Concerns About Anxiety and Sleep Medication Dependency - Psychiatry

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Fear of addiction to anxiolytics and sleep medications?


Hello Doctor: Since I got married, I have hardly spent a night away from home (7 years).
My parents have passed away, and although I have siblings, our relationships are quite distant and we rarely keep in touch.
Therefore, I spend the New Year at home.
My family runs a motorcycle shop in the suburbs, mainly serving college students and neighbors, but we don't have many customers.
My husband often goes to his friends' houses for other work.
I manage the shop every day from 8 AM to 10 PM, and my husband usually returns around dinner time to do some work in the shop.
We don't have children; I tried but eventually gave up, as I felt like I was alone in the shop every day.
I often resort to online shopping and playing games to avoid feeling like I'm imprisoned at home.
My husband is a workaholic and only takes 3 or 4 days off during the Lunar New Year; otherwise, he just wants to work and earn money.
I have to negotiate with him about going out, and when I return, he always gives me a cold shoulder.
He also treats my friends poorly when they come to repair their bikes or buy new ones.
I don't understand why this is happening.
I've argued with him about it, but there's still no resolution.

In January of this year, my sister had surgery (total hysterectomy) and asked for my help in taking care of her because her husband is not good at looking after patients.
I was actually quite happy to leave the house, having been cooped up for so long.
I asked my husband for 5 days off (during the winter break, when there are usually no customers, and he is often not around since customers typically schedule appointments for the evening).
I thought the shop could take a break during the day while he could still work.
On the fifth day, my sister said she was still uncomfortable and wanted to stay for two more days.
I called home to tell him, and he got very angry, saying I was preventing him from working.
I was also upset because my sister was sick, and I wasn't out having fun.
The phone call was very unpleasant, and we hung up.
Later, the doctor said we couldn't waste medical resources, so we were discharged on the fifth day, and I returned home as planned.
I called him to say I was back, and he said he would take me out for a big dinner.
I felt resentful and said no.
When I got home, I expressed my frustration about how I had prevented him from working, and I couldn't let it go.
Naturally, I was unwilling to engage in sexual relations with him because I was in a bad mood.
He thought I was doing it on purpose, saying he treats me poorly every day (I've been dealing with his attitude for 7 years...).

Since then, I suddenly started experiencing pain in my jaw.
I initially thought it was a result of my previous love for Thai dried squid.
I went to a nearby clinic, where they prescribed muscle relaxants and painkillers.
I experienced pain when opening and closing my mouth, or it would make a popping sound.
I researched online and suspected it was related to my temporomandibular joint, so I went to an ENT specialist.
The pain fluctuated, and later a nurse friend suggested I see an oral surgeon (I forgot the full name).
I never found the time to go.
In June, I told my husband I would be going to the south to visit my sister for three days in August.
The jaw pain continued intermittently, and during severe pain episodes, I would get muscle relaxants and painkillers from the nearby clinic.
Until I went to the south for three days in August, the intermittent jaw pain suddenly disappeared after 8 months.
When I returned and explained this to my doctor, he pointed out that it might be due to stress that I wasn't consciously aware of, which could have been released during sleep, causing me to unconsciously clench my jaw.
I realized how much stress I had been under.
The doctor prescribed me Anbong tablets to take one before bed every night, and the jaw pain has not recurred.
However, my husband's verbal abuse has become increasingly severe.
Sometimes after an argument, he expects sexual relations that night, even when I'm still upset.
He just says I'm being difficult.
I told him that women are not inclined to engage in such activities when they are upset, but he doesn't understand and only wants to have sex.
Not engaging with him only makes him more unhappy, which is frustrating.
So, I have given up on myself, using lubricant just to please him.
I don't want to argue anymore; fighting is exhausting.

