask her when she is planning on getting up. Sometimes I remember this happening but sometimes I dont. Usually she tells me it is only 11pm and then I go immediately back to sleep.

I noticed that about 9 months ago it got worse. I really think it is stress induced as it seems to happen almost daily when I am stressed out or very busy at work. I typically wake up shortly after going to bed (like 1030 or 11). I read that it could be a side effect of the propranolol. Sometimes I wonder if the propranolol even does anything positive for me.

Crispin, what are your thoughts about this? Any suggestions or helpful comments?

Jersy I think the problem is it relieves you of common sense 9 months before you read the side effects on the prescription No offense But

Crispin · Feb 23, 2013

jerseyben said:
120 mg

I would talk to you doctor about breaking it down to 60mg BID. It is a fairly short acting medication.

Best,
Crispin

Crispin · Feb 23, 2013

onfire said:
Jersy I think the problem is it relieves you of common sense 9 months before you read the side effects on the prescription No offense But

Can you elaborate? No sure what you are implying.

spartacus53 · Feb 23, 2013

Jerseyben, another great source for quick information is your local pharmacist. Actually, in most cases they are way more up to date with medications and reactions than the doctors are.

Crispin · Feb 24, 2013

spartacus53 said:
Jerseyben, another great source for quick information is your local pharmacist. Actually, in most cases they are way more up to date with medications and reactions than the doctors are.

LOL, thanks for the vote of confidence Spart!

spartacus53 · Feb 24, 2013

Crisp, no disrespect, but that's the only thing a pharmacist really studies, not the root causes. Besides, who comes to visit you when a new drug is released, the company's salesperson. You only know what they tell you, if they in error omit anything, well. :tongue3:

Just like in regular medicine, sometimes the pharmacist knows something over the counter that may be even better. :laughing7:

Crispin · Feb 24, 2013

spartacus53 said:
Crisp, no disrespect, but that's the only thing a pharmacist really studies, not the root causes. Besides, who comes to visit you when a new drug is released, the company's salesperson. You only know what they tell you, if they in error omit anything, well. Just like in regular medicine, sometimes the pharmacist knows something over the counter that may be even better.

True, very true. You got one thing wrong though. Who comes to visit me when a new drug comes out? Nobody. Drug reps and pharma are banned from my office. When a new drug comes out I obtain the data from the original study and review it for myself. Of course, I only do this with the drugs in my speciality. If I did that for every new drug that came out then that is all I would do.

Crispin