Concerned with being sleepy a lot throughout some days

How long have you been taking the MS Contin ? Sometimes the side effects become less the longer you take it. It sounds like a side effect of the MS Contin. I was prescribed 15 mg twice a day a number of yrs ago. I would be in the middle of typing an email and fall asleep. I had to decide between not having my pain managed as well on another med and being able to stay awake and dosome things or having my pain well managed and being so sleepy and tired that I could barely do anything. I choose not having my pain managed as well but being able to stay awake and do some things.

It's exhausting to the body to fight pain and to better understand this think about the release of endorphins during the sympathetic nervous systems state of "fight or flight" when you get scared like being in a accident or such. Your initially ramped up and wide awake,jittery and hyper all caused by the release of endorphins and adrenaline rush then shortly thereafter your just exhausted and weary and weak. The same substances in play then in our bodies are also the same ones our bodies release in response to pain.

Mark in saying the above I also want to say if your taking the 60mgs twice a day and the 2-30s regularly that's actually 180mgs of morphine per day as well as 20mgs of a benzodiazepine and although thats not the highest dose I have seen it is a heavy one and taking this into consideration the meds could be causing some of the fatigue. Have you tried holding one of your PRN doses a few days to see if there's a difference?

Thank you for all of the replies.

I have been on this dosage of the MSContin for a year now and the breakthrough MSIR was increased from 15mg 2x/day to 30mg 2x/day about 5 months ago. I have went a few days without taking the MSIR and I was still having the problem.

Also, a lot of days I don't take the 2nd Valium unless I need it or I will break it in half if I feel that I can get by on less. I'm taking it for panic disorder to prevent panic attacks. I used to take 1mg Klonopin 3x/day but my PM doc said that using the Valium instead could also help with calming my stomach down some, which it has done a little.

I also wanted to mention that because of all these digestive issues, there are times I go days without eating. Maybe that could also contribute to this problem?

If the increase occurred about five months ago then the meds could be the culprit. With the GI issues I imagine you don't metabolize the same as normal and the MS is designed to build up and maintaining blood serum levels is therapeutic however your probably building therapeutic levels at a much higher rate if your digestive system is not able to metabolize the excess quickly enough. People who have GI problems either go one way to the other,too much stored or not enough. It's likely dumping all of the excess meds at once on you at points of the day. You may do better overall on a transdermal form of delivery. I'm not sure why your Dr has not considered the metabolism issues.

WB also is right about sleep apnea and its prevalent in long-term opiate users so if it doesn't resolve with other modalities I would definitely look into a sleep study.

There are medications used to treat the lethargy from opiate therapy but again how well those would work with metabolism issues is guesswork.

It sounds like maybe you just have a combination of things happening and stress and worry can sure add to all that. I wonder if your Dr approaches the insurance company from the stance of your metabolism issues would they likely approve the fent again? Susie might know.

Low potassium is not anything to play around with and can be extremely dangerous Mark. Potassium regulates the ability of your heart to send and receive the electrical spark that controls rhythm. It's the foundation of the hearts natural pacemaker. Any fluctuations in the levels for long or greatly can cause cardiac arrest. Get those levels checked often with chronic diarrhea.

Do Not Cut Any Pills Without Checking With Your Pharmacist First. Extended release meds can be dangerous if cut.

Mark:
Valium is a potent smooth muscle relaxant that is also quite sedating. It's over use/over prescription in the early 1970's as "mother's little helper" placed the medication on much tighter review and regulation. At 10 mg twice a day, you are taking enough Valium to affect yours/anyone's level of alertness.

I have complete pituitary failure. Anytime after 6 pm, I am suspect to episodes of loss of alertness/consciousness. I can be typing on the computer, actively engaged and . . . poof . . . my brain "opts out." The next thing I know, 15 minutes have passed. There are several lines of zzzzz's across the computer screen, the result of my forehead blunting the keyboard when I lost consciousness.

I have had EEGs. All normal. And a sleep study. All normal.

My endocrinologist is under the opinion that my brain compensates as best as it can for as long as it can during the day, functioning as it does without the coordinating benefits of a functioning pituitary gland. Simply put: My brain is exhausted, the loss of alertness/consciousness a direct effect of the pituitary failure.

The pancreas is part of the over-all orchestration of the endocrine system. There are hundreds of hormones that act as chemical messengers, relaying information that aids in the functioning of the body's many and complex systems (digestive system, neurological system, musculoskeletal system, hearing/sight, respiration, and more). Perhaps some of your lack of alertness is related to a degree of functional loss of your pancreas.

In the end, there is a lot that medicine knows and can explain . . . and even more that medicine does not know and cannot explain.
- Karen -

Thank you both for your advice/information...actually thank you to everyone that posted here. I have a lot more things to bring up to my doctor now that I wasn't thinking about before or didn't know about. I am going to write down a list of everything I want to ask or discuss with my doctor before I go.

