severe test anxiety

[Colba55o]

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Wondering if anyone else has dealt with this and if they have any suggestions.

I think mine started around when I was preparing for the mcat and has just gotten progressively worse. The really damaging part is getting sleep the night before an exam which is near impossible for me. Even if I force myself to only sleep 3-4 hours two nights before..when it comes down to the night before I'm wide eyed, and awake. Of course as I sit down to take the exam, the sleep deprivation hits and Ive been known to all but doze off during a test.

Does anyone think taking a sleeping pill the night before would be wise? I can't keep up like this because my last exam, I did poorly and I know it was because I was too sleepy and made stupid mistakes.

Its not a matter of telling myself to relax..no matter what I think/try to do, I just can't will myself to sleep the night before an exam. I'm worried what will happen when I take boards! Thanks for any advice.

 

[Law2Doc]

Wondering if anyone else has dealt with this and if they have any suggestions.

I think mine started around when I was preparing for the mcat and has just gotten progressively worse. The really damaging part is getting sleep the night before an exam which is near impossible for me. Even if I force myself to only sleep 3-4 hours two nights before..when it comes down to the night before I'm wide eyed, and awake. Of course as I sit down to take the exam, the sleep deprivation hits and Ive been known to all but doze off during a test.

Does anyone think taking a sleeping pill the night before would be wise? I can't keep up like this because my last exam, I did poorly and I know it was because I was too sleepy and made stupid mistakes.

Its not a matter of telling myself to relax..no matter what I think/try to do, I just can't will myself to sleep the night before an exam. I'm worried what will happen when I take boards! Thanks for any advice.

I wouldn't go with the sleeping pill -- a lot of them leave you pretty groggy. Just get a good night's sleep two nights before the exam. This way, even if you aren't able to sleep much the actual night before the exam, you should have enough of your mental faculties intact to manage through a test. Missing a night's sleep is actually not all that uncommon in this career path, and you will find that you can actually operate at close to normal speed for that duration. And if they allow you to bring soda, chocolate or something with caffeine and sugar into the test, you may want to consider it. Will give you a short rush, but if you pace your sips/bites, you can milk it for a few hours.

 

[SoCuteMD]

I have it pretty bad, and I think it would be worse now if I hadn't taken a few years off in between college and med school. I keep a prescription for klonipin around (yes, I know it's a benzo, yes, I know it's addictive, no, I don't REALLY think that's a problem seeing as I just had to get a new script because the old one expired without me taking all the pills!!!) for the night before tests. I tried a few different benzos for test-night anxiety and found that for me, klonipin didn't leave me feeling groggy or hungover. The key is trying them beforehand so that you don't have this nasty surprise the morning of a test.

The benefit of taking something like that and NOT a sleeping pill is that it will get to the root of the problem (albeit temporarily), rather than just treating the symptoms. I've actually had my anxiety fight it's way through a sleeping pill so that I laid in bed awake for 8 hours (and THAT was a MISERABLE test to take the next morning!).

I also find that 1/2 a tab of benadryl works almost as well as any script.

 

[OMFSCardsFan]

I also find that 1/2 a tab of benadryl works...

Agreed. 25-50mg PO works like a charm. Whatever you try, I recommend a trial run before test night.

Like the other poster was saying, the night before the night before (i.e. two nights before) is pretty well-regarded as the more important night of sleep. If you stayed up all night the third and second night of sleep on purpose, this may have hurt you more than not being able to sleep the night before.

I don't think there are many people who slip off to a sound night of sleep before taking the USMLE. I've heard lots of people complain about it.

 

[anon-y-mouse]

I have it pretty bad, and I think it would be worse now if I hadn't taken a few years off in between college and med school. I keep a prescription for klonipin around (yes, I know it's a benzo, yes, I know it's addictive, no, I don't REALLY think that's a problem seeing as I just had to get a new script because the old one expired without me taking all the pills!!!) for the night before tests. I tried a few different benzos for test-night anxiety and found that for me, klonipin didn't leave me feeling groggy or hungover. The key is trying them beforehand so that you don't have this nasty surprise the morning of a test.

