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I cannot sleep, even if I am very tired. Why?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Sneha Kannan

Published At September 16, 2020
Reviewed AtDecember 5, 2023

Patient's Query

Hi doctor,

I have a type of insomnia where I cannot fall asleep even when I am tired. For a week now, I have been on Ativan to go to sleep every night because, for two whole nights, I had no sleep at all. I try naturally every night, and when I am just entering my sleep, my head goes fuzzy, and my heart rate increases, and I cannot go into sleep. I am now petrified whether this is a neurological issue or a disease. It all started very suddenly six days ago after being stressed. I was hospitalized on the third day when they administered 2 mg of Ativan. Since then, I have been using Ativan 1 mg every night as advised. Currently, I take 5 mg Lexapro, 5 mg Amitryptiline, 30 mg Cardizem thrice daily. I have been on these medications for years. Now Ativan 1 mg before bed, for the past five nights.

Hi,

Welcome to icliniq.com.

I can understand and empathize with your concern. You said that this is started six days back because of stress. First, you should know our basic instinct like hunger, thirst, and sleep are natural. We eat when we are hungry. We drink when we are thirsty. These are basic phenomena that we cannot stimulate. So when we think that we should sleep and continuously think about sleep and feeling why we cannot sleep, then our brain will be active, and for sleeping, brain activity needs to be diminished. In stressful conditions, we start active thinking, so we will be unable to sleep. I hope you understood. You are taking Ativan (Lorazepam) 1 mg, but what about stress which is still present? Do not be afraid. Ativan is an anxiolytic, and it reduces your anxiety level and promotes sleep. Do you feel sleepy during the day? For anxiety, you should try relaxation techniques and breathing exercises. And if you have prominent stress, you should start antidepressants in the daytime and 1 mg Ativan if sleep is proper. Please continue it, and as you feel better, start tapering the Ativan to stop. As you described, these are not symptoms of any neurological disorder. I hope this helps.

Patient's Query

Hi doctor,

Thanks for the reply.

My stress which preceded insomnia has resolved. But now, I have significant anxiety about not being able to sleep without medication. Are there any records of incidences where people cannot sleep without medication?

yes, so many peoples are in stress because of insomnia. the typical complain is when we get to bed, we feel no sleep at all. Do not concentrate on sleep, it's like when we r hungry and thinking about food and there is time to get food...what happen?? our appetite getting decrease and when our favorite food get ready we hardly take few bites. it's game of diversion.

Patient's Query

I read something about fatal insomnia, because I had never heard of anyone else going through what I am. Is that disease not likely? How come I’ve had anxiety all my life but never had a problem with getting to sleep until 6 days ago, and every time I try to sleep since then
May be you started over thinking this time and the stressor disturb you a lot in comparison of previous experiences. Because you read about fatal insomnia you are afraid and it is also become a stressor to you. when we r anxious we think more and more and getting more anxiety. these cycles goes on and we trapped in our own cycle that's why we try to sleep but cannot.

Patient's Query

It’s very shocking though that after having those 2 days initially of no sleep, the body was still unable (and is still) Unable to sleep without medication. I will stop annoying u now, even though I’m desperate for my sleep to go back to normal
I can understand ma'am u r in trouble that's why seeking help. don't be panic, as I said it happens and gradually with medicines u will feel better. sleep is natural we cannot call her forcefully. so being desperate u should leave it on medicines. ur sleep will be normal in few days. don't mind but you are using abnormal phenomenon (calling sleep) that's why it is abnormal. once medicine stable all the factors it will be normal.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Anil Kumar Kumawat
Dr. Anil Kumar Kumawat

Psychiatry

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