Getting More since Surgery?

Getting More since Surgery? Sleep! That is….. What did you suspect? (even those that skipped reading below felt the need to look) Charlie B.’s post is concerning "less Sleep" But many find that they Sleep More….. …thought I’d put in my 2 cents worth, But throw in a couple of bucks in change more…. ---------------------------------re-post (as Usual) Getting more Sleep, or even- needing more sleep Post-Op? Well, as to "Needing more," Early on when the body Is throwing off the pounds and still healing inside, There is an increased "need" for rest. Later, as the body gets smaller and easier to live in, generally, The ability to get "good sleep" improves dramatically. Besides the "comfort" of not wrestling that weight around On the bed anymore, medically observable changes occur. It’s sort of a given that Overweight people with obstructive sleep apnea (OSA) have their condition improved by weight reduction. The general medical conclusion is- "… improvement in obstructive sleep apnea after weight loss may be related to improvement in pharyngeal and glottic function." In People speak? Your "back of the throat area" has more room To Breath Through. This results in an approximate 20% increase in (resting) blood oxygen levels. The same is true for guys who haven’t been diagnosed with Sleep Apnea. There is just increased air flow, thus higher blood oxygen levels, for everyone who loses weight. So? Better sleep? Yes! Even less of it in duration, may well leave one more rested than longer nights with less oxygen that they had prior to dropping the weight. Another Bonus in Sleepy land comes from the additional daily exercise. Rather than just being tired all the time from carrying extra weight, Most WLS folks add exercise to their routines that specifically Tires the muscles, and releases endorphins and other Brain chemistry tricks, that lead to better sleep. Every "insomnia" solutions / recommendations list includes "Exercise" as a major contributors to a "good night’s sleep." Since most of us add exercise after WLS, this could very well be another of the reasons we notice more sleep. Or "More Productive Sleep" even from shortened duration. Hand in hand with the increased exercise? Lack of caffeinated beverages, or certainly a reduction of them. Most WLS Post-Ops have been taken off of caffeine in conjunction with their surgery. Many, never start back or add caffeine back in gradually. For myself? I used to drink enough diet Coke to bath in on a daily basis. Now? None. I do drink coffee again, And bit by bit I have gotten back up to Total Caffination! Probably even more than Pre-Op levels. For those who have cutout the caffiene, Increased the exercise, And are breathing better through the night, These things working together allow for better sleep, but Do all take advantage of it? Maybe not. For many Morbidly Obese, one of the patterns that got them to such a state (certainly in my case) is the eating pattern of using food as a "relaxer." Often the habit of eating late at night so as to get that- "Full as a Puppy" feeling, is one that many relied on for quite a while in order to "get to sleep" at night. I typically had a Peanut butter and banana sandwich (Thank you Elvis) or a big bowl of Ice Cream or such, every night. Skip it? And I was up until I did have a "little something." Like a lot of us, I counted on, or used, that blood sugar drop after a big wave of Carbs, to surf on into dreamland. Post-op? No such "tool" was available to me, and I suffered from insomnia quite a bit for a while. (Thus the "reading the entirety of the internet…) Only after adding enough exercise, and more importantly "Bi-oching" to my Doc about it, did I start getting sleep. My Doc gave me a small prescription of Trazodone. It’s actually an anti-depressant, but doesn’t reach "therapeutic levels until around 400mgs or higher. At 50 to 75 mgs it’ll put you right to sleep. Probably why it’s a rarely used anti-depressant, which is probably why it’s cheaper than Dirt! No morning grogginess, Great, Pure Sleep! At 1/25^th the price of a Lunesta tablet, you can be off in dreamland. It’s side effect is that at slightly higher dose, around 100mgs, it works like Cyalis or Viagra. Yes, Trazodone, ask for it by name! That topic on the table- Sex is a Great way, not only to end a perfect day, but it is the "End-All-Be-All" when it comes to producing Great Sleep! All sorts of brain chemistry at work there! "Head ache or not dear, I need to get my sleep! Sorry, Doctor’s orders!" For our young singles? As long as it’s sex with some one you respect, it doesn’t matter if you’re alone or not. One of the reasons that Alcohol addiction/dependence is so common among WLS Post-Ops is that "need for sleep aid" thing that used to be met By food. This, according to my Doc. He’s really big on recommending ANYTHING Else to help overcome the insomnia That many Post-Ops are met with once the comfort foods are gone. Now, if you really want some sleep- There are a couple of articles specifically addressing the connection of Obesity and sleep- "New studies are showing some fascinating associations between sleep and obesity." By Rachel A. Gifford, R.N., M.N., C.D.E. At- http://www.satevepost.org/issues/2005/0708/7370466.shtml?pag e=1 "Insomnia Can Hinder Your Weight Loss" By Laura Bofinger (swear that’s her real name) At- http://sparkpeople.com/resource/nutrition_articles.asp?id=12 9 If you find your self un-able to nod off, read these fairly dull articles About it and you’ll be off in no time. That’s everything I know / think concerning Post-Op Sleep. Hope it helps! So Guys? Did you go through a "insomnia period? If so, what did you do? Or no food to sleep correlation for you? Best Wishes- Dx