The benefit of taking something like that and NOT a sleeping pill is that it will get to the root of the problem (albeit temporarily), rather than just treating the symptoms. I've actually had my anxiety fight it's way through a sleeping pill so that I laid in bed awake for 8 hours (and THAT was a MISERABLE test to take the next morning!).

I also find that 1/2 a tab of benadryl works almost as well as any script.

Benadryl makes me feel groggy. Also, doesn't it suppress REM / restorative sleep?

Do you realize that clonazepam / "Klonopin" has effects on short-term memory? I don't think students should be taking benzodiazepines to sleep... although Valium works so well (my grandma took it for sleep at one point and gave me one, it was amazing).

The better alternative is to try to get a script for Ambien. Works EXTREMELY well at putting you to sleep, has none of the benzodiazepine side-effects, and you wake up with refreshed sleep!

I know what it's like to be groggy on an exam just because you couldn't sleep the night before... it sucks. Go to your doc for insomnia and say you need a short term rx for Ambien. Leave out any stress you might be having if your doctor asks about it (well duh, eliminate the pre-exam stress, eliminate the insomnia)

 

[omgwtfbbq?]

Try going to a hypnotist. Seriously. Not kidding.

I know, I know it's not proven science, not trying to start some big argument or anything, but I think it works, IF you're open to believing it working

I think its all about getting someone skilled to relax you to the point where you can open up to your WANTING to relax before an exam.

I had anxiety about something other than testing, but I went for hypnosis (to someone really reputable - i asked at a teaching center in my town, took a few tries to find someone i really clicked with, all are not alike)
and after a few sessions, i noticed a significant change. the panic edge was gone. and i think if i had gone back for a few more, i would have been even better.

Its something to think about. It really does work for a lot of people.

 

[SoCuteMD]

Benadryl makes me feel groggy. Also, doesn't it suppress REM / restorative sleep?

Do you realize that clonazepam / "Klonopin" has effects on short-term memory? I don't think students should be taking benzodiazepines to sleep... although Valium works so well (my grandma took it for sleep at one point and gave me one, it was amazing).

The better alternative is to try to get a script for Ambien. Works EXTREMELY well at putting you to sleep, has none of the benzodiazepine side-effects, and you wake up with refreshed sleep!

I know what it's like to be groggy on an exam just because you couldn't sleep the night before... it sucks. Go to your doc for insomnia and say you need a short term rx for Ambien. Leave out any stress you might be having if your doctor asks about it (well duh, eliminate the pre-exam stress, eliminate the insomnia)

I'm glad "you don't think that students should be using benzos to sleep" but I think I'll stick with the opinion of my board-certified psychiatrist on this one. And yes, my doctor did discuss the risks of benzos with me. I don't take them to sleep, I take them to get rid of the anxiety...thus allowing me to sleep.

I wake up much more groggy and hungover after Ambien than I do after klonipin. I haven't experienced any short-term memory effects. And you clearly did not read the part of my post where I said that I managed to worry myself awake even through a dose of Ambien. It was the most miserable experience I have EVER had.

 

[stoic]

Benadryl makes me feel groggy. Also, doesn't it suppress REM / restorative sleep?

Do you realize that clonazepam / "Klonopin" has effects on short-term memory? I don't think students should be taking benzodiazepines to sleep... although Valium works so well (my grandma took it for sleep at one point and gave me one, it was amazing).

The better alternative is to try to get a script for Ambien. Works EXTREMELY well at putting you to sleep, has none of the benzodiazepine side-effects, and you wake up with refreshed sleep!

I know what it's like to be groggy on an exam just because you couldn't sleep the night before... it sucks. Go to your doc for insomnia and say you need a short term rx for Ambien. Leave out any stress you might be having if your doctor asks about it (well duh, eliminate the pre-exam stress, eliminate the insomnia)

why don't you look up some information about the drugs you're talking about before you start giving advice regarding their use?

Ambien pretty much has all of the benzo side effects, with the sole benifit of being vastly more expensive... which is really only a benifit if you're a drug company. at normal theraputic doses, the short term memory of problems these drugs (benzo's and atypical hypnotics like ambien) can cause are generally not significant - though they can be in a certain subset of the population (which is why it's important to figure your system out before the next before the test)

Different meds/life-style changes work for different people for issues like pretest anxiety. the bottom line is that if you wanna try some drugs - and i don't think there's anything wrong with that - to do it under the guidence of your primary care doc.

