Daytime Sleepiness in Psychiatric Medication Management

Psychiatric conditions can lead to significant drowsiness?

Hello doctor, I have a history of panic disorder for a total of 10 years.
My condition was stable while on medication, but last month I experienced frequent episodes (suspected to be caused by migraines, as my EEG results were normal).
After my doctor adjusted my medication, I no longer had episodes or unexplained anxiety and headaches (taking Fu'an Yuan twice a day).
This has been maintained for almost a month, but I find myself feeling drowsy in the afternoon.
There’s a 2/3 chance that while sitting at home watching TV, I will start to feel sleepy and then suddenly fall asleep.
There’s a 1/3 chance that just resting my head against the back of a chair or sofa will make me drowsy.
If I try to force myself to wake up, I get startled.
However, I do not suddenly fall asleep when I am out; each time I sleep, it lasts 1.5 to 2 hours.
After waking up, I still feel sleepy until around 5 or 6 PM, but I don’t fall asleep again.
After dinner, if I watch TV for about 30 minutes to an hour, there’s a chance I will fall asleep again for 1 to 2 hours before waking up, then I watch TV until it’s time for bed.
I take my medication before sleeping, and my sleep duration from bedtime to the next morning is normal, around 6 to 8 hours.
Sometimes I wake up early, but I can’t tell if my daytime sleep is shortening my nighttime sleep.
In the morning, I sometimes feel sleepy, but it’s not the same as in the afternoon where I fall asleep directly.
Previously, before my medication dosage was increased, I also easily fell asleep, but this only happened 30 minutes to an hour after dinner, and I would sleep for 1.5 to 2 hours.
If I wake up on my own, I check if it’s time for bed; if not, I continue watching TV, and my sleepiness significantly decreases.
When it’s time for bed, I take my medication and go to sleep.
If I want to sleep until it’s time, I take my medication and go to bed.
I usually exercise, and my current medications are Metoprolol 30 mg (originally half a tablet, later increased to 3/4 of a tablet), 10 mg of a heart rhythm medication, and Fu'an Yuan 0.25 mg (originally taken when feeling unwell, later changed to once in the morning and once in the afternoon due to daytime anxiety).

1.
Why do I only feel drowsy in the afternoon? (I have been taking Fu'an Yuan for almost a month; occasionally, I don’t feel drowsy.
I’m unsure if I can skip the midday dose or if I need to taper off slowly to avoid withdrawal symptoms.
I currently don’t know if stopping suddenly after one month will cause withdrawal symptoms.)
2.
Will suddenly stopping psychiatric medication cause withdrawal symptoms? Typically, medications taken for several months should not be stopped abruptly.
3.
Why do I feel drowsy after dinner? Is this normal? (As soon as I fall asleep, I get scolded.)
4.
Other people have the habit of taking naps, but I do not.
How many hours of daytime sleep is considered acceptable for a normal person to avoid affecting nighttime sleep?

POP, 30~39 year old female. Ask Date: 2017/04/05

Dr. Ding Shuyan reply Psychiatry

Hello, if you have questions regarding your medical treatment, medication side effects, etc., you should discuss them with your physician, as they are most familiar with your condition and have the responsibility to clarify your concerns and adjust your medications.
Asking unfamiliar doctors online may not be beneficial for you, as I do not know your specific situation, and your questions involve personal circumstances that are difficult to generalize.
If there are discrepancies between my responses and your physician's answers, it could lead to confusion for you and create difficulties for your doctor.
Personally, I do not recommend asking unfamiliar doctors online about your personal medical diagnosis and ongoing medication issues.
Among your questions, only questions 2 and 4 are somewhat general, which I can briefly address.
The duration for which psychiatric medications should be taken before discontinuation depends on the type and dosage of the medication.
Some may lead to dependence relatively quickly, possibly within a few weeks, while others may not pose significant issues and can be stopped abruptly.
If you sleep well at night, taking a nap during the day is fine.
However, if you experience sleep disturbances at night, it is generally advised to avoid napping during the day, as this is a widely recognized point of sleep education.
The number of hours of sleep needed varies from person to person, and there is no definitive answer.
Wishing you all the best.
Sincerely, Dr.
Ding Shuo-Yan.

Reply Date: 2017/04/05

More Info

Understanding daytime sleepiness, especially in the context of psychiatric medication management, is crucial for both patients and healthcare providers. Your situation, characterized by a history of panic disorder and recent medication adjustments, highlights several important aspects of sleep and medication interactions.

Firstly, it’s essential to recognize that many psychiatric medications can have sedative effects, which may contribute to daytime sleepiness. In your case, you mentioned taking medications like 福安源 (Fluoxetine) and 美妥平 (Mirtazapine), both of which can influence sleep patterns. Mirtazapine, in particular, is known for its sedative properties, especially at lower doses. This sedative effect can lead to increased sleepiness during the day, particularly if the medication is taken in the morning or early afternoon.

1. Daytime Sleepiness: The fact that you experience significant sleepiness in the afternoon, especially after meals, is not uncommon. This phenomenon, often referred to as postprandial somnolence, can occur due to various factors, including the body's natural circadian rhythms and the effects of certain foods on blood sugar levels. Additionally, the sedative effects of your medication may exacerbate this tendency. If you find that your afternoon sleepiness is disruptive, it may be worth discussing with your doctor whether adjusting the timing of your medication or exploring alternative treatments could help.

2. Medication Management: Regarding your concerns about stopping medications, it is crucial to follow your healthcare provider's guidance. Abruptly discontinuing psychiatric medications can lead to withdrawal symptoms or a resurgence of anxiety and panic symptoms. Generally, medications like 福安源 and Mirtazapine should be tapered off gradually under medical supervision, especially if they have been taken for an extended period. Your doctor can provide a tapering schedule that minimizes withdrawal effects while ensuring your mental health remains stable.

3. Evening Sleepiness: Feeling sleepy after dinner is also a common experience, particularly if you have a routine of relaxing activities like watching TV. This can be exacerbated by the sedative effects of your medications. It’s essential to differentiate between normal tiredness and excessive sleepiness that could interfere with your nightly sleep. If you find that this evening sleepiness is impacting your ability to stay awake until your intended bedtime, consider adjusting your evening routine. Engaging in more stimulating activities or reducing the sedative effects of your medications in the evening may help.

4. Napping and Sleep Hygiene: While napping can be beneficial for some individuals, it can disrupt nighttime sleep for others, particularly if naps are too long or taken too late in the day. For optimal sleep hygiene, it is generally recommended that if you do nap, keep it short (20-30 minutes) and avoid napping late in the afternoon. This practice can help ensure that your nighttime sleep remains consolidated and restorative.

In conclusion, managing daytime sleepiness in the context of psychiatric medication requires a comprehensive approach that includes medication management, lifestyle adjustments, and sleep hygiene practices. It’s essential to maintain open communication with your healthcare provider about your experiences with sleepiness and any concerns regarding your medications. Together, you can develop a tailored plan that addresses both your mental health needs and your sleep quality.

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