Karen(Seashell): I was diagnosed with panic disorder with agoraphobia when I was 14 years old. Ever since then I have been on a benzodiazepine(I am almost 31 now). I have taken Klonopin at up to 2mg 3x/day, Xanax up to 1mg 4x/day, Ativan up to 2mg 3x/day, and Valium up to 10mg 3x/day. I wasn't always on high doses like these, but there were some periods of my life that I needed a high dosage for a while.

Up until I got sick with all of these digestive/pancreatic tumor problems, I was doing good on 0.5mg klonopin 3x/day. It took some work and a therapist to allow me to get down to that lower dosage. I am now on the Valium because my pain management doctor said that Valium is sometimes helpful for stomach/digestive issues. We went through my history of the different benzodiazepines and dosages that I have been prescribed and decided on 10mg 2x/day I guess due to the build-up of tolerance over all the years. She didn't think 5mg would be enough to have the effect of helping to calm my digestive system.

My anxiety and number of panic attacks greatly increased after I became ill so until I was switched to the Valium I was taking 1mg klonopin 3x/day

Anyway, my point is that I haven't experienced any side effects from benzodiazepines for many years now.

As others have already said, it can definitely be tricky to balance medication & pain. The meds need to bring our pain down just enough so we can function, but without getting rid of the pain. If adjusting your meds one way or another (or substituting something else in that works better) is an option, that would always be my personal first choice.

Beyond that, there are some behavioral changes that can help with daytime sleepiness. Opiates & benzos both are dehydrating, so my doc encourages me to drink at least 3L of water a day (about 12 8-oz glasses or 1.5 gallons). I also find that it's important for me to take the opiates with food to counteract drowsiness/dizziness. I make sure to open my drapes first thing in the morning to let the sunlight in as that helps. And I had a CBC blood test to check for vitamin/mineral deficiencies so now I take a multivitamin -- plus, I had been temporarily on prescription vitamins to get some of the levels up. Also, my sodium level kept coming back perilously low (which meant potassium was dangerously high). It happens sometimes with anticonvulsants like Neurontin & Lyrica. It's called hyponatremia. Do NOT ever start adding spoonfuls of salt to your diet without a doctor's supervision as it can cause heart failure. That said, in my case, being properly diagnosed with hyponatremia (which made sense because I would even wake up in the middle of the night with intense salt cravings) and working with my doctor to triple my salt intake meant I slept better, woke more refreshed & have more energy throughout the day. Even if it's not due to hyponatremia, there are all sorts of ways that pain/anxiety meds can mess with hormone levels and nutrients to cause fatigue and sleepiness. A visit to the doctor & full work-up is really the way to go.

And the last thing I tried (and I do mean _last_) was to temporarily take Provigil (or it's new sister Nuvigil). it is not habit-forming & promotes alertness. I took it for maybe 5-6 months while I was adjusting to a dose increase once and it was a lifesaver. I had made 2 mistakes at work before my doctor put me on it & it saved my job. No more mistakes after that & after a couple weeks, I was even cleared to drive... though I still usually took the bus. Any medication has the ability to cause side effects so I definitely would put this at the bottom of the list of things to try because the last thing any of us need are more problems.

Which brings me to what you wrote about not driving right now -- THANK YOU! THANK YOU! THANK YOU! I hear about people driving while impaired far too often & it scares me. A close family friend nearly died from doing that. She told herself & anyone who would listen that she "needed" to drive and that there "wasn't any other option". Told the cops that, too, after she drove right off the road, into someone's front lawn, nearly took out 2 bystanders before smashing into a lamppost and totaling her car. Insurance didn't pay a dime of her extensive medical expenses or the damage to her car because she shouldn't have been driving. She was cited DWI (yes, even though she always took her meds as prescribed) plus a bunch of other violations and revoked her license. One would think that a near-death experience would be enough to deter her from ever doing that again, but it wasn't until the second time when she dozed off at the wheel for a second causing another driver to have to swerve out of her way to avoid a collision ... followed by the police pulling her over, impounding her vehicle because she was driving without a license, driving while impaired & swerving across lanes ... that landed her a night in jail, $10K in fines & a felony conviction that cost her her job before she FINALLY agreed that perhaps driving when she wasn't completely alert wasn't actually a "right". Having worked for a top auto insurer for a number of years, I know these things happen every day in every state and very often have serious consequences (financial, legal, medical, or sometimes even fatal) all too often. Thank you for keeping our roads safe and not driving whilst you try to sort out this sleepiness issue with your medical team! I have young nieces & nephews that are like my own children and knowing there are people like you in this world who would sacrifice the privilege of driving to protect their young little lives means so, so, so much to me. Truly, I am more grateful than words can express. And I hope they get you fixed up & cleared to drive again really soon. :)