 

[omgwtfbbq?]

omfs... i am SO disturbed by your avatar.

 

[anon-y-mouse]

Ambien pretty much has all of the benzo side effects, with the sole benifit of being vastly more expensive... which is really only a benifit if you're a drug company. at normal theraputic doses, the short term memory of problems these drugs (benzo's and atypical hypnotics like ambien) can cause are generally not significant - though they can be in a certain subset of the population (which is why it's important to figure your system out before the next before the test)

Are you sure? My neuropharmacology text (Neuropsychopharmacology / Feldman) extolls the virtues of zolpidem over other benzodiazepines for insomnia, specifically for reduced side-effects and fewer memory effects.

 

[SoCuteMD]

Are you sure? My neuropharmacology text (Neuropsychopharmacology / Feldman) extolls the virtues of zolpidem over other benzodiazepines for insomnia, specifically for reduced side-effects and fewer memory effects.

...And if the book says it, it must be correct for ABSOLUTELY EVERYONE...

Also if you are going to be a doctor, you need to learn to listen to people's symptoms. This is insomnia secondary to test anxiety. Primary Dx - anxiety. Secondary Dx - insomnia.

Treat the ANXIETY and the insomnia will resolve itself.

 

[boulux]

I think that Zopiclone is a decent alternative if other medication make you feel groggy.

Also, methylphenidate works well for me to focus more on tests.

 

[anon-y-mouse]

...And if the book says it, it must be correct for ABSOLUTELY EVERYONE...

Also if you are going to be a doctor, you need to learn to listen to people's symptoms. This is insomnia secondary to test anxiety. Primary Dx - anxiety. Secondary Dx - insomnia.

Treat the ANXIETY and the insomnia will resolve itself.

That much was obvious. I'm thinking "quick fix" here -- band-aid solution. Obviously the long-term solution is to treat the anxiety.


Also, I have taken both benzos and ambien, and feel a significant difference with ambien. Anecdotal, but it seems to support what my text says.

 

[stoic]

Are you sure? My neuropharmacology text (Neuropsychopharmacology / Feldman) extolls the virtues of zolpidem over other benzodiazepines for insomnia, specifically for reduced side-effects and fewer memory effects.

actually, there are a group of people forming a class-action lawsuit against the makers of ambien (i think... maybe lunesta) because of short-term memory loss. like they do things the night of taking the drug and don't remember it. it was in newsweek a couple weeks ago.

there are a lot of people who take ambien and the like with no problems, and for them that's good. but the same can be said for the benzo's. the sedative/hypnotics work fast, which is their primary selling point b/c it lowers the risk of abuse - though they are still schedule IV, just like the benzo's. like one of the poster said, some people can worry themselves through ambien. all of the drugs have risk and benifits. benzo's are SOOO much cheaper than ambien (isn't ambien like 13 dollars a pill?), anyway, i'm just tired of "new" drugs that SOOOO vastly superior to older drugs that they cost 10 times as much, except it turns out that they really aren't all that much better than the old drug!

i'm not a doctor yet, and even if i was i couldn't really give medical advice out on the internet. but for someone without an abuse liability who was truely suffering from pre-test anxiety causing them stay up all night, i'm not sure what the advantage of a very expensive script for ambien would be over a much less expenive script for a short acting (ie less likely to make you groggy/cause memory problems) benzo. and as always gotta try it before you need it so you know it won't wipe you out the next day.

btw, a friend actually just tried ambien for some insomnia problems she was happening and she actually had problems with being groggy the next day.

myself, i take a flexeril when i can't sleep.

happy pill popping!

 

[SoCuteMD]

That much was obvious. I'm thinking "quick fix" here -- band-aid solution. Obviously the long-term solution is to treat the anxiety.


Also, I have taken both benzos and ambien, and feel a significant difference with ambien. Anecdotal, but it seems to support what my text says.

You make no sense - benzos are NEVER intended for long term use whether for anxiety or insomnia. Why would you treat anxiety with something intended for insomnia.

