Managing Insomnia Linked to Ankylosing Spondylitis: A Patient's Dilemma

Q: Managing Insomnia Linked to Ankylosing Spondylitis: A Patient's Dilemma

Hello, my personal opinion is as follows： both physicians are correct in their statements. <br>In recent months, due to certain reasons, the National Health Insurance Administration has implemented stricter regulations regarding the prescription of sleeping pills, which has made

Ankylosing spondylitis and spondylitis leading to insomnia?

Hello Dr.
Ding,
I have been suffering from insomnia for over 8 years since being diagnosed with ankylosing spondylitis.
I have consulted a psychiatrist who mentioned that they can only prescribe sleep aids, and the main cause of my condition still relies on my primary care physician.
I considered visiting two outpatient clinics, but they are quite expensive and are large hospitals.
I asked my primary care physician to prescribe sleep aids, and they did, but they said they cannot prescribe them continuously and that I still need a psychiatrist to prescribe them.

I have seen a psychiatrist, and my issue is not a mental health problem; rather, I often wake up stiff in the middle of the night.
Is it true that my primary care physician cannot prescribe medications continuously? Also, are sleep aids not allowed to be prescribed in higher doses? Given that I have been dealing with insomnia for over 8 years, and considering the tolerance issues with sleep medications, along with the strict regulations from health insurance, can't I receive a larger supply of sleep aids at once? Or do I still need to rely on the psychiatrist for prescriptions or evaluations? Would a letter from my primary care physician be sufficient?
Every time I run out of medication, I feel like I am being accused of misusing health insurance resources, and it feels really bad to be suspected of selling these medications outside.
Please help me come up with a good solution to these issues!

QQ, 20~29 year old female. Ask Date: 2014/01/08

Dr. Ding Shuyan reply Psychiatry

Hello, my personal opinion is as follows: both physicians are correct in their statements.
In recent months, due to certain reasons, the National Health Insurance Administration has implemented stricter regulations regarding the prescription of sleeping pills, which has made it challenging for non-psychiatric doctors to prescribe them.
Therefore, your physician may have referred you to a psychiatrist to avoid these restrictions.
If the psychiatrist determines that your insomnia is caused by discomfort from a physical illness, they will likely recommend that you return to the physician treating your physical condition to see if those discomforts can be alleviated, thus eliminating the need for sleeping pills.
It seems advisable for you to communicate with the psychiatrist again.
If your physical discomfort continues to affect your sleep in the short term, see if they can prescribe sleeping medication for you.
If that is not possible, switching to another physician or even another hospital is also an option! Wishing you all the best.
Sincerely, Dr.
Ding Shuo-Yan.

Reply Date: 2014/01/08

More Info

Managing insomnia can be particularly challenging for patients with Ankylosing Spondylitis (AS), especially when the condition itself contributes to sleep disturbances. AS is a type of inflammatory arthritis that primarily affects the spine and can lead to chronic pain and stiffness, which can significantly impact sleep quality. In your case, it seems that the insomnia has persisted for over eight years, which is understandably distressing.

First, it's important to recognize that insomnia in AS patients can stem from several factors, including pain, discomfort, anxiety about the condition, and even the side effects of medications. The fact that you experience stiffness and discomfort that disrupts your sleep indicates that the underlying condition is a significant contributor to your insomnia.
Regarding your concerns about medication, it is common for healthcare providers to be cautious when prescribing sleep aids, especially for long-term use. Many sleep medications can lead to tolerance, meaning that over time, you may require higher doses to achieve the same effect. This can create a cycle of dependency, which is why physicians often prefer to prescribe these medications on a short-term basis or in conjunction with other treatments.

You mentioned that your primary care physician has been hesitant to prescribe sleep medications continuously and that you have been referred to a psychiatrist for this purpose. This is not unusual, as psychiatrists often have more experience managing medications specifically for sleep disorders. However, it can be frustrating to navigate the healthcare system, especially when you feel that your insomnia is primarily related to your AS rather than a psychiatric issue.

Here are some strategies that may help you manage your insomnia more effectively:
1. Pain Management: Since pain is a significant factor in your insomnia, it is crucial to address it adequately. Discuss with your rheumatologist or primary care physician about optimizing your AS treatment. This may include adjusting your current medications or exploring additional therapies such as physical therapy, exercise, or even alternative treatments like acupuncture.

2. Sleep Hygiene: Implementing good sleep hygiene practices can significantly improve sleep quality. This includes maintaining a consistent sleep schedule, creating a comfortable sleep environment, avoiding caffeine and heavy meals before bedtime, and engaging in relaxing activities in the evening.

3. Cognitive Behavioral Therapy for Insomnia (CBT-I): This is a structured program that helps individuals identify and replace thoughts and behaviors that cause or worsen sleep problems. CBT-I has been shown to be effective for chronic insomnia and may be a valuable alternative to medication.

4. Medication Review: If you feel that your current medications are not adequately addressing your insomnia, consider discussing this with your healthcare provider. They may be able to prescribe a different class of sleep medication or adjust your current regimen to better suit your needs.

5. Communication with Healthcare Providers: It’s essential to maintain open communication with both your rheumatologist and psychiatrist. If you feel that your insomnia is not being adequately addressed, advocate for yourself by expressing your concerns and asking for a collaborative approach to your treatment plan.

6. Support Groups: Connecting with others who have AS can provide emotional support and practical tips for managing both the condition and its associated symptoms, including insomnia.

In conclusion, while it may feel like a complex situation, there are multiple avenues to explore for managing your insomnia linked to Ankylosing Spondylitis. By addressing the underlying pain, improving sleep hygiene, considering behavioral therapies, and maintaining open communication with your healthcare providers, you can work towards finding a solution that alleviates your insomnia and improves your overall quality of life.

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