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Please review any F2F physician contacts you have now.
Angel  It is Well with My Soul  Angel
For almost three years now, I have been trying to see a psychiatrist for treatment for my extremely severe insomnia, and have not been able to get an appointment. I had another frustrating experience last Saturday, with a clinic in Michigan called Alliance Behavioral Health Specialists.

I have found it pretty much impossible to find psychiatrists in my area who are taking new patients. For several years, I was on Medicaid, and virtually no psychiatrists take Medicaid. Under state law, mental health providers are forbidden from taking anything out of pocket from Medicaid patients. (Probably physical health providers are forbidden, too, I don't know.)

I am now on Medicare, and recently got a referral to a psychiatrist at Alliance Behavioral Health Specialists. This clinic is located several cities away from where I live. I called and asked to see a psychiatrist, and got an appointment to see a psychiatrist on 9/7 (last Saturday.) My husband drove me to the appointment, as I am currently too physically ill to drive.

The person I actually saw was not a psychiatrist or a physician at all; she was a nurse practitioner. She really didn't understand medications for insomnia well. I told her that Ambien had worked great for me in the past. I had a physician who had prescribed it for me for several years, and I had run into only one problem -- the physician had not warned me of a very common side effect that occurs if sleeping pills are taken too many night in a row. The first night the patients falls asleep without sleeping pills, they are likely to have intense, vivid dreams that are unpleasant. This is called "REM rebound" and occurs because sleeping pills suppress dreaming (REM sleep.) The need for REM sleep builds up, and the person will have intense periods of REM (dreaming) the first night they sleep without pills. I soon learned not to take Ambien too many nights in a row, or else I would have this REM rebound effect. Instead, I would try to sleep without Ambien. Typically, I wake up within about three hours, and need Ambien to get back to sleep. But by then, I have caught up some on my dreaming.

The nurse practitioner confused this extremely common side effect of vivid dreams with a much, much rarer one -- sleep walking. She said my vivid dreams were a life-threatening side effect and that next time, I might sleep walk into traffic and get myself killed. That is not true -- REM rebound are just intense dreams, and the person just lies in bed sleeping, with nothing moving but their eyes. I had never had a problem with sleep-walking, despite having taken Ambien most nights for a period of several years. (And yes, I went to other physicians, and yes, I tried many other medical and non-medical treatments in that time -- only Ambien works for me.)

So, she said she was not sure what might help me, and would have to look into it. I doubt the nurse practitioner will ever figure out anything that works for me. Meanwhile, there is a huge construction project going on across the street, with the construction crews repeatedly working in the middle of the night despite city rules forbidding that. I really need help with my sleep problems now.

I feel it is unethical to tell someone they are seeing a psychiatrist and then instead substitute a nurse practitioner. The co-pay was only $25, but with the drive there and back, it took up around half a day of my husband's very limited time. It was also a further disappointment that I just didn't need.

Ironically, the nurse practitioner was a very good counselor (she was sympathetic, encouraging, etc.) But, she doesn't do counseling; she only does medication management. I am also looking for a counselor, but her clinic currently is full and is not taking new counseling patients, only ones for medication management.

It is astonishingly difficult to get mental health care, at least in my area of the country.

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