I really suggest you hold off on the pharmacology advice until you are at least IN medical school

 

[Soleil9]

Hello OP!

I just want you to know that you are not alone with the test anxiety. I never had test anxiety until med school. My symptoms were pretty intense... In addition to the insomnia, I had nausea, vommiting, and diahrea. Plus I had some scary psychotic thoughts (feelings like I was sufficating, and other irrational thoughts). Some times my severe anxiety would start even 2 nights before the test. So I made an emergency appt with my doctor. She gave me 6 doses of Klonopin 0.5mg as a temp messure until I had time to do a more thourough work-up.

It worked great. In fact, I used only 5 of the doses and since I haven't used the 6th. I'm saving it just in case I have a problem again. But, I've actually gotten used to the med school tests, so its not so bad....


As for side effects, I didn't have any problems with memory, in fact, memory was much worse on the mornings post panic attack. I hypothesize that the short term memory problems might be due to info learned AFTER you take the dose. The Klonopin didn't make me sleepy, it just calmed my nerves so I could sleep. It also didn't make me feel so good that I feel inclined to take it recreationally. So I don't feel I'm at risk for abusing it.

So, go see your doctor and see if Klonopin might work for you...

Good Luck!!! Go to your doctor, you'll feel so much better!!

🙂

 

[Ypo.]

Wondering if anyone else has dealt with this and if they have any suggestions.

I think mine started around when I was preparing for the mcat and has just gotten progressively worse. The really damaging part is getting sleep the night before an exam which is near impossible for me. Even if I force myself to only sleep 3-4 hours two nights before..when it comes down to the night before I'm wide eyed, and awake. Of course as I sit down to take the exam, the sleep deprivation hits and Ive been known to all but doze off during a test.

Does anyone think taking a sleeping pill the night before would be wise? I can't keep up like this because my last exam, I did poorly and I know it was because I was too sleepy and made stupid mistakes.

Its not a matter of telling myself to relax..no matter what I think/try to do, I just can't will myself to sleep the night before an exam. I'm worried what will happen when I take boards! Thanks for any advice.

You'll get over it. Or else you'll adapt to getting no sleep. I have had to choose the latter. I've become quite good at thinking on 20 minutes of sleep. I just took the biggest neuro exam of the semester friday and only took a short nap. I wish I could just go to sleep, but since I can't, I spend the night studying. Seems to work fine for me, but it took some getting used to.

 

[anon-y-mouse]

You make no sense - benzos are NEVER intended for long term use whether for anxiety or insomnia. Why would you treat anxiety with something intended for insomnia.

I really suggest you hold off on the pharmacology advice until you are at least IN medical school

The OP said that s/he has anxiety ONLY the night before tests and not generalized anxiety. Is this considered short or long term? I was never EVER advocating benzodiazepine use for long-term use. Oh, and just because this happens every so often for the two pre-clinical years of medical school doesn't qualify it as long term (which I would consider "used everyday"). This scenario is the functional equivalent of a patient who has a fear of flying who needs a sleeping pill to get through a transatlantic flight. Quit being catty if you can't interpret what's going on.

With respect to medical advice, I suggest you not dispense it at all unless you actually have an MD. The poster simply wanted suggestions.

 

[SoCuteMD]

I wasn't the one offering advice, I was offering my own experiences. You offered advice.

Now off to pre-allo you go 🙂.

 

[anon-y-mouse]

I wasn't the one offering advice, I was offering my own experiences. You offered advice.

Now off to pre-allo you go 🙂.

Seriously, I don't understand why you need resort to condescension, it's really not necessary and is the hallmark of someone who has some issues to work out. I really hope you have some time to reflect and work on this in medical school.

I also offered my personal experience and mentioned a few facts in my textbook. All I said was, in my experience and from what I have read, ambien > benzo for short term ("albeit temporar[y]") use. Don't read more into it.

 

[Colba55o]

so didn't mean to start the flame war!

I actually DO have some generalized anxiety, but I deal with it for the most part. I'm a musician and take propanolol before any audition/performance and it works perfectly. My docs have tried zoloft and cymbalta, but the side effects were too harsh- not worth the benefit.
I was thinking of trying to take a propanolol next time to see if that works. I think treating the anxiety (ie some kind of beta blocker) would be safer than a sleeping pill.
I was actually prescribed klonapin for everyday use a few years ago but stopped because it knocked me out and made me too tired.
Thanks for the advice..I'll be trying either the klono or a propanolol. Glad to know something other than sleeping pills have worked for people.

