Experiences Nocturnal Bruxism and Is Unable to Take Meds
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Q:  Experiences Nocturnal Bruxism and Is Unable to Take Meds

Dr. Phelps,

I have a complicated medical history and a complicated question that I have been unable to find any resources to help me.  I am hoping that with your vast experience you can point me in some direction.  I will try to simplify the question as best I can.  I have numerous chronic illnesses in addition to bipolar.  I have a long history of trauma and abuse and have always taken my stress into my body.  For the past ten years I have had nocturnal bruxism that is so bad talking and eating are extremely difficult.  I am in my seventh year of difficult perimenopause and my situation is unbearable.  I am able to sleep but when my bipolar episodes are very bad I clench and fight in my sleep waking up with bruises etc.  All traditional therapies do not work.  I am unable to take any meds. A sleep study is out of the question with my past history of abuse. I have such vivid, aggressive dreams especially when the mania is  at its worst.  Are there any books, etc. that discuss "manic sleep" injury to the body?  I must stop this damaging clenching and body destruction.  Please respond to this question as I have nowhere else to turn.

Many thanks,

Dear Elizabeth --
This sounds awful.  I wish I had a good answer.  Unfortunately, there is only a single line in your story that really catches my eye.  That is this one: "I am unable to take any meds." 

I have seen quite a few patients who have stories similar to yours, although perhaps not quite as awful.  Among them, indeed among all my patients, I've never met someone who was unable to take any medications at all. 

So, because your symptoms sound so severe, I fear that trying to manage this without a medication approach might be quite difficult.  So my curiosity runs most strongly toward the reason why you are unable to take any medications.  Since we have medications that might be used for these symptoms which come from several different classes, he might be unfortunate and unable to take one class, but it would be really unusual to be unable to take anything from several different classes -- e.g. anticonvulsants, low-dose antipsychotics (and I mean really low dose), benzodiazepines, hypnotics (like Ambien), sedating antidepressants like trazodone (which seems not to bother bipolar disorder much, somewhat to my surprise).  

However, just in case it might possibly be of some value (I think I have one or two patients so far who have bad trauma histories and have found them useful), you might check out the story about amber lenses blocking blue light in my essay about Light and Darkness.  It won't help you while you're asleep, but it might help you get there with less tension.  It's cheap, and so far I can't think of a way in which it might be harmful.  Might be worth a try.  Good luck finding some help for all this -- 

Dr. Phelps 

Published August, 2008


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