I've been taking Anbong for almost two months, but recently I've started having trouble sleeping again.
While I can fall asleep easily, I wake up whenever he rolls over and touches me, resulting in poor sleep quality.
The doctor advised me to take two Anbong tablets and one sleep aid an hour and a half before bed.
This way, I wouldn't be disturbed during sleep, but I still wake up after five hours and feel like I haven't slept at all during the day, leaving me very fatigued.
Friends have advised me to see a specialist in psychosomatic medicine.
During the consultation, the doctor didn't ask me anything, and I didn't know where to start, so I just described my situation.
The psychosomatic doctor prescribed me seven doses of Lian Duo Mian and said I could decide whether to continue taking Anbong (the local clinic had prescribed it to me for three months as a chronic prescription).
I'm afraid of becoming dependent or addicted to these medications because I know my husband won't change, and the root of my stress will always be there.
Is it really okay to keep relying on these medications? My friends keep saying sleeping pills are bad, and the decision of whether to take them or not makes me even more anxious.

hen wu nai, 40~49 year old female. Ask Date: 2016/12/10

Dr. Qiu Junda reply Psychiatry


Hello: Most people generally prefer not to take medication if possible, especially sedative-hypnotics.
However, it is important to consider that we take medication because it is necessary for our condition.
Since these medications can help improve our symptoms, we should not dismiss them lightly.
Additionally, modern sedative-hypnotics are safer than those in the past.
If you have concerns about side effects such as addiction, it is advisable to discuss them with your treating physician to alleviate your worries about medication use.

Reply Date: 2016/12/10

More Info


Your situation is indeed complex and challenging, and it's understandable that you're feeling overwhelmed. The interplay between anxiety, sleep disturbances, and medication dependency is a significant concern for many individuals, especially when compounded by personal circumstances like yours. Let's break down the issues you're facing and explore some potential solutions.


Understanding Anxiety and Sleep Medication
1. Anxiety and Sleep Disturbances: Anxiety can significantly impact sleep quality. When you're anxious, your mind is often racing, making it difficult to fall asleep or stay asleep. This can lead to a vicious cycle where lack of sleep exacerbates anxiety, creating a feedback loop that is hard to break. It's crucial to address both the anxiety and the sleep issues simultaneously.

2. Medication Dependency: The concern about becoming dependent on sleep medications is valid. Many sleep aids, particularly benzodiazepines and certain sedatives, can lead to tolerance (where you need higher doses to achieve the same effect) and dependence (where you feel unable to sleep without them). It's essential to use these medications judiciously and under the guidance of a healthcare professional.

3. Types of Medications: The medications you've mentioned, such as 安邦錠 (Anxiolytics) and 恋多眠 (sleep aids), can be effective in the short term for managing anxiety and sleep issues. However, they are not a long-term solution. It's important to discuss with your doctor the potential for side effects, including daytime drowsiness, which you've experienced.


Alternative Approaches
1. Cognitive Behavioral Therapy (CBT): CBT for insomnia (CBT-I) is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems. This therapy can be highly effective and is often recommended as a first-line treatment for insomnia.

2. Lifestyle Modifications: Consider implementing some lifestyle changes that can improve your sleep quality:
- Sleep Hygiene: Create a relaxing bedtime routine, limit screen time before bed, and ensure your sleep environment is comfortable and conducive to rest.

- Physical Activity: Regular exercise can help reduce anxiety and improve sleep quality. Aim for at least 30 minutes of moderate exercise most days, but try to avoid vigorous activity close to bedtime.

- Mindfulness and Relaxation Techniques: Practices such as meditation, yoga, or deep-breathing exercises can help reduce anxiety and promote relaxation, making it easier to fall asleep.

3. Support Systems: Given your situation with your husband and the emotional strain it causes, seeking support from friends, family, or support groups can be beneficial. Sometimes, just talking about your feelings can alleviate some of the burdens.

4. Professional Help: If you feel comfortable, consider seeking a mental health professional who specializes in anxiety and sleep disorders. They can provide tailored strategies and support to help you navigate your challenges.


Conclusion
It's essential to address both your anxiety and sleep issues holistically. While medications can provide temporary relief, they should not be the sole solution. Engaging in therapy, making lifestyle changes, and building a support network can significantly improve your overall well-being. Remember, it's okay to seek help and take the time you need to find the right balance for your mental health and sleep quality. Don't hesitate to reach out to a healthcare provider to discuss your concerns about medication dependency and explore alternative treatment options. Your mental health is a priority, and there are paths to feeling better.

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