PS. I remember a woman at my old job gave me a pill, that she was prescribed to help her stay awake, but I forgot what it was called! It supposedly works very well, and is non addictive, doesnt make you feel jittery. anyone know what I'm talking about? i think it started with an S

 

[SoCuteMD]

Seriously, I don't understand why you need resort to condescension, it's really not necessary and is the hallmark of someone who has some issues to work out. I really hope you have some time to reflect and work on this in medical school.

I also offered my personal experience and mentioned a few facts in my textbook. All I said was, in my experience and from what I have read, ambien > benzo for short term ("albeit temporar[y]") use. Don't read more into it.

Actually, you began with the blanket statement "I don't think medical students should use benzodiazepines."

Unfortunately being a medical student leaves me little time to work out my "issues" but you've got plenty of time to work on yours before school starts!!!

Have a fabulous day!

 

[DarkFark]

One thing that works for me is to have a beer or two- it helps to feel relaxed and even tired, I sleep like a log, and it has none of those druggy after-effects.

For some people alcohol actually disrupts sleep. For me, that's only the case if I drink so much that I wake up in the middle of the night to go to the bathroom.

I'm not suggesting you get drunk, and if your one of those people who gets hangovers really easily, it probably isnt a good idea, but it does take the edge off.

 

[azzarah]

Mine started in the middle of second year and thankfully went away completely once I started rotations. Palpitations, cold sweats, nausea, terrible chest pain the night before every exam. I tried taking benedryl the night before but my mind was just not working the next day. It was almost better if I didn't sleep all night than if I slept after taking the benedryl. Knowing that I would be taking exams frequently for the rest of my career/life, I finally got fed up with all the anxiety and went to my school's student assistance program. The person I saw showed me some relaxation exercises that really helped. At first, I thought WTF, this silly relaxation stuff is not going to work, but it really did. If your school has a similar program for med students, I suggest you check it out! Good luck!

BTW, I don't personally recommend drinking alcohol or taking benzos when you can potentially get rid of most of your anxiety by *learning* to relax.

 

[t33sg1rl]

Have you tried working out?

I find that when I get text anxiety (and I get it bad when I know I'm not ready) an hour of cardio helps reduce my stress level a LOT.

ps. Make sure your workout is over at least 4 hours before bedtime.

pps. In some people, caffeine affects them up to 8-10 hours after drinking it... so don't drink any after lunch! Water is better during your workout anyway.

Good luck!

 

[OMFSCardsFan]

...And if the book says it, it must be correct for ABSOLUTELY EVERYONE...

I was thinking the exact same thing...

 

[SoCuteMD]

I actually think the exercise and relaxation suggestions are great, too. I just know myself - you can barely get me to do that stuff when I'm not freaking out over a test. Those kinds of things really should be "first line" though!! I also cut out caffeine after 7 pm - helps a TON!

 

[Law2Doc]

Have you tried working out?

I like this advice. Folks on this thread are a bit quick to prescribe meds -- like kids with new toys, I guess. They all have their place, but I'm not sure they are always the best first resort.

 

[azzarah]

Have you tried working out?

I find that when I get text anxiety (and I get it bad when I know I'm not ready) an hour of cardio helps reduce my stress level a LOT.

ps. Make sure your workout is over at least 4 hours before bedtime.

pps. In some people, caffeine affects them up to 8-10 hours after drinking it... so don't drink any after lunch! Water is better during your workout anyway.

Good luck!

Wise words! I totally agree!

 

[MNsocsci]

I managed to worry myself awake even through a dose of Ambien. It was the most miserable experience I have EVER had.

I did the same thing the night before my MCAT! I took an Ambien but was so anxious that I was still up all night and experienced really weird altered thoughts from the Ambien. For me, Ambien worked for a while, but eventually stopped working altogether. I haven't taken any meds in a while but still have major insomnia issues. Has anyone tried that newer med, Lunesta? It's supposed to be better for long-term use.