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Suggest Treatment For Severe Migraine, Depression And Severe Sleep Deprivation
Question: Dear Doctor, on March 15, 2014, My father died of a massive heart attack (ventricular tachycardia). I was very close to him and I will always love him for eternity. Beginning on the first night of my father's death, I became severely sleep deprived. My sleep ranges from less the one hour up to 3 hours every single night. I also experience severe nightmares during the very little sleep I do get. Once I stopped breathing and I had a near death experience. I saw a neurologist on April 26, 2015 and I am now on 200mg Elavil, 1mg Clonazepam and 20mg. Belsomra . My blood pressure was last registered at 160/111 with a resting heart rate of 102. In addition to having horrible migraine headaches and seizures in which I suffered a traumatic brain injury (2008), my Doctor diagnosed me as having Depression and Severe Sleep Deprivation. I do have all of the symptoms, including suicidal thoughts. Since I started the new medications I now get 4 - 4 1/2 of sleep every night without any disturbances, except for the nightmares . I am still sleep deprived, but I am a little bit more alert and moving around more. Here's the problem that leads to my question: I had a near death experience on May 26, 2015, while I was asleep. I died of a sudden heart attack. I was pulled out of my dream by my mother who saw me in severe distress early that morning. After some personal research, I also conclude that I may also have some form of Post Traumatic Stress. Losing my father has devastated me. And I am afraid of losing my mother in the future. My Question Is This: Am I at an Extreme Risk Of Death? With these experiences, physical and psychological problems, including my health deteriorating, I am very scared. Thank You For Your Time, XXXX
Brief Answer:
These symptoms are probably due to extended grief
Detailed Answer:
Hello, Welcome to Health Care Magic
I am really sorry about your loss. In most of individuals after loss of loved one symptoms of grief develop. Prolonged crying, insomnia, restlessness, nightmares etc are commonly seen. These symptoms last for about 6 months, but in few persons sometimes these symptoms persist beyond 6 months and cause significant distress. This is also called prolonged grief or extended grief. Though the symptoms have similarities with PTSD but in my opinion your symptoms suggest prolonged grief disorder which has progressed to depression. Please try to relax yourself, I know it's very difficult but you have to accept this. Spend your time in doing constructive work and keep yourself busy.
Your sleep is very less in quantity and the medicines like 200 mg Amitryptiline, Clonazepam 1 and 20 mg Suvorexant are not working properly and you have only 4-4.5 hours of non refreshing sleep along with depressive symptoms like suicidal ideation.
I can reassure you that you are not at danger of death. The high BP was probably due to autonomic arousal due to depression and grief symptoms. Improvement of symptoms will normalise the BP. That episode was just a severe nightmare. Don't remain distressed with this. No need to worry.
In my opinion you should consult a psychiatrist for evaluation of these symptoms. Medicines like Mirtazapine, Trazodone etc can help in good sleep and will help in depression also. Apart from this in my opinion medicines like Melatonin, Ramelteon can help to normalise the sleep rhythm and will reduce the incidence of nightmares. Clonazepam should be continued along with these medicines. Please consult a psychiatrist for proper evaluation and treatment.
Thanks, hope this helps you. Please don't hesitate to ask again for more doubts.
Take care
These symptoms are probably due to extended grief
Detailed Answer:
Hello, Welcome to Health Care Magic
I am really sorry about your loss. In most of individuals after loss of loved one symptoms of grief develop. Prolonged crying, insomnia, restlessness, nightmares etc are commonly seen. These symptoms last for about 6 months, but in few persons sometimes these symptoms persist beyond 6 months and cause significant distress. This is also called prolonged grief or extended grief. Though the symptoms have similarities with PTSD but in my opinion your symptoms suggest prolonged grief disorder which has progressed to depression. Please try to relax yourself, I know it's very difficult but you have to accept this. Spend your time in doing constructive work and keep yourself busy.
Your sleep is very less in quantity and the medicines like 200 mg Amitryptiline, Clonazepam 1 and 20 mg Suvorexant are not working properly and you have only 4-4.5 hours of non refreshing sleep along with depressive symptoms like suicidal ideation.
I can reassure you that you are not at danger of death. The high BP was probably due to autonomic arousal due to depression and grief symptoms. Improvement of symptoms will normalise the BP. That episode was just a severe nightmare. Don't remain distressed with this. No need to worry.
In my opinion you should consult a psychiatrist for evaluation of these symptoms. Medicines like Mirtazapine, Trazodone etc can help in good sleep and will help in depression also. Apart from this in my opinion medicines like Melatonin, Ramelteon can help to normalise the sleep rhythm and will reduce the incidence of nightmares. Clonazepam should be continued along with these medicines. Please consult a psychiatrist for proper evaluation and treatment.
Thanks, hope this helps you. Please don't hesitate to ask again for more doubts.
Take care
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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