Before the inescapable "erectile dysfunction" drugs were introduced to the market, the only drug of any note that listed "priapism" (an erection that can't/won't go down) as a side-effect was trazodone.  (BTW, the evidence that trazodone can cause priapism is a lot stronger than any evidence that you can develop it from taking Viagra, etc.) BTW, here's a note on priapism from the Wikipedia: Potential complications [of priapism] include ischemia, clotting of the blood retained in the penis (thrombosis), and damage to the blood vessels of the penis which may result in an impaired erectile function or impotence. In serious cases, the ischemia may result in gangrene, which could necessitate penis removal. There isn't a whole lot of good evidence that trazodone is useful in the treatment of insomnia, though it certainly causes drowsiness in people given it as an antidepressant (and it's not even all that effective an antidepressant).  If drug treatment is considered for insomnia, it's probably a lot safer to go with one of the Z-drugs: Ambien, Lunesta or Sonata, rather than give a man a drug that has a risk, however small, of causing a urological emergency.  The logic behind a doctor prescribing trazodone to a man for insomnia is a bit like deciding that they'd rather make a man a eunuch than an addict!  (The risks of either are pretty low, but I wouldn't guess which was less likely!) I found that I had terrible insomnia for the first six weeks post-op (I think this was mainly because I was spending too many late nights on the computer.)  I finally limited my late nights on-line, and also tried a low-dose of melatonin (0.5mg) two hours before I went to bed.  A week of doing both of these seemed to do the trick. /Steve

Welcome back, Dx. We missed you.  Boner

Steve, Good point. I hadn’t considered the risks to be that high. I took Trazadone for around 3 months and then maybe once to three times a week for another 3 months. I found it very effective at putting me "almost instantly" to sleep. No instances of priapism, but noticeably more "vigor." Attending support groups since ’03, I’ve run across dozens of folks (men and women) who have been prescribed Trazadone as a sleep aid, all from different docs. On the Grads Board here back in ’05, there were many who had been Using it successfully as well, and granted, probably 70 to 80% of those Were women as well. In all of those cases, I haven’t heard of any instances of priapism among the men. Let alone gangrene and "Penis-ectomies." Must have been a rash of stupid Dr.s writing prescriptions  without first consulting the wisdom of Wikipedia. (Sorry, I can rarely resist being an ass-hole.) On the Boards over the last 5 years I have seen many, many, many cases of Alcoholism, Insomnia, and Re-gain from eating late-night snacks in order to reach that "Comfort zone" that many Obese use to relax. Melatonin is a very effect solution. I travel a lot from coast to coast And use Melatonin to insure that first night of sleep in a strange hotel. Back when I was prescribed the Trazadone, Melatonin wasn’t doing the trick. I had just come off of multiple months of Morphine, so Melatonin Was about as effective as a cup of warm water. There are risks. For me they were worth it. Side note--- The risks of developing impotence, gangrene or permanent damage of any sort to the penis from taking Trazadone, are far less than the risk of Developing fatal Liver Damage from taking Tylenol. Couple the stress that rapid weight-loss has on the liver with that fact? What doctor would be silly enough to risk their patents life over a simple headache?

I’m thankful I had a Dr. silly enough to risk to help me  get my sleeping pattern back to normal without the risk  of addiction transfer, or falling back on old eating habits. Coming up on 5 years at or below goal? I’m very glad he did….. If the Melatonin works for folks? Go with it! Sorry for the mild attempt at humor while sharing "what worked for me." I hope it does lead to the loss of anyone’s penis. I’d hate to feel responsible for that. Just sayin’, I’ve met a hell of a lot of addicts out here, And to date? No eunuchs!

