I have a chemical imbalance and am currently taking Paxil 20mg. I cannot function without it. I get up each morning around 5:30 a.m. Since I started taking the drug I find that around 7:30 a.m. I am unable to stay awake. This has created a lot of problems for me, as I am a school bus driver. I had to give up driving on a full time basis. It is so bad that I feel like I need toothpicks to keep my eyes open. Is there anything I can do to help the situation? Thank you for any help that you can give me in this area.

—Jean, Age 50

Hi Jean—

You need to schedule a follow-up appointment with your physician and tell her or him that you are falling asleep driving and that you are not sure what the cause is. It may be the medication or it may be a sleep disorder. You must impress on your physician the seriousness of your current situation. If he or she does not respond with a full check-up and a referral to a sleep disorders center I would complain to whomever is above your physician until you get that referral. Your tiredness is affecting your ability to earn a livelihood and threatens the lives of countless schoolchildren should you fall asleep some time by accident. Treat this tiredness with all seriousness and insist that you receive proper treatment until you no longer are tired.