Medication Side Effects: Sleepwalking and Confusion Concerns

Unsure if the medication dosage is excessive?

Doctor, I have been taking psychiatric medication for a year and a half.
This time, the doctor prescribed medication that causes me to feel disoriented before sleep, leading to actions that feel like dreams when I wake up, similar to sleepwalking.
I have done things like trimming my own eyebrows and self-harm (which I had previously done but has gradually decreased over the past two months).
Upon waking, I always have to check what I did the night before, and I often have nightmares.
I feel like I can no longer distinguish between what I did during that disoriented state before sleep and what happened in my dreams; I am scared of the things that happened in my dreams.
The doctor prescribed me a one-month supply of REMERON SolTab 30mg, Seroquel 100mg to take at bedtime, STILNOX 10mg, and ALPRALINE 1mg for morning and noon, along with ALPRALINE 0.5mg.
I would like to ask the doctor which of these medications might be causing these unusual behaviors before sleep.
I am afraid that one day I might do something terrifying before going to sleep.

zoo, 20~29 year old female. Ask Date: 2006/03/12

Dr. Lü Shuhui reply Pharmacology

Hello,
Rest is essential for going further, and sleep is the source of energy for the next day.
Dreaming is a natural physiological phenomenon; however, when nightmares occur frequently, waking up in fear not only disrupts your sleep but also makes the night feel long and unbearable.
The line between reality and dreams can blur, leading to confusion and anxiety.

Establishing good sleep habits can reduce the occurrence of nightmares.
Avoiding caffeine-containing beverages and large meals or alcohol intake in the evening, as well as creating a comfortable sleep environment, can be beneficial.
Additionally, recent stress and changes in your health condition may also be contributing factors.

Regarding medication, Remeron Soltab is an antidepressant, and while some individuals may experience abnormal dreaming, the incidence is quite low.
Some sleeping pills and sedatives can also cause amnesia and nightmares.
Your current behavior of self-harming by cutting your eyelashes, along with experiencing nightmares, is indeed unusual.
Since you are in the process of changing medications, it is important to determine whether this is related to your current prescriptions.
Please do not stop taking your medication on your own.
I recommend that you schedule an appointment to discuss this matter in detail with your physician.

I hope you can soon be free from the torment and shadows of nightmares.

Reply Date: 2006/03/12

More Info

It sounds like you're experiencing some concerning side effects from your medications, particularly related to sleepwalking, confusion, and vivid dreams. Let's break down the medications you're taking and their potential effects.

1. Remeron (Mirtazapine): This medication is an antidepressant that is often prescribed for sleep issues due to its sedative properties. While it can help with sleep, it may also cause side effects such as drowsiness, confusion, and vivid dreams. In some cases, it can lead to unusual behaviors during sleep, including sleepwalking or engaging in activities without full awareness.

2. Seroquel (Quetiapine): This is an atypical antipsychotic that is also used to treat mood disorders and can have sedative effects. Similar to Mirtazapine, Seroquel can cause drowsiness and confusion, particularly when starting the medication or increasing the dose. It has been associated with sleep-related behaviors, including sleepwalking and other complex behaviors during sleep.

3. Stilnox (Zolpidem): This is a sedative-hypnotic medication used for the short-term treatment of insomnia. Zolpidem is known to cause side effects such as sleepwalking, sleep-driving, and other complex behaviors while not fully awake. These behaviors can occur without the individual being aware of them and can lead to dangerous situations.

4. Alpraline (Alprazolam): This medication is a benzodiazepine used to treat anxiety and panic disorders. It can cause sedation, confusion, and memory issues, especially when taken in higher doses or for extended periods. The combination of Alprazolam with other sedative medications can enhance these effects, leading to increased risks of confusion and unusual behaviors.

Given your experiences of feeling disoriented, engaging in activities like self-harm during these episodes, and having difficulty distinguishing between dreams and reality, it is crucial to discuss these side effects with your prescribing physician. They may consider adjusting your medication regimen, reducing doses, or switching to alternatives that may not have the same sedative effects.

It's important to note that the combination of these medications can amplify side effects, particularly those related to sedation and cognitive function. The risk of engaging in complex behaviors during sleep increases when multiple sedative medications are used together.
Additionally, the presence of nightmares and the fear of not knowing what you might do while in this altered state of consciousness is understandably distressing. It may be beneficial to keep a sleep diary to document your experiences, which can provide valuable information to your healthcare provider.

In summary, the medications you are taking—Remeron, Seroquel, Stilnox, and Alprazolam—can contribute to the side effects you are experiencing, including confusion, sleepwalking, and vivid dreams. It is essential to communicate openly with your doctor about these concerns, as they can help you find a safer and more effective treatment plan. In the meantime, ensure that your environment is safe to minimize the risk of injury during these episodes.

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