Best Wishes- Dx

The concern about "off-label" use of trazodone for insomnia comes from the fact that it's never been tested for this indication in controlled trials (like any FDA-approved sleep medication needs to be), and because it has an admittedly rare (but hardly non-existent) and unique risk of priapism in men.  When a doctor prescribes a drug for a non-life-threatening condition, it is only reasonable to factor in its risks along with its benefits, especially when compared to other drugs.  We have a bit of a handle on trazodone's risks, but all the benefits in treating insomnia are just anecdotal reports.  (That is not to say that it DOESN'T work to promote sleep, just that it hasn't been quantified or qualified.)  It may be that the risk of dependence and addiction (and sleep-eating and sleep-QVCing) from the Z-drugs have made less of an impact on received clinical wisdom than trazodone's risk of priapism, because most of these wise-men are men themselves--the risk of priapism gets their attention! That doesn't mean that trazodone isn't used widely to treat insomnia; in fact, sleep is probably the only reason the drug is sold anymore!  But its popularity comes completely from word-of-mouth.  I'm sure its use would be completely uncontroversial (even with the lack of controlled studies) if it didn't have this unusual side-effect. In the 7 years after trazodone was introduced to the US market, 20 cases of priapism were reported in the published literature, which is hardly an epidemic, but is probably an undercount.   It's even been reported in low doses.  Of course, a rare side-effect takes a large population to see it occur, so it's completely expected that you wouldn't encounter it in casual discussions with men who have taken it (presumable without any problems.) So, the next time someone (some guy) takes it, he should ask: "Do I feel (UN)lucky?!"  /Steve

Funny coincidence you bring up Trazodone ..   My bossman was recently prescribed it as a sleep aid ..  As you mention, it made a lousy anti-depressant, but turned out to be a great sleep aid ..  The boss was taking 150 mg. a night, but the other night he took some about an hour before heading to bed ..  He heads up stairs then for bed and the next thing he knows he's getting dizzy and hits the floor, out cold ..  He wakes up to ambulance attendants and vomiting ..  After spending a night in the hospital and undergoing all kinds of tests for stroke and heart attack, then cannot fgure out what happened ..  They could only conclude that the Trazodone hit his system a little harder than usual, as he was also a bit dehydrated.   Before that, it had only made him a little dizzy once in a while.   Hopefully that was it ..  < fingers crossed >  At least it's better than Lunestra, which was causing dudes to walk around naked outside their hotel/motel rooms at night and not even realize it  ..   LOL 

One of the guys I work with takes that lunestra and he does some crazzzzzy stuff and doesent even know he did it . He ordered some stuff off the TV ( qvc or something like that )  Next thing he knows he's getting some knifes'in the mail , he ordered some Rachel Ray set of cook ware and a set of knifes , and he is one of the TIGHTEST  people i know . He sent it back and was p-ssed he had to pay shiping . LOL                  Nick

  LOL, Nick!   Bossman told me stories about a good bud of his and a couple of clients that took it and the wild stuff that happened to them in their sleep ...   He said his bud told him he had woken up one a.m. and he found he was wearing THREE sets of clothes, one over the other ..  Apparently he had "awaken" earlier and thought it was time to get up and get dressed for work, so he did ..  And then promptly went back to bed again to sleep ..  He did that 3 times in his sleep, each time putting on clothes but not taking them off ..   ROFLO   His bud also mentioned how one afternoon he called some friend of his and started asking him some questions about things in general ..  The friend got mad and said, "you ALREADY asked me those questions and I answered them earlier .. "   The bud asked, "when was this?"  ..  And he responded, quite aggravated, "when you called me AT THREE O'CLOCK THIS MORNING!"     His bud said he sure never remembered doing that    &:-x)    One the bossman's clients, a lady, said she woke up one morning to find a full dinner prepared and sitting on the dinner table ..  She apparently got up in the middle of the night and prepared ti and sat the table, and then went back to bed, forgetting she had ever done it ..    The "naked motel guest" is based on some recent news items about guys doing that ..  Leaving their motel or hotel room in the middle of the night w/o any clothes on, and typically walking up to the front desk to ask for something.  One luxury hotel chain (I think it was the Sheraton) has had that happen so often in the past couple of years that they have developed a co. policy on how their employees should handle those situations when they arise, and required that all their front desk people and managers learn the policy!   

HiJack. DX, Is Tunica this weekend? Can you PM me some info, if it is not too late to attend. I will be in Monroe, LA tomorrow, and Tunica is not too far from there. Might be able to make it. jp