Falling asleep in the morning

[MaggieSylvie]

I don't understand why I keep falling asleep after breakfast. It has begun recently after about 4 pm but now, while I'm waking up at the sort of time everyone else is who has to go to work i.e. 7 am-ish, and even if I persuade myself to sleep in a bit, I can't. I feel good and rarin' to go. This is new to me. But then I find myself nodding off a while after I've eaten - whether it's cereal or my once-a-week cooked breakfast - it makes no difference. Today, I was woken up at mid-day by my smoke alarm (no apparent reason). Even after that, my head was woozy and I nodded off again. I feel I could sleep all day.

I take Pregabalin to help me sleep at night otherwise I wouldn't sleep at all when I'm supposed to. I have stopped taking Maxitram at night and now take Paracetamol. Is this tendency to sleep during the day a symptom? I am not aware of any other symptoms of MDS/MPN triple negative.

I'm just going to have my second cappuccino of the day as it's the only thing that can usually bring me out of this fug. I'm sure there are those who will say it's old age (I'm 79) but this has come on a bit suddenly.

Does anyone else have this going on?

[EPguy]

How long ago did you stop the Maxitram? It is in part an opioid, so using and stopping it can have strong effects.

It's also listed as having Major interactions with pregabalin, did the same Dr Rx both of them?:

drugs.com/drug-interactions...

Effects past and present from these meds are the most likely factors to check, but of course there may be other factors.

I relate to needing meds to sleep, Sjogren's will do that. I've evolved a set of low dose meds that do the job.

[MaggieSylvie in reply to EPguy]

Oh I didn't know. My GP prescribed both. I am aware that if I run out of pregabalin I suffer withdrawals. I am only taking 200 but that's strong enough for me. I stopped Maxitram about a week ago. I was taking it for pain control; I've also been prescribed paracetamol, and I find that just as effective. Also, while sleep and bladder control may always need to be medicated, pain, I hope will disappear as healing takes place. Last night I took nothing but pregabalin and I still slept. This morning I woke to the alarm (not good) but I am still awake. Yay😀

[EPguy in reply to MaggieSylvie]

Since you describe these troubles as recent, and you stopped Maxitram recently it's plausible Maxitram withdrawal is a factor. Esp with the "Major" interaction noted above. According to:

drugs.com/medical-answers/l...

"Symptoms of tramadol withdrawal can start 8-24 hours after the last dose. Untreated, withdrawal symptoms usually last for 4-10 days. Tramadol withdrawal is caused by stopping the drug suddenly"

So one can hope you will feel more normal soon. Have you discussed with your GP?

[MaggieSylvie in reply to EPguy]

I replaced the Maxitram at night with Paracetamol because I was losing half a day to sleeping.

I've been too busy to discuss with my GP and we have had the added problem with lack of internet as well, so I'm just getting on with my life and noticing what happens when I make a change.

I haven't experienced withdrawal symptoms. I'm back to falling asleep in the afternoon now, but that could be due to the MPN or te MDS.

I'm already up too late this evening. I think I've been feeling a little more normal today.

[IsabelleHo]

Hello MaggieSylvie,

I also take a low dose of pregabalin (I have arthrosis) every evening.

I honestly don’t know if what I’m about to say makes any medical sense, but it’s what I’ve noticed in my case.

I take all my pills (I’m on Hydrea + aspirin as I have ET) just before supper so I can sleep off any side effects. From what I’ve noticed for me is that digestion makes the medication work (sorry… English is not my language). If I take pregabalin on an empty stomach and without eating, it won’t make me sleepy. But as soon as I eat, even hours after taking it, I will need to go sleep. This obviously doesn’t happen with Hydrea and aspirin.

Have you tried « testing » pregabalin with and without eating?

[MaggieSylvie in reply to IsabelleHo]

Thank you for that Isabelle, I wasn't sure I could take it so early, but what you say makes sense. I usually take it as I'm about to get into bed, and that would usually be at least three hours after eating. Your English, by the way, is better than many natives - by far. I have high platelets, so I'm on aspirin, too, but my haemaglobin has what I think of as far worse problems than the platelets. I see I have a reply from Hunter, so he will have something relevant to add.

[hunter5582]

What you ae describing with somnolence can have multiple causes, including medication side effects from pregabalin and other medications. Fatigue is the most common MPN constitutional symptom and may also play a role. It is worth noting that it is not unusual to feel a bit sleepy after eating (postprandial somnolence).

Pregabalin can be effective for neuropathic pain. I tried it but had to discontinue due to loss of the ability to concentrate. It is has a half-life of 6.3 hours, which mean that the following morning, you still have a significant amount of pregabalin active in your body. This is good for pain management but a potential issue when having side effects.

Suggest that you review this issue with your care team. Perhaps alternatives and strategies can yield a better outcome.

[MaggieSylvie in reply to hunter5582]

Thanks, Hunter. I am aware that it is normal to feel sleepy after a meal, but it has not affected me like this - ever, until recently. Today, I'm ok. The last sentence in your penultimate paragraph is halpful to read. But my body/mind is a pain; while I takke on what you have said, I went to bed at midnight and took my 2 pregabs, read for an hour probably and got up this morning at 8.0. I usually need to sleep longer than that. I'm not doing myself any favours by not keeping to regular hours I know. I am too busy to speak to the nurses at the moment because sleeping has taken away at least a day of useful working hours i.e. dealing with issues.

But tonight I will take my pregabs just after 9 pm probably. I don't get hungry - that's why I finish eating so late. Thanks again😊😊

[IsabelleHo]

From Hunter: " It is has a half-life of 6.3 hours, which mean that the following morning, you still have a significant amount of pregabalin active in your body." So that would explain it. Digestion could "trigger" the pregabalin still active in the morning, thus your sleepiness.

[MaggieSylvie in reply to IsabelleHo]

Oh YES!

[IsabelleHo in reply to MaggieSylvie]

And I think I'm going to try taking it earlier in the evening to see if there's any difference in the amount of coffee I need to wake up in the morning LOL

[MaggieSylvie in reply to IsabelleHo]

LOL. It's all a matter of balance, isn't it?