bipolar disorder, Dr. Paul Markovitz  Q. When I'm in a hypomanic state, sleep becomes impossible. At night I take 2 mg. Ativan, 10 mg. Ambien, 1200 mg. Neurontin, 50 mg. Seroquel, 2 Darvocet, plus Carafatea and Prilosec. Why doesn't that knock me out? Is there anything the doctor could recommend for sleep, that I could discuss with my psychiatrist? I'm desperate for some sleep, I would do just about anything to sleep.

  A. My guess is that the sleep problem is part of your illness, and the illness is not under good control. The best thing you can do is to get the illness under better control. I know that is easier said than done.

I happen to like Trazodone for sleep, but it can leave you sedated in the morning. Since it works in many of the same ways as Seroquel (5-HT2 antagonism for both) it should not make you manic/hypomanic. Use anywhere from 100 to 600 mg at bedtime as needed. Hope this helps.